ISSN 1301 - 0883 / E-ISSN 1339 - 3886


Eastern J Med: 24 (1)
Volume: 24  Issue: 1 - 2019
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1.An Assessment of Gender Difference in Visual Cephalometric Analysis Applied to Class I Individuals: In Turkish Adults A Preliminary Study
Zekiye Karaca Bozdag, Ayla Kurkcuoglu, Ayca Ustdal Guney, Yener Cam, Ozkan Oguz
doi: 10.5505/ejm.2019.40570  Pages 1 - 7
INTRODUCTION: Cephalometric analyzes play an important role in determining the individual's skeletal and dental structure, soft tissue and their relationship to each other. Visual cephalometric analyzes are primarily based on determining the fitness between mid-face and maxilla, then positioning the mandible relative to the midface.Thus, as in the other cephalometric analyzes, changes related to the treatment and development of the current state of the individual are determined. In the study we aimed to reveal sex-related changes of four different angles and compare them with the norm.
METHODS: This study was performed on right lateral cephalometric views of 80 healthy (40 women, 40 men) Turkish individuals in Anatolia aged 21-71, with Class I skeletal (ANB=2.19±1.43). In all images, angles formed by long axis of the upper incisor and palatal plan (U1/PP); the long axis of the lower incisor and mandibular plan (A1/MP); the long axes of the lower and incisor (U1/A1); the palatal plan and mandibular plan (PP/MP) were analyzed.The participants and their families were chosen from people who are Turkish and living in Anatolia.
RESULTS: The PP/MP value of women was found to be significantly higher than men’s (p<0.01), while no significant difference was found between the U1/PP, A1/MP and U1/A1. Statistically significant negative correlations were found between correlations of all angular measurements in both genders (p<0.05).
DISCUSSION AND CONCLUSION: As a result, gender should also be considered as another factor beside the knowledge of angles of U1/PP, A1/MP, U1/A1 and PP/MP in orthodontic diagnosis and treatment planning.Our work continues by increasing the number of data.

2.Effects of Home Visits on Medication Adherence of Elderly Individuals with Diabetes and Hypertension
Ozlem Sinan, Aygul Akyuz
doi: 10.5505/ejm.2019.71463  Pages 8 - 14
INTRODUCTION: This research was a pre-final measured quasi-experimental study evaluating the effects of home visits aimed at increasing the medication adherence of elderly individuals with diabetes and hypertension.
METHODS: The research was carried out in the private homes of elderly individuals, who were then followed up by staff of the Geriatrics Polyclinic. The study subjects were elderly individuals with diabetes and hypertension who met the research criteria (n = 45). The data were collected with the data collection form prepared in accordance with the literature, a form to determine drug use status in the elderly, and the Medication Adherence Self-Efficacy Scale-Short Form.Two home visits were conducted for each patient. During these home visits, the individuals were educated regarding their medications, and their medication adherence levels were evaluated both before and after the education.
RESULTS: The study results demonstrated that the medication adherence levels of the subjects increased after the first home visit. The subjects also became more aware of the important points regarding the medicines they were using, as demonstrated by a statistically significant difference in the average HbA1c values after the home visits (p<0.05).
DISCUSSION AND CONCLUSION: This study revealed that the provision of patient education via home visits is quite effective in creating awareness about medications and increasing the adherence level of elderly individuals’ medication adherence. The results suggest that home visits should be planned for patients in a given period, and that nurses should take an active role in these home visits.

