ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of İstanbul - North Clin Istanb: 8 (4)
Volume: 8  Issue: 4 - 2021
RESEARCH ARTICLE
1. Evaluation of patients with COVID-19 and the United Kingdom mutations in a training and research hospital in Istanbul
Habip Yilmaz, Mustafa Cakir, Selen Zeliha Mart Komurcu, Cemal Kazezoglu, Abdullah Emre Guner, Kemal Memisoglu, Isil Maral
PMID: 34585064  PMCID: PMC8430359  doi: 10.14744/nci.2021.90947  Pages 317 - 320
OBJECTIVE: This study aims to evaluate the patient clinics by studying Variant of Concern (VOC) Polymerase Chain Reaction (PCR) on conventional PCR-positive samples in a training and research hospital COVID test center in Istanbul.
METHODS: The study is a descriptive type and VOC PCR from all samples (from a total of 1300 samples) which detected positive by conventional PCR in a training and research hospital COVID test center between February 2 and 9, 2021. The United Kingdom mutation (VOC 202012/01, B.1.1.7) has been studied. Clinics parameters of the patients were evaluated from Public Health Management System (HSYS) records. The statistical significance was taken as p<0.05 in the analysis.
RESULTS: Within the scope of the research, 1300 PCR-positive COVID-19 patients were evaluated. VOC mutation was positive in 26.1% of all patients (339 persons), and 5.8% of patients (75 persons) were hospitalized. While 3.2% (11 persons) of those with VOC positivity were hospitalized, 6.7% (64 persons) of VOC negatives were hospitalized (p=0.020). About 18.2% of hospitalized VOC positives (two persons) and 23.4% of VOC negatives (15 persons) are in intensive care.
CONCLUSION: When VOC mutation was examined in all admitted and hospitalized patients, it was detected that VOC mutation was less frequent in hospitalized patients. No relationship between hospitalization and intensive care stay and VOC mutation was detected. It is recommended to determine with studies the contagiousness of patients with VOC mutations.

2. Global evaluation of coronavirus disease 2019 cases and clustering of similar countries
Handan Ankarali, Seyit Ankarali, Erkan Kilinc
PMID: 34585065  PMCID: PMC8430355  doi: 10.14744/nci.2021.42492  Pages 321 - 331
OBJECTIVE: It was aimed to be obtained descriptive values with respect to the outbreak time course, demographic structure, and symptom distribution by the help of case-based data, and to be compared countries by being grouped according to their similarities of outbreak indicators.
METHODS: The data were obtained from open-access database. Univariate tests and cluster analysis were used to analyze the data.
RESULTS: After the symptoms onset, the prolonged admission to the hospital significantly increases the risk of death. The average age and percentage of the male gender of the deceased cases were found to be significantly higher. In addition, the symptoms including fever, throat complaints, and dyspnea were determined in 70%. Countries were divided into four clusters according to their similarities in terms of three outbreak indicators. The differences among the clusters with regard to mean age, urban rate, and average of the outbreak indicators were found significant.
CONCLUSION: Delaying treatment from the moment the symptoms appear will increase the risk of death and the average time to recovery or death was 2.5 weeks. It can be stated that the most important measure is to focus on methods that can detect the cases before symptoms. The indicators that have a very important role in defining the pandemic are also related to each other. Therefore, multivariate methods, which take these relationships into account, are able to produce more accurate information in determining the similarities of countries.

3. Evaluation of radiological findings in pediatric patients with COVID-19 in Turkey
Sevinc Kalin, Saliha Ciraci, Deniz Cakir, Aslihan Semiz Oysu, Betul Sozeri, Ferhat Demir, Yasar Bukte
PMID: 34585066  PMCID: PMC8430353  doi: 10.14744/nci.2020.97947  Pages 332 - 339
OBJECTIVE: The objective of the study was to describe the findings of pediatric patients diagnosed with COVID-19 in computed tomography (CT) and chest X-ray (CXR) images. Therefore, the aim of this study is to show protecting the children from radiation as much as possible while guiding the diagnosis.
METHODS: Between March and June 2020, 148 pediatric patients examined who underwent CT due to suspicion of COVID-19. Fifty patients of 148 with normal thorax CT and negative reverse transcription polymerase chain reaction (RT-PCR) were excluded from the study. Of the remaining 98 patients were evaluated retrospectively by two pediatric radiologists with 15 years of experience.
RESULTS: The demographic, clinical, and laboratory data were evaluated for 52 RT-PCR-positive patients. CT finding of 23 RT-PCR positive and 12 negative patients was classified. According to our study, unilateral (61–67%), multifocal (50–52%), and peripheral (83–91%) involvement were higher in all groups. Lower lobe involvement was frequently detected (58–65%). The most frequently detected parenchymal lesion was ground-glass opacity followed by consolidated areas accompanying ground-grass opacities. Halo sign and vascular enlargement signs were the common signs of lung lesions (35%). In addition, some rare findings not previously described in this disease in children were mentioned in this study. The clinical course of all our patients was mild and control radiological imaging checked by CXR.
CONCLUSION: Most pediatric patients have a mild course. Hence, a balance between the risk of radiation and necessity for chest CT is very important. Low-dose CT scan is more suitable for pediatric patients but still it should be used cautiously.

