OBJECTIVE: This study aimed to investigate the QT, QTc, and QTc dispersion changes that may occur with the use of hydroxychloroquine (HCQ), favipiravir, and moxifloxacin in combination or alone in COVID 19 patients.
METHODS: This study was retrospectively conducted on 193 inpatients diagnosed with COVID-19. We divided the patients into four separate groups due to their medications as, group-1: favipiravir, group-2: favipiravir + HCQ, group-3: favipiravir + moxifloxacin, and group-4: favipiravir + moxifloxacin + HCQ. We recorded their pre and post-treatment QT parameters of each group and evaluated the changes of these parameters with the SPSS statistical program.
RESULTS: The mean age of the patients was 63.1±17.7. In group 1 and 2, although there were slight changes in QT parameters, these results were not statistically significant. In group 3, significant increases in QT and QTc dispersion occurred (p=0.005 and p=0.018). In the 4th group where the triple therapy was applied, there was a significant increase only in the QTc values (p=0.027). When we compared the changes of QT parameters for each group, a significant difference was found in ΔQTc dispersion, and post hoc analysis showed that it was due to changes in the third group (p=0.047).
CONCLUSION: We thought that, if there is a COVID-19 infection with an additional bacterial infection, and if there is a need of using moxifloxacin alone or together with HCQ, additional risk factors that may cause QT interval prolongation should be reviewed and ECG monitoring of the patients should be performed during the treatment period.

OBJECTIVE: We aim to investigate whether the use of dipeptidyl peptidase inhibitors (DPP-4i) affects the severity of disease, hospital mortality, and 3-month post-discharge mortality in type 2 diabetes mellitus (T2DM) individuals with coronavirus disease 2019 (COVID-19) infection.
METHODS: The study included 217 patients with type 2 diabetes hospitalized due to COVID-19 between March and October 2020. The patients included in the study were divided into two groups those using DPP-4i and those not using DPP-4i. Demographic characteristics, laboratory parameters, accompanying risk factors, concomitant comorbidities, hospital mortality, clinical course, and 3-month post-discharge mortality were compared between the patients who used DPP-4i and those who did not use.
RESULTS: The duration of hospitalization was 10.96±9.16 days in the group using DPP-4i, 12.22±9.1 days in the group not using DPP-4i, and when both groups were evaluated together, it was determined as 11.91±9.11 days. The hospitalization periods were similar between DPP-4i users and non-DPP-4i users (p=0.384). The need for mechanical ventilation (p=0.478 OR 0.710 95% confidence interval [CI], 0.274–1.836) and high-flow nasal cannula (p=0.457, OR: 0.331, 95% CI: 0.41–2.67) were similar between DPP-4i users and non-users. It was determined that the mortality (p=0.208, OR: 0.409, 95% CI: 0.117–1.429) and 3-month post-discharge mortality (p=0.383) were similar in the group using DPP-4i and those not using DPP-4i.
CONCLUSION: This study demonstrated that the use of DPP-4i by patients with T2DM in catching COVID-19 does not affect the mortality due to COVID-19, the severity of COVID-19 disease, and 3-month post-discharge mortality.

OBJECTIVE: Poor sleep quality among higher education students is a world public health problem that can lead to a decrease of the concentration and consequently the academic performance. This study aimed to determine sleep quality among higher education students and to verify its association with internet addiction and psychological disorders (anxiety and depression).
METHODS: The sample comprised 148 higher education students of the south of Portugal, being 108 (73%) female, aged between 18 and 54 years old. The measuring instrument included a sociodemographic questionnaire, the Pittsburgh Sleep Quality Index, the Internet Addiction Test, and the Hospital Anxiety and Depression Scale.
RESULTS: Fifty-five (37.2%) students had a good sleep quality, 77 (52%) poor sleep quality, and 16 (10.8%) a severe sleep disorder. Forty-one (27.7%) students said that they went to bed between 12: 00 am and 12.30 am and 37 (25%) between 11 pm and 11.30 pm. The sleep duration was 7: 08±1: 31. Fifty (48.1%) students who classified with poor sleep quality classified themselves as good sleepers (p≤0.001). Internet addiction was not associated with poor sleep quality. Students who present anxiety and/or depression symptoms had 0.31 (CI: 0.135–0.71; p=0.005) more probabilities to have sleep disorders compared to those who did not show these symptoms.
CONCLUSION: This study found that most of the analyzed students present a poor quality of sleep and this was associated with a presence of anxiety and/or depression. It becomes necessary to develop sleep hygiene education programs for prevention and treatment of sleep disturbances in this population. (NCI-2021-3-36/R2)

