ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 25 (3)
Volume: 25  Issue: 3 - 2020
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1.Automated UV- C LED stethoscope decontamination: a useful barrier in the time of COVID-19.
Rosalia Ragusa, Gabriele Giorgianni, Alessandro Lombardo, Giuseppina Faro, Lorenzo Lupo, Marina Marranzano
doi: 10.5505/ejm.2020.06978  Pages 330 - 339
INTRODUCTION: INTRODUCTION: The use of incorrectly cleaned or disinfected hospital’s equipment can also pose an infection risk and may contribute to the dissemination of microorganisms. Generally, stethoscopes are not considered a main infection risk, but the stethoscope is the most-used medical tool in the world. A new light-emitting diode (LED) disinfection option has recently been introduced by the LED industry. We wanted to determine where and when this new disinfection system would be useful in reducing contamination and whether any specific type of patient would benefit more from the use of this device.

METHODS: The evaluation was conducted using a multidisciplinary approach and has provided an analysis of the 7 domains recommended by EUnetHTA (Health problem and current use of the technology, technical characteristic, clinical effectiveness, safety, economic evaluation, organizational aspects, ethical aspects).
RESULTS: We observe the use of sthethoscope while delivering routine care in three different intensity of care departments on at least one hour every week for three months. Between one patient and another, a disinfection or cleaning procedure is never performed by most operators. We collected 248 samples from different departments to evaluate the efficacy of a new device. We observed a reduction in the bacterial load in 70% of the cases after using the UV-C LED device.
DISCUSSION AND CONCLUSION: This device could be useful in encouraging the adoption of good hygiene practices and could reduce the risks associated with the treatment of infections. The tool has proved to be particularly useful in the intensive care unit.

2.Retrospective evaluation of chidren with lymphadenopathy: Single centre experince
Serap Karaman, Enver Uslu, MURAT BAŞARANOĞLU, Tülay Kamaşak, Eda Çelebi Bitkin
doi: 10.5505/ejm.2020.60243  Pages 340 - 344
INTRODUCTION: Lymphadenopathy (LAP) is a common clinical finding in childhood. It is mostly reactive and has a good prognosis. Childhood cancers rarely occur. In our study, it was aimed to investigate the clinical and laboratory features of patients who were sent to the general child outpatient clinic due to LAP.
METHODS: The records of patients with LAP who applied to our General Children's outpatient clinics between January 2018 and December 2019 retrospectively. Age, gender, duration of complaint, treatment, systemic signs and symptoms, features of lymph node, laboratory results was recorded
RESULTS: The median age of 90 patients included in the study was 7 years; It takes place between 3-19 years. The complaints of the application were the most common neck swelling and submandibular and axillary sore after the second. Thirty (33%) of our cases had sore throat. Spleen and liver size were detected in 18 cases. In our study, 16% of cases were performed biopsi. Reactive hyperplasia in nine cases, nodular fasciitis in one case, granulomatous lymphadenitis in two cases, malignancy in two cases and Castleman Disease in one case were detected.
DISCUSSION AND CONCLUSION: We found that childhood lymphadenopathy frequently develops due to benign causes.

3.Evaluating Posterior Edentulous Mandible Alveolar Crest Dimensions By Cone Beam Computed Tomography
Alaettin Koç, Ruşen Erdem
doi: 10.5505/ejm.2020.24471  Pages 345 - 349
INTRODUCTION: In this study, alveolar crest height (CH) and width (CW) in patients with edentulous mandible were measured, also the impact of gender and age factors on obtained values were evaluated.
METHODS: Cone beam computed tomography (CBCT) images of 39 males and 38 females were analyzed retrospectively. CH and CW at 10 mm distal of right mental foramen of patients were measured on sectional images. Independent sample T-test and One-way ANOVA test were used for statistical analysis.
RESULTS: In CH measurements, there was no significant difference between males and females (p= 0.058). However, males had significantly higher CW values compared to females (p=0.039). Considering age criteria, it was understood that age of patient have no significant effect on CW (p=0.586) and CH (p=0.465).
DISCUSSION AND CONCLUSION: In this study, males just had significantly higher CW values. Besides, age factor had no significant effect on crest dimensions and it was concluded that each patient should be evaluated in itself during dental implant replacement regardless of age and gender.

