ISSN 1301 - 0883 | E-ISSN: 2687-5101
Eastern Journal Of Medicine - Eastern J Med: 26 (3)
Volume: 26  Issue: 3 - 2021
ORIGINAL ARTICLE
1.Perineal Color Doppler Ultrasound of periurethral vascularization in women affected by urinary stress incontinence
Sara Mascaretti, Carlo Masciocchi, Giulio Mascaretti, Eva Fascetti, Angela Dalfonso, Pietro Cignini, Michele Fichera, Alessandro Serva
doi: 10.5505/ejm.2021.43433  Pages 354 - 361
INTRODUCTION: This study aimed to assess the vascular parameters of the urethra through an ultrasound assessment using the trans-labial convex probe (Voluson E8 GE) in women affected by stress incontinence and compare them with women who do not have the disorder.
METHODS: Patients with USI recruited for the group of cases were 12, and the women not affected by USI were 12. The study compares patients with a disease (cases) with patients who do not have the disease (controls). The design of the study is a controlled case-control observational trial. Thus, the data gathered were the resistance index (RI) and the color score of the studied area to quantify the degree of vascularization. The semi-quantitative parameter identified through the power doppler was the resistance index (RI). The qualitative parameter was the color score of the studied area, obtained through the color doppler assessment; these data were used to quantify each patient's vascularization degree.
RESULTS: The ANOVA test showed a significant difference between the RI values in group 0 (NO USI) and group 1 (USI). The ROC curve analysis was used, demonstrating that the diagnostic test is adequate and has a high discriminating value for identifying the true positives and the true negatives.
DISCUSSION AND CONCLUSION: The Doppler, therefore, is an important instrument that helps diagnose the more common vascular disorders in climacteric and menopause.

2.Reliability of YouTube videos on knee injection
SEZAİ ÖZKAN, Şeyhmus KAPLAN, Cihan Adanaş, Volkan Şah
doi: 10.5505/ejm.2021.54871  Pages 362 - 366
INTRODUCTION: Intra-articular injection requires a visual learning and the knee is the most commonly used joint for this application. YouTube videos have become a source of visual learning. However, there is a obscurity whether YouTube videos on medical education provide safe and useful information. Therefore, this study aim to evaluate the reliability of YouTube videos on knee joint injection according to the current approach.

METHODS: The term ʺknee joint injection techniqueʺ was used to search the related YouTube videos. The videos were grouped in terms of the uploader, uploading years, and the number of views. The procedure was evaluated and scored for positioning of the patient, palpation of the landmarks, washing hands and wearing gloves, needle approach and entry, drug injection, removing the needle and placing the sponge and finally bandaging.
RESULTS: Of the 61 videos, only 11 (18%) had enough quality. The score of videos uploaded by an institution was significantly higher than others (p=0.006). The score of videos viewed over (n=31) and lower (n=30) than 10000 times was 4.5 (IQR 2.0) and 3.5 (IQR 2.0), respectively (p=0.018). There was no statistical significance between the groups according to uploading years (p=0.694).
DISCUSSION AND CONCLUSION: YouTube videos are not enough qualified enaugh reliable visual learning of knee joint injection. The institutional YouTube videos are more educational sources than others. YouTube videos with higher views count also have higher reliability.

3.The clinical effect of platelet-rich plasma injections on symptomatic meniscal tears of the knee
Veysel Delen, Levent Ediz, Mahmut Alpaycı
doi: 10.5505/ejm.2021.71363  Pages 367 - 370
INTRODUCTION: This study aims to assess the clinical efficacy of intra-articular platelet-rich plasma injections in symptomatic meniscus tears of the knee.
METHODS: Forty one patients (12 males, 29 females; mean age 38.2±8.37 years; range 21 to 50 years) with meniscal tear included in the study. Lateral patellofemoral approach was used for intra-articular platelet-rich plasma injections. The platelet-rich plasma applications were performed three times one week apart. Patients were evaluated usingVisual Analogue Scale (VAS) and Lequesne Index. Baseline scores were obtained pre-first injection and compared to satisfaction scores one- and four-weeks post-last injections.
RESULTS: Compared with pre-treatment, at post-treatment weeks 1 and 4, both VAS and Lequesne Index scores significantly decreased (p<0.001). Also, compared with post-treatment week 1, at post-treatment week 4, both VAS and Lequesne Index scores significantly decreased (p<0.001).
DISCUSSION AND CONCLUSION: Our study results suggest that platelet-rich plasma injections improve pain and disability in patients with meniscus tears of the knee.

