"What doesn't defeat me makes me stronger" A Qualitative Study drawing on the Perspectives of Syrian Refugee University Students in Turkey

Education is one of the most crucial instruments for refugee youth to remove the disadvantages and enhance their social and structural integration into society. However, the unequal education opportunities concerning the barriers avoid the integration of refugee students into society and make them prone to discrimination. This qualitative descriptive design study aimed at describing the experiences of the subjective perspectives of Syrian refugee students about higher education. The participants were final-year undergraduate Syrian refugee students. Data were collected by conducting in-depth semi-structured face-to-face interviews using a pilot-tested interview guide. The researchers followed a systematic data analysis procedure. The themes were finalized once the researchers had reached a consensus. The responses of the students were subsumed under the following three main themes: (1) Being 'other', (2) Hopes vs Realities, and (3) What doesn't defeat me makes me stronger. The participants reported feeling ignored and worthless due to the biases and assumptions of society, which result in stigma and discrimination. Additionally, refugee students revealed that their peers and even educators may sometimes share the same beliefs. However, the study also underlined the value of resilience in shaping the perspectives, even though they faced many challenging experiences.

Isolated Pituitary Metastasis of Renal Cell Carcinoma: A Case Report and Systematic Review of the Literature

BACKGROUND

Isolated pituitary gland metastasis is an extremely rare event in renal cell carcinoma. We present a unique case of isolated pituitary metastasis of renal cell carcinoma and a systematic review of literature on it.

CASE REPORT

In this case, an abdominal ultrasound in an asymptomatic 51-year-old female patient showed a mass in her left kidney. Radical nephrectomy was performed and the tumor was diagnosed as a stage 1 clear cell carcinoma. Throughout the 3 months of the follow-up period, the patient started complaining of visual disturbances and headaches. A pituitary mass was found on brain magnetic resonance imaging and was suspected to be a macroadenoma. Surgical resection of the tumor was performed and the final pathological diagnosis was made as a pituitary metastasis of the renal cell carcinoma. After surgery, radiotherapy with sunitinib, a receptor tyrosine inhibitor, was performed.

CONCLUSION

The clinical symptoms are usually related to the mass effect of the tumor and anterior pituitary involvement. Most of the cases mimic pituitary macroadenoma on MRI. The most preferred treatment combination is surgery and radiotherapy. We recommend adding sunitinib to this combination. This illustrative case and those found in a systematic review of the literature highlight the importance of histopathologic diagnosis and appropriate management since isolated pituitary metastasis is challenging to preoperative diagnosis.

AB1176 DOES VACCINATION AND VARIANTS AFFECT THE COURSE OF THE COVID-19 IN INFLAMMATORY RHEUMATIC DISEASE?

Background

Although there have been expansion of knowledge about the course of COVID-19 in rheumatologic diseases, it still remains unclear the effect of vaccination status and variants on the disease course.

Objectives

We aimed to investigate the general clinical characteristics of our patients with inflammatory rheumatic disease (IRD) who had COVID-19 disease, their vaccination status and the time periods in which different variants were dominant during the disease.

Methods

During the routine follow-up of our patient’s with IRD, whether the patients had COVID-19 disease, when they were vaccinated (Pfizer/Biontech or Sinovac in our Country) and main clinical characteristics and their comorbid diseases were recorded. The last patient was included in the study on January 25, 2022.

They were divided into those who received insufficient or no vaccine and those who received a full dose of vaccine. The patients were divided into 3 groups according to the period they had the disease: Those who had the disease between March 2020 and June 2021accepted as “1st period patietns”, the period when the Alpha and Beta variants, the initial forms of the disease, were dominant variants in populations; those who had the disease between July 2021 and November 2021, when the Delta variant dominated the World and in our country accepted as “2nd period patients”; and those who had the disease in December 2021 and later, when the Omicron variant was dominant throughout the world and in our country, was accepted as “ 3rd period” patients.

