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Abstract Background Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). Materials/methods This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. Results Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). Conclusions Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.

Aim To describe a therapeutic approach, indications for abdominoperineal resection (APR), survival and oncological results for patients who received treatment in our surgical clinic for anal canal squamous cell cancer (SCC). Methods Patients were randomized into two groups according to the treatment method: Group 1- Chemoradiotherapy (CRT) without surgery, Group 2- CRT + APR. Results Eighteen patients with anal canal SCC were included in the study; 11 (61.1%) patients were in Group 1 and 7 (38.8%) in Group 2. Reasons for APR was as follows: three patients had insufficient CRT, two had recurrence after CRT, one had complete faecal incontinence and one patient had rectovaginal fistula. Overall five year survival (OS) and disease free survival (DFS) was 77.7% and 72.7%, respectively. Comparing two groups five year OS was 90.9% and 57.1%, whereas DFS was 81.8%, 57.1%, respectively (p=0.389 and 0.324, respectively). Conclusion Gold standard therapy for anal canal SCC is CRT. However, APR should be applied as an escape treatment for patients suffering from tumour progression, insufficient CRT and recurrence (30%).

Aim To investigate the efficacy and safety of the single-step surgery in elderly patients with obstructive colorectal cancer. Methods All patients who underwent single-step surgery and primary anastomosis for obstructive colorectal cancer in the period between January 2012 December 2017 were evaluated in this study. The patients were divided into two groups: younger than 65 (Group Young) and older than 65 (Group Old). Demographic data, American Society of Anesthesiologists scores (ASA) scores, comorbidities, preoperative albumin levels, type of surgery, postoperative morbidity and mortality, pathological stages, and overall survival rates were investigated. Results A total of 89 patients were included: 49 (54%) were older than 65 (Group Old). In Group Old, the mean age was 75 (65-97), of which 28 (58.3%) were males. There were 41 patients younger than 65 (Group Young) with the mean age of 52.6 (41-64 years of age), of which 21 (51.2%) were males. There was no difference between groups according to albumin level. There was no statistical difference between two groups according to tumour localization, pathological stage and type of surgery, as well as according to surgical complications. The median overall survival rate was 11 months in both groups (0-66) (p=0.320). Conclusion Meticulous preparation of older patients (correction of anaemia, electrolyte levels and pH ) paves the road for successful surgeries, including single-step resection and primary anastomosis.

Objective: We aimed to define indication of Hartmann procedure (HP) under emergency conditions, analyze, and present in which cases this procedure should be used. Methods: The patients who underwent emergency surgery for colorectal cancer were analyzed. Rates of mortality, overall, and disease-free survival of the patients were evaluated. The colostomy closure rate, operative mortality, and surgical complications of the secondary operation performed after the HP were also assessed. Results: Fifty-seven patients who underwent HP were included in the study. The indications were obstruction (n = 37) or perforation (n = 20). The post-operative mortality and morbidity rates were 21.1% and 63.2%, respectively. The 1-, 3-, and 5-year survival rates for all patients were 54%, 49%, and 45%. Conclusion: HP can be a life-saving procedure in cases of high risk, emergency colorectal disease. Surgeons create a temporary stoma as a part of this procedure that is generally closed with a second operation. However, it is not possible to close the stoma in some cases, and the potential physical and emotional issues related to the stoma should be a part of the surgeon’s considerations.

Background: Umbilical hernias are especially common along with overweight, multiparous women. Laparoscopic hernia repair is preferred due to many advantages. On the other hand, the risk of trocar site hernia is disadvantageous. Trocars do not go through the abdominal wall via transvaginal natural orifice transluminal endoscopic surgery (V-NOTES). We investigate the V-NOTES hysterectomy and concomitant umbilical hernia repairment feasibility and outcomes. Methods: Six morbidly obese patients underwent V-NOTES hysterectomy and concurrent umbilical hernia repair between April 2020 and January 2021. Demographic features of patients, operating time, hernia size, complications, hospitalization time, recurrence of the hernia, visual analog scale (VAS) at 6th, 12th, and 24th hours, first, fourth, 12th weeks, and sixth months were recorded. Results: The average age of patients was 47.667 ± 2.422 (45–52). Mean body mass index (BMI), hernia and operating time size were 44.367 ± 3.217 kg/m2 (40.3–48.5), 6.167 ± 1.722 cm (4–9) and 88 ± 12.791 minutes (75–110), respectively. Intraoperative complications did not occur. Seroma was detected in one patient(16.6%). In six month follow-up period, we did not establish a diagnosis of hernia recurrence and postoperative chronic pain. Conclusion: Our study offers a novel perspective on V-NOTES umbilical hernia repair and hysterectomy in morbidly obese patients. According to our study, performing V-NOTES umbilical hernia repairment in a risky patient population is feasible and has promising outcomes.

