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Eastern J Med: 24 (2)
Volume: 24  Issue: 2 - 2019
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ORIGINAL ARTICLE
1.Protective effect of Ferulago angulata (Schlecht.) Boiss on N-nitrosodimethylamine induced oxidative stress in rats.
Hatice Kızıltaş, Suat Ekin, Mahire Bayramoğlu Akkoyun, Gökhan Oto, Esvet Akbaş
doi: 10.5505/ejm.2019.85866  Pages 117 - 122
INTRODUCTION: The aim of the present study was to investigate the effect of Ferulago angulata (Schlecht.) Boiss. (FASB) extract on mineral (Ca, K, Na) and trace element (Cu, Zn, Se, Co, Fe, Mn, Cr, Pb, Ni, Cd) levels were determined in rat heart tissue, which was oxidatively stressed with N-nitrosodimethylamine (NDMA).
METHODS: Experimental period was continued with Wistar-Albino rats (n: 60) in 21 days. Rats were treated with NDMA (10 mg/kg) in first seven days. FASB plant extract was given to the rats each day of the study. The rats were divided into six groups of ten rats each. The mineral and trace element levels of heart tissue were analyzed by using ICP-OES.
RESULTS: The results show that NDMA group was significantly lower results than control group with regarding to Zn, Co and Na levels (p<0.05, p<0.01 and p<0.05). On the other hand the NDMA group was also significantly lower results than the FASB (300 mg/kg) group regarding Zn and Co levels (p<0.05 and p<0.05), whereas the FASB (150 mg/kg) group had increased level of Na according to NDMA group (p<0.05).
DISCUSSION AND CONCLUSION: In conclusion, due to the positive effect on significantly alteration in Zn and Co level of heart tissue, it was suggested that the FASB (150, 300 mg/kg) can be used in preventing hearth damage.

2.Why Do Nursing and Midwifery Students Choose Their Profession in Turkey?
Şükriye İlkay Güner, Selver Karaaslan, Reyhan Orhun
doi: 10.5505/ejm.2019.74436  Pages 123 - 129
INTRODUCTION: This is a study carried out in order to find out the opinions of nursing and midwifery students about their professions
METHODS: This cross-sectional and descriptive study was conducted on Yuzuncu Yil University Health School students in 2014-2015 spring term. No sampling was made. 473 voluntary students were included in the study (except the cases of absence, suspension of registration and non-voluntary students). The data were collected by the question form prepared by the researchers, and were evaluated in SPSS software with the application of percentage and chi-squared tests.
RESULTS: It was found out that the majority of our students have chosen the profession due to the ease in finding a job. It was also found out that half of our students had a desire to change their professions. On the other hand, the ones who made their career choice in the light of strong reasons did not have such intentions. While most of our students (92.8%) knew their profession was taking major roles in treatment and aftercare periods, a significant proportion (42.5%) did not consider their professional status positively, and almost half of them (43.6%) stated that they believed their profession was not well-known enough. Students stated that the education of nursing and midwifery needed to be given at the bachelor level (84.4%) and would like to specialize in branches of their profession. Students (87.9%) also evaluated the participation of males to the profession positively.
DISCUSSION AND CONCLUSION: In the 21st century, employment is a major reason for profession selection and our students seem to have made their choice in accordance with this reality. It was determined that our students were aware of the responsibilities of their profession, but were affected by the negative public image of their professions.

3.Mid-term outcome of arteriovenous fistula in paediatric patients with end-stage renal disease: A single centre experience
Emrah Şişli, Ali Kemal Gür
doi: 10.5505/ejm.2019.27928  Pages 130 - 134
INTRODUCTION: The aim of the study was to evaluate the patency rates of arteriovenous fistula (AVF) in pediatric patients with end-stage renal disease (ESRD) in the mid-term.
METHODS: The study was conducted retrospectively. The medical archive was searched between January 2015 and February 2018. A total of 26 patients comprised the study population.
RESULTS: The median age and weight of the patients at the time of AVF creation were 13.2 years (IQR=11.9 – 15.6 years) and 41.5 kg (34.8 – 50.5 kg), respectively. Eight (69.2%) patents were male. The AVF created was radio-cephalic in 21 (80.8%) and brachial-level in 5 (19.2%) patients; brachio-cephalic in 3 and brachio-basilic in 2 patients. The patients with a radial-level AVF was younger (p=0.001), and the body weight of them was lower (p<0.001). In patients with radio-cephalic AVF, age (rs= -0.48, p=0.028) and weight (rs= -0.56, p=0.008) revealed negative correlation with duration of AVF maturation. The duration of follow-up was 21.2 month (IQR= 14.5 – 28.3 months). At 1 and 2 years, while the primary rates were 92.3% and 84.6%, the secondary patency rates were 96.2% and 92.3%, respectively.
DISCUSSION AND CONCLUSION: Our result showed that AVF is the most suitable and durable renal replacement therapy in patients with ESRD. The weight and level of AVF have a considerable influence on the duration of AVF maturation. In summary, the AVF still remains the procedure of choice in the regions where the pediatric kidney transplantation programmes are not completely set-up with resultant long waiting period for transplantation.

