NCI-2020-0045

OBJECTIVE: This study aimed to evaluate the penetration of moxifloxacin and doripenem into the pleural fluid (PF) using a rabbit model of empyema.
METHODS: An empyema was induced using the intrapleural injection of turpentine (1 mL), followed 24 h later by instillation of 5 mL Klebsiella Pneumoniae (ATCC 33495), Fusobacterium nucleatum (ATCC 25586) and Streptokok Pneumoniae (ATCC 6305) into the pleural space. After an empyema was corroborated, Moxifloxacin (25 mg/kg-1) and Doripenem (20 mg/kg-1) were administered intraperitoneally. To determine the levels of antibiotics measured by High-Performance Liquid Chromatography in pleural and blood samples were obtained serially at 8, 24, 48 and 72nd hour.
RESULTS: The penetration of both antibiotics into the PF was very good. The penetration rate of doripenem (area under the curve (AUC) for PF/blood (AUCPF/AUCblood) ratio=1.68) was better than moxifloxacin (ratio=0.78). Equalization time between the PF and blood concentration of doripenem was more quickly than moxifloxacin. Peak PF concentration of moxifloxacin was 0,81 μg/mL-1 and occurred 8 h after infusion and then gradually decreased; at the beginning of the blood and pleural fluid concentrations of doripenem were equal. While the pleura concentration was increasing, blood concentration was almost the same. Doripenem reached a peak concentration (0.54 μg/ml) 24 h post-administration.
CONCLUSION: Differences were found in the penetration of the two antibiotics. Doripenem had convenient penetration PF compared to moxifloxacin. Due to the differences between human and rabbit pleural thickness, doripenem’s pleural penetration should be examined in infection models in animals with equal pleura thickness and clinical trials.

OBJECTIVE: Pump thrombosis in left ventricular assist device (LVAD) patients is an important cause of mortality and morbidity. Inflow cannula migration is a predisposing factor for pump thrombosis. Telecardiographic measurements can be used to follow up apical cannula deviation. In this study, we aimed to evaluate the migration of the inflow cannulas in patients with LVADs using angle measurements on telecardiograms
METHODS: Twenty-three patients who were implanted left ventricular assist devices in our clinic between February 2013 and April 2016 were included in our study. During the first year of follow-up, changes in angle measurements on postoperative 1st, 3rd, 6th, and 12th month telecardiograms were compared against the incidence of device thrombus and serum Lactate Dehydrogenase (LDH) levels.
RESULTS: Patients who were diagnosed with device thrombosis had more change in inflow cannula angles than patients without device thrombus (p<0.05 at 6th and 12th months). Patients with higher LDH values had more parallel angular changes at all intervals, and the change in angle was statistically significant at 3rd, 6th and 12th months (p<0.05).
CONCLUSION: This study shows that it is possible to track the migration of inflow cannulas in patients with left ventricular heart failure using telecardiograms. The correlation between angle change and LDH levels and embolic events may suggest that telecardiographic follow up of angles may be a useful tool for ventricular assist devices teams for early detection of thrombus.

OBJECTIVE: We hypothesized that hemogram parameters should be related to the development of coronary collateral vessels. For this purpose, we aimed to compare platelet distribution width (PDW) and PDW to platelet ratio (PPR) in subjects with stable coronary artery disease having adequate or inadequate coronary collateral development.
METHODS: A total of 398 patients with stable angina pectoris undergoing coronary angiography were enrolled and divided on the basis of the development of coronary collateral (CCD) (inadequate CCD (n=267) and adequate CCD (n=131). Routine complete blood count and biochemical parameters were measured before coronary arteriography.
RESULTS: Mean PDW and PPR values of inadequate and adequate CCD groups were 17.5% (10–23) and 12.4% (9.8–22) %, p<0.001, respectively. In multivariate analysis, age (p=0.012, 95% CI for OR: 0.958 (0.933–0.983) and PDW (p<0.001, 95% CI for OR: 1.432 (1.252–1.618) were found to be statistically significantly different inadequate CCD group compared to adequate CCD group. Receiver operating curve (ROC) analyses revealed that a PPR value greater than 0.057 had 76% sensitivity and 51% specificity and a PDW higher than 16.2% had 80% sensitivity and 66% specificity in predicting inadequate CCD.
CONCLUSION: The present study suggests that PDW and PPR may be associated with the degree of collateral development in chronic stable coronary artery disease (CAD).

