ISSN 1301 - 0883 | E-ISSN: 2687-5101
Eastern Journal Of Medicine - Eastern J Med: 26 (2)
Volume: 26  Issue: 2 - 2021
ORIGINAL ARTICLE
1.Diagnostic value of neutrophil to lymphocyte ratio for assessing the disease severity in covid-19 patients
Ngakan Ketut Wira Suastika, Ketut Suega
doi: 10.5505/ejm.2021.35761  Pages 199 - 203
INTRODUCTION: Deterioration of the clinical condition in corona virus disease 2019 (Covid-19) patients can be rapid and unpredictable. A sensitive biomarker is required to assess the disease severity to anticipate these condition. Neutrophil to lymphocyte ratio (NLR) is easily calculated from a complete blood count parameters, so it can be used as a biomarker to assess disease severity in Covid-19 patients.
METHODS: Patients characteristic and NLR were obtained from patients confirmed by Covid-19 at Udayana University Hospital, Bali, Indonesia from April to September 2020. The Mann Whitney U test is used to determine the difference of NLR in severe and non-severe cases of Covid-19. The receiver operating characteristic curve (ROC) is used to determine the optimal cut-off value, sensitivity, specificity, and area under curve (AUC) of the NLR in assessing disease severity in Covid-19 patients. Binary logistic regression analysis was performed to determine the effect of age, comorbidities and other significant variables that have a significant effect on disease severity.
RESULTS: A total of 411 patients were included in this study. We found a significant difference of NLR between severe and non-severe cases of Covid-19 (p < 0.001). We found an optimal NLR cut-off value of 3.0, with 81.4% sensitivity, 81.2% specificity, and area under curve of 0.886 (95% confidence interval (CI) 0.848 – 0.923; p < 0.001).
DISCUSSION AND CONCLUSION: Neutrophil to lymphocyte ratio is a biomarker that has a high diagnostic value for assessing the disease severity in Covid-19 patients

2.The role of Human Cytomegalovirus (HCMV) in Patients with Active Coeliac Disease (CD)
Inas K. Sharquie, Shatha F. Abdullah, Aytan M. AL Bayati
doi: 10.5505/ejm.2021.28009  Pages 204 - 209
INTRODUCTION: Researchers have recently increased their focus on the link between autoimmune diseases and infections. Most of the recent research indicates that silent HCMV, may have diverse roles in the initiation, development, and exacerbation of autoimmune diseases, such as CD and inflammatory bowel disease. The aim of this study is to evaluate the role of HCMV infection in Iraqi patients with CD.
METHODS: Serum samples were obtained from 60 patients with CD, and from 60 healthy subjects (the control group). The ELISA technique (enzyme-linked immunosorbent assay) was used to determine the Anti-Transglutaminase screen, Anti-Gliadin IgA (secretory immunoglobulin), and Anti-Gliadin IgG (immunoglobulin G), as well as the HCMV IgM (immunoglobulin M) and IgG levels in the serum samples.
RESULTS: Highly significantly increased mean levels of serum Anti- transglutaminase,serum Anti-Gliadin A and serum Anti-Gliadin G(P = 0.00, P < 0.01) in active CD patients from the healthy controls. A non-significant difference (P > 0.05) of serum Anti-HCMV IgM, with negative predominant, both in CD patients and in the control group (Positive 2 (3.3%), Negative 58 (96.7%)), with (P = 1.00, P > 0.05). Parallel results of serum Anti-HCMV IgG, with positive predominant, both in CD patients (Positive 46, (76.7%), Negative 14 (23.3%)) and in the control group (Positive 47 (78.3%), Negative 13 (21.7%)), with (P = 0.827, P > 0.05).
DISCUSSION AND CONCLUSION: Detection of Anti-Gliadin A/G, by a rapid non-invasive test, is helpful for an easy diagnosis of CD, and for screening family members. Infection with HCMV does not trigger the development of CD.

3.Impact of YouTube platform in the Realm of Interventional Cardiology Techniques Such as: Double Kissing Crush
Flora Ozkalaycı, Emrah Erdogan
doi: 10.5505/ejm.2021.58265  Pages 210 - 217
INTRODUCTION: Internet has become a widely used resource for obtaining medical information.
However, the quality of information on online platforms is still debated. Our goal is to evaluate YouTube video platform regarding its’ usefulness and reliability in terms of teaching the steps of Double kissing crush (DK-crush).

METHODS: “DK-crush”, “DK-crush stenting technique”,“DK-crush technique” were the key words queried on the search bar of http: //www.YouTube.com. All the videos were screened and those videos in English and Turkish and those videos without voice yet involves the explanation of DK-Crush technique were included. Each video was scored according to the reference article. One point was given for each step shown and 0 for those steps that are not demonstrated, "total DK-crush step score" (TDCS) was calculated for each video. HONcode, JAMA and modified DISCERN scores were calculated.
RESULTS: A total of 26 videos were included in the analysis. Most videos met all the essential criteria and have certain amount of correlation with the scoring systems. Mild correlation between modified Discern score and total DK-Crush step score was found. HONcode score and TDCS were likely to be higher in the videos downloaded or presented by individuals with academic degrees.
DISCUSSION AND CONCLUSION: Those videos in which DK-Crush technique was performed and presented by those with academic degrees are likely to be more instructive. Most videos were compatible in terms of fitting the referential procedural steps of DK-crush. Among all videos HONcode and JAMA has no correlation with TDCS, yet modified Discern has mild correlation with total DK-crush step score.