4.Endoscopic and Histopathological Findings, And The Presence of Helicobacter Pylori in Diabetic and Non-Diabetic Patients Admitted to the Emergency Department with Dyspeptic Complaints
Mehmet Ali Bilgili
doi: 10.5505/ejm.2021.20981  Pages 371 - 375
INTRODUCTION: The patients presenting with dyspeptic complaints constitute a significant rate among all patients. We investigated the endoscopic findings and the presence of helicobacter pylori (HP) in patients who presented to the emergency department with dyspeptic complaints.
METHODS: Patients, who presented to the emergency department of our hospital with dyspeptic complaints and underwent an endoscopic examination of the upper gastrointestinal system between February/2018 and September/2019, were included in the study. The demographic characteristics of the patients, the treatments they were administered, and the data on smoking and alcohol consumption were documented. Endoscopic findings and histopathological data of the patients were documented. It was examined whether there was a statistical difference between the diabetic and non-diabetic groups.
RESULTS: A total of 100 patients were included in the study. The DM group consisted of 50 patients in total, 30(60%) female; and the non-DM group consisted of 50 patients in total, 28(56%) female. The most common endoscopic finding in both groups was pangastritis. According to the comparison made between the groups in terms of endoscopic findings; the laxity of the LES was found in the non-DM group with a statistically higher rate (p=0.027). However, other endoscopic findings and the presence of HP were similar in both groups (p>0.05).
DISCUSSION AND CONCLUSION: While pangastritis was frequently present in patients presenting with dyspepsia in the emergency department, there was no significant difference between diabetic and non-diabetic groups in terms of endoscopic findings and presence of HP.

5.Elastic characteristics of the aorta in patients with a new diagnosis of metabolic syndrome
Ender Özgün Çakmak, Ugur Findikcioglu, Emrah Erdogan, Ertuğrul Zencirci, Ali Karagoz, Fatma Seden Erten Celik, Özer Soylu
doi: 10.5505/ejm.2021.75010  Pages 376 - 381
INTRODUCTION: Metabolic syndrome (MS) is a known risk factor of cardiovascular disease. However, it is not identified whether MS made alterations in the elasticity of the aorta in the early period before significant atherosclerosis occurred. The purpose of the study was to evaluate aortic elastic properties of patients who were newly diagnosed with MS.
METHODS: The research was performed among 100 patients of newly diagnosed MS(49 males; mean age 46 ± 9 years) with normal sinus rhythm, and 55 cases without MS (29 males; mean age 45 ± 9 years), matched by age. All participants underwent comprehensive physical and cardiological examination, biochemical examination, anthropological measurement and echocardiography.
RESULTS: Aortic diameter change was significantly lower in MS group compared to control group (0.014 ± 0.04 vs 0.25 ± 0.1, p <0.01), aortic stiffness was significantly higher in the MS group (10.65 ± 4.52 vs 5.7 ± 2.42, p<0.01) compared to the age-matched control group. Multiple regression analysis shows that there is an independent relationship with each of the age, body mass index, HDL cholesterol and systolic blood pressure.

DISCUSSION AND CONCLUSION: Aortic stiffness index was higher in newly diagnosed MS patients compared to the control group. The vascular system can be affected even without diabetes, hypertension, hyperlipidemia, and coronary artery disease, which is excluded by history and noninvasive evaluation.

6.The Association Between The Severity of Coronary Atherosclerosis and Abnormal Nocturnal Blood Pressure Variations in Hypertensive Patients
Remzi Sarikaya, Ömer Kümet
doi: 10.5505/ejm.2021.48254  Pages 382 - 387
INTRODUCTION: It is well known that the hypertension and coronary artery disease show a strong cause and effect relationship, but the severity and complexity of atherosclerosis in non-dipper hypertensive patients is undefined yet. We evaluated the association between dipper or non-dipper hypertension and the extent of coronary atherosclerosis by SYNTAX score, in patients with the chronic coronary syndrome referred for percutan coronary angiography.
METHODS: Hypertensive patients that performed a percutan coronary angiography for the first time were included, and the SYNTAX score was computed. According to their ambulatory blood pressure measurements, the hypertensive patients were grouped as dippers and non-dippers.
RESULTS: One hundred and twenty-four patients were included. 87 hypertensive patients were accepted as dipper group, and 37 patients were in non-dipper hypertension group. The mean SYNTAX score for dipper group was 10.3±2.6 and 14.6±3.9 for non-dipper group (p<0.001). The number of diseased vessels is higher at the non-dipper group (1.5±1.1 versus 2.2±1.7, p<0.001). The hypertensive patients that have a high SS were more likely to be non-dipper.
DISCUSSION AND CONCLUSION: In hypertensive patients, the non-dipper pattern of nocturnal blood pressure variations is associated with more complex and severe coronary artery lesions in chronic coronary syndrome.