4.Evaluation of cardiopulmonary resuscitation (CPR) practice of nurses at a tertiary hospital
Atakan Yılmaz, Evrim Simsek
doi: 10.5505/ejm.2019.48343  Pages 135 - 140
INTRODUCTION: Nurses are usually the members of the health team who first reach the patients with cardiopulmonary arrest. The theoretical and practical training of the nurses on basic life support (BLS) is important.
METHODS: The study was designed to assess the cardiopulmonary resuscitation (CPR) knowledge and practice of the all nurses who attended BLS course in a tertiary care hospital. The participants were asked to respond to the questions about CPR training information, CPR experiences, and self-confidence in this area before the training. After the questionnaire the participants’ CPR performances on the model were evaluated and the steps are repeated after training.
RESULTS: A total of 287 nurses had the training course and all of them were recruited in the study. 11.8% of the participants did not receive any practical training. Only 43.2% of them performed effective CPR. Previous practical training did not show any difference for effective CPR (41.9% versus 52.9% p = 0.222). Those with CPR experience carried out significantly more effective CPR (49.3% versus 27.5% p = 0.001). The ones with real-life CPR experience reported significantly more self-confidence (91.3% versus 66.3%, p<0001). After the training, the rate of effective CPR and self-confidence significantly increased (p <0.001).
DISCUSSION AND CONCLUSION: Only 43.2% of the participant was able to perform effective CPR. CPR experience in real life was the most important factor for successful CPR rates.

5.The effects of Streptozotocin on spinal cord motor neurons count in rat: A stereological study
Omed Omer Rahım, Neşe Çölçimen, Murat Çetin Rağbetli
doi: 10.5505/ejm.2019.78942  Pages 141 - 145
INTRODUCTION: In this study we investigated effects of Streptozotocin (STZ) administered at different doses on the total number of neurons in segment Thoracic 11 (T11) of the spinal cord of adult rats by using stereological methods
METHODS: Twenty-eight adult male Wistar albino rats were used. The rats were divided into four groups; control group, saline group (0.5 ml of 0.9% NaCl i.p.), 45mg/kg of STZ (i.p.) group and 65 mg/kg of STZ (i.p) exposed group. At the seventh day, the rats were perfused with 10% neutral buffered formaldehyde. T11, which is one of the transverse spinal cord segments, was isolated and processed for routine histologic examination. Semithin sections (0.5µm thick) were obtained using a ultramicrotome according to systematic random sampling strategies. The sections were stained with Toluidine Blue with Borax. The motor neurons were counted unbiased stereological disector/Cavalieri combination method. The groups were compared statistically.
RESULTS: . In terms of motor neuron number, no significant difference among the groups was found (p>0.05).
DISCUSSION AND CONCLUSION: Our results indicated that exposure to different doses of Streptozotocin has no effect on the T11 segment of the spinal cord total motor neuron number of the adult rats

6.Evaluation of pediatric patients with severe pulmonary arterial hypertension
Serdar Epçaçan, Mehmet Gökhan Ramoğlu, Emrah Şişli, Çayan Çakır, Zerrin Karakuş Epçaçan, Mustafa Orhan Bulut
doi: 10.5505/ejm.2019.24654  Pages 146 - 154
INTRODUCTION: Pulmonary arterial hypertension (PAH) is an important cause of morbidity and mortality. Congenital heart disease associated PAH (APAH-CHD) and idiopathic PAH are classified in Group 1 PAH. There are limited studies about pediatric patients with PAH. The aim of our study is to evaluate the clinical, diagnostic and treatment characteristics of pediatric PAH.
METHODS: 53 consecutive patients with PAH in a 7 years’ study period were retrospectively analyzed. Clinical, echocardiographic and cardiac catheterization findings and targeted treatment modalities were noted.
RESULTS: Thirty (56.6%) patients were male and mean age at diagnosis was 5.27 ± 4.30 years. All patients were classified as group 1 consisting of APAH-CHD and idiopathic PAH. Patients with Eisenmenger syndrome was the largest group. Ventricular septal defect was the most CHD associated with PAH overall. Atrial septal defect, patent ductus arteriosus, atrioventricular septal defect, aortopulmonary window, double inlet left ventricle, double outlet right ventricle, d-transposition of great arteries and truncus arteriosus were other congenital heart malformations detected. Targeted therapy were given to 34 patients (%64.1%), of them, 22 were under monotherapy, while 12 were under combined therapy. Bosentan was the most chosen drug in all. NYHA FC, exercise capacity with 6MWT improved well by targeted therapy.
DISCUSSION AND CONCLUSION: Life quality and survey are improved with the targeted therapies in pediatric patients with PAH. Single drug or combination therapies including bosentan, tadalafil and inhaled iloprost are effective, safe and well tolerated with rare and minor side effects in pediatric patients with group 1 PAH.

