INTRODUCTION: Our objective is to point out the value of the different clinical observation scales in determining the mortality rates.
METHODS: The information of 2.386 patients who were admitted to the neurology clinics of our hospital with the diagnosis of ischemic cerebrovascular disease (CVD) within 4 years was scanned from stroke database. The age, gender, and deaths of the patients were recorded. CVD clinical picture; evaluated by OCSP, NIHSS, GCS, SAPS, and mRs.
RESULTS: The mean age of 2.386 cases included in the study was 65.7 years, and the death rate increased significantly as the age increased. There was no significant relationship between the death rate and gender (women 51.7%). According to the OCSP classification, the highest number of patients was in the PACI group (30.6%), while the group with the highest number of deaths was the TACI group (48.1%). The highest mortality rate was found in the group with NIHSS ≥23 (84.8%). In the group with GCS: 3–6 (10.8%), the mortality rate was the highest with 87.9%. Death occurred 82.8% of patients with a SAPS ≥14. Mortality rate was 21.9% in patients with a mRs ≥3. In comparison with the Chi-square test, all parameters except gender had a significant effect on death. (p<0.0001) As a result of logistic regression analysis, all parameters except mRs had a significant effect on death.
DISCUSSION AND CONCLUSION: This article reviews both functional outcome measures and detailed neurological deficit measures used in stroke therapeutic efficacy study. While neurological measures predict mortality by detecting minor changes in neurological function, functional outcome measures seem to be more relevant to the patient’s ability to function independently.

INTRODUCTION: The aim of the study was to compare the clinical and radiological results of long proximal femoral nail antirotation (LPFNA) with proximal femoral locking compression plate (PFLCP) in fixation of reverse oblique intertrochanteric fractures that are classified as 31A3.
METHODS: Sixty-two patients were included in the study. Fixations were performed with LPFNA in 35 patients (n group) and PFLCP in 27 patients (p group). We retrospectively reviewed all patients’ pre-operative, perioperative, and post-operative data. All variables were compared between the groups.
RESULTS: The mean age was 61.7 (range; 29–92) years. The mean estimated total blood loss, the mean operation and fluoroscopy times, the patient receiving the blood transfusion ratio, and the number of anatomical quality of reduction were statistically significantly higher in the p group than of the n group. The mean change of neck-shaft and femoral anteversion angles was statistically significantly higher in the N group than of the p group.
DISCUSSION AND CONCLUSION: Although the LPFNA was superior in the perioperative data, the PFLCP was superior in providing and persistent of the reduction. In functional scores, both implants had similar and satisfactory outcomes. According to our results, PFLCP could be a good option for fixation of reverse oblique trochanteric fractures.

INTRODUCTION: We aimed to investigate the effects of inhaled corticosteroids (CS) on bone mineral density (BMD), bone formation-resorption markers, and quality of life in premenopausal asthmatic women.
METHODS: Premenopausal women diagnosed with asthma and using regular inhaled CS for at least 3 months were included in our cross-sectional study. As the control group, premenopausal women without a diagnosis of asthma and who had not used steroid before were included in the study. Serum bone-specific alkaline phosphatase (BAP), osteocalcin, and β crosslapse levels were evaluated as bone formation-resorption markers. BMD, T and Z scores of lumbar vertebra L2-L4 anterior, left femoral neck, and total hip were measured. The Short Form 36 (SF-36) quality of life scale was used to assess the quality of life.
RESULTS: Twenty-two asthmatic patients and 22 non-asthmatic individuals as a control group were included in the study. There was no statistically significant difference between L2-L4 anterior, femoral neck and total hip BMD, T and Z scores, and serum osteocalcin, β crosslaps, and BAP levels between both groups (p>0.05). No statistically significant correlation was found between the duration of inhaled CS use, cumulative inhaled CS dose, and BMD in asthmatic patients (p>0.05). SF-36 quality of life scale pain score was found to be statistically significantly higher in patients with asthma compared to the control group (p<0.05). No significant difference was found in the other subscales of the SF-36 quality of life scale (p>0.05).
DISCUSSION AND CONCLUSION: In our study, we did not find the effect of inhaled CS on BMD and bone formation and resorption markers. We did not find any difference between the asthmatic patients and the control group in the sub-parameters of the SF-36 quality of life scale, except for pain. This suggests that inhaled CS may have a positive effect on quality of life in patients with asthma.