7.Evaluation of TP53 codon 72 polymorphism in esophageal cancer susceptibility in Eastern Anatolia Region of Turkey
Zehra Kaya, Necat Almalı, Burak Mugdat Karan, Gokhan Gorgisen
doi: 10.5505/ejm.2021.65707  Pages 388 - 395
INTRODUCTION: The tumor suppressor TP53 gene plays a key role in the regulation of cell cycle. Polymorphisms in this gene have been associated with many cancers including esophageal cancer (EC). Many previous studies have focused on the relationship between TP53 codon 72 polymorphism and EC risk in most of the populations except Turkish population. The aim of this study was to explore the effect of codon 72 polymorphism on the EC risk in eastern Turkey.
METHODS: The codon 72 polymorphism was genotyped by real time polymerase chain reaction (qPCR) with TaqMan SNP genotyping assay in 79 patients and 80 healthy control subjects.

RESULTS: No statistically significant difference was observed in distribution of genotype and allele frequencies. Heterozygous Arg/Pro (CG) was the most frequent genotype in both patients and controls. Homozygous Arg/Arg (GG) genotype frequency was higher in patients than controls, but not statistically significant (p>0.05). However, tumor location in the lower part of the esophagus was significantly higher in non-C carriers (GG, Arg/Arg) compared to C-carriers (CG/CC) (p=0.01). G-carriers were also more likely to have poorer survival compared to patients with CC genotype (p=0.04).

DISCUSSION AND CONCLUSION: Our results suggest that the Codon 72 polymorphism was not associated with the EC in eastern Turkey. However, GG genotype (Arg/Arg) may have a role in tumor development at the lower location of the esophagus. Additionally, G carriers may exist the poorer survival compared to the non-G carriers (CC). Therefore, it is thought that individuals with CC genotype (Pro/Pro) may have better survival.


8.Outcomes of the modified McBride procedure for hallux valgus: analysis of the radiographic measurements
Emre Bilgin
doi: 10.5505/ejm.2021.54771  Pages 396 - 402
INTRODUCTION: The current study aimed to analyze both the modified McBride procedure's radiographic outcomes and the relationships between radiographic measurements after this technique.
METHODS: Forty-five feet of 42 patients who underwent isolated modified McBride procedure were included in the study. Preoperative and postoperative radiographic measurements, including hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and fibular sesamoid distance (FSD) to second metatarsal, as well as their relationships were assessed. Postoperative pain was evaluated using the visual analog scale (VAS).
RESULTS: Mean age of the patients was 44.6±16.8 (range, 17-78) years, and the mean follow-up period was 42.4±9 (range, 25-59) months. Postoperatively, mean HVA, IMA, and TSP significantly decreased from 37.4° to 14.9°, from 15.1° to 11.5°, and from 2.2 to 1.1, respectively (p<0.01). FSD did not change significantly (p=0.47). Recurrence of the deformity was observed in 23 feet. Feet with HVA>35° did not have a higher recurrence rate than feet with HVA<35° (p=0.15). VAS was not significantly different in recurrent and non-recurrent feet (p=0.69). While TSP correction was significantly reduced in feet with preoperative IMA>15°, FSD correction was significantly higher in feet with HVA correction >20° (p<0.01 for both).
DISCUSSION AND CONCLUSION: Modified McBride was sufficient for reducing the HVA, IMA, and TSP but did not influence FSD. Recurrence was observed in more than half of the feet, but having a preoperative HVA>35° was not associated with higher recurrence rates, as well as worse pain. Further studies may be needed better to understand the complicated relationship between angular measurements and sesamoids.

9.Evaluation of Factors Affecting Mortality in 35 Biliary Tree Injury Cases
TOLGA KALAYCI, ÜMİT HALUK İLİKLERDEN
doi: 10.5505/ejm.2021.49344  Pages 403 - 409
INTRODUCTION: Cholecystectomy is one of the most common operations performed by general surgeons. With the increase in surgeons' skills and advances in technology, laparoscopic cholecystectomy has become the gold standard. However, laparoscopic approach carries a higher risk for biliary tree injury. In this study, it was aimed to perform clinical analyzes of patients operated on for biliary tree injury and to evaluate the treatment results and mortality factors.
METHODS: Patients who were operated for bile duct injuries between 1994 and 2018 at XXX were selected for the study retrospectively. The data of the patients were collected and the factors determining mortality were evaluated using the Mann-Whitney U test, Chi-Square test and Fisher Exact Test, assuming p = 0.05.
RESULTS: Among 35 patients included in this study, 25 were female (71.4%). The mean age of patients was 45.1 years (22-75). In the etiology, gall bladder operations (n=29, 82.8%) performed for cholecystolithiasis was the most common. According to the Bismuth-Strasberg classification, while isolated E type injury was seen in 22 patients (62.9%), isolated D type injury was seen in 10 patients (28.6%). The most performed surgery was hepaticojejunostomy (48.5%). Gender, age, first surgery etiology and indication, the day between first surgery and reconstructive surgery, type of injury, type of reconstructive surgery, and hospital stay did not affect mortality (p>0.05).
DISCUSSION AND CONCLUSION: Biliary tree injury is a life-threatening complication of cholecystectomy and should be managed with a multidisciplinary approach. Although no factor affecting mortality was found in this study; late diagnosis and treatment increases both morbidity and mortality.

