Organ transplantation is a life-saving treatment option for patients with end-stage organ failure. Graft rejection is a significant complication that can develop after an organ transplant, and its pathophysiology depends on many variables. Macrophages are one of the main cell types of the innate immune system. Clinical studies showed that macrophages recognize the antigens and play an important role in graft rejection. Infiltration of macrophages is associated with an increased incidence of graft rejection. Macrophage-targeted therapeutic studies are required to prevent long- and short-term graft rejection and increase graft survival. This review focused on the potential macrophage-targeted therapeutic strategies to improve graft survival. Also, we reviewed the literature regarding the role of macrophages in organ transplantation.

Objective: The association between blood markers and testicular viability after testicular torsion (TT) is not well known. Here, the role of the neutrophil-tolymphocyte ratio (NLR) in predicting testicular viability in children with TT was evaluated.
Methods: Clinical data of eighty children younger than 18 years of age who underwent TT between 2018 and 2023 were analyzed. Age, symptom duration, degree of spermatic cord torsion, surgical approach adopted, and hematological parameters including neutrophil, lymphocyte, and C-reactive protein (CRP) levels were obtained. The NLR was calculated.
Results: The median age was 14 (1-17) and the median duration of symptoms was 24 h (1-168 h). Testicular blood flow in color Doppler ultrasonography was absent in 64 patients (81%). During scrotal exploration, 39 patients (49%) underwent orchiopexy and 41 (51%) underwent orchiectomy. Median NLR (2.8 vs 5 p<0.001), and CRP (2.6 vs 27 p<0.001) were higher among patients who underwent orchiectomy. Patients with higher than 3.5 NLR were significantly more likely to undergo orchiectomy (37% vs 63%).
Conclusion: NLR and CRP were significantly associated with testicular viability, and both parameters can be used to predict the outcome of testis in TT.

Objective: The mean erythrocyte volume (MCV) plays an important role in the differential diagnosis of nutritional anemia. Generally, the causes of microcytic anemia in low MCV and macrocytic anemia causes in high MCV are considered. In this study, it was aimed to examine the relationship between nutritional anemias and erythrocyte indices.
Methods: The files of patients with nutritional anemia in the pediatric hematology outpatient clinic were analyzed retrospectively. Patients whose hemogram parameters, iron, total iron binding capacity, ferritin, B12 and folic acid levels were studied were included in the study. Combined nutritional anemia was defined as the coexistence of both types of anemia (iron deficiency and B12 deficiency).
Results: A total of 407 patients, 252 (61.9%) female and 155 (38.1%) male, were included in the study. The mean age of the patients was 8.82±6.15 years. Iron deficiency anemia was found in 192 (47.2%) patients, combined nutritional anemia in 185 (45.4%) patients, and B12 deficiency anemia in 23 (5.7%) patients. MCV, iron and transferrin saturation were found to be lower in the iron deficiency anemia group compared to the group with combined nutritional anemia (p<0.05). However, both the iron deficiency group and the combined nutritional anemia group had microcytic anemia (respectively, MCV: 70.39 fL, MCV: 78.18 fL).
Conclusion: Combined nutritional anemia is as common as iron deficiency anemia and may present as microcytic anemia. MCV is not a guide in these patients. Therefore, B12 levels should be checked in addition to iron parameters in patients who present with microcytic anemia and are thought to have nutritional anemia.

