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Eastern J Med: 24 (3)
Volume: 24  Issue: 3 - 2019
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ORIGINAL ARTICLE
1.Factors Influencing the Ethical Sensitivity of Nurses Working in a University Hospital
Esma Ayşe Öztürk, Asuman Şener, Zeliha Koç, Latif Duran
doi: 10.5505/ejm.2019.05025  Pages 257 - 264
INTRODUCTION: Ethical sensitivity is defined as sensitivity to ethical problems, which for nurses means being acquainted with ethical values within a situation or situations concerning human health. As a nurse, having high ethical sensitivity not only leads to occupational professionalization, but it also directly influences the quality of nursing care provided to patients.

METHODS: This study was conducted in 2016 by 178 nurses working in a university hospital in the center of Samsun. The data was collected using an introductory information form and the Moral Sensitivity Questionnaire (MSQ).

RESULTS: In this study, the median nurse’s result on the Moral Sensitivity Questionnaire (MSQ) was 88(52–187), whereas the median result on its sub-dimensions, such as autonomy, benevolence, holistic approach, experiencing conflict, practice, and orientation, were 20(8–45), 12(4–25), 12(5–35), 13(5–21), 12(4–25), and 7(4–28), respectively. Nonetheless, it has been observed that MSQ median results change according to the working year, the number of patients, and the work satisfaction level at any given institution; it has also been observed that the ethical sensitivity level is higher for nurses who have worked for 20 to 28 years, who care for 11–21 patients daily, and who have a moderate work satisfaction level.


DISCUSSION AND CONCLUSION: This study suggests that MSQ score varies depending on some sociodemographic and professional characteristics such as income level, work life quality, professional satisfaction, length of service of nurses, whether or not they are satisfied with the service they work at, number of patients cared per day, total number of nurses at the service they work at.

2.Lipoic acid decreases 3-nitrotyrosine and cytokine levels in a rat sepsis model
Behzat Çimen, Leyla Çimen, İhsan Çetin
doi: 10.5505/ejm.2019.14237  Pages 265 - 270
INTRODUCTION: It was aimed to investigate the effects of lipoic acid (LA) on 3-nitrotyrosine (3-NT), interleukin-1β (IL-1β), tumor necrosis factor- α (TNF-α), magnesium and trace elements levels in serum of rats with sepsis.
METHODS: Control group (n=10) received a single dose of saline, lipopolysaccharide (LPS) group (n=10) was injected a single dose of 20 mg/kg LPS, and LA+LPS (n=10) group was injected a single dose of 20 mg/kg LPS at the end of third day of 10 mg/kg/day LA injection. The serum 3-NT levels were determined by a high performance liquid chromatography. The serum levels of IL-1β and TNF-α were measured by enzyme linked immunosorbent assay. Determination of magnesium and trace element levels were performed by inductively coupled plasma mass spectrometer.
RESULTS: 3-NT, IL-1β and TNF-α levels in control and LA+LPS groups were not determined. However, observable levels of these parameters were detected in the LPS group. It was found that manganese levels were positively correlated with IL-1β and TNF-α in LPS group. LA increased the manganese levels, while it decreased magnesium and iron levels in LA+LPS group.
DISCUSSION AND CONCLUSION: Our results show that LA decreases serum levels of 3-NT, IL-1β and TNF-α in rats with sepsis, and it is also effective on trace element levels. Decreased levels of manganese and its association with IL-1β and TNF-α in the LPS group suggest that manganese may be associated with immune response.

3.The Comparison of Diffusion Weighted Imaging with Other Breast Magnetic Resonance Imaging Parameters in diagnosis of Breast Masses
MESUT ÖZGÖKÇE, Nuri Havan, ferhat cuce, FATMA DURMAZ, Zakir Sakci
doi: 10.5505/ejm.2019.60590  Pages 271 - 275
INTRODUCTION: The magnetic resonance imaging parameters such as morphologic features, enhancement kinetics and diffusion restriction can be used for the differential diagnosis of lesions. We aimed to compare the apparent diffusion coefficient values of masses with other magnetic resonance imaging parameters in diagnosis of breast masses.
METHODS: Between March 2014 and September 2017, 49 female patients in whom a breast mass was diagnosed, determined using ultrasound and mammography and who were further examined with magnetic resonance imaging were enrolled to this study. Total 51 lesions were detected. Routine breast magnetic resonance imaging protocol was performed and images were evaluated. The apparent diffusion coefficient cut-off value was taken as 1,1×10-3mm2 /s according to the literature.
RESULTS: Fifty-one lesions were diagnosed with biopsy. Of these lesions, 23 (45.1%) were malignant (20 invasive ductal carcinoma and others) and 28 (54.9%) were benign (20 fibroadenomas and others). The accuracy rate of dynamic contrast enhanced of magnetic resonance imaging assessment was 90,9% for benign lesions in with a type 1 curved lesions, and 81,8% for malign lesions in with a type 3 curved lesions. The accuracy rate of apparent diffusion coefficient values was 93,1% for benign lesions and 95,5% for malign lesions.
DISCUSSION AND CONCLUSION: We believe that the apparent diffusion coefficient value can provide a higher diagnostic accuracy with the combination of morphological characteristics and contrast kinetics of the lesion and that apparent diffusion coefficient can be used alone because of its high diagnostic accuracy in some cases.