7.Comparison of Ketamine-Midazolam-Propofol Combination and Fentanyl-Midazolam-Propofol Combination for Sedation in Colonoscopy
Selda Kayaaltı, Ömer Kayaaltı
doi: 10.5505/ejm.2019.27880  Pages 155 - 162
INTRODUCTION: In this study, we aimed to compare the combination of ketamine-midazolam-propofol (KMP group) with fentanyl-midazolam-propofol (FMP group) for sedoanalgesia in ASA I-II adult patients undergoing colonoscopy in terms of patient satisfaction, side effects, and technical characteristics such as procedure duration and recovery time.
METHODS: A total of 60 ASA I-II patients who underwent colonoscopy were randomly divided into two groups. Both groups received 1 mg midazolam and 30-50 mg propofol. 50 mg ketamine was administered to the KMP group and 50 mg fentanyl to the FMP group. The additional dose of propofol was determined by the anesthesiologist to achieve 4-5 sedation level of Ramsay Sedation Scale. At the end of the procedure, propofol consumption dose, side effects, the duration of the procedure, and the recovery time of the patients were recorded. Mann-Whitney U test, Chi-square, and Fischer’s exact test were used to analyze data.
RESULTS: Total propofol consumption of FMP group was significantly higher (p ˂ 0.05) than KMP group. The procedure time in the FMP group was significantly lower (p ˂ 0.05) than the KMP group.
DISCUSSION AND CONCLUSION: The combination of ketamine-midazolam-propofol and fentanyl-midazolam-propofol can be used safely in terms of patient satisfaction and cardiovascular and other possible side effects. The combination of ketamine-midazolam-propofol is superior to the combination of fentanyl-midazolam-propofol thanks to the use of propofol in lower quantities.

8.Evaluation of relationships between postural and functional lateral preferences and chewing side among the university students in Van.
Ozlem Ergul Erkec, SIDDIK KESKİN
doi: 10.5505/ejm.2019.91886  Pages 163 - 168
INTRODUCTION: This study aims to evaluate the relationships between postural and functional lateral preferences and the preferred chewing side among young subjects.
METHODS: Functional lateral preferences, postural lateral preferences and the preferred chewing side were assessed in 376 young individuals (178 men, 198 women, mean age: 20.07).
RESULTS: Of the 376 individuals, 31.1 % were strong right-handers, 58.8 % were weak right-handers, 2.9% were ambidextrous, 5.9% were weak left-handers, 1.3% was strong left-handers. There was a right-side preference for handedness (89.9%), footedness (75.8%), earedness (59.2%), eyedness (paper tube test, 70.0%), eyedness (Rosenbach dominant eye test, 62.9%), hand clapping (78.4%), leg-crossing (64.4%), preferred chewing side (60.9%) and a left-side preference for hand-clasping (55.2%), and arm-folding (55.3%). Only eyedness (paper tube test) differed between the genders; women mostly preferred the left eye when looking through the paper tube.
DISCUSSION AND CONCLUSION: Handedness, footedness, earedness, and eyedness (paper tube) were each related with hand-clapping, however not with hand clasping and arm folding. In addition, hand clapping and leg crossing (but not hand clasping and arm folding) were each related to preferred chewing side. In general, individuals who preferred the right side were right sided in all of the variables, while individuals who preferred the left side were closely related to individuals who preferred both sides. Thus, it can be concluded that individuals who preferred the left side tended to be mostly bilateral, compared with individuals who preferred only the right side. These results may bring insight into the relationships between functional and postural lateral preferences and the preferred chewing side for the young population.



9.Socio-demographic determinants of dental anxiety and fear among college students
Esin Özlek, abdullah yıldırım, alaettin koç, Murat Boysan
doi: 10.5505/ejm.2019.50570  Pages 169 - 175
INTRODUCTION: The purpose of this study is to investigate the relationships of dental anxiety and fear with socio-demographic and clinical features, as well as physical exercise frequency.
METHODS: A total of 230 undergraduate students from five different majors including dentistry, medicine, veterinary medicine, physical education vocational high school, and faculty of education participated in the study. The mean age of participants was 23.27 (SS=2.09). A socio-demographic questionnaire, the Modified Dental Anxiety Scale (MDAS) and the Dental Fear Scale (DFS) were used in the study. In order to evaluate the correlates of dental fear and anxiety, two multiple regression analyses were performed where the scores of Dental Fear Scale and Dental Anxiety Scale were dependent variables.
RESULTS: Multiple regression analyses showed that both dental fear and dental anxiety were significantly associated with being of younger age, being female, having a prior history of a psychiatric disorder, and less likely to exercise physically. Considering differences across five majors, medicine and dentistry students were less likely to report dental fear and anxiety relative to other majors.
DISCUSSION AND CONCLUSION: We concluded that females, individuals with a younger age, individuals with a psychiatric history, an those less likely to exercise physically were at greater risk of dental anxiety and fear.

