ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of İstanbul - North Clin Istanb: 8 (6)
Volume: 8  Issue: 6 - 2021
1. Frontmatters

Pages I - V

RESEARCH ARTICLE
2. Rehabilitation status of children with cerebral palsy and anxiety of their caregivers during the COVID-19 pandemic
Pinar Akpinar, Ilknur Aktas, Feyza Unlu Ozkan, Arzu Atici, Meryem Yilmaz Kaysin, Kubra Cambekli
PMID: 35284796  PMCID: PMC8848495  doi: 10.14744/nci.2021.32068  Pages 545 - 553
OBJECTIVE: The purpose of the study is to explore the rehabilitation status of children with cerebral palsy (CP) and anxiety level of their caregivers during the Coronavirus disease-2019 (COVID-19) pandemic.
METHODS: Caregivers of children with CP who were being followed up in our outpatient CP clinic were contacted between May 28 and June 26, 2020. Two hundred and six caregivers who voluntarily agreed to participate were administered the State-Trait Anxiety Inventory and were questioned about the rehabilitation status of their children. Demographic data, other health problems, Gross Motor Function Classification System, and Manual Ability Classification System levels of children were recorded from their files.
RESULTS: All children were at home with their families during the pandemic. Their mean age was 9.58±3.84 years. One hundred and ninety-nine children were going to the rehabilitation center before the pandemic, only three children went to the rehabilitation center twice a week during the pandemic period. The anxiety level of all the caregivers was found to be high. Trait anxiety of the caregivers who did not perform home exercise to their children were found to be statistically significantly higher than those who performed exercise (p<0.05).
CONCLUSION: Rehabilitation strategies should focus on reducing anxiety level in caregivers of children with CP and effective homecare therapy techniques should be acquired by the caregivers.

3. Frequency of typical and atypical computed tomography findings of COVID-19 and their effect on hospitalization
Mahmut Corapli, Ercan Cil, Haci Taner Bulut, Cemil Oktay, Gokhan Corapli
PMID: 35284798  PMCID: PMC8848491  doi: 10.14744/nci.2021.24865  Pages 554 - 561
OBJECTIVE: This study aimed to determine the frequency of typical and atypical computed tomography (CT) findings of COVID-19 and their effect on hospitalization.
METHODS: We retrospectively assessed 414 patients who were diagnosed with COVID-19 by real-time reverse transcription-polymerase chain reaction and who had lung involvement in their admission chest CT. We evaluated the frequency of typical and atypical chest CT findings and analyzed the relationship between typical and atypical findings of COVID-19 in patients treated in ambulatory versus inpatient settings.
RESULTS: Ground-glass opacities were the most common typical finding of COVID-19 chest CT scans. The frequencies of other typical findings, including consolidation, air bronchogram, pulmonary vascular enlargement (PVE), airway changes, crazy paving pattern, and reticular pattern, were similar to those reported in the literature. Atypical findings were less common and found at varying frequencies. Crazy paving pattern, air bronchogram, reticular pattern, and PVE were significantly more common in hospitalized patients (p<0.001). The frequencies of other typical and atypical findings were not significantly different between ambulatory and hospitalized patients.
CONCLUSION: Increased recognition of typical and atypical findings of COVID-19 and their frequencies, as well as knowledge of admission chest CT findings that are associated with hospitalization, will facilitate medical care during the pandemic.

4. Effect of hydroxychloroquine use on the length of hospital stay in children diagnosed with COVID-19
Hatice Uygun, Habip Almis, Ibrahim Hakan Bucak, Mehmet Turgut
PMID: 35284787  PMCID: PMC8848482  doi: 10.14744/nci.2021.65471  Pages 562 - 567
OBJECTIVE: COVID-19 since the reporting of the first case of infection and its declaration as a pandemic, it caused morbidity and mortality in hundreds of thousands of people. In the early stages of the COVID-19 pandemic, the number of confirmed cases among children was relatively low, and therefore, data were limited. However, the number of pediatric cases has also risen markedly among children in the later stages of the pandemic.
METHODS: Forty patients from 1 month to 18 years of age who presented to the Division of Pediatric Infectious Diseases of a tertiary research and training hospital between March 10, 2020, and May 31, 2020, with symptoms suggestive of COVID-19 infection and whose combined oropharyngeal and nasopharyngeal swab specimens tested positive on real-time reverse transcription polymerase chain reaction (rRT-PCR) were included in the study.
RESULTS: Forty pediatric patients with a mean age of 109.1±66.1 months were included in the study. Among patients, 62.5% (25/40) were girls and 37.5% (15/40) were boys. The most presentation symptom was cough in 19 (47.5%) patients. Hydroxychloroquine (HQ) therapy was given as part of combination treatment to 15 symptomatic patients older than 72 months of age (72–143 months of age: 4 patient, 144–216 months of age: 11 patients). The mean time to a rRT-PCR negative test was 7.2±1.69 (4–10) days for the group receiving an HQ treatment protocol and 8.2±1.44 (6–11) days for the group receiving a non-HQ treatment protocol with no significant difference between the groups (p=0.054).
CONCLUSION: In this study, it was shown that the use of HQ had no effect on the length of hospital stay and that there was no significant difference between patients in terms of epidemiological data.