4. Assessment of children and adolescent presenting to the dermatology outpatient clinic in Turkey during the coronavirus disease-2019 pandemic
Sevil Savas Erdogan, Tugba Falay Gur, Bilal Dogan
PMID: 34585067  PMCID: PMC8430357  doi: 10.14744/nci.2020.90836  Pages 340 - 344
OBJECTIVE: The coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. During the partial curfews implemented in the pandemic period, the pediatric patients presenting to the dermatology clinic of our hospital were examined taking the necessary precautions. We aimed to identify children and adolescent cases requiring dermatology services and their urgency when the number of COVID-19 cases was rapidly increasing and partial curfews were being imposed in Turkey.
METHODS: The study was conducted with pediatric patients that presented to our hospital dermatology outpatient clinic, a tertiary health care institution between March 11, 2020, and May 29, 2020, and their differences according to age groups and presentation period were evaluated.
RESULTS: The most common reason for a dermatology clinic visit was acneiform diseases (n=103, 33.3%). According to age groups, the most common diagnosis was eczema diseases in both the 0–2 and 3–6 years groups (n=10 [55.6%] and n=11 [47.8%]), respectively), infectious diseases in the 7–12 years group (n=19, 31.10%), and acneiform diseases in the 13–18 years group (n=100, 48.3%). While 144 patients visited the clinic within the first 15 days after the declaration of pandemic, the number of patients presenting in the following month decreased by more than 80% (n=23 for the second 15-day period and n=14 for the third 15-day period). There was a moderate increase in the number of pediatric dermatology patients 45 days after the declaration of pandemic (n=57 for the fourth 15-day period and n=71 for the fifth 15-day period). A correlation was observed between the number of newly diagnosed COVID-19 cases in Turkey and the number of pediatric patients presenting to our outpatient clinic
CONCLUSION: Considering that non-urgent and follow-up pediatric patients continue to present to dermatology outpatient clinics during the pandemic process, it is necessary to encourage the implementation of patient care methods, such as telemedicine in hospitals as part of the health system.

5. Prognostic factors of endometrial cancer in elderly patient group and their effects on survival
Songul Alemdaroglu, Gulsen Dogan Durdag, Safak Yilmaz Baran, Seda Yuksel Simsek, Selcuk Yetkinel, Didem Alkas Yaginc, Ozan Cem Guler, Husnu Celik
PMID: 34585068  PMCID: PMC8430360  doi: 10.14744/nci.2020.47154  Pages 345 - 353
OBJECTIVE: The objective of the study was to investigate the prognostic factors of the elderly group and their effects on survival by examining the histopathological features, surgical treatment protocols, and treatment modalities of patients diagnosed with endometrial cancer (EC).
METHODS: The records of 397 EC patients who completed their treatment and follow-up at a single center between 2012 and 2019 were evaluated retrospectively. The patients were evaluated in two groups as <70 years old (n: 301; 75.8%) and >70 years old (n: 96; 24.2%). Following the evaluation of histopathological features and treatment protocols, independent risk factors influencing survival were investigated with the Cox regression model.
RESULTS: The incidence of non-endometrioid histology (16.3% vs. 32.3%, p: 0.001), high-grade tumors (50.5% vs. 69.8%; p: 0.001), and >50 myometrial invasion (19.6% vs. 36.5%, p: 0.003) in the >70 age group was more frequent than that in the <70 age group. The independent risk factors on overall survival in the >70 age group were determined as non-endometrioid histology (HR: 5.9; 95% CI: 1.4– 24.7) and lymph node metastasis (HR: 6.4; 95% CI: 1.6–25.0). In the <70 age group, non-endometrioid histology (HR: 11.3; 95% CI: 4.0–32.0) was identified as the only independent risk factor affecting 5-year survival.
CONCLUSION: EC, with non-endometrioid histology, which is observed at a higher rate in elderly patients despite equal surgery and adjuvant therapy, is the primary factor that affects survival.

