ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 23 (3)
Volume: 23  Issue: 3 - 2018
1.Epidemiology of Traumatic Vertebral Fractures; Retrospective Analysis of Patients Underwent Spinal Fusion Surgery
Nur Topyalın
doi: 10.5505/ejm.2018.32154  Pages 141 - 145
INTRODUCTION: Traumatic spinal fractures are seen frequently and decrease quality of life and also with spinal cord injuries influence the patients’ life socially and financially. The level of the injury and the presence of the neurological deficit are significant in terms of treatment and prognosis.
METHODS: This study is a partial, retrospective, descriptive, cross-sectional study. The aim of this study to determine the incidence and functionally outcome of the traumatic injuries of the spine who went spinal fusion surgery with instrumentation in the period from period January 1, 2013 to January 1, 2016, at the Neurosurgery Department of Van Yuzuncu Yıl University.
RESULTS: We observed that 71 of the patients were men and 31 were women. The most common causes of traumatic spine fractures were high energy falls 64 (%63) and traffic accidents 38 (%37). The distrubution of the injuries by vertebral segments, there were 19 cervical (%24), 4 thoracolumbar (%3), 30 thoracic (%23), 47 lumbar (%50) fractures. 21 of 102 patients multilevel fractures. The neurological deficits were categorized using ASIA Scale 14 (%14) patients had complete neurological deficit, 10 patients (%10) incomplete neurological deficit, 78 (%76) patients had no neurological deficit.
DISCUSSION AND CONCLUSION: We can suggest that early stabilization was not also significantly improve the early preop ASIA score but improve the postop 6th Month ASIA score. Lomber region is the most affected location of injury. The cause of this may be falls from height is common this district because of the affected people mostly construction workers and fastening seat belt in traffic accidents.

2.Evaluation of hematologic and biochemical parameters in patients with early stage uterine malignancy receiving radiotherapy
Feryal Karaca, Selahattin Menteş, Sıddık Keskin
doi: 10.5505/ejm.2018.96158  Pages 146 - 152
INTRODUCTION: Surgery is the primary choice of treatment fort this disorder. Radiotherapy is an important step of treatment in this cancer after surgery due to the stage of the disease. Lack of prospective randomised data for survival limits the use of adjuvant radiotherapy. Hovewer Adjuvant radiotherapy is suggested for high risk patients to reduce locoregional recurrence. The aim of this study is to define the statistical difference of hemogram, transaminases, kidney function tests and electrolyte changes in patients before starting radiotherapy, the end of radiotherapy, with the onset of acute side effects, and three months after finishing radiotherapy with the onset of chronic side effects.
METHODS: .18 patients with early stage endometrial malignancy attending to Adana Numune Training and Research Hospital have been included. This study has assessed the changes in hemogram, blood transaminases, ürea, creatinin and electrolyte values of patients before radiotherapy, at the last week of radiotherapy and three months after radiotherapy have been compared.
RESULTS: The values for were statistically significant for AST, Ca, LDH, urea, Hb ve HTC values before treatment, at the end of the treatment and three months after treatment (p<0.05).
DISCUSSION AND CONCLUSION: The effect of radiotheraphy seen as lower values of hemoglobin and hematocrite in endometrial malignancy patients resolved and become normal after three months of the radiotherapy.

3.Our Medium-Term Functional and Radiological Outcomes in Revision Total Knee Arthroplasty
Huseyin Ozdemir, Sehmuz Kaya, Cihan Adanas, Abdullah Yalcın Tabak
doi: 10.5505/ejm.2018.51423  Pages 153 - 159
INTRODUCTION: To investigate the medium-term outcomes of the patients who underwent revision total knee arthroplasty, and to come to a conclusion regarding the efficacy of the method by comparing these with literature data.
METHODS: 34 knees of 33 patients who underwent revision knee arthroplasty operation between January 2008 and January 2012 and were sufficiently followed-up were included into this study. Single-stage revision knee arthroplasty was performed for 25 knees for aseptic reasons, and two-stage revision knee arthroplasty was performed for 9 knees for septic reasons.
RESULTS: The patients’ mean knee score and functional score was detected to be 34.7 (4-57) and 33.5 (5-55), respectively, and to be 78.2 (62-90) and 73.8 (50-90) after revision. In pre-operative assessments performed based on Knee Society radiographic assessment form, mean alpha angle was found to be 95.3 (77-103), mean beta angle to be 84.8 (71-100), mean gamma angle to be 5.8 (0 - 30), mean sigma angle to be 83.3 (49-97), and mean total valgus angle to be 0.1 (-13 - 12). In post-operative assessments, mean alpha angle was found to be 94.7 (90-99), mean beta angle to be 88.4 (84-92), mean gamma angle to be 3.7 (0 - 10), mean sigma angle to be 88.1 (85-92), and mean total valgus angle to be 3.1 (-1 - 8).
DISCUSSION AND CONCLUSION: When revision knee arthroplasty operation is performed for proper indication and according to the surgical technique, it is a highly effective and preferable method in decreasing the pain severity and improving the life quality of the patients.