5. Predictive value of FibroScan in detecting liver fibrosis in HBeAg negative patients with chronic hepatitis B whose HBV DNA 2000–20000 IU/ml with ALT 1–2 times the upper limit of normal and those with HBV DNA >20000 IU/ml and normal ALT
Nilay Danis, Ulus Salih Akarca, Ilker Turan, Zeki Karasu, Galip Ersoz, Funda Yilmaz, Deniz Nart, Aysin Zeytinoglu, Memnune Selda Erensoy, Fulya Gunsar
PMID: 35284786  PMCID: PMC8848484  doi: 10.14744/nci.2021.35545  Pages 568 - 574
OBJECTIVE: In hepatitis B infection, it is difficult to make a treatment decision in patients with slightly elevated transaminases and HBV DNA level between 2000 and 20000 IU/ml, and in those with normal ALT, despite high levels of HBV DNA. Objectives: In HBeAg negative patients whose HBV DNA levels were between 2000 and 20000 IU/ml with ALT 1–2 times the upper limit of normal (ULN) and those with HBV DNA >20000 IU/ml and normal ALT, the concordance between liver fibrosis in biopsy and liver stiffness measured by transient elastography with FibroScan® (FS) was investigated, and diagnostic value of FS to predict the liver fibrosis was tested.
METHODS: The patients were selected from the outpatient hepatology clinics between the dates of November 2014 and October 2016 among those who were taken liver biopsy. Transient elastography was obtained within 3 months after liver biopsy. The diagnostic value of FS in detecting advanced fibrosis or moderate to advanced (MTA) fibrosis was investigated for each group.
RESULTS: In 38 patients with HBV DNA 2000–20000 IU/ml and ALT 1–2×ULN, advanced fibrosis was detected in only one patient (2.6%) on liver biopsy, sensitivity of FS to show advanced fibrosis is 100%, specificity 78.3%, and diagnostic accuracy rate 79%. The area under curve was determined to be 0.892. In detecting MTA fibrosis, these values are 100%, 62%, 71%, and 0.810, respectively. Of 79 patients with HBV DNA >20000 IU/ml and normal ALT, five had advanced (5.5%) and 18 had MTA (23%) fibrosis. Sensitivity of FS in detecting advanced fibrosis was 100%, specificity 87.8%, and accuracy 88.6%, and these values for MTA fibrosis were 85.7%, 81%, and 82.3%, respectively.
CONCLUSION: Because of false negativity in a few patients with HBV DNA >20000 IU/ml in detecting MTA, FS may be combined with other non-invasive techniques. Negative predictive values of FS in predicting advanced or MTA fibrosis were very high, while positive predictive values were low. However, FS may save several patients from liver biopsy.

6. Neutrophil to C-reactive protein ratio: An estimating factor for intestinal ischemia before the surgery of incarcerated inguinal hernia
Kemal Eyvaz, Onur Ilkay Dincer, Murat Kazim Kazan, Aydin Dincer, Arif Aslaner, Aylin Acar, Tugrul Cakir
PMID: 35284784  PMCID: PMC8848489  doi: 10.14744/nci.2021.26878  Pages 575 - 580
OBJECTIVE: An inguinal hernia may transform to an incarcerated hernia, which would require emergency surgery with increased morbidity and mortality. This study aims to analyze whether it is possible to predict intestinal ischemia in incarcerated hernia using complete blood count parameters and serum C-reactive protein (CRP).
METHODS: Medical records of 129 patients were used to analyze whether there is a correlation between intestinal ischemia and laboratory parameters. Receiver operating characteristics analysis and Youden index were used to determine cutoff values, sensitivity, and specificity.
RESULTS: Female patients, those with a femoral type hernia, and patients with additional diseases were found to be more prone to bowel resection. CRP, lymphocyte to CRP ratio (LCR), and neutrophil to CRP ratio (NCR) parameters were significant (AUC=0.914, p<0.001; AUC=0.901, p<0.001; and AUC=0.908, p<0.001, respectively). A value <0.45 for NCR has a sensitivity of 93.3% and specificity of 87.8%; a value >19 in CRP has a 90% sensitivity and 88.9% specificity.
CONCLUSION: Decreased pre-operative NCR and LCR, and increased CRP levels can be used as a predictor for estimating intestinal ischemia.