3.Assessement of the complications of Ultrasound and Fluoroscopy-Guided Placement of Totally implantable venous access ports
Sercan Özkaçmaz, Muhammed Alpaslan, Yeliz Dadalı, Alpaslan Yavuz
doi: 10.5505/ejm.2019.08108  Pages 15 - 22
INTRODUCTION: Totally implantable venous access systems are widely used in oncology; however, their complications are extremely common which, sometimes, require device removal, thereby, leading to delayed chemotherapy and infusion therapies. In this study, we aimed to investigate the immediate, early, and late complications of venous port implantation in our oncology patients.
METHODS: A total of 219 consecutive cancer patients (111 males, 108 females; mean age: 56.9 years; range: 1 to 81 years) were retrospectively analyzed between January 2013 and June 2014. A total of 220 ultrasound- and fluoroscopy-guided totally implantable venous port systems were implanted through the right or left internal jugular vein access.
RESULTS: The mean follow-up was 83.7 (range: 2 to 410) days. Overall complication rate was 8.6% (19/220). Eight devices in seven patients were removed due to complications. Two ports were removed in one patient. The complications which required port removal were compromised port-related bloodstream infection (n=5), central venous thrombosis (n=3), and catheter thrombosis (n=1). No major complication or no mortality associated with the port implantation was seen during follow-up. Totally seven immediate complications including local hematoma (n=2), catheter tip retraction (n=2), pain (n=1), catheter loop formation (n=1), catheter malposition (n=1), two early complications (n=2; 1 wound dehiscence, and 1 wound infection), and 10 late complications including catheter-related blood stream infection (n=5), central venous thrombosis (n=3), catheter thrombosis (n=1), and tunnel hematoma (n=1) occurred.
DISCUSSION AND CONCLUSION: Low incidence of complications suggest ultrasound- and fluoroscopy-guided venous port implantation is a safe and reliable method for long-term venous access.

4.Simple Peripheral Markers for Inflammation in Drug-Naive, Comorbidity-Free Adolescents with Obsessive–Compulsive Disorder
Halit Necmi Uçar, Duygu Murat, Şafak Eray
doi: 10.5505/ejm.2019.50455  Pages 23 - 29
INTRODUCTION: Obsessive Compulsive Disorder (OCD) is a psychiatric disorder which has different etiopathogenic mechanisms. One of these mechanisms is immunologic factors. Studies on immunologic factors, various cytokines and cellular elements were investigated. In order to evaluate the immunological factors in psychiatric disorders, a simple and inexpensive method, hemogram parameters have been investigated. We aimed to evaluate hemogram parameters in drug-naive, comorbidity-free adolescents with OCD comparing with controls.
METHODS: A total of 31 patients diagnosed with OCD, who do not have comorbid diseases and do not take any medical therapy within the past one month, were included in the study. The control group consisted of 47 healthy subjects with no organic and psychiatric disorders.
RESULTS: Lymphocytes, RDW, platelets, and PCT values of the adolescents with OCD were significantly lower than those of the control group. There were no differences between the two groups in terms of WBC, hemoglobin, RBC, HCT, MCV, MCH, MCHC, MPV, Neutrophils, neutrophil–lymphocyte ratio, and platelet-lymphocyte ratio.
DISCUSSION AND CONCLUSION: The findings of the study reveal that lymphocytes and RDW tend to be lower in adolescents with OCD. The findings of our study are consistent with those of previous studies, indicating decreased hemogram parameters associated with inflammation in adolescents with OCD. Our study suggest that we need further study to fully understand the role of inflammation in the etiology and treatment of OCD, and follow-up studies should focus on the process of inflammation in psychiatric diseases in children and adolescents.

5.The value of diffusion-weighted imaging in the diagnosis of active sacroiliitis
Hüseyin Akdeniz, Serhat Avcu, Özkan Ünal, Aydın Bora, Mustafa Kasım Karahocagil
doi: 10.5505/ejm.2019.40085  Pages 30 - 37
INTRODUCTION: The aim of this study was to evaluate the effectiveness of diffusion-weighted imaging (DWI) in the diagnosis of active sacroiliitis.
METHODS: In this prospective study, 66 patients with clinical prediagnosis of active sacroiliitis were evaluated. Four patients who were not suitable for MRI examination were excluded. Twenty subjects with no complaint of low back pain constituted the control group. All of the patients underwent sacroiliac MRI examination performed with a 1.5 Tesla unit using phase array body coil. Before DWI, oblique axial and coronal T1 and T2-weighted TSE followed by STIR sequences were obtained. DWI examinations were obtained on SS-SE EPI sequence through chemical shifting selective fat supression technique. ‘b’ value was chosen as 50, 400 and 800 mm²/sec and total scanning time was 114 seconds. ADC calculations were made from the ADC maps by placing ROI on the active inflammatory regions in case group and on sacrum and iliac bones in control group.
RESULTS: Of the 62 cases, 42 had a radiologic diagnosis of active sacroiliitis, and 20 were regarded as normal. Mean ADC values in 42 patients with active sacroiliitis were significantly higher than control group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of DWI in the diagnosis of active sacroiliitis were found to be 100 % for all. The cut-off ADC value was 0.94x10-3 mm²/sec for right sacroiliitis and 0.89x10-3 mm²/sec for left sacroiliitis.
DISCUSSION AND CONCLUSION: We believe that DWI and ADC quantification can be used successfully for the early diagnosis and follow-up of active sacroiliitis.

