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Eastern J Med: 23 (1)
Volume: 23  Issue: 1 - 2018
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ORIGINAL ARTICLE
1.Early retinal changes after uncomplicated mild and hard cataract surgery
Özkan Sever, Fatih Horozoglu
doi: 10.5505/ejm.2018.04274  Pages 1 - 5
INTRODUCTION: To evaluate and compare the possible effects of hard and soft nuclear cataract surgeries in the development of early postoperative retinal complications.
METHODS: In a retrospective study design 1388 uncomplicated phacoemulsification surgery were enrolled in the study. Data for 688 Grade 5-6 and 700 Grade 2-3 nuclear cataracts according to Lens Opacities Classification System III (LOCS III) were used for comparison. All patients were evaluated for visual acuity (VA),intraocular pressure (IOP), central macular thickness (CMT) and angiographic fluid leakage pattern at 1 week and 1 month. Biomicroscopic evaluation, optical coherence tomography (OCT), fleuroscein angiography (FA) and indocyanine green angiography (ICG) were used for examination.
RESULTS: Follow up time was 1 month. Mean CMT of patients were higher at hard cataracts but not statistically significant (p>0.24). Clinically significant cystoid macular edema after hard nuclear cataract surgery was 1.59 %(11) and 1.28 %(9) for soft cataracts(p> 0.05). After 20/20 visual acuity at 1 week, 5 (0.72 %) patients from hard nuclear group had visual loss and hemorrhagic pigment epitelial detachment(PED) at 1 month control. Angiographic evaluations revealed them 4 as insignificant polypoid choroidal vasculopathy (PCV). One of them is still controversial. IOP and VA results were similar at both controls (p> 0.05).
DISCUSSION AND CONCLUSION: Subretinal hemorrhage after cataract surgery may be the first sign of some PCV patients.Patients who were diagnosed with PCV should be carefully evaluated for cataract surgery. Hard nuclear cataract may be a predisposing factor for early hemorhagic PED in patients with PCV. Any retinal pathology should be carefully evaluted before cataract surgeries.

2.Problems encountered in screening study with ultrasound for early diagnosis of developmental dysplasia of hip in eastern region of Turkey
Mehmet Fethi Ceylan, Savas Güner, Mehmet Ata Gökalp, Zehra Kurdoğlu, Abdurrahim Gözen, Mehmet Fatih Korkmaz, Tülin Türközü, Hüseyin Akdeniz, Oğuz Tuncer
doi: 10.5505/ejm.2018.32932  Pages 6 - 10
INTRODUCTION: The aim of this study is to evaluate results of the screening program of the developmental dysplasia of the hip (DDH) were examined in newborn period. The problems encountered in the applicability of the early screening program were evaluated.
METHODS: By interviewing with the family of 1680 newborns born in our institution or referred, the information was given about the DDH and its risk factors, learnt were recorded. The families were told to bring their babies for examination and hip ultrasound at the 3rd or 4th week of birth. In addition, all the parents were called by telephone to be remind their appointments one day ago.
RESULTS: Five hundred and thirty-six babies (31.3%) were brought to the first appointment. Forty-two hips (3.9%) of the 30 infants (5.6%) were detected to be the dislocation (Type 2c, D, 3). The 8 of these 30 patients (26.7%) whom the treatment was started were brought for the second control. Asymmetry of thigh folds was positive in the highest rate as the finding of the examination in the infants brought to the appointment. The rate of swaddling at the first appointment was found to be 74.2%.
DISCUSSION AND CONCLUSION: Surprisingly, less than one third of children were brought to ultrasound examination at first control. Similarly, about 3/4 of the parents continued to use swaddling for their babies. In order for the planned national DDH screening program to be successful, additional precautions must be taken to ensure the participation of the families and release of the swaddling.

