ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 18 (4)
Volume: 18  Issue: 4 - 2013
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1.HIV/AIDS stigma-reduction on VCT uptake: An adapted systematic review
Prem Misir
Pages 150 - 164
Both qualitative and quantitative studies have shown that stigma and discrimination impact people's decisions to access voluntary counseling and testing, (VCT) and treatment services. This systematic review attempts to answer the research question: What is the impact of HIV/AIDS-related stigma reduction interventions on VCT uptake in the developing world? This study used a systematic review. Data was collected from five major databases during 2000 – 2011, and four studies which involved 6.651 participants. The studies were assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool which addressed selection bias, study design, confounders, blinding, data collection, and withdrawals and drop-outs. One study had a 'Strong' Global rating; one had a 'Weak' Global rating. Two had a 'Moderate' Global rating. Other results revealed that lack of stigma, HIV-related knowledge, and self-efficacy were positively related to HIV testing. Also, stigma was found to be a significant barrier to HIV testing and disclosure. In addition, reduced stigma had significant correlations to VCT use, knowing where to get tested, and willingness to disclose test results. Very importantly, positive correlations were found between exposure to a radio serial drama program (intervention) and reduced stigma as well as greater intention to obtain HIV testing. It would appear that revising the existing knowledge about the effectiveness of stigma interventions in reducing stigma is critical to appreciate the effects of reducing HIV/AIDS stigma on VCT uptake in the developing world. More exploratory studies, similar to the study which had a ‘Strong’ Global rating, should be conducted.

2.Obstructive sleep apnea syndrome and blood flow to the eyes
Selvi Asker, Ozgur Bulent Timucin, Ahmet Ursavas, Mehmet Emin Aslanci, Mehmet Baykara, Haluk Erturk, Muntecep Asker, Sami Yilmaz, Derya Tuzun Kaya
Pages 165 - 171
To evaluate the pulsatile ocular blood flow (POBF) in patients with obstructive sleep apnea syndrome (OSAS). Forty-one newly diagnosed OSAS patients without comorbidities and 17 healthy control subjects were included to the study. Subjects were classified into groups of control, mild- moderate OSAS and severe OSAS, based on apnea–hypopnea index (AHI) values as control [AHI=<5 h(-1)), mild-moderate [AHI= 5-30 h(-1)], and severe [AHI >30 h(-1)]. For each eye, the Ocular Blood Flow Analyzer was used to obtain measurements of POBF. This study included 41 patients (10 female, 31 male) and 17 controls (6 female, 11 male). Cases and controls were comparable in body mass index, sex, and age. No statistical difference was found between the groups of patients with OSAS and healthy control subjects in age, BMI, sex, ocular axial length, IOP and mean blood pressure. There was no significant difference between control and OSAS patients in terms of POBF (T-test; p>0.05). There was no significant difference between groups in terms of POBF (one way ANOVA; p=0.3). In severe OSAS group, no statistically significant correlation was found between AHI and POBF(r= 0.09, p=0.5). These data show that the OSAS patients exhibit no significant difference in POBF compared to control group.

3.Higher TSH levels in the first trimester of pregnancy are related to lower birth weight
Nilgün Güdücü, Gökçenur Gönenç, Herman İşçi, Alin Başgül Yiğiter, İlkkan Dünder
Pages 172 - 175
To determine whether there was an association between birth weight and maternal thyroid function in the early first trimester. Early first trimester thyroid stimulating hormon (TSH) levels and birth weight percentiles of pregnants attending to our outpatient obstetrics clinic were searched retrospectively. Mothers of infants with small for gestational age (SGA) infants had statistically significantly higher mean TSH values when compared to mothers of infants with appropriate for gestational age (AGA) and large for gestational age (LGA) infants (2.5±8 and 1.7±1.5 respectively, p=0.007). Also, mothers of infants under 2500g weight had higher TSH values in the first trimester when compared to mothers of infants over 2500g weight (2±0.8 and 1.8±1.6 respectively, p=0.045). There was an association between high TSH levels in the early first trimester and low birth weight, screening of thyroid functions and treatment before pregnancy might be considered as a better policy.