4.The Evaluation of Common Chromosomal Rearrangements and Their Frequencies in Adult Acute Myeloid Leukemia Cases in Malatya Province of Turkey
Gonca Gulbay, Elif Yesilada, MEHMET ALI ERKURT, Harika Gozde Gozukara Bag
doi: 10.5505/ejm.2020.05945  Pages 350 - 355
INTRODUCTION: Recurrent balanced translocations are generally considered as the main parameter for prognosis in acute myeloid leukemia (AML). In recent years, genetic studies have focused on the ascertaintment of molecular aspects of various oncofusion proteins associated with AML, such as t(15;17) PML-RARA, t(8;21) RUNX1-RUNX1T1, t(9;22) BCR-ABL1 and inv (16) CBFB-MYH11. Therefore, we evaluated AML cases with RT-PCR for known specific genetic abnormalities that could lead to more accurate prognosis.
METHODS: In our study, we retrospectively reviewed the records of 211 cases (59.2% males and 40.8% females). RT-PCR technique was performed to identify t(15;17) PML-RARA, t(8;21) RUNX1-RUNX1T1, t(9;22) BCR-ABL1 and inv (16) CBFB-MYH11.
RESULTS: The most common rearrangement was found to be t (15; 17) (%12.8) followed by t (8; 21) (7.11%), t (9; 22) (7.6%) and inv (16) (1.42%). Also, in two other cases (0.95%) t(15;17) and t(8;21) were seen together. In addition, none of these rearrangement were found in 148 cases (70.14%) with AML.
DISCUSSION AND CONCLUSION: The presence of chromosomal rearrangements is very important in the diagnosis of AML. Therefore, rapid identification of specific rearrangements during diagnosis is important for prognostic purposes and can help identify the cause of leukemogenesis and provide new strategies for the treatment of cases. This study will be a baseline reference for future analysis and epidemiological data useful for transplant centers and oncologists both in Turkey and the region.

5.Evaluation of the relationship between ingrown toenail and hallux interphalangeal angle
Tolgahan Kuru, Hacı Ali Olçar
doi: 10.5505/ejm.2020.50470  Pages 356 - 361
INTRODUCTION: Commonly encountered ingrown toenail has been associated especially with shoe properties or nail care. The objective of this study was to investigate the relationship between ingrown toenail and hallux interphalangeal angle (HIA).
METHODS: A total of 28 patients (30 feet) diagnosed with ingrown toenail and had no foot deformity except hallux interphalangeal angle were included in the study. Twenty-eight persons (30 feet) who had no any complaint of ingrown toenail or any foot deformity, and who consecutively presented due to any complaint other than lower extremity were enrolled as the control group. Hallux interphalangeal angle was calculated both in patients and control subjects with dorsoplantar projection of the foot, and compared between the groups.
RESULTS: The groups were similar in age and gender, but showed differences in terms of HIA. The mean HIA value was significantly higher in the patient group compared to the controls. Whereas HIA was higher in male patients with ingrown toenail, this relationship could not be shown in female patients.
DISCUSSION AND CONCLUSION: Increased HIA may be among the risk factors for ingrown toenail. Deformities of the forefoot should be evaluated in patients with ingrown toenail.

6.Single center experience on colonic volvulus; Is CT necessary for diagnosis?
Mesut AYDIN, Serhat Özer, Yaren Dirik, Sehmus Ölmez, Çetin Kotan, Canan Demir
doi: 10.5505/ejm.2020.30316  Pages 362 - 365
INTRODUCTION: Colonic volvulus is rare but hazardous cause of bowel obstruction. We tried in this study to assess efficacy of plain x-ray and endoscopic decompression in diagnosis and treatment, respectively.
METHODS: A total of 34 patients diagnosed with colonic volvulus were retrospectively analyzed and success rates of endoscopic decompression were noted. Descriptive statistics for continuous variables were expressed as Mean±Standard Deviation and Median (Min-Max), and it is expressed as number and percentage for categorical variables. Correlations between some parameters in colonic volvulus patients were examined.
RESULTS: A total of 34 patients, 76% (n = 26) male and 24% (n = 8) female, were included in the study. All patients except those with mucosal necrosis underwent successful colonoscopic detorsion (n=29; 85%). Plain x-ray alone was sufficient for diagnosis in 94%.
DISCUSSION AND CONCLUSION: A total of 34 patients, 76% (n = 26) male and 24% (n = 8) female, were included in the study. All patients except those with mucosal necrosis underwent successful colonoscopic detorsion (n=29; 85%). Plain x-ray alone was sufficient for diagnosis in 94%. Colonoscopic detorsion, by gaining time for elective surgery, is an effective treatment modality and computed tomography (CT) is not necessary for diagnosis in colonic volvulus.

7.Relationship between serum Asymmetrical Dimethylarginine level and urolithiasis
Ozgur Yazici, Kadriye Aydin, Sule Temizkan, Fehmi Narter, Akif Erbin, Alper Kafkasli, Alkan Cubuk, Rahmi Aslan, Kemal Sarıca
doi: 10.5505/ejm.2020.08870  Pages 366 - 370
INTRODUCTION: In the present prospective clinical human study, we focused on researching whether or not there is a difference between metabolic syndrome (MS) positive/negative and renal stone disease (SD) positive/negative patients with regard to asymmetrical dimethylarginine (ADMA) serum levels to clarify the possible effect of endothelial cell dysfunction on renal SD.
METHODS: We included 76 patients (17 males and 59 females) who were admitted to the endocrinology and urology outpatient clinic between December 2014 and February 2018. Patients were segregated into 4 groups; group 1; MS (–) SD (-), group 2; MS (–) SD (+), group 3; MS (+) SD (-) and group 4; MS (+) SD (+). Patients’ age, sex, medical history, and anthropometric measurements were recorded. Endothelial dysfunction was assessed with serum ADMA levels.
RESULTS: The mean age was 40.1 ± 11.4 years (range: 18–59). There was a statistically significant difference between groups for mean homocysteine, uric acid and BMI values. However, there was no statistically significant difference between groups for mean CRP, age and creatinine values. The mean ADMA value was 152 ± 77 (range: 51–445). There was no statistically significant difference between groups for the mean ADMA values.
DISCUSSION AND CONCLUSION: These results showed that studies must focus on MS components separately from each other and sex distribution between patients must be homogeneous or different sexes must be examined separately. In addition, stone compositions of patients enrolled in the study must be known to arrive at more trustworthy and worthwhile results.