10.Specific and Non-spesicific Dermatoses of Pregnancy in the Emergency Department
Mehmet Ali Bilgili, Sevdegül Karadaş Bilvanisi, Serap Gunes Bilgili, AYSE GÜLER OKYAY, Recep Dursun, Ayse Serap Karadag
doi: 10.5505/ejm.2019.94830  Pages 176 - 181
INTRODUCTION: Dermatological changes both specific to pregnancy and nonspecific to it may be observed during gestation. In this study, specific and nonspecific dermatoses of pregnancy were investigated in patients admitted with dermatologic complaints to the emergency department. This information will be useful in identifying common and important dermatoses of pregnancy that need to be recognized at the point of primary care, so that the proper initial treatment and referrals can be instituted.

METHODS: Pregnant patients admitted with dermatological complaints to the emergency service were enrolled in the study. We retrospectively collected clinical and laboratory findings, diagnoses, administered treatments and admission rates.

RESULTS: Of the 4,280 pregnant patients admitted to the emergency service, 99 pregnant patients had dermatological complaints. While pregnancy-specific dermatoses were detected in 22 % of the patients, dermatoses nonspecific to the pregnancy were found in 78 % of them. Listed in descending order, specific dermatoses of pregnancy were atopic eruption of pregnancy (12%), polymorphic eruption of pregnancy (6%), intrahepatic cholestasis of pregnancy (2%), and pemphigoid gestationis (2%). Urticaria and angioedema were the most frequently diagnosed diseases among the dermatoses nonspecific to the pregnancy.
DISCUSSION AND CONCLUSION: There are many dermatoses are seen in the pregnancy, while urticaria and angioedema are the most common. Atopic eruption of pregnancy and the polymorphic eruption of pregnancy are the most common specific dermatoses. It was seen that the frequency of dermatological causes was quite low among the pregnant patients applying to the emergency service. However, some of these dermatoses may necessitate early diagnosis and immediate treatment. I


11.Prevalence of Post-Traumatic Stress Disorder Following Unintentional Injuries in Children
mehmet iz, Veysi Ceri, MEHMET EMIN LAYIK, fatma betül ay
doi: 10.5505/ejm.2019.10337  Pages 182 - 189
INTRODUCTION: Post-traumatic stress disorder (PTSD) is a trauma and stressor-related disorder that might have prominent negative effects on the social and academic life of children. Unintentional injuries are the leading reason for physical disability and death during childhood. We aimed to investigate PTSD symptoms in children withunintentional injuries who weretreated in hospital
METHODS: Children who were injured due to various causes and treated in emergency servicewere retrospectively evaluated for PTSD symptoms. The PTSD symptoms were assessed by the revised Children’s Revised Impact of Event Scale (CRIES-8), and The Schedule for Affective Disorders and Schizophrenia for School-Age Children.
RESULTS: The average age of the study sample consisting of fifty-eight male and thirty-one female children (total 89) was found to be 13.5 + 2.9. On average, 5.2 + 3.4 months had passed after the event. The most common cause of injury was traffic accidents (37.1%) and it was followed by falling from high (33.7%), burn (25.8%), and sharp object injury (2.2%). PTSD was prevalent as 24.7% according to K-SADSevaluation. PTSD rates were observed to vary according to the nature of the event that caused the injury.
DISCUSSION AND CONCLUSION: The findings of our study show that more than one-third of the children, who were hospitalized due to unintentional injuries, developed severe PTSD symptoms. Children who treated for unintentional injuries in emergency services should be referred for psychiatric evaluation.

12.Hydrostatic Reduction Supported With External Manuel Reduction In Treatment Of Intussusception: A New Technical Synthesis
Burhan Beger, Baran Serdar Kızılyıldız, Metin Şimşek, Ebuzer Düz, Hüseyin Akdeniz
doi: 10.5505/ejm.2019.47550  Pages 190 - 193
INTRODUCTION: Intussusception treatment is routinely performed in our clinic using ultrasound-guided hydrostatic reduction (USGHR). Because of the difficulties seen in technique and its less-than-ideal success rate, alternative methods are searched. In this study, we would like to discuss using external manual reduction (EMR) in combination with USGHR in intussusception treatment
METHODS: This retrospective study was completed in Pediatric Surgery Department of Van Training and Research Hospital, between February2018 and May 2018. Patients that treated with USGHR marked as Group 1 and Patients that treated with combination of USGHR and marked as Group 2. Patients age, gender, symptoms, treatment techniques, complications and hospitalization periods were noted.
RESULTS: In Group 1; 14 patients were treated with a single session and 2 were treated with 2 sessions. 4 patients were treated with surgery. Mean reduction time was calculated as 16 minutes, the fluid volume required for each reduction was 84 ml/kg and mean hospitalization period was calculated as 33 hours.
In Group 2; 18 out of 20 patients were treated in the first session and 2 required a secondary session. Mean reduction time was calculated as 13 minutes, the fluid volume required for reduction was 65 ml/kg and mean hospitalization period was calculated as 25 hours.
The results were statistically assessed by using SPSS version 24. Normality controls were done using Shapiro-Wilk Test.

DISCUSSION AND CONCLUSION: As an alternative; USGHR supported by EMR can be beneficial in increasing the treatment success rate in intussusception treatment and decreasing negative laparotomy rates, especially in partial reduction cases.