OBJECTIVE: We aimed to investigate the presence of dyslipidemia in blood biochemistry of patients with idiopathic tinnitus and to point out that dyslipidemia poses a risk to coronary artery disease.
METHODS: Blood lipoprotein values and age and gender were compared between 158 patients with idiopathic tinnitus and 160 patients without tinnitus. Results were statistically evaluated.
RESULTS: In total, more than half of 318 patients had high blood cholesterol levels. In both groups, the cholesterol average was 215 mg/dl. Furthermore, low density lipoprotein (LDL) and high density lipoprotein (HDL) levels were higher than normal. However, no statistically significant difference was determined in the comparison of Cholesterol, HDL, and LDL levels in both groups (p<0.05). However, serum triglyceride levels of patients with tinnitus were when compared with the control group, a statistically significant difference was found (p=0.001); The numbers of men and women were approximately close to each other and the number of patients between the ages of 50 and 60 was higher. The average age is 53. As a result, the risk of life-threatening coronary heart disease increases, as the majority of patients with tinnitus are in the middle age group and have high lipoprotein values.
CONCLUSION: In patients presenting with the complaint of tinnitus, high serum lipoprotein values may not be directly related to tinnitus. However, it should be remembered that the presence of dyslipidemia may affect coronary vessels and lead to coronary artery diseases. However, a significant correlation was found between high serum triglyceride levels and tinnitus. In addition, if the patient has dyslipidemia, it will be healthy to treat dyslipidemia.

OBJECTIVE: Patients with Inborn Errors of Immunity, also known as Primary Immunodeficiency (PID), are prone to recurrent bacterial infections and these patients often require lifelong IgG replacement therapy. The aim of this presentation is to evaluate the efficacy, safety, and patient satisfaction in PID patients receiving subcutaneous immunoglobulin (SCIG) treatment and to share our expe-riences.
METHODS: Twenty-one patients who were followed up with the diagnosis of PID by our Pediatric Allergy and Immunology Clinic and received regular intravenous immunoglobulin therapy (IVIG) befo-re starting SCIG treatment were included in the study.
RESULTS: A total of 21 patients were included in the study. 10 of the patients (47.6%) were female, 11 (52.4%) were male, and the mean age was 8.8±4.42 years. Five of the patients were Syrian patients living in the refugee camp. Threshold IgG levels of the patients were evaluated every 3 months. IgG levels were significantly higher than baseline IVIG levels at weeks 3, 6, and 12 of SCIG treatment, respectively. There was no significant difference between 3rd, 6th and 12th months of SCIG treatment. A statistically significant decrease was observed in the frequency of infections in patients who received SCIG treatment (p=0.003). During SCIG treatment, the total infection rate was 4.1/person/year. According to the TSQM-9 satisfaction questionnaire, the annual hospitalization rate was 0.9/patient/year for IVIG and 0.4/patient/year for SCIG (p>0.005), and 61.9% of patients were moderately satisfied, 14.2%. 19% were very satisfied and 4.7% were not satisfied with the treatment. When the satisfaction criteria were evaluated, it was observed that the patients mostly (71%) were satisfied with the absence of vascular access prob-lems and the comfort of self-application at home.
CONCLUSION: SCIG therapy causes high serum IgG levels and a reduced frequency of infections and can be a safe, effective, and well-tolerated treatment alternative in patients with PID with high patient satisfaction.