8.Comparing the effects of sugammadex and neostigmine on neuromuscular block and bispectral index in recovery from intracranial mass resection operations
Mustafa Kurçaloğlu, Bahriye Binnur Sarıhasan, Erhan Çetin Çetinoğlu
doi: 10.5505/ejm.2020.99705  Pages 371 - 377
INTRODUCTION: Neuromuscular recovery (NMR) is a critical part of recovery from general anesthesia. Neostigmine is a choline esterase inhibitor and one of the leading agents which are used for NMR from non-depolarizing neuromuscular block. Its effect depends on competitive antagonism of the neuromuscular blocking agent (NMBA) in the neuromuscular junction (NMJ). Sugammadex is a new agent which has attracted attention with dramatically rapid NMR from non-depolarizing neuromuscular blocking agents (NDNMBAs). It effects via chemically antagonizing NMBAs.
METHODS: Effects of neostigmine and sugammadex concerning recovery from general anesthesia for intracranial mass excision operations were compared. Totally 60 patients were included in the study. Neostigmine was used for 30 patients, and sugammadex was used for 30 patients. Evaluation criteria were the train of four (TOF), bispectral index (BIS), Glasgow Coma Scale (GCS), Modified Aldrete Score (MAS), Ramsey Sedation Score (RSS), vital signs and existed complications.
RESULTS: It is observed that NMR and recovery from anesthesia were significantly shorter in the sugammadex group (p<0,05). It is also seen that the duration of attaining BIS level to 80 was significantly shorter in the sugammadex group but this result is attributed to the artifact of the rapidly increasing neuromuscular activity in the sugammadex group.
DISCUSSION AND CONCLUSION: We suggest that both neostigmine and sugammadex are useful agents for NMR. Sugammadex has more advantages than neostigmine because of rapid onset of action without increased complications but much more studies are needed about sugammadex to take the place of neostigmine.

9.The Effect of N-acetylcysteine on Amylase, Electrolytes, Vitamins and Nitrosative Stress Levels in Rats Treated with Maras Powder
Velid Unsal, Ergul Belge Kurutas
doi: 10.5505/ejm.2020.26680  Pages 378 - 382
INTRODUCTION: The aim of this study is to investigate the effects of N-acetylcysteine (NAC) on amylase, electrolytes, vitamins and nitrosative stress levels in the plasma of rats treated with smokeless tobacco "maras powder".
METHODS: Control (n = 10), the group using maras powder (n = 10), maras powder+ NAC group. To the Maras powder group, 200 mg maras powder was placed in the sublingual area under general anesthesia. It was waited for 15 minutes for Maras powder to be absorbed through mucosa. This procedure was repeated once a day and for 7 days. To the NAC group, 200 mg of Maras powder was given as in the Maras powder group and NAC was injected intraperitoneally with a dose of 100 mg / kg / day. On the 8th day, all parameters in the plasma of all three groups were measured by ELISA method.
RESULTS: It was determined that amylase, 3-NTx, NO, electrolyte levels increased in the group using Maras powder compared to the control and NAC groups, but vitamin levels decreased. (p <0.05). It was detected that the levels of amylase, 3-NTx, NO, electrolyte in the group treated with NAC decreased compared to the group using Maras powder, whereas vitamin levels significantly increased and approached to the values of the control group.
DISCUSSION AND CONCLUSION: Smokeless tobacco 'Maras powder' increases nitrosative stress and distorts the levels of vitamin A, E, C and electrolyte in the plasma. NAC has a positive function in reducing the damage caused by Maras powder

