ISSN 1301 - 0883 | E-ISSN: 2687-5101
Eastern Journal Of Medicine - Eastern J Med: 26 (1)
Volume: 26  Issue: 1 - 2021
1.Diagnostic Value of Endobronchial Ultrasonography in Lung and Mediastinal Lesions
mehmet durğun, mehmet kabak
doi: 10.5505/ejm.2021.15579  Pages 1 - 5
INTRODUCTION: EBUS (Endobronchial Ultrasonography) is a highly invasive diagnostic method with high rate of diagnosis by needle aspiration from mediastinal lymph nodes or masses, extremely low complication rate and costly compared to other invasive methods.
METHODS: Patients with mediastinal masses, mediastinal lymph nodes and lung parenchymal masses who underwent FNAB accompanied by EBUS between January 2016 and January 2018 were evaluated retrospectively.

RESULTS: 170 (65.1%) of 261 patients who underwent aspiration biopsy with EBUS were male; 91 (34.9%) patients were female.While the diagnosis was reached in 154 (90%) of 170 male patients who underwent EBUS, it was observed that the diagnosis was reached in 81(89.0%) of 91 female patients.There was no statistically significant difference between gender and diagnosis (p value 0.685).The average age of the patients was 59.8.There was no statistical difference between age and diagnosis(p: 0.836).While 73(31.06%) of 98(41.7%) malignant patients were non-small cell, 20(8.51%) patients had small cell lung cancer, 5(2.12%) patients had metastatic tumor.137 Benign lesion was detected in the patient (58.3%).Of the 28 patients with granulomatous inflammation,14(5.95%) were found to have sarcoidosis and 14(5.95%) had tuberculosis.In addition, anthractosis in 52(22.12%) patients, inflammation in 45(19.14%) patients, and normal tissue in 12(5.1%) patients.The remaining patients were non-diagnostic.
DISCUSSION AND CONCLUSION: As a result;EBUS distinguishes between malignant / benign masses and granulomatous disease with material taken from leucions in lung and mediastinum.The diagnosis rate is high, the complication rate is low and the cost is cheaper compared to other invasive methods and now it is used more frequently.

2.Prolidase, paraoxonase-1, arylesterase activity in oral squamous cell carcinoma, a preliminary study.
şeyda belli, HALIT DEMIR, Bilge Özdemir, Canan Demir
doi: 10.5505/ejm.2021.39358  Pages 6 - 10
INTRODUCTION: In many types of cancer, reactive oxygen and nitrogen products have been detected at high levels. Arylesterase, and paraoxonase1 are esterase enzymes that have strong antioxidant characteristics. The prolidase enzyme is a rate-limiting metalloenzyme which also plays a role in collagen turnover, and is dependent on its NO-activity. In this study, we aimed to investigate the possible relationship between serum paraoxonase1, arilesterase and prolidase enzyme activity in patients with squamous cell carcinoma of the oral cavity and to investigate the etiology and mechanism of oral cavity cancer.
METHODS: The study included 24 patients with oral cavity cancer, and 22 healthy age- and sex- matched individuals. Arylesterase, paraoxonase1 and prolidase activities were measured using spectrophotometry.
RESULTS: Paraoxonase1 activity was 11.6±2.32 nmol/l in the patient group and 29.46±6.18 nmol/l in the controls. Arylesterase activity was 32.2±14.57 nmol/l in the patient group and 80.71±7.23 nmol/l in the controls. Prolidase activity was 39.51±3.02 nmol/l in the patient group and 19.53±1.13 nmol/l in the controls.The mean paraoxonase1 and arylesterase levels in the patient group were statistically lower than the control group and the mean prolidase levels were high (p = 0.0001).
DISCUSSION AND CONCLUSION: In our study, arylesterase and paraoxonase1 enzyme activity was low in patients with oral cavity cancer. The prolidase activity was higher in the same group. As a result, paraoxonase1, arylesterase and prolidase enzyme activities play an important role in the etiopathogenesis of oral cavity cancers. In addition, more research should be done on both clinical and molecular levels of oral cavity cancer.

3.Analysis of the Eye Clinic Visits of Syrian Immigrants at a State Tertiary Hospital
Umut Dağ, Mehtap Çağlayan, Mehmet Fuat Alakuş, Hasan Öncül
doi: 10.5505/ejm.2021.91489  Pages 11 - 16
INTRODUCTION: The aim of this study was to investigate the demographic and clinical characteristics of Syrian immigrants visiting an ophthalmology clinic, and to evaluate the causes of severe vision loss and blindness in this population.
METHODS: The data of 1,498 Syrian patients who presented to our clinic with eye complaints between January 2013 and January 2019 were analyzed retrospectively. The cases were divided into three groups based on age: under 18, 18–65, and over 65 years old. Their diagnoses, severe vision loss incidences, and causes of blindness were investigated.
RESULTS: The mean age was 36.15 ± 23 (0–91) years old, with 385 (25.7%) of the patients under the age of 18, 780 (52.1%) between the ages of 18 and 65, and 333 (22.2%) over 65 years old. In all three groups, the most common reasons for admission were treatable conditions, such as conjunctivitis, blepharitis, and dry eye. The most important cause of severe vision loss under the age of 18 was a refractive error, while the most important cause of blindness was a congenital cataract. Cataracts were the most important causes of severe vision loss in the 18–65 and over 65 years old age groups, while the most important causes of blindness were traumas and cataracts.
DISCUSSION AND CONCLUSION: By providing immigrants with fast, easy, and free access to health care services, the severe vision loss and blindness rates can be minimized.

4.The effect of positive pressure volume control mechanical ventilation on arterial stiffness measured by carotid-femoral (aortic) pulse wave velocity in patients who operated for coronary artery bypass surgery
Pınar Kolusarı, Kamil Karaoğlu, Mustafa Yıldız
doi: 10.5505/ejm.2021.52386  Pages 17 - 23
INTRODUCTION: Coronary artery bypass surgery is the most commonly performed heart surgery. After operation, at a certain time, patients are followed in mechanical ventilator support at intensive care units. Pulse wave velocity (PWV) is one of the most important parameters to evaluate elastic properties of great arteries. Increased values of PWV is an indicator of diffuse atherosclerosis. Mechanical ventilation induces cyclic changes in vena cava blood flow, pulmonary artery blood flow and aortic blood flow. In this context, respiratory changes in aortic blood flow are reflected by swings in blood pressure. In this study, the effect of mechanical ventilation on arterial stiffness measured by carotid-femoral (aortic) PWV in patients who operated for coronary artery bypass surgery were investigated.
METHODS: A total of 20 patients who are operated for coronary artery bypass surgery, followed at intensive care units and applied mechanical ventilation, were enrolled in this study. Aortic PWV measurements were performed twice, including preoperative and postoperative times, from patients. Aortic PWV was determined by using an automatic device, the Complior Colson (France),which allows online pulse wave recording and automatic calculation of PWV.
RESULTS: Preoperative measured systolic, diastolic and mean blood pressures, PWV values ​​higher than according to the values ​​measured postoperative (respectively p=0.014, p<0.001, p<0.001, p=0.001); PWV propagation time and heart rate (respectively p=0.033, p=0.006) values were higher at postoperative care.
DISCUSSION AND CONCLUSION: In our study, the effect of positive pressure volume control mechanical ventilation on the patients who operated for coronary artery bypass surgery was caused by a decrease in PWV.