Objective: We planned to investigate the age of onset of type 2 diabetes mellitus (T2DM) in our region and the factors affecting it in the İstanbul Kartal Region.
Methods: Age at diagnosis, body mass index, exercise, alcohol consumption, smoking, and co-morbidity anamnesis were taken from 566 T2DM patients who applied to our hospital. Factors related to diabetes were questioned in these cases.
Results: The mean age of onset for all cases was 50.01±10.50 years, whereas the age at diagnosis was 49.20 years in females and 51.40 years in males. The mean age at diagnosis is 47.11±9.56 (p=0.001) years in women with maternal T2DM, and it decreased to 45.89±9.57 years in women with paternal T2DM (p=0.001). In males, the mean age at diagnosis was 54.16±11.10 years in the absence of maternal T2DM, whereas it decreased to 47.93±9.58 years in the maternal T2DM (p=0.001). The presence of T2DM on the paternal side in men did not affect the age at diagnosis. In addition, a positive correlation was found between the number of pregnancies and age at diagnosis (p=0.001). Obesity, educational status, exercise, nutritional status, smoking, and marital status did not affect the age of onset.
Conclusion: Our study showed that female gender and family history decreased the age of onset of T2DM, whereas the total number of pregnancies increased the age at diagnosis. Our study results suggest that T2DM screening should be performed earlier in women and/or those with a family history of T2DM.

Objective: Sarcopenia is progressive and generalized loss of muscle mass, muscle strength, and function. In this study, we aimed to examine the relationship between the presence of depression and insomnia in elderly sarcopenic patients.
Methods: Volunteer patients to participate in the study who applied to the geriatric outpatient clinic with any complaints as of June 2022 were included. The inclusion criteria were being over 65 years of age and with a score of over 24 out of 30 in the mini-mental state examination. Neuropsychological tests were performed by specialist psychologists in an appropriate environment and at an appropriate time. Those diagnosed with depression according to the Geriatric Depression Scale were recorded. Patients with insomnias were questioned whether they had complaints about sleep onset latency, staying asleep, and duration of sleep.
Results: Two hundred-five patients were included in the study. The mean age of the patients was 75.54 (±6.5) years, with 117 females 57% and 88 males 43%. According to the European Sarcopenia Diagnostic Guide, 48 (23.4%) patients were found to be sarcopenic. There was no difference between men and women in terms of the frequency of sarcopenia. Depression was significantly more common in the sarcopenic group. We found out that patients with sarcopenia had a higher rate of insomnia. Sleep onset latency, staying asleep, and duration of sleep problems were more common in these patients.
Conclusion: When sarcopenic patients and non-sarcopenic patients were compared, depression and insomnia were more common in the sarcopenic group.

Objective: Pancreatic cancer is one of the deadliest cancers. The 5-year survival rate in advanced pancreatic cancer is 2%. The presence of sarcopenia in advanced pancreatic cancer is associated with negative outcomes. Although there are many measurements for the diagnosis of sarcopenia, there is still no standard method. In our study, the effect of radiological measurement of sarcopenia on the results of pancreatic cancer was investigated.
Methods: Seventy-four patients were retrospectively evaluated. Demographic data and laboratory and imaging parameters of the patients were recorded and analyzed using the SPSS 25 program.
Results: The mean age was 64.4 years, and the mean body mass index (BMI) was 25.5 kg/m2. 58.1% of the patients were male. mOS was 9.3±2.4 months in patients with sarcopenia detected with Psoas muscle density (PMD) Hounsfield unit avarage calculation, and 16.1 16.1±1.5 months in those without (*p=0.002). mOS was 5.6±1.6 months in patients with sarcopenia detected with PMI and 16.1 16.1±1.5 months in those without (*p<0.0001). Age, gender, BMI, hemoglobin, CA19-9, and albumin levels did not affect overall survival.
Conclusion: Overall survival is significantly lower in patients with radiologically detected sarcopenia with PMD and PMI. The use of PMI and PMD is an effective method for radiological evaluation of sarcopenia.