Results

Total 463 (294 woman) IRD patients enrolled to the study. Distrubution of these patients included Behcet’s syndrome:15; familial mediterranean fever: 57, rheumatoid arthritis:134, Sjogren’s syndrome:24, systemic lupus erythematosus:26, Spondyloarthritis:141, necrotising vasculitis:6 and Others:50 cases. Mean age of patients were 46±13,2 (18-83) years. 354 (77%) of our patients got sick in the 1st period, 80 (17%) in the 2nd period and 28 (6%) in the 3rd period. When patients were compared in terms of their clinical complaints in these periods, dyspnea was significantly higher in patients in the 1st period (1st.period 36% vs 3rd period 18%; p:0.039), but there was no difference between other complaints including lung involvement and the frequency of hospitalization (p>0.05). 53% of patients had received at least 2 doses of mRNA vaccine. 84% of the patient has had COVID19 before full vaccination with any valid vaccine. When the patients who were full vaccinated and those who were not vaccinated or inadequately vaccinated at the time of illness were compared in terms of clinical features, lung involvement frequency and hospitalization frequency, no difference was found between them. (p>0.05, for all). However, hospitalization and lung involvement were less in those who received a booster dose of any valid vaccine (p: 0.03). While the average hospitalization rate was 17% for all groups, this rate was 50% for necrotizing vasculitis and was significantly higher (p:0,005). The probability of lung involvement and hospitalization were found to be significantly higher in patients using prednisolone 5mg (or equivalents) or more; (p:0.008 and p:0.000, respectively). Pulmonary involvement was significantly higher among patients receiving sulphasalasine (p:0.008). Among the patients on Rituximab, the probability of hospitalization was higher than those who did not (p: 0.01). There was no statistical difference in terms of hospitalization and pulmonary involvement between patients who took other drugs (p>0.05, for all). A total of 5 cases died, including 2 GPA, 1 EGPA, 1 RA and 1 FMF patients. Only 8 patients had a second history of COVID19.

Conclusion

The frequency of COVID-19 among IRD cases seems to decrease over time. Full vaccination seems effective for the prevention of COVID-19. It should be recommended that IRD patients have the full dose of vaccines and boosters. The risk of lung involvement and hospitalization increases in patients using certain drugs, such as corticosteroids, sulphasalasine and rituximab. These patients should be followed more closely.

Disclosure of Interests

None declared

A Successful Model for an Introductory Oncology Teaching Conference and Its Impact on Preclinical and Clinical Medical Students

PURPOSE

Oncology education at medical schools is often fragmented, under-represented, and nonstandardized. Medical students lack essential knowledge, skills, and attitudes necessary for them to provide optimal primary care to patients with cancer upon graduation.

METHODS

In this study, we designed and assessed the impact of a compact oncology teaching conference on medical students. The conference covered topics in cancer biology, public health, diagnosis, patient management, treatment, and communication skills. Medical students completed voluntary presurveys and postsurveys regarding their perceived knowledge, attitudes, and perspectives. The event was promoted by student groups, particularly our ASCO Oncology Student Interest Group, and took place online.

RESULTS

A total of 228 responses from medical students representing 50 universities were analyzed. We revealed significant baseline confidence and perceived knowledge deficits especially in diagnosis and patient management, and treatment modalities. Our conference positively affected self-assessed knowledge acquisition among students, with the most pronounced differences seen in diagnosis and patient management (2.51 ± 1 v 3.87 ± 0.81) and treatment modalities (2.54 ± 0.96 v 3.79 ± 0.88), P < .001. Students believed the program was beneficial, felt more confident in applying their knowledge in the clinic and in delivering bad news, and were more interested in pursuing oncology-related fields, P < .001.

CONCLUSION

We demonstrated that a compact teaching conference resulted in significant improvements in students' confidence and perceived knowledge about oncology. Our successful teaching model can be adapted and implemented at medical schools globally. Development and evaluation of teaching programs are important to urgently reform undergraduate medical education in oncology.

The COVID-19 pandemic: The evaluation of the emergency remote parent training program based on at-home support for children with down syndrome

During the COVID-19 pandemic, the development of emergency remote training programs for young children with Down syndrome, learning difficulties, and severe health problems and their parents became a requirement. The present study aimed to evaluate the impact of the "applied emergency remote training program", prepared to address the needs of parents with children with Down syndrome and to offer them at-home support. It is an evaluative case study conducted with 11 parents of 11-35 months old children with Down syndrome. The findings demonstrated that the program could be conducted in a home environment, it improved the interactional behavior of both parents and children, reduced the number of difficult routines, and was considered as an educational, instructive, and band-aid solution. Issues such as the development of systematic psycho-social support systems that increase full participation and motivation of parents in distance education programs are important during extreme times such as the pandemic. Difficulties in online data collection, the employment of coaching and counseling systems in information maintenance, individualization of the program, the improvement of the interactivity in the program, and the development of applied training programs on different topics still wait for a solution.

