Sema Yilmaz

Lymphangiomatosis, a rare condition characterized by the widespread development of lymphangiomas, often affects children under five years of age. Lymphangiomas, a type of lymphatic malformation, frequently manifest as cysts or lobulated masses in the head, neck, extremities, and trunk. While treatment options include observation, sclerotherapy, radiofrequency ablation, laser therapy, and surgery, the effectiveness can be limited. A 5-year-old girl was admitted to our department with a history of tongue enlargement, foul breath, bleeding, difficulty chewing, and impaired speech and nutrition. Upon physical examination, her tongue was noticeably enlarged, bluish in color, and covered with microvesicles and dark scabs. A diagnosis of microcystic lymphangioma of the tongue was confirmed through magnetic resonance imaging. Due to the inoperability of the lesion, propranolol 2 mg/kg/day was ordered for 3 months. But no improvement was seen. The patient was treated with sirolimus at a dosage of 1.8 mg/m²/day for six months. This treatment led to a noticeable reduction in lesion size. Subsequent follow-up visits, conducted every three months, revealed a significant improvement in all symptoms within one year. Treatment options for children with tongue lymphangioma are quite limited. Our findings demonstrate that sirolimus is a promising treatment option for this condition, with manageable side effects. We therefore advocate for prompt and efficient care and treatment with sirolimus in pediatric lymphangiomatosis to improve patient outcomes.

Ergenlik dönemi, bireylerin duygusal ve bilişsel gelişimlerinde kritik değişimlerin yaşandığı bir evre olduğundan bu süreçte geliştirilen başa çıkma mekanizmaları büyük önem taşımaktadır. Bu çalışmanın temel amacı, 14-18 yaş aralığındaki ergenlerde duygusal zekâ ve dinî başa çıkma stratejilerinin, ruminasyon (zihinsel geviş getirme) düzeyleri üzerindeki etkisini ve bu değişkenler arasındaki ilişkiyi incelemektir. Araştırmanın örneklemini, 2024–2025 eğitim-öğretim yılı Nisan-Haziran aylarında Sivas ilinde Millî Eğitim Müdürlüğüne bağlı üç farklı lise türünde öğrenim gören öğrenciler oluşturmaktadır. Tesadüfi olmayan kolayda örnekleme yöntemiyle seçilen 508 öğrenci üzerinde yürütülen çalışmada, nicel araştırma desenlerinden korelasyonel yöntem tercih edilmiştir. Veri toplama aracı olarak Ruminatif Düşünme Biçimi, Duygusal Zekâ ve Dinî Başa Çıkma ölçekleri ile Kişisel Bilgi Formu kullanılmıştır. Elde edilen bulgulara göre; cinsiyet değişkeninde kız öğrencilerin, yaş değişkeninde ise 14 yaş grubunun ruminatif düşünce puanlarının anlamlı düzeyde yüksek olduğu saptanmıştır. Okul türü açısından İmam Hatip Lisesi öğrencileri hem dinî başa çıkma hem de ruminatif düşünce boyutunda en yüksek ortalamalara sahipken anne eğitim düzeyi düştükçe dinî başa çıkma düzeyinin, baba eğitim düzeyi yükseldikçe ise ruminasyonun arttığı görülmüştür. Ayrıca dindarlık düzeyi ve kardeş sayısı arttıkça dinî başa çıkma stratejilerinin anlamlı şekilde güçlendiği belirlenmiştir. Korelasyon analizinde dinî başa çıkma ile ruminasyon arasında zayıf, negatif ve anlamlı bir ilişki tespit edilmiştir. Regresyon analizi sonucunda dinî başa çıkmanın ruminasyonu negatif yönde yordadığı görülse de açıklanan varyansın (%1.3) düşük olması, bu etkinin istatistiksel olarak anlamlı ancak pratik açıdan sınırlı bir güce sahip olduğunu ortaya koymaktadır.