3.The relationship between the ABO blood group and tumor diameters in patients with carotid body tumors
Nazim Bozan, Ufuk Duzenli, Muzaffer Arı, Mahfuz Turan, Ahmet Faruk Kıroglu, Mehmet Aslan
doi: 10.5505/ejm.2018.21042  Pages 11 - 14
INTRODUCTION: Several studies have assessed the association between blood group of ABO and many cancer. Nevertheless, there was no data regarding the connection between blood group of ABO and tumor diameters in carotid body tumors (CBTs) patients. The purpose of our study was to analyses possible association between tumor diameters and gender, ABO blood group in CBTs patients compared healthy controls.
METHODS: The demographic and laboratory data of 65 CBTs patients (57 females and 8 males) who underwent surgical intervention and 65 healthy controls (52 females and 13 males) were retrospectively analyzed.
RESULTS: The mean age of CBTs patients was 51.81±9.82 years, and the mean age of the healthy subjects was 52.72±8.50 years. There were no statistically significant between two groups with regard to age and gender. The mean of tumor diameters was 3.72±1.50 cm (range=1-8 cm). There was no statistically significant difference between study groups according to AB0 blood group (p=0.87). The females/males ratio of patients was 57/8. The mean tumor diameters of females was 3.57±1.34 cm and the mean tumor diameters of males was 4.77±2.16 cm; the difference was statistically significant (p=0.03). There was a positive correlation between male gender and the tumor diameters (r=0.23, p=0.03).
DISCUSSION AND CONCLUSION: This is the first report investigating association between the tumor diameters and AB0 blood group in CBTs. Although CBTs were shown higher in females, tumor diameters were found significantly higher in males than females. However, we did not determine any association between AB0 blood group and tumor diameters.

4.Roadside bombs and routes to life: The experience of Turkey
Sebahattin Çelik
doi: 10.5505/ejm.2018.87049  Pages 15 - 22
INTRODUCTION: Injuries caused by roadside improvised explosive devices (IEDs) have recently been on the increase in Turkey. The aim of the present study is to evaluate the types of injuries sustained by victims of IEDs, and the pre-hospital/inter-hospital handling of patients transported to a Level 1 trauma center following roadside bombings.
METHODS: Data were obtained from the registry of an earlier multi-centric prospective study designed to evaluate injuries caused by high kinetic energy weapons. Here, we retrospectively analyze injuries resulting from roadside bombs. All patients in the registry from August 2015 to May 2016 who were victims of roadside explosions were included. Patient demographics, injury severity scores (ISS), wound types, and transfusions needs were recorded and outcomes (length of hospital stay and mortalities) were evaluated.
RESULTS: Of 390 patients injured by high kinetic energy weapons, 51 were wounded by roadside bombs (an estimated hospital incidence of 13; 1%). Fourteen separate incidents were observed (an average of 3.6 patients per incident). Of these patients, 8 were civilian and 43 were security personnel. The injury ratio to multiple body regions was 71.8% and the mortality ratio was 15.7%. Pneumothorax and pulmonary contusion were the leading pathologies in terms of lethality. Vehicular accidents were frequently observed as causes of tertiary blast injuries. Twelve patients were transported to hospital who did not have physical injuries
DISCUSSION AND CONCLUSION: Our experience has shown that a roadside bomb not only causes an explosion, but also possibly a vehicular accident, burns, and, severe psychological trauma as well.

5.Evaluation of cardiac autonomic functions in Children with Thalassemia Trait, Iron Deficiency Anemia and Iron Deficiency
Mecnun Çetin, Nichal Moumin, Bertan Karaboğa, Şenol Coşkun, Hüseyin Gülen
doi: 10.5505/ejm.2018.17363  Pages 23 - 30
INTRODUCTION: Distruption of cardiac autonomic functions during diseases associated with anemia were reported in multiple studies previously. Objective in this study to investigate heart rate variability (HRV) for evaluation of cardiac autonomic functions in children patients with Thalassemia trait (TT), iron deficiency anemia (IDA) and iron deficiency(ID) without anemia.
METHODS: Twenty-five patients with TT, 25 patients with IDA, 25 patients with ID, and 25 healthy controls were assessed with 24-hour ambulatory electrocardiography recordings. The following time-domain indices were calculated; standard deviation values of all normal sinus R-R intervals over 24 hours(SDNN), standard deviation levels of all mean normal sinus R-R interspaces for each 5-minute strip in the 24-hour enrollments(SDANN), the square root of the mean of the sum of squares of differences between adjacent RR intervals(RMSSD), percentage of difference between adjacent normal R-R intervals that are greater than 50 ms computed over the entire 24-hour ECG recording(pNN50). Re-evaluation regarding HRV were done in children with IDA after 4 months of treatment.
RESULTS: Although reduction in HRV parameters was detected in IDA group compared to ID, TT, and control groups, it was statistically not significant(p>0.05). The pNN50 was significantly low only in the IDA group(p=0.042). In the ID and TT groups, HRV parameters were not affected(p> 0.05). In IDA group, SDNN, SDANN, RMSSD and pNN50 index were significantly higher after treatment(p=0.002, p=0.005, p=0.005, p=0.010, respectively).
DISCUSSION AND CONCLUSION: Our results indicate that cardiac autonomic activity are affected in IDA and improvement occurs after treatment. HRV parameters were found to be especially associated with hemoglobin and hematocrit values.

