ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 25 (1)
Volume: 25  Issue: 1 - 2020
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1.Results of Coronary Artery Bypass Grafting Surgery in Female Smokers and Female Patients who make Tandoori who had Chronic Obstructive Pulmonary Disease
Ali Kemal Gür, Şahin Şahinalp, Harun Unal
doi: 10.5505/ejm.2020.82621  Pages 1 - 7
INTRODUCTION: Among the risk factors for coronary artery disease, the most important is smoking. Another major risk factor for coronary artery disease is the smoke from tandoor ovens, to which many rural women are exposed over a period of years.
METHODS: Of 856 patients who underwent elective CABG surgery in our clinic between January 2011 and January 2017, 345 female patients were investigated retrospectively.
RESULTS: The patients were divided into two groups: Group 1 (smokers, n = 47) and Group 2 (tandoor bakers, n = 91). The mean age was 59.4 ± 5.2 years for Group 1 and 62.3 ± 4.2 years in Group 2. The average number of distal anastomoses was 2.2 ± 1.5 in Group 1 and 2.6 ± 1.7 in Group 2. The average length of stay in the intensive care unit was 2.1 ± 1.5 days for Group 1 and 4.4 ± 2.2 days for Group 2 (p <.05).
DISCUSSION AND CONCLUSION: Chronic obstructive pulmonary disease is an independent risk factor for CABG. Aside from smoking, which frequently results in COPD, pulmonary functions are exacerbated in people (usually women) who bake using tandoor ovens. In these patients, the duration of postoperative intubation, length of stay in the intensive care unit and in the hospital are extended, and the need for Continuous Positive Airway Pressure (CPAP) machines in the intensive care unit increases. Therefore, women who use tandoor ovens should be considered high risk patients for CABG surgery, and these patients should be managed and followed up with caution.

Feryal Karaca, Selahattin Menteş, Çiğdem Usul Afşar, Yaşar Sertdemir, Timuçin Çil
doi: 10.5505/ejm.2020.03371  Pages 8 - 12
INTRODUCTION: Bone is the third most common site of metastasis after lung and liver. Most of the bone metastases come from either prostat or breast cancers. The incidence of developing bone metastases in advanced diseases is quite high. Besides; depression is common in cancer patients with metastases. Beck Depression Inventory is used in assessment of depression in patients.
METHODS: One hundred patients were included in the study according to their primary diseases. Patients were divided into four groups and Beck depression test was performed twice to determine the depression levels of the patients before and after radiotherapy. Before radiotherapy patients were given Beck-0 and after radiotherapy they were given Beck-1
RESULTS: Results of Beck -0 and Beck -1, were statistically significant among any group itself and among all groups p<0.001. Those scores were also significant for number of bone metastases and number of radiotherapy treatment. p: <0.001.
DISCUSSION AND CONCLUSION: Depression is a common disease among the oncologhy patients, and can effect them, negatively. Beck scale scores after radiotheraphy have been found to be higher than those before radiotheraphy.

3.Retrospective Evaluation of Unstable Patients Fed Parenterally in Intensive Care Unit: Single Center Experience.
Gülseren Elay, Cevdet Yardımcı, Kürşat Gündoğan
doi: 10.5505/ejm.2020.30592  Pages 13 - 18
INTRODUCTION: The aim of this study is to determine the demographic and clinical characteristics of the patients fed with total parenteral nutrition who is hemodynamic unstable in the ICU.
METHODS: This study was performed retrospectively in the Internal Medicine intensive care unit of Erciyes University. Information was obtained from patient files, hospital electronic registry system and feeding unit registration forms.
RESULTS: The study included 51 patients. The mean age of the patients was 57 ± 19 years. 47% of the patients were male. When the reasons of total parenteral nutrition were evaluated it was seen that the most common causes of total parenteral nutrition were septic shock (47%) and gastrointestinal bleeding (23%). The daily calorie intake of the patients’ was 1389 ± 286 kcal and the target caloric value was 1824 ± 256. The number of mechanical ventilator days was 5 (median 0-42), the number of days of intensive care unit stay was 9 (median 1-125)and the number of stay in hospital was 13 (median 1-155). Mortality rate of the patients’ was 71%. Serum albumin levels were found to be lower in patients who died than the living patients and these low levels of albumin were statistically significant (p=0,015).
DISCUSSION AND CONCLUSION: In the intensive care unit, it is seen that total parenteral nutrition most commonly applied to in the septic schok state patients who had vasopressor support and had gastrointestinal bleeding. In addition, it was determined that the target energy value could not be reached.

4.Assessment Of Maternal And Fetal Outcomes In Adolescent And Non-Adolescent Pregnant Women
Elçin Balcı, Zehra İncedal Sonkaya, Şemsinnur Göçer
doi: 10.5505/ejm.2020.43265  Pages 19 - 25
INTRODUCTION: The teenage pregnancy can result in unfavorable maternal and fetal outcomes. Here, we aimed to assess maternal and fetal outcomes in adolescent and non-adolescent pregnant women.
METHODS: The study was conducted at Sabuncuoglu Serefeddin Teaching and Research Hospital of Amasya University. It is a retrospective, comparative study. The study included all of 272 adolescent pregnant women (aged 13-19 years) who presented for delivery between 2010 and 2015 and 269 non-adolescent pregnant women (aged 20-49 years) selected from those presented for delivery during same period.
RESULTS: The gestational age at birth was significantly higher in patients aged≤19 years than those aged≥20 years.
The rate of infants with birth weight>4000 g, height and head circumference, and Apgar scores at minute 1 and 5 were significantly lower in patients aged≤19 years than those aged≥20 years.