10.Do Avanafil and Zaprinast Change Some Selected Cytokine Levels in Ovariectomized Rat's Liver?
Zübeyir Huyut, Nuri Bakan, Erdem Çokluk, Halil İbrahim Akbay, Hamit Hakan Alp, Mehmet Ramazan Şekeroğlu
doi: 10.5505/ejm.2020.57689  Pages 383 - 387
INTRODUCTION: Studies reported that phosphodiesterase-5 inhibitors (PDE-5Is) positively contributed to bone-mineral-density and thickness in rats with ovariectomy, which have the same condition with postmenapozal period. To explain the positive contribution mechanism on bone mineral density of PDE-5Is, we investigated the effect of zaprinast and avanafil on levels of some pro-or anti-resorptive cytokines in ovariectomized-rats.
METHODS: Albino female rats (8 months and 250-350 g) were used and four groups of equal-number were randomly assigned (n=6). Groups; was the sahm operated, positive control (OVX), Zaprinast and OVX, Avanafil and OVX groups, respectively. The levels of Estrogen, IL-1β, IL-6, IL-8, IL-10 and TNF-α were measured by ELISA kits, in liver of rats.
RESULTS: IL-1β, IL-6, IL-8 and TNF-α levels were high in groups with OVX compared to sham group, while IL-10 levels were low. Also, IL-1β, IL-6, IL-8 and TNF-α levels were low in zaprinast and especially avanafil-treated groups with OVX and were similar to the sahm group values (p=0.001 for IL-1β, p=0.045 for IL-6, p=0.008 for IL-8, p=0.006 for IL-10, p=0.026 for TNF-α).
DISCUSSION AND CONCLUSION: Zaprinast and especially avanafil inhibited IL-1β, 8 and TNF-α and increased the IL-10 levels compared to the OVX group. This may support opinion that PDE-5Is enhance bone mineralization by inhibiting proresorptive cytokines.

11.Evaluatıon Of Neutrophıl-To-Lymphocyte Ratıo And Mean Platelet Volume In Patıents With Hyperthyroıdısm
Murat Alay, Gülçin Miyase Sönmez, Saliha YILDIZ
doi: 10.5505/ejm.2020.79037  Pages 388 - 392
INTRODUCTION: Both Lymphocytes and platelets play an important role in the pathogenesis of Graves' disease, a chronic inflammatory autoimmune disease. The mean platelet volume (MPV), which is considered as an indirect indicator of platelet function, may be increased as an inflammatory marker in Graves' disease. In our study, we evaluated MPV and NLR (neutrophil-lymphocyte ratio) values before and after treatment in patients with Graves' disease and toxic nodular goiter. The aim of this study is to prove that the autoimmune, chronic inflammatory pathogenesis of Graves' disease can be demonstrated by evaluating the whole blood count parameters
METHODS: A total of 75 patients of which 41 were diagnosed as Graves' disease and 34 were diagnosed as toxic nodular goiter (toxic adenoma or toxic multinodular goiter) were included in the study. Complete blood count parameters were evaluated in both groups before treatment and after treatment when euthyroidism was achieved.
RESULTS: In Graves' disease (GD) group, pretreatment MPV values were significantly higher than toxic nodular goiter (TNG) group (p: 0.021). There was a statistically significant decrease in NLR in GD group compared to TNG group after treatment (p: 0,025). Although there was no statistically significant difference, lymphocyte count was higher in GD group compared to TNG group before treatment. The monocyte count was significantly higher in the GD group compared to the TNG group before treatment (p: 0.006). There was no correlation between MPV and free T3, free T4, TSH values before and after treatment in GD group.

DISCUSSION AND CONCLUSION: These results suggest that autoimmunity and inflammation in GD are reflected in whole blood count parameters and that MPV elevation in GD is related to autoimmunity rather than the metabolic effect of thyroid hormones

12.Evaluation of the effect of sound intensity on vital signs in neonatal intensive care unit
Murat Başaranoğlu, Serap Karaman, Bülent Sönmez, Oğuz Tuncer
doi: 10.5505/ejm.2020.14238  Pages 393 - 398
INTRODUCTION: Newborns, and especially prematures, suffer acute and chronic damage from noise during hospitalization. Therefore, it is important to monitor the noise levels of both the in-tub and out-of-tub environment. In this study we aimed to evaluate the effects of sound level measurement, noise sources and sound level on the vital signs of infants in Neonatal Intensive Care Unit.
METHODS: We measured the sound levels at three different time point and two different sites during the day to determine the sources of the noise using the Benetech Sound Level Meter GM1352. During each measurement, the number of people in two sections of the NICU, the number of devices working, and the vital signs of the patients were recorded.
RESULTS: The average noise level in the first region was 58.58±10.7 dB and the average noise level in the second region was 50.17±6,407 db. There was a significant decrease in SaO2 values, especially during periods when the volume was high (p<0.01). It was also determined that the number of breaths, pulse and sleeplessness levels increased during periods when the sound level rose above a certain level. As a source of noise the number of people working devices used and the presence of the nurse desk in the section were found.
DISCUSSION AND CONCLUSION: İt was determined that the recommended sound level in our unit was generally exceeded and that these levels had various adverse effects on infants. It is necessary to take measures to reduce the negative effects of noise on babies.

