INTRODUCTION: The primary goal in solitary pulmonary nodule (SPN) management is to distinguish malignant lesions from benign ones. In our study, we aimed to evaluate the follow-up results, malignancy rates, and risk factors for malignancy of SPNs, which were discussed in our multidisciplinary lung cancer council (MLCC) with suspicion of malignancy and decided for surgical treatment.
METHODS: Cases that were decided for surgical diagnosis and treatment after evaluation in the council were included in our study, which was planned prospectively. Demographic features, nodulsize, radiological features, location, Positron Emission Tomography (PET) findings, whether bronchoscopy and endobronchial ultrasonography were performed and their results, duration of follow-up before surgery, interventions and their results made for diagnosis, surgical method performed, and the final diagnosis were recorded. Chi-square and Mann–Whitney U tests were used in statistical analysis.
RESULTS: Of the 33 cases in our study, 10 (30.3%) were female and 23 (69.7%) were male; the average age was 60.2±7.9 (min: 42;max: 77) years. The average diameter of SPN was measured as 16.5±6.3 (min: 7; max: 30) mm. When looking at their locations, it was seen that 72.7% were located in the upper lobes. 75.8% of the nodules were solid in character, 39.4% had spiculated contours, and 33.3% had lobulated contours. There was no calcification in 87.9% of the nodules. In the PET computed tomography examination, the average SUVmax value of nodules was measured as 6.05±6.01 (min: 0; max: 22), and there was no FDG uptake in the mediastinal lymph nodes of 21 (63.6%) cases. Surgical intervention was decided in 27 (81.8%) cases without a diagnosis. The final diagnosis was malignancy in 69.7% of cases. A statistically significant correlation was found between the final diagnosis and the edge features of the nodule and the SUVmax value (p=0.021, p=0.048, respectively).
DISCUSSION AND CONCLUSION: Since SPN can represent early-stage primary lung cancer, risk factors and radiological features for each patient in SPN management should be individually assessed, and decisions should be made with a multidisciplinary approach. The aim is to minimize the outcomes of over-investigation, including patient anxiety and cumulative radiation exposure, while identifying nodules representing early malignancy.

INTRODUCTION: The purpose of this study was to showcase the outcomes of endovascular treatment, assessing its safety and efficacy for patients with symptomatic severe atherosclerotic stenosis of the vertebral artery, who did not respond to medical management and were treated at our institution.
METHODS: We performed a retrospective analysis on patients who had suffered a transient ischemic attack or ischemic stroke and received endovascular treatment for symptomatic vertebral stenosis despite being under medical care. The endovascular techniques utilized were cataloged as angioplasty alone, balloon-mounted stenting, or angioplasty with subsequent self-expanding stent insertion. We recorded both peri-procedural complications, such as in-stent thrombosis, dissection, and guide wire perforation, as well as post-procedural complications, including stroke and transient ischemic attack. The study focused on analyzing the endovascular treatment methodologies alongside clinical and radiological outcomes.
RESULTS: From January 2020 to December 2022, 15 patients were treated, including 6 with V1 segment stenosis, 2 with V2, and 7 with V4 segment stenosis. The rate of successful stent placement was 100% (15 out of 15). Six patients (40%) received a balloon-expandable stent in addition to angioplasty, while the remaining nine (60%) were treated with a self-expanding stent following angioplasty. No peri-procedural complications were reported in patients who had extracranial stenting. However, during intracranial stenting, complications occurred in two cases: one patient had a dissection leading to occlusion of a perforator artery, and another experienced stent thrombosis. These complications resulted in ischemic strokes and subsequent mortality during hospitalization in two patients (13% of the cohort). The median follow-up duration was 15 months, with an interquartile range of 9 to 24 months. An improvement in the modified Rankin Score was noted in 10 patients, while no change was observed in 3 patients.
DISCUSSION AND CONCLUSION: Our findings advocate for the safety and probable efficacy of endovascular treatment in patients with vertebral artery stenosis who are non-responsive to optimal medical therapies. Stenting, particularly for extracranial vertebral artery stenosis, can be performed with a low rate of complications and is deemed safe.