4.Prick Test Results and Total IgE Levels of Asthma Patients in A University Hospital
Barış Çil, Mehmet Kabak, İclal Hocanlı, Ayşe Füsun Topçu, Mahşuk Taylan
doi: 10.5505/ejm.2019.59389  Pages 276 - 279
INTRODUCTION: Respiratory allergies are currently on the rise and affect all age groups. Aeroallergens play a major role in the pathogenesis of respiratory allergic diseases, especially in asthma and allergic rhinitis. Skin prick tests and specific blood tests can be used to safely ascertain allergen-specific IgE. When correctly implemented, aeroallergens such as house mites, pollens, and pet allergens can be determined. Skin tests are widely used to assess sensitivity to allergens due to their relatively easy application and safety.
The present study aims to delineate a regional allergen profile and compare this profile with that of other regions of the country. Furthermore, a comparison of total IgE elevation and prick test positivity was made to assess the sensitivity and specificity of total IgE levels.
METHODS: One hundred and sixty seven patients over 18 years of age that applied to either in- or out-patient clinics, that had a diagnosis of asthma according to the criteria of GINA(the Global Initiative for Asthma) and had been attack-free for at least one month were included. Forty one patients were male and 124 were female.
RESULTS: The prick test was positive in 18.7%.Pollens(41.9%), mite(22.5%) and cochroach were the most frequently detected allergens.Those that had serum IgE levels higher than the serum reference value had significantly higher rate of prick test positivity(p=0.029).
DISCUSSION AND CONCLUSION: The present study demonstrates inter-regional variability of allergen profiles and the direct correlation between total IgE elevation and prick test positivity.In cases where prick tests are not available, allergen sensitivity can be determined by total IgE levels.

5.The place of preoperative imaging scans in parathyroid surgery
Sema Yuksekdag, Ahmet Topcu, Fatma Gulcicek Ayranci, Esin Cibiroglu, Ethem Unal
doi: 10.5505/ejm.2019.55265  Pages 280 - 282
INTRODUCTION: The aim of this article is to evaluate early postoperative results of patients operated for hyperparathyroidism.
METHODS: Demographics, underlying diseases, preoprative localization scans and efficacy of surgical techniques applied were evaluated in patients with hyperparathyroidism, operated by one surgeon between 2014 and 2017.
RESULTS: Mean age of total 14 patients was 56.6 (range, 22-73). The success rate of ultrasonography applied in all patients (USG, 100 %) was 71.4%. Scintigraphy was done in all patients (100 %); localization was wrong in two (14.2%) and false negative ratio was 28.5 % (n=4). Computed tomography and magnetic resonance were used in 17.2 and 28.5%, respectively. Mean preoperative serum calcium level of 11.9 mg/dL (range, 10.6-18.2) was normalized to 8.8 mg/dL (range, 7.1-10.1) in a follow-up of 26 months (range, 6-44). The most common involvements were right lower (n=6, % 50) and left lower glands (n=4, % 33). Most important surgical indications were adenoma (n=12, 85.7 %) and tertiary hyperparathyroidism in kidney transplant patients (n=2, 14.2%). Histopathology revealed adenoma diameter as 1.4 cm (range, 0.5-4). There was no permanent morbidity.
DISCUSSION AND CONCLUSION: Although the importance of noninvasive localization studies for effective surgical treatment of hyperparathyroidism is generally accepted, bilateral neck dissection and intraoperative exploration seem sine qua non.

6.Hyaluran is a biomarker in patients without sepsis-related liver injury or not?
İlhan Bahar, Gülseren Elay, Adnan Bayram
doi: 10.5505/ejm.2019.94899  Pages 283 - 288
INTRODUCTION: The aim of the present study is to evaluate the value of hyaluran (HA) as a biomarker of sepsis in patients not showing sepsis-associated liver dysfunction and to investigate the relationship between HA level and disease severity
METHODS: Sepsis patients that had been followed-up between 2015 and 2016 in intensive care unit of Erciyes University Hospital were included in this prospective study. Sepsis was defined according to the 2013 Sepsis Survival Campaign Guidelines. The patients were classified as sepsis, severe sepsis, and septic shock. Blood samples were collected from the patients on the first and the third days to measure the HA level. A single blood sample was collected from each subject in the control group. The demographic characteristics, the duration of intensive care unit stay, and mortality data of the patient and the control groups were analyzed.
RESULTS: A total of 46 patients and 30 control subjects were evaluated. HA levels were found to be higher in the sepsis group than the others. HA was neither a predictor of the disease mortality, nor was it correlated with the inflammatory markers, C-reactive protein (CRP), and procalcitonin (PCT).

DISCUSSION AND CONCLUSION: HA is not a sepsis biomarker in the patients with sepsis who do not show sepsis-associated liver dysfunction.