10.Examining of the individuals who have attempted suicide in the east of Turkey in terms of psychological factors
Faruk Kurhan, Gülsüm Zuhal KAMIŞ, Abdullah Atli
doi: 10.5505/ejm.2021.69862  Pages 410 - 417
INTRODUCTION: We aimed to retrospectively review the data of the people applying to our hospital due to suicide attempt in the last 8 years and to examine the psychiatric diagnoses and sociodemographic data of the patients.
METHODS: The data of 940 patients examined in our hospital between 2012-2019 due to suicide attempts were reviewed retrospectively. Characteristics like age, gender, occupation, marital status, previous psychiatric treatment, presence of psychiatric illness and presence of psychiatric drug if the attempt is by drug were examined from patients data files.
RESULTS: In this study, 403 (42.9%) of the applicants were male and 537 (57.1%) were female. Suicide attempts were done by a sharp device, hanging, jumping off respectively,and the least by firearm and the most by drugs. Considering the distribution of psychiatric diagnoses, it was seen that 153 (31.1%) of them had depressive disorders, 121 (24.6%) had substance and alcohol use disorder and 55 (11.2%) had personality pathology.
DISCUSSION AND CONCLUSION: A significant number of the applicants applying the emergency department for suicide attempt were single, unemployed and students. The most common suicide attempt age range was 20-25. Psychological problems and psychiatric treatment history are important predictors of a person's future suicide attempt.

11.Abnormal First And Second Trimester Matenal Seum Marker Levels For Aneuploidy Screening And Adverse Pregnancy Outcomes
Lale Susan Turkgeldi, Engin Turkgeldi, Huseyin Kiyak, NEŞE YÜCEL
doi: 10.5505/ejm.2021.77775  Pages 418 - 425
INTRODUCTION: To investigate if there is an association between pregnancy complications and abnormal maternal serum analytes used for first and second trimester screening for aneuploidy.
METHODS: Between July 2009 and January 2010, 218 pregnant women who had first or second trimester screening for birth Down syndrome were entered. First trimester maternal serum levels of PAPP-A and free hCG or second trimester maternal serum levels of AFP, hCG and uE3 were compared between normal pregnancies and pregnancies complicated with preeclampsia, intrauterine growth retardation, intrauterine fetal death or oligohydramnios.
RESULTS: PAPP-A levels below 0.4 MoMs were associated with an increased risk of preeclampsia and fetal growth retardation. AFP levels over 2.5 MoMs were associated with all of the adverse outcomes evaluated in the study including preeclampsia, fetal growth retardation, intrauterine fetal demise and oligohydramnios. While uE3 levels below 0.5 MoM were found to be associated with an increased incidence of preeclampsia, elevated second trimester hCG levels over 3.0 MoMs were associated with fetal growth retardation. No significant relationship could be established between low first trimester free hCG levels (less than 0.5 MoMs) and any of the adverse outcomes.
DISCUSSION AND CONCLUSION: There are significant associations between first and second trimester serum analytes for Down syndrome screening and adverse pregnancy outcomes. However, due to their low sensitivity and positive predictive values, these analytes are not proven to be effective in the

