Objective: The present study aims to examine the protective effects of barbaloin on renal injured by cecal ligation and puncture (CLP) model.
Methods: In our study, animals were divided into four groups. Study groups were designed as follows: sham, CLP, DMSO+CLP and 20 mg/kg barbaloin+CLP. Oxidative stress and cytokines were evaluated in renal tissues obtained at the end of the experiment.
Results: The findings showed that the TOS, OSI, MPO, MDA, TNF-α and IL-1β increased and TAS and SOD decreased in the CLP group, but in the treatment group, molecule concentrations changed significantly.
Conclusion: Our results have demonstrated that of barbaloin is effective against kidney injury caused by CLP-induced polymicrobial sepsis model.

INTRODUCTION: This study aims to investigate the expression levels of adiponectin signaling related proteins in mammary tissue, liver and breast cancer tissue in mice. Adiponectin, an adipocytokine, is secreted from adipose tissue and has been documented to have roles in diabetes, inflammation, and cancer development. In particular, levels of serum adiponectin are inversely associated with obesity and a decrease in serum adiponectin levels have been reported to be associated with breast cancer. There are two adiponectin receptor subtypes, AdipoR1 and AdipoR2, which have been identified in mammalian tissues, including human cancer cell lines and also in human mammary tumors. However, the role of adiponectin receptors in breast cancer development remains to be established.
METHODS: In this study, MMTV-TGF-a transgenic mice were fed from week 10 up to week 74 of age. Expression levels of adiponectin, AdipoR1 and AdipoR2 proteins were measured in the mammary fat pad (MFP), mammary tumor (MT) and liver tissues from 74 weeks old MMTV-TGF-a transgenic mice with and without MT using Western Blot. Adiponectin levels were measured using ELISA assay.
RESULTS: Protein expression levels of Adiponectin and AdipoR1 were significantly lower in MTs compared to control tissues. However, AdipoR2 protein expression levels were similar in MT and MFP tissues from MT-positive and MT-negative mice. The expression levels of adiponectin, AdipoR1 and AdipoR2 proteins in liver tissues were also similar in MT-positive and MT-negative mice. Serum adiponectin levels of the MT-positive and MT-negative mice were similar.
DISCUSSION AND CONCLUSION: These results indicate that adiponectin and its receptors are differentially regulated depending upon the specific tissue analyzed. AdipoR1 and adiponectin may play important roles in MT development.

INTRODUCTION: The present study aims to investigate the correlation of neck pain with Modic changes and uncal degeneration. Our secondary goal is to investigate the relationship among Modic changes, disc herniation and uncovertebral joint degeneration in the cervical spine.
METHODS: In this study, patients with a presenting symptom of neck pain were evaluated. We have excluded patients with spinal and cervical mass lesions, spinal fracture and history of cervical vertebral operation. Pain evaluation was made using the Visual Analog Scale (VAS) at rest. The cervical vertebral MRI and X-ray were used for radiological evaluation. In these scannings, loss of cervical lordosis, uncal degeneration, Modic changes and intervertebral disc degeneration were recorded.
RESULTS: The findings showed that Modic changes were more frequent in patients with disc hernia compared with patients without disc hernia (p<0.001). The uncal degeneration was significantly more frequent in patients with Modic changes than in patients without Modic changes (p<0.001). The VAS scores were not associated with Modic changes (p=0.919).
DISCUSSION AND CONCLUSION: The disc herniations and uncal degeneration are related to Modic changes in the cervical spine. The neck pain was not associated with Modic changes, which may arises from the study population with mostly chronic neck pain. Recommendations are provided to investigate a new large cohort study in the patient with acute pain.