5.Relation of Heme oxygenase-1 Enzyme gen polymorphism and levels of last products with Chronic Obstructive Pulmonary Disease and exacerbations
Nevra Güllü Arslan, Füsun Öner Eyuboglu, Hatice Pınar Baysan Çebi
doi: 10.5505/ejm.2021.93585  Pages 24 - 29
INTRODUCTION: Genetic predisposition is one of the causes of Chronic Obstructive Pulmonary Disease (COPD). This study is designed to investigate effect of the activity of an important antioxidant enzyme heme oxygenase-1 (HOX-1) by (GT)n dinucleotide repeat (GT)n ≤ 26 S allel, 27≤(GT)n≤ 31 M allel, (GT)n ≥ 32 L (long) allel), levels of serum iron and bilirubin, the last products of enzyme, on severity of COPD and exacerbations of disease.
METHODS: Three different staged 90 COPD patients,who were followed for one year in terms of exacerbation, and 93 controls were included.
RESULTS: By increasing the severity of disease, bilirubin levels were coming closer to the lower limit within normal range. Iron levels of Group 2 (moderate) and 3 (severe) were significantly lower than Group 1 (mild), (p=0,025, p=0,035). There was an inversely related statistically significant correlation between exacerbation numbers and iron (p=0,016). Allel frequency and carrier of L ((GT)n ≥ 32) allel were similar between patient and control group, and patient group in its own (p=0,458, p=0,445). There was no significant relation between individuals with L allel (SL, ML, LL) and without L allel (SS, SM, MM) according to levels of iron and bilirubin, number of exacerbations and FEV1 (p=0,631, p=0,065, p=0,356).
DISCUSSION AND CONCLUSION: By the progression of COPD, levels of bilirubin and iron are liable to decrease while the number of exacerbations is increasing. (GT)n polymorphism of COPD patients in the study group is not a risk factor for development and stage of disease, frequent exacerbation, low iron and bilirubin levels.

6.Evaluating The Use of Energy Drinks, Food Supplements and Nutrition Habits among Adolescents in terms of Ecological Approach: Antalya Sample
Derya Adıbelli, Yasemin Demir Avci, Selvinaz Saçan
doi: 10.5505/ejm.2021.22438  Pages 30 - 39
INTRODUCTION: This study was conducted to determine adolescents’ habits of consumption of energy drinks and supplementary foods and to evaluate the results using an ecological approach.
METHODS: This study was conducted with 1084 adolescents between December 2016 and June 2017 in a city center to determine adolescents’ habits of consumption of energy drinks and supplementary foods and to evaluate the results using an ecological approach. Data were collected using a self-questionaired form prepared by the researchers.
RESULTS: Male adolescents consumed more sports drinks, energy drinks and protein powders than girls (p <.001). Female students were more unable to stop themselves while they were eating compared to male students. Parental continuous dieting was associated with adolescent energy consumption (OR = 0.64, p =.038) and adverse drug use (OR = 6.28, p =.002) (OR = 2.85, p =.008). To criticise continually due to past mistakesrelated to energy consumption (OR = 0.43, p <.05), parental desire to know their adolescent’s friends was found to be related to drug use (OR = 0.11, p <.001) to lose weight. Additionally, we found that depression was related to smoking (OR = 4.05, p <.001).
DISCUSSION AND CONCLUSION: The unconscious use of energy drinks and supplements is increasing rapidly and the effect on the body is unknown.

7.The efficiency of MRI technique in determining the depth of myometrial invasion in endometrial cancer cases
Gazi Yıldız, Kasım Turan, Pınar Yıldız
doi: 10.5505/ejm.2021.5470  Pages 40 - 46
INTRODUCTION: The aim of the present study was to determine the efficiency of preoperative magnetic resonance imaging investigation in the determination of the depth of myometrial invasion in endometrial cancer.
METHODS: 41 cases diagnosed with endometrial cancer via endometrial sampling and who underwent investigation with magnetic resonance imaging in preoperative period so as to determine the depth of myometrial invasion were evaluated retrospectively. Imaging and operation data and pathology results were retrieved from hospital files.
RESULTS: Mean age of the patients was 60.5±10.18 (43-86). As surgical procedure, they underwent total abdominal hysterectomy and bilateral salpinghooopherectomy, bilateral pelvic lymph node dissection ± paraaortic lymph node dissection. Preoperative magnetic resonance imaging findings were compared with postoperative histology results and sensivitity of magnetic resonance imaging was found to be 68.2%, specifity 84.5%, PPD 68.2% and NPD 84.5% in the evaluation of the depth of myometrial invasion.
DISCUSSION AND CONCLUSION: Magnetic resonance imaging is an efficient imaging method in the preoperative evaluation of the depth of myometrial invasion in endometrial cancer.

8.CT and MRI findings of branchial cleft cysts
Erkan Gökçe, Murat Beyhan
doi: 10.5505/ejm.2021.94914  Pages 47 - 52
INTRODUCTION: Our aim in this study was to evaluate the CT and MRI findings of branchial cleft cysts (BCCs).
METHODS: The demographic characteristics of patients who were found to have BCC in their neck radiological examinations were evaluated retrospectively. The dimensions and localizations of the BCCs, and the presence of septation and ruptures in the cysts were examined. Lesion density on CT and T1- and T2-weighted signal properties compared to the sternocleidomastoid muscle on MRI of the lesions, as well as their contrast-enhancement patterns, were evaluated. First BCCs were subclassified based on Work classification system while Bailey classification was used to subclassify second BCCs.
RESULTS: BCC was observed in 16 cases (10 female and 6 male). The mean age of the cases with BCC was 28.4±15.0 years. Fifteen of the BCCs were second BCC while one was first BCC. The only first BCC was Type 1 pattern based on Work classification. According to Bailey classification, 13 of the second BCCs had Type 2, one had Type 1 and one had Type 3 pattern. BCC diameters varied from 12 to 60 mm. Mean density of the BCCs was 33.5±12.6 HU. On MRI, BCCs were mostly hyperintense on T1- and T2-weighted images. Peripheral enhancement was detected in 12 BCCs. Septation was observed in three BCCs while one of them was ruptured.
DISCUSSION AND CONCLUSION: BCCs are more frequently observed in female and on the right side of the neck. They mostly have second BCC pattern. Radiologically, BCCs are cysts with different densities which can have peripheral enhancement, and they rarely have septations and ruptures.