13.The Effects of Different Doses Ketamine on The Renal Ischemia/Reperfusion Injury in Rats
Hilmi Demirkiran, Nimet Senoglu, Hafize Oksuz, Zafer Dogan, Fatih Yuzbasıogu, Ertan Bulbuloglu, Fatma Inanc Tolun, Murat Aral, Harun Ciralik, Mustafa Goksu, Cevdet Yardimci
doi: 10.5505/ejm.2019.48658  Pages 194 - 199
INTRODUCTION: In the patients who have perioperative renal failure risk, anesthetical substances should be choosen with caution to protect the function of kidneys. We aim to compare the effects of different doses of ketamine on ischemia/reperfusion (I/R) injury mediated by free radicals in rats.
METHODS: In this study, 42 wistar albino male rats were randomized into 7 different groups. In the ketamine group, ketamine was applied intraperitoneally (IP) in different doses (3 mg kg־1, 10 mg kg־1, 30 mg kg־1, 60 mg kg־1, 80 mg kg־1) on the 45 th minutes. Clamps were opened at the end of 60 minutes ischemia period. At the end of the reperfusion period, renal tissue and blood samples were taken from the rats. In the plasma samples, pro-inflammatory biomarkers [Interleukin (IL)-1β, IL-6, tumour necrosis factor alpha (TNF-α)] were analysed. In renal tissue samples, antioxidating activities [Superoxide dismutase (SOD), glutathione peroxidase (GPx) and nitric oxide (NO)] and lipid peroxidation product “Malondialdehyde (MDA)” levels were studied biochemically. Renal tissue damage was evaluated histopathologically.
RESULTS: There were no differences among the beneficial effects of 10-30-60-80 mg kg־1 ketamine given groups before reperfusion in the way of antioxidant activities, pro-inflammatory markers and lipid peroxidation product. When ketamin was applied at a 3 mg kg־1 dose there were beneficial effects on tissues and significiant values for SOD, GPx, NO, MDA and histopathologically (p<0.05).
DISCUSSION AND CONCLUSION: Some studies have shown that ketamine has little anti-inflammatory properties. This animal study have shown that ketamine in low doses significantly reduces the I/R injury in rats (p<0.05).

14.Therapeutic Curettage On Follow Up Human Chorionic Gonadotropin Levels in Ectopic Pregnancy
Melih Bestel, Onur Karaaslan, Ayşegül Bestel, Süleyman Salman
doi: 10.5505/ejm.2019.26818  Pages 200 - 203
INTRODUCTION: In this study, we aimed to investigate the effect of therapeutic curettage and adjuvant metotrexate treatment on follow up human chorionic gonadotropin levels in ectopic pregnancy.
METHODS: Twenty-five patients who received methotrexate treatment out of 57 patients with a diagnosis of ectopic pregnancy and who completed their treatment at the hospital between 2016-2017 were included in the study. With random grouping, curettage was performed in 14 patients and was not performed in 11 patients. The percentage of changes in serum human chorionic gonadotropin levels between days 1 and 4, days 4 and 7, and days 1 and 7 were compared.
RESULTS: Comparing two groups, there was no statistically significant difference between the percentages of changes in serum human chorionic gonadotropin levels.
DISCUSSION AND CONCLUSION: Early diagnosis and treatment of ectopic pregnancy, an important cause of maternal mortality in the first trimester, is crucial. Regarding the surgical burden and no significant changes in serum levels of human chorionic gonadotropin in patients treated with therapeutic curettage and concurrent methotrexate treatment, curettage should be performed in selected patients or in patients with difficulty in diagnosis.

15.Overexpression of Insulin Receptor Substrate 1 (IRS1) Promotes Radioresistance in A172 Glioblastoma Cell Line
Gokhan Gorgisen, Tahir Çakır, can ateş, Ismail Musab GULACAR, Zafer Yaren
doi: 10.5505/ejm.2019.82713  Pages 204 - 209
INTRODUCTION: Insulin receptor substrate 1 (IRS1) is the main adaptor molecule in insulin and insulin like growth factor signaling. Increased level of expression of IRS1 and IGF-1R proteins are associated with many human malignancies. They also induced resistance to therapeutic approaches such as chemo- and radiotherapy in cancer treatment but their molecular mechanisms are still unclear. Glioblastoma Multiforme (GBM) is the most common primary brain tumor in adults and radiotherapy has a pivotal role in its treatment. In this study, it is aimed to determine the relationship between IRS1 expression and radiosensitivity of GBM cells.
METHODS: Therefore, A172 cells transfected with pcDNA3.1-HA-tagged human IRS1 gene. Its overexpression was confirmed by western blot. IRS1 overexpressed A172 cells were irradiated with 5,8 and 10 Gray ionizing radiation and their effects on cell viability determined by MTT and clonogenic assay.
RESULTS: Our results showed that overexpression of IRS1 led a decrease on sensitivity of the radiation in GBM cells.
DISCUSSION AND CONCLUSION: As a conclusion, this study should be confirmed by further molecular analysis and in vivo studies. IRS1 may be a predictive marker of radiosensitivity for GBM.