4.Beta-Fibrinogen 455 G/A and Angiotensin Converting Enzyme Ins/Del Polymorphisms In Patients With Lung Cancer
Hamit Hakan Alp, Fatma Zuhal Umudum, Ebubekir Bakan
doi: 10.5505/ejm.2018.91885  Pages 160 - 167
INTRODUCTION: In our study we have investigated polymorphism due to base change occurring at -455 position of promoter region of β-fibrinogen synthesizing gene in lung cancer patients. In addition, we have also investigated insertion/deletion (I/D) polymorphism in intron 16 of Angiotensin Converting Enzyme (ACE) gene, located on chromosome 17q23. Aim of our study is to determine polymorphisms of β-fibrinogen -455 G/A and ACE I/D in patients with lung cancer and healthy control and to determine whether these polymorphisms contribute to the formation of lung cancer. In addition, we aimed to clarify whether β-fibrinogen -455 G/A polymorphism effect the level of fibrinogen synthesis in patients with lung cancer.
METHODS: Samples in our study was obtained from 100 patients with lung cancer and 100 healthy volunteers. Plasma fibrinogen levels were measured with ELISA method. Polymorphism analyses were determined with PCR-reverse hybridization method.
RESULTS: Results of our study revealed that fibrinogen levels of patients with lung cancer were significantly higher than healthy control group (p<0.01). No difference was determined for β-fibrinogen -455 G/A and ACE I/D polymorphisms between patients with lung cancer and healthy control group. In both of the groups fibrinogen level was higher in AA genotype compared to GG and GA genotypes in both of the groups (p<0.05)
DISCUSSION AND CONCLUSION: As a result, it can be stated that β-fibrinogen -455 G/A and ACE I/D polymorphisms are not related with formation and prognosis of lung cancer.

5.Mortality and severity related factors during the admission: H1N1 pneumonia
Hanifi Yıldız, Selami Ekin, Ahmet Arısoy, Hüseyin Akdeniz, Hasan Ali Gümrükçüoğlu, Selvi Aşker, Aysel Sünnetçioğlu, Hülya Günbatar, Nureddin Yüzkat, Mehmet Hakan Bilgin, Mesut Özgökçe, Mahfuz Turan
doi: 10.5505/ejm.2018.04834  Pages 168 - 176
INTRODUCTION: In our country, fatal cases of H1N1 pneumonia were detected between 2015-2016 years. Our aim is to analyze the mortality and severity related factors, during admission of these patients.
METHODS: By conducting a retrospective analysis, 17 cases, confirmed to have H1N1 pneumonia, included in the study. Findings were compared in terms of ARDS and mortality.
RESULTS: ICU and hospital mortality rates were 50% and 30%. The mean age of patients was 50 years. Serum LDH, CK, CK-MB, CRP AST, ALT levels, and the neutrophil-to-lymphocyte ratio (NLR) were found to be increased. In terms of co-infections, there wasn't a significant difference between died and survived patients. The mortality rate was 50% in patients with ARDS. Tere was no relationship between hospital stay with mortality. The symptom of restlessness was related to mortality, and presence of ARDS (P<.05). In died and alive patients, the mean-ranks of PaO2, SpO2, and CURB-65 scores were 3.5, 9.7, 4.3, 10.96, 14.6, and 6.6, respectively (P<.05). PaO2 and SpO2 values were lower, and CURB-65 scores were higher in dead patients. SpO2 <79.5, PaO2 <62.5, and CURB-65 scores ≥2 were related to mortality (P<.05). However, CURB-65 <2 didn’t exclude severe pneumonia. There wasn't a relationship between comorbid diseases and mortality. The main radiographic finding was bilateral infiltrates.
DISCUSSION AND CONCLUSION: This study suggests that PaO2, SpO2, and CURB scores of ≥2 and the presence of restlessness can be used to predict the severity and mortality in patients suspected to have H1N1 pneumonia, during admission.

