OBJECTIVE: Computed tomography of the thorax (Thorax CT) is frequently used to diagnose viral pneumonia in moderate to severe COVID-19 patients, but its diagnostic performance in mildly symptomatic COVID-19 patients is still unclear. Assessing the diagnostic performance of thorax CT in mildly symptomatic COVID-19 patients was the purpose of our study.
METHODS: Mildly symptomatic and clinically stable, suspected COVID-19 patients scanned with Thorax CTs between March 11, 2020, and April 13, 2020, were included in this study. The sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, and the respective accuracies were calculated for diagnostic purposes.
RESULTS: Among the 1119 patients enrolled in our study, abnormal thorax CT scans were 527 out of which 363/527 (68.9%) had typical CT features for COVID-19. According to analysis of typical COVID findings, sensitivity, specificity, positive predictive values, negative predictive value, and the accuracy of Thorax CTs with were 51.45%, 86.07%, 78.24%, 64.55%, and 68.99%, respectively. When typical CT findings and atypical CT findings were combined for the statistical analysis, the sensitivity, specificity, and accuracy observed 68.84%, 74%, and 71.49%.
CONCLUSION: Diagnosing pneumonia can be challenging in mildly symptomatic COVID-19 patients since the Reverse Transcription Polymerase Chain Reaction test results, when compared with symptoms are not always evident. According to our study, thorax CT sensitivity was higher when atypical COVID-19 CT findings were included compared to those with typical COVID-19 CT findings alone. Our study which included the largest number of patients among all other similar studies indicates that not only typical but also atypical CT findings should be considered for an accured diagnosis of COVID-19 pneumonia.

OBJECTIVE: The purpose of the study was to assess the effect of neutrophil-to-lymphocyte ratio (NLR) on recurrence and survival in patients with Esophageal Squamous Cell Carcinoma (ESCC) undergoing surgery.
METHODS: This was a retrospective analysis of the 80 resectable ESCC patients who underwent surgery at Yuzuncu Yil University Faculty of Medicine between 2008 and 2018. Receiver operator characteristics curve of NLR was plotted for disease-free survival (DFS). The area under the curve of NLR was 0.692 (p=0.008) with 65.2% sensitivity and 2.8 with 69.5% specificity. Patients were divided into two groups based on the NLR as follows: NLR <2.8 and NLR ≥2.8.
RESULTS: Among 80 ESCC patients, 54 (65.5%) were female. The median age was 55 years (range, 26–77). The NLR was <2.8 in 47 (58.7%) patients. Median DFS was 55 months in patients with NLR ≥2.8, whereas it was not reached in those with NLR <2.8 (p=0.008), with corresponding overall survival (OS) durations of 71 months and not reached (p=0.027). Eastern Cooperative Oncology Group performance score 2, presence of obstruction at diagnosis, lower 1/3 esophageal localization, neoadjuvant treatment, and NLR ≥2.8 were found to be the factors related to survival.
CONCLUSION: The present study demonstrated that high pre-treatment NLR was associated with worse DFS and OS in patients with resectable esophageal cancer. We believe that pre-treatment NLR may help guide predicting treatment outcomes in non-metastatic resectable ESCC patients.

OBJECTIVE: Epidemic and pandemic outbreak periods are as stressful for psychiatric symptoms as well as the physical symptoms of the epidemic disease and can trigger and aggravate psychiatric symptoms, especially anxiety. There is no scale specific to the outbreak period and which can be used in other outbreaks. In this study, it was planned to develop a scale to evaluate the anxiety associated with epidemic disease, especially during the epidemic period.
METHODS: In this study, a Likert type scale with 15 items was developed by our research team to evaluate outbreak disease anxiety, and the scale form created was transferred to online use and the reliability of validity was evaluated by obtaining the results of 311 participants in the online environment. The internal consistency of the scale was assessed with Cronbach’s Alpha coefficients. Split-half reliability was estimated using Spearman-Brown coefficients unequel length. Explanatory factor analysis, confirmatory factor analysis in AMOS, correlation analysis, and construct validity analysis (convergent validity and discriminant validity) were conducted. Beck Anxiety Inventory and Health Anxiety Inventory was used to evaluate concurrent and discriminant validity.
RESULTS: The Cronbach Alpha coefficient calculated for the evaluation of the internal consistency (homogeneity) of the outbreak anxiety scale was determined as 0.94 and this value shows that the scale has high reliability. With the results of this study, the scale’s content validity and construct validity, discrimination, and criterion validity were evaluated and it was shown to have acceptable valid features in all.
CONCLUSION: Outbreak anxiety scale is a valid and reliable tool to evaluate anxiety related with outbreak of epidemic and pandemic disease.

