ISSN 1301 - 0883 / E-ISSN 1309 - 3886
 
 








  Eastern J Med: 22 (2)
Volume: 22  Issue: 2 - 2017
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ORIGINAL ARTICLE
1.Mean Platelet Volume: A Simple Tool For Early Risk Stratification Of Pulmonary Embolism
Aysegul Senturk, Asiye Kanbay, Serpil Erdogan, Hatice Kilic, Tuba Ogut, Habibe Hezer, Hatice Canan Hasanoglu
doi: 10.5505/ejm.2017.43534  Pages 34 - 38
INTRODUCTION: Pulmonary embolism (PE) is still major health problem associated with a significant mortality and morbidity. Rapidly recognition of massive and submassive cases should be easy and available in order to commencement appropriate therapy. The aim of this study is to assess the relationship between mean platelet volume (MPV) and PE severity.
METHODS: Three hundred twenty five patients with proven PE (massive=113, submassive =129, and non-massive=83 patients) groups were retrospectively evaluated.
RESULTS: The MPV value of patients with PE group was significantly higher compared to healthy subjects 9.8 ± 1.7 fl vs. 9.1 ±0.8 fl, P < 0.001). There were significant differences in regards to MPV levels between the patients with massive, sub-massive, and non-massive PE [10 (6.9-17.2) vs. 9.8 (6.6- 19.5) vs. 9.2(5.8- 13.2) fl, respectively p = 0.004].
DISCUSSION AND CONCLUSION: MPV is significantly higher in subjects with newly diagnosed PE patients and also MPV is strongly associated with the severity of PE.

2.The Outcomes of Open Reduction by the Medial Approach for Developmental Dysplasia of the Hip in the 3-18 Months Old Patients
Tülin Türközü, Savaş Güner, Mehmet Fethi Ceylan, Necip Güven
doi: 10.5505/ejm.2017.66376  Pages 39 - 44
INTRODUCTION: This study has aimed to evaluate the outcomes of open reduction technique by the medial approach performed in the 3-18 months old infants.

METHODS: The patients who were undergone open reduction by the medial approach for typical dysplasia of hip between the years 2007-2011 were screened retrospectively. The study included 28 hips of 19 patients. The correction percentage of acetabular index was calculated by acetabular angle measurements performed prior to operation and at the last control examination. Avascular necrosis was classified by the criteria of Kalamchi-MacEwen while radiological and clinical evaluations were performed using Severin and McKay criteria.
RESULTS: The mean age at surgery was 12.1 months (3-18 months) while mean follow-up period duration was found 18.6 months (6-48 months). According to Severin radiological criteria, 9 (32.1%) and 9 (32.1%) hips were evaluated as excellent and good, respectively. Whereas, according to the evaluation based on McKay criteria, 22 (78.6%) and 6 (21.4%) hips were found excellent and good, respectively. Avascular necrosis of the femoral head was encountered in 3 (10.7%) of the 28 hips. According to the criteria of Kalamchi-MacEwen Classification; 2 and 1 hips revealed Type I and Type 4 avascular necrosis, respectively.
DISCUSSION AND CONCLUSION: We have encountered according to outcomes data of this study that open reduction technique by the medial approach for treatment of developmental dysplasia of the hip presented more successful clinical and radiological outcomes in the 3-12 months old infants compared with its application in the 13-18 months old infants.