6.Disseminated Intravascular Coagulation: A Single Center Experience
Omer Ekinci, Omer Candar, Ali Dogan, Ramazan Esen, Cengiz Demir
doi: 10.5505/ejm.2018.48568  Pages 31 - 35
INTRODUCTION: We aimed to evaluate the clinical and demographic data of adult patients diagnosed with acute disseminated intravascular coagulation (DIC) who had been referred to the hematology unit by other clinics, as well as to evaluate the effect of clinical and laboratory parameters on patient survival.
METHODS: The records of 87 adult patients admitted to the Department of Hematology of Yuzuncu Yil University Faculty of Medicine between January 2013 and May 2017 and diagnosed with acute DIC were retrospectively examined.
RESULTS: Of the patients participating in the study, 64 (73.6%) were female and 23 (26.4%) were male. Regarding the distribution of etiology in patients with acute DIC, the most common etiology, at 49.3%, was obstectic pathologies. Acute DIC was more frequent in women and younger adults (p = 0.001). Patients with trauma had the highest mortality rate (p = 0.001). Patients diagnosed with acute DIC who died as a result were older, and mortality was higher in males (p < 0.001 for both). Comparing ISTH scores, patients with acute DIC had significantly higher mortality (p = 0.028).
DISCUSSION AND CONCLUSION: In this study, a majority of the patients diagnosed with acute DIC were young and female. Despite their high incidence of acute DIC however, the mortality rate for young female patients was low. The mortality rate was higher in elderly and male patients, although intensive treatment was administered following diagnosis of acute DIC. We believe that early diagnosis and appropriate treatment are of critical importance for patients thought to have acute DIC, regardless of underlying condition.

CASE REPORT
7.A rare case of cerebellar and lung tuberculosis coexistence which presenting intracranial mass symptoms
Mükremin Er, Ayşe Şule Ateş, Osama Abuzaina, H.canan Hasanoğlu
doi: 10.5505/ejm.2018.36035  Pages 36 - 39
Background: Tuberculosis continues to be a problem in the entire world and can be confused with other diseases, when presented extra-pulmonary involvement. Cerebellar tuberculoma may present with symptoms of intracranial mass.
Case Report: A 53-years-old male patient was admitted with complaints of dizziness, nausea and vomiting. Cranial magnetic resonance imaging was observed mass in the posterior fossa and the patient was operated. Pathology of the lesion was reported as necrotizing granuloma. Patient diagnosed with tuberculosis meningoencephalitis and treated standard four drug anti tuberculosis regimen plus methylprednisolone. The symptoms of the patient were completely disappeared during treatment. Follow-up magnetic resonance imaging which taken 6 months after onset of the treatment shows cranial tuberculoma sequelae in the cerebellum.
Conclusion: Central nervous system tuberculosis may be difficult to diagnose as it is an infrequent entity that can easily mimic an intracranial mass. Especially in tuberculosis endemic areas, in the patients who presenting with symptoms of intracranial lesion, tuberculosis diagnosis should be considered.

8.Uncommon Presentation of theTraumatic Diaphragm Rupture
Mustafa Silcan, Hayriye Gönüllü, Caglar Alptekin, İsmet Parlak
doi: 10.5505/ejm.2018.24119  Pages 40 - 42
The clinical diagnosis of traumatic diaphragmatic rupture is difficult and it may even be more problematic if there are any concurrent injuries. In underdiagnosed patients, the symptoms may emerge in late terms. For an early and definitive diagnosis, the patient should be evaluated with a thoracoabdominal computerized tomography and a chest X-ray. This paper presents the case report of a patient diagnosed with the traumatic rupture of the diaphragm on the 2nd day of trauma although the initial radiographic imaging tests had provided normal findings.

9.Recurrent Spontan OHSS in a 10 Week Pregnant: A Case Report
Numan Çim, Egemen Harun Tolunay, Barış Boza, Sena Sayan, Güler Hanım Şahin, Recep Yıldızhan
doi: 10.5505/ejm.2018.30502  Pages 43 - 44
Ovarian hyperstimulation syndrome (OHSS) most often occurs in the context of assisted conception like in-vitro fertilization (IVF). OHSS can be a reason of acute abdomen. USG is very important in the diagnosis of OHSS. Severe complications can be seen in OHSS. İncidence of OHSS is increasing todays, so this situation should be kept in mind and the early diagnosis of OHSS is very important.

