Mevlana Tıp Bilimleri Archive

ÖZET
Sağa eğri penisi olan 13 yaşındaki erkek adolesanda; ciddi sosyal ve ürogenital sorun olan ve nadir görülen penil kurvatur (PK) olgusunu sunmaktayız. Genel anestezi altında üretradan mesaneye 10 Fr Silikon Foley kateter yerleştirildi. Glans penis koronasının 1/2 cm proksimalinden sirküler cilt kesisi yapıldı; penis cildi radikse kadar çepeçevre diseke edildi. Sağa kurvatur gösteren penisin sol
tarafına, Buck Fasiası (fasia penis profunda) ve daha derindeki Tunika Albuginea'dan geçen 3/0 vikril ile 3 adet paralel plikasyon sütürü konularak kurvatur düzeltilip penis sargıya alındı. Postoperatif dönemde kontrolleri yapılan hastada; 9 yıldan beri penil kurvatur görülmedi. Hastanın yaşam kalitesi ve psikolojik durumu düzeldi. Ürogenital sistem şikayetleri ile başvuran çocuk ve adolesanların ayırıcı tanısında; hipospadias, epispadias, ambiguous genitalia yanında PK da düşünülmelidir.

ABSTRACT
We aimed to present a rare case with penile curvature to the right side which causes serious social and urogenital problem in a 13-years-old boy. A 10 Fr Foley Catheter was settled to his bladder via urethra as an urethral catheter under general anaesthesia. An incision was made in a circumferential manner from 1/2 cm proximal section of corona of glans penis. Cutis of the penis was freed completely down to the penoscrotal junction. Penile curvature was corrected with three parallel lateral plication sutures with 3/0 vicryl which passed Buck's Fascia (fascia penis profunda) and Tunica Albuginea in the left side of the body of the penis. Postoperative evaluation documented no penile curvature for 9 years' follow-up. The patient has high life quality and has no social problem. Penile curvature should be considered in the differential diagnosis of children and adolescents who are admitted with the urogenital system anomalies in addition to hypospadias, epispadias, and ambiguous genitalia. 

Aim: This study aimed to investigate the changes in serum levels of various electrolytes on the 1st day of treatment in patients receiving chemotherapy due to hematological malignancies.
Patients and Methods: Serum levels of various electrolytes before and after the first course of chemotherapy were compared retrospectively in patients receiving chemotherapy for hematological malignancies between 2010-2014.
Results: Data from 195 patients were analyzed. Serum calcium concentrations decreased significantly in multiple myeloma (p=0.013), Hodgkin lymphoma (p=0.03) and non-Hodgkin lymphoma (p=0.002) groups after chemotherapy compared to pre-chemotherapy levels. In the chronic lymphocytic lymphoma group sodium (p=0.017) and magnesium (p=0.006) concentrations, in the acute myeloid leukemia group sodium concentration (p=0.012) were decreased significantly after chemotherapy. In the acute lymphoblastic leukemia group, magnesium concentration significantly increased after chemotherapy (p=0.028).
Conclusion: In patients receiving chemotherapy for hematological malignancies significant changes occur in plasma concentrations of serum electrolytes even in the early period after chemotherapy.

Backround: The triglycerides-glucose index (TyG) is a simple indicator of insulin resistance. The TyG is independently associated with stroke occurrence. Previous studies have investigated the relationship between the TyG in stroke and hemodialysis patients.
Aim: There is no study investigating the relationship between stroke and TyG in hemodialysis patients. Therefore, we wanted to examine whether the TyG predicts stroke in hemodialysis
Methods: We retrostprctively analyzed 149 end-stage kidney disease (ESKD) who had been on hemodialysis for more than six months were included. The patients were divided into groups, stroke, and non-stroke, according to their MR images and clinics. Binary logistic regression analysis was performed to identify independent predictors for stroke.
Results: The mean TyG value was 9.13 ± 0.74 and significantly higher in patients with stroke (p= 0.003). The number of patients with stroke was higher in the group above the median value (OR= 1.981, p= 0.039). In the bivariate correlation analysis, the TyG value was positively correlated with C-reactive protein and negatively associated with HDL. As a result of our multivariable analysis, age and TyG values were independent predictors of stroke.
Conclusion: The determination of the TyG index as an independent predictor for stroke in the regression analysis in our study proves that the TyG index is a helpful indicator for stroke in patients undergoing hemodialysis.

