Scopus Açık Erişimli Yayınlar

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A Local Search Heuristic with Self-tuning Parameter for Permutation Flow-Shop Scheduling Problem
(2009) Dengiz, Berna; Alabas-Uslu, Cigdem; Sabuncuoglu, Ihsan
In this paper, a new local search metaheuristic is proposed for the permutation flow-shop scheduling problem. In general, metaheuristics are widely used to solve this problem due to its NP-completeness. Although these heuristics are quite effective to solve the problem, they suffer from the need to optimize parameters. The proposed heuristic, named STLS, has a single self-tuning parameter which is calculated and updated dynamically based on both the response surface information of the problem field and the performance measure of the method throughout the search process. Especially, application simplicity of the algorithm is attractive for the users. Results of the experimental study show that STLS generates high quality solutions and outperforms the basic tabu search, simulated annealing, and record-to-record travel algorithms which are well-known local search based metaheuristics.
Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice
(2015) Cavusoglu, Yuksel; Altay, Hakan; Ekmekci, Ahmet; Eren, Mehmet; Kucukoglu, Mehmet Serdar; Nalbantgil, Sanem; San, Ibrahim; Selcuk, Timur; Temizhan, Ahmet; Ural, Dilek; 26574641
Heart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature.
Children with Iron Deficiency Anemia Have a Tendency to Hypercoagulation: An Evaluation by Thromboelastography
(2020) Kilci, Ceren; Olcay, Lale; Ozdemir, Beril; Fettah, Ali; Colak, Meric Yavuz; 0000-0002-5684-0581; 0000-0002-0294-6874; 31852173; AAK-3548-2021; AAA-4360-2021
Sodium glucose co-transporter 2 inhibitors in heart failure therapy
(2020) Cavusoglu, Yuksel; Altay, Hakan; Cahn, Avivit; Celik, Ahmet; Demir, Serafettin; Kilicaslan, Baris; Nalbantgil, Sanem; Raz, Itamar; Temizhan, Ahmet; Yildirimturk, Ozlem; Yilmaz, Mehmet Birhan; AAE-1392-2021; 32281958
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are a new class of drugs for patients with type 2 diabetes (T2DM) which inhibit urinary glucose reabsorption in the proximal tubule of the nephron and result in glucosuria, natriuresis and diuresis. In large, randomized clinical trials, SGLT-2i have been shown to reduce major cardiovascular (CV) events and heart failure (HF) hospitalizations in patients with T2DM who have atherosclerotic CV disease or CV risk factors. In these trials, SGLT-2i is have their greatest and most consistent effect on reducing the risk of HF hospitalization. The reduction in HF hospitalization was also observed in subgroups of patients with a HF diagnosis at baseline, which raised the possibility of a clinical benefit of SGLT-2i in HF patients, regardless of the presence or absence of T2DM. In very recently published DAPA-HF trial, a SGLT-2i, dapagliflozin treatment on top of standard HF therapy has been shown to have clear clinical benefits in terms of reducing HF hospitalization, CV mortality, all-cause mortality and improving quality of life in HF patients. This compelling evidence suggests that SGLT-2i have a potential to be an effective treatment option in HF, regardless of diabetes. This article provides a comprehensive overview focused on the role of SGLT-2i in the treatment of HF.