6.Hypermobility syndrome and proprioception in patients with knee ligament injury
Aslıhan Uzunkulaoğlu, Nuri Çetin
doi: 10.5505/ejm.2019.14227  Pages 38 - 41
INTRODUCTION: The aim of this prospective controlled study was to determine the effect of hypermobility on proprioception and knee ligament injuries in a young patient population.
METHODS: 20 cases admitted to outpatient clinic of physical medicine and rehabilitation department with diagnosed as knee ligament injury (patient group) and 17 healthy individuals (control group) were included in this controlled study. Beighton scores (BS) were obtained from each patient. Cybex NORM dynamometer (770 Norm, Lumex Inc. Ronkonkoma, NY USA) were used for proprioception testing. Measurements were recorded for three times in both flexion and extension and mean values were noted.
RESULTS: The frequency of hypermobility was higher in the patient group than the control group with a statistically significance (p<0.05). When the proprioception measurements were evaluated, the increase in average absolute angle error values for extension to flexion and for flexion to extension was higher in patient group than control group (4,86 ± 3,39 vs 3,78 ± 3,85 and 4,61 ± 4,18 vs 4,26 ± 1,90), but this difference was not statistically significant (p>0.05). The increase in average absolute angle error values for extension to flexion and for flexion to extension was higher in patients with hypermobility for both groups but this difference was not statistically significant (p>0.05)
DISCUSSION AND CONCLUSION: Hypermobility and knee ligament injuries both contributes to proprioception deficits and hypermobility can more likely lead to knee ligament injuries. Further studies with randomized controlled design are needed.

7.Systemic inflammatory blood markers in patients with tympanosclerosis
Ufuk Düzenli, Nazım Bozan, Ramazan Akın, Ahmet Faruk Kıroğlu, Mehmet Aslan
doi: 10.5505/ejm.2019.00710  Pages 42 - 46
INTRODUCTION: Tympanosclerosis is a disorder as known hyaline accumulation in the middle ear. Inflammation has been proposed in the development of tympanosclerosis. The mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width (RDW) are most common markers of systemic inflammation.
METHODS: Fourty patients who diagnosed tympanosclerosis intraoperatively and 35 subjects without tympanosclerosis were enrolled in this retrospective study. The MPV, RDW, neutrophil and lymphocyte as well as platelet count were evaluated from complete blood counts in both trial participants. NLR was calculated.
The purpose of this research was to determine blood systemic inflammatory markers in patients with tympanosclerosis.

RESULTS: The average age of patients with tympanosclerosis was 23.4±9.2 years, and it was found 24.7± 8.9 years in subjects without tympanosclerosis. There were 21 female and 19 male in subjects with tympanosclerosis and 17 female and 18 male in subjects without tympanosclerosis. Two groups have similar results with respect to age and gender. There was no important difference between two research participants with respect to the MPV, RDW and NLR (p>0.05).
DISCUSSION AND CONCLUSION: We could not find any association between the markers of blood systemic inflammatory and tympanosclerosis. Therefore, tympanosclerosis does not seem to change the systemic inflammation.