16.Recurrent laryngeal nerve injury (RLNI) in total thyroidectomy with intraoperative nerve monitoring (IONM) and harmonic sealing instrument: A retrospective analysis and treatment results
Sema Yuksekdag, Ahmet Topcu, Ildem Deveci, Ethem Unal
doi: 10.5505/ejm.2019.33254  Pages 210 - 214
INTRODUCTION: The aim of the current study was to reveal the incidence of RLNI in our patients with total thyroidectomy and to evaluate their clinical outcomes.
METHODS: Charts of 260 patients who underwent total thyroidectomy between 2014 and 2018 were interrogated retrospectively. Standard IONM and harmonic seal were used in all. Patients with suspect of RLNI were further evaluated. Demographics, etiologic disease and the overall treatment results were presented.
RESULTS: A total of 12 patients with RLNI (4.6 %) were presented. Nine (75 %) were women and 3 (25 %) were men. Mean age was 51 years (range, 32-67). RLNI was unilateral in 8 patients (3 %; 50 % in right RLN and 50 % in left RLN) and bilateral in four (1.5 %). All were started corticosteroid and follow-up period was 26 months (range, 9-52). Mean hospital stay was 4 days (range, 2-14). Histopathological evaluations revealed papillary carcinoma (n=7, 58 %), multinodular goitre with thyroiditis (n=4, 34 %) and multinodular goitre with parathyroid adenoma (n=1, 8 %). In a patient with bilateral RLNI (0.3 %), tracheostomy was done on postoperative day 2, and closed on postoperative month 4. Thyroplasty and suture lateralization were applied to other bilateral RLNI cases. In 5 patients with unilateral RLNI and one with bilateral palsy, vocal cords became normal in first 6 months (transient palsy, 2.3
DISCUSSION AND CONCLUSION: Careful surgical dissection with harmonic and IONM employed in total thyroidectomy are both reliable methods. In case of inevitable RLNI, a close follow-up and cooperation are mandatory to have optimal results.

17.The Efficacy of Magnetic Resonance Imaging in The Determination Of Meniscus Tears in Patients With Anterior Cruciate Ligament Tears
Merve Gürsoy, Tugrul Bulut, Berna Dirim Mete, Ozgur Tosun, Emine Merve Horoz, Safa Gürsoy
doi: 10.5505/ejm.2019.25338  Pages 215 - 221
INTRODUCTION: The aim of this study was to determine the accuracy of MRI in meniscus and cruciate ligament(CL) pathologies.Another aim of the study was to determine the accuracy of MRI in the determination of meniscus tears in cases with and without ACL tear.
METHODS: The study included 96 patients who were applied for meniscus and/or CL injury and examined by MRI between 2015-2018.The meniscus and CL were examined by MRI for findings of tears.The arthroscopy results were accepted as the gold standard and compared with the MRI results.The sensitivity, specificity, PPV, NPV, accuracy of MRI were calculated in the determination of meniscus and CL tears.The patients were also separated into 2 groups as those with ACL tear and without ACL tear. MRI accuracy in meniscus tear was compared between the 2 groups.
RESULTS: The sensitivity, specificity, PPV, NPV and accuracy rates of MRI in the evaluation of the medial meniscus tears were 93.5%, 88.8%, 97.3%, 76.1% and 92.7% respectively.These values were 64.8%, 94.9%, 88.8%, 81.1% and 83.3% for the lateral meniscus(LM), 55.5%, 81.6%, 64.5%, 75.3% and 71.8% for ACL and 100%, 98.9%, 66.6%, 100% and 98.9% for posterior cruciate ligament.In the determination of LM tears, the specificity of MRI was significantly lower in the group with ACL tear (p=0.021).No statistically significant difference was determined in respect of the other values.

DISCUSSION AND CONCLUSION: MRI has lower accuracy rates for ACL tear than for the meniscus.No significant difference was found in the accuracy of the MRI of meniscus tears between the groups with and without ACL tear.

18.Hook Plate Applications in Type 3 Acromioclavicular Dislocations
Sezai Özkan, Cihan Adanaş
doi: 10.5505/ejm.2019.30932  Pages 222 - 226
INTRODUCTION: Backgraund: Acromioclavicular (AC) joint dislocations are caused by sports injuries.fall from height or traffic accidents. While the treatment of Type 1 and Type 2 in AC dislocations is conservative, the treatment of Type 4,5 and 6 is surgery. Treatment of type III dislocations is controversial. In this study; We aimed to investigate the functional results of patients who surgical treatment by using clavicle hook plate in Type III AC joint dislocations

METHODS: 21 patients (18 males, 3 females; mean age 34 years) with Type III AC joint dislocation who were admitted to our clinic between 2015-2017 were treated with clavicle hook plate. The surgical results of the patients at the 6th month were evaluated according to the Constant score.

