Muftuoglu, Sevda Fatma; Bozdag, Gurkan; Mumusoglu, Sezcan; Portakal, Oytun; Coşkun, Neslihan; Sökmensüer, Lale Karakoç; Güneş, Ali Can; Zirh, Selim

Objective: This study aimed to evaluate whether administration of luteinizing hormone (LH) before the ovulation trigger could modulate elevated progesterone levels. Methods: Human granulosa-theca tissues were obtained from 15 women aged 18–38 years undergoing laparoscopic ovarian cystectomy at the Department of Gynecology and Obstetrics, Hacettepe University. The tissues were cultured in vitro and treated with 12.5 mIU/mL recombinant follicle-stimulating hormone (r-FSH; Group A), 18.75 mIU/mL r-FSH (Group B), or 18.75 mIU/mL r-FSH plus 6.25 mIU/mL recombinant LH (r- LH; Group C). Baseline and post-treatment estradiol (E2) and progesterone concentrations were measured at 0, 24, and 48 hours. Immunofluorescence staining for aromatase, cytochrome P450, and Ki67 was performed to assess steroidogenic activity and cellular proliferation. Results: A mild trend toward reduced progesterone and increased E2 levels was observed following LH supplementation at both time points; however, these changes did not reach statistically significant. No statistically significante differences were observed in progesterone or E2 levels among the treatment groups at 24 h (P=0.891 and P=0.805, respectively) or 48 h (P=0.878 and P=0.505, respectively). Expression levels of aromatase, cytochrome P450, and Ki67 did not differ significantly between groups at 24 h (P=0.665, P=0.932 and P=0.953, respectively) or 48 h (P=0.911, P=0.674 and P=0.202, respectively). Conclusion: These findings suggest that although r-LH addition to high-dose r-FSH does not significantly alter progesterone synthesis, it may exert a subtle regulatory effect on steroidogenesis. Larger studies with extended culture durations are needed to further elucidate the biological and clinical significance of these observations.

Çevikkalp, Eralp; Yapici, Furkan

Objectives: The pain sensation of the clavicle is innervated by two separate plexuses. Regional anesthesia techniques for this area are challenging and complicated. Interscalene block, superficial cervical block, or a combination of these two is commonly used for regional anesthesia in clavicle surgery. The aim of this study was to investigate the efficacy of C5 nerve root block for clavicle surgery. Methods: Patients were divided into two groups: Group C5B (patients who received C5 nerve root block + superficial cervical plexus block) and Group ISB (patients who received interscalene block + superficial cervical plexus block). Motor block was assessed by the Medical Research Council Scale for Muscle Strength, while the sensory block of the areas corresponding to the nerve trace was assessed using the pinprick and cold testing. Furthermore, ultrasound was employed to evaluate phrenic nerve paralysis. Results: There was no difference between the groups in terms of mean age. The mean age of Group ISB was higher; however, the comparison of comorbidities revealed no significant difference between the groups. This statistically significant difference was clinically insignificant. Group C5B had lower 6-hour pain at rest, lower 0, 2, 4-hour pain on movement, and less postoperative analgesic consumption. Moreover, the time to first analgesic requirement was significantly longer in Group C5B. The motor examination of the peripheral nerves showed a significant difference in Group C5B.Conclusions: We are of the opinion that C5 nerve root block can be used instead of interscalene block since it does not produce a motor block in hand movements and preserves diaphragmatic functions. C5 nerve root block may therefore be considered an alternative to conventional interscalene block for clavicle surgery.