6.Effects of Acute Aerobic Exercise on NADPH Oxidase Levels in Trained Male Subjects
Sermin Algül, Okan Arihan, Oguz Ozcelik
doi: 10.5505/ejm.2018.07769  Pages 177 - 181
INTRODUCTION: Exercise induced muscle activity causes an increase in oxidative stress and free radical levels. Cardiac and skeletal muscle activity results in elevated NADPH oxidase levels in body. In the present study, we intended to evaluate NADPH oxidase levels in response to the aerobic exercise performed in the morning and at night in trained male subjects.
METHODS: Total of 10 healthy trained subjects (age: 19.3±0.7 years and height: 171.8±2.2cm) performed 2 aerobic running exercise in the morning and at night on different days. Venous blood samples were taken at onset and after exercise. NADPH oxidase levels were measured using ELISA method.
RESULTS: NADPH oxidase levels were found as 355.17±48.65 nmol/L at basal and increased to 374.42±47.41 nmol/L (p<0.0001) in morning exercise. In addition, it was 353.42±56.07 nmol/L at basal and increased to 368.68±55.12 nmol/L after exercise at night (p<0.0001). During exercise, observation of increased percent of NADPH oxidase levels was 6.20±1.8 % in morning and 6.28±1.3 % in night exercise, and no statistical significance was found (p=0.2).
DISCUSSION AND CONCLUSION: As a result, acute aerobic exercise may cause an increase in NADPH oxidase levels in trained subjects but it was not dependent with the time of exercise.

7.Surgical Evaluation of the Early Extraction of Deciduous Teeth by Faculty of Dentistry Oral and Maxillofacial Surgery Clinic Throughout A Year: A Retrospective Study
Cennet Neslihan Eroğlu, Ömer Faruk Boylu, Mesut Kurt, Sadi Elasan
doi: 10.5505/ejm.2018.48379  Pages 182 - 186
INTRODUCTION: Early deciduous tooth extraction is a common public health problem that causes long-term economic and time-related loss. Early deciduous tooth extraction is common due to lack of a pedodontists in the dentistry faculty and parental awareness. For this reason, this retrospective study was planned to determine the number of early extractions of all the deciduous teeth in the last year and to raise awareness for child patients in terms of surgery.
METHODS: Between January 2017 and December 2017, data-processing documents of child patients between the ages of 4-12 whose deciduous teeth were extracted were examined. A classification was made based on age group, lower-upper jaw, gender, early extraction times, and the physiological eruption times of the deciduous teeth The used anesthesia techniques and individual number of extractions were evaluated.
RESULTS: It was identified that approximately half of all extractions were early, and it was observed in early extractions that the incisor and canine teeth extraction in girls and the 1st deciduous molar teeth extraction in boys exhibited statistically significant differences.
DISCUSSION AND CONCLUSION: The examinations of pediatric specialists and treatment protocols in child patients, access to pedodontists easier, and raising parental awareness can seriously impact the prevalence of early extractions in oral and maxillofacial surgery clinics. A single extraction in a single session would be more comfortable for both the child and the physician.