INTRODUCTION: The primary treatment of primary spontaneous pneumothorax (PSP) is still controversial. The large-bore thoracic catheter has traditionally been used, but there is now a global trend toward the increased use of the small-bore thoracic catheters (SBTC). The present study aims to compare the use of SBTC and chest tube (CT) in first-line treatment of PSP.
METHODS: This prospective randomized study included 90 patients diagnosed with PSP. The patients were randomly distributed into two groups. In the first group, catheter thoracostomy was applied with an 8 French thorax catheter and in the other group, a tube thoracostomy with a 28 French chest tube. The parameters used for comparison in this study were defined as pneumothorax side, pneumothorax size, pain, need of additional analgesia, malpositioning drain, duration of air leakage, duration of hospitalization, complications and recurrence.
RESULTS: In the evaluation of pain using the Numerical Rating Scale (NRS) at 1, 4, 12 and 24 hours after the application, the mean NRS values of the SBTC patients were seen to be lower than those of the CT patients but at 1, 12 and 24 hours, the difference was not statistically significant. At the 4th hour, the difference was determined to be statistically significant (p=0.022). The duration of air leakage was 1.7±1.4 days for the SBTC group and 2.2±1.9 days for the CT group. The period of termination of the drain was 3.3±1.2 days for the SBTC group and 4.0±1.7 days for the CT group. The duration of hospitalization was 3.5±1.3 days for the SBTC group and 4.5±1.9 days for the CT group.
DISCUSSION AND CONCLUSION: No significant difference was determined in respect of air leakage, hospital stay, failure rates or complications between the two procedures. When compared concerning postoperative pain, ease of application, patient comfort and incision scar, SBTC can be considered to be subjectively superior to CT, and can be used safely in the treatment of PSP.

INTRODUCTION: It is assumed that lower endotracheal tube (ETT) cuff pressure is associated with a lower incidence of postoperative sore throat. However, this is not confirmed in many studies. The relation between ETT size and cuff pressure and the incidence of postoperative sore throat were studied in three different facilities.
METHODS: Three facilities at Hamad Medical Corporation, Qatar, Tertiary care hospital/two secondary care hospitals (2ry (1) and 2ry (2)) were addressed in this study. ETT cuff pressure and size were measured by blinded observer after induction of general anesthesia and patients’ intubation before the surgery. The sore throat was recorded after full recovery of the patients and before discharge from PACU by a blinded observer. Statistical analysis was performed using Chi-square for comparing between two categorical variables, Pearson Correlation for parametric variables were used to correlate tube size to cuff pressure. Spearman’s for non-parametric variables was used to correlate throat pain to changes in cuff pressure and tube size (Sig. is p<0.05).
RESULTS: The sore throat was not significantly correlated to either tube size or cuff pressure in the three facilities. Only at 2ry (1), the tube size was significantly correlated to cuff pressure, probably more standardized work.
DISCUSSION AND CONCLUSION: A large number of trainees at tertiary care hospitals may explain the increased incidence of postoperative sore throat and not ETT size and/or cuff pressure.

INTRODUCTION: Operations performed with only local anesthesia may be extremely painful and discomfortable for patients. The present study aims to investigate the optimal analgesic method in endometrial sampling and fractional curettage procedures.
METHODS: This prospective, randomized clinical study was conducted at our Clinic between March 2007 and December 2014. Two hundred fifty patients were randomized into five groups as follows: intrauterine saline group (group 1, n=50), paracervical lidocaine group (group 2, n=50), intrauterine lidocaine group (group 3, n=50), oral and vaginal misoprostol group (group4, n=50), oral misoprostol and 550 mg naproxen sodium group (group 5, n=50). All groups were evaluated by visual analogue scale (VAS) before the procedure, during the procedure and 30 minutes after the procedure.
RESULTS: Assessment of increase in pain during the procedure showed that the paracervical lidocaine group and intrauterine lidocaine group were effective in providing mild pain (VAS: 0–2). These two groups were also effective to prevent maximal pain (VAS: 7–10). The paracervical lidocaine group had the lowest median VAS score was compared with all groups.

DISCUSSION AND CONCLUSION: Effective analgesia for endometrial sampling and fractional curettage were provided with the paracervical lidocaine and intrauterine lidocaine administration. The procedure with the lowest median VAS score was paracervical lidocaine administration.