8.Investigation of antibiotic resistance genes of beta-hemolytic and non-hemolytic streptococci with molecular methods
Gülhan Bora, Ömer Akgül, Elif Naz Kıymaz
doi: 10.5505/ejm.2019.68542  Pages 47 - 52
INTRODUCTION: Infectious diseases have been one of the most important problems affecting all societies since the existence of mankind. Streptococci are an important cause of diseases in humans such as meningitis, acute otitis media, rhinosinusitis and community-acquired pneumonia.
METHODS: In this study, various clinical samples belonging to the disease were taken between January and September 2015. Analyzes of determined and identified antibiotic resistance genes of isolated and identified streptococci strains were carried out in the Microbiology laboratory of Yüzüncü Yıl University Faculty of Pharmacy by PCR. The detection of pbp1a for penicillin G antibiotic, pbp2x for cefotaxime antibiotic, and gyrA resistance genes for quinolone antibiotics were targeted. In this study, the primers used in Table-2 were taken as reference.
RESULTS: A total of 30 streptococcus strains were isolated and identified from various clinical samples including 8 sputum, 6 urine, 5 BOS, 4 blood, 4 nasopharyngeal swab, 2 ear effusion and 1 abse. As a result of the PCR analysis, the resistance of pbp1a was found in 6 of the streptococcal isolates, pbp2x in 8, and resistance in the gyrA gene region in 5. In our study, no three resistance genes were found in 22 isolates and the presence of all three (pbp1a, pbp2x and gyrA) resistance genes in 5 isolates was determined.
DISCUSSION AND CONCLUSION: It is expected that the data obtained from this research will contribute to national and international knowledge accumulation.

9.Effect of Acetaminophen on Viability of HeLa Cells
Gökhan Görgişen, İsmail Musab Gülaçar, Ersoy Öksüz
doi: 10.5505/ejm.2019.16362  Pages 53 - 56
INTRODUCTION: Acetaminophen is a widely used analgesic to release pain and reduce fever. Overdose medication could lead to serious medical conditions such as hepatotoxicity and liver failure. In addition to its cytotoxicity effects, it has an anti-proliferative effect in human cancer cells. In this study it is aimed to determine the cytotoxic effect of acetaminophen in HeLa cells.
METHODS: In this perspective, HeLa cells were treated with different concentrations of acetaminophen at three different exposure times. Cell viability was determined by MTT analysis.
RESULTS: Results showed that acetaminophen inhibited viability of HeLa cells. Its cytotoxic effect depends on exposure time and concentration.
DISCUSSION AND CONCLUSION: Prolonged exposure of acetaminophen led to decrease in cell survival even at minimum concentrations.

10.Health Capital, Primary Health Care and Economic Growth
Tengiz Verulava
doi: 10.5505/ejm.2019.35762  Pages 57 - 62
INTRODUCTION: Investments in healthcare are important in terms of formation of the health capital. The research aims to find out the role of the health capital in economic growth of a Georgia (country).
METHODS: This study is based on the secondary sources of data. The study data were obtained from Human Development Report, Ministry of Labor, Health and Social Protection of Georgia. As a proxy indicator for measuring the health capital we used the life expectancy, the morbidity prevalence and Incidence rate, maternal and children’s mortality rate, outpatient referral rate, the state expenses on healthcare.
RESULTS: The average life expectancy has increased in recent 25 years. The maternal and children’s mortality rate has decreased, healthcare expenses have become higher and outpatient referral rate has also become more constant character. All these have a positive influence on the people’s health and country’s economic growth. However, the state expenses on health and primary healthcare referral rate is far below the European level. Patients are less motivated to go to a primary healthcare for prevention and decide to receive medical service only when they are in critical condition. All this shows that the primary healthcare system cannot fulfill the role of the so-called ‘gatekeeper’. In general, the primary healthcare system has not developed in Georgia
DISCUSSION AND CONCLUSION: As the health capital fulfills significant role in terms of the country’s economic growth in a long-run perspective, it is advisable to promote the development of the primary healthcare system and taking WHO recommendations concerning state healthcare expenses into account