8.Morphologic Effect of Intermittent Fasting on Sciatic Nerve in Acrylamide Administered Rats
Elif Kaval Oğuz
doi: 10.5505/ejm.2018.06078  Pages 187 - 190
INTRODUCTION: Acrylamide is a widely used chemical in industrial manufacturing and laboratory studies. Long term use of this chemical causes axonal degeneration.
METHODS: In this study, 20 mg/kg of acrylamide was administered to Wistar-albino rats daily and effects on sciatic nerve and any potential protective activity of intermittent fasting were investigated. Effect of acrylamide and intermittent fasting was assessed by immunefluorescent method.
RESULTS: As a result paralysis in hind legs and coordination problems during walking was observed in acrylamide administered group. These problems were less frequent in intermittent fasting group. In addition, a decrease in neurofilament number was observed in acrylamide group whereas neurofilament level was similar with control group in intermittent fasting group.
DISCUSSION AND CONCLUSION: Concomitant administration of acrylamide and intermittent fasting caused ameliorating effect of intermittent fasting. A potential protective effect of intermittent fasting against acrylamide can be considered according to such results.

9.Congenital duodenal obstruction: Ten-year results of a tertiary center
Veli Avci, Salim Bilici, Ebuzer Düz, Burhan Beger, İbrahim Değer
doi: 10.5505/ejm.2018.04909  Pages 191 - 194
INTRODUCTION: The most common place of gastrointestinal obstruction in the newborn is duodenum. In this study, we aimed to present our 10 years of experience about patients that diagnosed with congenital duodenal obstruction by the guidence of literature.
METHODS: Between 2008 and 2017, patients who underwent surgery for congenital duodenal obstruction were evaluated retrospectively in terms of age, gender, birth weight, symptom-findings, additional congenital anomalies, treatment modalities, postoperative complications, average length of hospitalization and morbidity-mortality.
RESULTS: A total of 32 patients (18 male, 14 female) with congenital duodenal obstruction were included in the study. The mean birth weight of the patients was 1920 ± 1130 grams. Vomiting (75%) was the most common symptom. Surgical intervention was performed with an average of two days; the most prefered (59%) method was duodenodeudenostomy. The most common complication after surgery was wound infections (22%). 50% of the patients had additional congenital anomalies. Down syndrome was the most common one. Two patients died due to sepsis. The average length of hospitalization was 14 ± 5 days.
DISCUSSION AND CONCLUSION: For a good outcome in congenital duodenal obstruction, the tips of early diagnosis and treatment should be known.

10.Is Accompanying Organ Damage Related with Mortality in Renal Trauma?
Recep Eryılmaz, Murat Demir, Rahmi Aslan, Kerem Taken
doi: 10.5505/ejm.2018.48657  Pages 195 - 198
INTRODUCTION: Our aim in this study was to retrospectively review the accompanying organ damage, treatment and follow-up processes of patients in our clinic who had had renal trauma within the last five years.
METHODS: 78 patients who were followed due to renal injury were retrospectively reviewed. The cases were evaluated in terms of age, sex, trauma mechanism, accompanying injuries, injury severity, hematuria, treatment type, blood transfusion, hospitalization duration and results.
RESULTS: Of the 78 patients, renal injury was observed in 33 (42.3%) patients due to a motor vehicle accident and in 16 (20.5%) patients due to falling. Conservative treatment was applied for 77% (n=60) of the patients, while 23% (n=18) of the patients underwent nephrectomy. The most common intra-abdominal injury was observed as a hepatic injury in 18 (23%) patients. In our study, six (7.7%) of the 78 patients had died. Accompanying organ damage was observed in all patients who died, and all of them had high grade renal injury.
DISCUSSION AND CONCLUSION: Conservative treatment is still important today regardless of the severity of the renal trauma after providing hemodynamic stability. High-grade renal injury and accompanying organ damage are important risk factors in terms of mortality

11.Can Kinesio-taping be a novel treatment option for emesis gravidarum? A randomized preliminary study
Erbil Karaman, Şeyhmus Kaplan, Mahmut Alpaycı, Orkun Çetin, Ali Kolusarı, Hanım Güler Şahin
doi: 10.5505/ejm.2018.54254  Pages 199 - 205
INTRODUCTION: To investigate the effect of Kinesio taping on nausea and vomiting in women with emesis gravidarum.
METHODS: This prospective, randomized study included 77 women divided randomly into two groups. The study group received standard medications as metaclopramide(10 mg) twice in a day and vitamin B6(30 mg) single dose in a day and was performed Kinesio taping on the stomach region over the abdomen, while the control group received only the standard medications for treatment of emesis gravidarum. The degree of nausea and vomiting was evaluated by a 10-cm visual analogue scale (VAS) and Pregnancy unique quantification of emesis (PUQE) scoring.
RESULTS: There was no statistically significant difference between the two groups regarding mean of age, gravidity, parity, body mass index, gestational weeks at admission. Both groups showed a significant reduction in nausea and vomiting after the treatments. However, when considering the decrease in PUQE scores and VAS scores in groups from baseline at admission to the fifth day of treatment, the Kinesio tape group was significantly superior than the control group(p=0.048).
DISCUSSION AND CONCLUSION: This randomized, preliminary study demonstrates that Kinesio taping can be a useful and novel treatment option as supplement to the standard medication in the management of emesis gravidarum.