OBJECTIVE: Vitamin D deficiency is common in children. The effects of Vitamin D on bone health are well-known. However, its effect on glucose and lipid metabolism in obese children remains controversial. This study projected to evaluate the association between Vitamin D level and glucose, lipid, and bone metabolism parameters in obese children. In addition, the objective of the study was to determine the change in insulin resistance after Vitamin D replacement therapy in obese children with Vitamin D deficiency.
METHODS: Hundred fifty children with obesity were included in our retrospective cross-sectional study. The patients were separated into two groups as the study group (serum 25(OH)D level <20 ng/ml) and the control group (serum 25(OH)D level ≥20 ng/ml). Physical examination, body fat mass, and laboratory findings of the two groups were compared. Moreover, patients in the study group were supplemented with Vitamin D 2000 IU/d for 24 weeks. Glucose, insulin levels were analyzed before and after treatment.
RESULTS: Body fat mass and percentage were evaluated as more raised in the study group than those in the control group. The study group had a higher level of insulin resistance. There was a significant loss in body weight of patients after treatment in the study group and insulin resistance of the study group decreased after Vitamin D3 treatment.
CONCLUSION: Considering the low side effects and affordability of Vitamin D, it would be a reasonable approach to identify serum Vitamin D levels in obese children and to administer a treatment to those with Vitamin D deficiency.

OBJECTIVE: Neuropathic pain (NP) is caused by damage or disease affecting the somatosensory nervous system. The aim of this study was to evaluate the clinical characteristics, pathophysiologies, and treatments applied in pediatric cancer patients with NP.
METHODS: Patients with cancer having NP between 5 and 18 years of age who were followed up in the pediatric oncology clinic of Okmeydani Training and Research Hospital between January 2015 and April 2019 were included in this study. NP was described as tingling, burning, and stinging. Patients with acute lymphoblastic leukemia and brain tumors were excluded from the study. A number of pediatric cancer patients were also recorded. Patients’ age, gender, cancer diagnosis, NP characteristics and causes, treatments, and response to those treatments were investigated retrospectively and groups of NP according to their pathophysiological mechanism were established.
RESULTS: NP was found in 26 (16%) of 160 patients followed up for childhood cancers. The average age was 11.8±4 years. Ten of the patients (38.4%) were female, and 16 (61.5%) were male. Osteosarcoma was the most common diagnosis in 10 (38%) patients. The most common cause of NP was compression of a nerve/root/spinal cord in 9 (35%) patients and the second most common was related with limb-sparing surgery. NP was found to be associated with chemotherapy (CT) in 5 (19%) patients, mostly with vincristine. Gabapentin was administered in a total of 22 (85%) patients for treatment. Opioid administration was more common as the disease stage progressed (p<0.05). A good or partial response to treatment was achieved in 19 (73%) patients.
CONCLUSION: NP can occur in childhood cancers and is related to the cancer itself, CT, surgical treatment, and disseminated disease. Although there is no standard protocol, gabapentin and, for advanced-stage patients, opioids are the most commonly used treatment options.

OBJECTIVE: The purpose of the study was to evaluate the impact of escitalopram co-prescription on plasma anastrozole levels in post-menopausal breast cancer patients.
METHODS: A total of 24 post-menopausal operated breast cancer patients co-prescribed with escitalopram and anastrozole were included. Blood samples were collected, before and 1-month after the onset of escitalopram to analyze plasma anastrozole and estradiol levels.
RESULTS: No significant difference was noted in basal plasma anastrozole levels with respect to age, body mass index (BMI), tumor stage, previous antineoplastic treatments, concomitant medications, and serum estradiol levels. Overall, 17 patients completed the 1-month escitalopram treatment, while 7 patients discontinued escitalopram within the 1st week of the treatment. Basal anastrozole levels of 24 patients were 26.1±2.4 ng/mL. Among 17 patients who continued 1-month escitalopram treatment was associated with significant increase in plasma anastrozole levels (24.5±2.3 ng/mL to 32.2±3.2 ng/mL, p<0.05). Notably, 1-month escitalopram use was associated with significant increase in plasma anastrozole levels only in the subgroup of obese (BMI >29 kg/m2) patients (23.1±2.8 to 35.9±4.7 ng/mL, p<0.01), while no such interaction was noted among non-obese patients. The estradiol levels of the patients were below ≤10 pg/mL in 75% of patients and no change occurred after escitalopram administration.
CONCLUSION: Escitalopram co-prescription resulted in significant increase in plasma anastrozole levels without affecting the serum estradiol levels. Our findings emphasize the need for close monitoring in case of concomitant use of anastrozole and escitalopram, especially in obese patients and the potential role of therapeutic drug monitoring.