DISCUSSION AND CONCLUSION: Adolescent pregnancy is a major risk factor for many health and social outcomes.

5.Hereditary thrombophilia risk factors in patients with venous thromboembolism
Sabahattin Destek, Vahit Onur Gül
doi: 10.5505/ejm.2020.81905  Pages 26 - 32
INTRODUCTION: Venous thromboembolic disease (VTD) is a serious cause of mortality and morbidity with an incidence of 0.1% per year. The etiology of VTD is multifactorial and associated with acquired and hereditary conditions. The aim of our study was to investigate the presence of rare genetic mutations in VTD patients and to evaluate their distribution according to thrombosis sites.
METHODS: The study group consisted of 107 patients who underwent genetic testing for thrombophilia due to VTD between 2015 and 2017. Patients with VTD who underwent thrombophilic genetic examination by polymerase chain reaction method were included in the study. Antithrombin III, protein C and protein S deficiency patients diagnosed with biochemical tests were excluded from the study. The demographic characteristics and clinical results of the patients were obtained from the hospital archive. The control group consisted of 112 healthy individuals randomly selected from the community. The patient group and the control group were compared.
RESULTS: The mean age of the patients was 39.6 years. The female/male ratio was 1.7. Advanced age and female gender were statistically significantly more frequent in the patient group (In both, p=0.0001). Factor V G1691A and B-Fibrinogen-455 genetic defects were statistically significantly higher in the patient group (Respectively; p=0.008, p=0.049). The most frequent (54.2%) PAI-4G&5G heterozygous gene defect was found in the patients. Deep venous thrombosis was detected in 54.2%, intraabdominal VTD in 4.7%, pulmonary embolism in 27.1%, and cerebral venous thrombosis in 30.8% of the VTD patients.
DISCUSSION AND CONCLUSION: Thrombophilic genetic mutations are not uncommon in patients with VTD. Thrombophilic genetic mutations in VTD etiology and in selected patients should be investigated. In patients without known thrombophilia mutations, rare thrombophilic mutations should be examined.

6.A rare case: isolated tubal torsion
ONUR KARAASLAN, Dogukan Yildirim, Erkan Şimşek, latif hacıoğlu
doi: 10.5505/ejm.2020.71602  Pages 33 - 35
Although isolated torsion of the tuba is very rare, it should be kept in mind especially in women of reproductive age who present with abdominal pain, as it causes fertility problems especially in late diagnosed cases. Pre-operative diagnosis is difficult because there is no pathognomonic symptom or specific clinical, imaging and laboratory findings. Therefore, it should be considered in reproductive age women presenting with undiagnosed abdominal pain.

7.The influence of loud crying on pulmonary gradients obtained by transthoracic echocardiography in children with pulmonary valve stenosis
Mecnun Çetin
doi: 10.5505/ejm.2020.16878  Pages 36 - 40
INTRODUCTION: Pulmonary valve stenosis (PS) is the obstruction of blood outflow from the right ventricle of the heart at the level of the pulmonary valve. Crying is associate with an increase in venous return and it has been known to have some acute effects on cardiovascular system, the data about the alterations in echocardiographic findings during crying is limited. To explore the influences of loud crying in evaluation of transvalvular gradient obtained by Doppler echocardiography in children with pulmonary valve stenosis (PS).
METHODS: Our study group included a total of 48 children, aged between 2 and 43 months who were diagnosed with pulmonary valve stenosis based on the clinical signs and laboratory (Echocardiography) findings in our hospital. We compared the pulmonary gradients obtained by echocardiography while the children were crying and while they were calm.
RESULTS: Totally 48 patients (23 male, 25 female) diagnosed with PS in our hospital were included in the study. The mean age of the patients was 19.27±11.14 months (range: 2-43 months). During crying, both maximum and mean pulmonary gradients were statistically significantly higher compared with the results obtained while the patients were calm (p<0.001, p =0.001, respectively).
DISCUSSION AND CONCLUSION: In conclusion, significant increases in both maximum and mean pulmonary gradients were determined during loud crying. Since these parameters are the main determinants of management of patients with PS, this condition should be kept in mind and if possible these measurements should be obtained while the children are in a calm state. Larger prospective studies are warranted to support our findings.

8.Evaluation of the effects of alcohol on the heart by stereological methods
Neşe Çölçimen
doi: 10.5505/ejm.2020.89410  Pages 41 - 44
INTRODUCTION: Alcohol is an agent with known toxic effects on body organs and tissues. It injures heart tissue, causing arrhythmia, left ventricular hypertrophy, and sudden death. In the present study we aimed to determine ethanol’s detrimental cardiac effects using the stereological technique.
METHODS: We enrolled 13 male Wistar albino rats. They were randomized into two groups as the Control (n=6) and Ethanol (n=7) groups. The ethanol group was orally administered 6.4% ethanol mixed with drinking water. The control group was subjected to no application. These procedures were continued for 18 days. At the end of the experiment the cardiac tissue was excised under anesthesia and the left ventricle was dissected. It was then subjected to the routine light microscopic histological examination procedure and embedded in paraffin. Sections of 5µm thick were taken and stained with Hematoxylin & Eosin. In the stereological measurement the modified method of the Cavalieri principle was used.
RESULTS: We detected a left ventricular volume increase by the stereological technique, supporting the view that alcohol forms left ventricular hypertrophy.
DISCUSSION AND CONCLUSION: We detected a left ventricular volume increase by the stereological technique, supporting the view that alcohol forms left ventricular hypertrophy.

