ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 25 (4)
Volume: 25  Issue: 4 - 2020
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1.Self-care agency and affecting factors in patients with chronic obstructive pulmonary disease
Züleyha Kılıç, Songül Göriş
doi: 10.5505/ejm.2020.55822  Pages 484 - 490
INTRODUCTION: In the studies about self-care agency in chronic obstructive pulmonary disease (COPD) patients with a high agency of self-care have been found to be more successful at disease management. Determining the self-care agency (SCA) and affecting factors in patients with COPD are important nursing interventions in order to plan proper care and to support the SCA for patients with COPD. This study was conducted to determine SCA and affecting factors in patients with COPD.
METHODS: Totally 226 patients with COPD who applied to chest diseases outpatient clinics of a governmental hospital in Turkey were recruited to the study between November 2012 and April 2013. Data were collected with a “patient identification form” which was prepared after a literature review and with the “self-care agency scale (SCAS).
RESULTS: According to the research results, mean score of self-care agency of patients with COPD was found to be 70.15±13.75. Patients with COPD who were male, high school graduates, married, governmental officers, and who had given up smoking and who perceived their health status as good had a significantly higher level of self-care agency than other groups (p<0.05).
DISCUSSION AND CONCLUSION: İn the present study it was seen that patients’ self-care agency scale scores were at a moderate level. Self-care agency of patients with COPD is affected by gender, education status, marital status, occupation, smoking status and perception of health. This study provides basic data for the future researches.

2.Surgeons Experience and Consistency to Determine Surgical Procedures for Hallux Valgus
Evrim Sirin, Barış Yılmaz, Guzelali Ozdemir, Erhan Okay, Celaleddin Bildik, Dursun Ak, Bulent Erol, Hasan Hilmi Muratlı
doi: 10.5505/ejm.2020.20438  Pages 491 - 499
INTRODUCTION: There are various surgical techniques introduced for the treatment of hallux valgus deformity, however there is still considerable debate about the most appropriate one. This study analyses the consistency of interpretation of the deformity and data leading to a specific treatment indication among orthopaedic surgeons with different experience in the field.
METHODS: Nine surgeons were divided into three groups according to their surgical experience,namely; group I, with over 10 years of experience; group II with 5–10 years of experience and group III with less than 5 years of experience. 50 feet with hallux valgus deformity were analysed twice in one month of time interval based on routine physical examination and angle measurements, and also some other parameters including joint congruence, evidence of arthrosis, prominence of bunion and grading of sesamoid.
RESULTS: Eventually more experienced surgeons paid less attention to measurements; however, their consistency for the surgical decision was higher. Conversely, less experienced surgeons paid more attention to the measured values however their consistency and matching rates for surgical decision were lower.
DISCUSSION AND CONCLUSION: For more experienced surgeons, the measurable values were of less importance. Less experienced surgeons paid more attention to radiological parameters and their measurements were more consistent, however their uniformity in surgical decisions was lower compared to more experienced surgeons.

3.The Evaluation Of The Treatment Outcomes With Pavlik Harness In Developmental Dysplasia Of The Hip
Tülin Türközü, Necip Güven
doi: 10.5505/ejm.2020.96729  Pages 500 - 505
INTRODUCTION: Developmental dysplasia of the hip (DDH) is the most common developmental abnormality that affects the hip. The aim of the treatment of DDH is to achieve the anatomical reduction for normal development of femoral head and acetabulum in the soonest possible time and to maintain this reduction. Therefore, Pavlik harness is primarily preferred. In the present study, it was aimed to compare the clinical and radiological results with literature in the 0-6 month patients with DDH who were treated using Pavlik harness and also to investigate the effects of the patient variables on treatment outcomes.
METHODS: 82 hips of the 52 patients treated and followed-up by two authors were included in the study. The data from the patient files such as age at diagnosis, ultrasonography (US) type according to the Graf method, treatment duration, the findings of physcial examination, risk factors and presence of avascular necrosis (AVN) were analyzed.
RESULTS: According to the Graf method; 2, 38, 33 and 9 hips were classified as type IIa-, IIb, IIc and III, respectively. Pavlik harness treatment was accepted successful in 72 (87.8%) hips whereas treatment was considered unsuccessful in 10 (12.2%) hips. The rate of type IIb hip was significantly higher in the successful treatment group. The rate of treatment failure was significantly higher in the type III hip.
DISCUSSION AND CONCLUSION: We have concluded that presence of limitation of abduction and Graf type III hip increased the rate of treatment failure in the Pavlik harness treatment of DDH.