9.Is There a Relationship Between Buccally Displaced Maxillary Canine and Nasal Septum Deviation?
TURKAN Sezen Erhamza, Burçin AKAN
doi: 10.5505/ejm.2021.77698  Pages 53 - 56
INTRODUCTION: The aim of this study was to evalute the relation between buccally displaced canine and nasal septum deviation.
METHODS: 822 individuals (mean age 12,91±2,21; 459 female, 353 male) were divided into has buccally displaced canine (n=411) and has no buccally displaced group (n=411). Intra-oral photographs were used to evaluate the position of displaced canine. Postero-anterior radiographs were used to determine the deviated nasal septum. Chi-square test was used for analysing the variables.
RESULTS: While the incidence of septum deviation is 70.1% in individuals with buccal ectopic canine, the rate of septum deviation in individuals with canine teeth in normal position is 40.6%. A statistically significant relationship was found between the presence of canine in the ectopic position in the buccal and the deviation of the septum(p=0,000).
DISCUSSION AND CONCLUSION: In intraoral examination, it can be estimated that there may also be a nasal septum deviation when buccal ectopic canine is found. It should be kept in mind that a patients may be directed to medical doctor to prevent problems that may occur in the long term as a result of the nasal septum deviation.

10.Evaluation of Psychological Variables in Women Who Takes İnfertility Care
Faruk Kurhan, Ümit Sertan Çöpoğlu
doi: 10.5505/ejm.2021.81542  Pages 57 - 61
INTRODUCTION: Infertility can cause many psychological problems in many women with numerous different ways. We aim to evaluate social support and family relation among women who takes treatment of infertility and who have depression, anxiety and guiltiness, shyness and infertility problems inventory
METHODS: 71 women who have applied to department of obstetrics and gynaecology have been included in that study. Control group consist of 71 women between 18-45 ages, who were volunteer and had never taken treatment of infertility and also they had child. Various tests were applied to these women such as Hamilton Depression Test (HAM-D), Hamilton Anxiety Test (HAM-A), Shyness-Guiltiness Test, Multi-Dimensional Perceived Social Support Scale (ÇBASDÖ) and Family Support Test.
RESULTS: According to analysis there was not difference between infertile group and control group of depression rate (infertile group %14.1 control group %9.9, p.0.438);but there was a significant difference between infertile and control groups for anxiety levels (infertile group 10.2-42, control group 7.0-34 p<0.001), shyness-guiltiness (infertile group in 101 control group 69, p<0.001), perceived social support (infertile group 55 control group 52, p<0.001), fertility problems (infertile group 170, control group 135 p<0.001).
DISCUSSION AND CONCLUSION: In our study, we determined that anxiety, shyness and guiltiness were very high in infertile people and on the other hand family support was low. Our findings showed that infertile patients need psychological support from the time of diagnosis and during the treatment. For this reason, it can be said that it is usefull to set a good connection between infertile polyclinic and psychiatry polyclinic.

11.Retrospective evaluation of percutaneous tracheostomy methods applied in a tertiary intensive care unit
Cevdet Yardımcı, Gamze Talih, Ahmet Yüksek
doi: 10.5505/ejm.2021.70845  Pages 62 - 66
INTRODUCTION: Tracheostomy is a usual procedure for patients who will be dependent on ventilator therapy for a long time to reduce complications associated with long-term endotracheal intubation. Different percutaneous methods focused on safety and convenience have also been described to perform tracheostomy.
METHODS: After obtaining ethical approval from local ethical committee file records of patients stayed in our ICU between March 2019 and March 2020 were assessed. Fifty four patients to whom percutaneous tracheostomy applied were included in the study.
RESULTS: Among the patients included in the study, the groups were similar according to the age, gender and duration of intubation. The procedure time was less in the Group GWFD (mean±SD; 18.62±6.92 mins) than in Group BR (mean±SD; 23.40±5.37 mins) (p: 0.006). There was no difference between the groups in terms of minor bleeding, major bleeding, pneumothorax, emphysema and hypoxia. But the total complication rate were higher in Group GWFD [10 (41.7%)] than in Group BR [5 (16.7%)] (p: 0.042).
DISCUSSION AND CONCLUSION: Our study results reveal that the GWFD technique is faster but the BR technique is safer. Differences in the definition of procedure time may have affected the results. For this reason, more studies are needed in this area.

12.Evaluation of blood glucose and inflammation markers in pediatric head injuries
Huseyin Fatih Gul, Abdullah Talha Şimşek, Turgut Dolanbay, Murat Aras, Ümit Yasar Gul, Levent Şahin, Seda Celik
doi: 10.5505/ejm.2021.16768  Pages 67 - 74
INTRODUCTION: The aim of this study was to investigate the relationship between early (at the first admission to the emergency room) blood glucose, C-reactive protein (CRP) and leukocyte (WBC) levels and Glasgow Coma Scale (GCS) in patients with pediatric isolated head injury (IHI) and to reveal their effects on prognosis in the emergency department.
METHODS: The data of 74 patients with IHI under the age of 18 and over the age of 2, admitted to XXX Hospital Emergency Department between 2016 and 2019, were obtained from the hospital information system and analyzed retrospectively.
RESULTS: It was reported that 54 of our patients were boys and 20 were girls. Concerning injury etiology, it was determined that 21.6% were exposed to head injury due to a traffic accident, 59.5% due to falling, 9.5% due to battery, and the same percentage due to a foreign body hit on the head. According to the severity of brain damage, 65 patients with the GCS score above eight and 9 patients with the GCS score below and equal to eight were identified. While a significant negative correlation was found between the GCS scores and blood glucose and WBC levels of our patients, the difference between the CRP levels was found to be insignificant.
DISCUSSION AND CONCLUSION: In children with pediatric IHI, a negative correlation was found between increased blood glucose and WBC levels and GCS score in the early period in predicting the severity of damage in addition to CBT, and it was associated with poor prognosis in the emergency department.

