ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 27 (1)
Volume: 27  Issue: 1 - 2022
1.The multi-relationship structure between some symptoms and features seen during the new coronavirus 19 infection and the levels of post-covid anxiety and depression
Mehmet Tahir Huyut, Süleyman Soygüder
doi: 10.5505/ejm.2022.35336  Pages 1 - 10
INTRODUCTION: The novel-coronavirus (SARS-CoV-2 or COVID-19) epidemic and the measures taken to combat it have adversely affected the psychological-health of societies and individuals. In this study, it was aimed to examine the multi-relationship structure between some symptoms, demographic characteristics during the infection period of individuals treated for COVID-19 infection and their anxiety/depression levels after discharge.
METHODS: One hundred individuals (n=100) who were treated with the diagnosis of COVID-19 participated in the study. Some symptoms and socio-demographic characteristics of the participants during the infection-period were recorded and the Beck anxiety/depression scale was administered to the participants after discharge. Firstly, variables that create multicollinearity were removed from the data set via explanatory-factor-analysis and the variable was reduced. Then, the independent-principal-components were determined and their attributes were found. The relationship structure between the features and the anxiety/depression levels of the patients was analyzed by reducing them to two dimensions via Multiple-Correspondence-Analysis.
RESULTS: In this study, patients with chronic renal failure who received oxygen support during the infection process were positively associated with mild/moderate post-infection anxiety. Patients with chronic-renal-failure were found to have higher depression than those without. Patients with COPD who experienced loss of appetite and fever during the infection were positively associated with moderate to high levels of anxiety and moderate depression. In addition, these individuals received more oxygen-support during the treatment-process and the depression level of these individuals was higher than the other patients.
DISCUSSION AND CONCLUSION: Our study revealed the multi-relationships structure between some symptoms and features seen during COVID-19 infection and post-COVID anxiety-depression levels.

2.Radiological Appearance of Hiatal Hernias on Computed Tomography Radiology of Hiatal Hernias
Veysel Atilla Ayyildiz, Mesut Özgökçe, Saim Türkoğlu, İlyas Dündar, Fatma Durmaz, Sercan Özkaçmaz, Ensar Türko
doi: 10.5505/ejm.2022.33341  Pages 11 - 15
INTRODUCTION: A hiatal hernia is the herniation of organs and structures in the abdominal cavity through the esophageal opening of the diaphragm. We aimed to present the tomographic findings of hiatal hernia types.
METHODS: The computed tomography (CT) images and demographic characteristics of the patients diagnosed with hiatal hernias based on contrast-enhanced and/or non-contrast thorax-abdominal CT scan between January 2016 and December 2019 were retrospectively reviewed. Oral contrast material wasn’t given to the patients..

RESULTS: 210 patients with hiatal hernias, 126 (60%) were female and 84 (40%) were male. Among these patients, 124 (59 %) had type 1, 76 (36 %) had type 2, nine (4.2 %) had type 3, and one (0.4 %) had type 4 hiatal hernia. The most common complaints were cough (64%) and mild shortness of breath (34%). The most common clinical signs seen in the majority of patients were weight loss (73%) and loss of appetite (41%). All of the cases were mainly diagnosed based on radiological (CT) findings.

DISCUSSION AND CONCLUSION: With the increase in the use of CT for thoracic and abdominal diseases, there has been an increase in the frequency of incidental detection of hiatal hernias. Hernia diagnosis is important for preoperative surgical planning. Radiologists should be aware that complications of hiatal hernia can cause morbidity and mortality. The best diagnosis method is considered as CT, which is also useful in determining the type of hiatal hernias.