4.Serum IL-6 and CRP levels in patients with trauma involving low-extremity bone fractures
Cengiz Karakaya, Tevfik Noyan, Suat Ekin, Elnur Babayev
Pages 176 - 180
Cytokines and acute phase proteins have been implicated in the systemic response to trauma. The aim of this study was to measure the IL-6, CRP, ALP, calcium and phosphorus levels in patients with trauma involving low-extremity bone fractures at 6, 24 and 48 hours following trauma. Serum samples were obtained from 21 trauma patients with femoral or tibial fractures at 6th, 24th and 48th hour following trauma. Serum IL-6, CRP, ALP, calcium and phosphorus levels were measured in these samples. Serum levels of IL-6, CRP and ALP at 24th hour were found to be significantly elevated in comparison to their levels at 6th hour (p=0.01, p<0.01 and p<0.05, respectively). Moreover, the levels of CRP and ALP were found to be significantly elevated at 48th hour compared to their levels at 6th hour (p<0.01). However, serum IL-6 levels at 48th hour were found to be lower than the levels at 6th hour (p<0.01). There was not a significant correlation between CRP and IL-6 levels at different time points. Serum calcium and phosphorus levels did not change significantly. We have demonstrated that IL-6 reached its peak level in 24 hours after trauma and its level in the 48th hour decreased below that of 6th hour. CRP, as an acute phase reactant, increased for the first 24 hours and stayed elevated for the next 24 hours. Further studies should be conducted to demonstrate the correlation between the extent of injury and IL-6 and CRP levels.

5.Descriptive epidemiology of Non-Hodgkin’s lymphomas in Hatay
Tümay Özgür, Mehmet Yaldız, Hasan Kaya, Erhan Yengil, Serhat Toprak
Pages 181 - 184
The incidence of Non-Hodgkin’s Lymphomas (NHL) varies among different parts of the world. NHL are the 12th most common cancer in Europe and increasing dramatically during the last years. In this study, it was aimed to analyse the descriptive epidemiology of NHL in Hatay region with retrospective archieve datas. One hundred and thirty-three NHL cases between 2005 and 2013 have been reviewed retrospectively in the Pathology Department of the Mustafa Kemal University. All of the cases were classified according to World Health Organization modified in 2008. Eighty-two (61.7%) cases were male and 51 (38.3%) cases were female. Ninety-two of the cases (69.2%) were nodal lymphoma, and the remaining 41 (30.8%) were extranodal lymphoma. The most common extranodal involvement regions were tonsils and nasopharynx with frequencies of 21.9% (9) and 19.5% (8), respectively. The age distribution pattern revealed that NHL were mostly diagnosed in the ages of 41-65 years in nodal (41.3%) and extranodal sited NHL groups (53.6%). The most frequent NHL was diffuse large cell B cell lymphoma (50.4%) and chronic lymphocytic leukemia/small lymphocytic lymphoma (17.3%). Our results were similar with the literature. Further epidemiologic studies with larger series defining the profile of NHL subtypes may be more worthy.