13.Traditional and Complementary Medicine Methods Which Have Become Widespread from The Perspective of Family Physicians and self-Employed Pharmacists; Approaches, Thoughts
doi: 10.5505/ejm.2021.24482  Pages 75 - 79
INTRODUCTION: Traditional and complementary medicine, which has been defined by the World Health Organization as the whole of knowledge, skills, and practices based on different cultures specific theories, beliefs and experiences, are used in the protection of health through the diagnosis and treatment of physical and mental disorders, has become widespread in our society with the support of the ministry of health on the subject in recent years. We aimed to evaluate the opinions of family physicians and freelance pharmacists working in the city center of Tokat regarding traditional medicine.
METHODS: This cross-sectional study with free pharmacists and family physicians working in the city center of Tokat between 10.12.2019 and 20.12.2019. The data were obtained by a questionnaire, questioning the demographic information and the attitudes of the participants towards traditional treatment methods. Cross-tables and chi-square tests were used to evaluate qualitative variables. In the calculations, statistical software (SPSS Statistics 19) was used.
RESULTS: Regarding the participants, 41 (48.8%) were men and 43 (52.2%) were women. It was observed that there were 12 (14.3%) family medicine specialists, 41 (48.8%) general practitioners, 31 freelance pharmacists (36.9%). The average age was 40.6 (27-71). The rate of receiving traditional and complementary medicine practice training was found to be statistically significantly higher among pharmacists than physicians (p <0.05). However 73.1% of participants who did not receive training stated that they wanted to receive education.
DISCUSSION AND CONCLUSION: We would like to emphasize the importance and necessity of taking traditional and complementary medical education programs within the scope of in-service education programs.

14.The effects McGrath® MAC video laryngoscope assisted education on the endotracheal intubation practices of students
Havva Sayhan Kaplan, İbrahim Halil Üney
doi: 10.5505/ejm.2021.75768  Pages 80 - 85
INTRODUCTION: Endotracheal intubation is an important step in maintaining the open status of the airway and in controlling breathing. Every doctor should have the ability to manage the airway; and this skill should be taught to doctors in their medical training. In the present study, the effect of the training on medical students with video laryngoscope and direct laryngoscope on endotracheal intubation success was examined.
METHODS: A total of 66 students who had no previous endotracheal intubation experience and who received anesthesiology internship were included in the study. The students were randomly divided into 2 groups. The intubation with video laryngoscope was applied after intubation with direct laryngoscope in Group D, and the intubation with direct laryngoscope was applied after intubation with video laryngoscope in Group V. The intubation times and success rates were recorded in all attempts.
RESULTS: The time between the first and second attempts of students who used video laryngoscope in the first attempt and direct laryngoscope in the second attempt decreased significantly (p<0.001). The first attempt times between the direct laryngoscope and video laryngoscope groups were very close to each other.
DISCUSSION AND CONCLUSION: Our study showed that training medical students using the McGrath® MAC video laryngoscope yields better results than using direct laryngoscopy.

15.Evaluation Of Patients Delivered To The Postoperative Intensive Care Unit
Münire Babayiğit, Necla Dereli, Handan Gulec, Zehra Tutal, Mehmet Şahap, Mustafa Alparslan Babayiğit, Eyüp Horasanlı
doi: 10.5505/ejm.2021.78553  Pages 86 - 91
INTRODUCTION: In our study, the purpose was to investigate the preoperative evaluations and indications of hospitalization of patients projected to be followed-up in postoperative Intensive Care Unit (ICU).
METHODS: A total of 77 patients who were projected to need ICU in the postoperative period and referred to postoperative ICU peroperatively as a result of preoperative evaluations for one year, were included in the study. The age, gender, ASA, type of surgery (elective/emergency), anesthesia method, postoperative stay in postoperative Intensive Care Unit and results (discharge/exitus) of the patients were recorded.
RESULTS: In preoperative evaluation, it was determined that a total of 12.5% of patients projected to be hospitalized in postoperative ICU were referred to postoperative services. It was determined that 89.6% of patients were ASA III-V, 24.7% had malignancy, and 49.4% were operated urgently. As the indication of hospitalization at ICU, follow-up with monitoring was detected at 57.1%, hemodynamic instability at 27.3%, respiratory failure at 11.7%, and peroperative complications at 3.9%. While 92.5% of our patients were discharged with cure, 4.5% were exitus, and 3% were referred to another center.
DISCUSSION AND CONCLUSION: It was determined that our patients with postoperative ICU indications were elderly, male, and ASA III and above. The need for postoperative monitoring and hemodynamic instability were observed to be the most common indications for hospitalization. It was revealed that our hospital needed intermediary intensive care for the effective use of ICU capacities and optimum postoperative patient care.

16.Changes In Aortic Flow Propagation Velocity Before And After Treatment In Patients With Hypertension
Fatih Öztürk
doi: 10.5505/ejm.2021.76768  Pages 92 - 98
INTRODUCTION: Propose of this study is to evaluate whether the aortic resistance measured by Aortic flow propagation velocity (APV) is improved or not by the treatment by comparing pre- and post-treatment APV values in patients with newly diagnosed essential hypertension.
METHODS: 117 patients with hypertension and 100 volunteers of similar age group without hypertension were included in this study. 24-hour Holter blood pressure and APV values before and after the treatment were compared.
RESULTS: There was a statistically significant difference in APV values before the treatment between the patient group (41,07±7,82 cm/sec) and the control group (58,75±5,19 cm/sec) (p<0.001). The statistical difference in APV values between the patient (54,35±8,28) and control groups disappeared after the treatment (p: 0,822) and APV values showed a positive increase.
DISCUSSION AND CONCLUSION: In this study, APV values were lower in patients with hypertension compared to healthy individuals during the early periods of diagnosis, and a certain level of improvement was achieved in APV values with the hypertension treatment.

17.The determination of mecA gene presence in MRSA strains isolated from intensive care unit by conventional, automated and PCR method
Naziye Yıldız Deniz, YASEMIN BAYRAM, Mehmet Parlak, Şevin İrden, Hüseyin Güdücüoglu
doi: 10.5505/ejm.2021.89801  Pages 99 - 103
INTRODUCTION: Meticillin-resistant S. aureus (MRSA) strains are becoming increasingly important as a cause of hospital and community-acquired infections. The aim of this study is to compare PCR, gradient tests and automated system which are the methods determining methicillin resistance in S. aureus strains
METHODS: The study included 50 MRSA strains isolated from various samples (wound, blood, sputum, respiration, abscess, osteomyelitis, etc.) from the microbiology laboratory of XXX University Medical Faculty between 2010-2016. A single isolate was obtained from each patient. In our study, the presence of mecA gene in MRSA strains was investigated by conventional, automated and PCR method
RESULTS: The presence of methicillin resistance was found in 49 of 50 MRSA strains which examined by Oxacillin E-test method(MIC˃2). All of the strains which tested by cefoxitin E-test were found resistance to methicillin(MIC˃4). Vitek 2 automated system detected that all of the strains are resistance to methicillin. All samples examined by PCR method were positive, the presence of mecA gene was determined. Sensitivity rate of strains examined by oxacillin E-test method was 98%, while the susceptibility rate of strains examined by cefoxitin E-test, Vitek 2 automated system and PCR methods was 100%.
DISCUSSION AND CONCLUSION: In order to obtain the necessary precautions in hospitals with high MRSA ratio, mecA investigation is of great importance in achieving the correct results. Since the results of the three methods are almost close to each other, three methods can be used to determine the correct results.