7. Evaluation of visual and auditory reaction time, pain, and hand grip strength performance before and after conventional physiotherapy in patients with herniated cervical intervertebral disc with radiculopathy
Deniz Senol, Fatma Kizilay, Seyma Toy, Rukiye Ciftci, Yuksel Ersoy
PMID: 35284799  PMCID: PMC8848488  doi: 10.14744/nci.2020.15821  Pages 581 - 587
OBJECTIVE: Herniated cervical intervertebral disc (cervical disc herniation [CDH]) with radiculopathy is known to occur in seven or eight out of 100 people worldwide. This disease causes movement limitation, loss of strength, and pain of upper extremity. The aim of this study is the effect of conventional physiotherapy agents on predetermined parameters in patients with cervical radiculopathy and to compare the results with healthy controls.
METHODS: A total of 102 patients with CDH with radiculopathy and 98 healthy controls were included in the study. Visual reaction time (VRT) and auditory reaction time (ART) measurements were evaluated with reaction timer, while the pain was assessed with visual analog scale (VAS) and handgrip strength (HGS) assessed with hand dynamometer, respectively. Conventional physiotherapy (transcutaneous electrical nerve stimulation, hot pack application, and therapeutic ultrasound) agents were applied 5 days/week for 3 weeks as treatment protocol.
RESULTS: As a result, VAS, VRT, and ART scores were significantly decreased, and HGS scores increased significantly in both female and male patients post-treatment measures (p<0.05). There was no statistically significant difference between patient group and control group measurements in post-treatment evaluations (p>0.05).
CONCLUSION: This study presents the conclusion to literature that conventional physiotherapy agents have the effect of decreasing pain and regaining motor function and also a therapeutic effect on VRT and ART in the treatment of patients with CDH with radiculopathy.

8. The concordance between colposcopic biopsy and loop electrosurgical excision procedures in patients with known smear cytology and human papillomavirus results
Sener Gezer, Sumeyye Kanbay Ozturk, Sibel Balci, Izzet Yucesoy
PMID: 35284797  PMCID: PMC8848493  doi: 10.14744/nci.2021.80090  Pages 588 - 594
OBJECTIVE: The objective of the study was to evaluate the concordance between colposcopic biopsy and loop electrosurgical excision procedure (LEEP) methods to diagnose cervical pre-invasive lesions and cervical cancer, and to calculate the low and high prediction rates of lesions for both methods.
METHODS: A total of 241 patients who underwent LEEP after colposcopic biopsy for different indications and also known cervical cytology and human papillomavirus test results were included in the study. Clinical variables such as age, gravida, parity, menopausal status, smoking, endocervical curettage results, and surgical margins were recorded.
RESULTS: The total concordance between colposcopic biopsy and LEEP was 41.9%. The rates of finding a more serious lesion than in colposcopic biopsy with LEEP (underestimation) for negative, Cervical Intraepithelial Neoplasia (CIN) 1, CIN 2, and CIN 3 were calculated as 100%, 12.8%, 14.8%, and 3.9%, respectively. Rates of finding a less serious lesion than detected in colposcopic biopsy with LEEP (overestimation) for CIN 1, CIN 2, and CIN 3, cervical carcinoma were calculated as 56.4%, 33.3%, 3.9%, and 0%, respectively. Underestimation was seen in a total of 28 patients, and overestimation was present in 113 patients. Parity was found to be the only associated factor that affected the final diagnosis for high-grade lesions in univariate logistic regression analysis (odds ratio=1.234, 95% confidence interval: 1.005–1.514).
CONCLUSION: Discrepancies between colposcopically directed punch biopsy and subsequent histopathologic LEEP findings are common. New methods to reduce the inconsistency between colposcopic biopsy and LEEP are necessary to prevent patients from being under or over treated.