INTRODUCTION: In this study, the effects of gliclazides, a second generation sulfonylurea group, on BDNF and NGF plasma levels, which are considered neurodegeneration biomarkers, will be examined. When designing our study, we assumed that gliazides might have positive neuronal effects. Thus, the possible positive effects of gliclazide will be emphasized in our study.
METHODS: In the experiment, 21 adult male Wistar-Albino rats were used. Serum BDNF and NGF levels were determined by analyzing with enzyme-linked immunosorbent assay kit in accordance with the recommendations.
RESULTS: BDNF levels were significantly lower in gliclazide-treated diabetic rats and non-medicated diabetic rats compared to the healthy control group (p=0.017, p<0.001, respectively). Although the BDNF level of rats with diabetes given gliclazide was increased compared to rats with and without diabetes, this difference was not significant (p=0.107). Similarly, NGF levels were significantly lower in rats given gliclazide (p=0.009) and diabetic rats not given gliclazide (p=0.001) compared to the healthy control group. When the diabetic groups were compared among themselves, although the NGF level was increased in the gliclazide group, this difference was not statistically significant (p=0.638). The differences between the groups were significant in cyclic AMP regulatory element binding (p<0.001), c-FOS (p<0.001), amyloid precursor protein (p<0.001), B-SECRETASE1 (p=0.004), and doublecortin (p<0.001) levels.
DISCUSSION AND CONCLUSION: As a result, serum BDNF and NGF levels were significantly higher in non-diabetic healthy control group rats than in diabetic rats. While low serum levels of BDNF and NGF neurotrophins, which increase in neurodegeneration, were observed in diabetic rats, this level was observed to be higher in diabetic rats given gliclazide.

INTRODUCTION: Emergency departments have been the first step in managing the COVID-19 infection, which has been declared a worldwide pandemic. This study aims to determine the clinical characteristics of patients admitted to the emergency department with the suspicion or symptoms of COVID-19 infection.
METHODS: The sample of our study consisted of patients aged 18 and over who were admitted to the emergency department of a tertiary hospital in Istanbul with symptoms or suspicion of COVID-19 between September and December 2020. Five hundred patients with positive RT-PCR test results and 500 patients with negative test results were included in the study. The patients’ data were retrieved retrospectively through the hospital’s information management system.
RESULTS: The mean age of patients with COVID -19 (-) (53.2±18.1) was lower than that of patients with COVID -19 (+) (59.2±18.4) (p=0.001). The distribution of sex (p=0.61) and occupation (p=0.52) was similar in both groups. The rate of presentation with dyspnea was higher in COVID -19 (+) patients (37.6%) than in the COVID -19 (-) group (22%) (p=0.001). Body temperature measured in the emergency department was higher in COVID -19 (+) patients than in COVID -19 (-) patients (p=0.04). Mean SPO2 was lower in COVID -19 (+) patients (92.3±9.6%) than in COVID -19 (-) patients (96.2±4.8%) (p=0.001). The incidence of ground-glass opacities in the thorax CT was higher (59.6%) in the COVID -19 (+) patient group than in the COVID -19 (-) (47.5%) patient group (p=0.003).
DISCUSSION AND CONCLUSION: In this study, the clinical features of COVID-19 infection in patients admitted to the emergency department were compared with the literature. Conducting similar studies on COVID-19 infection is essential to update the existing literature and add new data. More comprehensive studies and evidence are needed to effectively manage the diagnosis and treatment process of the epidemic.

INTRODUCTION: With the announcement of the pandemic, in the era of countries with lockdown, city quarantines, postponed non-obligatory clinical appointments, and curfew, the importance of the shift of health-care services to virtual environment increased. In this study, it was aimed to interpret the search volumes of “telepsychiatry” and “online therapy” topics, one of the telemental health services, based on Google Trends, to evaluate the health seeking behavior in society and the demand for telemental health services.
METHODS: Google Trends is a free to access tool that provides relative volume of the terms that people searched in Google engine. Relative Search Volumes on two topics, Telepsychiatry and Online Counseling, were obtained through Google Trends. Search titles are used as “topics” since they represent a group of terms in any language that Google trends covers.
RESULTS: Relative search results were evaluated as before and after the pandemic, online therapy and telepsychiatry. Comparisons that not normally distributed were assessed through Mann–Whitney U test. The search volume for telepsychiatry and online therapy after the pandemic increased significantly compared to before the pandemic (p<0.05). When search volumes in both before and after the pandemic were compared, interest to online therapy was superior than telepsychiatry in both periods (p<0.05).
DISCUSSION AND CONCLUSION: It could be said that, in time periods like pandemics and the cases that people cannot reach conventional mental health support, if the issues in legal, ethical, technical, therapeutic relationship, and professionalism could be overcome, the interest in telemental health would increase.