Objective: This study was conducted to determine the effect of symptom severity on quality of life and urinary incontinence (UI) risk factors affecting quality of life in women with UI.
Methods: The study was conducted with a descriptive, cross-sectional, and comparative design. Data were collected using the “description form” and “King’s health questionnaire (KHQ)” with 160 women applying to a university hospital’s urogynecology polyclinic. The Number Cruncher Statistical System 2007 (Kaysville, Utah, USA) program was used for data analysis. The data were analyzed using numbers, percentages, Mann-Whitney U test, and linear regression analyses. P<0.05 was considered significant.
Results: It was found that 45% of women had none/low symptom severity and 55% had medium/high symptom severity. The women’s KHQ first part subscale mean score was found to be “general health condition” 41.09±20.48; “incontinence effect” 56.46±28.47; “role limitation” 41.04±33.43; “physical limitation” 46.67±33.01; “social limitation” 31.94±30.26; “personal relationship” 15.94±25.72; “emotions” 43.61±34.82; “sleep energy level” 27.71±27.97; “severity measurements” 38.46±24.56; KHQ second part (symptom severity scale) mean score was 9.56±5.97. It was found that women with medium/high symptom severity had statistically significant higher scores from all subscales of KHQ’s quality of life part than women with none/low severity (p<0.01).
Conclusion: It was concluded that incontinence in women affected quality of life at a medium level, quality of life decreased as incontinence’s symptom severity increased, and many UI risk factors affected quality of life. This study reveals that incontinence symptom severity has a negative effect on women’s quality of life.

Objective: The current study aims to contribute to the identification of distinctive histomorphological findings of BRCA-associated high-grade ovarian carcinomas.
Methods: The study was planned to include high-grade serous carcinoma cases diagnosed in 2020-2021. The histopathological features of the groups with and without BRCA mutation were evaluated comparatively in the tumor slides of the cases.
Results: Solid/pseudo-endometrioid/transitional cell carcinoma-like growth pattern and high mitotic rates were observed more frequently in the BRCA mutation group than in those without mutations, which was statistically significant. There was no significant difference between the two groups in terms of significant nuclear pleomorphism, frequency of necrosis, and prominent tumor infiltrating lymphocytes.
Conclusion: Pathologists may play a crucial role in detecting BRCA mutations in patients without a family history of carcinoma. In this respect, it should be kept in mind that BRCA mutations may be present in high-grade serous ovarian carcinoma cases with solid/pseudo-endometrioid/transitional carcinoma-like growth pattern, necrosis, prominent nuclear pleomorphism, high mitotic activity and prominent tumor-infiltrating lymphocytes.

Objective: Therapeutic plasma exchange (TPE) is frequently employed to treat neurological conditions with known or presumed immune pathogenesis in adults, however knowledge and experience in children remains insufficient. The purpose of this study is to perform a retrospective assessment of the indications, long-term efficacy, safety, and complications of TPE in children with various neuroimmunological conditions.
Methods: This investigation was a single-center, retrospective cohort study conducted at a tertiary hospital, analyzing pediatric patients with neuroimmunological diseases who were subjected to TPE.
Results: The median age of the patients was 74.5 (22-180) months, and 60% (n=6) of the patients were female. The indications for TPE included acute disseminated encephalomyelitis, Guillain-Barré syndrome, autoimmune encephalitis, acute necrotizing encephalopathy of childhood, transverse myelitis, acute flaccid myelitis, thrombotic thrombocytopenic purpura, and febrile infection-related epilepsy syndrome. The median number of TPE sessions per patient was five, with a median duration of 8.5 (5-14) days. The study found that two (20%) patients exhibited a complete response to TPE, while partial response was observed in remaining eight (80%) patients. There was neither mortality nor serious adverse events associated with the TPE procedure. At the most recent follow-up, 80% of the patients exhibited neurological sequelae.
Conclusion: TPE was observed to be an effective and well-tolerated treatment modality for children with various neuroimmunological disorders, resulting in a partial response in the majority of cases without any life-threatening complications. The rate of neurological sequelae was high despite positive clinical response, albeit in varying degrees.