18.Does Suppression Of Tsh Affect The Mean Platelet Volume? Retrospective Case Control Study
Mine Öztürk
doi: 10.5505/ejm.2021.85619  Pages 104 - 108
INTRODUCTION: There have been reports that the mean platelet volume changes in the way of increasing or decreasing in inflammatory diseases. We also wanted to investigate whether there is such a change in the mean platelet volume in thyroid diseases.

METHODS: The data of 1410 patients admitted to the endocrine outpatient clinic were reviewed retrospectively. Age, sex, thyroid disease diagnoses, TSH(μIU/ml), fT3(pg/ml), fT4(ng/dl), MPV(fl) values were recorded. The patients were divided into three groups according to TSH levels and their diagnosis
RESULTS: This study included 1410 patients who were admitted to our endocrine outpatient clinic with a preliminary diagnosis of thyroid. 75.2% of the patients were female and 24.8% were male. The mean age of all patients was 47.87. The mean and standard deviation value of MPV(fl) was 7.49±1.25. We divided the patients into 3 according to their TSH levels: those with TSH values less than 0.35 μIU/ml, those with TSH values 0.35-4.94 μIU/ml and TSH values 4.94 μIU/ml ' greater than.There was no significant correlation between MPV and TSH (p=0.19).
At the subgroups according to the diagnosis; (subacute thyroiditis, Graves disease, toxic adenoma, toxic multinodular goiter, hypothyroidism, tsh suppression in pregnancy, thyroid cancer, euthyroidism, suppressed TSH due to excessive drug use) there was no significant correlation between MPV and TSH (p=0.11, p=0.56, p=0.50, p=0.06, p=0.14, p=0.53, p=0.33, p=0.30, p=0.91 respectively).
DISCUSSION AND CONCLUSION: Is MPV a biomarker or can it play a role in thyroid diseases? According to our study, MPV is not considered as a suitable biomarker for thyroid diseases.

19.The Efficacies of Medicinal Leech Therapy and Platelet Rich Plasma Injection added to Muscle Stretching Exercises in the Treatment of Myofascial Pain Syndrome
Levent Ediz, Aydın Çağaç, Veysel Delen
doi: 10.5505/ejm.2021.06025  Pages 109 - 116
INTRODUCTION: Myofascial pain syndrome is among the most common cause of physical disability and severe chronic muscle pain and affect millions of people worldwide. So far muscle stretching exercises and some therapeutic interventions have been recomended with various effects.

METHODS: Sixty-six patients with myofascial pain syndrome due to trigger points in trapezius muscle were included in this study. Patients were divided randomly into 2 groups of 33 patients: group 1; medicinal leech therapy group, group 2; platelet rich plasma injection group. To the first group, 4 medicinal leech were applied to the trigger points 2 times in a 4 week interval. To the second group, a total of 2 ml platelet rich plasma was administered to each trigger point 2 times in a 4 week interval. All patients had also taught and given trapezius muscle stretching exercises for ten minutes as a daily diary shedule for 12 weeks.
RESULTS: At the end of the study there was a significant decrease in visual analogue scale scores in both groups, while a significant increase in pain treshold values in medicinal leech therapy group (p<0.05). Significant differences were found between groups in short form-36 pain, general health and vitality scores in favor of leech therapy group (p <0.05).
DISCUSSION AND CONCLUSION: Although both methods were found effective in the treatment of myofascial pain syndrome, the clinical efficacy of medicinal leech therapy was greater than platelet rich plasma. Leech therapy seems to be an effective and reliable treatment option when added to muscle stretching exercises in myofascial pain syndrome.

20.Investigation of Alpha Globin Gene Mutations by Complementary Methods in Antalya
Ibrahim Keser, Tuğba Karaman Mercan, TÜRKER BILGEN, Osman Alphan Kupesiz, yunus arikan, Duran Canatan
doi: 10.5505/ejm.2021.04796  Pages 117 - 122
INTRODUCTION: Alpha (α) thalassemia syndromes are inherited autosomal recessively and caused by mutations on optionally one or more of the four α-globin genes (αα/αα). Alpha thalassemic mutations could be more commonly deletional or rarely non-deletional. While small deletional mutations such as -3.7 cause α+-thalassemia, large deletions such as -26.5 -20.5 cause α0-thalassemia. The objective of this study was to determine the spectrum of deletional and non-deletional α-thalassemia mutations in the Antalya population,Turkey.
METHODS: In this study, 250 individuals with low hematological values, normal Hb A2 who were not affected with beta thalassemia were investigated the presence of α-thalassemia mutations by reverse dot blot hybridization(RDBH) and, the confirmation of some positive and negative cases by multiplex ligation dependent probe amplification(MLPA), at the latest DNA sequencing.
RESULTS: Eight different mutations were determined in 112 (44.8%) of patients. The -αα3.7 deletion was the most common mutation(73.3%). Others common mutations were the – α 20.5 (13.0%) and –MED (6.5%), --FIL (2.4%), Hb Adana (2.4%). These five mutations make up 97.5 % of total mutations. Three patients with Hb H disease were found related with - α 3.7 /-(α) -20.5 genotype. One patient (2.04%) had the ααα anti-3.7 gene triplication. Two rare mutations, α2 codon 64 (G>C) (Hb Fontainebleau) and α2 codon 193 (G>A) (Hb G- Waimanalo) were determined by DNA sequencing firstly in Antalya Province, Turkey.
DISCUSSION AND CONCLUSION: Our results may be valuable to give accurate premarital genetic counseling, classical prenatal and preimplantation genetic diagnosis by the comlementary methods such as RDBH, MLPA and DNA sequencing on carrier screening.