Objectives: We investigated the incidence of and risk factors for nephrotoxicity in patients using intravenous colistin. Methods: This retrospective, observational study was conducted at Karadeniz Technical University, Faculty of Medicine, clinics and intensive care unit between 1 January 2009 and 1 January 2013. Intravenous colistin was administered to 133 patients at a dose of 2.5−5.0 mg/kg/day. Results: The patients mean age was 54.3±19.1 years and the mean duration of treatment was 13.5±3.6 days. Nephrotoxicity developed in 5.0±2.8 days in 38 (28.6%) patients. Based on RIFLE (risk, injury, failure, loss of kidney function, and end-stage kidney disease) criteria, 15 (39.5%) patients were class 1, 17 (44.7%) were class 2, six (15.8%) were class 3, and none were class 4. The mean duration of development of nephrotoxicity was 5.0±2.8 days. Hemodialysis requirement was observed in two (5.2%) of the 38 patients who developed nephrotoxicity. In these cases, colistin therapy was not discontinued. Nephrotoxicity was correlated with advanced age, high pretreatment serum creatinine levels, diabetes mellitus, and chronic obstructive pulmonary disease. Conclusions: The use of colistin is relatively safe for patients that have normal renal functions. However, better standardization of the definition of nephrotoxicity in those patients with the use of scoring systems and close monitoring are necessary.

Abstract Background Enterocytozoon bieneusi is the most common species found in humans. Although E. bieneusi has been investigated in humans, genotype profile of E. bieneusi is not known in Türkiye. Methods In this study, we screened E. bieneusi in patients (n = 94) with different types of malignant solid tumors by Real Time PCR and then sequenced E. bieneusi positive samples. All cancer patients were undergoing chemotherapy and had diarrhea. Moreover, as control groups, we also screened E. bieneusi in patients with diarrhea (n = 50) and without diarrhea (n = 50). Results Among all patients analyzed, 33 (17%) were found to be E. bieneusi-positive. As the patients were categorized, the molecular prevalence of E. bieneusi increased to 25.5% among cancer patients with diarrhea. However, the molecular prevalence of E. bieneusi was found to be lower in patients with presenting only diarrhea (8%) and patients without diarrhea (10%). The high molecular prevalence value detected among cancer patients with diarrhea was also statistically significant compared to other patient groups (P = 0.00112 and P = 0.0269). Among the 33 Real Time PCR positive samples, 10 of them were amplified by nested PCR and among these 10 samples, 6 of them were successfully genotyped. The phylogenetic tree showed the presence of D and Type IV which were also identified in stray cats living in İzmir in our previous study. Conclusions High molecular prevalence value indicates the importance of screening stool samples of cancer patients with diarrhea for E. bieneusi and genotyping results indicate that D and Type IV are circulating between humans and cats.