10.Pulmonary Edema Because of Incomplete Hanging Attempt
Cevdet Yardimci, Atilla Tekin, Hilmi Demirkiran
doi: 10.5505/ejm.2018.96967  Pages 45 - 47
Hanging is used in suicide worlwide for suicide. It is generally ends with sudden death.But if the person is reached in a short time after hanging attempt, the patient can be saved. But we may come across some medical problems like pulmonary edema, cervical vertebra instability, impaired cognitive functions. 28 year old female patient had been taken to our hospital after incomplete hanging attempt with suicide intention. While she was in our hospital she had pulmonary complication. She had mechanical ventilation need, We supported her wiht mechanical ventilation both invasively and noninvasively. After 4 days of mechanical ventilation support she was discharged to the psychiatry clinic without any sequel.

REVIEW ARTICLE
11.Advances in current medication and new therapeutic approaches in epilepsy
Oruc Allahverdiyev, Sara Dzhafar, Mehmet Berköz, Metin Yıldırım
doi: 10.5505/ejm.2018.62534  Pages 48 - 59
Epilepsy is one of the most complicated hypersynchronization inneurological state; however, the affected part of the brain defines the patient abnormality behavior. Unlike the younger patients whose seizures are usually overcome after the age of 16-18, older patients hardly overcome seizures, especially once the type of seizure developed to generalize tonic-clonic phase. Globally, epilepsy is considered as one of the burden brain electrical disorder that approached to effect 50 million people throughout the world. Pharmacoresistance, drug interactions, drug tolerability and various adverse effects are among the common problems associated with treatments of epilepsy with antiepileptic drugs (AEDs). Although, approximately 70% of the patients exhibit complete controlled seizures with most AEDs, the remaining 30% fail to respond to treatment with AEDs. Thus, looking for traditional alternatives like medicinal plants, ketogenic diet and the Atkins diet, using self-physical therapy power like relaxation and yoga, are all positive options for substituting the use of medications in seizure control. Medical plants are more common used by folk in making infusions herbal teas for pain relief and maintanence of health wellness, moreover they generate a rich source for ethnopharmacologist scientists to investigate the active components of extracted plant and produce it as a new agent from the nature with less side effects and economic value. Surgical intervention therapy is the last option that can be carried out after the failure of the suggested alternative therapies; however, all those alternatives minimize the seizures in terms of syndromes but not in completely eliminating the disease.

12.Postpartum Psychosis
Mesut Işık
doi: 10.5505/ejm.2018.62207  Pages 60 - 63
The postpartum period is a risky period for the emergence or exacerbation of psychiatric disorders. Postpartum psychosis is the most severe psychiatric disorder in the postpartum period that requires immediate intervention. In most of the cases, the onset is immediate and it is usually in the first two weeks of postpartum period. Sleep disturbances, mood swings, delusions, hallucinations, disorganized behavior, psychomotor agitation, food rejection may be seen. Due to risk of suicide and infanticide, patients should be admitted to the hospital. The most important treatment option in addition to antipsychotic drug therapy is electroconvulsive therapy. Bipolar disorder or postpartum psychosis history, sleep deprivation, primiparity, postpartum hormone changes are important risk factors. The etiology has not been clearly identified yet, although here are many ongoing studies.

LETTER TO EDITOR
13.Vitamin D receptor polimorphism can be associated with coronary artery disaese
Sadık Volkan Emren, Mehmet Tokaç
doi: 10.5505/ejm.2018.44154  Page 64
To the Editor,
We have read the article entitled “ Assessment of vitamin D levels in patients with acute coronary syndrome” by Şimşek et al. (1) with great pleasure, which was published in East J Med 2016; 21(4): 178-182.(4) We congratulated the authors for this excellent study. In this study the investigators reported that Vitamin D insufficiency is not a risk factor for acute coronary syndrome. According to the results of this study, there was no association between vitamin D plasma level and the risk of acute coronary syndrome. In this regard we aim to highlight the some points regarding the relation between vitamin D and coronary artery disease.

vitamin D receptor gene polymorphism can also be associated with coronary artery disease regardless of vitamin D level. Abu El Maaty et al has recently reported that Vitamin D receptor polymorphism especially Fok1 gene has been related to coronary artery disease, although the determined vitamin D genotypes were not related to vitamin D levels (2). Besides Hossein- Nezhad et al demonstrated the association of Fok1 polymorphism with the level of collateralization in patients with coronary artery disease (3) however we have no data about the association with vitamin D polymorphism and coronary artery disease in Turkish population. In this context we advise to investigate the vitamin D receptor gene polymorphism in order to delineate the association with coronary artery disease and vitamin D.



 
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