Aim: To determine the reasons and frequency of preoperative and/or postoperative neurology consultation in open heart surgery patients.
Methods: Between 2015 and 2020, 3145 patients who underwent open heart surgery were retrospectively analyzed. A total of 294 patients who underwent preoperative and/or postoperative neurology consultation were included in the study. Results: The total number of neurology consultations was 294 (9.3%). The number of preoperative consultations was 168 (57.1%) and the number of postoperative consultations was 126 (42.8%). The number of patients who underwent both preoperative and postoperative consultation was 15 (5.1%). Reasons and numbers of preoperative neurology consultation requests: Previous stroke 64.2%, epilepsy 11.9%, tremor/ parkinsonian 7.1%, vertigo 4.1%, headache 2.9%, dementia 2.9%, peripheral facial paralysis 1.7%, etiology
of syncope 1.7%, TIA 1.7%, and neuropathy 1.1%. Reasons and numbers of postoperative consultation requests: Acute stroke 42.8%, consciousness disorder etiology 30.1%, delirium 10.3%, probable stroke (not investigated) 10.3%, post-operative seizures 3.9%, TIA 1.5% and acute subarachnoid hemorrhage 0.7%. Preoperative consultation request time distribution: 1 day before the operation 48.2%, 2 days before 28.5%, 3 days before 14.2%, 5-7 days before 8,9% was found. Postoperative consultation request time: on the same day of surgery 10.3%, on the first day 19%, and on the second day 26.1%. In the other days, the distribution
was between 6.3%-11.9%
Conclusion: The most common reason for neurology consultation preoperatively was previous stroke, while the most common reason postoperatively was acute stroke. The majority of patients who were consulted preoperatively and required reconsultation postoperatively had acute stroke

Aim: Bevacizumab is a target therapy drug inhibiting vascular endothelial growth factor (VEGF). High serum VEGF levels are related to increased visceral and abdominal fat mass. We aim to observe the relation of body mass index (BMI) with survival in metastatic colorectal cancer (mCRC) receiving bevacizumab with cytotoxic therapy.
Methods: The study included 90 metastatic colon cancer patients receiving bevacizumab-based systemic chemotherapy in first-line treatment. Study population was stratified into two according to the BMI. Group 1 was consisted of patients with a BMI lower than 25 kg/m 2 , Group 2 was consisted of patients with a BMI higher than 25 kg/m 2 . Overall survival (OS), progression free survival (PFS), clinic characteristics, laboratory parameters, and response rates were compared between the groups.
Results: The mPFS of group 1 and group 2 were 15.8 (95% Conf. Int: 10.1-21.5) and 15.6 (95% Conf. Int:10.1-21.5) months (p=0.4), respectively. The mOS was 22.6 (95% Conf. Int: 20.1-28.8) months for group 1 and 27.61 (95% Conf. Int: 21.81-29.92) months for group 2 (p=0.02). In multivariate analysis, BMI (Hazard Ratio: 0.89, 95% Conf. Int: 0.69-0.96, p=0.024) was determined to be a risk factor for OS.
Conclusion: Increased BMI was related with more prolonged survival in patients with mCRC receiving bevacizumab. Increased BMI was found to be an independent predictive marker for improved OS.