OBJECTIVE: Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children. Biologics have changed the faith of children with rheumatic diseases. The main objective of this study was to demonstrate the rate of usage, efficacy and safety of biologics in JIA subtypes.
METHODS: This retrospective observational cohort study was conducted between May 2010 and September 2017. All children with the diagnosis of JIA and children under a biological agent treatment were recorded into the local registry system. Age, gender, JIA subtype, medications used, the clinical status of the patient, tuberculosis screening results, and side effects observed under biologics were retrieved from the registry.
RESULTS: There were 405 patients with the diagnosis of JIA in the cohort. Biologics were used in 123 (30.3%) JIA patients. Subtype frequencies of JIA patients were as follows: persistent oligoarticular JIA (33.6%), enthesitis-related arthritis (29.2%), systemic JIA (13%), rheumatoid factor (RF)-negative polyarticular JIA (13%), extended oligoarticular JIA (4.2%), RF-positive polyarticular JIA (3.4%), psoriatic arthritis (1.8%) and unclassified arthritis (1.8%). The rate of biologic use was high in extended oligoarticular JIA (64.7% of the cases), RF-positive polyarticular JIA (57.1%), psoriatic arthritis (57.1%), RF-negative polyarticular JIA (41.5%), and in systemic JIA (39.6%). Enthesitis-related arthritis (27.1%), persistent oligoarticular JIA (17.6%) and unclassified arthritis (16.6%) patients were the cases that needed a biologic agent in the last order. At the last control, 78.9% of the cases were in remission, while 21.1% of them were active despite biologic treatment. Isoniazid prophylaxis was used in 30.8% of the patients. None of the patients developed active tuberculosis infection under prophylaxis. Adverse events were observed in 18.6% of patients under biologics as recurrent uncomplicated upper respiratory tract infections being the most common.
CONCLUSION: Biologics are safe and effective treatment options in children with JIA. Most of the JIA patients with polyarticular involvement require biologics earlier in the disease course. The risk of tuberculosis infection seems not to be increased after appropriate screening and prophylaxis.

OBJECTIVE: In this study, the relationship between the frequency of bronchopulmonary dysplasia, perinatal risk factors and other prematurity comorbidities were evaluated in very low birth weight infants.
METHODS: A total of 872 very low birth weight infants’ files were retrospectively reviewed. The effects of the clinical parameters, such as type of birth, small for gestational age, gender, antenatal steroids, early membrane rupture, chorioamnionitis, surfactant administration, respiratory distress syndrome, patent ductus arteriosus, apnea, early and late sepsis on the frequency of bronchopulmonary dysplasia, were evaluated by binary logistic regression analysis.
RESULTS: The overall mortality rate was 20.9%. After the first 28-day mortality reduction, the total bronchopulmonary dysplasia frequency was found to be 20.1%. The odds ratio and 95% confidence intervals of the factors affecting the development of bronchopulmonary dysplasia were found to be as follows respectively: respiratory distress syndrome (OR 6.2, 95% CI 3.6–10.6, p<0.01), patent ductus arteriosus (OR 4.9, 95% Cl 2.4–9.9, p<0.01), apnea (OR 4.1, 95% CI 2.5–6.9, p<0.01), late sepsis (OR 2.7, 95% CI 1.6–4.5, p<0.01), early membrane rupture (OR 2.6, 95% Cl 1.2–5.5, p=0.01), and male gender (OR 1.6, 95% CI 1.0-2.7, p=0.04) was found. However, there was no effect of chorioamnionitis, antenatal steroids, small for gestational age, early sepsis and type of birth on bronchopulmonary dysplasia.
CONCLUSION: Differently from the usual factors which are low birth weight and a gestational week, there was a significant but non-linear risk relationship between respiratory distress syndrome, patent ductus arteriosus, late sepsis, apnea, early membrane rupture, male gender and bronchopulmonary dysplasia.