Low Prognostic Nutritional Index Predicts Poor Clinical Outcomes in Patients with Stage IIIB Non-small-cell Lung Carcinoma Undergoing Chemoradiotherapy
(2020) Ozdemir, Yurday; Topkan, Erkan; Mertsoylu, Huseyin; Selek, Ugur; 0000-0002-1932-9784; 0000-0001-8120-7123; 0000-0002-2218-2074; 32214853; M-9530-2014; AAG-2213-2021; AAG-5629-2021
Purpose: To investigate the prognostic utility of the prognostic nutritional index (PNI) in stage IIIB non-small-cell lung carcinoma (NSCLC) patients undergoing concurrent chemoradiotherapy (CRT). Methods: A total of 358 stage IIIB NSCLC patients who received a total dose of 60-66 Gy (2 Gy/fraction) radiotherapy and >= 1 cycle(s) of platinum-based chemotherapy were analyzed. The receiver operating curve analysis was utilized to identify the optimal PNI cut-off value demonstrating a significant connection with the overall survival (OS), locoregional progression-free survival (LRPFS), and progression-free survival (PFS). Results: At a median follow-up time of 22.5 months (range: 2.4-123.5), 30.2% and 14% of the patients were still alive and free of disease progression, respectively.The median OS, LRPFS, and PFS were 25.2 [95% confidence interval (CI): 36.3-46.6 months], 15.4 (95% CI: 26.6-35.3 months), and 10.7 (95% CI: 36.8-69.9 months), individually, for the whole study accomplice. The ROC analysis revealed an optimum rounded cut-off that associated meaningfully with each of the OS [area under the curve (AUC): 84.1%; sensitivity: 75.9%;72.4% specificity], LRPFS (AUC: 92.4%; sensitivity: 87.9%; 85.1% specificity), and PFS (AUC: 80.1%; sensitivity: 73.7%; 71.6% specificity) at a value of 40.5. Comparative analyses revealed that the patients presenting with PNI <= 40.5 had significantly inferior OS (16.8 vs 36.7; P<0.001), LRPFS (11.5 vs 19.5; P<0.001), and PFS (8.6 vs 13.6; P<0.001) outcomes compared to patients with PNI>40.5. In univariate analyses, lower T-stage (1-2 vs 3-4; P< 0.001), lower N-stage (N2 vs N3; P< 0.001), anemia status (absent vs present; P< 0.001), weight loss status (<5% vs >= 5%; P< 0.001), and PM group (<= 40.5 vs >40.5; P<0.001) were the factors found to be associated with OS, LRPFS and PFS results. The results of multivariate analysis exhibited that the PM was independently associated with each of the OS (P<0.001), LRPFS (P<0.001), and PFS (P<0.001) outcomes. Conclusion: The pretreatment PNI appears to be a robust novel prognostic factor that stratifies patients with stage IIIB NSCLC into two significantly distinct survival groups after CRT.
A viable snore detection system: hardware and software implementations
(2020) Tuncer, Ahmet Turgut; Bilgen, Mehmet
A stand-alone, custom-made biomedical system was introduced for long-term monitoring of sleep and detection of snoring events. Commercially available electronic components were assembled for recording audio, pulse, and respiration signals. Its software was implemented for off-line processing of the acquired signals in C++ and MATLAB environments. The linear and nonlinear features of the signals were extracted and characterized using spectral energy distribution, entropy, and largest Lyapunov exponent (LLE). The performance of the system was evaluated with real physiological data gathered from 14 chronic snorers. Analysis of the cases indicated that the system identified the snoring events with an accuracy of 88.22%, sensitivity of 94.91%, and positive predictive value of 90.95%. This high level of validation confirmed the reliability and utility of the system in detecting snoring.
Early pregnancy after bariatric surgery: a single-institute preliminary experience
(2020) Gunakan, Emre; Bulus, Hakan; Tohma, Yusuf Aytac; 0000-0001-9418-4733; 31840970; AAE-6482-2021
Background/aim: Pregnancy after bariatric surgery is an issue of growing importance with increasing number of women undergoing bariatric surgery. Therefore, in this study we present patients who conceived after sleeve gastrectomy and evaluate the obstetric outcomes. Materials and methods: This retrospective case-control study includes 23 women who conceived after laparoscopic sleeve gastrectomy. Patients were evaluated in two groups according to the number of months between surgery and conception (group 1: <= 12 months; group 2: >12 months). Results: The mean body mass index of patients before surgery and at the time of conception was 46.6 kg/m(2) and 29.7 kg/m(2), respectively. Nine patients (39.1%) had a history of infertility. There was no statistical difference between groups 1 and 2 for haemoglobin, ferritin, and 25-OH Vit-D levels or maternofoetal complication rates and pregnancy outcomes. Enteral nutrition requirements and intravenous iron replacement needs were higher in group 1, although this difference was not statistically significant. Conclusion: Pregnancy in the first years after sleeve gastrectomy seems to have similar obstetric outcomes compared to pregnancies occurring later, but it remains a controversial issue. Although the results did not have statistical significance in our study, well-designed prospective series may determine the role of enteral nutrition and intravenous iron replacement in patient management.