INTRODUCTION: Brain damage in the early-period after subarachnoid hemorrhage (SAH) is a significant cause of mortality; however, cell proliferation, apoptosis, and inflammatory cascades play roles in preventing. This study aimed to determine the effect of progesterone on miR-30a and miR-143 expressions after SAH.
METHODS: The research was conducted on 40 Sprague-Dawley rats. They were assigned to four groups: Group 1 with SAH (n=10); Group 2, SAH+8mg progesterone (n=10); Group 3, SAH+10mg progesterone (n=10); and Group 4, the controls (n=10). Experimental SAH was created by cisternal injection model. RNAs were isolated from brain tissues and miRNA expression levels were determined by Quantitative Real-Time PCR.
RESULTS: There was a 176-fold and 126-fold decrease in miR-30a and miR-143 expressions of male rats with SAH (p<0.05). In the male rats administered with 8 mg and 16 mg progesterone, 39-fold and 2.4-fold decreases were found in miR-30a expressions (p<0.05). In the expression levels, there were a 2.3-fold decrease and a 15-fold increase in miR-30a and miR-143 in females (p<0.05). In the female rats administered with 8 mg and 16 mg progesterone, a 1.25-fold increase and 4.5-fold decrease were found in miR-30a expressions (p<0.05); however, 1400-fold and 400-fold increases were found in miR-143 expressions (p<0.05) on the females with 8 mg and 16 mg progesterone.
DISCUSSION AND CONCLUSION: The decrease in miR-30a and miR-143 expressions in the males with SAH approached the normal limits by increasing doses of progesterone. We think that the molecular basis of this dose-dependent effect of progesterone in miR-30a and miR-143 expressions should be investigated in further studies.

INTRODUCTION: The global COVID-19 pandemic has led to significant changes in emergent and elective treatment approaches in medical field, including ophthalmology. The aim of our study is to evaluate the indications, anatomical, and visual results of vitreoretinal surgery (VR) procedures performed during the pandemic and quarantine period.
METHODS: VR procedures applied in the treatment of various retinal diseases in a tertiary eye hospital between March 11th and May 31st, 2020, during the COVID-19 pandemic and quarantine period were retrospectively reviewed. Indications of the applications, anatomical and visual results, and surgical complications were evaluated.
RESULTS: In this period, 197 (59%) of 335 patients who underwent VR procedure were male, 138 (41%) were female. VR procedure was performed frequently in rhegmatogenous retinal detachment (48.6%) cases, followed by diabetic tractional retinal detachment (14.0%), complicated vitreous hemorrhage (11%), silicone oil extraction due to silicon-related complications (10%), endophthalmitis (7.5%), vitreoretinal pathologies secondary to trauma (5.8%), nucleus drop (2.1%), and intraocular lens drop (1.5%) cases. The pre-operative mean best corrected visual acuity of cases increased from 0.021±0.167 to 0.258±0.213 (p=0.042) logMAR. Local anesthesia was applied to 255 (76.1%) and general anesthesia to 80 (23.9%) of the patients who underwent VR in guideline adhered operating rooms. About 95% (n=318) of the patients were anatomically successful and the retina was reattached. Intraocular pressure fluctuations were the most common complication in patients. Elevated intraocular pressure was observed in 9.8% of the patients who underwent treatment for RRD, and hypotonia was found in 9.3% of the patients who underwent silicone oil extraction.
DISCUSSION AND CONCLUSION: The visual and anatomical success and complication rates of VR procedures during the COVID-19 period are similar to pre-pandemic period. If appropriate protection, ventilation, and operating room conditions are provided, the risk of contamination for healthcare workers and patients can be minimized and VR interventions may be safely applied.

INTRODUCTION: Clozapine is an effective atypical antipsychotic that has been successfully used in the treatment of schizophrenia and schizoaffective disorder, but its utilization is restricted due to the side effects. We aimed to investigate the side effects reported by patients using clozapine and their role in the cessation of the treatment.
METHODS: In our study, the follow-up charts and admission files of patients with schizophrenia and schizoaffective disorder who were followed up regularly at outpatient clinics were reviewed retrospectively. 246 patients who had received or are currently taking clozapine were identified. The sociodemographic and clinical features of the patients, reported side effects, and the reasons for discontinuation were recorded.
RESULTS: The most frequently side effects reported by the patients were sedation (35.6%), hypersalivation (27.9%), weight gain (19%), incontinence (8.1%), obsessive–compulsive symptoms (6.5%), seizure-myoclonus (4.9%), orthostatic hypotension (4.5%), leukopenia (3.6%), sexual side effects (1.2%), and constipation (0.8%). Clozapine treatment was terminated in 26.6% of the patients due to non-adherence to medication (35.4%), inadequate effect/side effect ratio (13.8%), ineffectiveness (12.3%) leukopenia (9.2%), seizures (7.7%), incontinence (6.2%), sedation (6.2%), obsessive–compulsive symptoms (3.1%), weight gain (3.1%), hypersalivation (1.5%), and orthostatic hypotension (1.5%). When the reasons for discontinuation were analyzed, it was determined that failure to provide sufficient effect and irregular use were significantly higher in patients who have a history of more suicide attempts.
DISCUSSION AND CONCLUSION: Side effects of clozapine treatment are common. Approximately one-quarter of patients receiving clozapine discontinued the treatment due to intolerance of side effects, non-adherence to treatment, or failure to provide sufficient effect. In patients with a worse course since the onset of the disease, treatment discontinuation due to insufficient efficacy and irregular use was higher.

