ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 21 (1)
Volume: 21  Issue: 1 - 2016
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1.Investigation of the risk factors of pressure ulcers in intensive care unit patients: According to the Braden Scale
Pakize Özyürek, Meryem Yavuz, Özlem Yıldız
doi: 10.5505/ejm.2016.21939  Pages 1 - 9
The study was planned as a descriptive study investigating the frequency of pressure ulcers in intensive care units and the correlation between pressure ulcers and Braden risk factor scores. A total of 414 patients who were admitted to the stated intensive care units between October 1, 2008 and January 4, 2010 were evaluated. Among those, 323 patients met the inclusion criteria and were included in the study. The Braden Risk Assessment Scale was used for risk evaluation. The incidence of pressure ulcers in the intensive care units was 17.0% (n=55). According to the Braden Risk Assessment Scale, only 12.3% (n=40) of the patients had no risk of pressure ulcer development. The incidence of pressure ulcer development in the internal medicine intensive care unit was significantly higher than that of surgical medicine intensive care unit (p=0.00). Anemic patients with a long duration of hospital stay, low level of albumin, and who were hospitalized in the internal medicine intensive care unit were determined to be statistically significantly at “very high risk” of pressure ulcer development (p<0.05). A statistically significant correlation was observed between the risk levels of the patients and pressure ulcer development (p=0.04). According to the results of this study, the duration of hospital stay, immobility, obesity, unconsciousness, friction, and rupture parameters are risk factors that lead to the development of pressure ulcers.

2.Impact of combined hormonal therapy on coagulation inhibitory proteins
Eliana Ibrahimi, Mynyr Koni
doi: 10.5505/ejm.2016.52388  Pages 10 - 13
The objective of this study was to determine the effect of two combined oral contraceptives on two inhibitory coagulation proteins. The study included 56 women between ages 20 and 55, twenty six of them taking 30µg ethinyloestradiol (EE) and 75µg gestodene (GSD) and thirty of them taking 30 µg ethinyloestradiol and 75 µg levonogestrel (LNG) for two months. The subjects were healthy and they had not taken any other drug two months before starting the hormonal therapy. Plasma was used for measuring protein C and antithrombin III (AT III), before using the pill and after stopping it. Comparison of the values of protein C and AT III between two periods (before and after treatment) showed the following results: Concentrations of protein C was significantly increased while AT III level was decreased after treatment with 30 µg EE/ 75 µg GSD (p=0.001). Treatment with 30 µg EE/ 75 µg LNG showed no significant change in the level of AT III (p=0.058) and significantly increased protein C concentration (p=0.001). We conclude that treatment with 30 µg EE/ 75 µg GSD induces more changes in the inhibitory coagulation proteins than treatment with 30 µg EE/ 75 µg LNG, indicating an increased risk for thrombotic diseases.

3.Intramedullary nailing of femural shaft fracture
Mehmet Ata Gökalp, Seyyid Şerif Ünsal, Abdurrahim Gözen, Necip Güven, Savaş Güner
doi: 10.5505/ejm.2016.71135  Pages 14 - 20
In this study, we examined adult patients with femur shaft fracture who treated with open-closed reduction and reamerized intramedullary nailing. Thus we aimed to evaluate clinical and radiological results of the adult patients and compare them with the studies in the literature. 42 extremities of 40 patients (35 male-5 female) who admitted to Yüzüncü Yıl University Faculty of Medicine, Department of Orthopeady and Traumatology with femur shaft fracture and were treated with locked intramedullary nail between 2009 and 2012 are included in this study. We aimed to evaluate early results of locked intramedullary nailing. In light of these evaluations we saw that our results were compatible with the literature. We believe that locked intramedullary nailing is one of the most successful methods in the treatment of femur shaft fractures.

4.Maternal and fetal characteristics of premature deliveries in Western
Sarah Ourrad, Noria Harir, Feriel Sellam, Soumia Zeggai
doi: 10.5505/ejm.2016.43410  Pages 21 - 25
We performed a retrospective descriptive analytical study over all preterm birth babies along the period of 2011-2012 at the level of neonatology department of Sidi Bel Abbes city (Western Algeria). Primigravida (OR=7, 95% CI: 3, 16), primiparous (OR=6.23, 95% CI: 1.5, 9.5) and mother’s age < 25 years (OR=5.8, 95% CI: 1.5, 8.9) were the major risk factors of premature delivery. Abortion also raised the odds (OR=2.1, 95% CI: 1.2, 2.56). Twin delivery and intra uterine growth were also marginally significantly associated with premature delivery (OR=2.15; OR= respectively). Preterm babies suffered mainly from icterus and asphyxia. Prematurity is still considered as a major public health in developing countries and its causes in our studied area were multifactorial.