INTRODUCTION: Iatrogenic ureteral injuries are critical consequences of pelvic and vaginal surgeries that can lead to severe morbidity and even death. Therefore, the purpose of this study was to evaluate the outcomes of primary laparoscopic repair of ureteral injuries during laparoscopic hysterectomy (LH).
METHODS: Patients who underwent LH between November 2018 and October 2021 were evaluated retrospectively. Medical records of all patients with ureter injury were reviewed and their causes of injury, incidence, treatment and follow-up were evaluated.
RESULTS: A total of five patients had ureter injury during laparoscopic surgery. All ureter injuries immediately repaired during the same operation without conversion to laparotomy or additional trochar insertion.
DISCUSSION AND CONCLUSION: Identification of intra-operative urinary tract injury during gynecological operations allows for appropriate and immediate repair. The result of the study showed that gynecologists experienced in endoscopic surgery can successfully and effectively managed ureteral injury during laparoscopy.

INTRODUCTION: We aimed to determine the utility of CD4 T lymphocyte counts and percentages and CD4/CD8 ratios as markers for the progression of latent tuberculosis infection (LTBI) to active tuberculosis (TB) infection in HIV-positive patients followed in the Acquired Immunodeficiency Virus (HIV) Polyclinic of our hospital.
METHODS: The files of 530 HIV-positive patients were retrospectively analyzed. “Tuberculin skin test” (TST) was applied after the anti-HIV test was positive. Asymptomatic patients with a TST ≤5 mm were considered TB negative, patients with a TST ≤5 mm were considered LTBI, and all symptomatic patients (fever, cough, night sweats, weight loss) regardless of TST result were considered as active TB infection. CD4 counts and percentages and CD4/CD8 ratios were calculated and the relationship between LTBI and active TB infection was evaluated using Mann-Whitney U test and independent sample t-test.
RESULTS: During the specified period, 530 patients were admitted to the HIV Outpatient Clinic. There were 43 (8.11%) patients in the LTBI group, of whom 4 (9.3%) were female and 39 (90.7%) were male. CD4 was <200 mm³ in 7 (16.3%) patients and >200 mm³ in 36 (83.7%) patients. The mean CD4/CD8 ratio was 0.55 (0.08-1.45). 21 (3.96%) patients had symptoms of fever, cough, night sweats and weight loss and were diagnosed with active TB infection. Among these patients, 1 (4.8%) was female and 20 (95.2%) were male. CD4 was <200 mm³ in 5 (23.8%) patients and >200 mm³ in 16 (76.2%) patients. The mean CD4/CD8 ratio was 0.38 (0.07-1.8). The difference in CD4 counts between patients with LTBI and active TB infection was not significant, but the difference in CD4/CD8 ratio was significant (p<0.05).
DISCUSSION AND CONCLUSION: Immune dysfunction that occurs in HIV and TB co-infection facilitates the activation of LTBI. While CD4 counts and CD4 percentages were not significant as risk markers, CD4/CD8 ratio was found as significant.

INTRODUCTION: There is strong evidence that excess and early cardiovascular disease (CVD) occurs in patients with unipolar depression (UD) and bipolar disorder - depressive episode (BD-d). The aim of this study is to evaluate plasma atherogenic index (AIP), atherogenic coefficient (AC), Castelli risk index I-II (CRI-I and II) and high-density lipoprotein (HDL) related ratios in UD, BD-d and HC.
METHODS: The present study was designed as a retrospective and observational study. This study included 128 patients with UD, 184 individuals as a healthy control group and 34 patients with BD-d. AIP [log (TG/HDL)], AC [(TC-HDL)/HDL], CRI-I (TC/HDL) and II (LDL/HDL), MHR (monocyte/HDL), NHR (neutrophil/HDL), PHR (platelet/HDL) and LHR (lymphocyte/HDL) were calculated in these three groups. ANCOVA was used for age- and sex- adjusted means.
RESULTS: There were significant differences in fasting glucose (FG) (p=0.016), LDL (p=0.004), HDL (p<0.001), TG (p<0.001), TC (p=0.01), AIP (p<0.001), NHR (p<0.001), MHR (p=0.007), LHR (p<0.001), PHR (p<0.001) between three groups. All these metabolic parameters were correlated with duration of disorder.
DISCUSSION AND CONCLUSION: Along with the care of a depressive episode, the management of abnormal metabolic parameters should be planned during diagnosis, follow-up, and treatment. Assessment of AIP and NHR, especially in chronic and unresponsive processes, may be useful in both disorders. In future studies, it is recommended to conduct large-scale studies that are prospectively designed, that monitor the severity of the disease, and that evaluate the CVD risk parameters and treatment of the participants.