OBJECTIVE: The objective of the study was to develop a scale to determine the attitude of nursing and midwifery university students towards disabled women.
METHODS: In the development of the scale; expert opinion, content validity, item reliability, and construct validity stages were included in the study. It was realized with a total of 167 students. To evaluate the suitability of the data for factor analysis, the Kaiser-Meyer-Olkin Sample Fit Test and Bartlett’s test have been applied. To evaluate validity and reliability; test-retest, factor analysis, and internal consistency analysis have been applied. Permission from the institutions and ethics committee permission was obtained.
RESULTS: The number of the items in the scale decreased from 64 to 31 in accordance with expert opinion. Internal consistency, Cronbach’s alpha coefficient was 0.817 and the test-retest correlation coefficient was 0.992. The exploratory factor analysis revealed an four-factor structure, accounting for 59.81% of the variance. Kaiser-Meyer Olkin coefficient of 0.793, p<0.005 in Bartlett’s test showed a correlation between the items and there was a positive correlation between the items. As a result of the analyses, the number of the items decreased to 17.
CONCLUSION: It was concluded that the Disabled Woman Attitude Scale can be used as a valid and reliable measurement tool in healthcare workers.

OBJECTIVE: In the present study, we aimed to evaluate the clinicopathological features and prognostic factors in extra-gastrointestinal stromal tumor (EGIST) cases, which are observed very rare, by examining the data the cases obtained in a single center.
METHODS: Data of 14 EGIST cases who were operated by a general surgeon between January 2007 and May 2020 were obtained and analyzed.
RESULTS: The median age was 47.5 (range: 34–87) years. A total of 135 patients were operated for GIST, and 14 (10.4%) of these patients were EGIST. The mean tumor diameter was 16.8±10.5 (range: 2.8–40) cm. The mitotic index was 5/50 high power field and below in seven (50%) cases. Twelve (85.7%) of the patients were in the high-risk group. The overall survival (OS) rate was 80%, and the 5-year survival rate was 88.9%. Mean OS was 78.5±50.7 months, 5-year OS and disease-free survival (DFS) were both 53.3±20.0 months, and overall DFS was 58.0±59.8 months. The mean OS and DFS durations were found to be significantly lower in women than men (p=0.006 for both comparisons). The mean OS was found to be significantly lower in patients over 60 years of age compared to those aged 60 and under (p=0.013).
CONCLUSION: In the present study, it has been determined that the rare EGISTs are large in size and that the mitotic index is often low. In addition, it has been observed that the prognosis may be similar to other GISTs, however, may be worse in elderly patients and in women.

OBJECTIVE: Congenital hypothyroidism (CH) is literally described as congenital thyroid hormone imperfection. The primary objective of this research was to reveal the possible relation between receptor-acting protein kinase 3 (RIPK3) activity and neuronal damages in rat pups with CH. In addition, we evaluated the favorable impacts of 3.6-dibromo-α-([phenylamino] methyl)-9H-carbazole-9-ethanol (P7C3) reducing RIPK3 activity.
METHODS: Adult rats were accordingly assigned into four groups: Group 1, which is called congenital hypothyroid; Group 2, which is called congenital hypothyroid administered P7C3; Group 3, called CH administered P7C3 and L-thyroxine; and Group 4, control group. RIPK3 level in plasma concentration and its expression in tissue was determined in all groups.
RESULTS: Increased RIPK3 expressions were detected as high in the CH group when it is compared to the control group. Furthermore; the expressions in neuronal cytoplasm were found similar among Groups II and III. RIPK3 expressions in those two groups were relatively higher than in the control group. Most reacted parts of the brain were especially Purkinje cells in the cerebellum.
CONCLUSION: It is concluded that there is excellent parallelism among damaged neurons and high RIPK3 activity in CH pathogenesis. P7C3 compounds may have a safeguarding impact on CH due to decreasing RIPK3 activity.