4.Premenarchal ovarian torsion: ten years of experience of a tertiary center
Deniz Dirik, Burhan Beger, Tuba YANGILAR OKYAY, Lokman Soysal, Erbil Karaman
doi: 10.5505/ejm.2021.45220  Pages 218 - 223
INTRODUCTION: Ovarian torsion is a surgical emergency, as it could lead to tissue necrosis and loss of fertility in the long term when diagnosis and intervention are delayed. In this study, the effectiveness of sonographic ovarian appearance in the decision of surgery and the clinical value of ovarian size in the diagnosis of torsion were investigated in premenarchal girls whose diagnosis of ovarian torsion was surgically verified
METHODS: A retrospective cohort study design was utilized. Demographic characteristics, physical examination findings, laboratory findings, ultrasonography findings, operation records, pathology reports of 20 premenarchal girls who were admitted to Van Yuzuncu Yil University Dursun Odabas Medical Center Emergency Service between 2010-2020 and who were surgically confirmed to have torsion scanned and recorded.
RESULTS: The cases included in the study were divided into two groups: nine patients with normal ovarian torsion (group1) and eleven patients with mass or cystic ovarian torsion (group2). Regarding the duration passed between admission to the emergency department and undergoing surgery, the time was shorter in group2 compared to group1 (13.54±6.02 hours and 77.0±101.86 hours respectively; p=0.053). Conservative surgical treatment was realized in all patients in Group1 (9/9; 100%) and 7 patients in Group2 (7/11; 63.6%); patients in Group2 underwent cystectomy. Furthermore, oophorectomy was performed on 4 patients in Group2. In terms of the torsion side, right-sided torsion predominance was detected in the ovary in both groups (6 patients;66.6%) in Group1 and 7 patients (63.6%) in Group2.
DISCUSSION AND CONCLUSION: Ovarian volume and Doppler flow could be considered as a potential predictive variable for ovarian torsion

5.The Prognostic Role of AB0 Blood Groups In Pancreas Cancer
Sema Turker, Ebru Cilbir, Deniz Can Güven, Hayriye Şahinli, Cengiz Karaçin, Şuayib Yalçın
doi: 10.5505/ejm.2021.03360  Pages 224 - 227
INTRODUCTION: Previous studies have reported the relationship between the risk of developing pancreatic cancer and blood groups. There have been conflicting results with respect to the prognostic significance of the AB0 blood group in pancreas cancer. We aimed to evaluate the impacts of blood groups on prognosis in our pancreatic cancer patient population.
METHODS: Patients diagnosed with pancreas cancer between January 2014 and December 2018 were analyzed retrospectively. We analyzed the prognostic significance of AB0 blood groups for PDAC(pancreatic ductal adenocarcinoma) patients based on stages of the disease (early, locally advanced, and metastatic).
RESULTS: We evaluated 366 patients diagnosed with pancreatic cancer.The median age of the patients was 65 (27-83). The median overall survival (OS) was 11 months (95% CI 9.49-12.50 months). Median survival was as follows: 13 months for blood group A (95% Cl, 10.59-15.41), 11 months for blood group B (95% Cl, 8.80-13.19),12 months for blood group AB (95% CI 6.63-17.36), and eight months for blood group 0 (95% Cl, 5.43-10.56) (p = 0.171). 304 (83.3%) of the patients were not alive at the end of the study. We concluded that the survival of those with 0 blood group was shorter in patients with metastatic pancreatic cancer (p <0.001), taking into account the relationship between stages and blood groups.
DISCUSSION AND CONCLUSION: There was no prognostic effect of AB0 blood groups on pancreatic cancer in our patient group. However, we found that blood group 0 negatively affected OS in metastatic pancreas cancer patients, based on the subgroup analysis according to stages.

6.The levels of CRP in non-complicated patients with total laparoscopic hysterectomy and its role in predicting vaginal cuff hematoma
Pınar Kadiroğulları, Huseyin Kiyak, Erkan Şimşek, Emine Karabuk, Kerem Doga Seckin
doi: 10.5505/ejm.2021.26779  Pages 228 - 235
INTRODUCTION: We aimed to evaluate the mean C-reactive protein (CRP) levels in the patients who did not have any complications other than cuff hematoma after total laparoscopic hysterectomy (TLH) in order to determine the CRP levels to predict the potential to develop postoperative cuff hematoma.
METHODS: The study was designed prospectively. The CRP levels, white blood cell (WBC) count, and haemoglobin values (Hb) of 106 patients, who underwent TLH for benign reasons, were measured preoperatively and on the days 1,2 and 7 postoperatively. The laboratory parameters of the patients who developed postoperative cuff hematoma were compared to those of the patients, who did not have any complications.
RESULTS: Of a total of 106 patients who underwent a laparoscopic hysterectomy, there were no differences in the demographic characteristics between the groups. The duration of operation was significantly longer in the group of patients with cuff hematoma (p<0.05). In the hematoma group, the level of CRP was statistically significantly different on POD7 (p<0.05).
DISCUSSION AND CONCLUSION: We are of the opinion that CRP levels below the cut-off value of 12.5 mg/L measured on the postoperative 7th day indicate tissue damage secondary to surgical trauma, while care should be exercised to detect any possible complications in the patients with higher CRP levels above this value. We suggest that routine follow-up of the CRP levels may provide a cautious approach after a laparoscopic hysterectomy, allowing for early diagnosis and treatment for potentially developing complications including cuff hematoma and postoperative infections.