4.The effect of neuromuscular electrical stimulation therapy on stress urinary incontinence recurrence: A randomized prospective study
erbil karaman, Şeyhmus Kaplan, Ali Kolusarı
doi: 10.5505/ejm.2020.87609  Pages 506 - 512
INTRODUCTION: The urinary incontinence poses a health problem in community. The standard care for stress urinary incontinence (UI) is surgical therapy. However there are several methods for prevetion of UI recurrence in these patients. Here, we aimed to evaluate the effect of functional electrical stimulation therapy on stress urinary incontinence recurrence in the postoperative period.
METHODS: Patients who had stress UI and underwent anti-incontinence surgery in our University’s Hospital Gynecology Department were randomly divided into two groups. The group 1 received postoperative electrical stimulation of pelvic floor muscles twice in a week (30 minutes) for 4 weeks plus Kegel’s exercise and group 2 received only postoperative Kegel’s exercise for prevetention of UI recurrence. After completion of therapy, the patients were assesed for urinary recurrence by Wagner’s Quality of Life scores Turkish version, pad test and urinary diary.
RESULTS: A total of 48 patients were included in the study. All patients had anti-incontinence surgery of which 39 had transvaginal tape (TVT), 7 had transobturator tape (TOT) and 2 had Burch Colposuspension procedure. The main predominant diagnosis was Stress UI in all cases. 20 patients included in group 1 and underwent electrical stimulation with Kegel’s exercise and 28 patients included in group 2 which had only Kegel’s exercise in postoperative period of one month. The demographic characteristic in terms of age, body mass index, gravidity, parity and co-morbid disease did not show any statistical difference(P>0.05). The rate of recurrence in UI was significantly lower in Group 1 than Group 2, respectively (2/20, 10% vs 5/28, 17.8%, p<0.05). The mean Qulaity of life scores in group 1 was statistically significantly lower than group 2(7.3±6.2 vs 18.4±6.52, p<0.05). The pad test result did not show any statistical difference (5.4±4.2 gr vs 7.4±6.4 gr, p>0.05).
DISCUSSION AND CONCLUSION: The electrical stimulation of pelvic floor muscles in postoperative period seems to be effective in prevention of UI recurrence and may be a good strategy to improve the Quality of Life of patients.

5.Comparing Therapeutic Results Of The Hyperbaric Oxygen Therapy Starting Time For Sudden Sensorineural Hearing Loss
Yaser Said Çetin, Gülin Ergun Taşdöven
doi: 10.5505/ejm.2020.85688  Pages 513 - 518
INTRODUCTION: This study aimed to assess the impact of the hyperbaric oxygen (HBO) therapy starting time (early or late) on the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL).
METHODS: A retrospective analysis examined 203 patients with ISSNHL between January 2014 and June 2018 at Van Training And Research Hospital. We divided the patients into two groups according to the HBO therapy starting time as follows: early HBO (n = 88) and late HBO (n = 115).
RESULTS: The early HBO group demonstrated complete, partial, weak, and no recovery in 21 (23.9%), 15 (17.0%), 17 (19.3%), and 35 (39.8%) patients, respectively. The late HBO group demonstrated complete, partial, weak, and no recovery in 5 (4.3%), 9 (7.8%), 15 (13.0%), and 86 (74.8%) patients, respectively. In addition, 53 (60.2%) and 29 (25.2%) patients in the early and late HBO groups, respectively, responded to treatment, which was statistically significant (P < 0.05). Considering patients with severe and profound hearing loss only, we observed a statistically significant difference in response to treatment between the early and late HBO groups (P < 0.05).
DISCUSSION AND CONCLUSION: The study demonstrates that providing HBO therapy during the first 14 days of the treatment period contributed significantly to treatment success. Therefore, patients with severe and profound hearing loss can significantly benefit by starting HBO therapy at an early stage of the disease.