OBJECTIVE: Our aim was to evaluate the long-term results of Ritleng bicanalicular silicone intubation for congenital and adult partially acquired nasolacrimal duct (NLD) obstruction.
METHODS: We evaluated 28 eyes of the 26 patients treated with lacrimal intubation with the Ritleng method retrospectively. Patients were divided into two groups. Patients with congenital NLD obstruction (n: 16) constituted Group 1 and patients with adult partially acquired NLD obstruction (n: 10) constituted Group 2. The Ritleng probe was inserted from the canaliculus into the inferior meatus. Success was defined within two parameters: (1) Intubation of the silicone tube without complications and (2) recovery of the previous signs and symptoms and a normal fluorescein dye test.
RESULTS: Mean of the patients’ ages was 2.4±1.6 years in Group 1 and 49±15 years in Group 2. The intubation was successful in all of the patients (100%) in Group 1, meanwhile in Group 2, false passage was observed in 2 patients (20%). Silicone tube was removed through the punctum in outpatient clinic conditions between 2 weeks and 3 months (mean: 2.1 months) in Group 1 and 4–6 months (mean: 5.2 months) in Group 2. Patients in Groups 1 and 2 were followed for 26±18.6–36±25 months, respectively. Previous signs and symptoms were recovered in 75% of the patients in Group 1 and the dye tests of these patients were normal. In Group 2, only two patient’s symptoms were resolved (20%). For the adult patients whose symptoms were not resolved, an external dacryocystorhinostomy operation was performed.
CONCLUSION: The Ritleng lacrimal intubation system is an effective procedure for the treatment of congenital NLD obstruction for both short and long term. On the other hand, the effectiveness of the procedure is limited for the adult partially acquired NLD obstruction.

OBJECTIVE: Xanthogranulomatus inflammation is an uncommon variant of chronic inflammation and a well-established pathological entity involving various organs and systems. It may be associated with infection and obstruction, defective lipid transport, immunological disturbances, and often confused as a malignant neoplasm. The confirmative diagnosis is made on histopathology.
METHODS: This is a retrospective study conducted from January 2008 to April 2020 on histopathologically diagnosed xanthogranulomatus lesions. All the relevant available data regarding age, sex, and organ involvement were collected from histopathology lab records. The macroscopic and microscopic evaluation of cases was also done. This study was aimed to determine the significance of histopathology in the diagnosis of xanthogranulomatus lesions, revealing pathological changes, and clinicopathological correlation.
RESULTS: In the current study, there were 93 cases of xanthogranulomatus inflammatory lesion. Gall bladder was frequently involved 70 (75.27%), followed by 5 (5.37%) kidney, gastrointestinal Tract 6 (3 [3.23%] cases in colon and 3 [3.23%] in appendix, respectively), and others. The maximum number of cases was in the age group of 31–40 years with 24 (25.80%) cases. The female to male sex ratio was 2.3: 1.
CONCLUSION: Awareness and knowledge of xanthogranulomatus inflammatory lesion is significant to the pathologist and surgeon to prevent extensive surgery. This lesion often mimics as malignancy and confirmatory diagnosis is made on histopathology. Thus, every excised specimen must be examined histopathologically to diagnose and rule out differential. (NCI-2020-0312.R2)

OBJECTIVE: Exercise-induced bronchoconstriction (EIB) without asthma and non-allergic rhinitis is frequently reported in athletes who are facing high-risk of airway dysfunctions such as elite swimmers. Therefore, we aimed to evaluate the effect of exercise on nasal and pulmonary functions, additionally to determine the prevalence of EIB and rhinitis in adolescent elite swimmers.
METHODS: The study included 47 adolescent licensed-swimmers (26 males and 21 females) aged between 10 and 17 years old. The prevalence of asthma and allergic disease and the symptom severity scores measured before and after swimming training were assessed through an interview form which includes information related to our study goal. In addition, acoustic rhinometry was utilized to evaluate nasal airway, spirometry was utilized to evaluate EIB in accordance with standard protocols.
RESULTS: Six swimmers had a history of allergic rhinitis (12.8%), while three (6.4%) had asthma. Post-swim mean forced vital capacity (FVC) was significantly higher than pre-swim FVC (p=0.019) and forced expiratory volume 1 (FEV-l)/FVC ratio was significantly lower than pre-swim FEV-l/FVC ratio (p=0.034). In addition, the prevalence of EIB was 8.5%. Moreover, level of nasal discharge statistically increased in post-swim period (p=0.003).
CONCLUSION: We have documented that swimming cause’s nasal discharge but do not effect nasal passages. In addition, we observed that the overall prevalence of EIB in swimmers was not different from that of the general population, furthermore swimming exercise significantly increased FVC of swimmers. Therefore, we concluded swimming training can be recommended for children diagnosed with asthma or allergic rhinitis.