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are one of the most common causes of nosocomial infections and have high mortality rates due to difficulties in treatment. In this study, the in vitro synergistic interactions of the colistin (CT)–meropenem (MEM) combination and patient clinical outcomes were compared in CRAB-infected patients that receive CT–MEM antimicrobial combination therapy. In addition, in vitro synergistic interactions of MEM–ertapenem (ETP), MEM–fosfomycin (FF) and CT–FF antimicrobial combinations were investigated. Finally, the epsilometer (E) test and checkerboard test results were compared and the compatibility of these two tests was evaluated. Methods Twenty-one patients were included in the study. Bacterial identification was performed with MALDI–TOF, and antimicrobial susceptibility was assessed with an automated system. Synergy studies were performed using the E test and checkerboard method. Results For the checkerboard method, the synergy rates for CT–MEM, MEM–FF, MEM–ETP and CT–FF were 100%, 52.3%, 23.8% and 28.5%, respectively. In the E test synergy tests, synergistic effects were detected for two isolates each in the CT–MEM and CT–FF combinations. Microbial eradication was achieved in nine (52.9%) of the 17 patients that received CT–MEM combination therapy. The agreement between the E test and the checkerboard test was 6.5%. Conclusions A synergistic effect was found with the checkerboard method for the CT–MEM combination in all isolates in our study, and approximately 70% of the patients benefited from treatment with this combination. In addition, more than half of the isolates showed a synergistic effect for the MEM–FF combination. Combinations of CT–MEM and MEM–FF may be options for the treatment of CRAB infections. However, a comprehensive understanding of the potential of the microorganism to develop resistant mutants under applied exposures, as well as factors that directly affect antimicrobial activity, such as pharmacokinetics/pharmacodynamics, is essential for providing treatment advice. We found a low rate of agreement between the E test method and the checkerboard test method in our study, in contrast to the literature. Comprehensive studies that compare clinical results with methods are needed to determine the ideal synergy test and interpretation method.

Abstract This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020–15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639–16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137–20.172), the need for mechanical ventilation (p

Objective:In this study, it was aimed to retrospectively evaluate the anti-Toxoplasma IgG, IgM and avidity index results of patients who were requested for Toxoplasma serology in our hospital between 01.01.2017 and 31.12.2021.Methods:Anti-Toxoplasma antibodies are studied with Abbott Architect İ2000 SR device that using the chemiluminescent microparticle immunoassay method (CMIA), according to the company's recommendations. The age, gender, nationality, sending clinic/polyclinic, and pregnancy status information of patients were scanned from the hospital system.Results:In the five-year period between 2017 and 2021, 29.58% of anti-Toxoplasma IgG tests requested from 12694 patients and 0.94% of anti-Toxoplasma IgM tests sent from 12546 patients were found positive. It is striking that the number of test requests is higher in women. IgG positivity is highest in women in the age group of 30-39 (9.97%), and in men in the age group of 60-69 (6.97%). IgM positivity is higher in both women and men in the 20-29 age group (0.48% and 0.38%, respectively). Anti-Toxoplasma IgG was positive in 27.78% and IgM in 0.64% of the pregnant women. IgG positivity in Turkish and Syrian pregnant women were determined as 25.88%; 47.10% and IgM positivity as 0.49% and 1.83%, respectively, and the difference was statistically significant (p

Abstract Background Discovery of new Toxoplasma gondii serotyping epitopes is important due to reports showing the influence of genotype on the severity of toxoplasmosis. In Turkey, genotypes belonging to type II, type III and Africa 1 lineages were mainly detected. The present study focused on to find out epitopes with high discriminative capacity to serotype these genotypes using well characterized strains isolated from Turkey. Methods To meet this objective, GRA6 and GRA7 genes were sequenced from strains belonging to the type II, III and Africa 1 lineages, and B cell epitopes inside these sequences were predicted by Bcepred and additional docking analysis was performed with B cell receptor. Based on these analyses, 22 peptides harboring lineage specific epitopes were synthesized. Then, the serotyping potency of these peptides was tested using peptide ELISA and well categorized serum samples collected from stray cats infected with genotypes of the different lineages type II (n:9), III (n:1) and Africa 1 (n:1). As a result of peptide-ELISA, a serotyping schema was constructed with peptides that show high discriminative capacity and this assay was validated by sera collected from humans after an outbreak (n:30) and mother/newborn pair sera (n:3). Later, the validated serotyping schema was used to serotype a larger group of human (n:38) and cat (n:24) sera. Results Among 22 peptides, GRA6II/c, GRA7III/d, and GRA6 Africa 1/b epitopes have shown discriminative capacity. During the validation of peptide-ELISA, the serotype of toxoplasmosis outbreak and mother/newborn cases were detected to be serotype II. Moreover, the analyses in a larger group showed that serotype II was prevalent in humans and stray cats. Conclusions Overall, the results showed that the serotyping schema could be successfully used to serotype T. gondii infections caused by type II, III and Africa 1 genotype.