Selective generalized travelling salesman problem
(2020) Derya, Tusan; Dinler, Esra; Kececi, Baris; 0000-0002-2730-5993; F-1639-2011
This paper introduces the Selective Generalized Traveling Salesman Problem (SGTSP). In SGTSP, the goal is to determine the maximum profitable tour within the given threshold of the tour's duration, which consists of a subset of clusters and a subset of nodes in each cluster visited on the tour. This problem is a combination of cluster and node selection and determining the shortest path between the selected nodes. We propose eight mixed integer programming (MIP) formulations for SGTSP. All of the given MIP formulations are completely new, which is one of the major novelties of the study. The performance of the proposed formulations is evaluated on a set of test instances by conducting 4608 experimental runs. Overall, 4138 out of 4608 (similar to 90%) test instances were solved optimally by using all formulations.
Significance of the Cerebellopontine Cistern Cross-Sectional Area and Trigeminal Nerve Anatomy in Trigeminal Neuralgia: An Anatomical Study Using Magnetic Resonance Imaging
(2020) Gunesli, Aylin; Tufan, Kadir; 0000-0003-1509-4575; 32091126; AAK-1686-2021
AIM: To evaluate the relationship between trigeminal neuralgia (TN) and potential magnetic resonance imaging (MRI)-related measurements in patients with TN. MATERIAL and METHODS: Retrospective analysis of 104 patients with TN was performed. MRI studies of 98 healthy controls were included in the study to compare the parameters with TN patients' measurements. MRI measurements of cerebellopontine cistern (CPC) cross-sectional area, trigeminal-pontine angle (TPA) width, and trigeminal nerve cisternal segment length and thickness were assessed on both symptomatic and asymptomatic sides using 1.5T MRI with constructive interference in steady-state sequences. The images were interpreted by two radiologists blinded to the affected sides of the patients. RESULTS: There were significant differences between the symptomatic and asymptomatic sides in terms of mean trigeminal nerve length (8.8 +/- 2.34 mm vs. 9.39 +/- 2.29 mm; respectively, p=0.001) and thickness (20.9 +/- 9.6 mm(2) vs. 25 +/- 9.98 mm(2), respectively; p<0.001). The median cerebellopontine cistern cross-sectional area was considerably lower on the symptomatic side compared with the asymptomatic side [201 mm(2) (interquartile range=93) vs. 224.5 mm(2) (interquartile range=77), respectively; p<0.001]. There were no significant differences between the trigeminal-pontine angle width on either side (38.32 +/- 10.38 vs. 38.78 +/- 10.9, respectively; p=0.679). There were no statistically significant differences between the right and left sides regarding these parameters in the control group. CONCLUSION: Smaller CPC cross-sectional area, trigeminal nerve length, and trigeminal nerve thickness on MRI were demonstrated to commonly exist on the symptomatic side in patients with TN. We suggest that this narrow space may increase the risk of vascular compression on the nerve.
Ethical Issues Encountered within the Context of an Adrenoleukodystrophy Case
(2020) Karabulut, Seyhan Demir; Yildirim, Rifat Vedat; Celik, Zerrin Yilmaz; 0000-0001-5473-573X; AAB-3163-2021
Adrenoleukodystrophy (ALD) is a disorder of peroxisomal fatty acid beta oxidation which results in the accumulation of very-long chain fatty acids in tissues throughout the body. The most severely affected tissues are the myelin in the central nervous system, the adrenal cortex and the Leydig cells in the testes. Clinically, ALD is a heterogeneous disorder, presenting with several distinct phenotypes, and no clear pattern of genotype-phenotype correlation. As an X-linked disorder, ALD presents most commonly in males, however approximately 50% of heterozygote females show some symptoms later in life. In the case presented in this paper, the subject is a 19-year-old woman who applied to the genetics polyclinic. Her grandmother, mother and two siblings have ALD. She wonders and is concerned about her status as a carrier. Her parents do not want their daughter to take a diagnostic test and the sick siblings in in the family are hidden from the person to whom she will get married. The patient applied to the genetic outpatient clinic without the knowledge of her family, the first tests were performed and the other sick patients at home were also suggested to take a test for the diagnosis to be confirmed. That the patient was prevented from taking a test, that her health information was not shared with the person she will get married to and the patient's wish to have her six-year-old sister/brother, who can not make his/her own decisions take the test, necessitated the discussion of the case ethically.