7.Drug-drug interactions in the risky population: elderly, urological patients admitted to the intensive care unit
Muhammet serdar buğday, Ersoy öksüz
doi: 10.5505/ejm.2021.04864  Pages 236 - 241
INTRODUCTION: Drug drug interactions (DDI) are a common health problem. It causes more serious side effects as well as more common in patients with multiple diseases, especially in the elderly.it was aimed to examine the frequency of DDI in elderly patients treated at ICU due to urological diseases.
METHODS: This retrospective study was performed in hospitalized patients over age 85 because of urologic diseases in the intensive care unit. DDI was evaluated Rx mediapharma and lexi interact programs.
RESULTS: A total of 91 different medications were administered to 100 patients. 87 of the patients had DDI and the total number of DDI was 550. When all interactions were examined, DDI was most likely to cause side effects on the cardiovascular system such as arrhythmia, hypotension or hypertension (40%). The drugs that participated most in DDI were furosemide (n: 87), and enoxaparin sodium (n: 74) was acetyl salicylic acid (n: 45).
DISCUSSION AND CONCLUSION: The results of our study show that DDI is seen quite frequently in elderly patients hospitalized due to primary urological diseases in the ICU. The most common ADR in these patients is bleeding, changes in the therapeutic levels of drugs and hyperkalaemia.

8.Shaping efficiency of WaveOne Gold and One Curve in simulated J-shaped root canals
Ayfer Atav Ateş, Burçin Arıcan
doi: 10.5505/ejm.2021.04710  Pages 242 - 247
INTRODUCTION: To evaluate the shaping efficiency of WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland) and One Curve (OC; Micro-Mega, Besancon, France) in J-shaped resin blocks.
METHODS: Forty simulated J-shaped root canals with 0.15 mm apical diameters and 2 % taper were divided into two groups (n=20) as follows; WOGG/WOG (25.07) group (glide path was created with WaveOne Gold Glider) and OneG/OC (25.06) (glide path was created with One G) group. The pre- and post-instrumentation images were taken, and the transportation value (TV), centering ability (CA) and the total amount of resin removed (TRR) were calculated by using the superimposition of the images. These parameters calculated with Image J Software Program based on 18 reference points with 1-mm intervals of the canal. The data were analyzed with Kruskal-Wallis and than Dunn's multiple comparison tests. The significance level was set at P ≤.05.
RESULTS: There was no statistically significant difference among OG/OC and WOG/WOGG groups' apical (points 1-3), middle (points 4-6), and coronal (points 7-9) sections in terms of both TV and TRR. The centering ability of the instruments was decreased in the curvature part (middle section) of the canals. While WOG group showed better centering ability at points 6- 7, OC group exhibited better result at point 2.
DISCUSSION AND CONCLUSION: Within the limits of this study, WaveOne Gold and One Curve, which are single-file systems, could be used safely in J-shaped root canals with their glide path files. Further investigations on the extracted tooth and clinical conditions are needed.

9.Are Appendix Weight and Length Related to Inflammatory Parameters and Alvarado Score in Acute Appendicitis?
Remzi KIZILTAN, iskan ÇALLI, Ali Riza KARAYIL, ABBAS ARAS, Çetin KOTAN
doi: 10.5505/ejm.2021.60566  Pages 248 - 254
INTRODUCTION: We aimed to investigate if appendix weight and length affects clinical presentation.
METHODS: This study prospectively enrolled 50 patients who were operated with the diagnosis of acute appendicitis. The appendix material was weighed in milligram. Then, the diameter of the appendix was measured in millimeter from its widest point using a surgical ruler. The length of the appendix was measured in millimeter using the same ruler. As appendix length may have influenced its weight, weight in milligram per millimeter was used for standardization. The obtained value was expressed as the unit weight (mg/mm).
In order to make a comparison by the obtained unit weight, the patients were divided into two groups.

RESULTS: Among 50 patients enrolled in the present study, 24 (48%) were men and 26 (52%) were women. The mean CRP level of the study population was 29.4 (3-160). The mean appendix diameter measured with ultrasonography at the preoperative period was 8.49 mm (range 6-13 mm), and the mean appendix diameter measured with a ruler at the postoperative period was 10.3 mm (range 8-20 mm). There was approximately a 2 mm difference between these measurements which were made from the widest points.
DISCUSSION AND CONCLUSION: In conclusion, it was found that the unit weight of the appendix increased proportionally to the CRP level. The appendix would be more edematous, have a greater diameter and weight, and be more likely to perforate in patients with a higher unit weight.