Objective: The aim of this study is to demonstrate the efficiency of preoperative 64-channel multidetector computed tomography in detection in detecting hepatocellular carcinoma (HCC) in patients who underwent transplantation due to cirrhosis.
Methods: The study was designed retrospectively, and data were obtained by reviewing patient records at the organ transplant clinic. A total of 37 patients who met the specified criteria were included in the study.
Results: In the study, 9 (24.3%) of the 37 included patients were female. There was no significant difference between the two observers. The correlation between both observers and pathology regarding the presence of lesions showed a strong correlation for both Observer 1 and Observer 2, with r-values of 0.799 and 0.510, respectively. The correlation between Observer 2 and pathology was moderate, with an r-value of 0.441. For Observer 1, the sensitivity of CT was 100% for lesions larger than 2 cm and 64.2% for lesions smaller than 2 cm. For Observer 2, the sensitivity was 100% for lesions larger than 2 cm and 50% for lesions smaller than 2 cm.
Conclusion: Especially in our study, although the sensitivity of CT is low in lesions smaller than 2 cm (50-64%), it is quite successful in lesions larger than 2 cm (100%). However, due to the high spatial and temporal resolution of contrast-enhanced CT, a high false-positive rate should be considered, and patients should not be unnecessarily removed from the transplantation list.

Objective: Social distancing mitigates transmission of Coronavirus disease-2019 but also can delay access to parenteral osteoporosis therapy. After discontinuation of denosumab therapy without concomitant biphosphanate use results with increased rate of multiple vertebral fractures within 2 to 10 months.
Methods: In this study, we wanted to evaluate whether restrictions during the pandemic resulted in an increased fracture rate due to denosumab discontination. For this, we compared the data between 2020-2021, when the restrictions were the most intense, and 2022-2023, when the restrictions were relaxed. Prospectively collected data of patients who applied to the neurosurgery clinic with osteoporotic vertebral fractures between 2020-2021 and 2022-2023 were retrospectively analyzed.
Results: A total of 49 patients were met the inclusion criteria, denosumab discontinuation was detected in five patients who presented with osteoporotic fractures during the period of intense restrictions, there was no patients with denosumab discontinuation during the period when the restrictions were relaxed. Discontinuation reasons was due to fear of access to hospital and mobility restriction in all patients. Mean time interval between treatment discontinuation and fracture occurrence was 12.6 months (10-15 months).
Conclusion: Patients should be warned about the durability of denosumab treatment, and if there is doubt about the durability, oral bisphosphonate therapy should be temporarily switched in pandemic.

Objective: Rational laboratory practices can provide significant savings in hospital expenses. In recent years, the use of Friedewald formula has been accepted as a cost-effective calculation method in the measurement of lipid parameters of a patient in the risk group screened for hypercholesterolemia. In patients with triglyceride (TG) ≤400 mg/dL, it can be said that measurements using the direct-low density lipoprotein (LDL) kit instead of this formula bring unnecessary testing costs to laboratories.
Methods: In our study, the test orders of registered outpatients between 01.01.2022-31.12.2022 were examined and 112,649 patient results were obtained with measurement of total cholesterol (TC), high density lipoprotein (HDL), TG and direct-LDL or at least one of them. After exclusion of patient results for TC, TG, HDL and direct-LDL tests not ordered together, results with TC >400 mg/dL and results with non-numeric test results, 720 patient results were included in the study. The ratio of the unnecessary test order cost to the SUT package reimbursement fee and the package fee excluding the examination fee was calculated.
Results: Of the 720 patient results included in the study, the highest number of unnecessary direct-LDL orders belonged to the internal medicine outpatient clinic with 261 (36.25%), while the lowest number of orders belonged to the dermatology, pulmonology, hematology and psychiatry outpatient clinics with one order each (0.14%). Since the tender price of the direct-LDL test was fixed at 4.75 TL per unit test, the unnecessary test cost ratio is proportional to the number of orders is 36.25% and 0.14%, respectively.
Conclusion: With this study, it can be said that it is more cost-effective in terms of institutions and national economy to use computational LDL test instead of direct-LDL test ordering when requesting lipid profile in individuals with risk factors and who are met for the first time, and then to request targeted test ordering.