3.Superficial femoral artery mirror lesions; risk factors, diagnosis, and clinical presentation
Emrah Erdogan, Ender Ozgun Cakmak, Elmin İmanov, Ayhan Tosun, Ali Furkan Tekatlı, Çetin Geçmen, Seyhmus Külahcioglu, Regayip Zehir, Mesut Sismanoglu, Cengiz Koksal
doi: 10.5505/ejm.2022.91328  Pages 16 - 21
INTRODUCTION: Two-sided atherosclerotic involvement of peripheral arteries is common in clinical practice however the data about it in the literature is limited.This study aimed to investigate the frequency, clinical characteristics, and predictors of bilateral symmetric total superficial femoral artery (SFA) occlusions (mirror lesions).
METHODS: Between January 2015 and April 2020, 167 patients with symptomatic total SFA occlusions were retrospectively analyzed. Unilateral and bilateral SFA occlusions were determined, and the risk factors and clinical presentation were investigated between the two groups.
RESULTS: Among 167 patients, 95 (57%) had bilateral SFA lesions, and 30 (18%) presented with critical limb ischemia (CLI). In the bilateral SFA occlusion group, male sex was dominant (p=0.002), and peripheral artery disease (PAD) history was higher (p=0.030). Additional iliac lesions (p = 0.003) and below-knee lesions (p <0.001) were more common in the bilateral SFA occlusion group. The sensitivity of Doppler ultrasonography in detecting SFA occlusions was 83.9%. In multivariate logistic regression analysis, younger age (OR; 0.95 CI; 0.91-0.99 p = 0.030) and history of PAD (OR; 2.08 CI; 1.02- 4, 24 p = 0.040) were identified as independent markers for predicting mirror SFA occlusions
DISCUSSION AND CONCLUSION: Our study demonstrates that the mirror lesion pattern is common in patients with symptomatic SFA total occlusion. Thus, the non-index leg evaluation should be recommended. The younger the age, and PAD history were the predictors of mirror total SFA occlusions.

4.X-ray Exposure Reduces the Number of Hippocampal Pyramidal Neurons in Offspring Rats
Fikret Altındağ, Salih Çibuk
doi: 10.5505/ejm.2022.10692  Pages 30 - 34
INTRODUCTION: X-rays are very important as an imaging tool in the medical diagnosis and treatment of diseases. However, it causes cell damage and death by inducing DNA damage and apoptosis in the hippocampus. The hippocampus is the part of the brain associated with many cognitive functions, especially memory. X-rays cause cell death by stimulating apoptosis in the hippocampus. In the current study, the effects of X-rays on the number of hippocampal pyramidal cells were investigated.
METHODS: A total of 30 rats in three groups were used in the study (n=10). Control group (C); X-ray was not applied. Neonatal group (N); Immediately after birth, newborn rats were exposed to a once-daily non-lethal dose (diagnostic) 8 Gy X-ray for one week. Prenatal+Neonatal group (PN); Pregnant rats were exposed to 8 Gy non-lethal X-rays once daily from the twelfth day of gestation, and newborn rats were exposed to 8 Gy non-lethal X-rays once daily for one week after birth. Hippocampal pyramidal cell numerical density was calculated by physical dissector counting method. In addition, MDA, SOD and CAT levels were measured in the brain.
RESULTS: Compared with the control group, the numerical density of hippocampal pyramidal cells was significantly decreased in both the N group and the PN group. While MDA level increased in N and PN groups, CAT level decreased. There was no change in SOD level between groups.
DISCUSSION AND CONCLUSION: The findings of our study reveal that X-rays reduce the number of pyramidal cells in the hippocampus and therefore may have negative effects on learning and memory.