11.Novel inflammatory markers in patients with psoriasis
Göknur Özaydın Yavuz, İbrahim Halil Yavuz
doi: 10.5505/ejm.2019.19327  Pages 63 - 68
INTRODUCTION: Psoriasis is an autoimmune, chronic, inflammatory skin disease affecting approximately 1-3% of the population worldwide. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are simple and practical methods used as predictive markers in numerous clinical conditions. In this study, we aimed to investigate the relationship between the severity of psoriasis and NLR, PLR, and MPV levels in patients with psoriasis.
METHODS: The study included 60 patients who were being followed up due to a diagnosis of psoriasis and 30 healthy controls. The NLR was calculated by dividing neutrophil count by lymphocyte count and the PLR was calculated by dividing platelet count by lymphocyte count.
RESULTS: The 90 participants comprised 45 (50.0%) men and 45 (50.0%) women with a mean age of 41.2±13.4 years. Mean PASI score was 8.1±5.2, mean MPV was 8.8±0.9 fL, mean platelet count was 262.7±71.3 10e3/uL, mean leukocyte count was 7.3±2.0 10e3/uL, mean NLR was 1.8±1.1, mean PLR was 112.9±45.9, and mean duration of disease was 9.4±7.3 years.
DISCUSSION AND CONCLUSION: No significant difference was found in the NLR, PLR, and MPV levels between the patients with psoriasis and the controls. Although psoriasis is a common disease in the general population, there is no specific laboratory marker for the determination of disease severity. On the other hand, although the NLR, PLR, and MPV levels, which can be easily determined by a CBC test, were found to be normal in the patients with psoriasis, accumulating evidence suggests that these parameters are promising for this disease.

12.Relationships between somatosensory amplification, health anxiety, and low back pain among pregnant women
Abdullah Yıldırım, Murat Boysan, Erbil Karaman, Orkun Çetin, Hanım Güler Şahin
doi: 10.5505/ejm.2019.52296  Pages 69 - 73
INTRODUCTION: A great proportion of pregnant women experience low back pain during pregnancy. The aim of this study was to uncover potential psychological mechanisms underlying pregnancy-related back pain.
METHODS: Fifty two women with low back pain and forty seven women without low back pain were volunteered to participate in the study. A battery set containing the Health Anxiety Inventory (HAI), Hospital Anxiety and Depression Scale (HADS), Somatosensory Amplification Scale (SSAS), and Visual Analog Scale (VAS) was completed by all participants. Group comparisons were conducted using logistic regression analysis. Relationships of psychological symptoms with pain as measured by the VAS were assessed using regression analysis.
RESULTS: Regression models showed that somatosensory amplification satisfactorily explained the group difference between pregnant women with and without low back pain. A tendency to anomalous somatic sensation was associated with the individual differences on scores of the VAS.
DISCUSSION AND CONCLUSION: We concluded that pregnant women high in somatosensory amplification were at greater risk of development of low back pain during pregnancy.

13.Evaluation of Subclinical Papilledema in Patients with Obstructive Sleep Apnea Syndrome
Zeynep Gürsel Özkurt, Melike Demir, Yusuf Yıldırım, Selahattin Balsak, Ümit Karaalp
doi: 10.5505/ejm.2019.46036  Pages 74 - 79
INTRODUCTION: The aim of this study is to analyze optic nerve head total retinal thickness (TRT) in Obstructive Sleep Apnea Syndrome (OSAS) and demonstrate a possible subclinical papilledema
METHODS: Thirty-six patients with suspected OSAS underwent standard overnight polysomnography and were grouped into mild, moderate and severe. Seventy eyes of thirty six OSAS patients and seventy-two eyes of healthy controls were included. Retinal nerve fiber layer thicknesses (RNLF) and TRT s were measured by optic coherence tomography.
RESULTS: RNFL segment values showed no difference between OSAS and control groups. RNFL superior segment and inferonasal segments of the mild OSAS subgroup were found to be thinner than the moderate and severe OSAS subgroups (p=0.034, p=0.025, respectively). RNFL point values also showed no difference between the two groups. The RNFL inferior point of the mild OSAS subgroup was found to be thinner than the moderate and severe subgroups (p=0.036). OSAS TRTs were thinner than the controls at inferior and temporal points (p=0.005, p=0.033, respectively). The TRT inferior point of the mild OSAS subgroup was found to be thinner than the moderate and severe subgroups (p=0.006). At all points
RNFL values were subtracted from the TRT values and compared. At the temporal point the OSAS group’s TRT-RNFL was thinner than that of the control groups (p=0.029).