10.The effect of the stay-at-home policy on ophthalmology outpatient clinic applications during the COVID-19 pandemic: A comparative study
Ali Ceyhun Gedik, Muhammet Derda Ozer
doi: 10.5505/ejm.2021.81488  Pages 255 - 260
INTRODUCTION: To report the effects of the stay-at-home policy on requests for ophthalmology outpatient clinic visits at a secondary care hospital during the COVID-19 outbreak.
METHODS: March 11, 2020, was the date on which the first confirmed coronavirus case was reported in Turkey and was therefore selected as the boundary date in the design of this study. All applications with urgent and non-urgent complaints were made to a secondary care hospital during the two months duration during the pandemic curfew period in 2020 and the same date interval in 2019 (March 11, 2019 – May 11, 2019) were examined retrospectively using the hospital’s automation system.
RESULTS: Of the patients who participated in the study, 7.6% (n = 512) were aged between 0 and 18 years, 62.2% (n = 4190) were between 18 and 65 years. The number/ratio of patients who visited the hospital during the pandemic period between the ages of 0–18 years and 65 years and older were found to be statistically significantly lower than the non-pandemic period (P < 0.001). The rate of patients who applied to the hospital during the pandemic period with an urgent eye complaint was statistically significantly higher than that of the non-pandemic period (P < 0.001; odds ratio = 3.7).
DISCUSSION AND CONCLUSION: The spectrum of ophthalmic conditions that led individuals to request ophthalmology outpatient clinic visits was similar during both periods; however, certain age groups showed decreased application rates during the pandemic period. The application of conjunctivitis cases significantly increased during the pandemic period.

11.Outcomes Of Splenectomy For Hematologic Diseases - A Single Center Experience
İskan Çallı, FIRAT ASLAN, ÜMİT HALUK İLİKLERDEN, Remzi KIZILTAN, çetin Kotan
doi: 10.5505/ejm.2021.34735  Pages 261 - 264
INTRODUCTION: SUMMARY

Introduction and Aim: Splenectomy is a standard, effective and approved approach to the treatment of patients with failed medical treatment who develop recurrent, refractory or chronic diseases. The leading indications for elective splenectomy are benign and malignant hematologic diseases. We present here the findings of a retrospective analysis of the splenectomies performed in a single center for the treatment of hematologic diseases, and the associated outcomes.


METHODS: Materials and Method: A retrospective examination was made of 64 patients who underwent splenectomy for the treatment of hematologic diseases at our clinic between 2010 and 2018. The patients were assessed for gender, age, hematologic disease, spleen size, presence of hepatomegaly, presence of accessory spleen, type of surgery (laparoscopic or open), wound site infection, preoperative and postoperative platelet counts, intraoperative and/or postoperative blood replacement, and length of hospital stay.


RESULTS: Results: The study sample comprised 23 (36%) male and 41 (64%) female patients, with a mean age of 40.4 years. Of the patients, 51 underwent laparoscopic splenectomy and 13 underwent splenectomy with laparotomy. Of the total, 57 (89%) patients responded fully to the splenectomy, six (9%) patients recorded a partial response and one (2%) patient had no response. Following the splenectomy procedure, one patient developed wound site infection and two patients died due to sepsis.

DISCUSSION AND CONCLUSION: Conclusion: Splenectomy should be considered a good treatment option in hematologic splenic diseases that are resistant to medical treatment, being also associated with low mortality and morbidity.

12.Investigation of the Associations between Posttraumatic Growth, Sleep Quality and Depression Symptoms in Syrian Refugees
Pınar Güzel Özdemir, Umut Kırlı, Mehmet Asoglu
doi: 10.5505/ejm2021.48108  Pages 265 - 272
INTRODUCTION: Multiple traumatic events that refugees experience have different impact on psychological dimensions from deficiency to growth. The aim of the study was to investigate the associations between sleep quality, depression and post-traumatic growth in Syrian refugees.
METHODS: Seventy two Syrian refugees attending to psychiatric outpatient clinic participated in this cross-sectional study. Participants were evaluated with Beck Depression Inventory (BDI), Post-Traumatic Growth Inventory (PTGI) and Pittsburgh Sleep Quality Index (PSQI) via clinical interviews.
RESULTS: All participants reported in various degrees of posttraumatic growth and the mean total PTGI score was 62.30 (SD: 18.25). Exposure to multiple traumas was common (Mean: 4.33, SD: 2.29). There were no significant differences on BDI, PSQI and PTGI scores between genderes. All of PTGI subdomain scores were negatively associated with BDI scores, with larger effect sizes with personal strength (R2: 0.18) and appreciation of life (R2: 0.16). Having no past psychiatric disorder history was significantly associated with PTGI (β = 29.1, p = 0.02). In the path model to predict depression symptom severity in a single model, posttraumatic growth was associated with less severe depression symptoms, and sleep quality mediated the association between depression symptom severity and trauma exposure
DISCUSSION AND CONCLUSION: Syrian refugees in outpatient clinics reported depressive symptomatology and posttraumatic growth after exposure to multiple traumatic events. Results suggest that posttraumatic growth and better sleep quality in refugee populations may index better outcomes of psychological distress.

13.Assessment of Sleep Quality in Patients with Type 2 Diabetes Mellitus: A Case-control Study
Şemsinnur Göçer, Ramazan Önalan, Tekin Yıldırım, Yunus Hacımusalar
doi: 10.5505/ejm.2021.79653  Pages 273 - 279
INTRODUCTION: Introduction: Sleep disorders increase risk for impaired glucose tolerance, insulin resistance, type 2 diabetes mellitus through changes in hormone release involved in energy homeostasis; on the other hand, complications occurring in patients with type 2 diabetes mellitus also lead sleep disorders. In the present study, it was aimed to assess sleep quality in patients with type 2 diabetes mellitus.