BACKGROUND: Cryptosporidium spp. is a protozoan parasite that infects many vertebrate animals, including humans. Since Cryptosporidium spp. can cause chronic life-threatening diarrhea and severe malabsorption in immunocompromised patients, we investigated the prevalence of this parasite among patients undergoing chemotherapy for malignant solid tumors. OBJECTIVE: Investigate the prevalence of Cryptosporidium spp. in stool samples. DESIGN: Cross-sectional. SETTING: Tertiary care. PATIENTS AND METHODS: Stool samples were collected from adult patients with malignant solid tumors receiving chemotherapy and diarrhea. Cryptosporidium spp. prevalence was determined using Ziehl–Neelsen staining, ELISA, and real-time PCR targeting of the COWP gene. MAIN OUTCOME MEASURE: The prevalence of Cryptosporidium spp. in patients undergoing chemotherapy for malignant solid tumors. SAMPLE SIZE: 94 RESULTS: The prevalence was 2.1% (2/94), 5.3% (5/94), and 5.3% (5/94) as detected by Ziehl–Neelsen staining, real-time PCR and ELISA, respectively. The prevalence reached 8.5% (8/94) using all results obtained from the three methods. Among eight positive stool samples, four were positive by at least two different methods (Ziehl–Neelsen staining-ELISA or ELISA-real-time PCR) whereas the remaining four were positive by either ELISA or real-time PCR. CONCLUSION: These findings show the risk of cryptosporidiosis in cancer patients and the necessity to use at least two diagnostic methods during the diagnosis of cryptosporidiosis to reach more accurate and trustworthy results. LIMITATIONS: Further studies with a larger sample size are recommended. CONFLICT OF INTEREST: None.

INTRODUCTION[|]Laparoscopic adrenalectomy is the gold standard for the resection of adrenal tumors. There are some technical difficulties due to the rarity in general surgical practice and the long learning curve. The present study aims to evaluate perioperative and postoperative results of laparoscopic transperitoneal adrenalectomy in a single center.[¤]METHODS[|]Between December 2008 and June 2018, 65 patients underwent laparoscopic transperitoneal adrenalectomy. Patients' demographic data, peroperative and postoperative results were retrospectively analyzed from hospital medical records.[¤]RESULTS[|]Sixty-five patients underwent laparoscopic transperitoneal adrenalectomy. In this study, there were 44 female and 21 male patients. According to the tumor types, there were forty-seven functional adrenal tumors, thirteen incidental adrenal tumors and three isolated adrenal metastasis from lung cancer. Thirty-one patients had right-sided and thirty-four patients had left-sided adrenal tumors. Conversion to open surgery was seen in five patients.[¤]DISCUSSION AND CONCLUSION[|]Laparoscopic transperitoneal adrenalectomy is a feasible and safe operative technique in adrenal tumors. Patients should be mobilized early and enforced to respiratory exercise to decrease postoperative complications. In addition to them, the surgeon should be experienced in laparoscopy to decrease the rate of conversion.[¤]

INTRODUCTION[|]The aim of the present study was to evaluate the treatment modalities and recurrence status of patients diagnosed with phyllodes tumor in light of a literature search.[¤]METHODS[|]All female patients who received treatment for phyllodes tumor between January 2015 and January 2017 were included in our study. All data were collected through retrospective analysis. Histopathological results, type of surgery, application of chemoradiotherapy, tumor size, recurrence rate, and demographic data were analyzed.[¤]RESULTS[|]Twenty-five cases were evaluated. Of the 25 cases, 8 were diagnosed as malignant. The rest were 3 borderline and 14 benign and fibroadenomas. Three of 8 malignancies were treated with mastectomy, and the other 5 were treated with wide local excision. Recurrence occurred in two cases; one of them received chemotherapy, and the other had chemoradiotherapy. All 17 remaining patients underwent wide local excision. A single case was treated with mastectomy due to large tumor size.[¤]DISCUSSION AND CONCLUSION[|]There is still an ongoing debate for the treatment of phyllodes tumors. Negative margins for malignant cases play a major role for successful treatment. There is no consensus for the application of chemo- and radiotherapy.[¤]