5.The Effects Of Proton Pump İnhibitors For Dispeptic Complaints In Patients With Nonalcoholic Steatohepatitis
Nurhan Önal Kalkan, Mustafa Öztürk
doi: 10.5505/ejm.2022.03274  Pages 35 - 40
INTRODUCTION: As the most common liver disease in recent years, nonalcoholic fatty liver disease (NAFLD) has gained great importance. In recent years, a close relationship with insulin resistance has been shown in the pathogenesis of NAFLD and its severe form, NASH. This study aimed to observe the effects of Proton pump inhibitors (PPIs) on insulin resistance and hepatosteatosis by causing hypergastrinemia.
METHODS: Forty-two patients diagnosed with steatohepatitis were included in the study. Seventeen of the 42 patients were followed up with dietary therapy alone, and 25 were followed up with diet+PPI for 2 months due to accompanying dyspeptic complaints. Biochemical and anthropometric measurements of the patients were made before and after the treatment
RESULTS: Levels of the following parameters decreased significantly after treatment in cases followed only with diet: total cholesterol (p=0.009), low-density lipoprotein (LDL) (p=0.007), weight (p=0.004), waist circumference (p=0.006), and body mass index (BMI) (p=0.026). Whereas, there was a significant decrease in the levels of alanine transaminase (ALT) (p=0.005), aspartate transaminase (AST) (p=0.009), total cholesterol (p=0.020), low-density lipoprotein (LDL) (p=0.031), and waist circumference (p=0.008) after treatment with diet+PPI. After two months, the increase in the mean insulin resistance levels (HOMA-IR) in the diet group was significantly higher than the increase of mean HOMA-IR levels in the diet+PPI group (p=0.02).
DISCUSSION AND CONCLUSION: In conclusion, a significant improvement in liver enzymes was observed in patients with steatohepatitis with 2 months of pantoprazole treatment added to dietary management.

6.Frostbite – from Turkish eastern border as a consequence of irregular migration
Sebahattin Çelik, Servet Elcin Alpat, Selin Bulut, Hakan Koksal
doi: 10.5505/ejm.2022.48569  Pages 41 - 46
INTRODUCTION: Frostbite is becoming more prevalent within the homeless, mentally ill and substance abusing subgroup. However; our objective is to evaluate the clinical presentation, treatment and consequences of frostbite seen in a different population– irregular migrants captured at Eastern Border of Turkey. In addition, up to date approach to frostbite injury is reviewed.
METHODS: Data extraction was done retrospectively from 40 patients’ admission to hospital from 26 January till 25 February 2020. Each patient was assigned with the grade of the most severe frostbite lesion detected at the admission. Clinical pictures were captured for the follow up of demarcation at each dressing change. Multidisciplinary treatment modality was summarized.
RESULTS: 38 patients were included. Within the population dominated mainly by male young adults, 74% of the patients presented with Grade 3-4 severity whereas 26% were assigned with Grade 1-2 frostbites. Majority of the frostbitten areas were confined to lower extremities. Assigned frostbite gradings at the admission didn’t deflect within the hospitalization period apart from 3 patients worsening towards grade 4 following fasciotomy.
DISCUSSION AND CONCLUSION: Frostbite injury has detrimental outcomes if not recognized and treated in a timely manner.  If not, the likelihood of receiving amputations significantly increase.

7.Diagnostic and Prognostic Value of Serum NT-ProBNP in the Diagnosis of Neonatal Sepsis
İbrahim Deger, Abdullah Ceylan
doi: 10.5505/ejm.2022.88156  Pages 47 - 52
INTRODUCTION: Despite the advances in the diagnosis and treatment of neonatal sepsis, it remains an important cause of morbidity and mortality. This study aimed to investigate the effectiveness of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in the diagnosis and prognosis of neonatal sepsis.
METHODS: Fifty neonates diagnosed with clinical sepsis in the neonatal intensive care unit were included in the study. The control group was composed of 50 healthy neonates.
RESULTS: As a result of the study, a statistically significant difference was observed between the groups in terms of NT-proBNP, C-reactive protein, leukocyte count, platelet count and I/M ratio (p<0.05). NT-proBNP level was 19624.1±15027.6 pg/mL in the case group, while it was 3203.8±4506.8 pg / ml in the control group. There was a positive correlation between NT-proBNP and neonatal sepsis in the case group. NT-proBNP measurements were found to be significant in differentiating neonatal sepsis. In the case group, 33 patients discharged with recovery, 17 patients died, and the mean NT-proBNP levels were 12732.2±12954.3 pg/mL and 35000 pg/ml, respectively. NT-proBNP levels were statistically significantly higher in died patients.
DISCUSSION AND CONCLUSION: NT-proBNP levels should be measured in the early diagnosis of neonatal sepsis and to determine the prognosis of patients diagnosed with neonatal sepsis. The use of NT-proBNP with other biomarkers helps the early diagnosis of neonatal sepsis. Further multicenter, prospective studies with large samples are needed to identify NT-proBNP levels in the diagnosis and prognosis of neonatal sepsis.