OBJECTIVE: The role of protein oxidation in the development of diabetic microvascular complications was investigated.
METHODS: In total, 266 participants were split into five groups: Group 1; diabetes mellitus for at least 10 years without any complications, Group 2; diabetic nephropathy, Group 3; diabetic neuropathy, Group 4; diabetic retinopathy, and Group 5; control group. Thiol, disulfide, ferroxidase, and ischemia-modified albumin (IMA) levels were analyzed in the serum.
RESULTS: Native thiol, total thiol, and native thiol/total thiol were lower in Group 4 than Groups 1, 3, and 5 (p<0.001). However, disulfide/native thiol and disulfide/total thiol were higher in Group 4 than all other groups (p<0.001). IMA was higher in Groups 3 and 4 than all other groups (p<0.001). Ferroxidase was lower in Groups 3 and 4 than Group 2 (p<0.001).
CONCLUSION: Thiol-disulfide homeostasis impairment in favor of disulfide may have a function in the progress of diabetic retinopathy. Furthermore, the disruptions of IMA and ferroxidase levels involve in the development of diabetic retinopathy and neuropathy.

OBJECTIVE: The aim of this study was to evaluate whether careful physical examination is as effective in diagnosis as magnetic resonance imaging (MRI) in pediatric patients with suspected scaphoid fractures and whether radiography is sufficient in the follow-up of these patients.
METHODS: This prospective study included patients with tenderness of the anatomic snuffbox on physical examination and no fracture on radiography between 2015 and 2019, and the data were evaluated retrospectively. A short-arm thumb spica casting was applied for an initial diagnosis of suspected scaphoid fracture. MRI was performed within 1 week after initial trauma. Physical examination and X-rays at 2-week intervals were applied during the follow-up period. The functional outcomes were evaluated using the Modified Mayo Wrist score.
RESULTS: A total of 92 patients (28 girls and 64 boys; mean age: 12.32±2.22 years) were diagnosed with suspected scaphoid fracture on physical examination and MRI was performed. The MRI confirmed the suspected scaphoid fracture at the rate of 77.2% (n=71). The sensitivity obtained for the radiograph was 14.08%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 25.61%. The mean Modified Mayo Wrist score was 92.43±2.64 (range, 85–98).
CONCLUSION: Detection of tenderness on the anatomic snuffbox without determination of fracture radiographically should be evaluated and treated in favor of a scaphoid fracture. These fractures are mostly treated successfully with conservative treatment

OBJECTIVE: Urticarial vasculitis (UV) is an uncommon disease clinically presenting with pruritic urticarial plaques of the skin. The disease is classified as normocomplementic and hypocomplementemic types according to their complement levels. We aimed to evaluate demographic characteristics, laboratory findings, and response to treatment of patients diagnosed as UV in our clinic.
METHODS: Between January 2015 and January 2019, the files of the patients were retrospectively reviewed. Demographic data, clinical features, laboratory findings, suspected triggering factors, disease course, treatment modalities, and treatment results of the patients were recorded.
RESULTS: A total of 16 patients (nine males [56.25%], seven females [43.75%]) were included in the study.The mean age at diagnosis was 45.2±10.4 years and the duration of the disease was 72.1±62 months. Twelve (75%) patients had angioedema and two (12.5%) patients had residual hyperpigmentation. The most common extracutaneous finding was arthralgia (43.7%). No hypocomplementemia was detected in the patients. The most common abnormal laboratory findings were CRP elevation (37.5%) and ANA positivity (n=4/15, 26.7%). Analgesic and antibiotic drugs use were the most common possible triggering factors for the disease (n=9, 56%). Oral antihistamines, oral corticosteroids, azathioprine, colchicine, dapsone, hydroxychloroquine, doxepin, and omalizumab were among the treatments given to the patients. Complete remission was achieved in three patients.
CONCLUSION: Compared with other studies, we found that angioedema was more frequent, postinflammatory hyperpigmentation was lower and long-term treatment was needed to control UV attacks. There are a few studies on UV and we think that more and larger patient groups are needed for standardization of treatment.