Objective: Several factors such as effectiveness, safety, and compliance affect the drug survival in chronic disorders. Physicians consider long-term retention rates and reasons for discontinuation when selecting therapies. Identification of predictors of clinical response to certolizumab pegol (CZP) may aid the decision-making process for treating patients with psoriatic arthritis (PsA). The purpose of this study is to assess the drug survival of CZP in patients with PsA and to identify the predictors and reasons for discontinuation. Methods: Data on patient characteristics, demographics, diagnosis, disease duration, treatment, and outcomes have been collected since 2011 in Turkish Biologic (TURKBIO) Registry. By the end of December 2020, 68 PsA patients received CZP and were included. Kaplan–Meier analysis was used for drug survival analysis. Cox regression analysis was performed to evaluate the predictors associated with drug survival. Results: During a median follow-up of 47 months, 17 patients discontinued CZP treatment. At 36 months, the retention rate was 61.6%. Patients who discontinued CZP were older and had longer disease duration (P=.012 and P=.002, respectively). HLA-B27 positivity was associated with lower drug survival (P=.035). Biologic-naive patients demonstrated higher drug survival in Kaplan–Meier analysis (log-rank P=.02), although baseline comparison did not reach statistical significance (P = .062). In Cox regression analysis, age was identified as an independent predictor of treatment discontinuation (hazard ratio: 1.063, 95% CI: 1.019-1.109, P=.004). Conclusion: In this real-world analysis from the TURKBIO registry, CZP demonstrated moderate long-term drug retention in patients with PsA. Older age was independently associated with reduced treatment persistence, while longer disease duration was also associated with lower retention. Biologic-naive status was linked to improved drug survival. HLA-B27 positivity was also associated with lower drug survival; however, this finding should be interpreted with caution due to limited data availability. These results support the potential benefit of earlier initiation of CZP, particularly in biologic-naive patients, while highlighting the need for further studies to clarify the role of genetic factors in treatment persistence.

Lymphoma is a type of cancer classified under blood cancer, emerging because of cell degradation. It is visualized using computed tomography (CT) and positron emission tomography (PET). Segmentation refers to the process of separating the desired object from the background and other elements in an image. In this study, CT images obtained from lymphoma patients were segmented using U-Net, a deep learning-based segmentation model. The test results achieved were a 0.83 Dice Similarity Coefficient (DSC), 0.73 Jaccard Index (JI), an average Hausdorff Distance (HD) of 15.81 mm for neck axial CT images, and a 0.75 DSC, 0.64 JI, and an average HD of 30.18 mm for neck coronal CT images. The detailed statistical and visual analyses demonstrated that the lymphoma lesion segmentation was successfully performed on neck coronal and axial CT images using U-Net.

Objectives: Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by progressive fibrosis, vasculopathy, and immune dysregulation, leading to multi-organ involvement. Cardiopulmonary complications are major determinants of morbidity and mortality in SSc. Epicardial adipose tissue (EAT), a metabolically active adipose tissue, has been implicated in systemic inflammation and cardiovascular risk. However, its role in SSc remains poorly understood. This study aims to evaluate the relationship between EAT and SSc patients. Methods: This retrospective cross-sectional study was performed at Rheumatology department between 2020 and 2021. Patients were classified according to the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for SSc. Laboratory and radiology results were obtained from the electronic registration database. Data were analyzed and compared between groups. EAT was measured using non-contrast computed tomography (CT), and its correlations with clinical features, inflammatory markers, and thoracic CT abnormalities were evaluated. Results: A total of 229 participants, 157 with SSc and 72 age-matched healthy controls, were included in the study. The mean EAT volume was 171.02±81.84 cm³. Correlation analysis revealed a significant positive correlation between EAT volume and interstitial lung disease (ILD) (r=0.260, P=0.001), C-reactive protein (CRP) levels (r= 0.250, P=0.002), disease duration (r=0.205, P=0.010), and age (r=0.528, P<0.001). ROC analysis showed a moderate discriminatory power of EAT volume with an area under the curve (AUC) of 0.647 (95% CI: 0.564-0.729, P<0.001). Conclusions: Higher EAT volume was observed in SSc patients with ILD, suggesting a possible role of epicardial fat in pulmonary involvement in SSc.