21.Is neutrophil lymphocyte ratio a useful biomarker in predicting fibrosis in chronic hepatitis C infection?
Yakup Ülger
doi: 10.5505/ejm.2021.07742  Pages 123 - 127
INTRODUCTION: Percutaneous liver biopsy is the gold standard in the evaluation of liver fibrosis in the chronic hepatitis C infection (HCV). Invasive biopsy leads to complication risks and high financial burden for each patient. Therefore, noninvasive methods are needed including neutrophil lymphocyte (NLR) ratio, thrombocyte lymphocyte ratio (PLR). The aim of this study was to investigate the effect of neutrophil-lymphocyte and platelet-lymphocyte ratios as a biomarker on the prediction of response status and fibrosis degrees of patients with HCV.
METHODS: We enrolled184 chronic hepatitis c in patients this retrospective study. The neutrophy-lymphocyte ratio and thrombocyte lymphocyte ratio of the patients were calculated using the hemogram data in the hospital registry system. The patients were evaluated in two groups according to their antiviral treatment response, with sustanied viral response and no response.
RESULTS: : It has been shown that sustained virological response in HCV infection decreases with increasing age (p value: 0.04). NLR was associated with the degree of fibrosis (p: 0,02) while PLR was not significant (p: 0,21). On the contrary, there was no significant relationship between NLR, PLR and treatment response status.
DISCUSSION AND CONCLUSION: This study conducted in the Turkish population is the first study to reveal the relationship between response and fibrosis with NLR and PLR in chronic hepatitis C infection using the largest sample size. Low NLR value can be used as a biomarker to predict advanced fibrosis due to chronic hepatitis C.

22.Real-Time Detection of Doxorubicin-Induced Apoptosis in Breast Cancer Cells Using the Back Reflection Spectroscopy
Ertan Kucuksayan, Aslinur Sircan-Kucuksayan
doi: 10.5505/ejm.2021.64935  Pages 128 - 134
INTRODUCTION: Apoptosis detection methods cause the cell culture medium to be physically or chemically affected. In addition, these methods have disadvantages such as cost and cell losses. The aim of this study is to develop a method to assess apoptosis in real-time using the back-reflection spectroscopy (BRS) in breast cancer cells.
METHODS: BRS experiment set up consists of a spectrometer, a tungsten-halogen light source and a fiber optic probe. In order to assess the changes associated with apoptosis, the intensity of the reflected light was measured with a fiber-optic probe from MCF7 breast cancer cell samples in which apoptosis induced doxorubicin. Spectroscopic measurements were performed 6 hours after incubation from control and doxorubicin groups. Cell viability measurement with MTT method, imaging of cell morphology with toluidine blue staining method, ROS measurement with DCFH-DA method were performed for the evaluation of apoptosis.
RESULTS: We analyzed the back reflection spectrum and determined the signal difference in apoptotic cell samples compared to the control. A significant difference was found in ROS measurements in all groups compared to the control. We did not observe any morphological change in the cells imaged with the toluidine blue method for 6 hours. Cell viability decreased 50% in all groups compared to the control for 24 hours.
DISCUSSION AND CONCLUSION: BRS is a new approach that may detect apoptosis in real time without interfering cell culture conditions. This method has the potential to be developed as a non-invasive, objective and reproducible technique that enables time-dependent monitoring of apoptosis.

23.Investigation of Irisin Level in Brucella Patients
Sermin Algül, Feray Ferda Senol, Seda Uğraş, Fatih Esmer, Mehmet Kara, Pinar Tanritanir Ekici, Oğuz Özçelik
doi: 10.5505/ejm.2021.70431  Pages 135 - 138
INTRODUCTION: Objective: This study aimed to determine whether the changes in the metabolism of Brucella patients affect the irisin hormone. Also, it is aimed to investigate the relationships between other laboratory findings used in the diagnosis of brucellosis patients and the irisin hormone.

METHODS: Material and Method: 160 persons (80 brucellosis, 80 controls) were included in this study. Blood was drawn from the people participating in the study following their overnight fast. Irisin level was measured by ELISA method, CRP and sedimentation levels were measured using autoanalysers and commercial kits.
RESULTS: Results: It was determined that the irisin level of Brucella patients was statistically significantly higher than the control group (p <0.05). It was determined that there is a negative correlation between irisin level and CRP and sedimentation level in Brucella patients.
DISCUSSION AND CONCLUSION: Conclusion: In Brucella patients, the higher irisin level than the control group showed a negative correlation with CRP and sedimentation levels, which are an infection diagnosis criteria; It suggests that the level of irisin can be considered as a supportive diagnostic marker in these patients. Further studies are needed to evaluate irisin hormone as a supportive diagnostic criterion.

24.The types of urodynamic detrusor overactivity and its relationship with neurological diseases. 10-years follow-up of 1000 invasive urodynamic studies
Alkan Çubuk, Ahmet ŞAHAN, Orkunt Özkaptan, Berkan Simsek, Muhammed Sulukaya, Fatih Tarhan
doi: 10.5505/ejm.2021.92678  Pages 139 - 144
INTRODUCTION: The aim of this study is to compare detrusor overactivity (DO) subtypes namely terminal (TDO) and phasic (PDO) in terms of frequency, etiological reasons, urodynamic findings and relationships with neurological diseases.
METHODS: Patients’ characteristics including age, gender, neurological diseases, were noted. Bladder volume on the first desire to voiding (FSD), the strong desire to voiding (SDV), maximum bladder capacity (MBC), bladder compliance (BC), presence and type of DO, and amplitude of DO (Ad) were also noted during the IUDS. Patients with TDO and PDO were compared in terms of patient characteristics, urodynamic parameters, and neurological diseases.
RESULTS: 1018 patients were enrolled in the study. Neurological disease was noted in 180 patients; spinal cord trauma (SCT): 46, Alzheimer Disease (AD): 8, Parkinson’s Disease (PD): 12, spina bifida (SB): 21, epilepsy (ED): 18, cerebrovascular disease (CVD): 20 and Multiple Sclerosis (MS): 55. Urodynamic DO was observed in 882 patients (neurogenic-DO: 149 and idiopathic-DO: 733), (PDO: 837, TDO: 45). A significant difference was observed between the groups regarding the FSD, MBC and Ad (p=0.032, p=0.049 and p=0.001 respectively). However, no difference was observed in BC (p=0.510). The incidence of TDO and PDO was 6% and 5% for neurogenic-DO and 94% and 95% for the idiopathic-DO, respectively (p=0.327). Among the neurogenic diseases only patients with SCT had significant differences regarding type of DO (TDO 11.1%, PDO 3.1%) (p= 0.04).

DISCUSSION AND CONCLUSION: Neurogenic diseases are not a significant risk factor for TDO. Spinal cord trauma İs associated with higher rates of TDO compare to other neurogenic diseases.