METHODS: Methods: The study included 40 patients (aged 18-65 years) diagnosed as type 2 diabetes mellitus (21 women; 19 men) and 42 healthy controls (26 women; 16 men). The data were collected using demographic data sheet, Pittsburgh Sleep Quality Index (PSQI) in this case-control study.

RESULTS: Results: In patients with type 2 diabetes mellitus, total PSQI score and component scores for sleep duration, sleep disturbance, use of sleep medication and daytime dysfunction were significantly higher when compared to controls. In addition, the proportion of patients with poor sleep quality was significantly higher in the patients with type 2 diabetes mellitus compared to controls (82.5% vs. 59.5%; x2= 5.224, p=0.022). The age and BMI were higher in patients with type 2 diabetes mellitus compared to controls.


DISCUSSION AND CONCLUSION: Discussion and Conclusion: It was found that sleep quality was poorer in patients with type 2 diabetes mellitus. It is important to identify problems that may result from sleep disorders and adverse effects of type 2 diabetes mellitus on sleep quality. To achieve glucose control in patients with type 2 diabetes mellitus, it is essential to improve sleep quality in addition to current approaches used in clinical practice.

14.An Experimental Study That Investigate Effects of Atreleuton in Metabolic Syndrome
Tevfik Noyan, Sertaç Burhanettin Ayhan
doi: 10.5505/ejm.2021.65477  Pages 280 - 285
INTRODUCTION: The inflammation, LDL oxidation, and insulin resistance play an important role in the development of metabolic syndrome (MetS). This study aims to investigate the effects of atreleuton on serum lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), leukotriene B4 (LTB-4), insulin, and adipose tissue glucose transporter 4 (GLUT-4) levels in an experimental MetS model in rats.
METHODS: The rats were randomly divided into 3 groups: Group 1 (control, n = 7); Group 2 (MetS group, n = 8), Group 3 (MetS + atreleuton administered group, atreleuton (25 mg/kg/day) was administrated orally by gavage during the last 4 weeks of the experiment). MetS was created by feeding rats with high fructose and fat diet for 10 weeks in groups 2 and 3. Measurements of test parameters were made by ELISA method.
RESULTS: The atreleuton caused a significant decrease in levels of serum LTB-4, LOX-1, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR), while significantly increase on quantitative insulin sensitivity check index (QUICKI). However, atreleuton did not cause a significant change in tissue GLUT-4 level.
DISCUSSION AND CONCLUSION: The results of this study suggest that atrelutone may be a protective agent against MetS complications by decreasing the levels of LTB-4 and LOX-1 that play an important role in MetS pathogenesis. Besides, the effect of atreleuton on the tissue GLUT-4 pathway needs to be supported by further studies.

15.Effects of testicular volume, follicle stimulating hormone, luteinizing hormone and presence of varicocele on successful sperm retrieval in non-obstructive azoospermia
İrfan Şafak Barlas, Lütfi Tunç, Ahmet Emin Doğan, Uğur Coşar, Ender Cem Bulut
doi: 10.5505/ejm.2021.05924  Pages 286 - 293
INTRODUCTION: The aim of the study was to evaluate the relation between the probability of positive sperm extraction with Testicular Sperm Extraction(TESE) and the clinical, laboratory and demographic features in a series of non-obstructive azoospermia(NOA) infertility patients who consulted to Gazi University School of Medicine, Urology Department in order to determine and inform couples who could not succeed and thus avoid unnecessary treatment.
METHODS: Sixty-four patients with non-obstructive azoospermia were enrolled to the study. Demographical features and previous varicocele operation history were noted. In all cases serum levels of Follicle Stimulating Hormone(FSH), Luteinizing Hormone(LH), genetic analysis and bilateral testicular volume were determined to find the correlation between probability of positive sperm extraction with TESE.
RESULTS: The incidence of NOA among all infertile men was 15.1%. TESE success rate in NOA was 29,6%. There were significant differences in FSH levels(p<0,001), LH levels(p=0,006), right testicular volume(p<0,001), and left testicular volume(p<0,001). The results were evaluated by ROC analysis. Success rate of TESE was decreased when FSH>8,9mIU/ml(sensitivity80%, specifity68%), LH>4,25mIU/ml(sensitivity76%, specifity53%), right testicular volume<8,5ml(sensitivity84%, specifity56%) and left testicular volume<7,25ml(sensitivity84%, specifity56%) in NOA. As there was no paramater with one hundred percent sensitivity, probability of positive sperm retrieval would stil exist in these patients.
DISCUSSION AND CONCLUSION: In NOA cases increased FSH and LH levels, decreased testis volumes have negative effect at sperm retrieval. Chromosomal damages like Klinefelter Syndrome also decrease success rate. Determining groups with poor prognosis, may help prevention of patients from unnecessary processes, risks and costs.