9.Evaluation of Dental Anxiety in Patients Undergoing Second-Stage Implant Surgery with Er,Cr: YSGG Laser Treatment: Randomized Clinical Trial
Serap Keskin Tunç, Nazli Zeynep Alpaslan Yayli, Ahmet Cemil Talmaç, Erkan Feslihan, Volkan Kaplan
doi: 10.5505/ejm.2020.60352  Pages 45 - 54
INTRODUCTION: Oral surgical procedures cause high-pain expectation and consequent anxiety in patients. The aim of this study is to compare the effects of Er,Cr: YSGG laser and scalpel method on dental anxiety level during second-stage implant surgery.
METHODS: 96 patients with 304 osseointegrated implants were divided into two groups. Implants embedded under the oral mucosa were exposed with scalpel or laser surgery. Before the operation the patients were asked to fill the STAI and DAS while resting in the waiting room. In addition, postoperative daily analgesic use, VAS scores perioperativly and on the postoperative 1st, 2nd and 3rd days and demographic information such as age and gender were also recorded.
RESULTS: There was no statistically significant relationship between surgical method and anxiety levels (p> 0.05).Also the differences between the scalpel and laser groups in terms of total DAS and STAI scores were statistically insignificant(p>0.05). But statistically significant difference was found between surgical method and the analgesic consumption(p<0.05). A higher rate of analgesic use was observed in the scalpel group.
DISCUSSION AND CONCLUSION: The use of Er,Cr;YSGG laser could reduce pain during minor oral surgical procedures but had no significant effect on dental anxiety. Different modalities that could provide additional benefits in overcoming this situation should be investigated.

10.Analysis of the factors increasing the mortality in emergency department following firearm injuries
Mehmet Reşit Öncü
doi: 10.5505/ejm.2020.90267  Pages 55 - 60
INTRODUCTION: In this study, we aimed to determine the factors that increase mortality in patients presenting to the emergency department after a gunshot injury.
METHODS: This is a retrospective study. Between January 2010 and 2014, 246 cases were reported to the tertiary university emergency department after firearm injury; age, sex, injury site and concomitant organ injuries, consciousness and hemoglobin levels, patient distribution according to months and years, length of stay in emergency department and factors increasing mortality were analyzed.
RESULTS: There were a total of 246 subjects included in the study: 211 (85.8%) males and 35 (14.2%) females. The average age was 29±13.5. The distribution of the firearm woundings indicated that they occurred most frequently in August 56 (22.7%). Injury localization was detected as head 53 (21.5%), thorax 35 (14.2%), abdomen 27 (10.9%) and extremity (106%). The accompanying injuries were as follows: 23 cases of hemopenumothorax (9.3%), 20 cases of intestine perforation in the abdomen (8.1%). The states of the patients' consciousness were evaluated using the Glasgow coma scale. The results were as follows: 31 subjects scored 3-8, 22 patients scored 9-13 and 193 patients scored 14-15. The length of stay in the emergency department was as follows; head and neck 119, thorax 150, abdomen 134, multiple trauma 161 and ex 55.
DISCUSSION AND CONCLUSION: Mortality rate was high in patients with low GCS and Hb levels. The length of stay in emergency department was short in patients with high mortality.

11.Do early adolescent and advanced maternal age pregnancies affect term birthweight?
Ali Ovayolu, Selver Güler
doi: 10.5505/ejm.2020.39327  Pages 61 - 67
INTRODUCTION: Although it is known that there is a relationship between birthweight and maternal age, adverse pregnancy outcomes are reported more frequently in adolescent pregnancies (AP) and advanced maternal age pregnancies (AMA). We aimed to compare the mean maternal age at delivery for the last 5 years in our hospital. And also we evaluated birthweights and adverse pregnancy outcomes in full-term births for maternal age categories.
METHODS: We evaluated 63,432 singleton birth between 2013 and 2018. In a subgroup, 21.575 full-term births were analyzed according to the birthweight, type of delivery, maternal age category (including early AP and AMA), and over the years. The Student t-test was used to evaluate continue values and the categorical values were evaluated using the Chi-Square Test. A P<.05 value was taken as significant.
RESULTS: The mean maternal age was 26 years and no significant change was found according to years. Stillbirth rates were determined as significantly higher in AMA (2.6%; p <0.001). In the early AP, the rate of low birthweight infants was highest (16%). The mean birthweight was found to be the highest in the AMA directly proportional to the maternal age (r = 0.13, p <0.001). The average birthweight was 3167 ± 339 g and when the subgroups were considered, it was 3167 ± 339 g in early AP and 3336 ± 459 g in the advanced maternal age group of 40 years and older.
DISCUSSION AND CONCLUSION: Birthweights increases in direct proportion to maternal age, although it does not make a clinically significant difference.