INTRODUCTION: This study aimed to compare the effectiveness of preoperative information and sedative premedication for decreasing preoperative anxiety of patients scheduled for elective surgery.
METHODS: ASAI-II, aged 20–65 years, 90 patients who were scheduled for surgery in a University Hospital, Gynaecology and Obstetrics Service were included in the study. Anxiety levels of all patients were measured with the STAI questionnaire one day before the operation. The patients were divided into three groups. After the questionnaire, detailed private information was given to a group of patients (GroupP) by the anaesthesiologist who will perform the anaesthesia. Oral diazepam was given to a group of patients (GroupPh) before they came to the operating room. Routine preoperative visits were made to the patients in the control group (GroupC) after applying the questionnaire. After they were brought to the operating room, the STAI questionnaire was applied to all patients again before the surgery.
RESULTS: Median State anxiety was 48 (23-70), median Trait anxiety was 44 (31-67) and median VAS was 50 (0-100) in all patients.After preoperative information, the state anxiety was lower significantly in GroupP (p<0.001).After diazepam, the state anxiety was lower significantly in Group Ph (p<0.001).The median state anxiety of GroupP and GroupPh that were assessed just before the surgery was lower than GroupC (p=023, p=0.007). There was no significant difference between the state anxiety of GroupP and GroupPh after the intervention (p=0.750).
DISCUSSION AND CONCLUSION: It has been shown that effective use of the time allocated to patients and informing by the anaesthesiologist who will perform the anaesthesia in reducing preoperative anxiety is as effective as drug-induced premedication.

INTRODUCTION: A glycoprotein hormone called erythropoietin (EPO) regulates hematopoiesis, but also affects many other tissues, such as the human endometrium. Patients with chronic kidney disease (CKD) are frequently treated for anemia using recombinant EPO. The aim of this preliminary study was to evaluate the impact of recombinant EPO on the postmenopausal endometrium of individuals with CKD.
METHODS: This prospectively designed study, non-hysterectomized postmenopausal women who were scheduled for Epoetin alpha treatment for their renal conditions in a nephrology clinic of a tertiary centre were included to the study between February 2017 and January 2018. To assess endometrial thickness measurements by transvaginal ultrasonography before (day 0) and at the 3rd, 30th and 90th days after the first EPO injections.
RESULTS: Endometrial thicknessess of the study participants who received EPO (50-150 IU/kg/week) were 2.98±1.07 mm at day 0, 5.01±1.51 mm at day 3, 4.41±2.01 mm at day 30, and 3.79±1.42 mm at day 90. Endometrial thicknessess were significantly higher at 3rd and 30th day visits, when compared to the basal measurements and declined gradually at the 90th day (Repeated measures analysis of variance, post-hoc Tuckey’s test, p<0.01).
DISCUSSION AND CONCLUSION: Short term recombinant EPO treatment has a reversible proliferative effect on postmenopausal endometrium. In this study, short term reversible proliferative effect of EPO was observed and in one patient a benign endometrial polyp developed. Larger prospective studies could answer the risk of neoplasia in patients on chronic EPO treatment. Our study may contribute to the early diagnosis of endometrial hyperplasia or neoplasia by raising awareness about patients receiving EPO treatment.

INTRODUCTION: We aimed to investigate whether the ratios of craniocaudal (CC), anteroposterior (AP), and mediolateral (ML) measurements to each other are useful in diagnosing thyroid papillary carcinoma by ultrasound.
METHODS: The patients who have a solid thyroid nodule on ultrasonography which were diagnosed by a histopathological examination after a trucut fine needle biopsy were included in this study. Proportions of all three dimensions to one another were recorded.
RESULTS: A total of 173 patients with a mean age of 44.49±14.54 years were included. Of the patients included in the study, 137 (79.19%) were female and 38 (20.81%) were male. AP/ML ratio (p=0.016) and CC/ML ratio showed a significant difference between thyroid papillary carcinoma group and benign nodule groups. Furthermore, a cut-off value of 0.7 AP/ML ratio showed sensitivity and specificity of 0.667 and 0.45, respectively.
DISCUSSION AND CONCLUSION: AP/ML ratio shows association with increased thyroid papillary carcinoma risk. CC/ML is also associated with increased risk. These rates may also contribute to clinical practice as a diagnostic tool.