5.Risk factors of acute cellulitis in adult patients: A case-control study
Mohammad Nassaji, Raheb Ghorbani, Sanaz Ghashghaee
doi: 10.5505/ejm.2016.95605  Pages 26 - 30
Cellulitis is a common medical condition with different severity varies from mild to life threatening disease. The identification of preventable risk factors could reduce morbidity and mortality from this disease and improve patient management. The aim of this study was to identify the risk factors associated with cellulitis in adult patients. We conducted a case-control study of 102 adult subjects with cellulitis and the same number of controls who were admitted to two university affiliated hospitals. Data were obtained with a questionnaire and from examination of patients. Two groups were matched based on age (p=0.717) and gender (p=0.661). The most common site of cellulitis was lower extremities (56.9%). The pack-year smoking and duration of smoking was significantly higher in patients with cellulitis (p=0<001). Logistic regression analysis showed that recent trauma (OR=55.8, 95% CI: 11.2-278.4, p<0.001), history of recent surgery (OR=6.3, 95% CI: 1.7-23.7, p=0.006), body mass index(OR=1.38, 95% CI: 1.22-1.57, p<0.001) and diabetes mellitus(OR=3.02, 95% CI: 1.17-7.81, p=0.022) was significantly associated with development of cellulitis. No association was observed between corticosteroid use and risk of cellulitis (p=0.158). Our study showed that the most important risk factors for cellulitis in adult include trauma, recent surgery, high body mass index, diabetes mellitus and smoking. Therefore, it is recommended that protection against trauma, controlling of blood glucose levels, reducing body weight and smoking cessation may lead to reducing incidence of cellulitis.

6.The Urinary System Infections caused by Extended-Spectrum-β-Lactamase-producing Escherichia coli and Klebsiella pneumoniae Strains
Kerem Taken, Mehmet Parlak, Mustafa Güneş, Müslüm Ergün, Recep Eryılmaz, Murat Demir, İlhan Geçit
doi: 10.5505/ejm.2016.87597  Pages 31 - 35
INTRODUCTION: Production of β-Lactamase enzymes is an important mechanism of resistance in Gram-negative bacteria. The aim of this study was to investigate the relationship between the Extended-Spectrum β-Lactamase (ESBL)-positive Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) strains isolated from the urine cultures and the underlying diseases and also to assess the antibiotic resistance.
METHODS: The bacteria were identified according to conventional methods including colony morphology, gram stains, oxidase test and biochemical tests (indole production, Triple Sugar Iron (TSI) agar, Simmon’s Citrate agar, Christensen’s Urea agar, and motility test medium). BD Phoenix automated system (Becton Dickinson, USA) was used for further identification of the bacteria that were identified as E. coli and K. pneumoniae and for assessing the resistance rates and ESBL production.
RESULTS: A total of 401 E. coli and 58 K. pneumoniae strains were isolated from the urinary specimens. Of these, 159 (39.6%) of E. coli and 26 (44.8%) of K. pneumoniae strains were ESBL-positive. The most active antibiotics against ESBL-positive E. coli and K. pneumoniae strains were carbapenems. Underlying diseases were detected in a total of 148 ESBL-positive strains (80%), including 127 (79.8%) of E. coli and 21 (80.8%) of K. pneumoniae strains. Common underlying diseases were benign prostate hyperplasia (BPH), urolithiasis, neurogenic bladder, urethral stricture, vesicoureteral reflux (VUR), hypospadias, ureteropelvic junction (UPJ) obstruction, vesicointestinal fistula, and cystocele (p<0.05).
DISCUSSION AND CONCLUSION: In the treatment of urinary system infections, ESBL-positive E. coli and K. pneumoniae strains should be kept in mind and the underlying diseases should be studied and treated.

7.A rare cause of jaundice in a case: Hydatid cyst infestation
Kaan Demirören, Kemal Ağengin, Veli Avcı, Salim Bilici
doi: 10.5505/ejm.2016.40316  Pages 36 - 38
Although the most common cause of obstructive jaundice is viral infections, there are some rare disorders which can cause this picture. We present a 15-year-old girl, admitted with an obstructive jaundice. Her laboratory tests including viral infections were normal. The diagnosis of hydatid cyst was performed with both ultrasonography and indirect hemagglutination assay. The patient was operated on and hydatid cyst was seen to be ruptured into the choledochus. In conclusion, nonviral causes of hepatitis are less common, but must be considered in the differential diagnosis. An important complication of hydatid disease is rupture to biliary tree. This situation may cause obstructive jaundice.