INTRODUCTION[|]The outcomes of endoscopic enteral stent applications in left colon or rectal cancers were evaluated.[¤]METHODS[|]All patients who received stent application between January 2016 and December 2017 for obstructive left colon and rectal cancers were retrospectively evaluated. Demographic data, obstructed side, indications, technical and clinical success of the procedure, and also mortality and morbidity rates were recorded.[¤]RESULTS[|]Stents were successfully placed in 12 (85.7%) out of 14 cases. Eight cases received stents for bridge to elective surgery, whereas four had stents for palliative purposes. In one of the palliative cases, Hartman procedure was applied due to perforation at the proximal side of the stent after 3 months. The technical and clinical success rates were 85.7% and 91.7%, respectively. There was no mortality.[¤]DISCUSSION AND CONCLUSION[|]Application of self-expanding metallic stent in patients with advanced stage obstructive colorectal cancer may be an alternative method compared with emergency surgeries. It can be safely and effectively performed and offers opportunities for palliative treatments and elective surgeries.[¤]

INTRODUCTION[|]Inguinal hernia is one of the most common encountered pathologies in general surgery. There are two main types of repair procedures, including open and laparoscopic inguinal hernia repair. In this study, we aimed to share the results of peroperative and postoperative surgical results of patients who underwent laparoscopic TEP technique by same surgeon.[¤]METHODS[|]In this study, the data of 115 patients with inguinal hernia, who were appropriate for the indications of hernia repair by laparoscopic TEP technique at the general surgery outpatient clinic between March 2012 and June 2018 were evaluated retrospectively. [¤]RESULTS[|]Of the 115 patients, 30 had bilateral inguinal hernias and 85 had unilateral inguinal hernias, all these patients were operated laparoscopically by same surgeon. Low recurrence rate and surgical complication were found in accordance with the literature. [¤]DISCUSSION AND CONCLUSION[|]With appropriate patient selection and adequate surgical experience, repair of inguinal hernia with laparoscopic TEP technique is a safe and feasible method. Advantages are less postoperative pain, earlier return to daily activities and better cosmetic results.[¤]

INTRODUCTION[|]We tried to describe our current approach to gastroesophageal disease and evaluate our results of anti-reflux surgery.[¤]METHODS[|]70 patients received laparoscopic Nissen funduplication procedure between January 2015 and December 2017 were included in our study. All data and information belonging to cases were retrieved retrospectively from hospital's data system. Clinical results of patients who underwent anti-reflux procedure was evaluated. [¤]RESULTS[|]34 female (% 48.5) and 36 male (%51.5) with median age 45 (20-84) was randomized. 14 patients (%29) received surgery for gastroosephageal reflux, whereas 56 (%80) for reflux+hiatal hernia. Median duration of complaints was 16 (6-96) months. Median follow-up time was 18 (10-45) months. Clinical results were as follows; very good in 55 cases (%78.6), good in 9 cases (%12.9) and moderate in 6 cases (%8.5).[¤]DISCUSSION AND CONCLUSION[|]Laparoscopic Nissen funduplication could be considered as a safe and effcetive surgery in controlling patients complaints, with sufficient preoperative evaluation, right indication and suitable surgical technique. [¤]

INTRODUCTION[|]The aim of this study was to modify the Alvarado scoring system to increase its sensitivity and specificity in predicting acute appendicitis in elderly patients.[¤]METHODS[|]The data of 81 patients older than 70 years of age who were admitted for acute abdominal pain between January 2015 and December 2017 were randomized into 2 groups and evaluated retrospectively. In Group 1 patients, acute appendicitis was not histopathologically established postoperatively, while Group 2 patients had pathological results consistent with acute appendicitis. The sensitivity and specificity of computed tomography (CT) scans and Alvarado scores were evaluated in the 2 groups.[¤]RESULTS[|]The specificity and sensitivity of the modified Alvarado score was 86% and 81%, respectively, whereas the specificity and sensitivity of a CT scan was 93% and 92.1%, respectively, in diagnosing acute appendicitis.[¤]DISCUSSION AND CONCLUSION[|]There are a limited number of studies related to acute appendicitis in elderly patients and the current strategy for treatment is not clear. Due to the decreased sensitivity of the Alvarado score in the diagnosis of acute appendicitis in elderly patients, the goal of this research was to adjust the scoring system. Scores >7 are more reliable in predicting appendicitis. We believe that patients can be more accurately diagnosed in a short period of time using this modified Alvarado scoring system. In combination with a CT scan evaluation, the success rate of diagnosis may be improved and delayed diagnosis prevented.[¤]