9. Drug-induced anaphylaxis in the emergency department: A prospective observational study
Fatma Sari Dogan, Vehbi Ozaydın
PMID: 35284792  PMCID: PMC8848485  doi: 10.14744/nci.2021.56667  Pages 595 - 600
OBJECTIVE: Anaphylaxis is an acute, life-threatening, systemic hypersensitivity reaction. It is usually triggered by drugs, foods, and insect stings. The primary objective of our study is to determine the factors affecting drug-induced anaphylaxis to contribute to early diagnosis and treatment in these patients.
METHODS: Patients over 18 years old who were diagnosed drug-induced anaphylaxis in the Goztepe Hospital within a period of 1 year were evaluated prospectively. Patients demographical data, etiological factors, clinical findings, and treatment information were recorded.
RESULTS: Forty-four patients were enrolled in the study of which 25 (56.8%) were female. The median age of women and men was 54 (min: 22, max 82) and 44 (min 18, max 82), respectively. Twenty-three (52%) of them had a history of anaphylaxis. The most common causes of drug-induced anaphylaxis were antibiotics (36%) and nonsteroidal anti-inflammatory drugs (18%), respectively. Adrenaline was applied to 17 (38%) of the patients in the treatment.
CONCLUSION: Antibiotics were the most common drugs causing drug-induced anaphylaxis and adrenaline was underused which is the first-line treatment in the anaphylaxis. Some clinicians refrain from administering adrenaline. The reasons underlying this approach should be investigated.

10. Calretinin immunohistochemical staining in Hirschsprung’s disease: An institutional experience
Ebru Zemheri, Pinar Engin Zerk, Cigdem Ulukaya Durakbasa
PMID: 35284789  PMCID: PMC8848486  doi: 10.14744/nci.2020.69376  Pages 601 - 606
OBJECTIVE: This study aims to evaluate the results obtained by calretinin staining on tissue samples for diagnosing Hirschsprung’s disease (HD) in a single institution, by single expert.
METHODS: A retrospective evaluation was done for calretinin immunostaining in HD patients for a period of 3 years. Calretinin staining was evaluated in nerve fibers. Calretinin immunohistochemistry was considered positive if any staining was seen in nerve fibers and/or ganglion cells in the lamina propria, muscularis mucosa or submucosa. According to staining intensity, staining was classified as strong, weak or negative. The pathological diagnosis was based on presence or absence of ganglion cells (G0/G1) and nerve hypertrophy (N0/N1). Samples were classified according to the depth (presence of submucosa or intermuscular area), the type (biopsy or resection specimen) and staining intensity of calretinin (strong, weak, or negative staining).
RESULTS: A total of 96 tissue samples from 56 patients were studied. Tissues were from colon (43.8%), rectum (43.8%), stoma (6.2%), ileum (3.1%) and appendix (3.1%). The pathological diagnosis was G0N0 in 14.6%, G1N0 in 54.2%, G0N1 in 25% and G1N1 in 6.2% of cases. Our materials consisted of 92 tissue biopsies and four resection specimens. Intermuscular layer was present in 87.5% of materials and 12.5% of biopsies contained submucosa. Calretinin staining was negative (C0) in 37.5% of cases, strong positive (C1) in 47.9%, and weak positive (C2) in 14.6%. When the C0 category was taken as the reference, the status of calretinin staining as C2 (weak positive) in cases with pathological diagnosis of G1N0 was found to be 37.575 times that of cases with G0N0 (OR [95% CI]: 37.575 [2.928, 482.176], p=0.006) and the status of calretinin staining as C1 (strong positive) in cases with pathologic diagnosis of G1N0 was found to be 131.401 times that of G0N0 (OR [95% CI]: 131.401 [9.263, 1864.082), p<0.001).
CONCLUSION: Calretinin staining is positive whenever ganglion cells are present independent from presence of nerve hypertrophy, the depth and the site of the biopsy or staining intensity. It is negative in all aganglionic samples. Calretinin staining is a reliable ancillary test in HD diagnosis.