RESULTS: Of the total 21 patient included in the study, n=18 were male (%86), and n=3 were female (%14). All patients were treated with clavicular hook plate. The average follow-up after treatment is 11 months. Functional results were obtained according to Constant scoring. There was no infection after surgery. Plaque irritation occurred in 2 patients and plaque was removed due to prolonged pain. 1 patient had recurrence.


DISCUSSION AND CONCLUSION: Although conservative treatment of Type 3 AC dislocations can provide adequate functional results in the long term, we believe that early results of the surgical treatment using clavicle hook plate is a reliable and effective method especially in the young age group.

19.The Use of Phosphate Enama in the Treatment of Short Segment Intususception Cases
Salim Bilici, Veli Avci
doi: 10.5505/ejm.2019.75436  Pages 227 - 230
INTRODUCTION: In the treatment of intussusception wide variety of surgical and non-surgical treatment modalities have been applied so far. Nowadays, it is usually treated with hydrostatic and pneumatic reduction. In this study, the reduction of short segment intussusception by using phosphate enema used as a practical method that was not previously reported.
METHODS: We retrospectively reviewed the cases of intussusception that is named reduction by phosphate enema applied by rectal administration in the pediatric surgery department. 88 patients were included in the study. Monobasic sodium phosphate + dibasic sodium phosphate containing 67.5 ml solution (Fleet Enema®) or Sodium Dihydrogenphosphate 3,5 gr + Disodium Hydrogenphosphate containing 67.5 ml solution (BT® Enema) was administered rectally in one shot. After defecation, the patients were reevaluated with ultrasonography.
RESULTS: The procedure was successful in 80 cases. Eight cases in which the procedure was unsuccessful were treated by ultrasound guided hydrostatic reduction.
DISCUSSION AND CONCLUSION: During childhood, short segment intussusception cases can be managed successfully with phosphate enema, it is easy to apply and a practical treatment. We believe that this approach would be an acceptable treatment when it is validated with larger scale studies.

20.Evaluation of musculoskeletal disability in patients admitted to the health board of a hospital in Van, Eastern Turkey
Murat Toprak, Metin Erden
doi: 10.5505/ejm.2019.87094  Pages 231 - 234
INTRODUCTION: This study aims to evaluate musculoskeletal disability in patients admitted to the health board of a hospital in Van, Eastern Turkey, in terms of age, sex, disability degree, and reasons for applying to the health board.
METHODS: For this purpose, we retrospectively reviewed the records of 4717 patients admitted to the health board of our hospital between January 01, 2014 and June 31, 2014.
RESULTS: A total of 2703 patients (57.3%) were male, 2014 (42.7%) were female, and the mean age was 40.75 ± 6.06 years. The most common reasons for admission to health board were to benefit from the law 2022 (n=2074; 43.9%) and to take advantage of the self care salaries (n=1903;40.3%). Osteoarthritis (n=584; 19.7%), cerebral palsy (n=387; 13.1%), hemiplegia (n=291; 9.8%) and developmental dysplasia of the hip (n=241; 8.2%) were the most common disorders. Severe disability were found in 726 (15.4%) cases. The permanent disability rate was 64.4% (n=3045).
DISCUSSION AND CONCLUSION: Musculoskeletal disability is a major problem in our country. We need to take measures of disability, necessary laws, training, and rehabilitation. This study may contribute to the health policy planning.

21.Effects of increasing Positive End-Expiratory Pressure (PEEP) values on intraabdominal pressure and hemodynamics: A prospective clinical study
UĞUR SERKAN DUMANLIDAĞ, NUREDDIN YUZKAT, Celaleddin Soyalp, NURÇIN GÜLHAS
doi: 10.5505/ejm.2019.50023  Pages 235 - 241
INTRODUCTION: In the present study, the purpose was to compare the effects of Positive End-Expiratory Pressure (PEEP), which is applied to intensive care patients, on Intraabdominal Pressure (IAP) and hemodynamic parameters.
METHODS: The patients were selected from among the patients who received mechanical ventilator support and PEEP at various levels in Intensive Care Unit, who were between 18-80 years of age, who did not have abdominal surgery.In the present study, a total of 64 patients were divided into 3 groups.Those who had PEEP value at 4 cmH2O were included as Group 4, those with PEEP value between 5-8 cmH2O were included in Group 8, and those with PEEP value between 9-12 cmH2O were included in Group 12.The intraabdominal pressures, central venous and arterial blood pressures, heart rates, peripheral oxygen saturation values, body temperatures, fluid balances and urine volumes were measured at 0, 6, 12, 18 and 24th hours.The Intra-Bladder Pressure Measurement Method was employed to measure the intra-abdominal pressure.
RESULTS: The lowest IAP values were measured in Group 4, and the highest values were measured in Group 12.The IAP values that were measured in Group 12 were higher than the other groups at a significant level.The intra and inter-group blood pressures, body temperatures, urine outputs, central venous pressures, and fluid balance values were similar in all groups.
DISCUSSION AND CONCLUSION: In the present study, it was concluded that IAP was low in low PEEP values, and the IAP was high in higher PEEP levels; and this increase caused mild intrabdominal hypertension; however, did not affect hemodynamics.