OBJECTIVE: The aim of this study was to evaluate the effect of double-balloon enteroscopy (DBE) on the success of endoscopic retrograde cholangiopancreatography (ERCP) procedures in patients with surgically modified gastrointestinal (GI) tract anatomy.
METHODS: The medical records of patients who underwent ERCP in the Gastroenterology Department of Kocaeli University School of Medicine hospital between December 2008 and September 2014 were examined. From the patient group that was scheduled to undergo DBE-ERCP, the details of cases in which ERCP via standard duodenoscope or DBE-ERCP was performed during the same session because standard ERCP failed were included. Procedure parameters, outcomes, and complications related to the procedure in both groups were analyzed. Patients who underwent the DBE-ERCP procedure directly, those who underwent push enteroscopy, or gastroscopy to evaluate the GI tract anatomy before the day of ERCP, and who underwent DBE-ERCP on a day other than the initial ERCP session were excluded. Afferent loop intubation, access to the major papilla, selective cannulation, therapeutic success rates, and the effect of DBE on overall procedure success were evaluated.
RESULTS: Fifty-one patients with a history of BII gastrojejunostomy and 11 patients with hepaticojejunostomy (with or without Roux-en-Y) were included in the study. In all patients, the ERCP procedure was initiated with a standard duodenoscope. If intubation of the afferent loop was unsuccessful in reaching the major papilla or enterobiliary anastomosis, DBE was used. In 30 (48.4%) of the 62 patients whose GI tract was anatomically altered, the duodenoscope was successfully advanced to the ampulla and 27 (43.5%) were cannulated successfully. Thirty-one patients underwent DBE-ERCP. DBE reached the ampulla or enterobiliary anastomosis in 30 patients (96.8%) and selective choledocus cannulation was achieved in all patients but 3 (90%), including 1 patient with a hepaticojejunostomy. The overall ERCP success rate increased from 43.5% (27/62) to 87.1% (54/62). Two perforations (1 during standard duodenoscopy and 1 with DBE-ERCP) were observed.
CONCLUSION: The overall success rate of ERCP increased with use of the DBE technique in patients with small bowel anatomic variations that were the result of previous surgery.

OBJECTIVE: Diabetes is one of the primary diagnoses for admission to home health care units. Although there are many studies about elderly diabetic patients, there are not many studies on home care patients with diabetes. The present study aims to analyze the current status of diabetic home care patients with their biochemical data and medications.
METHODS: This was a retrospective study, including 256 diabetic patients who were following up by the Home Health Unit of Istanbul Provincial Health Directorate Public Hospitals Services-2. In this study, we analyzed the current biochemical data of the patients with their medications.
RESULTS: In this study, 185 female (72.3%) and 71 male (27.7%) patients were recruited with the mean HbA1c of 8.25±1.77. Among these patients, 65% of them were using oral antidiabetic (OAD), and 58% were using insulin. There were 21 (8.2%) patients who were not receiving any treatment. While patients who were using only oral antidiabetic have better A1c levels (A1c: 7.73±1.45), patients who were insülin using had HbA1c levels as high as the patients who were not using any medication. This may be due to the progression of diabetes, fear of hypoglycemia or insufficient insülin use. While metformin was the most commonly used OAD, with a 38% usage rate. When compared to HbA1c levels, there was no difference between the types of insulin used (p=0.167).
CONCLUSION: As a result, it is important to plan regular visits and personalized treatment by keeping in mind the benefits to risk ratios in home-care diabetic patients.

OBJECTIVE: We aimed to investigate survival outcomes and survival-related prognostic factors in gastric cancer patients who were followed-up or received adjuvant therapy in our center.
METHODS: Patients with gastric cancer treated between 2005 and 2016 were evaluated retrospectively. We included 345 non-metastatic (stage I-III) gastric cancer patients in the study. The clinical, demographic, histologic data of the patients and treatment characteristics were obtained from the patient’s files.
RESULTS: While 50 patients were stage I, 94 patients were stage II, 201 patients were stage III. While 221 patients (64%) presenting with serosal or adjacent visceral organ invasion or with involved lymph nodes were treated with adjuvant chemoradiotherapy, 124 patients presenting with early-stage disease were followed after surgery. Median follow up time was 34 months (4–156 months). While the median overall survival (OS) was 51 months, median disease-free survival (DFS) was 35 months. Overall survival and disease-free survival rates for 1st, 3rd and 5th years were 85%, 55%, 45% and 72%, 49%, 38%, respectively. According to univariate analysis, tumor size, T stage (p<0.001), N stage (p<0.001), TNM stage (p<0.001), grade (p<0.001) and presence of lymphovascular invasion (p=0.005) were determined as prognostic factors that affect overall survival significantly. According to the multivariate analysis, only T and N stage (p<0.001) were determined as independent prognostic factors for overall survival.
CONCLUSION: Many different prognostic factors have been defined for gastric cancer. In concordance with the literature, we found T and N stages as prognostic factors in univariate and multivariate analysis.