INTRODUCTION: Promising reports from recent studies show the effect of convalescent plasma as an adjunct alternative in treatment. The subject of our study is evaluating the current knowledge level about convalescent plasma donation and psychometric properties of possible plasma donors and their change of tendency toward being donors after receiving structured information.
METHODS: Four hundred plasma donor candidates were assessed for their current knowledge level, anxiety, depression, and health anxiety scores. Their tendency to be voluntary plasma donors before and after structured information was evaluated with surveys.
RESULTS: In participants who are undereducated or uneducated, correct information changed the decision of being a plasma donor more than educated persons, and the statistical difference between donors that have different education levels nearly disappeared with sufficient knowledge (0.006 vs. 0.037, p values). Furthermore, the previous blood donation or need for blood products in the past was important factors to be a plasma donor volunteer, regardless of sufficient information. After the structured information given, it was observed that the psychological states of the participants had no effect on plasma donation tendencies.
DISCUSSION AND CONCLUSION: It was observed that after the correct information, the dispositional differences between the individuals disappeared, regardless of the psychological and educational status of the individuals. Furthermore, this study suggests that the previous blood donation history is a predictive factor for being a plasma donor; so, interventions to encourage blood donation are seen as an effective approach for the long-term to increase plasma donation supply in acute situations. The results of our study emphasize that informing individuals and society is one of the basic approaches to increase plasma donation in the short- and long-term.

INTRODUCTION: Main factors affecting survival in lung cancer are known to be histopathological subtype and stage. In this study, we aimed to uncover factors affecting long-term outcomes in early-stage lung cancer treated with thoracoscopic anatomical resection.
METHODS: The study took place between 2006 and 2018. A total of 204 patients who underwent thoracoscopic anatomical resection were evaluated retrospectively. Preoperative, perioperative, and postoperative parameters were evaluated, and their influence on survival was analyzed. Preoperative parameters, age, gender, and respiratory function tests — diffusing capacity of the lungs for carbon monoxide (DLCO) — are evaluated. Perioperative parameters included the type of anatomical resection and conversion to open thoracotomy. Postoperative parameters included major and minor complications, duration of hospital stay.
RESULTS: A total of 204 patients were included in the study. The 5-year survival rate was 76.5%. Age 65 or younger is related to better 5-year survival (80.6% vs. 67.7%, p=0.008). Five-year survival of patients with a DLCO value greater than 80% is 83.2%, and it is 51.1% for a DLCO value equal to or lower than 80% (p=0.001). Hospital stay for 4 days or less is related to better 5-year survival (86% vs 69%, p=0.017).
DISCUSSION AND CONCLUSION: In our study, it was determined that age, preoperative DLCO value, duration of hospital stay, and postoperative complication development were statistically significant in survival. However, conversion to open thoracotomy and the difference between segmentectomy and lobectomy did not have a specific effect on survival.

McLeod syndrome is a rare seen chorea etiology. A patient with chorea, epilepsy and cardiac problems usually suggests a neuroachantocytosis syndrome and the definite diagnosis depends on a detailed genetic investigation. Here we report 57 and 39 years old males who developed choreiform movements and tics afterwards, causing social disturbances and walking difficulty. Depending on the acanthocytosis seen on peripheral blood smear and genetic investigation, the patients has been diagnosed as McLeod syndrome with a novel and point mutations.

Ganglioneuroblastoma is a rare malignant pediatric tumor located in the posterior mediastinum. A giant mass lesion located in the posterior mediastinum and extending into the spinal canal was observed in a 4-year-old girl admitted to our hospital with walking difficulties. The mass was completely excised with a joint operation of neurosurgery and thoracic surgery. After the operation, the patient regained walking functions.

Toluene is a solvent used in various industries as a raw material to produce organic compounds and in the manufacture of diverse products. Contact with toluene can occur both accidentally and intentionally. Intoxication with toluene and its by-products, whether intentional or accidental, can be toxic to all systems, with the cardio-pulmonary system being primarily affected. The intentional use of toluene leads to psychoactive effects, including euphoria, which makes it the most widely inhaled volatile drug among all age groups in many countries. Renal tubular acidosis is the most common complication arising from toluene intoxication. This case report will discuss a 38-year-old patient who was admitted to the emergency service of our hospital.