The relationships among psychological resilience, intercultural sensitivity and empathetic tendency among teachers of Syrian refugee children in Turkey

Within the provision of education, teachers typically have the closest contact and play a key role in meeting the needs of refugee children through effective communication to achieve culturally qualified education and the provision of more humanistic approach. This descriptive cross-sectional design study is aimed to explore the relationships among psychological resilience, intercultural sensitivity and empathetic tendency in teachers of Syrian refugee children in Turkey. Data were collected from 367 teachers of Syrian refugee children. Teachers of Syrian refugee children who participated in the study had a high level of psychological resilience, moderate level of empathic tendencies and a high level of intercultural sensitivity. Statistically significant relationships were found among study variables. The data reveal that there is a relationship among psychological resilience, intercultural sensitivity and empathetic tendency among teachers of Syrian refugee children in Turkey. Furthermore, regression analysis revealed that psychological resilience significantly supports intercultural sensitivity and empathic tendencies.

The Effects of Music Therapy on Patients With Coronary Artery Disease Before the Invasive Procedure: A Randomized Controlled Study

PURPOSE

This study was designed to investigate the effects of music therapy provided to patients who would undergo Coronary Angiography before the invasive procedure on pain, anxiety, and vital signs to reduce the administration of sedatives and to ask the views of the patients regarding the music to which they listened.

DESIGN

This study was a randomized controlled study.

METHODS

The research sample included 62 patients; 31 in the experimental group and 31 in the control group, who were waiting for having femoral angiography in the waiting room of the invasive procedure and diagnostic laboratory of a training and research hospital in Izmir. Data were collected using "Patient Information Form", "Vital Signs Inspection Form", "State-Trait Anxiety Inventory", and "Visual Analog Scale". The experimental group listened to nonverbal and instrumental music in the forms of taqsim, saz semai, and peshrev at the speeds of 60 (Adagio) and 100 (Andante). Nihavend mode is the most used mode in music therapy and is suitable for the Turkish Cultural structure. The scale of nihavend mode has the same structure with the g minor scale of classical western music. For both groups, pain and anxiety levels were simultaneously measured before and after the process; vital signs were measured before, during, and after the process.

FINDINGS

The findings obtained in this study showed that there was a statistically significant difference between the means of anxiety (P = .000) and pain (P = .001) of the patients in experimental and control groups after the procedure. A significant difference was determined between the means before and after the procedure for diastolic (P = .002) blood pressure and pulse wave velocity (P = .002) in vital signs. A significant difference was not determined between the mean of patients' systolic blood pressures (P = .082) and respiration rates (P = .836) before and after the procedure.

CONCLUSIONS

The findings suggest that music therapy is effective in reducing blood pressure, respiration rate, anxiety, pain level, and sedative application for the patients. Music therapy within the scope of the nonpharmacological complementary therapies can be administered by the healthcare providers, given that the patients have no adverse effects or additional costs and thanks to ease of implementation.

Magnetic resonance imaging criteria for prediction of isocitrate dehydrogenase (IDH) mutation status in patients with grade II-III astrocytoma and oligodendroglioma

BACKGROUND

IDH mutation status is an important prognostic marker for glial tumors, which is detected immunohistochemically after surgery. Since this method is invasive, easy and noninvasive magnetic resonance imaging (MRI) methods have recently been used in predicting the IDH mutation status. However, there is currently no standard MRI technique to predict IDH mutation. We analyzed the value of conventional MRI to predict IDH mutation and its effect on survival among grade II-III astrocytoma and oligodendroglioma patients.