OBJECTIVE: Fear of post-cessation weight gain may be a barrier to cessation therapy or may lead to smoking relapse. This study aimed to evaluate the relationship between the change in eating behavior and post-cessation weight gain.
METHODS: A prospective study that included 103 cigarette smokers, who visited the family medicine clinics of a training and research hospital for smoking cessation treatment between June 2018 and December 2018, was planned. A face to face survey (including Turkish version of Dutch Eating Behaviour Questionnaire-DEBQ and weight measures) was applied to all individuals at first and the final visits for the assessment of restrained, emotional, and external eating behaviors. Statistical analyses were completed using the IBM SPSS Statistics 22 program.
RESULTS: Of 103 patients screened (M age=38.3 years SD=9.28), 58.3% were male, and 40.8% were in heavy nicotine dependence level (NDL) group. The mean weight increased by 4.74±2.63 kg in three months of smoking cessation. In the high NDL group, three subscales score (restrained p<0.001, emotional p=0.007, external p=0.005) of the DEBQ increased. Weight gain was significative associated with NDL (p=0.01). There was a positive correlation between Fagerstrom score and weight (kg) gain (r: 0.34; p=0.001). Weight change according to the emotional eating behavior was significantly different by gender (female p=0.005; male p=0.04). Women had a higher difference in emotional eating behavior score than men. Obese smokers had a higher initial restrained eating score than non-obese smokers (p=0.009). Weight gain of nicotine replacement therapy group had a similar result in the pharmacotherapy (varenicline) group (p=0.26). Both of treatment types concluded with a significant weight change (p=0.001).

OBJECTIVE: In this study, we reviewed GISTs with all morphological and immunohistochemical findings and assessed the prognostic parameters of these tumors.
METHODS: Files of 40 cases with GIST operated between 2002 and 2008 were retrospectively examined in this study. Patients were grouped as patients with and without recurrence within postop 1 year. The patients were grouped based on their localization, gender and age. The cases were stratified as the risk grades based on risk categorization table developed by Fletcher et al. according to the tumor diameter and number of mitoses. The cases were immunohistochemically investigated for CD117, CD34, S100, and Ki-67.
RESULTS: Male/female ratio was 25/15. The mean age was 61.55. Mean tumor diameters were statistically significantly higher in the recurrence (+) group than in the recurrence (-) group (p=0.048). The mean number of mitoses was statistically significantly higher in the recurrence (+) group than in the recurrence (-) group (p=0.038). No statistically significant difference was found in histological distribution of the recurrence (-) and recurrence (+) groups (p=0.8795). No statistically significant difference was found in CD34, S100, and Ki-67 distribution of the recurrence (-) and recurrence (+) groups (p=0.862, p=0.609, and p=0.023, respectively). All patients in the recurrence (+) group were in the high-risk group.
CONCLUSION: GISTs are studied in a wide range from benign, incidental tumors to malignant tumors with the risk for recurrence and metastasis concerning biological behaviour. GISTs have prognostic parameters, such as tumor localization, tumor diameter, mitotic index, cellularity, and pleomorphism grade.

OBJECTIVE: This study aims to evaluate the efficacy and safety of the addition of 10 or 25 mg of empagliflozin to patients with type 2 diabetes mellitus using a maximum tolerable dose of metformin and gliclazide.
METHODS: A total of 60 patients who had been receiving a maximum tolerable dose of metformin plus gliclazide. was divided into two groups in this study. In the first group (Group 1, n=32), 10 mg empagliflozin was added to the current treatment once a day, and in the second group (Group 2, n=28) 25 mg empagliflozin was added to the same treatment once a day. Biochemical results, weight and blood pressure changes of the patients in both groups were evaluated before and after 12 weeks of empagliflozin addition. Patients who developed urinary tract and genital infections after treatment were recorded.
RESULTS: There was a statistically significant decrease in HbA1c in both groups after empagliflozin treatment (Group 1, p<0.001 and Group2, p=0.001). When the lipid profile was evaluated, no significant difference was found between basal and post-treatment parameters (p>0.05). Patients in Group 1 and Group 2 lost 2.6±1.2 and 3.8±2.0 kg of body weight, respectively (p<0.0001 for each). There were also significant reductions in systolic and diastolic blood pressure for groups 1 and 2 (p<0.0001 for each). Although there was a numerical increase in the urinary tract and genital infections in both groups after empagliflozin treatment, there was no statistically significant difference compared to the pre-treatment period (p>0.05).
CONCLUSION: Two doses of empagliflozin added to the present treatments showed a dose-independent improvement in glycemic control and a neutral effect on lipid metabolism.