13.Percutaneous Nephrostomy: Is Ultrasound Alone Sufficient as Imaging Guidance?
Çağrı Damar, Mehmet Onay, Ali Burak Binboğa
doi: 10.5505/ejm.2020.22043  Pages 399 - 405
INTRODUCTION: Percutaneous nephrostomy (PN) is a frequently performed invasive procedure for the maintenance of renal function in cases of urinary obstruction. Transient hemorrhage is a common minor complication of this procedure. The aim of this study was to determine which of the selected methods was less traumatic in two groups of PN patients guided by two different radiological modalities.
METHODS: A total of 64 PN procedures performed in 2018, with an equal number of two different approaches to PN (ultrasound-guided PN, ultrasound and fluoroscopy-guided PN), were compared to determine which method was less traumatic. Urine samples were taken from the collecting system after needle insertion and after catheter placement, and the amount of blood in the urine samples was recorded to assess hematuria. In addition, the radiation exposure time, air kerma and kerma-area-product values were recorded and compared with data in the literature.
RESULTS: Although the average amounts of blood detected in the urine samples taken at two stages of two different methods differed, these differences were not statistically significant. There was a statistically significant positive correlation between the amount of the blood in the urine samples taken after the needle insertion and kidney parenchymal thickness (p=0.013).
DISCUSSION AND CONCLUSION: To protect patients and interventional radiologists from unnecessary radiation exposure, PN with US only guidance may be a good choice for selected cases, such as those with evident pelvicalyceal dilatation, pediatric patients and pregnant women.

14.Molecular Subtyping of Breast Cancer: Do We Define Them with B-mode US or ARFI Elastography?
Nurşen Toprak, Ali Mahir Gunduz
doi: 10.5505/ejm.2020.80378  Pages 406 - 414
INTRODUCTION: Imaging properties of breast cancer molecular subtypes differ and can be recognized by radiological methods. Acoustic radiation force (ARFI) can be associated with molecular subtypes and grade of breast cancer. The aim of this study was to determine the ultrasound and ARFI elastography correlates of different molecular subtypes of breast cancer.
METHODS: Seventy-two patients were included in the study. The lesions evaluated by B-mod ultrasound (US) and ARFI elastography methods, and US guided tru-cut biopsies were performed. Molecular subtypes were categorized as triple-negative breast cancer(TNBC), luminal A and B, or human epidermal growth factor receptor 2-enriched cancer at based on the immunohistochemical profiles. Clinicopathological features, B-mod US and elastographic features was analized with statistically.
RESULTS: Luminal cancers displayed more frequently an irregular shape, posterior shadowing, echogenic rim, and a hypoechoic or complex echo pattern than TNBC(p˂0.05). While the mean shear wave velocity (SWV) value increased as the lesion size increased, there was no significant difference between the molecular subtypes. In the evaluation of Virtual Touch(TM) Tissue Imaging (VTTI); small lesions showed more frequently pattern 4b, whereas large lesions showed pattern 3.
DISCUSSION AND CONCLUSION: Breast radiologist should be careful, to know that a mass that has a well-defined, posterior enhancement may also be malignant. According to accepted literature data; High SWV values and imaging patterns in VTTI are helpful in this regard to us.

15.TWIST1-overexpression induces glycolytic reprogramming and ATP production in 293T cells
Suray Pehlivanoğlu, Kadriye Aktaş Kont
doi: 10.5505/ejm.2020.63496  Pages 415 - 421
INTRODUCTION: Reprogramming of glucose metabolism in cancer cells triggers tumor development. Most cancer cells provide the energy needed from aerobic glycolysis called the "Warburg effect" to promote uncontrolled proliferation and invasion. Therefore, direct regulator molecules of aerobic glycolysis remain active research targets. Epithelial mesenchymal transition (EMT) is the main mechanism that promotes cancer invasion and poor prognosis. One of the key effector molecules of the EMT is TWIST1. In this study, we sought to investigate the role that TWIST1 has in driving glycolytic programming and cellular energy charges in 293T cells by overexpressing TWIST1 in 293T cells.
METHODS: Plasmid vectors were successfully transfected by lipofectamine 2000 and mRNA expressions of interested genes were assessed. Glucose, lactate and pH levels of culture supernatatnts were determined by radiometer analyzer. The cellular energy charge of the cells were calculated from ATP, ADP and AMP data analyzed by HPLC.
RESULTS: Here, we found that TWIST1 transcription factor, which has highly conserved sequences, is an important regulator for aerobic glycolysis. We found that TWIST1 increases the expression of glycolytic genes such as HK2, PKM2, LDHα, PFKM and G6PD, the production of lactate and extracellular acidification in 293T cells. We have also determined that TWIST1 promotes aerobic glycolysis metabolism by providing cellular energy exchange. TWIST1 overexpression reduced AMP/ATP and ADP/ATP ratios in 293T cells, with further increase seen in ATP production.
DISCUSSION AND CONCLUSION: By this work, we confirmed that TWIST1 is closely related to the glycolysis pathway and is an important regulator of the Warburg effect.