6. Risk analysis in persistent cervical lymphadenopathies: Malignant or benign?
Ulas Metin, Erdem Mengi, Cuneyt Orhan Kara, Ferda Bir
PMID: 34585069  PMCID: PMC8430358  doi: 10.14744/nci.2020.29895  Pages 354 - 358
OBJECTIVE: The objective of the study was to determine the parameters that can be used to predict malignancy in persistent cervical lymphadenopathies.
METHODS: We retrospectively reviewed the files of 162 patients diagnosed with persistent cervical lymphadenopathy who underwent an excisional biopsy in our department between January 2011 and October 2019. Patient demographics and the size, side, duration, and localization of lymphadenopathy were recorded, and their relationship with histopathological results was investigated. Multiple regression analysis was used to determine the relationship between clinical parameters and malignancy.
RESULTS: Of the 162 patients, 91 (56.2%) were male and 71 (43.8%) were female, and the mean age was 45.40±20.41 (2–84) years. Male gender (OR=3.099; p=0.003), increasing age (OR=1.029; p=0.002), short duration of lymphadenopathy (OR=0.989; p=0.048), and neck level V (OR=2.604; p=0.031) patients had a statistically significantly higher risk of malignancy. There was no statistically significant relationship between the side and size of the lymph node and the risk of malignancy (p>0.05).
CONCLUSION: In our study, male gender was determined to be the most predictive risk factor for malignancy in patients with cervical lymphadenopathy, followed by lymph node neck level, increased age, and duration of the disease.

7. Prevalence of HBsAg seropositivity during pregnancy and evaluation of vaccination programs: A multicenter study in Turkey
Fulya Bayindir Bilman, Selma Tosun, Ilknur Esen Yildiz, Handan Alay, Ayse Nur Evrenos, Huseyin Haydar Kutlu, Zeynep Sule Cakar, Recep Kesli, Sibel Baktir Altuntas, Bulent Altuntas
PMID: 34585070  PMCID: PMC8430362  doi: 10.14744/nci.2020.26504  Pages 359 - 364
OBJECTIVE: Hepatitis B virus (HBV) infection remains a global public health problem. Among its modes of transmission, vertical transmission from mother to child during pregnancy is exceedingly important. This study investigated seropositivity for hepatitis B surface antigen (HBsAg) among pregnant women aged 16–49 years and their pregnancy outcomes in several health institutions (university and state hospitals, family health centers) from seven cities in Turkey.
METHODS: An Excel form was sent to the sites participating in the study, and the total number of pregnant women who were tested for HBsAg between 2010 and 2017, HBsAg positivity rates, and the ages of HBsAg-positive pregnant women was collected retrospectively. Serum samples were obtained from 204,865 pregnant women from four regions between 2010 and 2017, including 107,463 from Black Sea, 2306 from Marmara, 48,339 from East Anatolia, and 46,757 from Aegean. HBsAg levels were determined on automated devices using chemiluminescence.
RESULTS: In the study, the data of 204,865 pregnant women from seven different provinces (Afyonkarahisar, Erzurum, Istanbul, Izmir, Manisa, Mus, and Rize) in different geographical regions were accessed, and HBsAg positivity was found in 2343 pregnant women (1.14%). The highest HBsAg seroprevalence was found in women who were older 26–40 years/1977–1991 birth year range on average. In the data of the present study, the number of pregnant women with HBsAg positivity among pregnant women born after the initiation of the national vaccination program and catch-up vaccination program is only 124 and constitutes 5.3% of all HBsAg-positive pregnant women
CONCLUSION: In this study, it has been found that HBsAg positivity in pregnant women has been decreasing in Turkey and that it is significantly lower, especially in those born after the initiation of the national vaccination program. Continuation of national neonatal HBV vaccination with high compliance is very important.