7.Retrospective Analysis of Pesticide Poisoning in Rural Area
DERYA ADIBELLİ, ilknur özkan, hasan ömür Özkan
doi: 10.5505/ejm.2019.77699  Pages 289 - 298
INTRODUCTION: Acute pesticide poisoning is an important public health problem. This research was done for the purposes of retrospectively examining the relationships between the recorded pesticide poisonings and socio-demographic factors.
METHODS: This retrospective descriptive study was conducted between December 2017 and February 2018. It was examined that thirty-two cases presented for pesticide poisoning between January 1, 2008 and December 31, 2017 to the Emergency Service of the ……….. Public Hospital. The hospital records were used to collect the research data. The χ2 test and logistic regression analysis were used, as well as descriptive statistics.
RESULTS: It was found that 12 cases used pesticides to commit suicide, and 9 cases presented to psychiatry polyclinics after a suicide attempt. It was found that pesticide poisoning was mostly in spring. The poisonings occurred most often via the gastrointestinal tract, inhalation, skin respectively. It was found that poisoning in order to attempt suicide in women were higher, and accidental and professional poisonings in men were higher. In the logistic regression analysis, it was found that the use of pesticides to commit suicide differed according to the gender (OR = 0.070, p < 0.05).
DISCUSSION AND CONCLUSION: This study revealed the existence of pesticide poisonings, and especially, suicidal attempts due to pesticides in a rural area.

8.Dosimetric comparison of 3D-conformal and IMRT radiotherapy techniques in gastric cancer
Tahir Çakır, Gökhan Yılmazer, Taylan Tuğrul
doi: 10.5505/ejm.2019.46794  Pages 299 - 302
INTRODUCTION: Stomach cancer is a malignancy which has poor prognosis and takes place on the top among deaths related with cancer in the world. Anatomically, stomach has relations with critical organs as heart, liver, kidneys, intestine and spinal cord. Doses and target volumes which taken by environmental critical organs in planning adjuvant radiotherapy of stomach cancer have importance from in terms of control and toxicity. In this study, it was aimed the examination of the best dose to target volume and the most appropriate treatment planning technique for maximum protection of organs at risk. Intensity Modulated Radiation Therapy(IMRT) technique and the 3D-conformal radiotherapy technique at patients who operated stomach cancer in terms of dosimetric have compared.
METHODS: This study was done on the Computed Tomography(CT) simulation images of 21 patients who applied to Yüzüncü Yıl University, Deparment of Radiation Oncology. CT simulation of patients was taken with 3mm thickness at 60th second using intravenous contrast agent. Then CT images transferred to Prowess Panther treatment planning system. At IMRT planning, 5 fields planning were done with 6MV photon energy. 3D-conformal planning were performed in 4 fields using 6 and 15MV photon energy.
RESULTS: It is seen that IMRT technique is statistically more advantageous against to conformal radiotherapy technique in terms of right-left kidney V20 rate, bilateral kidney V20 rate and mean dose rate of liver at the radiotherapy technique to be applied the patients who operated stomach cancer.
DISCUSSION AND CONCLUSION: IMRT technique is an effective and reliable treatment method for patients who has adjuvant stomach cancer.

9.The frequency of rhythm and conduction abnormalities and benefits of 24-hour Holter electrocardiogram on detecting these abnormalities in patients with acute rheumatic fever.
Serdar Epçaçan, Yasemin Nuran Dönmez
doi: 10.5505/ejm.2019.31932  Pages 303 - 309
INTRODUCTION: During the acute phase of acute rheumatic fever (ARF), cardiac arrhythmias and conduction disorders may occur. Standard electrocardiogram (ECG) may be insufficient in the cases of possible paroxysmal rhythm or conduction abnormalities. The aim of this study is to evaluate arrhythmias and conduction disorders and benefits of 24-hour Holter ECG on detecting these disorders in children with ARF.
METHODS: Two hundred and ten patients who were diagnosed with ARF during a four-year period, were retrospectively analyzed. Demographic characteristics, clinical, laboratory, and echocardiographic findings of the patients were evaluated. Standard ECG and 24-hour Holter analysis were revealed.
RESULTS: First (47.8%), second (6.9%) and third degree (4.3%) atrioventricular (AV) blocks, bundle branch blocks (9.8%), intermittent pre-excitation (1.1%), accelerated nodal rhythm (15.2%), supraventricular (10.9%) and ventricular premature contractions (8.7%), as well as supraventricular (3.3%) and ventricular tachycardia (1.1%) were detected with 24-hour Holter ECG. Frequency of both rhythm and conduction abnormalities were detected higher with Holter ECG than 12-lead ECG, and this was statistically significant (p<0.05). Second degree type II AV block and non-sustained supraventricular tachycardia as well as intermittent complete AV block were detected on 24-hour Holter analysis in patients with normal initial standard ECG.
DISCUSSION AND CONCLUSION: The incidence of rhythm and conduction abnormalities are higher than traditionally known. 24-hour Holter ECG is very helpful to detect especially paroxysmal abnormalities and to determine the more exact incidence of rhythm and conduction abnormalities in patients with ARF. For this reason, we suggest a routine 24-hour Holter ECG analysis in tertiary pediatric heart centers for patients with ARF.