Objective: In this study, it was aimed to calculate the measurement uncertainties of HbA1c and glucose parameters, which have important roles in the diagnosis and treatment of diabetes, and to evaluate the possible effects of these uncertainty values on clinical decision limits.
Methods: The measurement uncertainties of HbA1c and glucose tests were calculated according to ISO/TS 20914 guidelines. In 2022, the results of patients in whom HbA1c and glucose were ordered simultaneously were retrospectively analysed and the results were evaluated according to measurement uncertainty.
Results: The calculated measurement uncertainty values of HbA1c and glucose tests were 2.41% and 7.92% for level 1 and 1.37% and 7.68% for level 2, respectively. When the HbA1c results of the patients were evaluated according to the measurement uncertainty calculated for level 1 and level 2, 2493 (8.1%) and 1845 (5.9%) were in the grey zone according to negative uncertainty and 2816 (9.1%) and 2120 (6.9%) were in the grey zone according to positive uncertainty, respectively. When glucose results were evaluated according to negative and positive uncertainty at both levels, 3959 (12.8%) and 5934 (19.2%) patients were in the grey zone, respectively.
Conclusion: In our laboratory, uncertainty values calculated for the HbA1c parameter were below the TEa% values determined by all three international organizations. Although the uncertainty of the glucose test was below the CLIA and rilibak TEa% values, it was found to be higher than the BV TEa% value. It should be kept in mind that measurement uncertainty in values at medical decision levels may affect the diagnosis and treatment of DM.

Objective: The aim of this study is to evaluate the factors affecting the length of hospital stay after surgery in patients who underwent laparoscopic adrenalectomy.
Methods: Patients who underwent laparoscopic adrenalectomy between 2012 and 2022 were retrospectively analyzed. The 75th percentile of the study population was set as the limit for the length of stay. Staying longer than this time was defined as prolonged hospital stay. Factors affecting prolonged hospital stay were analyzed with univariate and multiple logistic regression analyses. Variables with a p-value of <0.10 in univariate logistic regression analysis were included in the multiple regression model.
Results: A total of 86 patients were included in the study. Seventy-one (83%) of the patients were women. The median age was 54 (interquartile range, 45-61) years. The median hospital stay was 2 (interquartile range, 2-2) days. According to the 75th percentile of the population, the duration of stay longer than 2 days was determined as prolonged hospital stay. Prolonged hospital stay was detected in 14 (16%) patients. As a result of multiple regression analysis, operation time (odds ratio: 1.03; p-value: 0.017), conversion to open surgery (odds ratio: 4.79; p-value: 0.045), and male gender (odds ratio: 5.61; p-value: 0.022), was associated with prolonged hospital stay.
Conclusion: Laparoscopic adrenalectomy is a safe technique in the treatment of various adrenal pathologies. Operation time and conversion to open surgery were associated with prolonged hospital stay; however, studies with a high level of evidence are needed.

Objective: In recent years, YouTube has been frequently used as a source of information in the medical field. To clarify the quality of Turkish language YouTube videos about cataracts and surgical management.
Methods: Two experienced ophthalmologists searched for the terms “cataract”, “cataract surgery”, “phacoemulsification cataract surgery”, and “intraocular lens” in YouTube. Queries were performed only in the Turkish language. Video characteristics were recorded, and quality and reliability of each video was analyzed with the global quality score (GQS), the modified DISCERN form, and the patient education materials assessment tool (PEMAT).
Results: A total of 184 YouTube videos were evaluated to for inclusion in the analysis, and 58 videos did not match with study inclusion criteria. The mean number of views was significantly higher in favor of professional videos (p=0.006). The duration on YouTube was significantly longer for non-professional videos (217.5 days vs. 400.0 days, p=0.005). Moreover, “like count” and “comment count” were significantly higher for professional videos (p=0.001 and p=0.003). Modified DISCERN score was 3.5 for professional videos and 2.1 for non-professional videos, and GQS was 3.4 for professional videos and 2.3 for non-professional videos (p=0.001 for both parameters). In addition, 75 (91.5%) videos uploaded by professional health care providers had PEMAT score >70, and 20 (58.8%) non-professional videos had PEMAT score >70 (p=0.001).
Conclusion: The present study demonstrated that view numbers, like count, and comment count were significantly higher for professional videos, but duration on YouTube was significantly longer for non-professional videos. Quality of professional YouTube videos about cataracts and surgical management were significantly better according to the modified DISCERN score, GQS, and PEMAT score.