8. Epicardial fat thickness is associated with retinopathy in patients with newly diagnosed hypertension
Savas Ozer, Burcu Yucekul, Ahmet Seyda Yilmaz, Ali Gokhan Ozyildiz, Mustafa Kinik, Oguzhan Ekrem Turan, Mehmet Gokhan Aslan, Mustafa Cetin
PMID: 34585071  PMCID: PMC8430367  doi: 10.14744/nci.2020.23334  Pages 365 - 370
OBJECTIVE: Hypertensive retinopathy develops based on endothelial dysfunction, inflammation, and atherosclerosis. Epicardial fat secretes various cytokines associated with endothelial dysfunction, oxidative stress, inflammation, and atherosclerosis. We aimed to evaluate whether epicardial adipose tissue (EAT) thickness is a marker for retinopathy in newly diagnosed hypertensive patients.
METHODS: A total of 73 newly diagnosed hypertension (HT) patients were included in the study. Transthoracic echocardiography (TTE) was used to measure EAT thickness. To evaluate the presence of retinopathy in HT patients, hypertensive retinopathy staging was performed by ophthalmologists, according to Scheie classification.
RESULTS: Retinopathy was detected in 27 (37.0%) of 73 patients. EAT thickness in HT patients with retinopathy was higher than the group without retinopathy (5.07±1.45 mm vs. 4.19±1.20 mm, p=0.007). Low-density lipoprotein cholesterol (LDL-C) levels in HT patients with retinopathy were higher than the group without retinopathy (162.4±41.2 mg/dl vs. 138.1±35.6 mg/dl, p=0.010). As a result of the regression analysis, LDL-C (OR=1.016, 95% CI 1.001–1.031, p=0.043) and EAT thickness (OR=1.674, 95% CI 1.069–2.626, p=0.043) were the independent predictors of retinopathy.
CONCLUSION: Increased EAT thickness is associated with the presence of retinopathy in hypertensive patients.

9. Relationship between heart rate recovery index and erectile dysfunction
Guven Erbay, Gokhan Ceyhun
PMID: 34585072  PMCID: PMC8430350  doi: 10.14744/nci.2020.23921  Pages 371 - 376
OBJECTIVE: Heart rate recovery (HRR) is a cardiac parameter that can be used to evaluate autonomic nervous system (ANS) function problems. We examined the possible relationship between erectile dysfunction (ED) and HRR which is a clinical condition associated with ANS dysfunction.
METHODS: Seventy-six male patients that were examined with an exercise stress test and completed the International Index of Erectile Function Questionnaire Form (IIEF-5) were included in the study. The patients were divided into two groups as those with a normal HRR index (≥12, n=42) and those with an abnormal HRR index (<12, n=34). Then, statistical analyses were conducted to evaluate the correlations between ED and HRR.
RESULTS: There were no differences between the groups in terms of risk factors, such as laboratory findings, age, BMI, hypertension, and smoking. However, in the group with an abnormal HRR index, the IIEF-5 score was significantly lower than the other group (11.2±4.2 vs. 20.3±4.6, p<0.001). A statistically significant positive correlation was observed between the IIEF-5 score and HRR index (r=0.702, p<0.001). In addition, the presence of diabetes mellitus and HRR index was independent risk factors for lowering the IIEF-5 score.
CONCLUSION: The HRR index can be considered as an independent predictor of ED since a reduced value, which is associated with cardiovascular mortality and also causes ANS dysfunction.

10. An analysis of 1344 consecutive acute intoxication cases admitted to an academic emergency medicine department in Turkey
Melis Efeoglu Sacak, Haldun Akoglu, Ozge Onur, Arzu Denizbasi Altinok
PMID: 34585073  PMCID: PMC8430352  doi: 10.14744/nci.2020.98957  Pages 377 - 384
OBJECTIVE: One of the major causes of emergency department (ED) visits is acute poisoning. Acute intoxications occur soon after either single or multiple exposures to toxic substances, and they started to be a more serious problem in developing countries. The objective of this study was to investigate the local patterns of acute intoxications, as well as clinical and sociodemographic characteristics of patients with acute poisoning, admitted to our hospital’s ED.
METHODS: This single-center, retrospective study was conducted using medical records of consecutive patients admitted to the ED between January 2016 and December 2017.
RESULTS: A total of 1344 patients were included in the statistical analysis. Of these, 673 (50.1%) were female. Mean (±SD) age was 32.2 (±12.0), ranging between 17 and 84 years. The highest number of poisoning cases was observed in summer, especially in July (10.0%) and August (11.8%), whereas lowest number of admissions related to poisoning occurred during winter in November (5.1%) and December (5.2%). Among admitted cases, many were suicide attempts (55.7%) followed by non-intentional (accidental) ingestion of non-pharmaceutical (n=553, 41.2%) and pharmaceutical agents (n=42, 3.1%). Single agents were the most common cause of acute intoxications (63.2%) rather than multidrug intoxications. Most frequently observed causes of poisonings were recreational substances (30.0%) and agents exposed by inhalation (13.2%). INR, lactate, and pH levels at admission were significant predictors of 7-day mortality without a significant paired difference between each other. The AUCs for each were 0.89 (SE 0.04; p<0.0001), 0.84 (SE 0.10; p=0.0007), and 0.79 (SE 0.11; p=0.0102), respectively.
CONCLUSION: We conclude that recreational substances and medicinal drug intoxications were the leading cause of acute poisonings in our region, occurring mostly during the summer.