10.Methods for the diagnosis of acute appendicitis in pregnant women.
TOLGA KALAYCI, ÜMİT HALUK İLİKLERDEN
doi: 10.5505/ejm.2019.80148  Pages 310 - 313
INTRODUCTION: Acute appendicitis (AA) is the most common non-obstetric surgical pathology during pregnancy. It is difficult to diagnose because of physiological changes. In our study, we aimed to define factors which are helpful in the diagnosis of AA.
METHODS: This study was started after obtaining permission from ethics committee in Yuzuncu Yil University. We collected the data retrospectively from the pregnant patients who underwent surgery between January 2013 and January 2018 with the diagnosis of AA. Demographic features, laboratory analyses, imaging modalities, intraoperative and postoperative pathologic findings were gathered. Final pathology was accepted as gold standard; the sensitivity and specifity of the investigated parameters were calculated. Z tests for two proportions were computed to compare proportions of AA in pregnant women.
RESULTS: From our study, the second trimester had been the most common surgery applied time (n=30, 49.2%). Although leukocytosis is seen in most patients (67.2%), there was no significant relationship between leukocytosis and AA.
In 51cases (83.6%) were suitable for AA from evaluation of operation material. In 33 cases (Alvarado score of 7 and above), pathology was suitable for acute appendicitis (positive predictive value = 89.2%). However, in 10 cases pathology was not suitable for AA (negative appendectomy rate was 16.4%).

DISCUSSION AND CONCLUSION: The most important result of our study is that; there is no valid diagnostic method in pregnant women for AA. We impress that the patient's history and physical examination is still the most important clinical parameter.

11.Evaluation and Comparison of Patients Poisoning with Acetaminophen and Nonsteroidal Anti-Inflammatory Drugs
Ahmet Çelik, Muhammed İkbal Şaşmaz
doi: 10.5505/ejm.2019.91259  Pages 314 - 319
INTRODUCTION: We aimed to determine and compare the clinical and demographical features, treatments, follow-ups, poisoning scores and outcomes of cases with the acetaminophen and NSAIDs intoxication.
METHODS: Data of the patients who were at the age of 18 and older and applied to the Emergency Department with the acetaminophen or NSAIDs intoxication were retrospectively examined. The cases were divided into 2 groups as the acetaminophen and NSAIDs group. The cases’ age, gender, drug amount, hospitalization status and periods, poisoning scores (PSS, APACHE-II) and last conditions in discharging from the hospital were compared.
RESULTS: The dose taken by 99 (55%) patients in the acetaminophen group was calculated as toxic, the intravenous acetylcysteine was administered to 70 (38.9%) patients as an antidote. When the APACHE-II scores of the patients hospitalized in the intensive care unit were examined, the mean APACHE-II score of 54 patients in the acetaminophen group was 3.15±3.70, the mean APACHE-II score of 34 patients in the NSAIDs group was 4.15±3.13 and it was statistically higher (p=0.031). All the patients followed-up in both groups were discharged with healing except only 1 (0.6%) patient who developed acute liver failure.
DISCUSSION AND CONCLUSION: The mean APACHE-II score was low in both groups. Therefore, following-up the patients in a unit such as a toxicology unit instead of the intensive care unit can be beneficial in terms of both reducing the place and labor force loads and cost. Moreover, the acetylcysteine treatments in the early period of the acetaminophen toxicity are very effective in decreasing the mortality and morbidity.

12.Comparison of Cleft Lift and Limberg Flap Techniques for Pilonidal Sinus Surgery
Orhan Agcaoglu, Ahmet Cem Dural, Candas ercetin, Tugan Tezcaner, Mahir KIRNAP, turgut Anuk
doi: 10.5505/ejm.2019.40412  Pages 320 - 324
INTRODUCTION: Sacrococcygeal pilonidal disease is an infection and also chronic inflammation of the sacral region which has been generally seen in young patient population. Though, numerous surgical techniques have been described in the medical literature, a recent Cochrane review shows that the resection with an off-midline close technique should be chosen to conventional primary midline closure due to its advantages including lower recurrence rates and faster wound healing. The aim of this study was to compare the outcomes of the Cleft-lift (CL) versus Limberg –flap (LF) techniques.
METHODS: Between 2007 and 2009, a total of 131 patients with sacrococcygeal pilonidal disease were randomized into two study groups regarding the operative technique of CL [Group-1 (G1)] and LF [Group-2 (G2)]. Patients with prior abscess drainage were excluded from the study. Groups were compared regarding the recurrence, operation time, duration of hospital stay and other morbidities. Data were collected retrospectively from patients charts and department database.
RESULTS: There were 60 patiens in group 1 and 71 patients in group 2. The mean age of the patients were 20.2 years (16-33). The mean operative time of group 1 (43.2 ± 7.9 minutes) was significantly shorter than group 2 (52.6±8.6 minutes) (p<0.01). There were no significant differences between study groups regarding hospital stay, wound infection and recurrences.
DISCUSSION AND CONCLUSION: In conclusion, CL procedure was found to be as effective as the LF technique due to advantage of shorter operative time and similar safety outcomes.