DISCUSSION AND CONCLUSION: TRT measurements could not demonstrate a possible subclinical papilledema. Thinning of RNFL thickness and TRT in OSAS patients could be the result of hypoxemia related chronic atrophy.

14.The activity of topical coenzyme Q10 (ubiquinol) in burned rats: Results from an experimental study
Ceren Canbey Göret, Aslı Kiraz, Nuri Emrah Göret, Sevilay Oğuz Kılıç, Ömer Faruk Özkan, Muammer Karaayvaz
doi: 10.5505/ejm.2019.66934  Pages 80 - 85
INTRODUCTION: The objective of this study was to investigate the effectiveness of topically applied coenzyme Q10 (CoQ10) (ubiquinol) for wound healing in rats with experimentally induced burn injuries.
METHODS: A total of 27 rats was divided into three groups, and administered general anesthesia. No further intervention was performed for Group 1 (Control). Hot water (95°C) was applied to rats in Groups 2 and 3 for 10 seconds. The rats in Group 2 received silver sulfadiazine, whereas those in Group 3 received topical CoQ10. Biopsy specimens were obtained at days 3 and 10.
RESULTS: In the group treated with CoQ10 (Group 3), there was not statistically meaningful difference among Days 3 and 10 in terms of inflammation and epidermal/vascular/collagen damage. In terms of edema, there was a statistically meaningful distinction among the CoQ10 group (Group 3) at Day 10 and the silver sulfadiazine group (Group 2) at Day 3. In terms of oxygen radicals, there was a statistically meaningful difference among the CoQ10 group and the silver sulfadiazine group at Day 10.
DISCUSSION AND CONCLUSION: This investigation did not demonstrate a beneficial role of treatment with CoQ10 for the healing of burn wounds for most parameters. But in the long term (10 day); immunohistochemical analysis performed to determine edema and oxidative stress showed that treatment with CoQ10 reduced the levels of oxygen radicals in biopsies. The limitation of our study is that the duration is limited to 10 days. For this reason longer term studies were required.

15.Agreement Between Endocervical Brush and Endocervical Curettage for the Diagnosis of Cervical Cancer
Melih Bestel, Baki Erdem, Aysegul Bestel, ONUR KARAASLAN
doi: 10.5505/ejm.2019.64325  Pages 86 - 90
INTRODUCTION: Endocervical curettage (ECC) and endocervical brush (ECB) are two of the methods that can be used in the diagnosis of cervical cancer, which is one of the most common gynecologic cancer. In this study, the agreement between two methods was investigated and it was evaluated whether ECB can be used instead of ECC, which is more invasive.
METHODS: The files of the patients admitted to the Gynecology and Obstetrics Clinic of a tertiary health care center were retrospectively reviewed. A total of 170 patients who were referred for colposcopy due to abnormal Papanicolaou test (pap smear) result and / or high-risk human papilloma virus (HPV) positivity and who underwent colposcopic biopsy without anesthesia, and cervical sampling with ECC and ECB were included. The ECB and ECC sampling results were divided into 3 groups, as “Negative”, “Low-grade” and “High-grade”.
RESULTS: ECB was negative in 132 (83.5%) of the 158 patients who had negative ECC results. Four patients with low-grade ECC results also had low-grade ECB results (100%). Only 4 patients (50%) had high-grade ECB results of 8 patients with high-grade ECC results. Regarding all the data between the two groups, a moderate degree of agreement was found with an ICC of 0.503 (95% CI: 0.327-0.633, p <0.001).
DISCUSSION AND CONCLUSION: Considering the moderate agreement between the two methods, especially higher in the negative group as well as the low-grade group, and ECB being less invasive, it can be concluded that both methods can be used interchangeably according to patients.

