INTRODUCTION: Sleep disorders are common in chronic kidney patients. However, knowledge about sleep quality in kidney transplant recipients (KTrs) is limited. Lower urinary tract dysfunction can also be caused by sleep disorders after renal transplantation. We evaluated the relationship between nocturia, quality of life, and sleep quality in KTrs.
METHODS: In our study, 99 KTrs >18 years were included. KTrs had a post-transplant period >6 months and serum creatinine <2 mg/dl. Simultaneously biochemical measurements on blood samples and 24-hour urine samples and Pittsburg Sleep Quality Index and SF-36 short-form health questionnaires were performed. The International Prostate Symptom Score (IPSS) was applied to 71 male patients.
RESULTS: The mean age and duration of transplantation 99 KTrs were 40.36 ± 10.3 years and 85.5 ± 59.7 months, respectively. The mean of pretransplant and posttransplant sleep duration was 7.72 ± 1.77 and 7.55 ± 1.37 hours, respectively. Nocturia was present in 85.9% of the KTrs. In patients with nocturia, IPSS was higher, and serum potassium and urinary density were lower. There was no relationship between nocturia and sleep quality. KTrs with poor sleep quality had lower SF-36 score, posttransplant duration <5 years, and higher blood urea nitrogenous.
DISCUSSION AND CONCLUSION: In our KTrs, the frequencies of sleep disorders and nocturia were high. Quality of life and sleep quality were better in patients with a transplant period of more than five years. In conclusion, sleep quality was independent of nocturia and related to quality of life.

INTRODUCTION: Acute pancreatitis is a progressive disease with inflammation of the pancreas. As the severity of the disease increases, its morbidity and mortality increase, so early diagnosis and treatment are very important. Therefore, many scoring methods are used to predict the prognosis of the disease. In this study, we aimed to show the severity of the disease with some biochemical parameters based on the radiological stage.
METHODS: 104 patients who had acute biliary pancreatitis in EskisehirOsmangaziUniversityFaculty of Medicine Hospital General Surgery Clinic were retrospectively detected. Age, gender, co-morbidity, laboratory parameters, length of stay, and radiological stages of these patients were evaluated. Balthazar scoring system was used to provide disease severity and radiological staging and standardization.
RESULTS: Of 104 patients with acute biliary pancreatitis, 46 were men and 58 were women, and the average age was 60. The length of stay was 9,33 (±9,81). There were 16 patients who underwent cholecystectomy earlier. Of the 26 patients had a history of an additional disease. As the severity of the disease increased, the length of hospital stay also increased. There was a positive correlation between disease severity and amylase, ALT, and glucose levels. There was a negative correlation between calcium level and disease severity and length of stay.
DISCUSSION AND CONCLUSION: As the disease gets more severe, it increases morbidity and mortality, and early evaluation increases the success of the treatment. Simple laboratory examinations can guide the severity of the disease, as in our study. High amylase, ALT values and low calcium levels can determine the prognosis of disease.

INTRODUCTION: Papillary thyroid carcinoma(PTC) is the most common thyroid malignancy. Since it generally has a favorable course, the current approach is to use less aggressive treatment modalities. However, patients with distant metastatic disease experience progression of disease with a higher mortality. This leads to the conclusion that it is crucial to understand which of these malignancies will metastasize to distant organs. The expression loss of the cell cycle inhibitor p27 is positively correlated with malignant behavior in many tumors. We aimed to investigate the relationship between tumor p27 expression and distant metastases in PTC.
METHODS: Our study included a total of 44 cases, 15 with distant organ metastases, 12 with lymph node metastases, and 17 without metastases, who were followed up in the endocrinology department. Immunohistochemical staining of p27 was performed for all the cases. The results were evaluated according to the percentage of positive staining.
RESULTS: While 2+ or 3+ staining was observed in 16(94.1%) of the cases without metastases, it was observed in only 5(33.3%) of those with distant organ metastasis. We found a statistically significant decrease in p27 expression in cases with distant organ metastasis(p = 0.002).
DISCUSSION AND CONCLUSION: We concluded that the evaluation of p27 expression in PTCs could be helpful in determining the biological behavior of the tumor.