MATERIAL AND METHODS

We included WHO grade II-III astrocytoma and oligodendroglioma patients who underwent surgery at Bahcesehir University Goztepe Medical Park Hospital. All patients were analyzed according to their immunohistochemical IDH mutation status. Preoperative conventional MRI studies with respect to their location, diffusion restriction, contrast enhancement, calcification and hemorrhage on susceptibility-weighted image (SWI) or T2*- weighted imaging (T2*WI), and T2 -FLAIR mismatch properties were retrospectively assessed by a neuroradiologist. The relation between MRI characteristics and IDH mutation was analyzed using a chi-square test. The sensitivity and specificity of radiological IDH mutation were determined by ROC analysis. The impact of IDH mutation on survival was also analyzed by Kaplan-Meier tests.

RESULTS

IDH mutation was found to be positive in 82.5% of tumors histopathologically and 54.4% radiologically. The sensitivity and specificity were 63.8% and 90%, respectively (Area under the curve/AUC = 0.369, p = 0.08). IDH wild gliomas were predominantly diffusion-restricted tumors. IDH mutant tumors were less likely to have contrast enhancement and had lower grades compared to the IDH wild tumors. The median survival time could not be reached and the overall survival was not related to any tumor characteristics or IDH mutation.

CONCLUSIONS

Conventional MRI predicts IDH-mutation status in Grade II-III astrocytoma and oligodendroglioma. Contrast-enhancement and restricted diffusion were strongly associated with grade III astrocytoma and oligodendroglioma, IDH-wild type. Location, T2-FLAIR mismatch, and SWI did not contribute to making a decision on the IDH mutation status. There was no significant difference between the survival times of patients and their IDH status.

Design, implementation, and assessment of an online-based oncology education program for medical students: An ASCO Oncology Student Interest Group initiative

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Background: Undergraduate medical education in oncology is often fragmented and non-standardized among medical schools (BMC Med Educ 17:100, 2017). Oncology education initiatives are thus critically needed to increase cancer awareness and improve medical students’ understanding of the principles and multidisciplinary approach of oncology. We designed and implemented an online education program with the aim of providing medical students with an early exposure to the field of oncology. Our program was adapted from the Australian Ideal Oncology Curriculum for Medical Schools and included six sessions covering the basics of cancer biology, prevention and screening, diagnosis and patient management, principles of treatment modalities, principles of surgical oncology, as well as counselling and communications skills. Methods: Medical students at our institution were invited to participate. We also invited medical students from other faculties via the support of student groups namely the nation’s medical student union and our ASCO Oncology Student Interest Group (OSIG). Invitations were sent by email and/or via social media along with a brochure outlining the conference’s program and instructions to use the Zoom platform. Students were asked to voluntarily fill online pre- and post-conference anonymous surveys. Students self-assessed their competency, personal attributes, future career aspirations, and provided an evaluation of the program. A five-point Likert scale was used for most questions, in which 1 indicated strong disagreement and 5 indicated strong agreement with the statement. Results: Nearly 300 students from over 50 medical schools in Turkey attended the live program. Only students (n = 228) who completed both the pre- and post-conference surveys were included in our study. ASCO OSIG members made up 24.1% (n = 55) of the students. Among the participants, 73.7% (n = 168) were preclinical students (years 1-3) and 26.3% (n = 60) were clinical students (years 4-6). Students’ overall self-reported rating of their knowledge significantly improved in each of the six sessions, with the greatest pre-post difference observed for diagnosis and patient management (2.51 ± 1 vs 3.87 ± 0.81) followed by principles of treatment modalities (2.54 ± 0.96 vs 3.79 ± 0.88), P < 0.001. Most students believed the program was beneficial in improving their current understanding of oncology with a mean of 4.43 ± 0.76. Most students (92.5%) were “likely” or “very likely” to recommend the program to their colleagues. Conclusions: Students’ evaluation of the online oncology program demonstrated significant benefit and knowledge improvement. Our successfully piloted teaching model of oncology for medical students can be adapted and implemented at medical schools globally. Further development and continuation of our educational initiative is undergoing.

AB0463 ETIOLOGY OF PALPABLE PURPURA; A SINGLE CENTER EXPERIENCE

Background:

Purpura are lesions that occur after bleeding on the skin, mucous or serosal surfaces. Purpura can be classified into 2 subgroups; which are linked to thrombocytopenia and non-trombocytopenic purpura. While thrombocytopenic purpura often occurs due to a hematological disease; in non-trombocytopenic purpura etiological causes are very variable, and systemic vasculitis has an important place among them.

Objectives:

The demographic features of the patients applying with purpura and the underlying causes and diseases were aimed to be revealed.