16.The visceral slide test for the prediction of abdominal wall adhesions: a prospective cohort study
Isil Safak Yildirim, Dogukan Yildirim, Seyma Yesiralioglu, Eser Sefik Ozyurek
doi: 10.5505/ejm.2019.34966  Pages 91 - 95
INTRODUCTION: An accurate prediction of abdominal wall adhesions would be extremely beneficial to help preventing injuries during the initial abdominal entry. Our aim was to evaluate the accuracy of the visceral slide test in predicting abdominal wall adhesions before surgery.

METHODS: One hundred fifty-five patients who underwent benign gynecologic surgery were prospectively enrolled. Seventy patients (45%) had previous baseline risk factors including abdominal surgeries, episodes of pelvic inflammatory disease [PID] or peritonitis. Eighty-five patients (55%) had no risk for intraabdominal adhesions. On the day of surgery, patients underwent the visceral slide test in five zones of the abdomen using ultrasonography, and a prediction of adhesions was made for each zone. Ultrasound findings were then compared with intraoperative visualization.
RESULTS: A total of 112 laparotomies and 43 laparoscopies were performed. The use of the visceral slide test for the prediction of adhesions showed an overall accuracy of 86.5%, a sensitivity of 78.6%, a specificity of 88.2, a positive predictive value of 59.5%, and a negative predictive value of 94.9%.
DISCUSSION AND CONCLUSION: Our study suggests that the visceral slide test is an easy, non-invasive, and reliable method for predicting abdominal wall adhesions in women undergoing benign gynecologic surgery.

17.Investigation of Synergistic, Additive and Antagonist Effect of Antimicrobial Combinations Used for Brucella spp., with E-test Combination Method
Halim Kaysadu, Yücel Duman, Yusuf Yakupogulları
doi: 10.5505/ejm.2019.66588  Pages 96 - 101
INTRODUCTION: The genus Brucella, which causes permanent infections in the reticuloendothelial system, is a significant cause of morbidity and mortality in humans. Clinically, a combination of two or three antibiotics is usually used for the treatment of brucellosis, but there is not enough information about the in vitro efficacy of these combinations.
METHODS: The in-vitro activity of the combination of doxycycline-rifampin, rifampin-cotrimoxazole, doxycycline-streptomycin, ciprofloxacin-cotrimoxazole and ciprofloxacin-streptomycin, which are most frequently used in clinical practice, was investigated by E-test combination method.
RESULTS: The results were evaluated using the Fractional Inhibitor Concentration Index and synergistic, additive and antagonist effects of these drugs were calculated. While the lowest MIK of the drug against to studied strains was detected as cotrimoxazole (as, 0.016 µg/ml), the highest MIK of the drug was detected as rifampin (as, 1.5 µg/ml). The combination of doxycycline-rifampin showed a synergistic activity to all tested strains (%100), and the combination of rifampin-cotrimoxazole exhibited antagonist activity to two strains (5%). The ratio of synergistic activities of ciprofloxacin-streptomycine and rifampin-cotrimoxazole combinations were found as 57.5% and 52.5%, orderly. The synergistic effect rates of combinations of doxycycline-streptomycin and ciprofloxacin-cotrimoxazole were 32.5% and 25%, respectively. The combination of rifampin with doxycycline showed a excellent synergistic effect against all strains.
DISCUSSION AND CONCLUSION: When clinical treatment is planned, testing the effectiveness of the antimicrobial combination will be beneficial in order for the treatment to be successful.In this context, we believe that in vitro detection of combination effects and single antibiotic susceptibility in the antimicrobial susceptibility tests against Brucella species would be beneficial.