INTRODUCTION: The aim of this study was to demonstrate the importance of changes in the leukocyte/erythrocyte ratio (LER) and hemogram parameters in the early diagnosis of obstructive sleep apnea syndrome (OSAS).
METHODS: The study included 99 patients diagnosed with OSAS in the Neurology Clinic Sleep and Sleep Disorders Centre of Health Sciences University Derince Training and Research Hospital in 2022, and a control group of 51 subjects determined with normal polysomnography. In the patient group and control group, sociodemographic data (age, gender, height, weight, body mass index), and risk factors for OSAS, the apnea hypopnea index (AHI), thrombocyte/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), and the new parameter of leukocyte/eryrthrocyte ratio (LER) were analyzed. The LER, PLR, NLR, and hemogram parameters were compared between the two groups.
RESULTS: According to the AHI, 51 (34%) cases were normal, 33 (22%) had mild OSAS, 22 (14.7%) had moderate OSAS, and 44 (29.3%) had severe OSAS. No statistically significant difference was determined between the groups in respect of the hemogram parameters (p>0.05). No statistically significant correlation was determined between the AHI values and the hemogram parameters(p>0.05). There was no statistically significant relationship between OSAS patients and the control group in terms of LER values (p=0.644;p>0.05). There was no statistically significant relationship between OSAS groups in terms of LER values according to AHI value (p=0.902;p>0.05).
DISCUSSION AND CONCLUSION: Besides NLR, PLR and hemogram parameters; LER as a new inflammatory marker; We think that there is a need for studies that can be evaluated in larger patient groups.

INTRODUCTION: Gastrointestinal(GI) polyps are mucosal or submucosal lesions protruding into the lumen.They can be neoplastic or non-neoplastic and often present with painless rectal bleeding. This study emphasizes the necessity of complete colonoscopy in pediatric patients with suspected colorectal polyps.
METHODS: This retrospective study, approved by the ethics committee,included pediatric patients (6 months – 18 years) who underwent colonoscopy between January 2019 and February 2021 and were identified with polyps.Patient data were analyzed.
RESULTS: Four hundred patients underwent colonoscopy,and 58 polyps were detected.28 of the patients were male and 11 were female;the average age was 6.8years. The most common complaint was rectal bleeding with 51.2%.All patients underwent colonoscopy by the same pediatric gastroenterologist.In our study, multiple polyps were detected in 28.2%, pedunculated polyps in 46.1%,and proximal rectosigmoid colon polyps in 15.3%.All neoplastic adenomatous polyps were located proximal to the rectosigmoid region and 75% were multiple polyps.
DISCUSSION AND CONCLUSION: Of the 400 patients who underwent colonoscopy,58 polyps were detected(28 males, 11females; mean age 6.8 years).Rectal bleeding was the most common presenting complaint(51.2%).All colonoscopies were performed by the same pediatric gastroenterologist.Multiple polyps were found in 28.2% of cases, pedunculated polyps in 46.1%,and proximal rectosigmoid colon polyps in15.3%.All neoplastic (adenomatous) polyps were located proximal to the rectosigmoid region, with75% presenting as multiple polyps.
While less common in children, right-sided colorectal polyps can occur and are closely associated with neoplasia. Therefore, in pediatric patients with suspected colorectal polyps,complete colonoscopy by an experienced pediatric gastroenterologist is essential.This increases polyp detection rates and prevents overlooking potentially neoplastic polyps in this age group.