Background/Objectives: This study aims to develop a comprehensive Clinical Decision Support System (CDSS) that integrates multi-sequence sacroiliac joint (SIJ) MRIs with rheumatological, clinical, and laboratory findings into the decision-making process for the early diagnosis of axial spondyloarthritis (axSpA), incorporating segmentation-supported explainability. Methods: Multi-sequence SIJ MRI data (T1-WI, T2-WI, STIR, and PD-WI) were analysed from 367 participants (n = 193 axSpA; n = 174 non-axSpA controls). Sequence-based classification was performed using VGG16, ResNet50, DenseNet121, and InceptionV3 models; additionally, a lightweight and parameter-efficient SacroNet architecture was developed. Slice-level probability scores were converted to patient-level scores using the Dynamic Top-K Averaging method. Image-based scores were combined with a logistic regression-based clinical risk score using weighted linear integration (0.60 image/0.40 clinical) and a conservative threshold (τ = 0.70). Grad-CAM was applied for visual interpretability. Furthermore, to support the diagnostic outcomes with precise spatial data, active inflammation in STIR and T2-WI sequences was segmented. For this purpose, the MDC-UNet model was employed and compared with baseline U-Net derivatives. Results: Sequence-specific analysis showed VGG16 performing best on T1-WI (AUC = 0.920; Accuracy = 0.878) and DenseNet121 on STIR (AUC = 0.793; Accuracy = 0.771). The SacroNet architecture provided competitive classification performance at the patient level despite its low number of parameters (~110 K). Furthermore, MDC-UNet successfully segmented active inflammation, yielding Dice scores of 0.752 (HD95: 19.25) for STIR and 0.682 (HD95: 26.21) for T2-WI. Conclusions: The findings demonstrate that patient-level decision integration based on multi-sequence MRI, when used in conjunction with clinical risk scoring and segmentation-assisted interpretability, can provide a feasible and interpretable DSS framework for the early diagnosis of axSpA.

Vascular involvement is a major cause of morbidity and mortality in Behçet’s disease (BD), particularly in male patients. Immunosuppressive therapy is the mainstay of treatment, but recurrent thrombotic events may occur despite conventional immunosuppression. We report a 53‐year‐old male with a history of BD complicated by recurrent pulmonary and deep venous thrombosis despite treatment with cyclophosphamide, azathioprine, and warfarin. He presented with left lower extremity pain and swelling. Doppler ultrasonography revealed acute and chronic deep venous thrombosis. Thoracoabdominal computed tomography angiography demonstrated a near‐complete filling defect consistent with pulmonary embolism without abdominal thrombosis and signs of other kinds of systemic vasculitis. High‐dose corticosteroids were initiated, and infliximab (5 mg/kg at Weeks 0, 2, and 6) was added to previous azathioprine and colchicine therapy. Warfarin was continued after consultation with the cardiovascular surgery team. Within 2 weeks, the patient showed marked clinical improvement, reduced inflammatory markers, and regression of the thrombus on follow‐up imaging. This case underscores the importance of reassessing inflammatory disease control and early consideration of biologic therapy, such as infliximab, especially in refractory cases, to prevent further vascular damage and improve outcomes.

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. in children. Children can be exposed to pesticides during pregnancy or by their parent carried out pesticides to home. The objective of this study was to study pesticide residues in both acute leukemia patients and healthy children. Methods: Twenty nine patients with acute leukemia [22 boys (76%) and 7 girls (24%)] and 33 healthy children [(19 boys (57%), 14 girls (43%)] were included in the study. We analyzed eight PCB (PCB 28, PCB 52, PCB 101, PCB 118, PCB 138, PCB 153, PCB 180 and PCB 202), HCB, three HCH isomers, 4,4′-DDT, 4,4′-DDD and 4,4′-DDE were investigated in bone marrow of newly diagnosed acute leukemia patients and peripheral blood samples of healthy children. Results: The most detectable OCPs were β-HCH, δ-HCH and PCB28, triflumizole and thiometon were commonly found as OPPs. The significant difference was found statistically between ALL cases and control group according to the residues of PCB28 (74,06±85,29), β-HCH (72,06±89,07) and δ-HCH (23,35±42,93) (p=0.001). Additionally, OPPs consisted triflumizole (7,23±9,17), thiometon (3,37±4,30) and halfenprox (1,90±3,22) showed distinctive difference statistically (p=0.001). Conclusion: Pesticide residues were estimated significantly in bone marrow of leukemia patients should be considered an important for public health with the decreasing or preventing of pesticide exposure which have a role in leukemia ethiology.