Methods:

44 consecutive patients (22 women, 22 men) who were admitted to the hospital in the last 6 months, due to purpura were evaluated. Average age of patients was 49.6 ± 19.6 years. Patients were questioned about a recent infection, drug use, concomitant or underlying diseases. The serological tests and other laboratory tests for etiology were performed and biopsy was taken from the skin lesions which are appropriate.

Results:

While 4 (9%) patients had widespread purpura on the trunk-upper-lower extremities, in 22 (50%) patients purpuric lesions were limited only to the lower limb. The period between the onset of the first symptom and the admission to the hospital was longer than 4 weeks in 35 (79.5%) patients, and shorter than 1 week in 9 (20.5%) patients. 24 (54%) patients had an anamnesis of infection 2-3 weeks before purpura, and 20 (45%) patients had an anamnesis of drug use. The most common accompanying symptom was abdominal pain and was present in 15 (34%) patients. Biopsy was performed from the skin lesion in 37 patients. Histopathological examination of all was compatible with leukocytoclastic vasculitis. In indirect immunofluorescence staining, 17 were found to be IgA positive. 2 (4.5%) patients were diagnosed PR3-ANCA positive granulomatosis with polyangiitis. 1 patient had Hepatitis B virus infection was detected in 1 patient (2.2%), HIV infection was detected in 1 patient (2.2%) and malignancy was detected in 1 patient (2.2%).

Conclusion:

In our study, the most common reason was found as IgA vasculitis in patients presenting with palpable purpura. Although vasculitic involvement was limited to the skin in most patients, organ-threatening systemic vasculitis was detected in a few patients. Patients applying with Purpura should be questioned for infection and drug use, should be examined for underlying diseases including systemic vasculitis, and closely monitored for organ involvement.

Disclosure of Interests:

None declared

Where do these guests come from? A diagnostic approach for metastatic lymph nodes

Objective

In cases presenting with lymphadenopathies (LAP) without a primary focus detected by simple radiological methods, the primary tumor can be diagnosed by a histopathological evaluation of the metastatic lymph nodes. We aimed to discuss the nonhematological malignancies presenting with lymphadenopathies and the histopathological results for primary tumors.

Material and Methods

In this retrospective study, cases diagnosed with metastasis in excisional lymph nodes between January 2013 and June 2016 were assessed for a histopathological diagnostic approach.

Results

Among 632 lymph node biopsies, a total of 21 cases, involving 12 male and 9 female patients with a mean age of 57.23 y (range, 33-92 y), of nonhematological solid tumors were included. The most common localizations of the involved lymph nodes were inguinal (n=8), axillary (n=6), cervical (n=4), and supraclavicular (n=3) region. The most common primary tumors were malignant melanoma (n=6), breast carcinoma (n=4), ovarian carcinoma (n=2), squamous cell carcinoma (n=2), and germ cell tumor (n=2). Others were papillary thyroid carcinoma, renal cell carcinoma, urothelial carcinoma, prostate adenocarcinoma, and endometrial adenocarcinoma.

Conclusion

Nonhematological malignancies presenting with lymphadenopathies are one of the most complicated cases for clinicians. The histopathological evaluation of the excisional metastatic lymph node biopsies is an important method because of cost effectiveness and easy applicability.

Comparison of icodextrin with thymoquinone: A new hope for postoperative adhesions

OBJECTIVE

The purpose of this study was to compare the effects of thymoquinone and icodextrin in rats within the framework of an experimental adhesion model.

MATERIALS AND METHODS

Rats were separated into three groups: (1) a control group consisting of rats that had 2 ml of isotonic solution administered intraperitoneally, (2) an ICO group administered with 2 ml of 4% icodextrin, and (3) a TQ group administered thymoquinone (10 mg/kg), all following cecal abrasion. The three groups underwent a reoperation on the 7th postoperative day. Hydroxyproline levels were analyzed in the resected adhesive tissues, and histopathological investigations were conducted. Blood samples were collected for biochemical analyses.