6.Diffusion-weighted MRI in the diagnosis of intracranial hematomas
Davut Şanlı, Özkan Ünal, Aydın Bora, Mehmet Beyazal, Alpaslan Yavuz, Serhat Avcu
Pages 185 - 194
To determinate the diagnostic value of diffusion-weighted MR imaging (DWI) in intracerebral hematomas, epidural hematomas, subdural hematomas, and subarachnoid hemorrhage, and to assess the contribution of diffusion signal characteristics in the differentiation of hematoma stages. In this prospective study, consecutive 67 patients (range: 3-89 years), 35 (18 men 17 women) with intracerebral hematoma, 18 (10 men 8 women) with subdural hematoma, 2 (1 man 1 woman) with epidural hematoma, and 12 (5 men 7 women) with subarachnoid hemorrhage on conventional MRI sequences constituted the case group and were evaluated with DWI. Intracerebral, subdural and epidural hematomas detected on conventional MR sequences were also shown on DWI. But none of the cases with subarachnoid hemorrhage was demonstrated on DWI. All intracranial hematomas detected on DWI except from chronic stage subdural hematomas showed similar signal intensity characteristics on DWI and T2WI, but were hypointense on ADC maps. All intracerebral, subdural and epidural hematomas seen on conventional MR sequences could be detected by DWI. On the contrary, DWI was not an effective imaging method for detecting subarachnoid hemorrhages. Using DWI alone for detecting the stages of hemorrhages can provide only additional information in subdural and intracerebral hematomas, and it is unable to give definite results, and the lesions should be evaluated by the correlation with other conventional MRI sequences.

7.Recurrent intrauterine pregnancy due to tubal recanalization after tubal sterilization by pomeroy technique
Cihangir Mutlu Ercan, Mehmet Sakıncı, Seyit Temel Ceyhan, Hakan Coksuer, Ugur Keskin, Kazım Emre Karasahin, Iskender Baser
Pages 195 - 197
Tubal sterilization is a widely used permanent contraceptive method for women who had completed their desired childbearing. If a pregnancy occurs after tubal sterilization, it is expected to be ectopic in most of the cases. However encountering an intrauterine pregnancy after Pomeroy tubal sterilization is extremely rare. A second time intrauterine pregnancy occured in a 34-year-old woman who had undergone tubal sterilization by Pomeroy technique in her last caesarean section. We are pointing out the failure risk of tubal sterilization with its possible mechanisms which might result in a viable intrauterine pregnancy.

8.Subcutaneous dermatofibrosarcoma protuberans in parotid region: Case report
Mehmet Fatih Garça, Mustafa Kösem, Mahfuz Turan, Nazım Bozan, Hakan Çankaya
Pages 198 - 201
Dermatofibrosarcoma protuberans (DFSP) is a low-grade soft tissue sarcoma (fibrosarcoma) originated from dermal and subdermal layer of the skin. But subcutaneous localization is quite rare. It is one of the rare tumors and accounts for 0.1% of all malignancies. The tumor infiltrates into the deeps in the villous and finger shape. For this reason, it is quite difficult to get surgical margins in the tumor excision and the recurrence is a problem encountered frequently. An excision or Mohs technique of micrographic surgery is suggested by leaving a surgical space up to 5 cm from the tumor margines. In this case report, a case with DFSP atypically subcutaneous localized on superficial parotis gland was presented. It should be kept in mind that probability of the microscopic spread is high in these patients and they should be followed by reminding that the disease can recur in the following long years.

9.Brucella endocarditis caused by brucella melitensis
Serkan Akdag, Aytac Akyol, Hakki Simsek, Musa Şahin, Mehmet Yaman
Pages 202 - 203
We present a rare case of brucella endocarditis, forming a vegetation on the mitral valve. The definitive diagnosis has been made with clinical suspicion, positive serology, the demonstration of the vegetation with the echocardiography and with the production from the multiple blood culture of brucella melitensis and from the excised valve. Our patient has been successfully treated with specific antibiotherapy and the surgery of replacement of mitral valve. Our aim in presenting the case is to remind the infective endocarditis which is due to this factor in the regions like our country which is endemic for brucellosis

10.Misplacement of nasogastric tube in two different cases: Case report
Onur Palabiyik, Ugur Goktas, Yasemin Isik, Ismail Kati, Dilara Sozen, Serhat Avcu
Pages 204 - 206
Although the insertion of nasogastric tube has been described as an easy and simple procedure, it may cause severe complications and death. It is therefore important to verify correct nasogastric tube placement. Placement of a nasogastric tube is confirmed using several methods, including auscultation over the epigastric area, aspiration of gastric content from the tube, measuring pH of gastric content and radiological methods. We present the inadvertent insertion of nasogastric tube into the airways, that resulted in respiratory distress, in two different patients to serve as a reminder that malpositioning may cause severe complications.