Amaç: CD19 eksikliği, “doğuştan gelen bağışıklık hataları (IEI)” sınıflandırmasında “baskın antikor eksiklikleri” grubunda yer alan yaygın bir değişken immün yetmezliktir (CVID). CD19 eksikliği, olan hastalarda otoimmün hastalıklar bildirilmiş olup bu hastalarda görülen otoimmün mekanizmalar hakkında literatürde veri bulunmamaktadır. Bu çalışmada CD19 eksikliği olan olgularda Foxp3 ekspresyonu ve düzenleyici T hücre (Treg)’lerin değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Çalışmaya CD19 eksikliği tanılı üç hasta, genetiği doğrulanmış 11 taşıyıcı ve akraba olmayan 10 sağlıklı kontrol dahil edildi. Treg hücre oranları akım sitometrik olarak analiz edildi.
Bulgular: Hasta, taşıyıcı ve kontroldeki yardımcı T (Th) ve Treg hücresinin yüzdeleri ve ortalama floresan yoğunluğu (MFI) değerleri karşılaştırıldı. Th lenfosit yüzdeleri ve Treg belirteçlerinin yüzde değerleri açısından gruplar arasında istatistiksel olarak anlamlı fark yoktu (p>0,05). Th yüzdeleri ve Treg yüzey belirteçlerinin yüzdesi açısından gruplar arasında istatistiksel olarak anlamlı fark bulunmazken (p>0,05), MFI açısından gruplar arasında istatistiksel olarak anlamlı bulundu (p<0,05).
Sonuç: CD19 eksikliği olan hastalarda Th ve Treg hücrelerde tespit edilen düşük MFI değerlerinin uygun olmayan T hücre aracılı immün yanıtlarla ilişkili olabileceğini düşündürdü. Ayrıca bu çalışma, CD19 eksikliğinde otoimmünite nedenini araştıran ilk çalışma özelliği taşımaktadır.

Aim: It was aimed to determine the levels of life satisfaction and hopelessness of medical faculty students and to reveal their effects on each other.
Materials and Methods: The data of the cross-sectional and descriptive study were collected by applying the Life Satisfaction Scale (LSS) and Beck Hopelessness Scale (BHS) questionnaire to medical students studying in the 2021-2022 academic year.
Results: The mean age of 315 students participating in the study was 21.72±2.3 years and 57.8% (n=182) were female. The factors affecting hopelessness and life satisfaction were: the class they were studying in, their income, having daily activities, social relations, the culture they were born into, the effects of their family and religion they believe in, their satisfaction with the city they live in and their career choice, and their career plans after graduation. The SWLS score of the students in the preclinical years (14.98±4.0) was significantly higher than that of the students in the clinical years (13.12±3.8) (p=0.001). There was a strong negative correlation between life satisfaction and hopelessness score (r=-0.618; p<0.001).
Conclusion: In medical education, increasing hopelessness and decreasing life satisfaction as clinical years pass is remarkable. Dissatisfaction with the city of residence and the chosen career are two important factors that decrease students' life satisfaction and increase their hopelessness.

Amaç: Tüm dünyada yaşlı nüfüsun artmasıyla rektum kanserli yaşlı hastaların sağkalımına etkileyen faktörlerrin incelenmesi amaçlandı.
Gereçler ve Yöntem: Aralık 2009- Haziran 2021 tarihleri arasında, 65 yaş üstü ve neoadjuvan KRT (nKRT) uygulanmış 171 hastanın verileri retrospektif olarak incelendi.
Bulgular: Çalışmaya dahil edilen hastaların 117 si erkekti ve median yaş 72 idi. Median izlem süresi 40,5 aydı. Hastaların %63 ü nKRT sonrası opere edildi. Ortalama genel sağkalım (GS) opere olanlarda 109 ay, opere olmayanlarda 29 ay idi (p<0,001). Kaplan Meier tek değişkenli analizlerde; yaş (<75 vs >75, p<0.00), Karnofsky Performans skalası (KPS, <70 vs>70, p=001), tanı anında lenf nodu durumu (LN+ vs LN-,p<0,001), opere olanlarda lenfovasküler invazyon durumu (LVI+ vs -, p<0,001) GS etkileyen faktörler olarak bulundu. Yaş gruplarına göre bakıldığında <75 yaşta operasyonun sağkalıma anlamlı katkısı varken (p<0,001), 75 yaş üstü hastalarda opere olup olmamanın sağkalıma katkısı gösterilemedi. Benzer şekilde >75 yaşta KPS nin anlamlı katkısı gösterilemedi.
Sonuç: Yaş ilerledikçe komorbid hastalıkların sık ve ağır seyretmesi ve performansı etkileyeceğinden operasyon durumunun sağkalıma etkisinin saptanamamış olabileceği düşünüldü.