13.The Association of NLR and MPV with Treatment Responses, Disease Stages, and International Prognostic Index Scores in DLBCL
Sinan Demircioğlu, Ali Doğan, Ömer Ekinci, Cengiz Demir
doi: 10.5505/ejm.2019.27676  Pages 325 - 329
INTRODUCTION: Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. International Prognostic Index (IPI) is the most commonly used scoring system predicting the prognosis. In this study, we aimed to investigate the association of Neutrophil/Lymphocyte Ratio (NLR) and Mean Platelet Volume (MPV) with IPI score, treatment responses, and disease stage.
METHODS: A total of 113 DLBCL patients who received R-CHOP treatment were recruited for this study. Demographic data, disease stages according to the Ann Arbor staging system, IPI scores, treatment methods, treatment responses, complete blood counts, and biochemical tests of the patients were retrospectively evaluated.
RESULTS: Elevated NLR had statistically significant correlation with disease stage and IPI score (p= 0.001 and p= 0.006, respectively). However, the NLR had no statistically significant correlation with the interim-treatment and post-treatment responses (p= 0.187, and p= 0.96, respectively). MPV showed no significant relationship with disease stages (p= 0.56), IPI scores (p= 0.188), interim-treatment and post-treatment responses (p= 0.122, and p= 0.239).
DISCUSSION AND CONCLUSION: In conclusion, NLR was associated with IPI score and disease stage. This suggests that NLR, a cheap and easy investigation, may be used to obtain information about the prognosis.

14.
The Retrospective Evaluation of Tuberculosis Cases in Mardin Between 2012 And 2018
mehmet kabak, Barış Çil, iclal hocanlı, Cengizhan Sezgi, Mahsuk Taylan, Ufuk Düzenli
doi: 10.5505/ejm.2019.49368  Pages 330 - 334
INTRODUCTION: Tuberculosis (TB) is a respiratory-borne disease.It can hold most of the lungs and other tissues and organs.In this study, we aimed to offer the clinical and demographic data of TB patients who were followed-up in our province between 2012 and 2018.

METHODS: In our province, tuberculosis dispensary records were examined retrospectively between 2012 and 2108.
RESULTS: Of 249 patients, 125 (50.2%) were females and 124 (49.8%) were males.The mean age of the patients was 37.5 years.
There were 132 (53%) patients with pulmonary tuberculosis, 112(45%) with extrapulmonary tuberculosis and 5 (2%) patients with both pulmonary and extrapulmonary tuberculosis.239 cases(96%) were new cases and 10 (4%) patients had recurrence.While 109 (43.8%) of the patients had smear positivity, 13 patients(5.4%) were diagnosed with pleural biopsy and 87(34.6%) patients were diagnosed histopathologically with lymph and other organ biopsies.
In 13(5.4%) patients, only ADA elevation and 27(10.8%) patients were diagnosed clinically and radiologic. 111 (44.6%) patients had no contact and 38(15.3%) patients had a history of in house or out of home contact.In addition, 100(40.2%) patients had no known contact.101 of our patients have studied culture, 20 of them have culture negativity, 81 of them have culture positivity. 5 patients had rifampicin resistance, 4 had streptomycin resistance, 5 had ethambutol resistance and 11 had isoniazid resistance.While 6(2.4%) patients were dead, 78(31.3%) patients were cured.Treatment success was achieved in 153(61.5%) patients and treatment was abandoned in 8(3.2%) patients.


DISCUSSION AND CONCLUSION: Tuberculosis is a disease that affects especially young people.Early diagnosis and treatment of TB patients are especially important for infectious diseases.



15.Anesthesia Management and Difficult Intubation Evaluations in Laparoscopic Sleeve Gastrectomy Cases
Arzu Esen tekeli, Esra Eker, Mehmet Kadir Bartın, Muzaffer Önder Öner
doi: 10.5505/ejm.2019.88709  Pages 335 - 339
INTRODUCTION: Obesity is a rapidly growing health condition worldwide and negatively affects the quality and duration of life. Anesthesia for morbidly obese patients is considered to be a real challenge to the anaesthetist. In this study we aimed to evaluate difficult tracheal intubation and anesthesia mangement for obese patients.
METHODS: This study included 60 patients who had undergone sleeve gastrectomy between July 2012 and July 2017. We recorded gender, age, and body mass index (BMI) at the time of LSG, intraoperative incident, presecence comorbidities duration of surgery, length of ICU admission.
RESULTS: The relation of weight with difficult intubation was statistically significant, but it was not correlated with height and body mass index. Weight and BMI were found to have a statistically significant relationship with neck extension limitation. Difficult cases of intubation were seen mostly by these patients.
DISCUSSION AND CONCLUSION: Airway management and anesthesia of laparoscopic sleeve gastrectomy. In this retrospective study, it was determined that 28% of patients had laparoscopic sleeve gastrectomy and intubation difficulty was independent of body mass index. more extensive studies should be done to demonstrate the specific