OBJECTIVE: Multiple myeloma and metastasis are common malignant bone marrow lesions. It may be difficult to distinguish from each other due to similar radiological findings. This study aimed to determine the usefulness of histogram analysis with diffusion-weighted imaging (DWI) in the differentiation of multiple myeloma and metastasis.
METHODS: Twenty patients with multiple myeloma and 20 patients with metastasis who underwent 3T magnetic resonance (MR) imaging with DWI (b=0, 1000 s/mm2) were enrolled. All patients had multiple enhancing nodular bone lesions on contrast-enhanced musculoskeletal MR imaging. Histogram analysis was performed from these lesions on the apparent diffusion coefficient (ADC) map. The mean, minimum, median, maximum, standard deviation of the histogram, variance, entropy, uniformity, skewness, kurtosis, size %lower, size %upper, and size %mean values were measured. Results of both groups were compared.
RESULTS: The mean, minimum, median, maximum, standard deviation, and variance values were found to be significantly lower in multiple myeloma than metastasis (p<0.001). When ROC analysis was performed for mean value, the area under the curve=1.000 and when threshold value was selected as 766.076, two groups could be differentiated with 100.0% sensitivity and 100.0% specificity.
CONCLUSION: ADC histogram analysis can be considered as a method to be used in the differentiation of metastases and multiple myeloma.

OBJECTIVE: Although basal cell carcinoma (BCC) is prevalent in the older population, it can be rarely seen in younger people. This study aims to investigate the risk factors and characteristics of BCC in young patients.
METHODS: Pathology reports in a single tertiary care institution between 2010 and 2020 were retrospectively reviewed. Patients under the age of 35 who were diagnosed with BCC were included for the analysis. Data were gathered from medical records and pathology reports. Demographic characteristics, accompanying pathologies, and clinical findings of these patients were analyzed.
RESULTS: There were a total of 32 patients in our cohort. Out of 32 patients, 20 were female and 12 were male. One male patient and five female patients were younger than 18. An accompanying risk factor (Gorlin syndrome, XP, renal transplantation, etc.) was present in six patients. There were no known additional diseases or risk factors in 26 patients. Metastasis and recurrence were not reported in any of our patients. Contrary to the information in the literature, the patients with BCC at a young age were not found more aggressive in our study.
CONCLUSION: Contrary to the information in the literature, the patients with BCC at a young age were not found more aggressive in our study. Understanding the risk factors associated with BCC is essential for designing prevention strategies and favoring early diagnosis. Awareness of early-onset BCC aids in early diagnosis and treatment of the disease. Therefore, BCC should be in the differential diagnosis of skin lesions in the young population. In addition, when we encounter early-onset BCC, we should not forget the accompanying risk factors and syndromes.

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) has been linked to “unhealthy” food consumption, but the studies in this area are insufficient. The aim of this study is to investigate the relationship between ADHD/related symptoms and processed meat products and snack consumption.
METHODS: This study was conducted on 390 children aged between 6 and 17 with 169 ADHD (38 Girls, 131 Boys) and 221 healthy controls (93 Girls, 128 Boys). Food consumption was evaluated by a modified food frequency questionnaire, including 18 food containing processed meat products and snacks. ADHD symptoms were evaluated by the teacher and parent Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-Scale) and Conners’ Rating Scale (CPRS, CTRS).
RESULTS: Children with ADHD consumed more processed meat products, milk-based desserts, and chocolate-sweets than controls (p<0.05). A positive correlation was observed between the ADHD symptom scores and the consumption amount of all snacks, the amount of chocolate-sweets consumption, the frequency of consumption of sujuk, chocolate, jelly beans, sweets, cakes, and chocolate spread (p<0.05).
CONCLUSION: Children with ADHD consume more foods rich in saturated fat and sugar than their healthy peers. Processed food consumption of children with ADHD may be associated with ADHD symptoms.