16.The effects of sugammadex on coagulation in pregnant rats
Mehmet Emin KESKİN, HAVVA SAYHAN KAPLAN, NURÇIN GÜLHAS, YASEMIN BAYRAM, yildiray basbugan
doi: 10.5505/ejm.2021.34711  Pages 294 - 298
INTRODUCTION: Some studies have reported that sugammadex affects coagulation parameters. However, the effects of sugammadex on coagulation in pregnant women have not been adequately evaluated. This study investigated the effects of sugammadex administration on routine coagulation tests and levels of coagulation factors in pregnant rats.
METHODS: After ethics committee approval (2019/06), 24 female Wistar albino rats (n = 12; 19–20 days of gestation; weight 230–380 g) were randomly divided into four groups: control (n = 6), sugammadex (n = 6), pregnant (n = 6), and pregnant sugammadex (n = 6). Ketamine (50 mg/kg) and xylazine (10 mg/kg) were administered intraperitoneally to all groups. Saline (SF) (1 ml/kg) was administered to the control and pregnant groups. Sugammadex was administered to the sugammadex and pregnant sugammadex groups at a dose of 16 mg/kg. Blood samples were collected at 30 min after SF and sugammadex administration in all rats. The levels of PT, INR, aPTT, fibrinogen and coagulation factors were measured in plasma obtained from blood samples. All animals were sacrificed by cervical dislocation after the procedure.
RESULTS: The mean weights of the rats were significantly higher in the pregnant groups (pregnant and pregnant sugammadex groups) than in the non-pregnant groups (control and sugammadex groups). The mean PT and INR values were significantly lower in the pregnant than non-pregnant groups. No significant differences were observed in any of the parameters evaluated between the sugammadex- and SF-administered groups.
DISCUSSION AND CONCLUSION: Sugammadex administration did not affect routine coagulation tests or the levels of coagulation factors in pregnant rats.



17.Phenotypic and Genotypic Analysis of the Antibiotic Resistance Profiles of Gram Negative Bacteria Isolated from the Blood Culture Samples
Ömer Akgül, Gülhan ARVAS, ALİ KUŞTAN
doi: 10.5505/ejm.2021.03880  Pages 299 - 307
INTRODUCTION: Sepsis, which is common and often lethal, is a serious public health problem. There is consensus that the incidence is increased in patients with sepsis due to an aging population, increased use of immunosuppressive therapy, and high-risk interventions.
METHODS: Seven hundred fifty patients with suspected sepsis hospitalized in intensive care units in the Health Education University Van Training and Research Hospital were evaluated. 750 patients were classified according to their age and sex. Bacteria were isolated from their blood cultures. Biochemical tests such as catalase test, oxidase test and Gram staining were performed. Vitek 2 Compact (Biomerieux, USA) device was used for identification of bacteria and evaluation of the antibiogram test. The blaOXA-48 and blaIMP genes were analyzed by polymerase chain reaction (PCR).
RESULTS: Ten multidrug-resistant bacteria were isolated and identified from patients with sepsis. Of our gram negative bacteria, only 2 K. pneumoniae isolates were found to be blaOXA-48 carriers. No blaIMP gene was found in any of our gram negative bacteria causing sepsis.
DISCUSSION AND CONCLUSION: İdentification of the bacteria causing sepsis in our hospital and determining the antibiotic resistance rates were found quite important. Among the causative agents of bloodstream enfections, effect of the presence of carbapenem, enlarged β-lactamase and multidrug resistance bacteria on human health were found to be very important.

18.Investigation of Corona virus pandemic Indicators of the Countries with Hierarchical Clustering and Multidimensional Scaling
Özlem Bezek Güre, Murat Kayri, Hikmet Şevgin
doi: 10.5505/ejm.2021.72681  Pages 308 - 315
INTRODUCTION: In this study it is aimed to analyze the similarities of 50 countries where coronavirus pandemic, which has been profoundly affecting the whole world socially, psychologically and economically, was mostly seen
METHODS: The similarities of the countries were investigated with Hierarchical Cluster Analysis and Multi-dimensional Scaling Analysis, which are among multivariate statistical analysis techniques in terms of coronavirus pandemic indicators. The variables used in the analysis are death rate, recovery rate, active rate, serious case rate, case rate per 1 million, death rate per 1 million, and test rate per 1 million.
RESULTS: As a result of Hierarchical cluster analysis, the countries were divided into seven clusters. In the two-dimensional projections of Multidimensional Scaling, Kruskal stress statistics was found as 0,00001. According to this, a complete compatibility was found between data distances and configuration distances. Also, the fact that R2 is 1,00000 shows that the model is quite powerful.
DISCUSSION AND CONCLUSION: As a result of the study, the results of both methods were found to be very close to each other. In the same subgroup, Turkey; Peru, Poland, Panama, Romania, Netherlands and Kazakhstan take place. In the study; both developed and underdeveloped countries were found to be in the same cluster. This is a surprising situation. While developed countries are expected to be more effective in combating the epidemic, it was observed that they showed similarities with underdeveloped countries.