16.Attitudes of Anesthesiology and Reanimation Specialists Towards Pediatric Anesthesia Outside of the Operating Room Practices: A survey analysis
Celaleddin Soyalp, Nureddin Yüzkat
doi: 10.5505/ejm.2019.50479  Pages 340 - 349
INTRODUCTION: There is a growing demand for safe and effective sedation/anesthesia of pediatric patients outside the operating room.
METHODS: This study was designed to investigate the practices and resources of pediatric anesthesia outside the operating room. A total of 219 anesthesiology and reanimation specialists (mean±SD age: 38.3±7.2 years, 50.7% female) voluntarily completed this online questionnaire survey. The questionnaire included items on demographic data, professional characteristics, type of hospital, and the characteristics of anesthesia applied outside the operating room.
RESULTS: Most respondents reported that they performed pediatric anesthesia outside the operating room frequently, ranging from a couple of days per week (47.2%) to every day (27.3%), mostly for MRI (87.7%), endoscopy (60.1%), pediatric angiography (58.9%) and biopsy (54.6%) procedures. Overall, 60.1% and 25.8% of the anesthetists stated that they use ASA criteria (inclusion of ASA I-II patients, 39.9%) and age criteria for candidacy, respectively. The professors were determined to be the group with the highest rates for the procedure (66.7%) on a daily basis, while state hospitals were associated with less frequent implementation of the procedure (p<0.001 for each).
DISCUSSION AND CONCLUSION: In conclusion, this questionnaire-based survey revealed frequent and guideline-adherent application of pediatric anesthesia outside the operating room by anesthesiology and reanimation specialists. Together with the likelihood of professional training and hospital type influencing the frequency of the procedure and recovery strategies, these findings emphasize the need for improved practice regarding consideration of appropriate candidacy for ASA physical status and patient age as well as a uniform and standardized recovery practice among anesthesiology and reanimation specialists.

17.Reproducibility of Tilt-table Test with Different Dosages of Sublingual Nitroglycerin
Çayan Çakır, Yemlihan Ceylan, Aykun Hakgor
doi: 10.5505/ejm.2019.75547  Pages 350 - 354
INTRODUCTION: Reproducibility of tilt-table test potentiated with sublingual nitrate is significant since it is directly related to diagnostic accuracy of the test. Nitrates shorten the test time and increase the sensitivity of the test. However the effects of different nitrate dosages on reproducibility have not been reported. Therefore we aimed to investigate the effects of 400 mcg, 800 mcg, and 1200 mcg sublingual spray nitroglycerin on reproducibility of tilt-table test.
METHODS: All patients undergoing tilt-table test at our hospital due to suspected syncope evaluated and patients giving consent included. First group received 400 mcg, second group received 800 mcg, and third group received 1200 mcg sublingual spray nitroglycerin. Patients underwent a second test with a same protocol within 1-7 days following the initial test.
RESULTS: Overall 189 patients included in this study. All of the patients in the first (n=62) and the second group (n=66) completed the initial test whereas 2 patients in the third group (n=65) terminated the initial test due to severe headache related to nitroglycerin. Five patients in the third group gave exaggerated response. The overall reproducibility of tilt-tablets was 81.9%, 88.9%, 82.1%, in the first, second, and third group, respectively. There was no statistically sigficant reproducibility difference between groups.
DISCUSSION AND CONCLUSION: The reproducibility of tilt-table test is similar with different dosages of sublingual nitroglycerin; however 1200 mcg nitroglycerin has more frequent side effects and exaggerated response.

18.The relationship between the presence of gastrointestinal symptoms and anemia, thyroid functions and bone mineral density in celiac patients
Ramazan Dertli, Yusuf Kayar, Neslihan Surmeli, Mehmet Ali Bilgili, Ahmet Karakarcayildiz, Nur Duzen Oflas, Nurettin Kurt
doi: 10.5505/ejm.2019.79664  Pages 355 - 360
INTRODUCTION: The prevalence of typical celiac patients decreases gradually with the investigation of patients presenting with non-gastrointestinal symptoms (non-GIS) like anemia, thyroid dysfunction, liver function test anomalies and dermatitis herpetiformis. The diagnosis of atypical and subclinical celiac has also increased due to the development of immunological and genetic tests. The aim of our study is to determine the relationship between the presence of GIS and anemia, thyroid functions, and bone mineral density in celiac patients.
METHODS: The study included 230 celiac patients who were diagnosed and followed-up in our clinics between 2015-2019. The demographic and anthropometric characteristics, initial presentation complaints, disease durations, dietary compliance of the patients were documented. Presence of anemia, thyroid functions, bone mineral density were documented and its relationship with presence of GIS was analyzed.
RESULTS: The age range of the patients was 18-65 years, and the mean age was 33,4±10,6 years. A total of 170(73.9%) patients were female and the duration of disease follow-up was 4,8±3,5 years. Osteoporosis/osteopenia was found in 146(63,5%) patients, anemia was found 65(28.3%) and thyroid disfunction was found 58(25.2%). Patients without GIS were significantly more anemic than patients with GIS (39.1%, 24.1% respectively) (p<0.05). In terms of thyroid function tests, the rates were similar in both groups and there wasn't significant difference (p>0.05). Osteoporosis was significantly higher in patients with GIS (p<0.05).
DISCUSSION AND CONCLUSION: The number of patients with atypical celiac disease is increasing. Celiac disease should be considered in patients presenting with unexplained anemia, a history of thyroid disease, and abnormal bone density.