Skin metastasis caused by carcinomas is associated with poor prognosis and is a rare and late clinical finding. Skin metastases occur in only 4–6.5% of Stage IV colorectal cancer. We present an unusual case of Stage IV unresectable rectal adenocarcinoma metastasized to the head and face. One and a half years after diagnosis, new skin lesions developed on his face. Biopsy showed mucinous adenocarcinoma consistent with rectal malignancy. Moreover, he died 3 months after the diagnosis of cutaneous metastasis. This case emphasizes the importance of the effect of skin lesions on prognosis in patients with a history of malignancy.

In this study, ophthalmologic examination findings, fundus fluorescein angiography, optic coherence tomography (OCT), visual field testing, electrophysiological, and systemic laboratory findings of a 43-year-old female patient who presented with blurry vision and who had retinal and corneal deposits were examined. Our patients’ best-corrected visual acuity was 0.9 bilaterally. Her anterior segments and intraocular pressures were bilaterally normal. Fundus examination revealed bilateral glistening yellowish intraretinal crystalline deposits in the posterior pole and midperipheral retina. The electroretinographic examination revealed a decrease in scotopic and photopic a and b wave amplitudes. Corneal and intraretinal glistening crystalloid deposits were observed in the OCT. Our patient and her husband were relatives. Her sister’s, brother’s, and children’s OCT also revealed bilateral corneal and intraretinal crystalloid deposits. We diagnosed this case as Bietti’s crystalline dystrophy which is a rare disease with genetic inheritance that must be considered in the differential diagnosis in countries in which consanguineous marriage is often.

Choanal atresia is a congenital condition referring to the blockage of the posterior nasal cavity. As bilateral choanal atresia (BCA) causes complete nasal congestion, it usually results in death due to asphyxia in the newborn if no emergency intervention is performed. Therefore, it is very rare to see a patient with BCA who has reached an advanced age. There are only 11 adult cases reported in the recent literature. Here, we report a case of a 60-year-old man diagnosed with BCA and we discuss the clinical presentation and treatment modalities with a review of the literature.

On December 31, 2019; unidentified pneumonia cases were reported from China. It was soon announced that these cases were of viral origin and the cause was a new coronavirus (CoV). Initially, the virus was called “novel CoV ” and then defined as “severe acute respiratory syndrome CoV 2 (SARS-CoV-2)” after more detailed investigations. The disease caused by SARS-CoV-2 was named CoV disease 2019 (COVID-19) by the World Health Organization. The rapid spread of the disease in a few months has resulted in a global pandemic and it continues. However, there are no specific effective anti-viral drugs for SARS-CoV-2 infection, some antiviral drugs are using in the therapy of COVID-19 with limited success. Currently, for the prevention of the pandemic, global vaccination seems to be important. Antiviral protection of vaccines is provided by the development of antibodies that can neutralize the virus. Antibody response develops against spike protein and nucleocapsid protein but neutralizing antibodies are formed against the receptor-binding domain of the spike protein. It has also been shown that most viral proteins are recognized in T-cell responses. Vaccine discovery trials for COVID-19 have begun all over the world since the outbreak began. More than 100 vaccine studies against COVID-19 have been published in the last year. Some of them were urgently approved and used worldwide. The current study aimed to review the progression and current use of COVID-19 vaccines.

Cholecystectomy is the standard treatment of acute cholecystitis. Surgery, however, poses significant risks for patients with advanced age and/or comorbid conditions. For such patients, percutaneous cholecystostomy (PC) is the only option. This interventional procedure does not have any absolute contraindications because of the life-threatening nature of the disease, in which other treatment options cannot be offered due to their risks. Nonetheless, these risk factors necessitate performing PC under urgent, rapid, and in many cases suboptimal conditions. In this article, PC was revisited in the light of our extensive experience in addition to the most current literature. Pre-procedural evaluation including the risk assessment and procedural steps was presented in detail. If conducted properly, PC provides significant clinical improvement in the short term and is life-saving, especially in the elderly and in patients with comorbid diseases or high surgical risk. It may also be the definitive treatment method for acute cholecystitis. (NCI-2021-1-50/R1)