Bu çalışmada Ocak 2014 ile Ağustos 2024 arasında Web of Science’da (WoS) taranan dindarlık temalı makalelerin bibliyometrik analizinin yapılması amaçlanmış ve bu amaç doğrultusunda RStudio ve VosViewer üzerinden analizler gerçekleştirilmiştir. Elde edilen sonuçlara göre; toplamda 3.372 makalenin incelendiği, makalelerin 9.089 yazar tarafından oluşturulduğu ve tek yazarlı makale sayısının 756 olduğu, makalelerin ortalama olarak 9.053 atıf aldıkları, yıllık belge değişim oranının %4,09, uluslararası ortak yazarlık oranının %24,47, belgelerin ortalama yaşının 4,12 ve taramada toplamda 129.474 referansa yer verildiği tespit edilmiştir. En fazla makale 2022 yılında üretilmiş, makale başına ortalama atıf sayısı ise en yüksek 2015 yılında gerçekleşmiştir. Yıllık ortalama makale sayısının en fazla olduğu yıl 2021, atıf alınan makalelerin en fazla yazıldığı yıl ise 2014'tür. Literatürde en fazla yayına sahip olan yazarın Harold G. Koenig (d. 1950), dindarlık temalı yayınlarda öne çıkan terimin "maneviyat" (spirituality), ve en fazla yayın yapılan derginin ise Journal of Religion & Health olduğu ortaya konmuştur. Ülkeler arasında, yayın sayısı bakımından Amerika Birleşik Devletleri (ABD) birinci sırada yer alırken, Türkiye yedinci sırada konumlanmıştır. Tek Ülke Yayınları (SCP) düzeylerinin, Çok Uluslu İş Birlikleri (MCP) düzeyine kıyasla daha yüksek olduğu gözlenmiştir. Bununla birlikte, ABD en geniş iş birliği ağına sahip ülke olarak öne çıkarken, Sırbistan, Macaristan, Gürcistan ve Brunei gibi ülkelerin diğer ülkelerle sınırlı iş birliği göstererek daha bağımsız bir konumda yer aldığı tespit edilmiştir. Üniversiteler bazında yapılan incelemelerde, Mississippi Eyalet Üniversitesi, Brigham Üniversitesi ve Baylor Üniversitesi gibi kurumların iş birliği ağlarının merkezinde yer aldığı ve daha geniş akademik bağlantılara sahip olduğu görülmüştür. Türkiye’den ise Marmara Üniversitesi bu alanda öne çıkan bir konumda yer almıştır. Yayınlarda en fazla kullanılan kelimelerin "spirituality", "attitudes"ve "health" olduğu belirlenmiştir. Yayınlarda en az kullanılan kelimenin ise "symptoms" olduğu tespit edilmiştir. Çalışma, ülkeler arası ilişkilerin özellikle ABD ve Kuzey Avrupa ülkelerinde yoğunlaştığını ortaya koymuştur.

Aims: We aimed to evaluate the effect of comorbidities on the first tumor necrosis factor inhibitor (TNFi) treatment response and retention in patients with rheumatoid arthritis (RA). Methods: The study included adult RA patients (with M05 and M06 ICD codes) registered in the TURKBIO database and receiving their first TNFi treatment. Data on demographic, clinical, and laboratory features, disease activity scores, and other follow-up parameters (at the beginning and months 6 and 12) were collected. The Log-Rank test and Kaplan-Meier curve were used to determine the TNFi retention rates. Results: There were 1172 bio-naive RA patients who initiated their first TNFi treatments. The median age (IQR) of the patients was 53 (51-61), and 79.8% (n=935) were women. The most commonly used TNFi was etanercept (38.9%), followed by adalimumab (27.9%), certolizumab (13.8%), golimumab (10.8%), and infliximab (8.7%). The most prevalent comorbidities in patients were hypertension (32.6%), obesity (32.6%), osteoporosis (22.3%), asthma/COPD (17.9%), and diabetes mellitus (15.7%). The presence of comorbidities at the beginning of TNFi treatment did not affect DAS28 CRP responses at months 6 and 12 (p=0.18 and p=0.83, respectively) and the continuation rates of the first TNFi drug. After conducting a thorough analysis that factored in variables including gender, age over 60 years, smoking, serologic status, presence of erosion, and basal disease activity scores, it was determined that there were no statistically significant hazard ratios (HR) for the first TNFi persistence. However, there was a 5% decrease in adherence to the first TNFi drug with an increase in median disease duration (HR 0.95, 95% CI=0.90-1.00, p=0.048). Conclusion: It has been observed that the presence of comorbidities in patients with RA does not significantly affect the TNFi treatment response and retention rate. However, evidence suggests that as the duration of the disease increases, the continuation of the first TNFi drug may decrease.