12.An overview of Superficial Musculo-Aponeurotic System; Anatomic and Radiologic Approach
Selma Çalışkan, Emre Can Celebioglu, Sinem Akkasoglu, Ibrahim Tanzer Sancak
doi: 10.5505/ejm.2020.72692  Pages 68 - 72
INTRODUCTION: Superficial musculo aponeurotic system(SMAS) is a network of collagen fibers, elastic fibers and fat interconnecting facial muscles and dermis. Subcutaneous morphology of face is more organized than subcutaneous layer of any part of body. SMAS has distinctive features in forehead, parotid region, zygomatic region, temporal region, cheek, infraorbital region, nasolabial fold, and lower lip. Because SMAS is a key feature for either percutaneous and surgical aesthetic interventions, neurovascular structure embedded in this tissue must be well known.
METHODS: Radiologic views were enrolled from the archive system of radiology department. Random selected images of 50 patients (29 male, 21 female) who underwent MR imaging for any reason were analyzed by the same radiologist who also has PhD degree in anatomy.
RESULTS: Thickness of SMAS for each region was measured. Continuity of the tissue was followed between the junctions of the regions in a proper sequence with MR images. Thickness of SMAS in the zygomatic region was measured in 50 patients and mean value was 0.12 mm. Left and right side measures were compared between genders and no statistical difference between gender groups was found. Correlation between measures and age was analyzed statistically and no correlation was found.
DISCUSSION AND CONCLUSION: A radiologically and clinically neglected tissue: SMAS deserves more attention because of its continuous course interconnecting distinct regions of face and acting as a functional unit for the expressions. Age and gender related changes in SMAS morphology studied in healthy individuals by means of radiology provides an important contribution to the literature.

13.Relationship Between Peripheral Perfusion İndex And Anxiety.
Ahmet Yüksek, Cevdet YARDIMCI
doi: 10.5505/ejm.2020.65002  Pages 73 - 76
INTRODUCTION: Peripheral perfusion index(PI) provides information about vascular tone and fluid status by interpreting the data obtained from pulse oximetry. However, the vascular tone may be affected by anxiety in patients. Impaired perfusion index in patients with high anxiety may cast a shadow on the predictive power of the PI. In our study, the relationship between anxiety and perfusion index values was evaluated as the primary aim.
METHODS: Methods: Preoperatively, Anxiety scores of the patients were measured by APAIS and STAi tests. Perfusion index values also recorded in preoperative room. Correlation between these values evaluated.
RESULTS: Results: 95 patients aged 18-65 years were included in the study. Mean anxiety scores of all patients were 48.35±4.42. Perfusion index values were significantly lower in patients with high anxiety. In addition, there is a negative and significant correlation between anxiety and perfusion index.
DISCUSSION AND CONCLUSION: Discussion: The perfusion index is a non-invasive, easy to apply and cost-effective tool. It has been used in important studies such as predicting the development of hypotension induced by anesthesia induction with its application to patients in the preoperative waiting room. However, according to the results of our study, this technique is affected by the anxiety levels of the patients. It may be misleading in patients whose anxietyis not obious.
Conclusion: Anxiety levels should be questioned in awake patients being used perfusion index and it should be kept in mind that perfusion index may decrease in high anxiety levels.

14.Investigation of Knowledge Levels of Neonatal Screening Programs in Medical Faculty Staff
Fatma Ay, Hüseyin Elbi, Fatih Özcan
doi: 10.5505/ejm.2020.36693  Pages 77 - 83
INTRODUCTION: Newborn screening tests are an important preventive public health program that provides early detection of the treatable diseases of infants. This study was carried out to investigate the knowledge levels of health workers and administrative personnel on neonatal screening programs.
METHODS: Our research is a descriptive study. The sample wasn’t selected and a questionnaire was conducted to 365 people in a period of approximately 2 months. The questionnaire used in the research consists of 20 questions prepared by searching the literature to measure the information participants’ about neonatal screening programs.
RESULTS: 89.04% and 10.95% of the employees participating in our study are health personnel and administrative personnel, respectively. 69% of the participants were female, and the average age was 33,13. 66% of the participants in the study had service years of 10 years or less while 44% had service years of 11 years and longer. The largest group of the participants in the study is research assistants (28.4%) and the second largest group is nurses (22.1%). The total of General Administrative services, technical services and auxiliary services is 10,94%. It was seen that 98.4% of the participants were aware of the newborn screening tests.
DISCUSSION AND CONCLUSION: In conclusion, it is pleasing that both physicians and assistant health personnel have high knowledge about subjects and applications related to newborn screening tests. However, it is noteworthy that some of the non-health staff members have inaccurate knowledge and thoughts about some applications related to newborn screening tests.

15.Can We Estimate The Recurrence Of Primary Spontaneous Pneumothorax With Simple Blood Tests?
Fatih Selvi, Cihan Bedel, Muharrem Özkaya
doi: 10.5505/ejm.2020.71501  Pages 84 - 88
INTRODUCTION: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with in inflammatory diseases and inflammation plays an important role in primary spontaneous pneumothorax (PSP). Therefore, this study evaluated the relationship between estimating recurrence risk and simple blood test such as NLR and PLR in patients with PSP.
METHODS: We designed a retrospective study examining the benefit of NLR and PLR in estimating recurrence in PSP patients. Patients were divided into 3 groups according to their recurrence: Group 1 (132 patients; defined as no recurrence); Group 2 (46 patients; defined as one recurrence); Group 3 (16 patients; defined as two or more recurrence). The clinical blood parameters were compared among the groups. Mann-Whitney U test, Chi-square and ANOVA test were used to analyze data.
RESULTS: NLR and PLR were significantly elevated in patients with recurrent PSP (p<0.001 and p<0.001,respectively). The best NLR cut-off value for predicting recurrence was 3.5 with 87% sensitivity and 63% specificity, and the best PLR cut-off value was 144.5 with 75% sensitivity and 66% specificity.
DISCUSSION AND CONCLUSION: NLR and PLR were two useful inflammatory markers for assessment of recurrence in PSP patients. The present study is the first report about the association of NLR and PLR with recurrence in PSP patients. The results may have clinical importance, because the early markers of recurrent PSP.