INTRODUCTION: Control of postoperative pain in live liver donor patients is extremely important in terms of both patient comfort and reducing morbidity. The aim of this retrospective cohort study was to compare intravenous (IV) and epidural-based analgesia methods in live liver donor patients in terms of postoperative pain levels, analgesic, and antiemetic consumption.
METHODS: After ethics committee approval, the data of the liver transplantation donors obtained within a period of seven years in our clinic were examined. Demographic data, surgical and clinical characteristics, postoperative pain scores, analgesic and antiemetic consumption of the patients were obtained from the records and files. The patients were classified according to the use of intravenous and epidural-based analgesia methods, and their demographic and clinical characteristics, intraoperative opioid consumptions, postoperative pain scores, postoperative analgesic and antiemetic use amounts were compared. SPSS software was used to analyze the data.
RESULTS: A total of 28 patients' data were obtained, five of which were in the IV group and 23 in the epidural group. Perioperative opioid consumption was significantly higher in the IV group (P = 0.009). There was a trend for lower postoperative pain scores in the epidural group. Rescue analgesic use on the second postoperative day was significantly higher in the IV group (P <0.041).
DISCUSSION AND CONCLUSION: Postoperative pain control is better with epidural analgesia in live liver donor patients. Patients with epidural analgesia have lower intraoperative opioid consumption, tend to have lower postoperative pain scores, and less rescue analgesic consumption on the second postoperative day.

INTRODUCTION: This study assessed the prognostic and predictive value of neutrophil-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and complete blood count (CBC) parameters in metastatic castration-resistant prostate cancer patients treated with enzalutamide.
METHODS: A retrospective review of 82 metastatic castration-resistant prostate cancer patients at Kocaeli University Hospital (2018-2023) was conducted. Parameters included prostate-specific antigen, hemoglobin, and cell counts. Formulas: SII = Neutrophil x Platelet/Lymphocyte; PLR = Platelet/Lymphocyte; dNLR = Neutrophil / (WBC - Neutrophil). Survival was analyzed using the Kaplan-Meier method, Log-rank test, and Cox regression.
RESULTS: High dNLR was associated with increased progression risk (HR 2.39, CI 1.03-5.49; P=0.04), whereas PLR, SII, and other CBC metrics were not. The mean survival was 53.0 ± 3.8 months. Patient cohorts categorized by prior docetaxel treatment, showed no correlation between the aforementioned values and progression-free survival.
DISCUSSION AND CONCLUSION: Elevated dNLR levels in patients undergoing enzalutamide therapy correlate with adverse outcomes, emphasizing the role of dNLR in treatment strategies.

INTRODUCTION: Our study aimed to evaluate patients with Polycystic Ovary Syndrome (PCOS) using Magnetic Resonance (MR) pelvimetry to determine if there is a specific pelvic type associated with hyperandrogenemia.


METHODS: This study retrospectively analyzed data collected from pelvic MR imaging performed on 36 patients diagnosed with PCOS who attended the outpatient clinic of Alanya Education and Research Hospital between 2021 and 2022. All cases were of reproductive age, between 18 and 49 years, and were initially diagnosed with PCOS via ultrasound, had a history of hirsutism or amenorrhea, followed by subsequent MR imaging. A control group of 35 patients, matched for reproductive age without PCOS diagnosis, hirsutism, amenorrhea, or menstrual irregularities, who underwent MR imaging for any other reason were recruited
RESULTS: No significant differences were observed between the groups in terms of age, gravidity, parity, abortions, except for weight and Body Mass Index (BMI). Comparison of MR pelvimetry results between the groups, including pelvic inlet transverse diameter (cm), interspinous diameter (cm), midsagittal pelvic inlet anteroposterior diameter (cm), and midsagittal pelvic outlet anteroposterior diameter (cm), revealed no significant differences.
DISCUSSION AND CONCLUSION: Unfortunatelly, the results did not provide convincing evidence to prove our hypothesis. If it were, we believe, it would provide a bridge between the animal expriments and clinical studies regarding the ethiplogy of PCOS.

INTRODUCTION: To evaluate the diagnostic value of procalcitonin, C-reactive protein (CRP), and lactate measurements in cerebrospinal fluid (CSF) for the identification of meningitis and the differential diagnosis of bacterial and viral meningitis.