The new coronavirus disease, in which 100,000 of people are infected in the world, appears in tables ranging from asymptomatic course to severe acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) is one of the salvage treatments applied in intubated patients due to high mortality. However, since ECMO treatment is a complicated treatment, the gain loss rate should be determined well. We aimed to share two cases that we applied ECMO treatment in our clinic. Although we could not achieve a successful result, we believe that new experiences should be shared in order to better understand the place of ECMO in coronavirus disease 2019 treatment.

Acute rheumatic fever (ARF) is a systemic autoimmune disease that results from abnormal immune response to group A streptococcus pharyngitis. Although first-degree atrioventricular (AV) block is the most common rhythm problem associated with the disease, other conduction abnormalities also could be seen. We reported three different types of conduction defects (first-degree AV block, second-degree AV block, and complete AV block) in a 15-year-old case diagnosed with ARF. A 15-year-old male patient presented with palpitation. Physical examination findings were unremarkable except dysrhythmic heart sounds. Acute phase reactants were positive, and electrocardiogram showed second-degree type I AV block at hospital admission. In the 2nd day of admission, right first metatarsophalangeal arthritis as well as arthralgia involved both knees and ankles developed. Echocardiography revealed moderate rheumatic mitral regurgitation. First-degree AV block with brief complete AV block episode was seen on 24 h rhythm Holter recordings. Based on clinical and laboratory findings, ARF diagnosis was made and anti-inflammatory therapy (naproxen sodium) with benzathine penicillin G was started to the patient. First-degree AV block lasted 3 weeks and other conduction disorders were not seen again first, second, and complete AV block which could be seen during ARF episode and ARF should be considered as a one of the causes of arrhythmias.

Cerebral toxoplasmosis is a rare but often life-threatening infection after hematopoietic stem cell transplantation (HSCT). In such cases, early diagnosis and initiation of treatment are vital. We describe a case of cerebral toxoplasmosis in a patient who underwent HSCT for acute myeloid leukemia. Infection was diagnosed with polymerase chain reaction (PCR) test of cerebrospinal fluid and cranial magnetic resonance imaging scan. The patient treated with trimethoprim-sulfamethoxazole and clindamycin combination. However, she died from nosocomial infection after 15 days of treatment. This life-threatening infection should be considered in a patient who is post-HSCT present with neurologic symptoms and brain lesions. PCR is an important and rapid diagnostic tool for toxoplasmosis. Cranial imaging scan and PCR should be used together to diagnosed.

A 58-year-old female patient presented at cardiology outpatient clinic with palpitation. The 12-lead electrocardiography on admission revealed monomorphic bigeminy premature ventricular contractions (PVCs) showed a left bundle-branch block configuration, monophasic R wave in lead I and aVL and precordial transition in V3 lead. Cardiac electrophysiological study was performed to patient. Activation mapping guided by three-dimensional electroanatomic system was done. The earliest ventricular activation was observed in the para-hisian region with the largest His potential (0.6 mV) during PVC. Due to the risk of atrioventricular (AV) block, radiofrequency (RF) ablation was planned to the region, where the His potential amplitude was lower (0.2 mV), the AV ratio was <1, and ventricular activation preceded the QRS onset by 37 ms. Subsequently, irrigated RF current was delivered in the distal His region with power starting at 15 W after PVC was suppressed, RF delivery was applied for a total of 90 s with gradually increasing power to 25 W. After ablation, under isoproterenol infusion, burst pacing from the right ventricle no PVCs/VTs was observed. A gradual RF energy application, a detailed activation mapping, and the distance from the largest His potential increase the likelihood of success in para-hisian PVC ablation.

Apelin is a G protein-linked receptor endogenous ligand, synthesized as a 77-amino acid pre-propeptide. Increased expression of apelin is present in many cardiovascular (CV) tissues, including cardiomyocytes. It is a peripheral vasodilator and one of the most potent stimulants of ventricular contraction. Apelin may be a valuable therapeutic for both blood pressure regulation and myocardial performance. More information is needed for the CV pathophysiology of apelin. We will discuss the importance of apelin level in CV diseases in this review.