8.A case of idiopathic pulmonary fibrosis treated with clarithromycin
Masashi Ohe, Satoshi Hashino
doi: 10.5505/ejm.2016.25820  Pages 39 - 41
We report a case of idiopathic pulmonary fibrosis (IPF) treated successfully using clarithromycin (CAM). A 64-year-old male patient suffering from IPF which had been diagnosed at 59 years old, presented with slowly progressive dyspnea. Until this time, his condition had been almost stable. He was diagnosed with exacerbation of IPF, based on exacerbation of lung ausculation, O2 saturation by pulse oxymetry, Krebs von den Lungen 6 levels and chest computed tomography findings of reticular opacities. He was successfully treated using CAM in expectation of its anti-inflammatory effects. This case shows that treatment using CAM may be effective in some cases of IPF.

9.Successful treatment with clarithromycin for a patient with rheumatoid arthritis
Masashi Ohe, Toshiyuki Bohgaki
doi: 10.5505/ejm.2016.81231  Pages 42 - 44
Macrolide antibiotics provide not only anti-bacterial activity but also anti-inflammatory effects. We report herein a case of rheumatoid arthritis (RA) successfully treated using clarithromycin (CAM), a macrolide, in expectation of its anti-inflammatory effects. A 77-year-old woman suffering from RA, presented with exacerbation of arthralgia and articular swellings. Because she was suffering from non-tuberculous mycobacterium and could not receive biological agents, CAM was successfully added to prednisolone and a nonsteroidal anti-inflammatory drug which had been administered before exacerbation. The present case suggests that CAM treatment may be effective for RA.

10.Pulmonary langerhans cell histiocytosis: Two cases with varied radiologic findings
Hulya Gunbatar, Alpaslan Yavuz, Bunyamin Sertogullarindan, Selami Ekin, Selvi Asker, Fuat Sayır, Irfan Bayram
doi: 10.5505/ejm.2016.83616  Pages 45 - 49
Pulmonary Langerhans Cell Histiocytosis (PLCH) is an idiopathic interstitial lung disease with Langerhans cell infiltration in the lung. PLCH X has non-spesific symptoms, and most patients have smoking history. A combination of stellate nodules, reticular and nodular opacities, upper zone cysts or honeycombing, preservation of lung volume and costophrenic angle sparing are highly specific for PLCH. To contribute to the literature, two cases are presented. First case is 30 years old man with 10 pack/years smoking history was admitted with cough and persevering interstitial opacities. Second case is 34 years old man with 15 pack/years smoking history was admitted with persistant cough. On thorax CT the first case had reticulonodular opacities at the perifery of the upper and middle zones, second case had multiple parenchymal cystic nodular lesions. Open lung biopsy performed, immunohistochemical examination CD1a, CD68, S100 detecting antigen-positive and histologically and radiologically confirmed diagnosed of PLCH.

11.A rare reason/cause of esophageal obstruction: Steakhouse syndrome
Öztekin Çıkman, Şükrü Taş, Hasan Ali Kiraz, Ömer Faruk Özkan, Gürhan Adam, Muammer Karaayvaz
doi: 10.5505/ejm.2016.81335  Pages 50 - 51
Steakhouse syndrome is an esophageal acute obstruction, due to improperly chewed meat. In most cases the etiology cannot be exactly shown, it is seen more frequently in patients with motility disorders in the lower esophageal sphincter and in alcoholics. Medical history and endoscopic examination are the first to be done for diagnosis. The endoscopic removal of foreign body after the diagnosis of obstruction is the most effective treatment method.

12.Anesthesia management of Jansen’s metaphyseal dysplasia
Ugur Goktas, Murat Tekin, Ismail Kati
doi: 10.5505/ejm.2016.55634  Pages 52 - 53
Metaphyseal chondrodysplasia is a rare autosomal dominant disorder characterized by accumulation of cartilage in specifically metaphysis of tubular bones. Hyperkalemia and hypophosphatemia were seen most of these patients. In this article we intended to draw attention to some issues releated with anesthesia hereby that a 9 year-old patient with Jansen’s metaphyseal dysplasia.

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