INTRODUCTION[|]The aim of this study was to examine and describe the efficiency of endoscopic balloon and bougie dilatation techniques applied to anastomotic strictures developed in patients who underwent a low anterior resection (LAR) and ileostomy.[¤]METHODS[|]A total of 167 patients underwent an LAR with an ileostomy due to rectal cancer between July 2014 and December 2017. Nineteen (%11.4) cases with anastomosis stricture were retrospectively evaluated and included in the study. Patients were classified according to the dilation time. Group 1 patients received dilatation within the first 3 months postoperatively, and Group 2 patients received dilatation after 3 months. Demographic data, the dilatation technique, the number of dilatation applications, the level of the stricture, the success rate, and the stoma closure time were evaluated.[¤]RESULTS[|]In Group 1, the mean number of dilatation procedures was 1.8 (range: 1–3), whereas in Group 2, the mean was 3.8 (range: 2–5). The success rate was 100% in Group 1 and 66.6% in Group 2. There was a statistically significant difference between the groups in the requirement for dilatation and the success rate (p=0.022, p=0.028, respectively).[¤]DISCUSSION AND CONCLUSION[|]It was concluded that dilatation techniques are most successful when applied within 3 months after surgery in cases with stenotic anastomoses. The risk of strictures and the number of repeated dilatations was lower and the success rate was significantly higher in these cases.[¤]

INTRODUCTION[|]To compare of the histopathological and oncological outcomes of patients undergoing laparoscopic or open resection surgery for sigmoid colon cancer.[¤]METHODS[|]All of the patients who underwent surgical resection for sigmoid colon cancer between July 2014 and December 2016 were included in this study. The demographic characteristics, T/N staging, number of benign/malignant lymph nodes, histopathological findings, follow-up period, overall survival, and disease-free survival (DFS) of both groups were evaluated.[¤]RESULTS[|]A total of 43 patients were evaluated in this study. The female to male ratio was 14/29. The mean age of the patients was 64.11+-11.75 years. The median number of dissected lymph nodes was 20.9 (10–31) in the open resection group and 19.46 (7–36) in the laparoscopic group (p=0.539). The overall 3-year survival was 87% in the open resection group and 85% in the laparoscopic group (p=0.62). The 3-year DFS rate was 79% in the open surgery group and 75% in the laparoscopic group (p=0.70).[¤]DISCUSSION AND CONCLUSION[|]Laparoscopic and open surgery for sigmoid colon cancer provide equivalent oncological results; laparoscopic surgery can be performed safely in these patients. When the laparoscopic surgery technique is standardized and efforts are made to improve training, laparoscopic surgery will likely become standard treatment for colon cancer.[¤]

INTRODUCTION[|]Retrorectal tumors (presacral, precoccyxgeal) are rare, and remain a significant diagnostic and therapeutic challenge. The aim of this study was to describe the surgical experience of 1 hospital with retrorectal tumors.[¤]METHODS[|]Twelve patients admitted to the Dr. Lutfi Kirdar Training and Research Hospital/Istanbul Department of General Surgery between January 2012 and December 2016 were included in our study. Medical records, radiology results, pathology reports, and surgical techniques were analyzed retrospectively.[¤]RESULTS[|]Of the 12 patients evaluated, 10 were female and 2 were male. The mean age was 45 years (range: 31-65 years). Eight patients had masses of a congenital origin, 3 patients had masses of neurogenic origin, and 1 had an angiomyxomatous tumor. Both an anterior and posterior surgical approach were used.[¤]DISCUSSION AND CONCLUSION[|]Complete removal of the tumor and preservation of neurological function remain major aspects of successful treatment. To achieve the best results, a multidisciplinary approach and correct planning are important.[¤]

Mucinous cystadenocarcinoma remains the second most frequent cause of appendiceal mucocele. Presently described is a case of mixed adenoneuroendocrine carcinoma (MANEC) located in the right retroperitoneal space. A 64-year-old male was admitted with a palpable mass in the right lower quadrant. An abdominal computed tomography scan revealed a cystic mass in the pelvic area 31x25x25 cm in size. A search of the literature yielded more than 50 similar cases, with mean diameter of 13 to 40 cm; however, only a few of these cases were mucinous cystadenocarcinoma. Usually, an appendectomy is sufficient therapy for cystadenoma and hyperplasia, while a right hemicolectomy is required for cystadenocarcinoma. To our knowledge, the present case is the first with a pathological diagnosis of MANEC (30/70 neuroendocrine carcinoma and adenocarcinoma) to be reported.