Kadıoğlu, Berrin Göktuğ; Nalçakan, Aysel; Dilek, Esra

Objectives: Aim of this study is to find out the clinical relevance of estimating paraoxonase activity of PON1 enzyme, triglyceride (TG), total cholesterol, HDL, and LDL levels in maternal serum and umbilical cord blood according to birth weight. Methods: Venous blood samples were taken from mothers just before birth. Babies were divided into four groups: normal-weight babies, premature babies, low birth weight babies, and postmature babies. The weight of the newborns was measured and cord blood was taken. The samples were looked at HDL, LDL, total cholesterol, triglyceride levels and PON1 activities. We have investigated the paraoxonase activity of the PON1 enzyme. Enzyme activity assay was obtained spectrophotometrically measurement of p‐nitrophenol at 412 nm. Results: Maternal PON1 paraoxonase activity levels in Pre-Term show a significant decrease in cases as compared to other groups. Baby PON1 paraoxonase activity levels are also found to be significantly decreased in cases concerning the Term and Post-Term groups. There was a significant difference in all values the such as baby's weight, TG, Total cholesterol, HDL, LDL and PON1.belonging to babies (p < 0.05).Conclusions: Decreased paraoxonase activity in maternal serum may be considered as an additional risk factor for the development of low birth weight. It appears that PON1 activity plays an important role in infant development and affects birth weight. We think that the paraoxonase activity of the PON1 enzyme in mothers may be a marker in predicting the babies who are at risk in terms of birth weight.

Işık, Nurten Arslan; Ünver, Edhem; Ölmez, Hasan; Tosun, Mustafa

Although most people with COVID-19 have mild to moderate symptoms; some people may experience worsened symptoms, such as pneumonia, acute respiratory distress syndrome (ARDS) and and respiratory failure. Here we reported a case of COVID-19 pneumonia with ARDS and secondary haemophagocytic lymphohistiocytosis (sHLH). A 44-year-old man presented to the emergency department with a history of cough, fever, sore throat, and muscle ache. The patient transferred to Chest Diseases Department, with a diagnosis of COVID-19 pneumonia. Oseltamivir, hydroxychloroquine, azithromycin, low molecular weight heparin (LMWH) and favipravir added to the treatment. Tocilizumab started after endotracheal intubation. In general, we saw improvement in respiratory values and vital signs. Administration of LMWH to the patient may have prevented the development of coagulopathy. In conclusion, using HFO system and using low tidal volume according to ARDS net protocol, using optimal PEEP/FiO2 ratio, paying attention to keeping driver pressures low may be beneficial for the clinical improvement of the disease.

Erdoğan, Abdullah; Keskin, Ercüment

Objectives: Although proximal ureteral stones are common, some difficulties are encountered in semi-rigid ureterorenoscopy (URS) treatment, especially as a result of stone migration to the kidney. In this paper, we present a different use of a basket catheter for the treatment of proximal ureteral stones. Methods: Between September 2016 and January 2019, 101 patients over 18 years of age detected to have a maximum 15-mm proximal ureteral stone were retrospectively evaluated, and 93 patients fulfilling the criteria were included in the study. Semi-rigid URS and a modified basket catheter were used together in 44 patients while no auxiliary equipment was utilized for the remaining 49 patients. In the study group, a 3F zero-tip basket catheter was disintegrated and positioned in a way to capture and retrieve the stone from the semi-rigid ureterorenoscope. Results: No difference was found between the two groups in terms of age, body mass index, gender, and stone characteristics. The duration of operation was shorter in the basket catheter group (p < 0.001). The rates of stone migration, requirement to switch to flexible ureterorenoscopy (FURS), and double J-stent (JJ-stent) placement were significantly higher in the control group (p < 0.005). There were no significant differences between the two groups concerning operation success and complications (p = 0.068 and p = 0.772, respectively). Conclusions: The modified basket catheter technique with semi-rigid URS was successful in preventing the migration of proximal ureteral stones. This method can be considered as an alternative in cases where FURS is not available. 