Objective: In flap survival, close postoperatively monitoring of neck flaps is essential; instant action increases the rate of flap salvage. The purpose of this research was to assess the ability of digital infrared thermal Imaging and software during laryngectomy and neck dissection monitoring to detect failure of neck flaps.
Methods: Twelve elderly patients who required total laryngectomy and bilateral neck dissection for advanced laryngeal cancer participated in this study. The hourly clinical examination of skin colour, capillary refilling and turgor were evaluated for both flaps. In addition, thermal images were taken synchronously with the digital camera. Such images were processed and analyzed as an indication of flap failure on their additional value.
Results: Out of 12 flaps, one failed due to hematoma, and venous congestion formed in two flaps. The mean flap temperature demonstrated to be most predictive of flap failing relative to the adjacent control skin. In contrast to the uncompromised flaps, both failed flaps demonstrated lower temperatures after failure.
Conclusion: An efficient thermal camera imaging can possibly improve post-operative flap monitoring. It could play an additional part in the non-invasive early diagnosis of flap failure if used in conjunction with other modalities. By analyzing relative differences in temperature between the flap and reference tissue, vascular occlusion in flaps may be differentiated.

Acute limb ischemia (ALI) is a medical emergency associated with high morbidity, significant disability, and life-threatening complications. Acute myocardial infarction (AMI) with concurrent ALI is a challenging clinical condition associated with adverse events including mortality and requires immediate simultaneous reperfusion. We present the case of a patient with a history of bifurcated graft operation due to abdominal aortic aneurysm six years ago who presented with inferior ST-elevation AMI and acute bifurcated graft thrombosis of the lower extremities causing ALI. The patient was successfully treated with simultaneous percutaneous coronary and peripheral revascularization. We emphasize that AMI and ALI may occur simultaneously, and concurrent percutaneous revascularization can be a safe and feasible treatment strategy in such patients.

Neonatal acute respiratory distress syndrome (ARDS) is a relatively new diagnosis. Specific treatment, beyond managing the underlying disease, generally relies on lung protective ventilation strategies. Viral infections such as coronavirus-2 are associated with severe ARDS. Dysfunctions in innate immunity contribute to the loss of control over viral replication and inflammatory processes, inevitably leading to a more severe clinical presentation and poor outcomes. In this case report, we present the cases of two siblings diagnosed and managed as N-ARDS with severe combined immune deficiency related to adenosine deaminase deficiency. These cases highlight the challenges of managing neonatal ARDS and the severity of viral infections in patients with immune system disorders, underlining the impact of these conditions on clinical outcomes.

One year old patient was referred to our clinic with the diagnosis of total anomalous venous connection. Despite tachycardia and pulmonary plethora, the patient was acyanotic and the transthoracic echocardiography detected pulmonary venous baffle or vertical vein. Considering these doubtful findings, computed tomography angiography was performed and revealed that right pulmonary veins was draining towards an enlarged vena cava superior while right pulmonary veins into the left atrium. Furthermore, a fibrotic tissue that encurtains the mitral orifice was observed. Consequently, the patient underwent surgery with the diagnoses of cor triatriatum sinistrum and partial anomalous pulmonary connection. The exact diagnosis was confirmed after a profound surgical inspection; afterwards, then the whole process was accomplished smoothly and the patient discharged in good condition.

Prostate cancer metastasizes most commonly to the pelvic lymph nodes and to the axial skeleton. Metastatic spread of prostate adenocarcinoma to the occipital bone is very rare. 68Ga-labelled prostate-specific membrane antigen position emission tomography/computed tomography (PSMA PET/CT) scanning has been shown to be more sensitive than conventional imaging techniques in patients with prostate cancer. 68Ga-PSMA PET/CT scans detect previously unsuspected disease and may influence planned clinical management in a high proportion of patients with prostate cancer. Our intention is to emphasize the role of the 68Ga-PSMA PET/CT where prostate cancer metastasis cannot be demonstrated by conventional imaging methods and thus contributes to the treatment choice.