16.Adult Patient Cancer Statistics of Mardin Province
Aydın Aytekin
doi: 10.5505/ejm.2020.82473  Pages 89 - 93
INTRODUCTION: Some types of cancer are more common in some regions. The data in Turkey are recorded with the cancer registry system but this data does not cover all cities. This study aimed to investigate the clinical and demographic characteristics of oncology patients admitted to Mardin State Hospital.
METHODS: The records of patients, who admitted to Mardin State Hospital Medical Oncology Clinic between 2014-2018, were retrospectively reviewed. Patients over 18 years of age were included in the study. Gender, diagnosis and disease stages of the patients were recorded.
RESULTS: The median age of the 1208 patients (654 female and 554 male) was 57 (18-94) years. The median age was 52.25 in women and 60.92 in men. The 5 most common cancers in the whole group were; breast cancer, colorectal cancer, lung cancer, prostate cancer and gastric cancer, respectively. In men; the most common types of cancer were; lung, colorectal, prostate, head-neck and gastric cancer. On the other hand in women, the most common types of cancer were breast, colorectal, ovarian, gastric and uterus corpus cancer. The most common presentation stage was stage 4 (n = 416, 34.4%) in the whole group, stage 2 (n = 204, 31.2%) in women and stage 4 (n = 253, 45.7%) in men. Adenocarcinoma was the most common histologic type in both the male and the whole group (female and male) of patients.
DISCUSSION AND CONCLUSION: In this study, the incidence of colorectal cancer in all groups (men, women and total) was higher in Mardin province when compared with Turkey data.

17.The Importance Of Timing In Congenital Nasolacrimal Duct Obstruction
Halil İbrahim Yener
doi: 10.5505/ejm.2020.98705  Pages 94 - 96
INTRODUCTION: Object: The aim of this study was to evaluate the efficacy of probing to treatcongenital nasolacrimal duct obstruction.

METHODS: In this study, 53 eyes of 39 patients who underwent probing for congenital nasolacrimal duct obstruction were retrospectively analyzed. Patients were divided into two groups according to the timing of the procedure. The operation time of the first group was 11-18 months and the second group was more than 18 months. After the procedure, efficacy and safety status were monitored.

RESULTS: There was 21 female and 18 male patients. The mean age of the patients were 13.56 months in the first group, and 25.94 months in the second group.While 30 eyes of 22 patients were studied in the first group, 23 eyes of 17 patients in the second group. The mean follow-up period was 26.15 months. The success rate was 96.7% in Group 1and 78.3% in Group 2. No complication was observed during follow-up.

DISCUSSION AND CONCLUSION: In the treatment of congenital nasolacrimal duct obstruction, probing procedure is highly effective especially in the early age group. The procedure is also effective and safe in delayed cases.

18.Platelet Distribution With is A Usable Parameter in Chronic Obstructive Pulmonary Disease Severity
Buket Mermit Çilingir, Aysel Sunnetcioglu
doi: 10.5505/ejm.2020.24572  Pages 97 - 102
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory disease with a high mortality and morbidity rate. The aim of our study was to investigate the relationship of hematological parameters including the MPV, PDW and RDW with the severity of COPD.
METHODS: We retrospectively enrolled patients with the diagnosis of COPD who were admitted to our Pulmonary Diseases Department. A total of 201 patients with COPD, were included in the study. Patients were divided into 4 groups according to the severity of COPD: group A (mild), group B (mild to moderate), group C (moderate to severe), and group D (severe). 159 healthy subjects were included as control.
RESULTS: There was statistically significant difference in PDW values between patients with COPD and controls (p =,001). There was no statistically significant difference in MPV values and RDW rates between patients with COPD and controls (p =,591, p =,677 respectively). Patients in the severe COPD group were older, more often were male, had higher hematocrit values. There were no statistically significant differences in MPV, PDW, and RDW values in the severity of COPD (p: , 639, p: ,082, p: , 662 respectively).
DISCUSSION AND CONCLUSION: PDW could be used an indicator of hypoxemia, underlying inflammation, and oxidative stress. It could be considered as a new marker in the determination of inflammation in COPD patients with rapid, inexpensive, easily measurable properties with routine CBC analysis. Morover,
measurement of changes in PDW value during follow-up can be used to assess the inflammatory response.