Tularemia is a rare zoonosis that is caused by Francisella tularensis and manifests with masses in the head and neck region. The most common form of tularemia is ulceroglandular form; the other clinical forms of tularemia are glandular, oculoglandular, pharyngeal, typhoidal, and pneumonic. The diagnosis of F. tularensis infection is made by serological, culture, or molecular methods. The epidemiological history should be thoroughly questioned and the necessary investigations should be planned with suspicion of tularemia for patients with lymphadenopathy (LAP) and history of contact with unregulated water sources. Although Trabzon is not an endemic area, we present two sporadic cases of oculoglandular and ulceroglandular tularemia in two brothers aged 59 and 57 years. Treatment with streptomycin for 14 days resulted in clinical improvement. Tularemia outbreaks associated with natural water sources in Turkey between January 1, 2000 and August 1, 2017 were screened and scrutinized using by the keywords "tularemi", "kaynak suyu", "LAP", "water resource", "tularemia", "lymphadenopathy" in PubMed, Google Scholar, and Web of Science. We determined that serologic methods are the most commonly used diagnostic method, the oropharyngeal form was the most common clinical form, and aminoglycosides were the most commonly used treatments, while ciprofloxacin and doxycycline are rarely used. There was no mortality except for one patient and there were not enough data about recurrence. Two cases of tularemia associated with natural water resources have been presented in this report. Even if patients do not come from endemic areas, tularemia should be considered in the differential diagnosis of LAP and targeted therapy should be planned.

Hantavirus is an enveloped virus with an RNA genome comprised of three negative-sense, single-stranded segments and belongs to the genus Hantavirus in family Bunyaviridae. Human infections are seen in two different clinical presentations: "Hemorrhagic fever with renal syndrome" and "Hantavirus cardiopulmonary syndrome". However, the main pathogenic mechanism is vascular endothelial dysfunction; viral properties and host immunogenetic factors both play a role in pathogenesis. Early diagnosis and supportive treatment are crucial to prevent mortality. Fluid/electrolyte and oxygen therapy, renal replacement, regulation of blood pressure, and blood or blood products replacement are the main components of supportive treatment. Although ribavirin is controversial in the specific treatment, some studies have suggested that it may be beneficial, especially during the oliguric phase. Favipiravir and icatibant are other effective drugs in the treatment, and the use of αvβ3 integrin inhibitors is also suggested. In recent years, monoclonal antibodies have been proposed for treatment as well as prophylaxis. DNA vaccines prepared with new technologies have good efficacy, enhancing the neutralizing antibody response. The next major breakthrough in Hantavirus immunization will be a vaccine that is effective against all viral subtypes.

Background:Human toxocariasis is a parasitic infection caused by the larvae of Toxocaracanis. We examine the Toxocara seroprevalance in veterinarians and animal husbandry workers living in the Mugla Province, Turkey to evaluate better the risk factors for Toxocara exposure. Methods: In 2014, 376 volunteers participated in the study in 2014. All blood specimens were tested using a commercial enzyme immunoassay kit and ELISA positive samples were confirmed by Western Blot (WB) method. Results: The seroprevalence of Toxocara, as determined by WB, was 8%. A statistically significant correlation was evident between patient age and Toxo­cara positivity among animal husbandry workers (P = 0.029). A strong associa­tion was also evident between sex and seropositivity in the animal husbandry group (P=0.024). Veterinarians working in pet clinics did in fact exhibit higher Toxocara seropositivities relative to those of other groups (P = 0.029). A statisti­cally significant difference was detected between the rural geographic areas surveyed (P = 0.04). Conclusion: In Mugla Province, seroprevalence of Toxocara is lower than other regions. Despite the low seroprevalence observed, especially in high risk professions toxocariasis remains an important medical concern within the region.