8.Examination of dosimetric verification of PROWESS Panther Treatment Planning System using Monte Carlo method for small fields
Taylan Tuğrul
doi: 10.5505/ejm.2022.88785  Pages 53 - 56
INTRODUCTION: Treatment planning systems (TPS) have an important role in the implementation of radiotherapy treatment. Quality control of TPS is extremely important in terms of treatment reliability. In this study, it was aimed to make quality control of TPS by comparing the data obtained from the PROWESS Panther TPS with the results of the Monte Carlo simulation for small fields.
METHODS: In this study, TPS used in the radiation oncology department was examined. For MC simulation, BEAMnrc and DOSXYZnrc codes were used in modeling and dose measurement of linear accelerator device. Gamma analysis method was used to compare measurement results.
RESULTS: When we examine the gamma analysis for PDDs in the study, the gamma values obtained in the 3x3 cm2, 4x4 cm2 and 5x5 cm2 field sizes for the 3% and 3mm criterion provide this criterion for each measurement point. The fact that each dose point in the measurement field is less than 0.1 gamma value indicates that the dose profiles obtained in PROWESS Panther TPS are in good agreement with the MC results.
DISCUSSION AND CONCLUSION: The doses calculated by PROWESS Panther TPS were found within the reference limits. It can be concluded that the dose calculated by PROWESS Panther TPS in homogeneous environments is within acceptable limits for use in radiotherapy. Studies should also be carried out in non-homogeneous environments such as lung, bone and soft tissue in order to obtain more accurate results about PROWESS Panther TPS.

9.Does Gastrectomy Or Diet Reduce Inflammation More In The Treatment Of Obesity?
Mine Öztürk, Süleyman Kargın
doi: 10.5505/ejm.2022.93823  Pages 57 - 63
INTRODUCTION: We investigated -using hemogram parameters- whether inflammation is more likely to decrease with bariatric surgery or diet.
METHODS: Pre-postoperative hemogram values of 41 patients who underwent sleeve gastrectomy were measured and hemogram values of 26 patients on diet were measured before and after diet in venous blood samples.Age, gender, size, weight, body mass index, lymphocyte percentage, neutrophil percentage, lymphocyte, neutrophil, white blood cells, hemoglobin, platelets, RDW (Red Cell Distribution Width), MPV (Mean platelet volume), neutrophil-lymphocyte ratio, platelet-lymphocyte ratio values were recorded.
RESULTS: 28 (%68.3) of the patients who underwent gastrectomy were female and 13 (%31.7) were male. 9 (%34.6) of the cases that were weakened by diet were women and 17 (%65.4) were men. Pre-operative/pre-diet and post operative / post diet weights of both groups were similar (p= 0.18/p=0.20). The body mass index of both groups before the operation and before the diet / after the operation and after the diet was similar (p= 0.11/p=0.33). Lymphocyte percentage, Neutrophil percentage, Lymphocyte, Neutrophil, White blood cells, Hemoglobin, Platelets, RDW, MPV, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio values were similar in patients who underwent gastrectomy and diet (Respectively p=0.82, p=0.13, p=0.98, p=0.11, p=0.12, p=0.41, p=0.41, p=0.92, p=0.95, p=0.47, p=0.53).
DISCUSSION AND CONCLUSION: Surgery or diet was not superior to each other in obesity treatment. The benefits we expected were available in both groups. They lost enough weight and their body mass index decreased. The important thing here was to lose weight. It is possible to live healthier and minimize inflammation by fighting obesity.