11. Association of lower serum irisin levels with diabetes mellitus: Irrespective of coronary collateral circulation, and syntax score
Aydin Akyuz, Beysim Mert, Demet Ozkaramanli Gur, Muhammet Mucip Efe, Huseyin Aykac, Seref Alpsoy, Savas Guzel
PMID: 35284785  PMCID: PMC8848496  doi: 10.14744/nci.2021.73669  Pages 607 - 614
OBJECTIVE: Irisin is a myokine thought to be involved in the pathophysiological process of atherosclerosis with its’ cardiovascular protective effects. Patients with diabetes mellitus (DM) have lower levels of irisin. Therefore, we investigated whether there is a connection between irisin, DM, coronary collateral circulation (CCC), and SYNTAX scores representing coronary artery disease (CAD) severity.
METHODS: This study evaluated 86 patients who have at least one epicardial coronary artery with chronic total occlusion. We included Rentrop 0–1 into the poor CCC group (n=45) and Rentrop 2–3 into the good CCC group (n=41) and measured serum irisin levels.
RESULTS: Irisin levels did not differ (17585 [882–37741] pg/ml and (17504 [813–47683] pg/ml, p=0.772) between the two groups. Irisin levels were lower in patients with diabetes (n=41; 14485 [813–29398] pg/ml) than those without diabetes (n=45; 19724 [865–47683] pg/ml (p=0.002). Irisin was not correlated with SYNTAX scores. In multivariate analysis, DM (OR=0.463; CI: 0.184–0.783; p=0.012) was a negative predictor of good CCC development
CONCLUSION: Although its level is decreased in patients with diabetes, serum irisin levels have no role in the pathophysiology of collateral development and CAD severity.

ORIGINAL IMAGES
12. Tuberculosis of the elbow mimicking rheumatoid arthritis
Sadettin Uslu
PMID: 35284788  PMCID: PMC8848494  doi: 10.14744/nci.2020.68916  Pages 615 - 616
NCI-2020-0180

13. Bullous drug eruption with low dose methotrexate
Tuba Yuce Inel
PMID: 35284795  PMCID: PMC8848487  doi: 10.14744/nci.2020.83798  Pages 617 - 618
NCI-2020-0320.R1

CASE REPORT
14. A rare complication of lightning strike: Pulmonary contusion
Ayse Tolunay Oflu, Emre Kacar, Ayhan Pektas, Aysegul Bukulmez
PMID: 35284794  PMCID: PMC8848497  doi: 10.14744/nci.2020.24022  Pages 619 - 622
Lightning strike is a devastating disaster, leading to various life-threating complications and even death. In lightning striking victims, high-voltage electric current can destroy many tissues and organs through various mechanisms. One of these mechanisms is the blunt trauma that injures the organs by creating a blast effect. Although not frequent, blunt trauma may result in various solid organ injuries such as pulmonary contusion. In this article, we reported a 15-year-old male patient who was admitted to the emergency department because of lightning strike in open terrain. Although he was conscious and vital signs were normal at presentation, respiratory distress developed on the 4th day. Unilateral pulmonary contusion was detected on the computerized tomography of the thorax. The patient was treated with supportive oxygen and intravenous hydration therapy. His respiratory distress improved on the 6th day and control posteroanterior chest radiograph revealed that pulmonary hemorrhage was spontaneously resorbed. On the 9th day, he was discharged with normal respiratory findings. The patient did not have any complaints during the 3-month follow-up after discharge.

15. Rare causes of anisocoria: Ipratropium bromide and Angel’s trumpet
Arzu Ekici, Busra Caglar, Ozlem Kara, Arzu Oto, Nevin Kilic
PMID: 35284801  PMCID: PMC8848498  doi: 10.14744/nci.2020.26428  Pages 623 - 625
It is considered a neurological emergency when a patient presents with anisocoria. It is important that the anisocoria whether or not accompanied by the neurological findings. Other reasons of anisocoria should be considered when the absence of neurological or ophthalmological signs such as change of mental status, hemiparesis, ophthalmoplegia, ptosis. Herein we report two cases of temporary anisocoria due to inhaler ipratropium bromide and Angel’s trumpet. (NCI-2019-0246.R2)

16. Solitary facial lesion of orf: An unusual presentation
Muge Gore Karaali, Ayse Esra Koku Aksu, Asude Kara Polat, Mehmet Salih Gurel
PMID: 35284790  PMCID: PMC8848492  doi: 10.14744/nci.2020.59254  Pages 626 - 628
Orf, ecthyma contagiosum, is a zoonotic viral infectious disease caused by parapoxvirus that affects particularly sheep and goats. Human may be infected with direct contact with contagious animals or by handling contaminated animal products. Lesions are localized mostly on the hands and fingers, but atypical localizations such as head or face have been rarely reported. Herein, we report a case of orf disease on the eyebrow with clinical follow-up images. Physicians should be aware of the possibility of this entity based on contact anamnesis with infected animals and clinical appearance.