INTRODUCTION: Pleural effusion is an important problem in cancer patients as it will affect the stage, prognosis and treatment. Therefore, it is necessary to distinguish between paramalignant and malignant effusions. In this study, we aimed to investigate the role of PET-CT in the evaluation of pleural effusion.
METHODS: Patients diagnosed with malignancy and associated pleural effusion and evaluated by PET-CT were prospectively included in this study. SUDmax values of pleural fluid were recorded in consideration of the demographic information and PET-CT findings. In all patients, biochemical parameters, including glucose, LDH, albumin and total protein and pH values of the pleural fluid obtained by thoracentesis, were measured. All pleural fluid samples were sent for cytological evaluation. After cytological evaluation, patients were defined as having malignant or paramalignant pleural effusion and accordingly divided into two groups. The t-test was used to compare SUDmax values between the groups. A chi-square test was used to compare categorical data.
RESULTS: A total of 69 patients (30 women [43%] and 39 men [57%]) with a mean age of 63.55 (37–88) years were included in this study. The cytological analysis revealed malignant pleural effusion in 53 patients. In the follow-up of 16 patients, pleural fluid was accepted as of paramalignant nature due to the absence of both atypical cells in the fluid cytology and also clinical findings favoring malignancy. The mean SUDmax value was found to be 1.43 in paramalignant fluids and 1.5 in malignant fluids but without any statistically significant difference. Malignant cytological findings were detected despite the absence of FDG involvement in 23 (33%) cases, including patients with lung cancer (n=13), mesothelioma (n=3), breast cancer (n=2), colon cancer (n=2), ovarian cancer (n=1), gastric cancer (n=1), or endometrial cancer (n=1). PET had a sensitivity of 56.6% and a specificity of 50% in the detection of malignant pleural effusions with a 78.9% positive, and 25.8%negative predictive value.
DISCUSSION AND CONCLUSION: Distinguishing between malignant and paramalignant effusions according to FDG uptake in pleural fluids may cause misleading results. Therefore, we suggest that advanced diagnostic procedures should be used in cases where the presence of malignant fluid will change the clinical approach.

INTRODUCTION: The elderly population is on an increasing trend around the world and constitutes around every one of five admissions in the emergency department (ED). The present study aims to analyse patients according to age who were admitted to ED for chest disease.
METHODS: This study was a retrospective and observational study conducted in a state hospital. All adult ED admissions with a pulmonary disease were investigated. Patients were divided into two groups according to their ages as <65 and ≥65. The diagnoses and treatment results were analyzed.
RESULTS: Pulmonary patients constituted 6.5% of all admissions. Patients with bronchitis were the youngest, while respiratory failure patients were the oldest. The hospitalization rate was 35% and in 29% a pulmonologist consultation was carried out. In this study, 45% of the admissions were aged ≥65. Elderly patients were more frequently consulted to a pulmonologist (p<0.001) and hospitalized (p<0.001) with a longer hospitalization duration (p=0.048). The group of the elderly patients also demonstrated higher hospital mortality rates (p<0.001).
DISCUSSION AND CONCLUSION: Pulmonary patients constitute a significant part of ED admissions and the elderly patient population within this population is dense. Elderly patients require more frequent hospitalization and specialist consultation. They require longer treatment duration and have higher mortality rates. All professionals/staff trained and work in the pulmonary health area bear an important level of responsibility for the care of elderly patients.

INTRODUCTION: To evaluate our cases diagnosed with inverted nasal papilloma (INP) and to contribute to the literature on the future surgical and clinical approaches in the light of the results obtained.
METHODS: In this study, 80 patients who underwent surgical treatment between 2010–2018 in our clinic were evaluated retrospectively. The patients were analysed according to demographic data, complaints, primary region, clinical stage, computed tomography (CT) scores, surgical methods, malign transformation and recurrence.
RESULTS: Of the patients, 65 (81.25%) were male, and 15 (18.75%) were female. The mean age was 53±12 years. The most common complaint was unilateral nasal obstruction (96.2%). The most common primary site of INP was the lateral nasal wall (52.5%). Bone erosion was observed in 11 patients (13.7%). Of the 74 (92.5%) patients who underwent endoscopic sinus surgery (ESS), 23 (28.8%) of them underwent lateral rhinotomy to complete the tumor excision. 9 (11.3%) patients underwent revision surgery due to recurrence. In 4 (5%) of the cases, nonkeratinized squamous cell carcinoma was observed.
DISCUSSION AND CONCLUSION: INPs have been investigated for both their diagnosis and treatment earlier with the introduction of endoscopy into the routine nasal examination. We think that close follow-up of cases is very important, especially because of the high rate of recurrence of these tumors and the transformation to malignancy.