19.Expression profiles of TRAIL and its receptors in normal, hyperplastic, and malignant endometrial tissues: Hints on endometrial cancer biology
Cigdem Aydin, Atil Bisgin, Ahter Dilsad Sanlioglu, Elif Pestereli, Gulgun Erdogan, Irem Hicran Ozbudak, Tayup Simsek, Salih Sanlioglu
doi: 10.5505/ejm.2019.21447  Pages 361 - 370
INTRODUCTION: Endometrial cancer is the sixth most common neoplasm in women worldwide, with a rising incidence largely attributed to the ongoing obesity epidemic. TNF-Related Apoptosis-Inducing Ligand (TRAIL) and TRAIL receptors have been tested for their predictive, diagnostic, and prognostic values in various cancers, as well as for possible use in combination therapies. The roles of TRAIL and its receptors in endometrial tissue biology has not yet been cleared, and the potential of these molecules as biomarkers in endometrial cancer is yet to be defined. We investigated the expression profiles of TRAIL and its transmembrane receptors during endometrial carcinogenesis to evaluate their potential as prognostic markers.
METHODS: Paraffin-embedded normal endometrium (n=18), endometrial hyperplasia (n=27), and endometrioid endometrial adenocarcinoma tissues (n=100) were analysed for TRAIL and receptor expression profiles via immunohistochemical staining. Apoptotic indexes in the corresponding tissues were defined by TUNEL assay.
RESULTS: Endometrial carcinoma displayed decreased TRAIL and DR4 expressions compared to the normal endometrium, while increased DR5 and decoy receptor (DcR1 and DcR2) expressions were evident. The complex atypical hyperplasia displayed the most similar expression profiles to the endometrial carcinoma, in accordance with the greatest risk of progression to endometrial carcinoma attributed to this tissue type. TRAIL/TRAIL receptor expression levels did not correlate with the prognostic factors of tumor stage or grade, or depth of myometrial invasion.
DISCUSSION AND CONCLUSION: Overall, distinct profiles of TRAIL and its receptor expressions were evident in progression from normal endometrium to hyperplasia and cancer, which may indicate significance of TRAIL signaling in the course of endometrial carcinoma development.

CASE REPORT
20.Reactivation of Hepatitis B Virus Infection 66 months after Rituximab Therapy For Chronic Lymphocytic Leukemia, Emphasis on Interplay between Infection, Drugs and Disease Biology
Elif Ümit, Hasan Ümit, Hasan Göze, Mehmet Baysal, Ahmet Muzaffer Demir
doi: 10.5505/ejm.2019.70299  Pages 371 - 374
Hepatitis B virus (HBV) reactivation (HBVr) in patients receiving immunosuppression is an evolving topic. American Gastroenterology Association (AGA) have reported a guideline for the management of patients with certain HBV status who will undergo immunosuppression with regard to patient’s HBV status as well as the category and duration of immunosuppression. Here we are presenting a case with CLL who have received rituxmab with bendamustine 66 months before, developing HBVr with an emphasis on the discussion pathophysiological process of the disease itself, not just the treatment course. 59 years old male patient diagnosed with CLL and chronic asymptomatic HBV infection received 3 lines of treatment under viral prophylaxis in 13 years. 66 months after the last treatment with rituximab, HBV reactivation developed and treated with dual antiviral therapy. During this period a decrease in lymphocyte count was observed concurrent with transaminase elevation. As the reactivation was controlled, lymphocyte counts increased back to pre-flare levels. While the patient had impaired antibody related immune response since monoclonal B cells are nonfunctional, an attempt to improve T cell related response may be resulted with both to the clearance of lymphocytes (as they were decreased) and the immune reaction of necroinflammation in the hepatocytes were triggered.

21.Ruptured pulmonary hydatıd cysts ın the course of enterıc fever; An unreported case
Hanifi Yıldız, Selami Ekin, Ahmet Arısoy, Hatice Beyazal Polat, Fatma Beyazal Çeliker
doi: 10.5505/ejm.2019.05900  Pages 375 - 378
A thirty-two-years-old female admitted to the emergency department of a peripheral hospital with complaints of fever, cough, nausea, vomiting, heartburn, and abdominal pain and an empiric treatment has been given the patient. Three days later, the patient has been referred to the department of internal medicine through increased complaints and was diagnosed with reflux and enteric fever by esophagography and serology. After an evaluation requested from our clinic due to ground-glass-opacities and a cavitary-lesion observed on the radiography, a ruptured cystic-echinococcosis was considered. The diagnosis was confirmed by IHA-test and cystic-membranes detected on computed tomography (CT). The patient refused the surgical treatment and was followed up for three months with oral albendazole. On the CT, taken in the second month, there was no pathology other than ruptured old cyst. As a result, this case will be the first case of pulmonary hydatid cyst reported to be ruptured in the course of enteric fever.