18.Diagnostic Value of Magnetic Resonance Imaging in Prediction of Malignancy in Adnexal Masses
Zarife Kerimova, Sunullah Soysal
doi: 10.5505/ejm.2019.39974  Pages 102 - 107
INTRODUCTION: An ovarian cancer is the leading cause of death in women among gynecological cancers. For this reason adnexal masses diagnosis is important to make differentiation of malignant lesions from benign lesions. Ultrasound is generally used as a second step of evaluation of adnexal masses after pelvic examination. Unfortunately ultrasound may not be enough to detect malignant lesions in adnexa. For this reason several diagnostic approaches are being used. Magnetic resonance imaging can be used in adnexal masses which have malignancy suspicion. This study aims to show the diagnostic value of MRI in diagnosis of adnexal masses
METHODS: Files of 98 patients who underwent surgery for adnexal masses were retrospectively investigated. Patients under 18 years of age, patients whose adnexal mass were incidentally diagnosed during surgery and patients who don’t have preoperative imaging studies were excluded from the study. Postoperative pathology results and preoperative MRI findings were compared.
RESULTS: For MRI evaluation of the patients; the contrast enhancement was found to be more positive in masses diagnosed as malignant (44%vs.6.4%).Also presence of both omental cake and free fluid was found to be related with diagnosis of malignancy in final result. Bilaterally located masses in MRI were found to be more malignant (57%vs.27,14%).
DISCUSSION AND CONCLUSION: When MRI finding were evaluated as malignant or benign the consistency with the final pathology results were studied. A moderate correlation with the final results was found with the MRI results. MRI can be used in differentiation of malignant adnexal masses.

19.Managing mechanical mitral valve on warfarin therapy with gross hematuria: a case report with unfractionated heparin as a bridging therapy
I Made Edwin Alberty Wardhana, Made Edwin Sridana, Putu Gede Budiana
doi: 10.5505/ejm.2019.09226  Pages 108 - 110
A dilemma can happen to a physician when managing bleeding case on a patient with mechanical heart valve with anticoagulant therapy. Major bleeding on anticoagulant treatment usually affects gastrointestinal tract (40-60 %) and urinary tract (15%). To manage the bleeding, vitamin K was restrictedly used in a patient with a mechanical heart valve and only can be used if there is major bleeding. The hypercoagulable state also must be considered when reinitiating warfarin therapy, once the bleeding already stopped. A 51-year-old female with St Jude Medical mechanical mitral valve replacement for 13 years and on regular warfarin therapy came with gross hematuria. INR level was 5.6, and nothing was found that can be the cause of the bleeding from the urinalysis, Urology ultrasonography, and CT Scan. Warfarin was stopped for 3 days, and bleeding still occurred. Unfractionated heparin then was given to the patient to prevent thromboembolism event and as a bridging therapy. On the sixth day, hematuria was stopped, and hemoglobin was reduced only by 2 mg/dL. No rebleeding was found from the patient until 3 months later.

20.Silver nanoparticles; a new hope in cancer therapy?
Şükriye Yeşilot, Çiğdem Aydın Acar
doi: 10.5505/ejm.2019.66487  Pages 111 - 116
Nowadays, with the rapid developments in nanotechnology, there has been a significant increase in the usage of nanoparticles within the biomedical field. Nanoparticles are defined as particles ranging in size from 1 to 100 nm. Especially, silver nanoparticles (AgNPs) have been extensively applied in biomedical areas due to their physicochemical, and biological therapeutic properties. Recent studies have shown that there are anti-fungal, anti-viral, anti-inflammatory, anti-angiogenic biological activities, especially anti-bacterial and anti-tumor properties of silver nanoparticles. Also, the appropriate knowledge of these characteristics is crucial since this knowledge enhances their potential applications in many areas while decreasing their possible dangers to humans and the environment. Recent researches demonstrate that multifunctional cytotoxic biological activities of biosynthesized silver nanoparticles can be used as an anti-cancer agent. In this work, it is aimed to give a literature review of the studies on silver nanoparticles, synthesis techniquies and their possible usages especially in cancer treatment and future challenges.

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