19.The First Three Years of Ablation Therapy in Cardiac Arrhythmias: Single Centre Experience
Yusuf Turkmen, naci babat
doi: 10.5505/ejm.2020.32650  Pages 103 - 108
INTRODUCTION: Improvements in both evaluation of intracardiac signals and molecular data yielded an easy understanding of complex cardiac arrhythmias and channelopathies in last years. However, the mentioned techniques are not applicable by all health providers because of high costs, requirement of well-educated team members, and the most importantly the presence of long learning curve for cardiologists In this article, the catheter ablation of arrhythmias in the xxx… in last three years will be reviewed.
METHODS: Intracardiac signals were filtered at 20-500 Hz, amplification gains were 10-80 mm/mV. All signals displayed and acquired on an electrophysiological recording system (EP-TRACER 2 system, Schwarzer Cardiotek, Germany). All types of arrhythmias such as atrioventricular nodal reentry tachycardia, atrioventricular reentry tachycardia, atrail flutter, atrial tachycardias, atrial fibrillation, premature ventricular contractions, and ventricular tachycardias were ablated according to the latest quidelines and techniques.
RESULTS: A total of 430 patients were screened in this trial. The success rate in the ablation of atrioventricular nodal reentry tachycardia, atrioventricular reentry tachycardia, atrail flutter, atrial tachycardias, atrial fibrillation, premature ventricular contractions, and ventricular tachycardias was 100%, 88.2%, 88.8%, 72.2%, 100%, 73.9%, and 87.5% respectively.
DISCUSSION AND CONCLUSION: There was only one death among 430 ablation procedures in our centre and the reason of death was not clear because of patient’s other co-morbidities. Otherwise, our success and complication rates were similar with the results of most advanced centres in all around of the world.

20.Five-Year Experience on Patients with Brain Death Diagnosis: A Two-Centered Retrospective Study
Okan Andıc, Hilmi Demirkiran, Ilhan Bahar, Arzu Esen Tekeli, Nurcin Gülhas
doi: 10.5505/ejm.2020.46547  Pages 109 - 113
INTRODUCTION: Brain death (BD) diagnosis is a clinical diagnosis, but in many countries, other confirmatory tests are obligatory. The study was aimed to investigate the clinical effects of the current process of BD in Turkey.
METHODS: This study was performed retrospectively by evaluating BD-diagnosed patients’ files and computer records in the XXX University Hospital Anesthesiology Intensive Care Unit (ICU) and in a XXX hospital’s general ICU. This study was conducted between 2012 and 2017 in Turkey.
RESULTS: Of the 57 patients included in the study, 63.2% were male (n = 36), and 36.8% were female (n = 21). The most common causes of hospital admissions were cerebral hemorrhage (38.6%; n = 22) and trauma (36.8%; n = 21). Of the patients who accepted organ transplantation, 80% (n = 4) were diagnosed at an average of 60 hours (min 24, max 120). The rates of using imaging methods in the clinical diagnosis of BD were as follows: 75.4% (n = 43) for Computerised Tomography (CT), 17.5% (n = 10) for Computerized Tomographic Angiography (CTA), and 7% (n = 4) for Transcranial Doppler (TD) Ultrasonography. Of the patients, 8.78% (n = 5) were used as donors.
DISCUSSION AND CONCLUSION: Studies in the literature have indicated that the short duration of BD diagnosis will lead to an increase in organ donation acceptance rates. This study found that the diagnosis time was longer than presented in the literature and that CTA was the most commonly used imaging modality in addition to the apnea test.

21.The investigation of prenatal screening test parameters in predicting HELLP Syndrome
Buğra Çoşkun, Selçuk Erkilinç, Özgür Kara, Bora Çoşkun, Burak Elmas, Dilek Şahin
doi: 10.5505/ejm.2020.16870  Pages 114 - 117
INTRODUCTION: We aimed to investigate whether first and second trimester prenatal screening test parameters may be useful in predicting "HELLP Syndrome"
METHODS: HELLP syndrome was defined according to Sibai criteria. The collected data were as follows; age, gravida, parity, body mass index, gestational week at labor, route of delivery, birthweight, aspartat aminotransferase (AST), Lactat dehidrogenase (LDH), biluribin, first trimester multiple of medians (MOM) of preganancy associeted plasma protein-A (PAPPA), and Beta human corionic gonadotropin (B hcg), second trimester Bhcg, unconjugated estriol (uE3) and AFP levels were measured.
RESULTS: A total of 80 patients in study group and 135 patients in control groups were included to the study. All the markers of HELLP syndrome was signficanty higher in study group due to the markers was the criteria for HELLP syndrome. While first trimester PAPP-A was significantly lower in study group, Bhcg levels were similar between groups. Second trimester AFP level was significantly lower also B-hcg level was significantly higher in study group. uE3 was not different in control and study groups.
DISCUSSION AND CONCLUSION: Low Papp-a levels and high second trimester bhcg levels may be associated with HELLP syndrome in subsequent gestational weeks.

22.The Effect of Cold Vapor Treated to Thyroidectomy Patients During Early Postoperative Period
Funda Zaman, Elif Karahan
doi: 10.5505/ejm.2020.18189  Pages 118 - 125
INTRODUCTION: Although thyroidectomy is one of the operations, that are frequently performed with a low mortality rate today, it may cause severe morbidity, bleeding, recurrent damage of neuronal and parathyroid glands and problems such as laryngeal edema.
In this analytical and prospective study, it was aimed to examine the effect of cold vapor that was applied to thyroidectomy patients during early postoperative period.

METHODS: The sample of the study was composed of 60 patients who underwent thyroidectomy. Patients were classified into two groups including control group and cold vapor group. Cold vapor was applied to both groups vapor for 15 minutes per hour within the first eight hours following the operation. Then, for cold vapor group cold vapor application was continued to apply at two and three hour intervals during the first 24hours. In both groups sore throat, cough, dysphagia and vocal status were evaluated in the first 24hours after surgery.
RESULTS: It was determined that sore throat was experienced significantly less in cold vapor group within the first 24hours following operation and it was increasingly cooling down. It was also found that cough was experienced significantly less in cold vapor group, and this problem disappeared completely at 8hours after the operation. Cold vapor applied during the first 24hours following thyroidectomy was found to have had a significant effect on decreasing swallowing impairment and eliminating hoarseness.
DISCUSSION AND CONCLUSION: Cold vapor application during the first 24 hours following operation was found to have an effect on alleviating sore throat, cough and swallowing impairment and eliminating hoarseness.