INTRODUCTION: The Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement reported that the blood transfusions are among the top five overused treatments in modern medicine. Optimal management of blood transfusion is one of the most important factors that increase patient safety, and special education is increasing all over the world in this regard. In this retrospective cohort study, our goal was to investigate the effects of periodic consensus meetings and training on perioperative blood transfusion by a team of different branches of medicine.
METHODS: Patients over the age of 18 undergoing cardiac surgery and required blood transfusion were included in this study. The transfusions were calculated cumulatively; the change concerning years was determined, as well as side effects and complications associated with transfusion. Patients’ cardiac reserves, laboratory values, anticoagulant drug use frequency, transfused blood volume, complications and mortality rates were recorded. The types of surgery, reexploration rate, length of intensive care and hospital stay were recorded.
RESULTS: Patients’ age, BMI, comorbidity ratio and antimicrobial drug use did not differ between years (p>0.05). The length of intensive care and hospital stay, amount of bleeding, mortality rate did not differ (p> 0.05). Cardiopulmonary Bypass time and Cross Clamp time in 2016, were significantly higher (p<0.05) than in 2014 and 2015. The amount of blood transfusion did not differ significantly (p>0.05). Besides, after 2014, an increase was observed in platelet transfusion. The change in Hb, Htc, platelet and INR did not differ significantly in the pre-postoperative period.
DISCUSSION AND CONCLUSION: Training on the restrictive use of blood products did not have a positive influence on blood transfusion in our study. It has been demonstrated that there are challenges in sufficiently transferring the knowledge to the clinical environment.

INTRODUCTION: To determine the causes of anxiety about surgery and to assess the impacts of informing about the surgical procedures on anxiety.
METHODS: Between 18 and 65 years old, 497 patients who were scheduled for elective surgery in the Urology Clinic were included in this study. At the preoperative period, patients were asked to complete the following forms twice, before and after informing about surgery: State-Trait Anxiety Inventory (STAI), Visual Analogue Scale (VAS), European Quality of Life-5 Dimensions (EQ-5D) and the form containing causes of anxiety. Mean scores of STAI and VAS were classified as low, moderate, and high.
RESULTS: The mean age of the patients was 56.54±0.58 and the mean STAI value was 39.16±0.42. Factors increasing the level of anxiety were female gender, unemployment and lack of surgical history (p<0.05). No statistically significant difference was found among STAI and VAS scores of the age, educational level, disease (benign - malign) and operation groups. The most frequent causes of anxiety were post-operative pain (38.3%), fear of organ loss (21.3%) and quality of life impairment (18.9%). However, the first reason for anxiety in the group with a high anxiety score was fear of death. After the patients had been informed, the STAI and VAS scores increased. The anxiety levels increased after informing especially the patients who were unemployed women, low educated and undergoing group A (major) operation (p<0.05). STAI was positively correlated with VAS but negatively correlated with EQ-5D (p<0.01).
DISCUSSION AND CONCLUSION: t is observed that the patients who will undergo urological surgery have a moderate anxiety level and the most common cause is postoperative pain. Informing patients in the preoperative period increases the anxiety level. Hence, their quality of life is adversely affected. To understand the effects of informing on anxiety more clearly, new studies, including an uninformed control group, should be conducted.

INTRODUCTION: The effect of adolescent idiopathic scoliosis (AIS) on shoulder dysfunction and upper limb functionality is still not poorly understood. In this study, we aimed to investigate the effects of AIS on upper extremity functionality and quality of life.
METHODS: Thirty-seven patients who had undergone surgery for adolescent idiopathic scoliosis participated in this study. Upper extremity functionality was evaluated using Turkish version of the Disabilities of the Arm, Shoulder and Hand (DASH-T) questionnaire, hand-grip strength Jamar hand dynamometer, and health-related quality of life was assessed using SF-36, and Scoliosis Research Society-22r Health-Related Quality of Life questionnaire (SRS-22).
RESULTS: The mean age of the patients was 17.08±2.96 years and the mean follow-up period was 34.44±25.37 months. The average DASH-T score was found 14.79±17.35. Patients quality of life scores was good level. The average right hand grip strength was 19.84±8.89 kg while left hand grip strength was 18.97±8.01 kg. There was no statistically significant difference between right and left hand grip strength (p=0.67). There was a moderate negative correlation with DASH-T and SRS-22 pain (r=-0.46, p=0.01) and SF-36 pain (r=0.54, p=0.01), and a weak positive correlation with SF-36 social function (r=-0.38, p=0.03). There was no statistically significant relationship between Cobb angle (Δ) and SRS-22, SF-36, DASH-T and hand grip strength.
DISCUSSION AND CONCLUSION: Further studies may examine the effects of surgery on upper extremity functionality, hand-grip strength, and quality of life in patients with AIS using both objective and patient-reported assessment tools.