12.What is The Case of More Accessible Treatment Options in COVID 19: Comparison of Hydroxychloroquine and Favipiravir Based on Laboratory Values?
Buket Mermit Çilingir, Aysel Sunnetcioglu, Hanifi YILDIZ, Berrak Mermit Erçek, Nuruban Delal Baykal
doi: 10.5505/ejm.2021.46548  Pages 426 - 432
INTRODUCTION: Two of the drugs are frequently used in COVID-19 treatment algorithm because of their low cost, easy availability and application; hydroxychloroquine(HCQ) and Favipiravir. Our aim in this study is to compare the laboratory parameters of patients diagnosed with COVID-19 Pneumonia in whomHCQ and Favipiravir treatment was initiated and to reveal the difference in the effectiveness of the treatments.
METHODS: 64COVID-19 patients whose diagnoses were confirmed by real-time polymerase chain reaction testand pneumonia image compatible with COVID-19 onThoraxCT were included in the study. Patients were divided into three groups: treated with HCQ,treated with favipiravir and who were switched to favipiravir treatment when they did not benefit fromHCQ.We compared the laboratory values on Day1, Day5 and at discharge.
RESULTS: There was no significant difference between the groups in which HCQ and Favipiravir was initiated. In the patient group who did not improve withHCQ and switched to favipiravir treatment,D-dimer and CRP values was statistically significant(p: 0.029, p: 0.048). PLT, Hemoglobin,RDW, MPV, NLR,PLR,INR values did not change significantly in any patient group.
DISCUSSION AND CONCLUSION: Our study with the most commonly used drugs in our country reveals that HCQ andFavipiravir are not superior to each other.When we changed the treatment with favipiravir in the group of patients receiving HCQ, D-dimer and CRPvalues decreased during discharge. This finding shows how effective the timely treatment change is in the recovery of the patient by closely following the patient clinically and interpreting the laboratory values correctly.We should direct the treatment of our patients by following the symptoms, risk factors and laboratory values.

13.Serum ionized calcium levels may be more closely related to the admission QTc interval than total calcium levels in patients hospitalized with COVID-19
Murat Çap, Ferhat Işık, Önder Bilge, Bernas Altıntaş, Flora Ozkalayci, Abdurrahman Akyüz, Burhan Aslan, ÜMİT İNCİ, Rojhat Altindag, İlyas Kaya, Kemal Güneş, İbrahim Halil Tanboğa
doi: 10.5505/ejm.2021.69345  Pages 433 - 441
INTRODUCTION: Hypocalcemia prolongs the QTc interval. Total calcium (TCa) measurement can be misleading in cases where the concentration of albumin is abnormal. We aimed to investigate which calcium level—ionised calcium (iCa) or TCa—may be more closely related to the QTc interval in COVID-19 patients in whom hypocalcemia and hypoalbuminemia are observed frequently.
METHODS: Adult patients hospitalised for COVID-19 were included in this study. ICa levels were obtained from the venous blood gas sample examined during the emergency department admission, and the TCa levels were obtained from the biochemistry results on admission. The pH-adjusted iCa (Corrected-iCa) and albumin-adjusted TCa (corrected-TCa) were calculated. The QT interval was measured from the admission ECG and corrected for heart rate using the Bazett formula.
RESULTS: Hundred and thirty-two patients were included in the study. The mean age was 50±19 years, and 62 (47%) patients were female. Median iCa level was 1,13 mmol/L (1,08-1,18 IQR), median TCa level was 2.13 mmol/L (2.02-2.22 IQR). 76 patients (57%) had hypocalcemia (iCa<1,16 mmol/L). The median QTc interval was 431 ms (414-450 IQR). In the multivariable linear regression analysis, a significant relationship was observed between the QTc interval and iCa and corrected-iCa levels (β=-2.22, SE=27.839, p=0.028, β=-2.16, SE=29.407, p=0.033), but no significant relationship was observed between TCa and corrected-TCa levels (β=-1.02, SE=3.959, p=0.312, β=-0.44, SE=4.635, p=0,650).
DISCUSSION AND CONCLUSION: A significant relationship was observed between iCa levels and the QTc interval, which was longer in patients with hypocalcemia, but there was no significant relationship observed with TCa levels.

14.The Value of a Prenatal MRI in Adjunct to Prenatal USG For Cases with Suspected or Diagnosed Fetal Anomalies
Mehmet Obut, Arife Akay, Özge Yücel Çelik, ihsan Bağlı, Ayşe Keleş, Alii Emre Tahaoglu, Cantekin İskender, Ali Turhan Çağlar
doi: 10.5505/ejm.2021.47640  Pages 442 - 449
INTRODUCTION: An accurate diagnosis of the anomalies plays a crucial role in the guidance and management of pregnancy, prenatal counselling, and postnatal therapies. This study aimed to evaluate the value of fetal magnetic resonance imaging (MRI) in adjunct to ultrasonography (USG) for cases with suspected or diagnosed fetal anomalies
METHODS: This retrospective study included 86 fetuses that were evaluated using a fetal MRI and USG within 14 days for a diagnostic query. To evaluate the diagnostic performance and value of the fetal MRI, patients were grouped according to the final diagnosis, which was revealed in the post-natal or post-terminated period. The patients were grouped according to weather, or not correct or additional findings revealed on these diagnostic modalities.
RESULTS: According to the final diagnosis, the most common anomaly was the central nervous system (CNS) (n=62, 72%), followed by genitourinary (n=11, 13%). Both modalities were correct, and MR did not reveal additional findings in most cases (65 of 86cases, 76%). İn eight cases (9%) MR was correct, but USG was incorrect. USG was correct and MRI was incorrect in 2 cases (2%). USG was correct but MRI revealed additional findings in 9 cases (10%) were in group 4. Both modalities were incorrect in 2 cases (2%).
DISCUSSION AND CONCLUSION: İn adjunct to USG, a fetal MRI increases the diagnostic accuracy and provides additional information. The MRI is more useful for certain indications, such as agenesis of corpus callosum, neural migration defects, posterior fossa anomalies, intracranial cysts, and urogenital system anomalies.