16.Is there a relationship between Helicobacter Pylori Eradication and Blood Group?
Sevki Konur, Neslihan Surmeli, Mehmet Ali Bilgili, Ramazan Dertli, Yusuf Kayar
doi: 10.5505/ejm.2020.05657  Pages 422 - 426
INTRODUCTION: Although there is an association between Helicobacter Pylori (HP) infection and blood group, the effect of blood groups on HP eradication is not yet known. Our aim in the study was to investigate the relationship between blood group and other risk factors with HP eradication after HP eradication therapy.
METHODS: 104 patients who underwent gastrointestinal system endoscopy and received gastric tissue biopsies were enrolled in the study at our hospital between June 2017-December 2018. Demographic and histopathological data of all patients were documented. HP eradication was performed by giving Amoxicillin and Clarithromycin and Pantoprazole treatment to all patients. Patients were divided into two groups according to HP eradication. The relationship between HP eradication rate and blood groups and risk factors was analyzed.
RESULTS: A total of 104 HP positivity was included in the study. The mean age of the patients was 47.7±14.6 years old. Fifty-two (50%) patients were women, the body mass index (BMI) was 27.6±4.7 (range: 17.7-42.1). The distrubition of blood groups were 49(47.1%) A, 13(12.5%) B, 9(8.7%) O, 33(31.7%) AB. HP eradication occurred in 70 (67.3%) patients after HP treatment. HP eradication rate was significantly higher in women, but there was no significant relation between HP eradication and age, BMI or blood groups.
DISCUSSION AND CONCLUSION: In conclusion, while there was a significant relationship between gender and HP eradication, no significant relationship was observed between ABO blood groups and HP eradication.

17.Comparison of the efficacy of letrozole and gonadotropin combination versus gonadotropin alone in intrauterine insemination cycles in patients with unexplained infertility
Süleyman Cemil Oğlak, Mehmet Nafi Sakar, Serhat Ege, Serap Mutlu Özçelik Otçu, Mehmet Obut, Bekir Kahveci, İsmail Yıldız
doi: 10.5505/ejm.2020.24993  Pages 427 - 433
INTRODUCTION: This study aimed to determine the outcomes of combined treatment of letrozole (LTZ) with recombinant follicle-stimulating hormone (rFSH) in comparison with rFSH alone in intrauterine insemination (IUI) cycles.
METHODS: This study consisted of 86 patients who experienced 106 IUI cycles. Patients were classified into two treatment groups: group I underwent a combination of LTZ plus rFSH, and group II received rFSH alone. Ovulation was triggered with human chorionic gonadotropin (hCG), and IUI performed 36 hours later. The number of follicles ≥18 mm, endometrial thickness, required dose of FSH, duration of ovulation induction (OI), clinical pregnancy rates, multiple pregnancy rates, spontaneous abortion rates, and live birth rates were evaluated.
RESULTS: The total required rFSH dose during the OI was significantly lower in the LTZ-rFSH combination group than the rFSH alone group (401.2±177.1 IU and 770.1±345.8 IU, respectively, p<0.001). The days of stimulation with rFSH were also lower in the LTZ co-treatment group than the rFSH-alone group (5.2±1.3 days and 10.1±3.0 days, respectively, p<0.001). Clinical pregnancy rate was 17.0% in LTZ-rFSH group, and 15.2% in rFSH group (p>0.05).
DISCUSSION AND CONCLUSION: The combined use of LTZ with rFSH resulted in a lower required dose of rFSH, a similar and acceptable endometrial thickness at the day of hCG administration, and comparable pregnancy rate compared with rFSH alone.

18.Assessment of Thyroid Nodules in Children: A Single Center Experience
Eda Çelebi Bitkin, Serap Karaman, Murat Başaranoğlu
doi: 10.5505/ejm.2020.22230  Pages 434 - 438
INTRODUCTION: Thyroid nodules in children are less common than adults, but with a higher risk of malignancy, metastasis and recurrence. Therefore, detection, follow-up and treatment of thyroid nodules in children is very important. Our study retrospectively analyzed the demographic features, concomitant diseases and ultrasonography (USG) findings of thyroid nodules in children and aimed to obtain information about incidence of malignancy.
METHODS: We retrospectively analyzed the clinical, laboratory, thyroid USG, Fine needle aspiration biopsy (FNAB) and surgical results of 45 pediatric patients with thyroid nodules.
RESULTS: Forty-five patients were included in the study, female domination was present, and most of the patients were adolescents. Six (13.3%) of the patients had a family history of thyroid cancer, and one had a history of radiation. Thyroid-related disease was present in 53.3% of the patients. Five patients had non-thyroid disease. Thyroid function tests were within normal limits in 33 (73.3%) of the patients. In our patients with pediatric thyroid nodules, FNAB was underwent in 46.6% according to the nodule size, and malignancy was detected in 2.2% of our patient group.
DISCUSSION AND CONCLUSION: Careful evaluation of thyroid nodules that are rarely seen in adults but higher in malignancy than adults should be evaluated. Diagnostic research for thyroid cancer is mostly done in adult patients, our study contributes to the assessment of risk conditions in thyroid nodules in children.