3.Histopathological and mechanical properties of different meshes in a rat model of pelvic prolapse surgery
Gulhan Gunes Elci, Erkan Elci, Cihan Kaya, Numan Cim, Ali Kolusari, Remzi Erten, Gulay Bulut
doi: 10.5505/ejm.2017.26349  Pages 45 - 52
INTRODUCTION: Different types of mesh materials are used to support pelvic structures in urogynecologic procedures. Our aim was to compare histopathological and mechanical effects of Prolene®, UltraPro®, Vypro II®, and Permacol® meshes used in pelvic organ prolapse.
METHODS: Thirty Sprague-Dawley rats were randomized into five groups. Group 1 served as a sham-operated control (n=6); Prolene® was used in group 2 (n=6), UltraPro® in group 3 (n=6), Vypro II® in group 4 (n=6), and Permacol® in group 5 (n=6). A 0.5 × 1 cm mesh was placed between the paravaginal tissue and bladder. After 12 weeks, the rats were reoperated and meshes were excised. Histopathological tissue reactions were compared.
RESULTS: The muscle penetration rate was 67% in the Prolene® group, which was significantly higher than that in the other groups (p=0.026). Minimum preserved postoperative surface area was seen with Prolene® at 0.31 cm2 and maximum with UltraPro® at 0.45 cm2, which was statistically significant. UltraPro® had the most preserved postoperative surface area and less shrinkage than the other meshes.
DISCUSSION AND CONCLUSION: The mesh materials cause an inflammatory reaction in surrounding tissue. Prolene® mesh had superior muscle penetration and tensile strength compared to the other materials.

4.Does HRT Change İntraocular Pressure in Postmenopausal Women ?
Coşkun Sait Özcan, Egemen Harun Tolunay, Deniz Özarslan Özcan, Fatih Mehmet Adıbelii, Neşe Gül Hilali, Korhan Kahraman
doi: 10.5505/ejm.2017.63825  Pages 53 - 56
INTRODUCTION: We aimed to investigate the changes of intraocular pressure in menopause patients with the use of hormone replacement therapy (HRT).
METHODS: Totally 137 postmenopausal women were evaluated in the study. 61 of them were under the treatment of HRT due to the menopausal symptoms. 76 women did not receive treatment. IOP ( intraocular pressure ) was measured with Goldmann tonometer (Optilasa,S.L., Madrid, Spain) in both groups.
RESULTS: In the HRT treatment group ( study group), mean values of IOP for 2 eyes in the first visits was 15.4 ± 1.7 mmHg and 13.9 ± 1.4 mmHg after 6 months use of HRT, respectively (p<0.05). In the non-HRT group (control group) mean values of IOP for 2 eyes in the first visits was 14.4 ± 1.4 mmHg and 14.3 ± 1.4 mmHg after six months, respectively( p˃0.05).
DISCUSSION AND CONCLUSION: HRT use and regular measurement of IOP seems to prevents to reduce risk the of glaucoma in these patients unless there are strong evidence that glaucoma does not occur in women on HRT.

5.Punicalagin isolated from Punica granatum husk can decrease the inflammatory response in RAW 264.7 macrophages
Mehmet Berköz, Oruc Allahverdiyev
doi: 10.5505/ejm.2017.08760  Pages 57 - 64
INTRODUCTION: Punicalagin, a natural occuring phytochemical extracted from pomegranate (Punica granatum) husk and it shows antioxidant and anti-tumoral activities. Previous studies have shown that Punica granatum can scavenge reactive oxygen intermediates (ROIs) and suppress the biosynthesis of prostaglandins (PGs). However, the anti-inflammatory property of punicalagin has not yet been elucidated. For this aim, we purposed to display the anti-inflammatory effects of punicalagin via measuring prostaglandin E2 (PGE2) and nitric oxide (NO) production and cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) gene expression in LPS induced RAW 264.7 macrophages.
METHODS: LPS-stimulated RAW 264.7 macrophages were treated with punicalagin at concentrations of 0-10 µM. NO levels in all groups were measured by the Griess method and PGE2 levels by ELISA kit. COX-2 and iNOS gene expression levels were measured using Real Time PCR.
RESULTS: According to our experiments, punicalagin decreased the production of PGE2 and NO by RAW 264.7 macrophages in a dose-dependent manner without affecting the viability of cells. Punicalagin attenuated the mRNA expression of iNOS and COX-2 of murine macrophages in a concentration dependent manner. Thus, the inhibition of NO and PGE2 production is at least partly because of the suppression of the transcription of the iNOS and COX-2 gene, respectively.
DISCUSSION AND CONCLUSION: In conclusion, punicalagin is a potent natural compound in inhibiting the inflammatory mediators. Its action can be delivered in vivo through an appropriate feeding scheme. Because the lower toxicity of punicalagin, it might be a suitable compound that can be used for clinical applications.