23.Relationship between biomass exposure, chronic headache and brain damage in young women
Ayse Arslan, Fatma Aykan Tüzün, Harun Arslan
doi: 10.5505/ejm.2020.25428  Pages 126 - 131
INTRODUCTION: Biomass, an energy source, is the general name of all non-fossilized biological material obtained from living or recently living organism. Household use of solid biomass fuels is the most common cause of indoor air pollution (IAP) worldwide. The aim of this study was to investigate the relationship between biomass exposure and the presence of headache and brain damage in young women
METHODS: This cross-sectional study included patient group consisted of 69 women who applied to the neurology outpatient clinic with complaints of chronic headache and fatigue and the control group consisted of 26 healthy volunteer women who were not exposed to tandir smoke. In all subjects, blood samples were obtained for biochemical analysis and brain Magnetic Resonance Imaging (MRI) scan was performed to evaluate brain damage
RESULTS: In the patient group, ischemic gliotic foci were detected in 56 patient (81.2%) while in the control group, gliotic foci was detected in 3 subjects (11.5%). The prevalence of gliotic foci was almost 8 times higher in subjects with a history of biomass smoke exposure than in subjects without a history of biomass smoke exposure (81.2% vs. 11.5%).
DISCUSSION AND CONCLUSION: These findings suggest that indoor air pollution may have an effect on the risk of headache and brain damage. However additional studies with larger sample sizes and including other ethnic or environmental communities are needed to determine in detail the role of indoor air pollution in the occurrence of headaches and brain damage

24.Forecasting the number of individual per dentist in Turkey; Comparison of Box-Jenkins and Brown Exponential Smoothing Estimation Methods
can ateş
doi: 10.5505/ejm.2020.57805  Pages 132 - 139
INTRODUCTION: Oral and dental diseases and the fight against these diseases are a difficult and costly issue for our country and most of the world countries. Protective and informative dentistry practices may be realized with the prospective realistic planning of Dentist personnel trained at adequate number and Oral Dental Health services.
METHODS: The aim of this study is to model the series of number of individual per dentist personnel in Turkey between the years of 1951-2016 with Box-Jenkins and Brown Exponential Smoothing methods, and to provide these forecast models derived to guide the policy-makers. Number of patient per dentist personnel is calculated prospectively in this study and values expected until 2023 are found with Box Jenkins and Brown Exponential Smoothing methods frequently used in making prospective forecasts.
RESULTS: Calculations of these two models are compared in terms of decision-making criteria and it is concluded that Brown Exponential Smoothing model produces more coherent results than Box Jenkins model on behalf of making prospective forecasts. For all fit statistics are better than Box Jenkins model regarding the Brown Exponential Smoothing method, notably MAPE value.
DISCUSSION AND CONCLUSION: While the importance of oral and dental diseases and struggle with these diseases could not be understood adequately in the world, the existing gap in this field in Turkey should be removed with the realistic state policies immediately. Oral and dental health that is required to be seen as a part of public health should be planned by the socio-economic condition of the society both in delivery of service and finance.

25.Could Bladder wall elastography be used as an indicator for the diagnosys of bladder outlet obstruction by Benign Prostate Hyperplasia?
recep eryılmaz, Rahmi Aslan, Harun Arslan, Murat Demir, Saim Türkoğlu, Şeyhmuz Araz, Kerem Taken
doi: 10.5505/ejm.2020.98698  Pages 140 - 145
INTRODUCTION: Benign prostatic hyperplasia(BPH) is one of the most common causes of bladder outlet obstruction in men. In this study, we aimed to evaluate the elasticity of the bladder by ARFI elastography in BPH patients
METHODS: Fifty benign prostate patients were included in the study. after evaluation of patients in the outpatient clinic. ARFI elastography was performed with full bladder. Elastography was performed separately on the anterior, right and left walls of the bladder. Then the patient underwent uroflowmetry. The maximum flow rate and post-mix residual values in uroflowmetry were recorded.
RESULTS: The mean age of the patients was 45.6 ± 3.77 the average of bladder anterior wall elasticity 3.39 ± 0.89, bladder left wall elasticity 2,69 ± 0,82 and bladder right wall elasticity was 3.69 ± 0.89.The mean prostate size 52.58 ± 24.16 the average of Qmax11.96 ± 4.85, the mean of PMR 77.8 ± 59.6 and mean of prostate elasticity was 2.97 ± 1.1
DISCUSSION AND CONCLUSION: Urinary bladder wall elasticity with ARFI can be a diagnostic indicator for bladder outlet obstruction due to BPH.