19.The effectiveness of emergency cervical cerclage: a retrospective observational study
Gürcan Türkyılmaz, Onur KARAASLAN
doi: 10.5505/ejm.2020.60430  Pages 439 - 443
INTRODUCTION: We purposed to determine the outcome of emergency cervical cerclage (ECC) in pregnancies who had cervical dilatation in clinical examination.
METHODS: We evaluated 20 women between 18-25 weeks and performed ECC with the McDonald technique. We collected data included: prolongation of pregnancy, gestational age at delivery, neonatal survival rate, and perioperative complications.
RESULTS: The mean gestational week of pregnancy was 21±1,6 at cerclage operation, and mean cervical dilatation was 2,5±1,1 mm. The mean prolongation of pregnancy and the mean gestational age at delivery were 47,3±37,1, and 27,8±5,3 were respectively. The mean birth weight was 1184±866 g. A perioperative complication occurred in 1 (5%) case. 15 of 20 (75%) neonates admitted to NICU and neonatal survival was 65%. Half of the cases delivered after 28 weeks of gestation, and there was no perinatal mortality in this group.
DISCUSSION AND CONCLUSION: ECC is a beneficial procedure to prolong pregnancy and to improve perinatal outcomes.

20.Isolated single umbilical artery: Implications for pregnancy
Mehmet Nafi Sakar, Süleyman Cemil Oğlak, SUREYYA SARIDAS DEMIR, Hüseyin Gültekin, Bulent Demir
doi: 10.5505/ejm.2020.13540  Pages 444 - 449
INTRODUCTION: This study aimed to evaluate whether the presence of an isolated single umbilical artery (iSUA) is associated with adverse perinatal outcomes.

METHODS: Material and Methods: Fifty-one patients with iSUA and 54 controls were enrolled in the case-control study. Demographic characteristics and perinatal outcomes were recorded.

RESULTS: All patients had normal umbilical artery (UMA) Doppler findings, and their detailed ultrasound weeks were between 18 and 23 weeks. The birth weights of the babies in the iSUA group were significantly lower than the control group (2898.82±434.56 g vs 3143.70±419.09 g, p=0.004). In the iSUA group, oligohydramnios (7.8% vs 0%), preterm premature rupture of membranes (PPROM) (3.9% vs 0%), preterm delivery (9.8% vs 3.7%), small for gestational age (SGA) (11.8% vs 3.7%) and neonatal intensive care unit (NICU) (2% vs 0%) admission rates were higher than control group, but there was no statistical significance (p>0.05). But the total adverse pregnancy outcomes were observed in 35.3% (18/51) of cases with iSUA is higher than controls 7.4% (4/54) ( p=0.001).
DISCUSSION AND CONCLUSION: In our study, iSUA is found to be associated with low newborn weight. In the iSUA group, oligohydramnios, PPROM, preterm delivery, SGA and NICU admission rates were high, but there was no statistical significance. But the total adverse pregnancy outcomes were higher in the iSUA group. These results indicate that close follow-up is essential to prevent and manage adverse perinatal outcomes in iSUA patients.

Muhammed Batur, TUNCAY ARTUÇ, Erbil Seven, Serek Tekin
doi: 10.5505/ejm.2020.59454  Pages 450 - 452
Accommodation spasm is a rare condition that presents with pseudomyopia usually in children and young adults. Most of the cases are associated with emotional conditions that causes functional spasm. Rarely, an underlying organic cause can be detected. Tetanus-diphtheria vaccine (Td) is a combined vaccine in toxoid form and performs to prevent infectious diseases caused by Clostiridium tetani and Corynebacterium diphtheriae, respectively. In this case report, we present the clinic features of a 13-year-old girl who applied with decreased vision after Td vaccination and diagnosed with isolated accommodation spasm.

22.Salmonella Ovarian Abscess in a Patient with Systemic Lupus Erytematosus Presented as Acute Abdomen: A Case Report and Review of the Literature
Ali Irfan Baran, Mahmut Sunnetcioglu, Umit Yakan, Abdussamet batur, Ergenekon Karagoz, Mustafa Kasim Karahocagil
doi: 10.5505/ejm.2020.27146  Pages 453 - 456
A Salmonella ovarian abscess is a rare entity, and is similarly uncommon in cases with Systemic Lupus Erythematosus. To the best of our knowledge, thirty four cases of Salmonella ovarian abscess have been published in the literature, and only four of them were related to Systemic Lupus Eritematosus. Our aim is to review this clinical entity using information from our own experience as well as that from published cases.

23.Bariatric Surgery as a Treatment for Obstructive Sleep Apnoea, Diabetes Mellitus, Hypertension and Asthma- A Case Report
Nurul Yaqeen Mohd Esa, Mohamed Faisal Abdul Hamid
doi: 10.5505/ejm.2020.47855  Pages 457 - 460
Weight loss by any method is a well-documented treatment for OSA. We report a case of an obese gentleman with poorly controlled asthma and found to have severe obstructive sleep apnea on the background of hypertension and type 2 diabetes. Bariatric surgery cured his OSA and improved the control of all of his other medical comorbidities.