15.Benign Gastric Outlet Obstruction Surgery: A Tertiary Center Experience
Ümit Haluk İLİKLERDEN, Tolga KALAYCI, Mehmet Çetin KOTAN
doi: 10.5505/ejm.2021.47354  Pages 450 - 456
INTRODUCTION: Gastric outlet obstruction is a clinical diagnosis that includes abdominal pain, postprandial nausea with or without vomiting, early satiety, and abdominal discomfort. In chronic cases, weight loss can also be added to the symptoms. In this study, it was aimed to examine the characteristics of gastric outlet obstructions underwent surgery for benign reasons in a single tertiary center.
METHODS: Patients who were operated due to benign gastric outlet obstruction between 2010 and 2018 in the XXX were selected retrospectively. Preoperative, intraoperative and postoperative data of the patients were collected from hospital records. The diagnosis process and treatment approaches of the patients were evaluated in the light of the literature.
RESULTS: Average age of 9 patients participating in the study was 47.4 ± 12.18 years (26-58) and the male/female ratio was 2. The most common symptom was abdominal pain (77.8%), while the most common symptom was dehydration (66.7%). In endoscopy, 8 patients had stenosis and 5 had ulcers. Billroth II gastrectomy was the main surgical procedure performed (n=7, 77.7%). Chronic gastritis (66.7%) was the main diagnosis in the pathological samples. In addition, Helicobacter pylori positivity was observed in 7 (77.8%) of 9 patients. Morbidity and mortality rates of the study were 33.3% and 22.2%, respectively.
DISCUSSION AND CONCLUSION: GOO due to benign diseases is a rare problem. Endoscopic methods and symptomatic treatments should be tried primarily in the treatment of GOO. If there is no improvement in symptoms and signs despite symptomatic treatments, surgical treatment should be applied.

16.Radiological imaging findings of avalanche victims with traumatic lesions in Van eastern province of Turkey
Sercan Özkaçmaz, İlyas Dündar, LEYLA TURGUT ÇOBAN, ibrahim ilik, FATMA DURMAZ, iskan çallı
doi: 10.5505/ejm.2021.46704  Pages 457 - 464
INTRODUCTION: This study aimed to present the radiological findings of survivors from two avalanches within two days in the same valley.
METHODS: This retrospective descriptive study was carried out in two centers after ethics committee approval. The radiological and demographical findings of 47 survivors were screened from two hospital databases. Patients were classified regarding the type of traumatic lesion as well as the lesion sites. A total of 39 traumatic lesions in 22 patients were detected via radiological imaging modalities.
RESULTS: The female/male ratio was 4.8% (1/21) and the mean age was 42.6±17.1 years (24-86 years). Among the 39 traumatic lesions, 13 (33.30%) were detected in the extremities (4 in the muscles/ligaments, 9 in the bones), 9 (23.1%) in the spine (5 transverse, 2 spinous process, and 2 corpus fractures), 9 (23..1%) in the thorax (5 pulmonary contusion, 1 pneumomediastinum, 1 hemothorax, and 2 rib fractures), and 8 (20.5%) in the head (1 subdural hematoma, 5 maxillofacial fractures, and 2 subcutaneous hematomas). There were no abdominal or pelvic lesions detected in this study.
DISCUSSION AND CONCLUSION: Traumatic lesions can be seen in all systems and organs. Results of this study revealed that spinal and extremity fractures and pulmonary contusions were the most commonly reported traumatic lesions in the included avalanche victims. Muscular injuries were also detected. The use of MRI increases the success of lesion detection in intracranial structures and muscular-ligamentous tissues.