Cyclospora cayetanensis one of the coccoidian parasite which presenting by gastrointestinal symptoms like prolonged wet diarrhea, abdominal pain, anorexia, weakness and nausea gastrointestinal diseases. Infections are mostly seen in immunocompromised hosts such HIV/AIDS patients. The clinical spectrum of the diseases can vary from asymptomatic infection to life-threating infections in immunocompromised patients. Differantial diagnosis should be made carefully and proper antibiotic treatment should be given in symptomatic cases. It should pay attention to distinguish C. cayetanensis from Cryptosporidium cysts on stool exams especially. In our study, 22 and 88 years-old symptomatic male patients with C. cayetanensis infection had been presented. Diagnosis is made by modified Ziehl-Neelsen staining and ultraviole microscopy in addition to direct microscopy in our patients. Both of the patients had no history of travel and antibiotic consumption however young patient had fast-food habits. Anti-HIV antibodies were found as negative in sera samples. Our patients were evaluated as immunocompetent individuals. The patient which had prolonged symptoms been treated successfully by trimethoprim-sulphametoxazole (TMP-SMX) 2 x 160/800 mg/day orally during one week. In other patient, succesfull response was achieved by moxifloxacin 1 x 400 mg/day IV which mainly starting for treatment of cellulitis and the treatment was continued for one week. Cyclopora cayatensis cycts were completely disappeared on control stool examinations in addition to improvement of clinical findings in our cases. Relapse was not observed in the three month follow-up of patients. C. cayetanensis should also take into consideration for immunocompetent patients with complaint of enteritis or nausea, abdominal pain. If these patients have prolonged complaints they should also treat such as immunocompromiseds.

The aim of this study, is to examine the orthodontic patients for the carrier incidence of Candida and to determine the effects of geographical and gender differences to the Candida incidence. One hundred and nine children, who do not have any systemic disease, who were not treated with removable orthodontic appliances before, who do not smoke, were investigated. As a result of this study, the incidence of Candida was %28.44 and the most three identifed Candida species were C. Albicans, C. Tropicalis and C. Guillermondii. As an istatisticaly, no significant differences were found in Candida incidence between the patients living in İsparta, Antalya and Burdur. Furtennore there is no significant difference between genders.

In this study, the financial performances of SMEs listed in the BIST SME Industrial Index are evaluated by using TOPSIS multicriteria decision-making method. The data of the study acquired from annual financial statements that reported between the 2016-2018 period. Financial performance ranks of SMEs are determined for each year and thus comparative financial performances of SMEs are detected. BIST SME Industrial Index is an index that includes stocks of industrial SMEs traded in BIST Stars, BIST Main, and BIST Emerging Companies markets. SMEs have great importance for the Turkish economy, with their dynamizing roles and with their crucial roles in regional development and job creation. According to the Turkey Statistical Institute data, Turkish SMEs constitute 99.8 % of all enterprises in Turkey. At the same time, Turkish SMEs provide 72.7% of total employment, 62% of total sales, and 58% of the total investments of the Turkish Economy. Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) is one of the multicriteria decision-making methods that commonly used in the evaluation of financial performances of firms. The TOPSIS method is based on two main points: the positive ideal solution and the negative ideal solution. With the help of the TOPSIS method, the distances positive ideal solutions and negative ideal solutions of all options are calculated. Options are ranked according to their proximity to the positive ideal solution and their distance to the negative ideal solution.

Objective: Posterolateral thoracotomy is the most frequently used operation in thoracic surgery, and may initiate an inflammatory process. We aimed to evaluate inflammatory response of the body to posterolateral thoracotomy., Methods: This study was conducted between January 2013 and June 2014. Blood samples were drawn from 36 patients who underwent posterolateral thoracotomy preoperatively, and on postoperative days one, three and seven The levels of PTX-3, CRP and WBC in the serums of the patients were identified. All the results were recorded and analyzed., Results: PTX-3 levels were found statistically significantly higher in patients with lung cancer and/or aged above 65 years. There were significant differences in WBC and CRP levels between preoperative levels and on those on postoperative days one, three and seven but not for PTX-3. The area under the curve(AUC) levels in the receiver operating characteristics(ROC) analysis, which was performed to estimate the strength of PTX-3 in the differentiation of malignant and benign patients was found statistically significant(p<0.05)., Conclusions: The present study suggests that the novel inflammatory marker PTX-3 may be used in the diagnosis and follow-up of prognosis as a biomarker of inflammatory response in patients with lung cancer. However, it showed that PTX-3 levels are insignificant to identify the levels of inflamatuar response due to posterolateral thoracotomy in thoracic surgery.