24.The administration of low molecular weight heparin in severe case of covid-19, a case report
Ngakan Ketut Wira Suastika, Ketut Suega, Putu Utami Dewi
doi: 10.5505/ejm.2020.92063  Pages 461 - 464
Coagulopathy and disseminated intravascular coagulation (DIC) is one of the complications of the corona virus disease 2019 (Covid-19) that can lead to death. Several studies have shown that anticoagulants provide good clinical outcomes in Covid-19 patients, especially in severe cases. This case emphasizes the administration of low molecular weight heparin (LMWH) to prevent venous thromboembolism (VTE) in severe case of Covid-19.

25.Ovarian torsion during pregnancy: a case of malignant ovarian cancer
Latif Hacıoğlu, Erbil Karaman, Deniz Dirik, Onur Karaaslan, Ali Kolusarı, Hanım Güler Şahin, Abdulaziz Gül
doi: 10.5505/ejm.2020.13008  Pages 465 - 467
INTRODUCTION: Ovarian torsion is an acute and emergency condition during pregnancy. It is caused mainly by the benign cystic mass in the ovary. However, ovarian cancer may be seen as a cause which is very rare during pregnancy. Here, we aim to present a case of pregnant women with ovarian torsion and diagnosed with malignant ovarian tumor.
METHODS: A 40 years old 25th week pregnant woman applied to our hospital with a sudden onset of abdominal pain. In the USG examination, a 20X18 cm multilobulated thick septal papillary cyst in the right adnexal area was observed. 10cm free liquid was observed in the abdomen. Since the patient had acute abdominal pain, an operation decision was taken. In the operation, approximately 2 liters of sero-mucinous fluid was observed in the abdomen, and a 20 cm cyst was observed in the right ovary. Right oophorectomy was performed.
RESULTS: The patient was diagnosed with grade 2 moderately differentiated mucinous carcinoma as a result of pathology. She didn't accept the postoperative chemotherapy until the delivery. Delivery was made by cesarean at week 37. Followed by a hysterectomy, unilateral oophorectomy and pelvic-paraaortic lymph node dissection, and apendectomy with omentectomy. The patient had no complications after the operation, was discharged.
DISCUSSION AND CONCLUSION: Although the incidence of ovarian cancer development during pregnancy is low, it should be kept in mind. Ovarian cancer may appear as ovarian torsion during pregnancy. Pregnancies complicated by ovarian cancer should be considered as a high-risk pregnancy and should be approached multidisciplinary

26.The rationale for current pharmacotherapy of COVID-19
Oruç Yunusoğlu, Hoshyar Saadi Ali
doi: 10.5505/ejm.2020.29053  Pages 468 - 476
Severe acute respiratory syndrome (SARS-CoV), Middle East respiratory syndrome (MERS) and SARS-CoV-2 are related to the coronaviridae family. The worldwide pandemic of the new coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan province of China, in December 2019, and spread rapidly throughout the world. More than 6 million cases and 370,000 deaths had been reported by 31 May 2020 in more than 200 countries. No data are available from any clinical trials supporting a proposed prophylactic therapy. More than 300 active clinical trials are currently underway. Many drugs have been studied against COVID-19, but there is no actual evidence from any randomized clinical trials with a potential therapy that can improve outcomes of a patient diagnosed with COVID-19. In some cases, many of the investigated drugs cause side effects, e.g. chloroquine, ribavirin. Besides its beneficial effects such as reducing disease progression and decreasing symptom duration, chloroquine can cause cardiac side effects. Ribavirin, on the other hand, is recognized as a teratogen and considered unsafe in pregnancy. No special effective antiviral therapy against COVID-19 is currently available. Although the course of the disease is mild and moderate in the majority of the COVID-19 patients, more than 5%-7% of the patients' life being under severely susceptible threats requires more effective medicinal products, urgently.

27.Psychological effects of abortion. An updated narrative review
Kornelia Zareba, Valentina Lucia La Rosa, Michal Ciebiera, Marta MAKARA-STUDZI&323;SKA, Elena Commodari, Jacek Gierus
doi: 10.5505/ejm.2020.82246  Pages 477 - 483
The results of studies on the psychological consequences experienced by women after termination are inconclusive. Some of the studies do not confirm an increased prevalence of psychological complications. However, the experience of abortion can lead to the development of post-traumatic stress disorder, depression and problems with interpersonal relations. The main factors which influence psychological effects include the reason for abortion, the type of medical procedure, the term of pregnancy as well as personal, social, economic, religious and cultural factors that shape the woman's attitude towards abortion. Often women while terminating pregnancy are not aware that they will require psychological support later due to subsequent psychological effects they experience. Usually, the first symptoms appear within four months up to a year from the procedure. Therefore, it is important to identify the high-risk women susceptible to subsequent psychological complications.

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