22.A successful intra-pleural fibrinolytic therapy with alteplase in a patient with empyematous multiloculated chylothorax
Mohamed Faisal, Rayhan Amisero, Nurashikin Mohammad
doi: 10.5505/ejm.2019.72621  Pages 379 - 382
Chylothorax is a collection of chyle in the pleural cavity resulting from leakage of lymphatic vessels, usually from the thoracic duct. In majority of cases, chylothoraxis a bacteriostatic pleural effusion. Incidence of infected or even empyematous chylothorax are not common. Here, we report a case of a 57-year-old man with end stage renal disease and complete central venous stenosis who presented with recurrent right-sided chylothorax. It was complicated with sepsis and multilocated empyema and treated successfully with intra-pleural fibrinolytic therapy using alteplase.

23.Umblical endometriosis: Presentation of a rare case
fevzi kurt, Cem Sezer
doi: 10.5505/ejm.2019.83792  Pages 383 - 385
Primary umblical endometrosis is a rarely seen entity. It consists of only 0.5 - 1% of extragenital endometrosis. Endometriosis may present in different regions with various clinical conditions. In this case report, a 45 years-old patient with an approximately 3 cm sized mobile, inflamed nodule with irregular appearance in umblicus which has cyclic umblical bloody discharge and pain during menstruation was underwent a total umblical excision. Cutaneous endometriosis was diagnosed as a result of the histopathological evaluation. With this case report, we want to emphasize that umblical endometriosis should be considered and taken in mind during evaluation of umblical nodule which lead to pain and bloody discharge from the umblicus with cyclic menstrual pain. And also, the diagnosis should be supported histopathologically after excision.
Keywords: endometrosis, umbilicus, cyclic menstrual pain.

24.Pulmonary adenocarcinoma presented with Lambert- Eaton myasthenic syndrome
Fettah Eren, Recep Aygul, Serefnur Ozturk
doi: 10.5505/ejm.2019.58855  Pages 386 - 389
Paraneoplastic neurological syndrome is an autoimmune disease caused by distant effect of tumor. Lambert- Eaton myasthenic syndrome (LEMS) is a paraneoplastic disease that is associated with voltage-dependent calcium channel antibodies. These autoantibodies affect especially presynaptic neuromuscular area. A 65-year-old male patient admitted to hospital with the complaint of difficulty in walking and climbing stairs. LEMS was considered with clinical examination and electrophysiological assessment. The diagnosis of lung adenocarcinoma was done by thoracic computed tomography and bronchoscopic biopsy. LEMS is especially associated with small cell lung cancer. It is rarely associated with lung adenocarcinoma like this patient. In the electrophysiological anlyses; significant amplitude increment is diagnostic with high frequency tetanic stimulation.

25.Pediatric sweet syndrome: A rare cause of fever of unknown origin
Özlem Özgür Gündeşlioğlu, Necdet Kuyucu, Ferah Tuncel Daloğlu, İclal Gürses
doi: 10.5505/ejm.2019.98704  Pages 390 - 392
Sweet syndrome or acute febrile neutrophilic dermatosis, is characterized by fever, elevated neutrophil count, painful erythematous cutaneous lesions that have an infiltrate of mature neutrophils typically located in the upper dermis. In general, it is associated with infections, malignancy and drugs. Sweet syndrome is rarely seen in pediatric patients. In this report, we present a child who was diagnosed with sweet syndrome because of a rare disease in children with unknown etiology of fever.

REVIEW ARTICLE
26.Modality for Disseminated Intravascular Coagulation and Current Treatment
yaren dirik, Pınar Kolusarı
doi: 10.5505/ejm.2019.24085  Pages 393 - 400
Disseminated Intravascular Coagulation (DIC) is a systemic syndrome that causes thrombosis in small and medium-diameter vessels as a result of disruption of hemostatic balance by several reasons, and progresses with the consumption of thrombocyte and coagulation factors, severe hemorrhage and impaired organ perfusion as a result of activation of disseminated intravascular coagulation mechanism. DIC is always a complication that occurs together with some diseases and various secondary pathological conditions. The tissue factor which occurs as a result of tissue factor firstly activates the coagulation cascade; and overproduction of thrombin forms the basis of pathogenesis of DIC. The clinical course of DIC is generally under the influence of the underlying etiologic factor. There is not a laboratory test diagnosing DIC alone; however, the laboratory findings are indispensable for diagnosis. Treating the disease causing DIC and predominant signs of bleeding or thrombosis in clinical table, and conducting prophylaxis for preventing repetitions in chronic DIC cases are the main steps of treatment.



 
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