25.Evaluation of Changes in the Smoking Habits of Patients with Coronavirus Disease-19
Derya Yenibertiz, Berna Akıncı Özyurek, Tijen Şengezer, Mehmet Enes Gökler, Gizem Söğütlük Dığrak, Filiz Koç
doi: 10.5505/ejm.2021.62681  Pages 145 - 150
INTRODUCTION: The purpose of our study was to determine the changes in the smoking habits of active smokers hospitalized with Coronavirus disease-19 (Covid-19).

METHODS: We conducted a single-center, retrospective research on smokers hospitalized with Covid-19 between March 2020 and June 2020. A total of 105 patients were included in the study. The age, gender, comorbidities, cigarette pack per year, PCR test results of the patients were recorded from the patient files. Patients were approached by telephone and a questionnaire was applied to them to evaluate smoking habits following discharge.

RESULTS: A total of 105 patients participated in the study. 42 (40.0%) were female and the mean age of the patients was 39.80 ± 12.66 (width, 16-69) years. Patients smoked 14.51 ±13.88 packs of cigarettes a year on average. Of the patients, 13.33% quit smoking. In our study, it was determined that after having Covid-19, 86.66% (n: 91) of the patients continued to smoke. Of those who did not quit smoking, 53.8% stated that they reduced smoking compared to the past, 76.9% thought to quit smoking, and 48.4% said they needed professional support to quit smoking. In addition, 38.5% of those who didn’t quit smoking stated that they believed they were caught Covid-19 due to smoking.

DISCUSSION AND CONCLUSION: Raising awareness that quitting smoking reduces the risks and complications of Covid-19 and activating new smoking cessation programs may help individuals to quit smoking during the pandemic.

26.Relationship between ocular pseudoexfoliation and sensorineural hearing loss
Serek Tekin, Muhammed Batur, Ufuk Düzenli, Erbil Seven, Muhammet Derda Ozer
doi: 10.5505/ejm.2021.57873  Pages 151 - 156
INTRODUCTION: The purpose of this study is to evaluate the air and bone conductance rates in audiogram between healthy individuals and the patients having pseudoexfoliation (PEX).
METHODS: Patients with evidence of ocular PEX and controls were included in the study. Air conduction hearing thresholds (minimal perceptible sounds) were determined at frequencies of 250, 500, 1000, 2000, 4000, 6000, 8000 Hz and bone conduction hearing thresholds were determined at frequencies of 500, 1000, 2000, 4000 Hz for each ear. At these frequencies, air and bone conductance rates in audiogram were measured for patients with PEX and control group to analyze the relation between conductance rates and PEX cases.
RESULTS: Eighty six participants were enrolled in this case-control study, in which 40 of them having PEX. The acquired results showed that the PEX group displayed significantly higher hearing tresholds in air conductance compared with control subjects at frequencies of 250, 500, 1000, 2000, 4000 Hz, but not at frequencies of 6000, 8000 Hz. Similar results were obtained in bone conduction thresholds as well, in terms of the tendency of decreasing significance level between the groups in higher frequencies.
DISCUSSION AND CONCLUSION: In our study, we have shown that there is a statistically significant sensorineural hearing loss in PEX patients comparing age control subjects. These findings are more significant in lower frequencies, and the significance level is decreased toward the higher frequencies. Based on these findings, we speculate that endolymphatic pressure increase could have a role in the pathogenesis of PEX related sensorineural hearing loss.

27.Effects of Parenteral Glutamine Supplementation on Endocan Levels in Septic Patients
Basak Kilic, Hulya Cicek, ayşe özlem mete, Suleyman Ganidagli, Berna KAYA UGUR
doi: 10.5505/ejm.2021.25986  Pages 157 - 164
INTRODUCTION: The purpose of this study was to investigate the effect of parenteral Glutamine (Gln) supplementation on Endocan levels in patients with sepsis receiving parenteral nutrition.
METHODS: A total of 60 patients with a diagnosis of sepsis were enrolled to the study. Patients were randomly divided into two groups to receive either standard parenteral nutrition or standard parenteral nutrition plus the parenteral dipeptide Gln-Ala. The Gln-Ala dipeptide dosage was calculated to be 0.35 mg / kg. Demographic data, CRP, ESR, lactate, WBC, Endocan serum levels, APACHE II scores at admission to ICU, and SOFA scores at day 0, 3rd and 7th days were all recorded. The outcomes of the patients were also recorded after 28-day follow up.
RESULTS: There was no statistically significant difference between the Endocan values of patients receiving parenteral dipeptide Gln-Ala plus the standard parenteral nutrition vs standard parenteral nutrition. Also, there was no significant difference in mortality and septic shock development rates between the two groups.
DISCUSSION AND CONCLUSION: According to our results, there was not a significant difference regarding outcomes of the patients in both study groups, including mortality rates and there was no beneficial effect of indiscriminate GLN supplementation. Further prospective studies with larger sample size are needed in order to make conclusive comments that there is no beneficial effect of administering GLN.

28.Low superoxide dismutase and catalase is associated with malondialdehyde and ischemia modified albumin in patients with non-ST elevated myocardial infarction (NSTEMI)
Nesim Aladağ, Abdulcebbar Şipal
doi: 10.5505/ejm.2021.79577  Pages 165 - 170
INTRODUCTION: Non-ST elevated myocardial infarction (NSTEMI)) diagnosis is difficult when the electrocardiography (ECG) normal and troponin parameters are slightly higher than the normal reference range. This study aimed to assess the IMA (ischemia modified albumin), MDA (malondialdehyde), SOD (superoxide dismutase), and catalase in patients with NSTEMI.
METHODS: The present study included 55 patients with NSTEMI and 55 healthy subjects prospectively. IMA, MDA, SOD, and catalase levels were measured from venous blood obtained from each patient within twelve hours after the onset of symptoms. Differences between the two groups were evaluated with Student's unpaired t-test for parameters with a normal distribution.
RESULTS: IMA (3.14 ± 0.06 vs. 1.49 ± 0.03) and MDA (3.14 ± 0.06 vs. 1.49 ± 0.03) were higher, and SOD (1.10 ± 0.03 vs. 2.31 ± 0.02) and catalase (0.54 ± 0.02) vs. 0.22 ± 0.02) were lower in NSTEMI patients than control subjects. There was a significant correlation among IMA, MDA, SOD and catalase.
DISCUSSION AND CONCLUSION: Our data reveal that levels of MDA and IMA were increased, and SOD and catalase levels were decreased significantly in patients with NSTEMI. Blood concentrations of oxidant and antioxidant parameters could assess the oxidative state in patients with NSTEMI.