17.The evaluation of traumas of victims in Avalanche disasters in Van province, Turkey on February 4-5, 2020
Duygu Mergan İliklerden, Tolga Kalaycı, İsmail Can Karacaoglu
doi: 10.5505/ejm.2021.86244  Pages 465 - 469
INTRODUCTION: Avalanche is a rapid flow of snow down of a slope, such as a mountain or a hill. In this study, we aimed to evaluate the traumas of the victims who were hospitalized in two avalanche disasters that occurred in Van province, Turkey on February 4 and 5, 2020.
METHODS: On February 4-5, 2020, two avalanche disasters occurred in Van province, Turkey. The data of all victims were gathered from hospital records and register of Disaster and Emergency Management Presidency of Turkey retrospectively. Victims who were treated and died in the avalanche area were excluded from the study.
RESULTS: At two avalanches, 126 victims were affected. The mean age of the hospitalized victims (50 victims) was 36.84±10.70 (18-61), 48 were male. 15 victims were affected (8 alive, 7 death) at the first avalanche, while 111 were affected (76 alive, 35 death) at the second avalanche. The burial time was nearly 90 minutes in the first avalanche and 30 minutes in the second avalanche. The most common pathology was scalp laceration in 12 (24%) victims. 46 (92%) victims were treated with medical treatment. The overall mortality of two avalanches was 33.3%, while the mortality rate of the first avalanches was 46.7%. No complications or mortality occurred in any patient admitted to the hospital.
DISCUSSION AND CONCLUSION: Avalanche disaster is a serious problem and requires early access to the area to shorten the burial time. Early access provides early intervention. Early intervention was delayed due to weather conditions and mortality rates increased.

18.The Effect of Currant (Ribes) on Human Health and Determination Certain Antioxidant Activities
Mustafa Bilici
doi: 10.5505/ejm.2021.89725  Pages 470 - 474
INTRODUCTION: Currant (ribes) belongs to Rosales order Saxifragaceae family, Ribes genus. Ribes genus is separated to four sub-genus groups. These are; Berisia, Ribesia, Coreosma and Grossularia sub-genus groups. Ribes fall under Ribesia and Coreosma sub-genus groups. Ribes that belong to Ribesia sub-genus groups include red and white ribes while Coreosma sub-genus include black ribes. In Turkey ribes are known to have five types and these types are black fruit ribes (Ribes nigrum L.), East Black Sea ribes (Ribes orientalis L.), Alpine ribes (Ribes alpinum L.), and Caucasus ribes (Ribes biebersteinii Berl. Ex. Dc.) together with Ribes rubrum used in landscape planning and planted as decoration plant (1).
METHODS: For this study red Ribes of Ribasia sub-genus was used from among the five ribes types grown in Turkey including black fruit ribes (Ribes nigrum L.), East Black Sea ribes (Ribes orientalis L.), Alpine ribes (Ribes alpinum L.), and Caucasus ribes (Ribes biebersteinii Berl. Ex. Dc.) together with Ribes rubrum used in landscape planning and planted as decoration plant.
RESULTS: Its protective effects such as healing effects on some cancer types are known. Level of Catalase (CAT) was found to be 0.00011 U/mI on average for fresh ribes. Level of Superoxide Dismutase (SOD) was found to be 11.6960 U/mI on average for fresh ribes. The level of Reduced Glutathione (GSH) was found to be 0.00011 mmol/dI on average for fresh ribes.
DISCUSSION AND CONCLUSION: Consequently, ribes was found to have a strong antioxidant activity. Thus, ribes was demonstrated to be a protective antioxidant against various diseases.



19.The Effect of Infliximab on Oxidative Stress in Ovarian Tissue in the Rat of Ovarian Hypersrimulation Syndrome
Deniz Dirik, Ahmet Ufuk Kömüroğlu
doi: 10.5505/ejm.2021.68878  Pages 475 - 480
INTRODUCTION: Ovarian hyperstimulation syndrome (OHSS) is a complication that occurs during assisted reproductive techniques. In this study, our aim is to study the effect of Infliximab (IFX) on oxidative stress in ovarian tissue in a rat model of ovarian hyperstimulation syndrome.
METHODS: A total of 32 immature female rats were divided into four groups randomly: Control, OHSS, OHSS+IFX, and IFX group. OHSS and OHSS+IFX groups were administered 30 IU pregnant mare serum gonadotropin/day on days 22-25 of life and 30 IU hCG on day 26. Plus, intraperitoneal IFX was administered half an hour before hCG administration to the OHSS+IFX group. On the 26th day, solely 7 mg/kg IFX was administered to the IFX group. 48 hours after administration of hCG administration, the rats were sacrificed and their ovarian tissues were sampled. The levels of MDA, AOPP, TSG as well as catalase activity were measured in these ovarian tissues.
RESULTS: Ovarian tissue MDA and AOPP levels of the OHSS group were determined to be significantly higher compared to the control and OHSS-IFX groups. Ovarian tissue catalase activity and TSG level of the control group was significantly higher compared to the OHSS and OHSS-IFX groups. It was determined that although ovarian tissue catalase activity and TSG level in the OHSS-IFX group were higher compared to the OHSS group but it was not significant.
DISCUSSION AND CONCLUSION: The results revealed that IFX could prevent oxidative stress in ovarian tissue induced by OHSS. These effects may be mediated by the anti-inflammatory and antioxidant properties of IFX.