12.Thiol/Disulphide homeostasis and oxidative stress in patients with peripheral facial paralysis
Canser Yilmaz DEMIR, Nazim BOZAN, Omer Faruk KOCAK, Erdem COKLUK, Yilmaz SULTANOGLU, Muhammet Eren ERSOZ
doi: 10.5505/ejm.2018.62533  Pages 206 - 212
INTRODUCTION: The main pathophysiological mechanism responsible from the peripheral facial paralysis (PFP) is the ischemia, inflammation and swelling of the facial nerve. The purpose of the present study was to assess the oxidative stress parameters including the thiol/disulphide homeostasis in patients with peripheral facial paralysis.
METHODS: A total of 32 patients with PFP and 32 healthy controls were recruited in this cross-sectional study. Serum samples were compared for thiol/disulphide homeostasis (TDH), total oxidant status (TOS), total antioxidant capacity (TAC), paraoxonase (PON), stimulated paraoxonase (SPON), arylesterase (ARES), ceruloplasmin (CLP), myeloperoxidase (MPO), and catalase (CAT) levels.
RESULTS: There were no significant differences between PFP patients and the control group regarding age and gender distribution. Remarkably, TOS (p=0.034), CAT (p<0.001), ARES (p<0.001), native thiol (p<0.001), total thiol (p<0.001), and native thiol/total thiol ratio (p<0.001) were significantly higher in the control group. In contrast, serum ceruloplasmin level (p=0.005) as well as disulphide/native thiol (%) (p=0.001) and disulphide/total thiol (%) (p<0.001) ratios were found to be higher in PFP patients compared to the control group.
DISCUSSION AND CONCLUSION: Thiol/disulphide homeostasis that was suggested as a useful indicator of oxidant/antioxidant imbalance may be a practical marker in diagnosis and follow-up of PFP. Further studies are warranted to determine the effects of nutritional and therapeutic approaches for normalization of oxidative stress in treatment and prevention of PFP.

13.A case of massive atenolol overdose successfully managed with intravenous calcium chloride
Ley Khim Teo, Daniel Je Wai Tham, Chee Ping Chong
doi: 10.5505/ejm.2018.63835  Pages 213 - 215
Atenolol has been widely used owing to its unique beta-adrenoceptor selectivity and favourable safety profile although overdose cases have been reported associated with its use. We report a 50-year-old man with hypertension who allegedly ingested 1 g of immediate-release atenolol. He presented with hypotension and other clinical manifestations of decreased tissue perfusion such as metabolic acidosis and oliguria in the absence of bradycardia. The patient was given activated charcoal and his hypotension was managed with continuous fluid resuscitation, intravenous inotropes and vasopressors. Despite these, he remained hypotensive until the administration of calcium chloride then which subsequent improvements in hemodynamic and metabolic parameters were observed. The patient recovered without any complications. In conclusion, calcium chloride can be used as an adjunct treatment of beta blocker overdose unresponsive to conventional treatments.

14.Herpes Encephalitis with Atypical Localization Presented through Status Epilepticus
Abdullah Kahraman
doi: 10.5505/ejm.2018.07379  Pages 216 - 217
Herpes virus is the most common cause of sporadic encephalitis. It usually manifests itself as fever, blurring of consciousness and epilepsy clinic. Mortality rate is quite high despite treatment. It is an infectious agent that radiologically seizes temporal lobe in a rate of 80 % and is definitively diagnosed through positiveness of HSV-DNA in CSF. In this study, we have aimed at presenting a patient of ours, who, as a very rare case in literature, was accepted to anesthesiology intensive care unit from emergency service, due to status epilepticus, was diagnosed with parieto-occipital lobe involvement, and was finally discharged after having fully recovered.