CAN CHOLECYSTECTOMY BE PERFORMED AS SAFELY IN ELDERLY PATIENTS AS IT IS IN YOUNG PATIENTS?
(2020) Arslan, Baha; Yilmaz, Tugbahan; Erol, Varlik; Tuncali, Bahattin; Gulay, Huseyin; 0000-0002-9590-0276; 0000-0002-7898-2943; 0000-0002-0442-6178; 0000-0003-4461-4904; AAJ-6354-2021; AAJ-7840-2021; AAJ-6407-2021; AAD-6127-2021
Introduction: In this study, we aimed to compare the surgical outcomes between elderly and young patients undergoing surgery for gallstone disease and determine variations in patient characteristics, if any. Materials and Method: Data of patients who underwent surgery for gallstone disease at a single center between 2010 and 2018 were analyzed retrospectively. Two patient groups were evaluated: patients <65 years and >= 65 years. Patient characteristics, preoperative outpatient clinic data, surgical data, and postoperative data were collected. Results: In total, 1,198 patients with a mean age of 54.77 +/- 15.03 (15-91) years were assessed. Comorbid conditions, including cardiovascular disease, pulmonary disease, renal disease, and diabetes mellitus were significantly more common in elderly patients (p<0.001). Acute cholecystitis in the preoperative period was noted in 15.36% of young patients and in 30.4% of elderly patients (p<0.001). Need for emergency surgery was higher in elderly patients than in young patients [13.86% (47) and 9.31% (80), respectively] (p=0.021). Laparoscopic cholecystectomy and open cholecystectomy were performed in 98.37% and 1.04% of young patients, respectively, and in 92.62% and 3.53% of elderly patients, respectively (p<0.001). Among factors affecting the length of hospital stay in elderly patients, the duration of hospitalization was significantly longer in elderly patients who underwent emergency surgery, open surgery, needed additional surgery, and who had high American Society of Anesthesiologists scores (p<0.001, p<0.001, p=0.013, p<0.001, respectively). Conclusion: Complications rates associated with cholecystectomy are similar between young and elderly patients when appropriate surgical preparations are performed. Surgery for gallstone disease can be performed safely in elderly patients with low morbidity and mortality rates.
Ingested foreign bodies in children: Do they really pass spontaneously from the gastrointestinal tract? A single-centre experience with 1000 cases
(2020) Gezer, Hasan Ozkan; Ezer, Semire Serin; Temiz, Abdulkerim; Ince, Emine; Hicsonmez, Akgun; 0000-0002-9597-3264; 0000-0002-4635-2613; 0000-0001-8789-6003; 32185763; AAJ-9529-2021; J-3197-2013; A-4719-2018
BACKGROUND: Foreign body (FB) ingestion is frequently encountered in all departments that treat children. FB may bring about significant anxiety for parents and physicians. The present study aims to determine the appropriate approach for FB ingestion in children. METHODS: The records of 1000 children with a history of FB ingestion between the years 2005 and 2017 were reviewed retrospectively in this study. RESULTS: Of 1000 children, 53.8% were male. The most common types of FBs were coins (35%). X-ray was negative in 49% of the patients, and 86% of these patients received no intervention. Of the 504 (51%) X-ray-positive patients, the oesophagus (68%) was the most common location. Life-threatening complications were tracheo-oesophageal fistula (I), Meckel's diverticulum perforation (I), and perforation due to rigid endoscopy (I). CONCLUSION: We demonstrated that coins, which are the most commonly ingested FBs, have various types and sizes according to their countries of origin, and this affects spontaneous passage. We found that only 48% (quite low compared to the literature) of the coins passed spontaneously. In asymptomatic patients with a gastric button battery, we suggest a "watchful waiting" approach. The patients should be observed and managed at home. In our study, we found that 85% of the button batteries that reached the stomach passed spontaneously.