INTRODUCTION: This study is aimed to compare socio-demographic variables, perinatal characteristics, developmental stages, comorbid medical illnesses between children and adolescents with neurodevelopmental psychiatric disorders and non-neurodevelopmental psychiatric disorders.
METHODS: In this study, the files of 2981 children and adolescents referred to our, child psychiatry outpatient clinic between January 2015 and September 2016, were examined retrospectively. The data of DSM 5 based psychiatric diagnosis, mean ages, gender, parental work status and education levels, perinatal characteristics, such as a birth week, birth weight, time of speech and walking, frequent comorbid medical conditions such as epilepsy, cardiac disease and asthma, were obtained.
RESULTS: The findings showed that children most often had attention deficit hyperactivity disorder, and anxiety disorders were the second common health problem. The mean ages and working rates of parents, education level of the mothers were significantly lower in children with a neurodevelopmental psychiatric disorder (n=1502) than children with non-neurodevelopmental disorder (n=690) and no psychiatric diagnosis (n=376) (p<0.05). Younger age, male gender, the requirement of neonatal intensive care unit, speech and walking delay and presence of comorbid epilepsy were associated with a neurodevelopmental psychiatric disorder.
DISCUSSION AND CONCLUSION: Knowing socio-demographic, developmental, medical and perinatal variables associated with neurodevelopmental and non-neurodevelopmental psychiatric disorders may help us to develop preventive interventions.

Hereditary angioedema (HAE) is a rare, inherited disease mostly associated with mutations in the SERPING1 gene (serpin family G member 1), which encodes the C1 inhibitor (C1-INH) protein. Regulation can lead to plasma deficiency and ensuing repeated attacks of severe angioedema. This disease was first described clinically and genetically in 1888 by William Osler, who named it “hereditary angioneurotic edema (HANE).” It took 75 years until Donaldson and Evans identified the fundamental role of C1-INH in the pathophysiology of so-called HANE by Osler. Significant progress has been made in the research of this genetic disease when the role of neural factors was documented as being too small to lead to edema, the name was changed as HAE. Therefore, the name of more than 490 different mutations have been reported in the region of the C1-INH gene (SERPING1) until mid-2018. It is now known that C1-INH deficiency overstimulates the plasma contact (kallikrein-kinin) system, which eventually results in the overproduction of bradykinin. By binding to the bradykinin B2 receptor, bradykinin increases vascular permeability (vasodilation) and causes contraction of nonvascular smooth muscle, and acts as a main/major mediator in the pathophysiology of HAE. Reports since 2000 have described a new type of HAE with “normal” CI-INH levels, primarily in Caucasians. A number of abnormalities in the genes encoding for factor XII, angiopoietin-1, and plasminogen have been identified in this novel disease entity. The establishment of treatment modalities for HAE with normal C1-INH is also expected.

Quality improvement studies have come to the forefront to eliminate the failure rates related to patient safety. The concept of quality in healthcare needs to be viewed from a broader perspective. The dimensions of healthcare quality have been tried to be expressed by many institutions and authors from different perspectives. A multidimensional approach to clinical quality aims to develop a more comprehensive perspective regarding the prevention of medical errors. Many factors, such as evidence-based practices, working environment, teamwork and the infrastructure of information technologies, are effective in the clinical quality process. Evidence-based medicine is a systematic approach for physicians to make decisions based on the best available evidence, combined with their own experience and patient characteristics and choices. The main purpose of evidence-based medical practices is to ensure that clinical decisions are made based on the best scientific evidence of the time. Starting with the formation of an appropriate question related to the problem, the process from the evaluation of the performance of the evidence-based practice consists of several steps. In this article, clinical quality is tried to be examined with all of its processes.

Kawasaki disease is an acute febrile systemic vasculitis presenting with unknown etiology. Coronary artery ectasia or aneurysms may develop in 15% to 25% of untreated children and may lead to sudden death or ischemic heart disease later in life. Thus, early diagnosis and treatment with intravenous immunoglobulin and acetylsalicylic acid as soon as possible are important. Patients who have persistent or recurrent fever more than 24 hours after completion of the initial treatment should also be assessed for other causes of fever including intercurrent infection, and the diagnosis of refractory Kawasaki disease should be reevaluated.