26.Comparison Of Snodgrass and Bracka Methods In Terms Of Urethral Fıstula and Meatal Stenosis In Hypospadias Repair
Ömer Faruk Koçak, Veli Avci, Kemal Ayengin
doi: 10.5505/ejm.2020.71676  Pages 146 - 150
INTRODUCTION: Hypospadias is one of the most frequent congenital anomalies in birth. Many factors may have part in etiology. Its treatment is possible only through surgical intervention, and there are more than 300 methods in literature identified for hypospadias repair. The purpose of this study is to compare Snodgrass and Bracka methods, the methods most frequently used for hypospadias repair, in terms of urethral fistula and meatal stenosis.
METHODS: In this study, the data of 40 patients operated between 2014 and 2019 years have been used. 20 of the patients have been operated with Snodgrass, and the others have been operated with Bracka method.
RESULTS: The average ages of the patients operated with Snodgrass method and Bracka method were 4 years 3 months and 2 years 9 months respectively. Average length for follow-up for the patients operated with Snodgrass method was 18 months 9 days, and it was 35 months 1 day for the patients operated with Bracka method. Urethral fistula was observed to develop in %30 of the patients operated with Snodgrass method and %25 of those operated with Bracka method totally. In both methods, rates of meatal stenosis were more frequent compared to fistula (Snodgrass: %35, Bracka %40).
DISCUSSION AND CONCLUSION: Fistula development is found numerically more in the patients operated with Snodgrass method while meatal stenosis development is observed numerically more in those operated with Bracka method.

27.Investigation of Factors Affecting General Mortality in Some Countries by Quantile Regression Method Alternative to Least Squares Method (LSM)
Yüksel Akay Ünvan
doi: 10.5505/ejm.2020.30074  Pages 151 - 160
INTRODUCTION: This study was conducted to find out the factor or factors affecting the overall mortality rates in a total of 31 countries, including 28 European Union countries.
METHODS: The data set consisting of 2014 year data was analyzed using the Eviews 9 program. After the descriptive statistics and covariance matrix were determined, the regression model was established by the LSM. It has been observed that this model does not provide the assumption that it does not contain outliers, which is one of the regression assumptions. Therefore, 3 Quantile Regression models were established by using the values of 0.25, 0.50 and 0.75. Interpretations were made according to these regression equations.
RESULTS: Factors affecting the General Mortality (OLM) are as follows. In the quantile model of 0.25; the Ratio of People With Asthma (RA) has a negative effect and the Ratio of People With Blood Pressure (TAN) has a positive effect. In the 0.50 quantiles model; only the TAN variable has a positive effect. In the last model with a value of 0.75 quantiles, again the TAN variable has a positive effect.
DISCUSSION AND CONCLUSION: The general result according to the models established for 3 quantile values is that the AST variable has a negative (decreasing) effect on General Mortality (OLM) while TAN variable has a positive (increasing) effect.

28.Use of Contractubex® (Allantoin, Heparin, Extractum Cepae) to Prevent Scar Formation in The Rabbits to Which Primary Closure has been Applied After Urethrotomy
KEMAL AYENGİN, Nizamettin Kılıç
doi: 10.5505/ejm.2020.80948  Pages 161 - 169
INTRODUCTION: The scar tissue occurring in operating area after the repair of hypospadias which is one of the common congenital anomalies of male children has part in formation of post operative complications. Many surgical techniques and materials have been used to reduce complications. The purpose of this study is to research the effects of contractubex® (allantoin, heparin, extractum cepae [AHEC]) gel on development of scar in the area repaired after urethrotomy.
METHODS: In the study, 45 male White New Zealand rabbits were used. The rabbits were divided into three groups randomly.
Group 1(K): The group to which urethrotomy and primary closure were applied
Group 2(A): The group to which urethrotomy, primary closure + 15-day AHEC were applied
Group 3(B): The group to which urethrotomy, primary closure + 30-day AHEC were applied
Urethras of the rabbits in the groups were calibrated with angiocath (24 Fr) once a day for 30 days. Along with calibration, AHEC was applied to the urethras of the rabbits in 2nd group for 15 days and urethras of the rabbits in the 3rd group for 30 days. To evaluate scar tissue, macroscopic and histopathological evaluations were carried out.

RESULTS: Although inflammation was much more in the groups to which AHEC was applied, fibrosis was determined to be less.
DISCUSSION AND CONCLUSION: It is thought that the application of AHEC may be effective in reducing scar formation after operation.

29.A rarely seen mass in atrioventricular sulcus: Cardiac hydatid cyst
Sadık Volkan Emren, Selcen Yakar Tülüce, Sedat Altay, Aykan Çelik, Ersin Çağrı Şimşek
doi: 10.5505/ejm.2020.98215  Pages 170 - 172
Cardiac hydatid cyst is a rare manifestation of Echinococcus infestation. It is mainly located in left ventricle followed by right ventricle, left atrium, pericardium, pulmonary artery in case of heart involvement. Herein we report a hydatid cyst in atrioventricular sulcus which is an unusual and rare location for cardiac hydatid cyst as demonstrated by three dimensional transthoracic and cardiac magnetic resonance imaging.

30.Thoracic wall foreign bodies following penetrating trauma in pediatric age group: report of two cases with literature review
Volkan Sarper Erikci
doi: 10.5505/ejm.2020.68094  Pages 173 - 176
Penetrating chest trauma is rarely seen in childhood. Following penetrative trauma various foreign objects may be detected as embedded in the tissues. A precise and prompt diagnosis together with an appropriate surgical management is paramount in these cases for a good prognosis. Here we present 2 cases with 2 different foreign bodies embedded in thoracic wall following different penetrating thoracic traumas. The purpose this report to critique the properties and handling of penetrative chest wall trauma in children with regard to post-traumatic retained FBs in thoracic wall and the topic is discussed under the light of relevant literature.

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