METHODS: Patients who underwent CSF sampling between January 2015 and September 2018 at our hospital in Izmir were included in this study. This prospective study included two patient groups: those with meningitis and controls, and patients with meningitis were further subdivided into viral and bacteriological etiology subgroups. Biochemistry, cell count, Gram staining, molecular viral panel, bacterial cultures, CRP, and procalcitonin were examined in the CSF. P-value of <0.05 was considered statistically significant.

RESULTS: In this study, 96 patients (47 cases and 49 controls) were included. Meningitis of viral and bacterial etiology was diagnosed in 12 (25.6%) and 35 (74.4%) patients, respectively. High CSF procalcitonin levels were highly discriminatory between controls and all meningitis patients, as well as between meningitis subgroups, with high sensitivity and specificity for the cut-off values. CSF CRP and lactate were also able to provide cut-off values for the differential diagnosis of meningitis subgroups. However, their sensitivity and specificity were not as high as those of procalcitonin.

DISCUSSION AND CONCLUSION: Procalcitonin and CRP measured in CSF may represent valuable biomarkers, particularly for diagnosing bacterial meningitis, although these biomarkers should be used in conjunction with other parameters for differential diagnosis.

INTRODUCTION: Innate immune defects are disorders in the functioning of the immune system, resulting in an increased susceptibility to atopic, infectious or autoimmune diseases. Atopic diseases and innate immune defects can coexist, precipitate or worsen each other. We aimed to determine the rate and type of atopic disease in patients who presented to our immunology and allergy clinic and were found to have primary antibody deficiency such as selective IgG, IgA and IgM deficiency.
METHODS: In this retrospective study, the files of 5460 patients examined in our outpatient clinic between September 2021 and September 2022 were analysed. 124 patients with primary antibody deficiency were included in the study. Demographic data, presence of parental consanguinity, diagnosis of atopic diseases (allergic asthma, allergic rhinitis, urticaria-angioedema, anaphylaxis, food allergy, drug allergy) were evaluated. Among laboratory findings, complete blood count, serum immunoglobulin (IgG, IgA, IgM, IgE) levels were recorded.
RESULTS: The mean age of the patients was 44.24± 17.17 years and 76 (61.29%) were female. 28 (22.50%) patients had consanguineous marriage between their parents. The diagnoses of patients were; (n=38, 30.64%) allergic rhinitis, (n=24, 19.35%) asthma, (n=26, 20.96%) urticaria-angioedema, (n=13, 10.48%) atopic dermatitis, (n=1, 0.80%) anaphylaxis, (n=19, 15.32%) drug allergy and (n=3, 0.24%) food allergy.
DISCUSSION AND CONCLUSION: Due to the high rate of consanguineous marriages in our country, primary immunodeficiency diseases are common. In order to reduce complications related to immunodeficiencies, physicians should be careful in terms of early diagnosis and treatment. Immunodeficiencies may coexist with allergic diseases. These diseases should also be taken into consideration when evaluating patients.

INTRODUCTION: The question whether there is a link between thyroid disease and inflammatory bowel diseases (IBD) is still to be answered. In this study, we aimed to investigate the frequency of thyroid disease in patients with IBD.
METHODS: Thirty-five IBD (23 ulcerative colitis; 12 Crohn’s disease) patients and 48 healthy control subjects were recruited into the study. Serum free T4, free T3, thyroid stimulating hormone, anti thyroglobulin, anti thyroid peroxidase levels and thyroid USG of the patients were analyzed retrospectively and compared with a control group.
RESULTS: The mean age of IBD patients (14 women) was 40.5±12.6 years. Among the control group 20 were female and their mean age was 39.2±13.4 years (P > 0.05). In terms of the frequency of thyroid disorder (including autoimmune thyroiditis and goiter), IBD patients (42.8 %) and controls (37.5 %) were similar (P = 0.655). Except for two control cases with subclinical hypothyroidism and goiter, no thyroid function abnormality was determined in patient and control groups. No significant differences were found between the patients and controls with respect to thyroid hormone profiles, the frequency of thyroid antibody positivity and thyroid volume measurements (P > 0.05). 14.2 % of IBD patients and 16.7 % of controls had autoimmune thyroiditis (P=1).
DISCUSSION AND CONCLUSION: Thyroid disorders are not more prevalent in patients with IBD. Regarding thyroid disorders in IBD patients, there does not seem to be a need for additional examinations and screenings other than the standard approach.