Is experience alone sufficient to diagnose developmental dysplasia of the hip without the bony roof (alpha angle) and the cartilage roof (beta angle) measurements? A diagnostic accuracy study
(2020) Sari, Ahmet Sinan; Karakus, Ozgun; 0000-0002-5429-1929; 32243403; AAO-7511-2020
In the Graf method of hip ultrasonography, the diagnosis of the infantile hip with developmental dysplasia of the hip (DDH) is strictly dependent on the bony roof (alpha angle) and the cartilage roof (beta angle) measurements. In this study, we investigated whether the infant hip could be diagnosed with DDH solely by evaluating ultrasound images obtained in the standard plane, without bony roof and cartilage roof measurements, in respect to different professional experience levels. Two hundred ten hip ultrasounds were randomly selected from patients who presented to our hospital for DDH screening. A total of 6 ultrasound images were obtained for each hip. The hip morphology evaluations were made without the bony roof and the cartilage roof measurements by 2 orthopedic surgery residents; 2 orthopedic surgery specialists, trained in the diagnosis and the treatment of the DDH; and 2 pediatric orthopedic surgery professors, highly experienced in the diagnosis and treatment of DDH. After hip morphology evaluations, the bony roof and the cartilage roof measurements were obtained and hip type evaluations were made by the same raters, according to the Graf method of hip ultrasonography. The highest intraobserver agreements between the hip maturity evaluation before and the hip type evaluation after measurements were .676 (P < .001) and .577 (P < .001) in professors 2 and 1, respectively, and the lowest agreements were .185 (P < .01) and .289 (P < .001) in specialist 1 and resident 2, respectively. The diagnosis of the infant hip as DDH could not be made solely by evaluation of the ultrasound images obtained in the standard plane without the bony roof and the cartilage roof measurements. The bony roof and the cartilage roof measurements were obligatory for the diagnosis of the infant hip as DDH, even in the very experienced pediatric orthopedic surgeons. Level of evidence: 2.
Prognostic value of MELD-XI score in patients referring to the emergency department with acute ST elevation myocardial infarction
(2020) Celik, Olgun; Ciftci, Orcun; Mudderisoglu, Ibrahim Haldun; 0000-0001-8926-9142; 0000-0002-7190-5443; W-5233-2018; AAD-5477-2021
Objective: We aimed to evaluate Model for End-stage Liver Disease excluding international normalized ratio (MELD-XI) score for prediction of 30-day in-hospital mortality in a cohort of patients with ST elevation myocardial infarction. Methods: The medical records of a total of 256 patients admitted with ST elevation myocardial infarction to the emergency department between January 2015 and January 2019 were retrospectively reviewed. A total of 111 patients were found eligible for the study. MELD-XI score was analyzed and compared on the basis of survival status. Results: A total of 111 patients with a mean age of 62.5 +/- 2.55 years were included in the study. In total, 81% (n = 90) of the patients were male and 19% (n = 21) were female. The mean MELD-XI score of the patients was 10.1 +/- 1.1. A total of 12 patients (12.9%) died within 30 days after hospitalization. The median MELD-XI score of the patients who died in the hospital was significantly higher than the patients survived (11.0 (10.5-11.6) vs 9.5 (9.4-13.8); p < 0.01). However, Gensini score was not significantly different between the surviving and deceased patients (p > 0.05). MELD-XI score was significantly correlated to left ventricular ejection fraction (r = -232, p < 0.01), and both parameters and age were significant independent predictors of in-hospital mortality (odds ratio: 1.73, 95% confidence interval: 1.25-2.39, p < 0.05; odds ratio: 0.89, 95% confidence interval: 0.81-0.99, p < 0.05; and odds ratio: 1.07, 95% confidence interval: 0.99-1.15, p < 0.05, respectively). A MELD-XI cut-off point of 10 had a sensitivity of 100% and a specificity of 78.8% for in-hospital mortality (area under receiver operating characteristics curve: 0.92, 95% confidence interval: 0.87-0.97, p < 0.05). A survival analysis based on a MELD-XI threshold of 10 revealed that the patients in the high-MELD-XI group had a significantly worse in-hospital survival (log rank test p < 0.001). Conclusion: MELD-XI score is a useful tool for in-hospital mortality prediction in patients referring to emergency medicine with acute ST elevation myocardial infarction.