11.Fat containing bilateral synchronous Wilms’ tumor: Imaging findings
Abdussamet Batur, Ulku Kerimoglu
Pages 207 - 209
The Wilms’ tumor (WT), an embryonic neoplasm deemed to arise from metanephric blastema, is the most common renal tumor of childhood. Bilaterality is reported to occur in approximately 5% of such cases. Although the sources in the radiologic literature state that when CT shows definite fat within a renal mass, angiomyolipoma can be established as the diagnosis and fat tissue can be seen in 7% of the WTs, as well. In this case report, we denote radiological features of a synchronous bilateral WT containing fatty tissue.

12.US and CT findings of Hibernoma in an unusual location
Alpaslan Yavuz, Aydın Bora, Mehmet Beyazal, Cemil Göya
Pages 210 - 213
Hibernomas are asymptomatic, slow-growing tumors occurring in the anatomical sites where of brown fatty tissue was found in fetal life such as inter-scapular region or thigh. Retroperitoneal localization is an unusual site for this tumor and only few cases have been published in the literature. These tumors are benign in nature without any recurrence after total excision or evidence of metastasis. The purpose of this presentation is to demonstrate the US and CT findings of retroperitoneal hibernoma with the review of the literature.

13.Recurrent left atrial myxoma: A case report
Berkay Ekici, Aslı Tanındı, Musa Şahin, Ziya Apaydın, Hasan Fehmi Töre
Pages 214 - 216
Cardiac myxomas are the most common primary cardiac tumors. A 69-year-old female patient with a history of operated left atrial myxoma 3 years ago readmitted to the hospital for evaluation of progressive dyspnea and atypical chest pain. The echocardiographic study revealed a new tumorous mass at the same localization. The tumor was resected with the underlying heart tissue by transseptal approach. Histologic analysis confirmed a recurrent myxoma. Postoperative echocardiographic examination revealed no abnormalities. We present this case because of its recurrence and accompany with idiopathic thrombocytopenic purpura.

14.A rare complication of prolonged bisphosphonate treatment: The osteonecrosis of jaw in a patient with metastatic prostate cancer
Mehmet Bilgehan Yuksel, Bilal Gumus, Serkan Borazan, Talha Muezzinoglu
Pages 217 - 220
Bisphosphonates are frequently used for the treatment of bone metastases. We described a 71 years old male with the previous diagnosis of bone metastatic prostate cancer and who underwent hormonotherapy combined with zolendronic acid treatment during 7.5 years and presented the complaints of severe jaw pain and inability of chewing. It was determined that the findings of increased PSA with osteonecrotic area on jaw at radiological imaging. He was urgently diagnosed with the diagnosis of osteonecrosis of jaw related to the long-term zolendronic acid treatment. Bisphosphonate treatment was stopped, and he was treated with conservative treatment, and the disorder was improved by this management. This unclear disorder is required more detailed studies on the terms of ethiology, treatment style, follow-up at the treatment period, and management of complications with the aim of applying these agents more safely.

15.Adult-onset atypical form of Hallervorden-Spatz disease
Aysel Milanlıoğlu, Mehmet Nuri Aydın, Alper Gökgül, Mehmet Hamamcı, Temel Tombul
Pages 221 - 223
Hallervorden-Spatz syndrome is a rare neurodegenerative disease, resulting from mutation in the Pantothenate kinase-2 gene, and characterized by progressive pyramidal and extrapyramidal dysfunction, dementia, retinal degeneration and optic nerve atrophy. Clinical symptoms are related to abnormal iron deposition in the globus pallidus and substantia nigra. We present a case report of a 50-year old woman that was diagnosed as atypical Hallervorden-Spatz disease with dominant extrapyramidal symptoms and the lack of typical eye-of-the-tiger sign in brain MRI.

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