OBJECTIVE: Differential diagnosis of mycosis fungoides (MF) in the early stages can be challenging. Dermoscopy has been reported to be useful in the evaluation of early MF. However, to our knowledge, there is no study that specifies these early stages as stage IA, IB or IIA. The present study aims to evaluate the dermoscopic findings of stage IIA MF in comparison with plaque psoriasis (PP).
METHODS: Thirty-four patients aged between 16-70 years with stage IIA MF (n=17) and PP (n=17) were evaluated in this prospective study. Dermoscopic examinations were performed by manual dermatoscopy (Dermlite DL4). χ2 test was used.
RESULTS: In patients with stage IIA MF, orange-yellow patches (88.2%), short, fine and linear vessels (82.3%), geometric white scales (70.5%), perifollicular white scales (47%) and white patches (35.2%) were common, while dotted vessels (94.1%), diffuse lamellar white scales (88.2%) and dotted and globular vessels (70.5%) were common in patients with PP. Although spermatozoa-like structures, purpuric dots, collarette white scales and Y-shaped arborizing vessels were common in patients with MF, this was not statistically significant. Geometric white scales (clinically; cigarette paper-like wrinkly scales) correlated with alternating parakeratosis and orthokeratosis in the stratum corneum histopathologically.
CONCLUSION: A unique aspect of our study is that this study provides insights about the importance of scales in differentiating MF from PP. Orange-yellow and white patches, short, fine and linear vessels, geometric and perifollicular white scales may be useful in distinguishing stage IIA MF from PP by hand-held dermoscopy.

OBJECTIVE: Laryngeal squamous cell carcinoma (LSCC) is the most frequently seen head and neck malignancy. Despite improvements in the treatment modalities within the last 20 years, the desired improvement in survival outcomes has not been achieved yet which led researchers to investigate factors that might affect prognosis in LSCCs.
METHODS: A total of 116 previously operated patients were included in this study. To assess systemic inflammation, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were calculated. The cut–off values for NLR and PLR were accepted as 2.79 and 112, respectively. To evaluate intratumoral inflammation, hematoxylin-eosin stained tumor sections were evaluated. Tumor-infiltrating lymphocyte (TIL) densities in the tumor area were scored as 1+, 2+ and 3+.
RESULTS: The mean overall survival was 29.5±17.7 months. In univariate analysis, a statistically significant correlation was seen between age group of 60 years, tumor stage, site and OS (p=0.025, p=0.026, p=0.029). There was no statistically significant relationship between PLR, NLR and TIL density and OS. In the multivariate analysis, the 60-year-old group and tumour stage were still significantly associated with the OS (p=0.033, p=0.046).
CONCLUSION: Age and tumor stage were significantly associated with survival in our study, but contrary to the literature, no correlation was found between local and systemic inflammatory response.

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Epithelial-myoepithelial carcinoma is a biphasic low-grade malignant tumor, which represents approximately 1% of all salivary gland tumors. This tumor occurs mostly in the parotid gland, followed by submandibular gland and minor salivary glands. Women, mostly fifth to the eighth decade of life, are commonly affected. Histopathologically, epithelial-myoepithelial carcinoma is composed of an inner single layer of eosinophilic cuboidal ductal cells and outer single or multiple layers of clear myoepithelial cells. We present a case of a 69 years old man who had a scar on lower the lip for 10 years and voice annoyance for three months. The biopsy for lower lip was reported “infiltrative clear cell epithelioid neoplasm” and vocal cord biopsy result was “verrucous carcinoma”. After cordectomy and wedge resection of the lower lip, histopathology revealed Epithelial-Myoepithelial Carcinoma for the lower lip and microinvasive verrucous carcinoma for the left vocal cord. Our case has a very uncommon location and presentation for EMC. The tumor location was minor salivary glands of the lower lip and the clinical presentation was quite different. Coexistence with microinvasive verrucous carcinoma of the vocal cord is the other unique part of our case.

The use of food additives in food production is inevitable in this modern world. Although only a safe amount of food additives is approved, their safety has always been questioned. To our knowledge, the effects of food additives on microbiota have not been investigated in a detailed manner in the literature so far. In this review, the effects of artificial sweeteners, sugar alcohols, emulsifiers, food colorants, flavor enhancers, thickeners, anticaking agents, and preservatives on microbiota were reviewed. Even though most of the results illustrated negative outcomes, few of them showed positive effects of food additives on the microbiota. Although it is difficult to obtain exact results due to differences in experimental animals and models, said the findings suggest that nonnutritive synthetic sweeteners may lead to glucose intolerance by affecting microbiota and a part of sugar alcohols show similar effects like probiotics.