6.The Effect of Body Mass Index On The Outcomes of Open Simple Prostatectomy
Ender Cem Bulut, Kasım Ertaş, Murat Yavuz Koparal, Serhat Çetin
doi: 10.5505/ejm.2020.49002  Pages 519 - 523
INTRODUCTION: Simple prostatectomy remains the gold standard treatment for patients with severe lower urinary tract symptoms(LUTS) and patients with enlarged prostate. Obesity, defined as a body mass index over 30kg/m2 by the World Health Organization(WHO), is associated with some perioperative complications. This study aims to investigate the effects of obesity on the outcomes of open simple prostatectomy.
METHODS: The study includes 72 patients that underwent open simple prostatectomy. We compared the treatment outcomes of 49 patients with a body mass index (BMI)<30kg/m2 and 16 patients with a BMI>30kg/m2. We compared the two groups in terms of change in International Prostate Symptom Score(IPSS), change in uroflowmetry maximum flow rate(Qmax), operation time, intraoperative blood loss, transfusion requirements.
RESULTS: The median of change in IPSS scores was 16(11-30) for the group where BMI<30kg/m2 and 15.5(10-20) for the group where BMI>30kg/m2. This difference was not statistically significant(p = 0.383). The mean duration of operation was 90.61±17.45 minutes for patients with BMI<30kg/m2 and 121.87±18.78 minutes for patients with a BMI>30kg/m2. The difference between the two groups was statistically significant(p<0.001). The median of blood loss was 450(200-700)cc for the BMI<30kg/m2 group and 725(550-850)cc for the BMI>30kg/m2 group, and this difference was statistically significant(p<0.001). However, the blood transfusion requirements of the two groups were statistically similar(p = 0.885).
DISCUSSION AND CONCLUSION: Open simple prostatectomy is very important technic in the treatment of BPH patients with enlarged prostates. Despite obesity is associated with a prolonged operation and increased transfusion rates in open simple prostatectomy, it can still be considered a safe treatment method.

7.The effect of cachexia on survival in metastatic gastric cancer patients treated with best supportive care
Ayşegül Sakin, mehmet naci aldemir
doi: 10.5505/ejm.2020.44365  Pages 524 - 529
INTRODUCTION: In this retrospective study, we aimed to investigate the effect of cachexia on survival in metastatic gastric cancer (GC) patients treated with best supportive care (BSC) using real-life data.
METHODS: From 2015 to 2019, metastatic GC patients who were treated with BSC were included in this study. The study enrolled 53 metastatic GC patients, 36 (67.9%) were male and 17 (32.1%) were female. The median age of the patients was 66 years. The patients were assigned into two groups, according to body mass index (BMI): BMI <18kg/m2 or BMI ≥18 kg/m2. A total of 18 patients (33.9%) were in the BMI <18kg/m2 group and 35 patients (66.1%) were in the BMI ≥18 kg/m2 group.
RESULTS: There was a statistically significant difference between the two BMI groups with a median overall survival (mOS) of 1 month in the BMI <18kg/m2 group and 3 months in the BMI ≥18 kg/m2 group (p<0.001). In the multivariate analyses, age (hazard ratio [HR], 0.97), chronic obstructive pulmonary (HR, 6.53), BMI <18kg/m2 (HR, 2.31), liver metastasis (HR, 3.53), and peritoneum metastasis (HR, 2.31) were associated with OS.
DISCUSSION AND CONCLUSION: In this study, we found that presence of cachexia at the time of diagnosis in metastatic GC patients treated with BSC was associated with shorter survival in comparison to non-cachectic patients.

8.Extraperitoneal cesarean, is it safe and comfortable?
Onur Karaaslan, Gürcan Türkyılmaz, Erkan Şimşek
doi: 10.5505/ejm.2020.78790  Pages 530 - 534
INTRODUCTION: We aimed to show that extraperitoneal cesarean delivery (EPCD) is more advantageous than trans peritoneal cesarean delivery (TPCD).
METHODS: Sixty cases analyzed either EPCD or TPCD were included in this study. Patients with suspected placental invasion anomalies (placenta accreta, increta or percreta), placenta previa, a history of midline uterine incision, multiple pregnancies, previous cesarean section, previous major abdominal surgery, delivery before 34 weeks of gestation or fetal macrosomia (estimated fetal weight >4500 g) were excluded. The endpoints were the duration of the operation, nausea and vomiting during the operation, postoperative nausea and vomiting, the number of analgesic medications, postoperative shoulder pain, postoperative gas/stool discharge time, complete blood count (CBC), urinary dysfunction, and neonatal outcomes.
RESULTS: TPCD patients suffered significantly more intraoperative nausea (10% vs. 33.3%, p: 0.03) and postoperative vomiting (0% vs. 13.3%, p: 0.04) compared to TPCD group. There was no significant difference in intraoperative vomiting and postoperative nausea rates between the two groups (p: 0,282). The duration of the operation was shorter in TPCD than EPCD groups (25,5 minutes vs. 28,7 minutes, p=0.01). After the operation, significantly fewer analgesic drugs were used in the EPCD than the TPCD groups (p: 0.01). The duration between defecation and operation was significantly shorter in the EPCD group compared to TPCD group (p: 0,042).
DISCUSSION AND CONCLUSION: EPCD reduces postoperative pain, analgesic requirement, nausea, vomiting, and bowel dysfunction in cesarean patients without an increase in significant complications.