22.Apparent Diffusion Coefficient Variabilities of the Optic Nerve in Multiple Sclerosis: Optic nerve head and Intraorbital segment
Mehmet Hamdi Şahan, Mikail İnal, Nese Asal, Nesrin Buyuktortop Gokcinar
doi: 10.5505/ejm.2019.04934  Pages 242 - 248
INTRODUCTION: To investigate the diffusion alterations in the optic nerve head/intraorbital segment in Multiple sclerosis (MS) patients (with or without a history of optic neuritis) in comparison with healthy controls.
METHODS: MS group consisted of 57 patients who had previously been diagnosed with MS. A total of 234 eyes which consisted of 114 eyes of the MS patients and 120 eyes of the healthy controls, were investigated. In 16 of the MS patients had the history of optic neuritis in one eye. The control group was selected from healthy subjects who were matched with MS patients group in terms of gender and age. Echo planar imaging (EPI) sequence was benefitted to attain diffusion-weighted images (DWI). The optic nerve head/intraorbital segment apparent diffusion-coefficient (ADC) values of two groups were compared.
RESULTS: The difference between the optic nerve head/intra-orbital segment ADC values of control group and MS patients was founded statistically considerable (P=0.009, P=0.006, respectively). The difference between the optic nerve head/intra-orbital segment ADC values of MS patients without optic neuritis and control group was also found statistically considerable (P= 0.016, P= 0.026, respectively). It was found that there is a positive correlation between the ADC values and duration of the disease in MS patients (R=0.485/0.428, P<0.01).
DISCUSSION AND CONCLUSION: The ADC values of the optic nerve head/intraorbital segment measured by ocular DWI may have potential for MS patients in the future and this method deserves additional validation in the disease staging and more work to predict patients at risk of optic neuritis.

CASE REPORT
23.A rare occurrence of Guillain-Barré syndrome after off-pump coronary artery bypass surgery
Esra Eker, Ali Kemal Gür, Emrah Şişli
doi: 10.5505/ejm.2019.00821  Pages 249 - 251
Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy resulting in symmetrical muscle weakness and diminished reflexes. With lack of exact etiology, GBS usually develops as an antecedent infection. Other than the known risk of neurological complications after coronary artery surgery, which includes intracranial hemorrhage, embolic events and transient ischemic attack, we aimed to present a patient in whom GBS developed after an off-pump coronary artery bypass grafting (CABG).
A 56 year-old-male presented muscle weakness and somnolence on the postoperative second day of CABG. There was no pathology other than suspicious plaque formations in cranial magnetic resonance imaging. Nerve conduction velocity study revealed prolonged distal latency, conduction velocity slowing and temporal dispersion of compound action potential which were all indicative of demyelination. Along with the clinical findings and high protein, glucose and cell number detected in cerebrospinal fluid, the diagnosis of GBS was made. The management of 0.4gr/kg/day intravenous immunoglobulin was initiated. During a period of 15-day intensive care unit follow-up, the symptoms started to improve at the 72th hour of intravenous immunoglobulin therapy. The patient was discharged in good clinical condition on postoperative 42 days.
Despite the pathophysiological mechanism of GBS is still unknown, one should remain alert to the development of GBS after cardiac surgery because, the disease yields favorable prognosis once the diagnosis is made early, and the treatment, either plasmapheresis and/or IVIG, is initiated at once.

REVIEW ARTICLE
24.Evolution of the Infirmary during the Medieval; Social, Economic and Religious Status
Levent Bayam, Vasileios Stogiannos, Sajid Khawaja, Robert Smith, Efstathios Drampalos
doi: 10.5505/ejm.2019.95967  Pages 252 - 256
INTRODUCTION: Infirmary as we know it nowadays did not exist during the Middle Ages, but various precursors of the modern hospital evolved as a result of interactions between East and West. There is hardly any research describing the influence of Medieval social, economic and religious status in the West and East on infirmary. The present work aims on the development of infirmary at Medieval or Middle age with a short insight to previous evolution.
METHODS: The research was conducted in different stages. Textbooks and lectures from Department of History and Methodology of Science of the University of Athens (UoA) and other relevant departments of Greek universities were consulted. To collect relevant information, the keywords “infirmary”, “medical theory”, “ antiquity”, “medieval”, “hospital”, “West” and “Asklipieion” were searched on Google, PubMed and Wikipedia.
RESULTS: The infirmaries in the East were not simple buildings, rather a complex of clinical, teaching/education and praying areas. These institutions formed a model to later European infirmaries. Many of the physicians of the East were ahead of their times. It is obvious that during Middle Ages, religion was a keystone for the function of infirmary. Both in the East and West, Christianity and Islam provide ethical base and funding for function and development of new hospitals.
DISCUSSION AND CONCLUSION: Despite the conflict between two worlds, their societies interacted and influenced medicine, the infirmary as an institution. It is the result of a long process of development of relations between people, societies or even religions and the way humanity perceives its nature and the future.



 
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