In Vitro Evaluation of Direct and Indirect Effects of Sonic and Ultrasonic Instrumentations on the Shear Bond Strength of Orthodontic Brackets
(2020) Oduncuoglu, Bahar Fusun; Yamanel, Kivanc; Kocak, Zahire Sahinoglu; 0000-0003-0647-9481; 32284897; AAQ-4792-2020
Objective: Sonic and ultrasonic instrumentations generate vibrations that may influence debonding characteristics. The objective of this in vitro study was to assess the direct and indirect effects of sonic and ultrasonic periodontal instrumentations on the shear bond strength (SBS) and the adhesive remnant index (ARI) scores of metallic orthodontic brackets. Methods: Metallic brackets were bonded to 75 extracted mandibular central incisors that were embedded in acrylic resin. Instrumentations around the bracket base performed with ultrasonic (UltrasonicB group, n=15) and sonic (SonicB group, n=15) scalers were used to evaluate the direct effects on the SBS of brackets. Lingual surface instrumentations with ultrasonic (UltrasonicL group, n=15) and sonic (SonicL group, n=15) scalers were performed to assess the indirect effects. The control group (n=15) did not have any treatment. Instrumentations were performed for 30 s with 0 degrees scaler tip angulations with settings recommended by manufacturers. The SBS of the brackets tested with a universal testing machine and ARI scores were recorded. Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Results: The mean SBS of the control group was significantly higher than that of the UltrasonicB and SonicB groups (p=0.008). The UltrasonicL and Sonicl group instrumentations also decreased the SBS, although the difference was statistically insignificant. Ultra-sonicB instrumentations caused significantly higher frequency of ARI scores than the control group. Conclusion: The decrease of the SBS of metallic brackets indicates the influence of ultrasonic and sonic instrumentations on the breakage behavior at the bracket-resin interface. Instrumentations around the bracket base should be conducted with caution to decrease the bond failure risk of metallic brackets.
Salusin beta, atherosclerosis, and coronary slow flow
(2020) Akinci, Sinan; Coner, Ali; 0000-0001-5250-5404; 32011318; AAD-5564-2021
Radiological approaches to COVID-19 pneumonia
(2020) Akcay, Sule; Ozlu, Tevfik; Yilmaz, Aydin; 0000-0002-8360-6459; 32299200; AAB-5175-2021
COVID-19 pneumonia has high mortality rates. The symptoms are undiagnostic, the results of viral nucleic acid detection method (PCR) can delay, so that chest computerized tomography is often key diagnostic test in patients with possible COVID-19 pneumonia. In this review, we discussed the main radiological findings of this infection.
Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy Techniques for Secondary Hyperparathyroidism in Chronic Renal Failure
(2020) Sari, Ramazan; Yabanoglu, Hakan; Hargura, Abdirahman Sakulen; Kus, Murat; Arer, Ilker Murat; 0000-0001-6529-7579; 0000-0002-1161-3369; 0000-0003-3492-9953; 0000-0003-0268-8999; 31931926; AAJ-7870-2021; AAG-1897-2021; AAJ-7865-2021; AAK-2011-2021
Objective: To compare the safety and the effectiveness of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for refractory secondary hyperparathyroidism in patients with chronic kidney disease. Study Design: A comparative study. Place and Duration of Study: Baskent University, Adana Medical and Research Center, Adana, Turkey, from January 2012 to November 2018. Methodology: Patients operated upon for refractory secondary hyperparathyroidism by the general surgery team were inducted. Overall, 25 (40%) patients underwent total parathyroidectomy with autotransplantation (Group 1), whereas 37 (60%) patients underwent subtotal parathyroidectomy (Group 2). Patient files were retrospectively analysed for recurrence or persistence of hyperparathyroidism. Results: A total of 62 patients, 32 (52%) of whom were females, with a mean age of 41.4 +/- 15.8 years for group 1; and 30 patients were males with a mean age of 43.1 +/- 16.7 years for group 2 were assessed in this study. The presenting complaints were bone pains and malaise supported by laboratory values that showed consistently elevated parathyroid hormone levels (>200 pg/ml). In the postoperative follow-up, 29 patients (46.8%) had transient hypocalcemia, while 3 (5%) had persistent hypoparathyroidism. In Group 1, one (4%) patient had a recurrence, while 4 (16%) patients had persistent hyperparathyroidism. In contrast, two (5.6%) patients in Group 2 had recurrence, whereas 8 (22%) patients had persistent hyperparathyroidism. Conclusion: Both surgical options can be safely utilised in the management of refarctory secondary hyperparathyroidism. Moreover, regardless of the procedure used, all the parathyroid glands must be explored. However, due to high morbidity and failure rates of subsequent surgeries, the surgeon should be keen and thorough in the initial procedure.