19.The Relationship Between Smoking and Gastric Histopathology in Patients Presented to the Emergency Department with Dyspeptic Complaints and Underwent Endoscopic Examination
Mehmet Ali Bilgili
doi: 10.5505/ejm.2021.87487  Pages 316 - 321
INTRODUCTION: Smoking is responsible for the etiology of most malignancies. It also causes pathologies involving the gastrointestinal system (GIS) such as gastroesophageal reflux (GER), peptic ulcer (PU), and malignancy. In our study, we aimed to examine the relationship of histopathological findings and the presence of helicobacter pylori (HP) with smoking in patients, who presented to the emergency department with dyspeptic complaints.
METHODS: A total of 118 patients, who underwent upper GIS endoscopy were included in the study. The patients were grouped as non-smokers, smokers, and ex-smokers. Data on demographic characteristics, smoking habits, alcohol use, endoscopic and histopathological findings were documented. In addition to smoking, the relationship between the number of cigarettes smoked and the time of cessation with HP and histopathological findings were examined
RESULTS: A total of 118 patients, 60 (50.8%) female and 58 (49.2%) male, were included in the study. There were 76 non-smokers, 31 smokers, 11 ex-smokers. The presence of HP and intestinal metaplasia were significantly higher in the group of smokers. The presence of HP and intestinal metaplasia were higher in smokers of 10 years or more compared to the non-smokers. Those who had quit smoking for less than 10 years had a higher rate of the presence of HP and metaplasia compared to the non-smokers.
DISCUSSION AND CONCLUSION: The fact that various histopathological data can be improved by preventing smoking, which is a serious public health problem, highlights the importance of raising awareness on this issue.

20.Athletes´ Heart: QTc Dispersion and Speckle Tracking Echocardiography
Remzi Sarikaya, Dilek Giray
doi: 10.5505/ejm.2021.28034  Pages 322 - 328
INTRODUCTION: The purpose of this study is to evaluate structure and function of the left ventricle by echocardiographic methods and to investigate the relationship between QT and corrected QT dispersion that calculated in 12-lead-electrocardiography.
METHODS: This study included 38 basketball players (17 male / 21 female) and age-sex matched 40 healthy untrained controls. The left ventricle systolic and diastolic functions were evaluated by conventional, Doppler and 2-dimensional speckle tracking echocardiography methods. Electrocardiography was performed to the subjects and QT and corrected QT dispersion were calculated.
RESULTS: Left ventricular internal diameter at end diastole and end systole, and also end diastolic and end systolic volumes were statistically higher in athletes in the M-mode echocardiographic examination (p<0.05). There were no significant differences between the global longitudinal strain values of the groups (p>0.05). The intervals of QT and corrected QT were statistically lower in athletes whereas, dispersions of QT and corrected QT intervals were statistically higher in the athletes (p<0.05). There was a significant positive correlation between the global longitudinal strain values and the corrected QT interval (p=0.043; r=0.494), and negative correlation between dispersions of QT and corrected QT (p=0.001; r=-0.804 and p=0.001; r=-0.764 respectively) in athletes.
DISCUSSION AND CONCLUSION: Calculation of QT and corrected QT dispersion, that is a feasible and simple method, will provide additional information to aid the differential diagnosis of physiological and pathological adaptation especially when there is a significant decrease in strain values of left ventricle.

21.Effectiveness of Hounsfield Unit Values in the Differentiation of Malign and Benign Thyroid Nodules
Fatma Durmaz, Mesut Özgökçe
doi: 10.5505/ejm.2021.36450  Pages 326 - 333
INTRODUCTION: Thyroid nodules are today encountered more frequently due to the advances in imaging methods. Here, we aimed to evaluate the efficacy of computed tomography Hounsfield Unit (HU) values in the differential diagnosis of benign or malignant thyroid nodules.
METHODS: This retrospective study involved 51 patients with thyroid nodules who had thyroid FNAB result and chest CT with or without contrast-enhanced, between January 2018 and September 2020. Circular ROIs (region of interest) were drawn on the section that best demonstrated the thyroid nodule on CT and obtained HU values were averaged. An independent t-test was applied to the HU values for the malign-benign differentiation.
RESULTS: Of the 40 patients who had contrast-enhanced CT, 25 were benign and 15 were malignant. Of the 11 patients who had non-enhanced CT, 6 were benign and 5 were malignant. In contrast-enhanced scans, nodule attenuation was statisticaly significantly higher in malignant nodules (116.26±17.74 HU) when compared with benign nodules (93.84±24.33 HU) (P = 0.004). A ROC analysis revealed an area under the curve of 78.8%. The sensitivity and specificity of the cut-off value of 104.5 for the area under the curve were found to be 80% each. In non-enhanced scans, nodule attenuations were not significantly different in malignant (49±12.14 HU) and benign (67.5±16 HU) nodules (P=0.72).
DISCUSSION AND CONCLUSION: Taking into consideration the possibility of malignancy in thyroid nodules, the thyroid gland should be evaluated carefully through thoracic CT. A sonographic correlation is recommended for nodules with an HU value of 104.5 and above detected on contrast-enhanced tomography images.