CASE REPORT
6.Staphylococcal toxic shock syndrome with pre-exposure to Cox-2 inhibitor: symptom masking and delayed treatment
Chee Ping Chong, Min Wei Ching
doi: 10.5505/ejm.2017.35229  Pages 65 - 69
Due to uncommon occurrence of staphylococcal toxic shock syndrome (TSS) in male patient, streptococcal origin is often suspected and treated as such. Pre-exposure to nonsteroidal anti-inflammatory drugs had been associated with masking of inflammatory symptoms. These two factors may lead to delay in receiving appropriate antibiotic treatment. We present a case of staphylococcal toxic shock in a diabetic male. He was initially presented to emergency department with abdominal pain, leg swelling and shortness of breath. The patient was having minor skin ulcerations twelve days before admission. He was prescribed with etoricoxib for his shoulder pain for 3 days prior to admission. Initial presentations upon admission showed upper gastrointestinal bleeding, metabolic acidosis and acute kidney injury. He developed TSS with multiorgan failure one day later. Initial diagnosis was streptococcal TSS and therefore intravenous immunoglobulin and clindamycin was initiated. Nevertheless, repeated culture from blood and wound showed staphylococcal infection. The diagnosis was changed to staphylococcal TSS and intravenous cloxacillin was initiated. However, the patient succumbed to the illness after 11 days of admission. In this case report, pre-exposure to etoricoxib may cause masking of inflammatory symptoms and rapid progression of a wound infection into TSS. Rarity of staphylococcal TSS in male and difficulties in differentiating between streptococcal and staphylococcal TSS led to delay in appropriate treatment.

7.Epstein-Barr virus positive primary sinonasal nasopharyngeal-type undifferentiated carcinoma: A distinct entity
Farah Dayana Zahedi, Nik Mohd Hazleigh Nik Hussin, Salina Husain, Ramesh Kumar, Balwant Singh Gendeh
doi: 10.5505/ejm.2017.76486  Pages 70 - 73
Introduction: Primary sinonasal nasopharyngeal-type undifferentiated carcinoma (PSNPC) is a rare variant of the sinonasal undifferentiated carcinoma (SNUC). The histological classification has implications on its management.

Case report: We report a case of a 32 year old lady who presented with progressive nasal obstruction due to a sinonasal tumour. Endoscopic excisionwas performed and histopathologicall examination confirmedPSNPC with positive Epstein Barr virus insitu hybridisation.

Conclusion: Identification and recognition of PSNPC as a separate clinicopathological entity from SNUC is important as it dictates the management of this rare variant. Immunohistochemical analysis is invaluable in this endeavor.

8.Bilateral Intraorbital Hemorrhage with Factor XIII Deficiency after Strabismus Surgery
Erbil Seven, Muhammed Batur, Adnan Çinal, Tekin Yaşar, Ahmet Demirok
doi: 10.5505/ejm.2017.46220  Pages 74 - 76
Factor XIII deficiency is a very rare, inherited bleeding disorder. In this study, we report a child with intraorbital hemorrhage following strabismus surgery who was diagnosed postoperatively with factor XIII deficiency.

REVIEW ARTICLE
9.Ultrasound Practice in Emergency Medicine
Ali Haydar Akça
doi: 10.5505/ejm.2017.09797  Pages 77 - 78
The use of ultrasound in emergency department has dramatically increased in recent years. Performing ultrasound examination without the aid of a radiologist at the patient’s bedside has become an usual experience for the emergency physicians and is now taking place in residency training. Ultrasound use has an important place in patient management especially in critically ill and undifferentiated patients. It has the capacity to revolutionize patient care and improve diagnostic and procedural efficacy. Access to the ultrasound has to be ensured in the emergency departments in order to increase patient safety and fasten the definite diagnosis and treatment.

LETTER TO EDITOR
10.Does Chiari’s Network affect atrial septal defect measurement?
Fatma Nur Gümrükçüoğlu, Hasan Ali Gümrükçüoğlu
doi: 10.5505/ejm.2017.36025  Page 79
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