10.Assessment of the relationship of oral hygiene habits and sociodemographic status with the periodontal health of patients attending the faculty of dentistry
Başak Kuşakcı Şeker, Tuğba Kavalcı, Melike Demirayak Akdemir, Hakan Özdemir
doi: 10.5505/ejm.2022.81568  Pages 64 - 71
INTRODUCTION: This study aims to evaluate the relationship of oral hygiene habits and sociodemographic status with the periodontal health of patients who attended the faculty of dentistry, using personal information and clinical examinations.
METHODS: A total of 1002 patients (age ranging from 18 to 69 with a mean age: 38±13.3) were included in this study. Individual characteristics, smoking and oral hygiene habits, and systemic and dental histories were recorded. Plaque and calculus index, the presence of bleeding on probing (BOP), attachment loss and pocket depth parameters were recorded as clinical data. After patients’ data were recorded, the relation of these parameters to attachment loss, pocket depth, prevalence of periodontal disease and BOP was determined.
RESULTS: Three hundred and eighty-nine of the patients were diagnosed with periodontitis and prevalence was significantly higher among males (45%) (p < 0.05). The percentage with periodontitis was significantly lower in individuals aged 18–39 (28.4%) compared to individuals aged 60 and over (64.8%) (p < 0.05). Periodontitis was diagnosed in 62.2% of those who did not brush their teeth. The percentage with periodontitis reached a peak of 52.9% among heavy smokers (p < 0.05). Mean attachment loss and probing depth increased significantly with age (p < 0.05). The prevalence of BOP was lower among university graduates and those who used dental floss (p < 0.05).
DISCUSSION AND CONCLUSION: Demographic characteristics, smoking and dental behaviours are associated with periodontal health. Improving sociodemographic status, preventive education and therapeutic services can be a way to improve oral health.

11.Effectiveness of Pulmonary Rehabilitation in Secondary Spontaneous Pneumothorax Patients
Halil Çiftçi, Ömer Gezginaslan
doi: 10.5505/ejm.2022.48278  Pages 72 - 76
INTRODUCTION: Our aim in conducting this study is to examine the effect of bronchial hygiene techniques and respiratory retraining techniques on the duration of drain and hospital in patients undergoing tube thoracostomy due to secondary spontaneous pneumothorax.
METHODS: Between April 2016 and April 2020, a total of 49 patients (36 males, 13 females; mean age: 53.1±9.95 years; range, 38 to 82 years) with the diagnosis of secondary spontaneous pneumothorax were included in the study. Two groups formed. Group 1 consisted of 26 patients and bronchial hygiene and respiratory retraining techniques were given. Group 2 consisted of 23 patients and the treatment of bronchial hygiene techniques were given patients' age, gender, smoking, duration of drain, length of hospital stay were evaluated.
RESULTS: There were no statistically significant differences in the age, sex, smoking between the groups (p>0.05). In the group 1, there was a statistically significant decrease in the duration of drain, length of hospital stay compared to the group 2 (p<0.05).
DISCUSSION AND CONCLUSION: Our study results show that the combination of bronchial hygiene and respiratory retraining techniques is more effective than performing bronchial hygiene techniques alone on duration of drain, length of hospital stay in patients with secondary spontaneous pneumothorax.