Atomoxetine associated red ear: A case report
(2020) Taner, Hande Ayraler; Sari, Burcu Akin; 0000-0002-9730-7206; 0000-0003-2106-7928; A-7296-2013; W-9188-2019
Red ear syndrome is defined as mostly unilateral burning pain and redness of external ear. It has two forms idiopathic and secondary. Idiopathic red ear syndrome is mostly seen in young people and associated with migraine. Secondary red ear syndrome is more frequent in adults and releated with cervical disorder. Our patient was a 10 year old boy diagnosed with attention deficit hyperactivity disorder (ADHD) and spesific learning disorder. He had a complaint of redness in his ear, following the atomoxetine treatment for ADHD. The redness was appearing after taking atomoxetine in 1 hour. The redness in his ear was unilateral and lasted in 4 hours. Sometimes headaches were accompanied with red ear. After atomoxetine treatment was ceased the redness and the headache in his ear were dissappered. In the pathophysiology of red ear sydrome there is a disregulation of sympathic outflow. Atomoxetine has a high selectivity for noradrenergic receptors and also has an effect on periferic noradrenergic receptors. Atomoxetine could change the sympathic vasodilation/vasoconstruction balance and cause red ear. Although the red ear is not a life threating situation, it could cause discomfort and anxiety, so the clinicians should keep in mind red ear syndrome while using atomoxetine. To our best knowledge this is the first red ear case associated with atomoxetinein literature.
The Relation Between Serum P-selectin, Thrombin-activatable Fibrinolysis Inhibitor Levels, and Carotid Artery Intima-media Thickness in Acute Ischemic Stroke
(2020) Okuyan, Dilek Yilmaz; Kurt, Seda Aladag; Onay, Aslihan; Karakus, Resul; Kocer, Belgin
Objective: Inflammation and migration of leukocytes to the brain parenchyma play a role in atherosclerosis and cerebral ischemic stroke. Migration occurs with the help of adhesion molecules on the surface of cerebral endothelial cells and leukocytes. P-selectin, an adhesion molecule, is present on the platelet and endothelial surface and allows leukocytes to loosely adhere to the endothelium, and its increase has been shown in acute ischemic stroke (AIS). Thrombin-activatable fibrinolysis inhibitor (TAFI) is a procarboxypeptidase molecule that can be another marker of AIS, which has been shown to increase the risk of thromboembolism and stroke 6-fold. Intima-media thickness (IMT) is thought to be associated with atherosclerotic diseases in carotid ultrasonography (USG) and increased risk of ischemic stroke has been found to be associated with increased carotid IMT. In this study, we investigated the relationship between P-selectin and TAFI levels, which have been shown to be effective for AIS via carotid IMT, and is considered significant for atherosclerosis. Materials and Methods: Forty patients with AIS and 22 healthy subjects were included in the study. In both groups, serum P-selectin and TAFI levels were studied at the time of presentation, and on day 7, day 14, and at one month; carotid IMT and stenosis rates were measured by Doppler USG. P-selectin and TAFI levels were compared with carotid IMT in both groups. Results: There was no significant difference between P-selectin levels and carotid IMT between the groups; TAFI levels were significantly higher in the patient group and were correlated with carotid IMT in both groups. Conclusion: TAFI increase has been suggested to be a marker of early atherosclerosis in asymptomatic atherosclerosis and ischemic stroke. A positive correlation between TAFT levels and carotid IMT and stenosis rates have been reported; however, the positive correlation between increased P-selectin levels in AIS and carotid IMT was not detected in our study.