22.Evaluation of the histopathological analysis and surgical indication of the gallbladder polyps determined by ultrasonography
Nazmi Özer, Feyzi Kurt
doi: 10.5505/ejm.2021.76148  Pages 334 - 338
INTRODUCTION: Since gallbladder polyps(GBP)may carry a risk of malignancy, their follow-up and treatment are of great importance.Today,many gallbladder polyps are diagnosed symptomatically or incidentally by ultrasonography.In this study,we examined the adequacy of the conditions that affect to surgical decision of gallbladder polyps that we operated in our clinic.
METHODS: The study was performed on 220 patients who were diagnosed with gallbladder polyp by abdominal ultrasonography and underwent laparoscopic cholecystectomy between October 2015 and October 2020.Patients with polyp size of 10 mm and above,patients with multiple polyps with smaller than 10 mm, patients with accompanied by stones and polyp, patients with who want to have surgery, patients with increased in polyp size during follow-up and patients with symptomatic were included in the study.Preoperative ultrasonography results, demographic characteristics,and postoperative pathology results of the patients were compared.
RESULTS: 61.8%(136) of the patients were female and 38.1%(84) were male,the mean age was 62.6 ± 9.5(23-83 years).The size of the polyps was 6.8±0.6mm(3-14).30.9%(68) of the patients had multiple polyps and 12.6%(28) had polyps 10 mm or more.In all of those with true polyps,the size of the polyp was greater than 10 mm.The most common histopathological diagnosis was cholesterol polyp on 37.3%(82) of patients,and the least common diagnose was adenomatous polyps were seen on 5.5%(12)of patients.
DISCUSSION AND CONCLUSION: In our study,no malignancy was observed as a result of pathology in any patient we operated for polyp.Therefore,surgical decision of patients with gallbladder polyp should not be made only with ultrasonography and demographic features,different risk factors that predict malignancy need to be identified.

23.Idiopathic Granulomatous Mastitis and Other Types of Mastitis; Comparison of Ultrasound Findings
Nurşen Toprak, Ali Mahir Gündüz
doi: 10.5505/ejm.2021.81598  Pages 339 - 343
INTRODUCTION: Idiopathic granulomatous mastitis (IGM) is a chronic autoimmune inflammatory condition that can negatively affect patient psychology, that effective diagnostic protocols and treatment plans have not yet been established. Since the treatment protocols used differ, other causes of mastitis should be excluded. The purpose of this study was to compare ultrasonography (US) findings of IGM with type of the other mastitis (OM) to identify the imaging signs essential for a correct differential diagnosis.
METHODS: This retrospective study was approved by the University Ethics Committee. This study was between August 2017 and August 2018. Parenchymal distortion and no discrete mass, mass-like lesions with indistinct borders, tubular connections, duct ectasia-periductal thickening, skin thickening and presence of an abscess were evaluated in US for each breast lesion.
RESULTS: The fifty seven patients with IGM and 38 with OM were included in the study. The mean age was 35.2±8.4 and 43.6±12.5 years for those with IGM and OM, respectively. US showed tubular connections (43(75.4%))with finger-like projections that tended to coalesce (P˂0.01) and mass-like hypoechoic lesions (51(89.5%)) with irregular margins in IGM. Most cases of OM, 37 (97.4%), had mass-like lesions with indistinct borders.
DISCUSSION AND CONCLUSION: The US findings of IGM sometimes overlap with types of OM. Although core biopsy is typically diagnostic, US findings are very useful in the differential diagnosis of IGM and OM. Especially, observation of tubular-related hypoechoic mass-like lesions may suggest IGM in the reproductive age patient with chronic mastitis.

24.Evaluation of Serum Levels of Trace Elements in Myeloproliferative Neoplasms: A Case-Control Study
Fatih Yetişgin, Mustafa Bilici, Ramazan Esen
doi: 10.5505/ejm.2021.58751  Pages 344 - 350
INTRODUCTION: The lack or excess of some of trace elements or heavy metals could be associated with the risk of hematologic malignancy. This study aimed to compare the patients with myeloproliferative neoplasm with the serum concentrations of Zinc (Zn), copper (Cu), manganese (Mn), nickel (Ni), lead (Pb), iron (Fe), cadmium (Cd) and cobalt (Co) in healthy individuals
METHODS: Healthy individuals in the control group and newly diagnosed patients with myeloproliferative neoplasm were involved in the research. The patient and control groups were similar in terms of socioeconomic status and eating
RESULTS: The myeloproliferative neoplasm group consisted of 60 patients while the control group consisted of 20 volunteers. In the patient group, serum Zn and Fe concentrations were significantly lower than the control group (p=0.001 and p=0.001). Serum Cu, Pb, Cd, Co, Ni, Mn concentrations were higher in the patient group (p=0.001, p=0.001, p=0.001, p=0.001, p=0.001, p=0.027). When a comparison was made between Mn serum level and the control group, Mn serum level was determined to be low in PMF (p>5%). Serum Cd and Ni levels were higher in PMF, ET, CML and PV (p=0.005). Pb serum level was higher in ET, CML and PV (p=0.001, p=0.001, p=0.001).
DISCUSSION AND CONCLUSION: Serum Zn and Fe levels were lower and Cu, Pb, Cd, Co, Ni and Mn levels were higher in patients with myeloproliferative neoplasm. In particular, Zn is a very strong antioxidant element, and the fact that Zn is low in patients suggests that it could be an important marker in PV, ET, CML and PMF cases.

CASE REPORT
25.Radiological Findings of Acute Calcific Tendinitis of the Longus Colli Muscle
Şükrüye Firuze Ocak Karataş, Murat Beyhan, Erkan Gökçe
doi: 10.5505/ejm.2021.72677  Pages 351 - 353
Acute calcific tendinitis of the longus colli muscle (CTLCM) is a rare reason of neck pain and symptoms can bear odynophagia, mild fever, and restricted cervical motion. Computed tomography is the most important radiologic examination for diagnosis, and magnetic resonance imaging or plain radiographs can also be used for diagnosis. We present two cases of acute CTLCM with specific imaging findings, prevertebral edema and calcium accumulation.

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