12.Relationship between SUVmax of 18F-FDG PET/CT and serum YKL-40 levels in breast cancer
Ebru Orsal Ibisoglu, Arif Kürşad Ayan, Zeynep Akar, Engin şebin
doi: 10.5505/ejm.2022.79027  Pages 77 - 83
INTRODUCTION: This investigation aimed to study the differences in tumor maximum standardized uptake values (SUVmax) in breast cancer patients and compare serum levels of YKL-40, an inflammatory glycoprotein found at high levels in patients with different types of cancer, with healthy controls.
METHODS: Fifty-one women who underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) imaging for the staging of pathologically-confirmed breast cancer were included. The tumor SUVmax of each patient was calculated by 18F-FDG PET/CT. Serum YKL-40, ischemia modified albumin (IMA), carcinoembryonic antigen (CEA), and cancer antigen 15-3 (CA15-3) levels were assessed.. A group of 38 healthy women were included as controls, from which serum YKL-40 and IMA levels were obtained.
RESULTS: Compared to healthy subjects, serum YKL-40 and IMA levels were significantly higher in patients with breast cancer (p<0.001 for both). Patients with a tumor size of 2-5 cm had significantly higher YKL-40 (p=0.002), SUVmax (p=0.008), CEA (p=0.025), and CA15-3 (p=0.016) measurements than patients with a tumor size of <2 cm. However, IMA levels did not vary (p>0.05) between the two groups of tumor sizes. While YKL-40 showed significant correlations with CA15-3 (r=0.318, p=0.023) and IMA (r=0.257, p=0.016), no correlation was found between SUVmax and the measured serum variables in the breast cancer group (p>0.05).

DISCUSSION AND CONCLUSION: Our results indicate that serum IMA and YKL-40 levels were above average in breast cancer patients. Also, increasing SUVmax and serum YKL-40 levels may be separately observed related to tumor size. YKL-40 and SUVmax may be utilized in the evaluation and follow-up of breast cancer.

13.Could A New Measurement, A New Body Shape Index, Replace BMI in Detecting Obesity and Predict The Presence of Obesity and Depression in Asthma Control?
Buket Mermit Çilingir, Selami Ekin, Hanifi Yıldız, Aysel Sunnetcioglu, Hulya Günbatar
doi: 10.5505/ejm.2022.50251  Pages 84 - 90
INTRODUCTION: Obesity is common in asthma. In recent years, the ‘A Body Shape Index’ (ABSI) based on waist circumference(WC) measurement has been developed and the higher ABSI corresponds to a more central body volume concentration. Our aim was to examine the effect of obesity and depression on asthma control in a way that questions the usability of ABSI, which is new in abdominal obesity measurement.
METHODS: A total of 99 asthmatic patients aged between 18-80 years who were followed up in Chest Diseases outpatient clinics were included in the study. Demographic and medical history of the patients were recorded. Waist circumference/BMI2/3XLength(m)2/3 was calculated for ABSI measurement. Beck Depression Scale(BDS) and Asthma Control Test(ACT) were applied.
RESULTS: Obese and morbidly obese patients had poor asthma control. The presence of depression caused poor asthma control in all BMI groups. The poorly controlled asthma group and obese patients had higher depression scores. BMI and waist circumference were higher in the poorly controlled asthma group(p: .002,.033 respectively). However, there was no significant difference between the asthma groups in terms of ABSI(p: .529).
DISCUSSION AND CONCLUSION: The findings of this study indicate that depressive symptoms, increased BMI and WC were significantly associated with poor asthma control. But ABSI is no superior to BMI in detecting asthma control and depressive mood.We should prompt our patients to treatment and exercise, especially for abdominal obesity. We should recommend that asthma patients with depression consult a psychiatrist. In this way, we can control our asthma patients more effectively by minimizing the existing risks.