11. Treatment of gastrointestinal stromal tumors: A single-center experience
Senar Ebinc, Zeynep Oruc
PMID: 34585074  PMCID: PMC8430361  doi: 10.14744/nci.2020.04468  Pages 385 - 392
OBJECTIVE: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract. We aimed to examine the clinical characteristics and treatment outcomes of patients diagnosed with gastrointestinal stromal tumor (GIST) who were followed up and treated in our center.
METHODS: This study retrospectively evaluated the clinical characteristics, disease stages, administered treatments, and treatment responses of 67 patients diagnosed with GIST who presented to our center between 2007 and 2015.
RESULTS: Of the 67 patients included in our study, 24 (35.8%) were female and 43 (64.2%) were male. Median age at diagnosis was 54 years (23–86). Primary tumor localization was the stomach in 38.8% (n=26), small intestine in 46.2% (n=31), colorectal in 6% (n=4), and extra-gastrointestinal in 9% (n=6) of the patients. At diagnosis, 19 patients (28.4%) were at a metastatic stage. Fifty-seven patients (85.1%) underwent surgery. Thirty-three patients received one line, 20 patients received two lines, and 12 patients received three lines of treatment. The first-line treatment resulted in complete response in 12 patients (36.4%), partial response in 15 patients (45.5%), stable disease in 5 patients (15.2%), and progression in 1 patient (3%). Progression-free survival (PFS) was 36 months for the first-line treatment. The second-line treatment resulted in partial response in 7 patients (35%), stable disease in 12 patients (60%), and progression in 1 patient (5%). PFS was 12 months for the second-line treatment. The third-line treatment resulted in complete response in 1 patient (8.3%), partial response in 3 patients (25%), stable disease in 5 patients (41.7%), and progression in 3 patients (25%). PFS was 9 months for the third-line treatment. The fourth-line treatment resulted in stable disease in 4 patients (80%) and progression in 1 patient (20%). PFS was 4 months for the fourth-line treatment. Overall survival was 90 months for all patients.
CONCLUSION: The use of tyrosine kinase inhibitors such as imatinib has a significant favorable effect on the prognosis in the treatment of GISTs, both in adjuvant therapy and in advanced stage disease.

ORIGINAL IMAGES
12. Ruptured sinus of Valsalva aneurysm with bicuspid aortic valve in adult patient
Ahmet Karaduman, Ismail Balaban, Berhan Keskin, Cem Dogan, Gokhan Kahveci
PMID: 34585075  PMCID: PMC8430351  doi: 10.14744/nci.2020.65390  Pages 393 - 394
NCI-2020-0079.R1

CASE REPORT
13. A rare complication after coronary bypass surgery: Incisional pyoderma gangrenosum
Mehmet Erdem Memetoglu, Abdulkerim Ozhan, Mehmet Yilmaz, Tamer Kehlibar, Bulend Ketenci
PMID: 34585076  PMCID: PMC8430364  doi: 10.14744/nci.2020.73554  Pages 395 - 397
Pyoderma gangrenosum (PG) is a non-infectious, necrotizing, destructive skin disease which is rarely seen after cardiac surgery. This report presents a PG case after coronary bypass surgery.