Doğan, Mehmet; Ünver, Edhem; Ölmez, Hasan; Tosun, Mustafa; Işık, Nurten Arslan

It has been observed that patients with COVID-19 infection may develop acute pulmonary embolism, acute myocardial infarction, limb thrombosis, and venous and/or arterial thrombosis, including central nervous system. Thrombosis formation in COVID-19 patients can be explained by the virchow triad. Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can directly attack vascular endothelial cells, causing excessive activation of the immune system and cytokine storm, causing thrombosis. Increased prothrombotic factors such as antiphospholipid antibodies, elevated factor VIII, high fibrinogen, circulating prothrombotic microparticles, neutrophil extracellular traps have been reported in COVID-19 infection. It has been argued that complement-mediated endothelial damage, increase in pro-inflammatory cytokines such as interleukin (IL)-1, IL-6, IL-8 and interferon-γ may be the cause of thrombosis. Autopsies of patients with COVID-19 revealed that the causes of death were pneumonia and pulmonary embolism. When monitoring COVID-19 patients, platelet, prothrombin time (PT) and activated partial thromboplastin time (aPTT), fibrinogen and Ddimer monitoring should be initiated every 1-2 days, especially in critically ill patients. High D-dimer levels are associated with high mortality; may indicate infection/sepsis, cytokine storm, and impending organ failure. Disseminated intravascular coagulation (DIC) may be seen in COVID-19 patients, but unlike DIC, fibrinogen is usually high. Clotting times and platelet counts are usually normal. Therefore, it is appropriate to use sepsisinduced coagulopathy (SIC) criteria in the follow-up of COVID-19 patients. Infected areas related to pulmonary embolism can be seen as radiological appearance. Some patients may have enlarged subsegmental pulmonary vessels. Treatment of the underlying disease is the most important treatment for all coagulopathies. Patients with venous thromboembolism, inpatient medical, surgical, and COVID-19 therapy should receive anticoagulant therapy unless there is a contraindication to anticoagulation (for example, active bleeding or severe bleeding within the previous 24 to 48 hours).

Karavaş, Erdal; Taydas, Onur; Gümüş, Burak

Objectives: To discuss the radiological characteristics of traumatic pulmonary pseudocyst (TPP) detected bythorax computed tomography.Methods: Retrospective screening was made of 107 patients applied with thorax computed tomography dueto blunt thoracic trauma between 2014 and 2017 at our hospital.Results: TPP was detected in 6 (5.6%) patients. The patients comprised 5 males and 1 female with a mean ageof 28 years (range, 15-49 years). Blunt thorax trauma was caused by traffic accidents in 4 patients and a fallfrom height in 2 patients. Eleven (64.7%) of the lesions were located in the lower lobes. The most commonfinding associated with TPP was ground glass opacities, which were present in all of the patients and representedthe parenchymal contusion.Conclusion: Thorax computed tomography is an effective and reliable method for early and definitive diagnosisof the rare development of TPP after blunt thoracic trauma.

Aydin, Sonay; Fatihoglu, Erdem

Objectives: Developmental dysplasia of the hip (DDH) is an important problem. Ultrasonography (US) is aproper method before 6 months of age. For older children, plain radiographs can be useful. Six risk factors areemphasized: breech presentation, female sex, a positive family history, being first-born, left hip affected, andmode of delivery. In some centers, clinicians prefer to perform a control US examination or pelvic radiographsafter 6 months of age for the children having a positive family history. We aimed to evaluate the necessity ofcontrol US/direct radiography examinations.Methods: A total of 205 children with a positive family history for DDH are included. US examinations areperformed according to Graf’s method. We have evaluated direct radiographs by using Hilgenreiner, Perkin,and Shenton lines, acetabular angle.Results: Initial US examinations are performed at a median age of 8.3 weeks. Seventy-four patients (36%)had a repeat ultrasound scan at a median age of 7 months; none of them demonstrated abnormal findings. Onehundred and thirty-one patients (63.9%) had control radiographs at a median age of 8.2 months. Shenton lineis considered as normal, and the upper femoral epiphysis is located in inferomedial quadrant according toHilgenreiner and Perkin lines.Conclusions: A positive family history for DDH may be a less important reason for performing control US orradiographic examination. Patients with a normal screening US result and having risk factors can be dischargedfrom follow up safely, so that unnecessary examinations and family anxiety will be reduced.