9.EUS accuracy against MRCP for detection of pancreaticobiliary lesions
Mustafa Zanyar Akkuzu, Engin Altıntaş, Serkan Yaraş, Osman Özdoğan, Enver Ucbilek, Fehmi Ates, Orhan Sezgin, Ferzan Aydın, Hatice Rızaoğlu Balcı, Yaren Dirik
doi: 10.5505/ejm.2020.92195  Pages 535 - 539
INTRODUCTION: Pathologies such as stenosis, dilatation, stone, and tumor are detected by imaging methods. Clinical symptoms, laboratory and imaging methods that cause mechanical jaundice are reached. We aimed to compare the patients with MRCP and EUS in our clinic and to determine their superiority in diagnostic terms.
METHODS: The results of 135 patients who underwent MRCP and EUS together in the Hospital Gastroenterology Clinic of ×××× University Medical Faculty between 2010-2018 were compared and the results were compared. After reviewing the reports; stone, tumor and pancreatitis sensitivity data were evaluated and analyzed.
RESULTS: 71 (52.6%) of the patients were male and 64 (47.4%) were female. The mean age of males was 60.5 ± 15.49 and the mean age of females was 61.2 ± 14.25. The age range of our patients was 23-91. In 97 (71.85%) patients, MRCP and EUS were reported in the same way and both imaging methods gave the correct results. There were 38 (28.14%) patients with different diagnoses and the total cases with stone, tumor and pancreatitis were evaluated and compared. The sensitivity of EUS for the stone was 88.88% and the MRCP was 81.48%. The sensitivity of EUS was 92.45% and 66.03% for MRI and Tumor and IPMN. In pancreatitis, the sensitivity of EUS was 89.65% and MRCP was 72.41%.
DISCUSSION AND CONCLUSION: EUS is a better diagnostic tool for the diagnosis of choledocholithiasis, tumor and pancreatitis than MRCP.

10.Does Cervical Length Predict the Successful Labor Induction in Term Nulliparous Women Who Had Unfavorable Cervix?
Gürcan Türkyılmaz, Onur Karaaslan, sebnem Turkyilmaz, emircan Ertürk
doi: 10.5505/ejm.2020.48992  Pages 540 - 545
INTRODUCTION: We aimed to determine the predictive value of cervical length (CL) measurement in the result of labor induction in term nulliparous women who had a strict cervix.
METHODS: We evaluated 78 pregnancies prospectively. Dinoprostone ovule was administered for the induction of labor in all cases. Low dose oxytocin was administered for augmentation of labor. Statistical analysis was performed with SPSS Version 24. A p-value <0.05 was determined to be statistically significant.
RESULTS: Dinoprostone indication for labor induction was post-term pregnancy in 57,7% of cases and unsafe fetal wellbeing in the remaining 42,3% of patients. 59% of patients delivered vaginally, and we performed a cesarean section in 41% of patients. The most cesarean indication was fetal distress (40,6%). The arrest of labor was considered in 31,2%, and failed labor induction was seen in 28,1% of women. A significant association was found between CL and successful labor induction. The AUC for CL was: 0.6975 (95% CI: 0.5816-0.8134). The sensitivity and specificity of CL≤ 20 mm were 94% and 45%, respectively, while the positive and negative predictive values associated with it were 57% and 90%. Sensitivity was 23%, and specificity was 84% at the CL≥ 30 mm cut-off point. There was no significant difference between umbilical cord ph and the route of delivery (p: 0,185).
DISCUSSION AND CONCLUSION: Our study indicates that CL measurement is a highly effective method to predict the result of induction of labor, particularly in nulliparous and had unfavorable cervix.