14. Different phenotypes of transthyretin-associated familial amyloid polyneuropathy due to a mutation in p.Glu109Gln in members of the same family
Cagdas Erdogan, Selma Tekin, Zeynep Unluturk, Zehra Oya Uyguner
PMID: 34585077  PMCID: PMC8430354  doi: 10.14744/nci.2020.98852  Pages 398 - 401
Transthyretin-associated familial amyloid polyneuropathy (TTR-FAP) is an unusual but life-threatening disease that is autosomal dominant inherited and involves the mutation of the transthyretin (TTR) gene. A total of 26 patients with TTR-FAP and different mutations, including the p.Glu 109Gln mutation (previously annotated p. Glu89Gln), were previously reported in Turkey. Herein, we reported two patients from the same family who had the same p.Glu 109Gln mutation but had different clinical phenotypes. The clinical picture mainly involved polyneuropathy in one patient and cardiac involvement in the other patient. This case report mentions that TTR-FAP can cause different clinical phenotypes, even due to the same mutation and even in the same family.

15. Low-molecular-weight heparin-associated multiple digital necrosis in a patient as a result of heparin-induced thrombocytopenia syndrome
Fatih Kabakas, Meric Ugurlar, Ozge Yapici Ugurlar, Yesim Bicer
PMID: 34585078  PMCID: PMC8430349  doi: 10.14744/nci.2020.37531  Pages 402 - 404
Heparin-induced thrombocytopenia syndrome (HITS) is a rare complication of low-molecular-weight heparin (LMWH). It is an autoimmune-mediated side effect of LMWH which is caused by platelet-activating antibodies that recognize platelet factor-4/heparin complexes. Although HITS often leads to thrombosis in large veins and arteries, it can be presented as microvascular thrombosis. In this article, we report a case of HITS complicated with multiple digital necrosis after administration of LMWH.

REVIEW
16. Primary immunodeficiency diseases in the newborn
Oner Ozdemir
PMID: 34585079  PMCID: PMC8430363  doi: 10.14744/nci.2020.43420  Pages 405 - 413
The normal neonate’s immune system is anatomically completed but antigenically inexperienced and shows somewhat decreased role of a number of immunological pathways. Aside from anatomic characteristics (e.g., thin skin and mucosal barriers) of newborn, weakened pro-inflammatory and T-helper cell type 1 cytokine release and lessened cell-mediated immunity predispose the neonate more susceptible to all types of infections. Furthermore, many types of primary immunodeficiency diseases (PIDs) that present in neonatal period are potentially life threatening. However, most of the newborns stand this period without sickness due to complete innate immunity with other adaptive immune system mechanisms and transferred maternal immunoglobulin G. Besides unique immunity of the preterm and normal newborns; risk factors, clinical features, and laboratory evaluation of most common PIDs in newborn are told in this article. The range of PIDs is growing, and the diagnosis and management of these disorders continues to increase in complexity. The most common PID types of the newborn including antibody deficiencies, cellular/combined immunodeficiencies, phagocytic diseases, complement deficiencies, and innate immune system and other disorders are briefly mentioned here as well.

17. Children’s only profession: Playing with toys
Nevin Cetin Dag, Emine Turkkan, Alper Kacar, Huseyin Dag
PMID: 34585080  PMCID: PMC8430366  doi: 10.14744/nci.2020.48243  Pages 414 - 420
The concepts of games and toys have a very important role in children’s lives. It contributes to the development of cognitive, motor, psychosocial, emotional, and linguistic skills. It also plays a key role in raising self-confident, creative, and happy children. Therefore, attention should be paid to the concepts of games and toys, which are so important for the child to be a part of society as a healthy individual at every stage of his development. On the other hand, providing playgrounds where children can play comfortably and safely are essential in reducing the risk of accidents related to toys. All health-care components, especially pediatricians and family physicians, should take an active role in ensuring that these play processes, which are the most beautiful parts of childhood, are healthy and safe.

LETTER TO THE EDITOR
18. Like “North Americans,” “Europeans,” or “Others: ” Where do Turkish children with juvenile idiopathic arthritis stand in the new classification system?
Mustafa Çakan, Gulcin Otar Yener, Nuray Aktay Ayaz
PMID: 34585081  PMCID: PMC8430356  doi: 10.14744/nci.2020.66563  Pages 421 - 424
NCI-2020-0286

19. A case of human leukocyte antigen B27 positive reactive arthritis associated with severe acute respiratory syndrome coronavirus 2 infection
Hakan Apaydin, Serdar Can Guven, Orhan Kucuksahin, Ahmet Omma, Sukkran Erten
PMID: 34585082  PMCID: PMC8430365  doi: 10.14744/nci.2020.88965  Pages 423 - 424
NCI-2020-0420

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