INTRODUCTION: Pilonidal sinus is a subcutaneous inflammatory disease most commonly seen in the sacrococcygeal region and is more common in boys. It is seen earlier in women because of the earlier onset of puberty and activation of sex hormones during this period. To the best of our knowledge there is a very limited research regarding the interrelation of insulin resistance levels and plonidal sinus disease (PSD). This study aims to determine the role of insulin resistance on the development of pilonidal sinus disease in female adolescents.
METHODS: This retrospective study includes a patient group of 30 adolescent girls who were operated for PSD and a control group created from the hospital records with the same number. Free T3, T4, TSH, insulin and fasting blood sugar levels were recorded from the hospital data-base. Homeostasis model assessment of insulin resistance (HOMA-IR) score was calculated to describe the insulin resistance. Insulin resistance was defined when HOMA-IR score ≥ 2.86 in adolescents.
RESULTS: The median age of the patients was 15.83±1.86 years and twenty-five of them (%83.3) were accepted to be insulin resistant. According to our findings the levels of thyroid function tests (free T3, free T4, and TSH) did not vary substantially between patient and control groups (p>0.05). A strong correlation was found between PSD and high insulin (mean±SD 19.46±7.28; p<0.05) and HOMA-IR score (mean±SD 4.59±1.87; p<0.05).
DISCUSSION AND CONCLUSION: According to the correlation analysis of HOMA-IR scores and insulin levels it is concluded that high insulin level with elevated HOMA-IR score may cause excessive hair growth by means of hormonal pathways. Therefore hyperinsulinemia is a risk factor for the development of PSD in female adolescents.

Ischemic stroke treatment has been changing in recent years and these procedures have positive effects on patients’ prognosis, morbidity, and mortality. Intravenous Treatment with Recombinant Tissue-Type Plasminogen Activator (iv r-tPA) is one of the most efficient approaches in ischemic stroke patients. When administered in the first 4.5 h from symptom onset, it has been proven to be effective in functional improvement. However, physicians may feel hesitant about administering these treatments regarding the possible complications,especially the patients with recurrent stroke. The aim of this article is to contribute to the literature on the efficacy and safety of recur-rent iv r-tPA therapy in patients with recurrent stroke. We present seven patients who underwent thrombolytic treatment more than one time between September 2017 and September 2020 and recorded the patients’ gender, risk factors, age, initial/final National Institutes of Health Stroke Scale (NIHSS), and hemorrhagic transformation rates. Mean interval of iv r-TPA treatment was 244.7 days (minimum 58 days, maximum 1 year 9 months 10 days). Average of NIHSS calculated as 7.57 before the first and 8.26 before the second iv r-tPA treatment; at the time of discharge mean of NIHSS was 1.57 and 2.8 respectively for five patients. Five of the patients have been identified as cardioembolic in aetiology. In two of our cases, clinical worsening was observed in the follow-ups after iv r-tPA. Our symptomatic intracranial hemorrhage rates were similar to the literature seen in one patient. Rates of bleeding were directly proportional with calculated HAS-BLED scores in patients who were started anticoagulation. Our complication rates were similar with literature and the prognosis of recurrent r-tPA was discovered to have a good prognosis in the first 3 months.

Endoscopy done on a 40-year-old female patient with dyspeptic complaints revealed a 25 mm subepithelial lesion on the posterior corpus wall. Subsequently, she was referred to our clinic for endoscopic ultrasound (EUS). In our EUS examination, a 24×17 mm subepithelial lesion originating from the muscularis propria and hypoechoic appearance was observed. EUS-fine-needle aspiration was performed; mucinous fluid was aspirated. Benign cystic growth lined with ciliated epithelium was interpreted as a bronchogenic cyst.

Primary hyperparathyroidism is an endocrine disease characterized by hypercalcemia-specific symptoms and signs with elevated parathormone (PTH). It can be accompanied by one or more adenomas, hyperplasia, or rarely parathyroid carcinoma. Parathyroidectomy is commonly used for treatment. Post-operative hypocalcemia or recurrent hyperplasia may develop so patients should be closely monitored. In this case report, a patient with isolated elevation of PTH levels, 2 years after total parathyroidectomy and forearm auto-transplantation, is presented. Detection of spuriously elevated PTH levels in the transplanted forearm may lead to misdiagnosis of recurrent hyperparathyroidism. If PTH levels remain high in patients with forearm auto-transplantation, it is essential to measure PTH levels in both arms.

Prompt and accurate histopathologic evaluation of breast lesions which are suspicious for malignancy is very important for early diagnosis and survival of breast cancer. Microcalcifications which are a sign of early breast cancer can be detected only by mammography. Biopsy and pre-operative localization of microcalcifications are only made by mammography guidance. At present, the standard procedure for mammographic biopsy is vacuum-assisted biopsy (VAB). VAB mostly provides accurate diagnosis without needing a surgery. This reduces the burden for the patients, clinicians, and the health system related with surgery. This review discusses the technical details and general evaluation of interventional procedures which are made by mammography guidance.