17. Giant composite pheochromocytoma and gastrointestinal stromal tumor in a patient with neurofibromatosis: A case report
Soykan Arıkan, Cihad Tatar, Ali Emre Nayci, Feyzullah Ersoz, Mehmet Baki Dogan, Feray Gunver
PMID: 35284800  PMCID: PMC8848499  doi: 10.14744/nci.2020.37431  Pages 629 - 633
A 54-year-old male was admitted to our department with neurofibromatosis and hypertension. During his examination, a mass was detected in the abdomen, and he was transferred to a surgical clinic. At the first examination of the patient, extensive café-au-lait spots and granulomas were detected on the body and the mass occupying right abdomen quadrant was palpable. The patient’s medical history indicated that he had hypertension for almost a decade. The patient also stated that nodules on the body existed from his earliest recollection and he had relatives with neurofibromatosis. The patient was taken to a surgical operation. A mass with 30×23 cm in size was removed. The area of the nodular structure, with 0.5 cm in diameter, in the stomach serosa was also removed. The tumor was composed of phaeochromocytoma in the larger spaces and ganglioneuromas in the relatively narrow spaces. The nodular area removed in gastric serosa was reported as a very low-risk gastrointestinal stromal tumor. Apart from this rare combination, adrenal mass removed from the patient was considerably larger than the masses in the literature until now. Therefore, we aimed to present this rare case with a literature background. (NCI-2019-0198.R2)

REVIEW
18. Perplexing issues for convalescent immune plasma therapy in COVID-19
Oner Ozdemir
PMID: 35284793  PMCID: PMC8848483  doi: 10.14744/nci.2021.73604  Pages 634 - 643
Convalescent immune plasma (CIP) therapy in coronavirus disease 2019 (COVID-19) is presently a trendy choice of treatment. On March 24, 2020, the United States Food and Drug Administration approved of CIP treatment for seriously ill COVID-19 patients as an emergency investigational new drug. The precise mechanisms of action for CIP in COVID-19 have not yet been undoubtedly recognized. However, earlier research demonstrated that the main mechanism of CIP such as in other viral infections is viral neutralization. Systematic reviews and meta-analyses of the CIP transfusion in severe infectious diseases have shown that CIP has some beneficial effects and it is a harmless process to cure infectious diseases early after symptom beginning. It is suggested that SARS-CoV-2 neutralizing antibody titers in CIP should be ideally higher than 1: 320, but lower thresholds could also be useful. The suggested minimum dose for one individual is one unit (200 mL) of CIP. The second unit can be given 48 h succeeding the end of the transfusion of the first unit of CIP. Moreover, CIP can be applied up to a maximum of three units (600 mL). CIP could be administered in other systemic diseases, viral infections coincidentally associated with SARS-CoV-2 infection, as well as other therapeutic approaches for COVID-19. There are generally no serious adverse events described from CIP transfusion in these recipients. CIP may have a significant role as one of the therapeutic modalities for various viral infections when enough vaccines or other specific therapeutic agents are not on hand.

19. Connection of reactive oxygen species as an essential actor for the mechanism of phenomena; ischemic preconditioning and postconditioning: Come to age or ripening?
Demet Sengul, Ilker Sengul
PMID: 35284791  PMCID: PMC8848490  doi: 10.14744/nci.2021.78466  Pages 644 - 649
Ischemic preconditioning (IPC), in 1986, and then ischemic postconditioning (IPoC), in 2003, were determined and lots of studies on the many organs were performed about the preventive effects of these strong endogenous mechanisms on the relevant tissues against ischemia-reperfusion and their protective impressions have been emphasized by many authorities up to date. Reactive oxygen molecules are immensely active molecules, originating from molecular oxygen, playing a principal role in intracellular signalization, aging, and various pathologic conditions. Reactive oxygen species (ROS) such as superoxide anion and hydrogen peroxide are known in the pathogenesis of ischemia-reperfusion (I/R) injury. In the pathogenesis of cellular and tissue injury in I/R, the significant output of ROS in the initial phase of reperfusion, particularly between the 1st and 7th min, has been propounded as being an essential and crucial main factor for the phenomena. Even though a great deal of mechanisms has been asserted for IPC and IPoC, the distinct shielder mechanism(s) was/were not clearly proved yet. However, occupying a significant place of ROS among these forecasted mechanisms has been advocated up to date.

LookUs & Online Makale