RESULTS

Fewer postoperative adhesions were observed in the ICO and TQ groups compared with the control group. A comparison of the TQ and ICO groups revealed lowers levels of postoperative adhesions in the TQ group. Compared with the control group, malondialdehyde, 8-OH-deoxyguanosine/deoxyguanosine (8-OHdG/10dG), Coenzyme Q10 (CoQ10), and CoenzymeQ10/reduced CoenzymeQ10 (CoQ10/CoQ10H) values were found to be lower in the TQ and ICO groups. When the TQ and ICO groups were compared with respect to their biochemical parameters, the results for all of the four parameters were found to be statistically significantly lower in the TQ group (P < 0.000). The levels of hydroxyproline in the control, ICO, and TQ groups were found to be (mean ± standard deviation) 502.25 ± 90.39 μg/g, 342.13 ± 66.61 μg/g, and 287.88 ± 49.59 μg/g, respectively.

CONCLUSIONS

A comparison of the antiadhesive effects of thymoquinone and icodextrin revealed thymoquinone to be more effective. These results indicate that thymoquinone is an efficient and strong antiadhesive molecule.

Strain and strain rate echocardiography in children with Wilson's disease

OBJECTIVE

This study aimed to evaluate strain and strain rate echocardiography in children with Wilson's disease to detect early cardiac dysfunction.

METHODS

In this study, 21 patients with Wilson's disease and a control group of 20 age- and gender-matched healthy children were included. All the patients and the control group were evaluated with two-dimensional (2D) and colour-coded conventional transthoracic echocardiography by the same paediatric cardiologist using the same echocardiography machine (Vivid E9, GE Healthcare, Norway) in standard precordial positions, according to the American Society of Echocardiography recommendations. 2D strain and strain rate echocardiography were performed after the ECG probes of the echocardiography machine were adjusted for ECG monitoring. Longitudinal, transverse and radial strain, and strain rate were assessed from six basal and six mid-ventricular segments of the left ventricle, as recommended by the American Society of Echocardiography.

RESULTS

Left ventricular wall thickness, systolic and diastolic diameters, left ventricular diameters normalised to body surface area, end-systolic and end-diastolic volumes, cardiac output and cardiac index values were within normal limits and statistically similar in the patient and control groups (p > 0.05). Global strain and strain rate: the patient group had a statistically significant lower peak A longitudinal velocity of the left basal point and peak E longitudinal velocity of the left basal (VAbasR) point, and higher global peak A longitudinal/circumferential strain rate (GSRa) compared to the corresponding values of the control group (p < 0.05). Radial strain and strain rate: end-systolic rotation [ROT (ES)] was statistically significantly lower in the patient group (p < 0.05). Longitudinal strain and strain rate: end-systolic longitudinal strain [SLSC (ES)] and positive peak transverse strain (STSR peak P) were statistically significantly lower in the patient group (p < 0.05). Segmental analysis showed that rotational strain measurement of the anterior and lateral segments of the patient group were statistically significantly lower than the corresponding values of the control group (p < 0.05). Segmental analysis showed statistically significantly lower values of endsystolic longitudinal strain [STSR (ES)] of the basal lateral (p < 0.05) and end-systolic longitudinal strain [SLSC (ES)] of the basal septal segment (p < 0.05) in the patient group. End-systolic longitudinal strain [SLSC (ES)] and positive peak transverse strain (STSR peak P) were statistically significantly lower in the patient group (p < 0.05). Segmental analysis showed statistically significantly lower values of endsystolic longitudinal strain [SLSC (ES)] of the mid-anterior and basal anterior segments (p < 0.05), end-systolic longitudinal strain [STSR (ES)] measurements of the posterior and mid-posterior segments, end-systolic longitudinal displacement [DLDC (ES)] of the basal posterior, mid-posterior and mid-antero-septal segments in the patient group.

CONCLUSION

Cardiac arrhythmias, cardiomyopathy and sudden cardiac death are rare complications but may be seen in children with Wilson's disease due to copper accumulation in the heart tissue. Strain and strain rate echocardiography is a relatively new and useful echocardiographic technique to evaluate cardiac function and cardiac deformation abnormalities. Our study showed that despite normal systolic function, patients with Wilson's disease showed diastolic dysfunction and regional deformation abnormalities, especially rotational strain and strain rate abnormalities.