15.A Rare Case of frontonasal malformation: The clinical features and surgical outcome
Farah Dayana Zahedi, Siti Hajar Sanudin, Salina Husain, Balwant Singh Gendeh
doi: 10.5505/ejm.2018.30075  Pages 218 - 221
Introduction: Frontorhiny is a type of frontonasal malformation that also known as median facial cleft syndrome characterised by hypertelorism, wide nasal bridge, short nasal ridge,splayed nasal bone, bifid nasal tip, widened columellar, long philtrum and midline notch In the upper lip. This sporadic congenital disorder is a rare autosomal recessive caused by homozygous mutations of ALX 3 gene, which is important in facial embryogenesis. There were 42 cases reported worldwide from 1980 to 2009, mainly from Brazil (10 cases), followed by London (5 cases), Bahamas (4 cases) and Venezuela (3 cases).

Case report: We present the first extremely rare case of frontorhiny in Malaysia, highlighting the clinical features and the surgical outcome.

Conclusion: Frontorhiny, ALX-3 related FNM,is an extremely rare frontonasal malformation with typical clinical features that presents a surgical reconstructive challenge and some cases may need multi stage surgery.

16.Anthrax in pregnancy
Onur Karaaslan
doi: 10.5505/ejm.2018.85057  Pages 222 - 224
A 28 year-old 33 week-pregnant patient who came into contact with the flesh of a slaughtered sick-animal applied to our hospital with a wound on the left hand and swelling on the entire elbow and armpit. The middle falls shaped, black colored, hyperemic lesions on the edges of the distal parts of 2nd and 3rd fingers at the left hand and also lymphadenopathies spreading to whole arm and the armpit were observed. Anthrax is diagnosed according to the patient's epidemiological history, physical examination findings, Bacillus anthracis presence in direct preparation and its propagation in the culture. The patient was treated with penicillin for 10 days. This case was presented as the patient was pregnant and there was no complications in the mother and the baby.

17.Anticholinergic Delirium Superimposed On Severe Cognitive Deficit Secondary to Benzhexol and Flupenthixol Decanoate: A Dilemma In Management.
Siti Nor Fadhlina Misron, Zahiruddin Othman, Lukmanul Hakim Misron
doi: 10.5505/ejm.2018.41275  Pages 225 - 228
The first and second generation antipsychotics are associated with cognitive impairment through the antidopaminergic and anticholinergic effects. However serious anticholinergic adverse events may occur in susceptible individual, such as being illustrated in this case, even though flupenthixol decanoate has never been reported to cause them. The concomitant use of anticholinergic medication to counter the antidopaminergic side effects may further accentuate this condition and leads to delirium despite within the therapeutic dosage.

18.Severe hypertriglyceridemia-induced pancreatitis in young female managed with plasmapharesis. A case report
Ahmed Abd Alah Khalifa, Sheref Abdelgawad Elseidy, Ahmed Mahmoud Khalifa
doi: 10.5505/ejm.2018.54227  Pages 229 - 231

Hypertriglyceridemia (HTG) is reported to cause 1-4% of acute pancreatitis (AP) episodes.Serum triglyceride (TG) levels above 1,000 mg/dl are usually considered necessary to ascribe causation for AP. The mechanism for HTGP is postulated to involve hydrolysis of TG by pancreatic lipase and release of free fatty acids that induce free radical damage. The reduction of triglyceride level to below 1000 mg/dL effectively prevents further episodes of pancreatitis. The mainstay of treatment for the hypertriglyceridemia associated with pancreatitis includes dietary restriction of fat and administration of lipid-lowering agents, Experiences with plasmapheresis are limited.
Case presentation:
This case reports a young female, 22 years old female patient non alcoholic, non diabetic, non obese with negative history for gall stones or significant drug use diagnosed with hypertriglyceridemic acute pancreatitis associated with acute kidney injury, and received one session of hemodialysis then plasmapharesis was initiated and she received 8 sessions with full dose of hypolipidemics, and responded only to plasmapharesis.

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