11.Preprocedural Platelet-to-Lymphocyte and Platelet-to-Neutrophile Ratios as the Predictors of Local Recurrence Following Ultrasound-Guided Microwave Ablation for Colorectal Cancer Liver Metastases
Serkan Arıbal
doi: 10.5505/ejm.2020.58608  Pages 546 - 551
INTRODUCTION: The aim of the present study was to demonstrate the role of blood parameters as a potential prognostic factor for local recurrence (LR) after ultrasound (US)-guided percutaneous microwave ablation (MWA) of colorectal liver metastases (CRLM).
METHODS: Between February 2016 and February 2020, 76 patients with US-guided percutaneous MWA of the CRLM were analysed. The patients with LR were included in first or study group (15 patients) and the patients with no evidence of LR were included in second or control group (20 patients). The following blood parameters obtained from the blood sampling at the day before the MWA treatment were also recorded: Haemoglobin (gr/dl), neutrophile (uL), lymphocyte (uL) and platelet (10^3/uL) counts, platelet distribution width (PDW) (fL) and red cell distribution width (RDW) (%) values. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet-to-neutrophile ratio (PNR) were calculated.
RESULTS: The mean PLR was 129.9 (97.6-197.7) and 92.1 (83.7-117.7) in the study and the control group respectively and we found statistically significant association between the groups (p=0.036). The mean PNR was 61.4 (49.5-68.5) and 44.35 (38-55.3) in study and control group respectively A statistically significant association were also seen between these two groups (p=0.003)
DISCUSSION AND CONCLUSION: In conclusion, this study suggests that CRLM patients with elevated preprocedural PLR and PNR values are more inclined to local recurrence after US-guided MWA. This simple and costless way can be easily used in order to predict the local response of the thermal ablative treatments in routine clinical practice.

12.Sexual Function Disorders in Type 2 Diabetic Women;Cross-Sectional Study
doi: 10.5505/ejm.2020.87369  Pages 552 - 557
INTRODUCTION: Our aim was to investigate the frequency of sexual dysfunction in type 2 diabetic

METHODS: 329 married women were included in the study. 213 of these women were diabetic
and 116 were not diabetic. All of them filled the Female Sexual Function Index(FSFI). This questionnaire consists of 6 parts: Desire, arousal, lubrication, orgasm, satisfaction, and pain. Cases’' age, menopause status, number of children, income status, smoking were recorded.

RESULTS: Sexual functions were impaired in 267 (81.9%) of all cases; in 170 (79.8%) diabetic cases and 97 (85.8%) non-diabetic cases. Lumbrication(p = 0.000) and orgasm(p = 0.003) were significantly impaired in diabetics. There was significant relationship between sexual dysfunction and age(In diabetics p=0.000 and in non-diabetics p=0.000). Sexual dysfunction was 85.1% in diabetic women in menopause and 74.5% in diabetic women premenopause (p = 0.052). There was a significant relationship between the number of children and lumbrication(p = 0.042), orgasm(p = 0.036) in all cases; and desire (p = 0.04), orgasm (p = 0.007) in diabetic patients. Lumbrication(p = 0.044) and orgasm(p = 0.008) were significantly impaired in smokers.
DISCUSSION AND CONCLUSION: Sexual dysfunction was high in both type 2 diabetic women and the control group. Sexual dysfunction in diabetic women was evident in the field of lumbrication and orgasm. Sexual dysfunction increased with age, menopause. As the number of children increased, sexual dysfunction was evident in the field of desire, lumbrication and orgasm.