Huge Left Atrial Pseudoaneurysm in a 5-Month-Old Baby Presented with Supraventricular Tachycardia

Cardiac pseudoaneurysm is an extremely rare condition in children. It can be congenital or acquired and has been primarily described in the left side of the heart. The congenital form of pseudoaneurysm is thought to be related to muscular dysplasia of the muscular layer of the heart. The acquired form is related to myocardial infarction, infective endocarditis or chest trauma. In this report we described a 5-month-old baby with left atrial pseudoaneurysm who was referred to our hospital due to tachycardia and hemodynamic instability. After diagnosis of left atrial pseudoaneurysm, aneurysmectomy was performed and the left atrial wall was successfully repaired by surgery three days after admission. In conclusion, due to life threatening complications such as dissection, arrhythmias, compression of aneurysm and tromboembolic complications, pseudoaneurysm should be treated by surgery.

KEY WORDS

Chest trauma; Left atrial pseudoaneurysm; Supraventricular arrhythmias.

Iliac arteriovenous fistula presenting with ascites

Arteriovenous fistula presents rarely with ascites. Diagnosis, with an elusive clinical presentation, is often incidental or delayed. A 35-year-old woman presented with ascites and cardiac decompensation. Contrast enhanced computed tomography revealed arteriovenous fistula between the left common iliac artery aneurysm and the left common iliac vein. The patient underwent endovascular treatment with arterial access was performed, with implantation of a stent graft in the iliac artery to cover the fistulous communication. At follow-up 1 month later, she was asymptomatic without ascites. Arteriovenous fistula should be considered in the differential diagnosis of patients with ascites and cardiac decompensation. The endovascular treatment of the arteriovenous fistula should be considered as a first line option.

Long-term Survival after Lapatinib Rechallenge in Isolated Brain Metastasis of HER2-positive Breast Cancer

Lapatinib is an effective drug in HER2-positive breast cancer. We present a case with successful treatment of lapatinib in brain metastasis of HER2+ breast cancer. Forty-eight years old woman was admitted our clinic with early breast cancer. In third years after adjuvant chemotherapy and trastuzumab, isolated and multiple brain metastasis were detected. After whole brain RT, lapatinib (with capecitabine for 10 months and with letrozole for 3 months) has been used. Volumetric reduction of lesions was achieved and symptoms disappeared. When lapatinib discontinued, brain metastasis relapses. Lapatinib plus capecitabine reinduction has been started. Totally, longer survival than 45 months was achieved after first brain metastasis detection. Because both combinations of lapatinib with capecitabine and letrozole were effective and reinduction treatment was successful, presented case has strongly supported activity of lapatinib treatment in brain metastasis of HER2+ breast cancer.

The effects of music therapy on pain in patients with neuropathic pain

The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity.

Effects of dietary supplementation of synbiotics and phytobiotics on performance, caecal coliform population and some oxidant/antioxidant parameters of broilers

The current study was conducted to evaluate the effects of dietary supplementation of synbiotics and phytobiotics on performance, small intestine weight, pH and caecal coliform counts of broilers. The influences of synbiotics and phytobiotics on oxidant/antioxidant status in the blood of broilers were also assessed. A total of 200 broiler chicks were randomly allotted to four dietary treatments, either fed a basal diet or the same diet supplemented with 1 g/kg synbiotic, 1 g/kg phytobiotic or 1 g/kg synbiotic plus 1 g/kg phytobiotic. The diet supplemented with both synbiotic and phytobiotic had no effect on body weight, body weight gain, feed intake and feed efficiency of broilers at the end of the study (p > 0.05). Neither small intestine weight nor pH was affected by any of the treatments. Supplementation of both synbiotic and phytobiotic to diet decreased the caecal coliform count (p < 0.01). Addition of synbiotics and phytobiotics in combination significantly increased plasma malondialdehyde (MDA) levels (p ≤ 0.05), whereasphytobiotic addition alone showed only a slight increase. Similarly, elevated nitric oxide (NO) level was recorded in the synbiotic- and phytobiotic-fed group and in the phytobiotic-fed group (p ≤ 0.001). Superoxide dismutase (SOD) activities did not differ between the groups. In conclusion, dietary supplementation of synbiotic and phytobiotic improved the gut health by decreasing the caecal total coliform count, but growth performance was not affected by the supplementations. Further investigations are needed to determine the effects of phytobiotics on oxidative/antioxidative metabolism as regards their compositional analysis.