29.The Role of Peripheral Blood Inflammatory Markers in the Staging of Breast Cancer
Fevzi Coskun Sokmen, Cengiz Karaçin
doi: 10.5505/ejm.2021.71542  Pages 171 - 174
INTRODUCTION: This study aims to evaluate the importance of neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII) in the staging of breast cancer.
METHODS: One-hundred patients with breast cancer between January 2005 and December 2019 were reviewed retrospectively. Clinical and demographic data of patients were reviewed from the hospital records. Age, gender, pre-treatment complete blood count results and stages were analyzed from patient files.
RESULTS: The median NLR, PLR, and SII values of the T3 stage were higher than the T1 and T2 stages. While there was no difference between the groups according to the N stage, a difference was found between the peripheral blood inflammatory markers of Stage I, II, and III groups. The median NLR, PLR, and SII values of stage III were higher than the stage II and III.
DISCUSSION AND CONCLUSION: As a result, NLR, PLR, LMR, and SII may be valuable in breast cancer staging.

30.Evaluation of Peripartum Hysterectomy; Ten Years of Experience of a Tertiary Center
Deniz Dirik, erbil karaman, Tuba YANGILAR OKYAY, Gokce Naz Kucukbas, ONUR KARAASLAN, ismet alkış, ABDULAZİZ GÜL, hanım güler şahin, Ali Kolusarı
doi: 10.5505/ejm.2021.02438  Pages 175 - 182
INTRODUCTION: The objective of this study is to assess the 10-year incidence of peripartum hysterectomy that was performed in the province of Van, Turkey, as well as its clinical results
METHODS: In this study, we retrospectively examined all patients who underwent peripartum hysterectomy, which was performed at Van Yuzuncu Yil University Dursun Odabas Medical Center between 2010 and 2020. 99 patients who underwent hysterectomy due to severe bleeding, which could not be stopped despite conservative treatments within 24 hours following the delivery, were included in the study.
RESULTS: The overall rate of peripartum hysterectomy was 99 of 22242 or 4.4 per 1,000 deliveries. The mean maternal age was 31.98 ± 5.41 years. The most common indications for peripartum hysterectomy are placental adhesion disorders (70.7%), uterine atony (25.2%), and uterine rupture (4%).
DISCUSSION AND CONCLUSION: Ultimately, the most common indication for peripartum hysterectomy is placental adhesion disorders. The rise in the number of cesarean section might have increased the incidence of placental adhesion disorders. Thus, patients should be provided with healthcare in centers that have adequate equipment and staff.

31.Treatment of a Rare Intramedullary Primary Spinal Glioblastoma Multiforme Lesion in an Adult Patient
Selahattin Menteş, Feryal Karaca, Ali Arslan, Muhammet Ahmet Güldür, Berna Bozkurt Duman
doi: 10.5505/ejm.2021.82612  Pages 183 - 187
Primary spinal cord tumors represent 2%–10% of all central nervous system tumors and mainly comprise astrocytoma, ependymoma, ganglioglioma, oligodendroglioma and subependymoma. Only 1%–3% of all spinal cord tumors show primary glioblastoma multiforme pathology.Spinal glioblastoma multiforme was diagnosed as a result of MRI findings of the patient (The thoracic spinal MR revealed an intramedullary nodular expansile lesion), who had numbness in lower extremities. Maximum safe resection was performed our patient. The lesion reported as GBM. Adjuvant radiotherapy and chemotherapy including temozolomide was applied subsequently. The primary treatment of spinal glioblastoma multiforme includes surgery, radiotherapy and chemotherapy. Despite multidisciplinary approaches available to treat spinal glioblastoma multiforme, the prognosis remains poor, with survival rates of 10–12 months. Total resection is nevertheless the main therapy for spinal glioblastoma multiforme in spite of current developments. Although spinal intramedullary glioblastoma multiforme particularly is quite rare, its treatment is very difficult.

32.A rare case of uterine rupture diagnosed in the late postpartum period
Onur Karaaslan, Ali Kolusarı, Pinar Turgut, Deniz Dirik, mehmet sakinci, erbil karaman
doi: 10.5505/ejm.2021.58234  Pages 188 - 190
Obstetric hemorrhages are still the most common cause of maternal mortality worldwide (1). Uterine rupture, which could be included among the causes of postpartum bleeding, results in serious mortality and morbidity. Although scarless uterine rupture is extremely rare, it might be seen with an approximate frequency of 1/5700 - 1/20000 in pregnancies (2-5). In general, it is diagnosed and treated in the early postpartum period as it usually presents symptoms at this very stage. A case of uterine rupture that was diagnosed and treated on the 28th postpartum day was discussed in this case.

33.A cardiac asystole case presented with seizure-like clinic
Hikmet Saçmacı, Vahit Demir, Tülin Aktürk, Nermin Tanık, Emine MEŞE, Yasar Turan
doi: 10.5505/ejm.2021.82687  Pages 191 - 193
The differential diagnosis of syncope and epilepsy appears as a very common entity in the emergency department. Conditions such as myoclonus or secondary seizure mimics may occur after cerebral hypoperfusion due to cardiac pathologies such as arrhythmia, asystole, atrioventricular block. Especially in non-recurrent interictal electrocardiography (EKG), pathologies that may be meaningful at all times may not be seen, and patients may be mistakenly referred to neurology as epilepsy. We wanted to present this case for the appropriate and necessary interventions to be carried out before it is too late in order not to increase potential mortality.

34.The effect of obesity on the outcomes of laparoscopic hysterectomy: a literature overview
Abdallah Chaar, Aline Khazzaka, Moussa AL-Alak, Michele Fichera, Antonio Schiattarella, Gaetano Riemma, Zaki Sleiman
doi: 10.5505/ejm.2021.79553  Pages 194 - 198
In the last decades, obesity has reached epidemic proportions in the world (40% in certain countries). It predisposes to many diseases and morbidities in both males and females. In the latter, obesity predisposes to multiple gynecological conditions requiring hysterectomy such as endometrial cancer. Over the years, technical improvements have allowed surgeons to perform a hysterectomy in a minimally invasive approach (laparoscopically) with clear benefits, safety and better outcomes compared to the abdominal approach. The aim of this review is to provide an overview of the effects of obesity on the outcomes of laparoscopic hysterectomy performed both for benign and malignant gynecological pathologies. We performed literature research on the electronic database PubMed from the database inception through June 29, 2019. Obesity does not seem to increase adverse outcomes in laparoscopic hysterectomy as compared to the increased postoperative complication rate after open surgery. Therefore, laparoscopic hysterectomy can be performed safely in this population and represent the approach of choice.

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