13.Assessment of pain perception after conventional frenectomy with application of cold atmospheric plasma
Basak KUSAKCI-SEKER, Hakan Ozdemır
doi: 10.5505/ejm.2020.37029  Pages 558 - 564
INTRODUCTION: Frenectomy is a surgical technique that purposes to remove the unusual frenum. There are a limited number of studies examining the effect of cold atmospheric plasma on periodontal tissues. The aim of this study was to investigate the effect of Cold Atmospheric Plasma (CAP) application on pain and discomfort in patients after conventional frenectomy operations.
METHODS: Eigthy-seven patients (38 male and 49 female, aged between 18-36 years) with mucogingival problems because of maxillary labial frenums were selected for this study. Patients were randomly divided into two groups: group 1(G1) frenectomy with conventional surgery and group 2(G2) frenectomy with conventional surgery+CAP. The frenum was held with a hemostat inserted to the depth of the vestibule and incision were placed on. After the triangular resected portion of the frenum was removed with the hemostat and wound were sutured. Conventional surgical technique was repeated for G2 and the surgical area was irradiated using CAP (kINPen 11). Visual Analog Scale(VAS) was used to rate postoperative degrees of pain and functional discomforts (chewing and speech) at 1st, 3rd, 7th and 10th days.
RESULTS: VAS score for pain was significantly lower in the G2 group as compared to the G1 on 1st, 3th, 7th and 10th days. Similarly, when the chewing and speech VAS values are compared, the values in the G2 are lower than the G1(p<0.05).
DISCUSSION AND CONCLUSION: According to these results, we can conclude that plasma reduces complications that may occur after frenectomy and these results may related to the positive effect of plasma on wound healing.

14.Evaluation Of Patient Satisfaction After Lateral Internal Spinchterotomy For The Treatment Of Chronic Anal Fissure
Mutlu Sahin, Dogan Ozturk
doi: 10.5505/ejm.2020.56887  Pages 565 - 570
INTRODUCTION: Lateral internal sphincterotomy (LIS) improves chronic fissures, but is associated with potential long-term complications such as fecal incontinence (FI). Our aim in this study is to reveal the effects of chronic anal fissure (CAF) and related FI on quality of life (QOL), and to evaluate the changes in patients' QOL after LIS operation.
METHODS: Patients who had undergone open LIS operation between 2016 and 2019 were included in the study. "Short Form-36 (SF-36)" QOL assessment form was applied to all patients, in the preoperative period and on the sixth month and / or first year follow-up.
RESULTS: A total of 86 patients were included in the study. In the SF-36 QOL scale comparisons of patients with and without FI; general health (GH), physical condition (PHC), psychological state (PSS) and social condition (SC) subscale scores were found to be statistically significantly different (p<0.05). SF-36 QOL subscale scores were found to be higher in the postoperative period compared to the preoperative period. The differences were statistically significant for GH, PHC and SC (p=0.002, p=0.005, p=0.001, respectively), except for PSS (p=0.178).
DISCUSSION AND CONCLUSION: LIS is a reliable operation with low complication rates, other than fecal incontinence. Fecal incontinence reduces the quality of life score, but can be ignored. Although there is a certain level of fecal incontinence risk after LIS operation, the quality of life increases in the majority of patients after this operation. Therefore, it is appropriate to recommend LIS operation to CAF patients, for a better quality of life.

15.Gastric İntestinal Metaplasia and COVID 19 Infection
Mesut Aydın, Ahmet Cumhur DÜLGER, serhat özer, yaren dirik, SIDDIK KESKİN, Canan Demir
doi: 10.5505/ejm.2020.68916  Pages 571 - 575
INTRODUCTION: Gastric intestinal metaplasia (GIM) is defined as immigration of enteric or colonic mucosa within gastric lining. COVID 19, which has been a global issue since late 2019, causes mostly respiratory symptoms; however, some patients may present with gastrointestinal symptoms including diarrhea, vomiting (5%) and abdominal pain ( 3.8%). A large Eestern study involving 78,985 patients revealed that prevalence of GIM in gastric biopsy specimens was 7%. We aimed found a clear association between acute COVID 19 infection and GIM in this work
METHODS: Between March and May 2020, we enrolled 39 patients with COVID 19 infection. An age-matched control group was selected from dyspeptic subjects without GIM. Gastroscopy with antral biopsy had been performed in all patients two years before pandemic began. All study subjects' histopathological records obtained by gastroscopic biopsy were evaluated and compared.
RESULTS: Data of 39 patients and 181 subjects were analyzed. Albumin and ferritin levels were found significantly lower and higher in patient group, respectively (p<0,05). MCV was higher in patient group (p<0,05). Intestinal metaplasia was found in 11 (28%) of 39 patients while in 7 (3,9%) of 181 controls (Table-2, p<0,05)
DISCUSSION AND CONCLUSION: GIM and COVID 19 infection could share same underlying etiologies and GIM may be a harbour for virus at gastrointestinal tractus. Focus on GIM prevention may block an enterance point of COVID 19 infection. The data above suggests that GIM affects gastric mucosal tissue with formation of toxic products, which may play a potential pathogenic role in developing COVID 19 infection