20.Investıgatıon Of The Effect Of Multıple Sclerosıs On Perıpheral Nerves
Gökhan Gökpınar, Aydın Çağaç, Aysel Milanlıoğlu
doi: 10.5505/ejm.2021.87846  Pages 481 - 486
INTRODUCTION: Multiple sclerosis is an autoimmune central nervous system disease characterized by inflammation, demyelination and axon damage. There are three subtypes of multiple sclerosis with different clinics.: relapsing remitting, secondary progressive and primary progressive. The aim of this study was to determine peripheral nerve involvement and related factors in patients with multiple sclerosis.
METHODS: In our study, 35 (70.0%) of the patients were suffering from Relapsing Remitting Multiple Sclerosis, and 15 (30.0%) of them had Secondary Progressive Multiple Sclerosis. The mean age of the symptom onset of the disease in patients was 30.44 ± 1.06 years, the mean score of the Multiple Sclerosis Disability Scale (EDDS) was 2.97 ± 2.58 points
RESULTS: Polyneuropatia was detected in 12 (24.0%) patients. Polyneuropathy was detected in 3 patients (6.0%) in the control group. In our study, peripheral nerve involvement was higher in male patients than female patients. There was a very strong positive correlation between the duration of disease development and the Extended Multiple Sclerosis Disability Scale scores.
DISCUSSION AND CONCLUSION: In the study, it was determined that multiple sclerosis was more commonly seen in women in accordance with the literature, and EDDS scores increased as the disease duration increased, and the frequency of polyneuropathy in men was higher than in women. In addition, the frequency of polyneuropathy in the control group was higher than expected.

21.Evaluation of Cardiology consultations during the COVID-19 Pandemic Period
Naci Babat, Ramazan DUZ, Medeni Karaduman, Mustafa Tuncer
doi: 10.5505/ejm.2021.02359  Pages 487 - 493
INTRODUCTION: In this study, we scientifically examined the consultations of the patients being hospitalized from the other departments to the cardiology department during Coronavirus Disease 2019 (COVID-19) pandemia.
METHODS: Consultations to the cardiology department between 01 April-31 May 2020 and 01 April-31 May 2019 were discussed. Demographic characteristics and reasons of consultations were compared. A different approach was followed in COVID-19 patients diagnosed with compared to patients in other clinics.
RESULTS: The rate of consulted patients in 2019 year was 14.4% (866/5989). Its rate in 2020 year was found as 18.5% (462/2486) (p: <0.001). A statistically significant difference was obtained in both groups. The use of drugs prolonging the Qt, preoperative and increase in cardiac enzymes were found statistically significant in terms of the consultations (p: <0.001 - <0.001 - 0.003 - 0.016, respectively). Face to face interviews were made in 29% (33/114) of the patients who were consulted from COVİD-19 clinics. In 71% (81/114) patients, electrocardiography (ECG)s were evaluated digitally.
DISCUSSION AND CONCLUSION: In this study, although there was a decrease in the number of hospitalized patients during the COVİD-19 pandemia, we observed an increase in the number of patients being consulted to cardiology clinic. The relationship between COVİD-19 disease and cardiovascular diseases and drugs being used in the treatment increased the workload of the cardiology clinic during the pandemic period.

CASE REPORT
22.Hepatic Portal Venous Gas After Blunt Abdominal Trauma In A Child
Burhan Beger, Baran Serdar Kızılyıldız, Oguzhan Ozdemir
doi: 10.5505/ejm.2021.06977  Pages 494 - 496
Hepatic portal venous gas is defined radiologically as tubular areas of decreased attenuation in the liver periphery. It is a rare finding and associated with numerous underlying abdominal diseases, ranging from benign causes to potentially lethal diseases. Reporting and recognition of hepatic portal venous gas have been increased due to widespread use of advanced imaging techniques. The presence of gas in the portal veins after blunt abdominal trauma is a transient incidental finding that could be resolved spontaneously. Here we report an extremely rare condition that describes a child who suffered air embolism of the portal veins secondary to blunt abdominal trauma. The condition was clinically benign and resolved spontaneously.

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