INTRODUCTION: Obturator reflex is one of the most feared complications of the transurethral bladder surgery, as it can result in bladder perforation. Also known as obturator jerk, the reflex occurs as a result of the stimulation of the obturator nerve by electrocautery used during surgery. We put forward an idea that the reflex can be detected and the power to the electrocautery can be cut off to prevent the complication. In this study we aimed to use electromyography sensors in the detection of the obturator reflex.
METHODS: Two male patients who had transurethral resection of bladder tumor operation under spinal anesthesia were included in the study. During the operation, electromyography measurements were made, and the responses of deviation from baseline due to electrocauterization were also recorded. Obturator reflexes observed and electrophysiological responses in this situation were also recorded.
RESULTS: The first patient developed a visible obturator reflex 10 times within three minutes. However, none of these were reflected in the electromyography recordings due to artifacts. The second patient did not develop the obturator reflex.
DISCUSSION AND CONCLUSION: Electrophysiological measurements made with electromyography in the evaluation of the obturator reflex that may occur in transurethral bladder surgery are of no value due to the intense artifacts that occur during the cauterization procedure. The use of systems to prevent electrocautery artifacts may make these measurements more useful.

Introduction: Persistent genital arousal disorder (PGAD) is a rare condition that primarily affects women and causes significant distress. The pathophysiology is not well understood, and treatment approaches differ. The goal of this study is to raise awareness about the possible link between PGAD and traumatic childhood life experiences, which is rarely mentioned in the literature.
Methods: A 41-year-old woman with PGAD was treated at Giresun Bulancak State Hospital's Psychiatry Outpatient Clinic with clomipramine, psychoeducation and supportive interviews. After the patient provided a history of traumatic childhood life experiences, her siblings who were living in different cities, were interviewed by phone and referred for psychiatric treatment. Patient had previously developed resistance to other antidepressants, antipsychotics, and antiepileptic medications.
Results: During the follow-up period, the patient experienced significant symptomatic improvement with clomipramine, psychoeducation and supportive interviews. Because of living in different cities, siblings with the same symptoms and possibly the same etiology were interviewed and referred to psychiatric treatment.
Conclusion: These case report series emphasize the significance of clinician recognition of PGAD symptoms, which patients frequently neglect to explain, as well as the importance of obtaining detailed anamnesis, including childhood history. Family members should be included in the symptom inquiry and anamnesis.

In coronavirus disease-2019 (COVID-19) caused by SARS-CoV-2, factors such as disruption of cellular immunity, neutropenia, pharmacological immunosuppression with glucocorticoid and anticytokine drugs used in the treatment may trigger the proliferation of opportunistic fungal infections such as mucormycosis. In this study, a 69-year-old female patient with type II diabetes mellitus, who was treated with methylprednisolone and tocilizumab due to severe COVID-19, and subsequently developed mucormycosis, is presented. On the 21st day of COVID-19 polymerase chain reaction (PCR) positivity, unilateral swelling was noticed on the face of the patient. A biopsy was taken from the necrotic area detected in the palatal durum, and fungal hyphae were observed in the histopathological examination. Rhizopus orizae was grown in tissue culture. In addition to intravenous (iv.) liposomal amphotericin B treatment, surgical debridement of the lesion was performed, and the patient died on the 48th day. With this case report, it is aimed to draw attention to the fact that opportunistic infections may develop after severe COVID-19 treatment, and that mucormycosis progresses rapidly despite antifungal drug and debridement treatments.