16.Evaluation of skin prick test results in patients with atopic dermatitis
Ömer Kutlu, Ahmet Metin
doi: 10.5505/ejm.2020.50490  Pages 578 - 585
INTRODUCTION: Skin prick test may be useful to detect possible intrinsic and extrinsic triggering factors for atopic dermatitis. In this study, patients with atopic dermatitis who were performed SPT are examined. The most common triggering allergens were evaluated. The association between demographic factors, accompanying other allergic disorders and SPT positivity was also investigated.
METHODS: This study was carried out retrospectively by examining the file records of 144 patients who were performed SPT due to atopic dermatitis.
RESULTS: The most frequent allergens with at least three positivity were grasses (31.2%), grasses mix (24,3%), Cynodon dactylon (15.3%), D.pteronyssinus (9.7%), D.farinae (7.6%), respectively. D. farinae and D. pteronyssinus positivity were significantly statistically more frequent in patients with above 18 years old than patients under 18 years old (p values were 0.003 and 0.007, respectively). There was statistical significant differences between at least one allergen positivity and allergic rhinitis (p=0.043) while there was no difference between at least one allergen positivity and other allergic conditions including asthma, conjuctivitis, and food hypersensitivty (0.721, 0.927, 0.258). The most common at lest tree positive allergens in patients with atopic dernatitis who accompaying with allergic rhinit were grasses (44.5%), grasses mix (37%), Cynodon dactylon (27.2%), D.farinae (9.9%), D.pteronyssinus (8.6%).
DISCUSSION AND CONCLUSION: In this study, house dust mites and grass allergens were the most common triggers of atopic dermatitis. The frequency of food allergens appears less common in atopic dermatitis. The most common allergic comorbidity associated with atopic dermatitis was allergic rhinitis, and house dust mites/grasses were the most common allergens in these cases.

17.Fixed Orthodontic Treatment of a Patient with Skeletal Class II Malocclusion with Infrazygomatic Anchorage and En-Masse Retraction
Saadet Çınarsoy Ciğerim, Seda Kotan, Gönül Dinç
doi: 10.5505/ejm.2020.00377  Pages 586 - 590
Treatment of skeletal Class II malocclusions is difficult anomalies in orthodontics. The treatment of skeletal Class II anomalies varies according to the jaw and the growth period of the anomalies. Adult individuals whose growth is over are treated with fixed orthodontic mechanics or orthognathic surgical approaches. If skeletal class II anomaly is not severe and does not constitute a problem aesthetically, camouflage treatment can be done with fixed orthodontic mechanics. This case report presents the results of orthodontic camouflage treatment and treatment applied to a skeletal Class II malocclusion female patient with chronological age of 18 years and skeletally in the Ru period. The molar relationship of the patient with a slightly convex profile is Angle Class II. In cephalometric examination, skeletal class II problem was detected (ANBº = 6º). At the end of the treatment, angle class II relation in the molar region, angle class I relation in the canine region and a smooth soft tissue profile were obtained.

18.Analysis on Worldwide Coronavirus (COVID-19) Cases
Shipra Gupta, Jasmeet Kalra, himanshu goyal, Vijay Kumar
doi: 10.5505/ejm.2020.54926  Pages 591 - 599
Now a day, the virus of COVID-19 becomes a global health problem for human beings. The main concern of this virus is that it can transmit from human-to-human. The symptoms of this virus are similar to pneumonia. One body to another body of human being transmissions have been described after only incubation times between 3 to 14 days. It can spread through one infected hand to another during hand shake, and also due to contact with the infected surface of metal, glass, plastic, concrete, dirty places and even by fiber cloths. The problem of this virus has been increased suddenly and captures the whole world. Thus in this manuscript we reviewed the literature regarding this problem, so that people become aware about this. Many studies have been analyzed in this manuscript and conclude that this virus may be survive on all surfaces for up to contact with sanitizer, ethanol, H2O2 (hydrogen per oxide) within 30-40 seconds. Other chemicals may be sodium hypochlorite, benzalkonium chloride, chlorhexidine digluconate etc. At present, no specific formula of drugs, vaccines are not available in India and at globe. The method to vanish this virus is only to stop the chain and it is possible by the stop of movement of the human beings (lock down). Thus, the governments of all countries are trying to lock down their state and cities. Only by precaution, human being can defeat this virus.

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