14.P Wave Dispersion in COVID-19
Mustafa Tuncer, Fatih Öztürk, Rabia Çoldur, Medeni Karaduman, Yılmaz Güneş
doi: 10.5505/ejm.2022.37531  Pages 91 - 94
INTRODUCTION: The effects of COVID-19 on the heart are still not fully known. In this study, we investigated how COVID-19 affects the P interval.
METHODS: Electrocardiographies (ECG) of 30 COVID-19 patients and the control group consisting of 23 healthy volunteers were examined and dispersion (Pd) of the P wave was calculated.
RESULTS: Compared to control group mean Pd (40,1±6,6 vs. 49,6±11,5, p: 0,006) values were significantly higher in Covid19 patients.
DISCUSSION AND CONCLUSION: Increased Pd was observed as an indication that COVID-19 affects the atriums.

15.The Analysis of the Relationship between the Cultural Intelligence and the Feeling of Compassion in the Health Staff
Şükriye İlkay Güner, Selver Karaaslan, Savaş Güner, Reyhan Orhun, Gül Ulay
doi: 10.5505/ejm.2022.48344  Pages 95 - 104
INTRODUCTION: In this study, we aim to analyze the relationship between the cultural intelligence and the feeling of compassion in the health staff.
METHODS: The universe of the research is composed of the health staff who service in a university hospital (n=925). The data of the research was collected with “Personal Information Form”, “The Cultural Intelligence Scale” and “The Compassion Scale”. Ratio Test, Mann-Whitney U Test, Kruskal-Wallis Test and Spearman Correlation Analysis were used for the statistical analysis. The Cronbach’s alpha internal consistency coefficient was found to be 0.895 for the cultural intelligence scale and to be 0.876 for the compassion scale, respectively.
RESULTS: Based on the study, it was determined that the age average of the health staff was 31.15±6.99 and the average service period was 7.83±6.06. It was found that among the health staff 83% performed their job with love, 65.4% considered their performance effective and 93.4% perceived themselves compassionate. 80.2% of the health staff believes that they had cultural intelligence. According to the cultural intelligence scale, the average score of the health staff was calculated to be 96.54±18.43. This number was found to be 88,61±14,96 in the compassion scale. It was determined that there was a strong positive relationship (r=0.74) between the cultural intelligence and the feeling of compassion in the health staff.
DISCUSSION AND CONCLUSION: We believe that the health staff that has a cultural intelligence would evaluate the patients considering cultural parameters and thus be less judgmental and show more compassion.

16.Investigation of the Relationship between Carboxyhemoglobin Level and End-Tidal Carbondioxide in Carbon Monoxide Poisoning
Ramazan Sami Aktaş, Polat Durukan, Sadi Elasan
doi: 10.5505/ejm.2022.98752  Pages 105 - 111
INTRODUCTION: Carbon monoxide (CO) poisoning constitutes an important part of deaths due to poisoning in the world. It may be hard to diagnose CO poisoning if it is not suspected because the clinical features are non-specific. We wanted to investigate the effects of end-tidal carbon dioxide (ETCO2) measurement in expirium on the diagnosis and follow-up of CO poisoning.
METHODS: After the patients were diagnosed as having CO poisoning by taking arterial blood gas from patients who were suspected of having CO poisoning, ETCO₂ was measured using the sidestream method. The data were analyzed using the SPSS (IBM SPSS for Windows, ver.23) statistical package program.
RESULTS: A total of 146 patients, 106 with CO poisoning and 40 control cases, were included in the study. After the demographic data were evaluated, the relationship between ETCO2 and carboxyhemoglobin (COHb) was analyzed. No statistically significant difference was found.
DISCUSSION AND CONCLUSION: To the best of our knowledge, this is the first study to look for a relationship between ETCO2 and COHb. More studies are required to investigate the relationship between ETCO2 and COHb.

17.The effect of hydroxychloroquine on ventricular repolarization parameters JTc and JTpc intervals in patients with COVID-19
Önder Bilge, Murat Çap, Ferhat Işık, Rojhat Altindag, Abdurrahman Akyüz, Ümit Inci, Burhan Aslan, İlyas Kaya, Mehmet Şahin Adıyaman, Nesim Aladağ, Halil Akın, Bernas Altıntaş
doi: 10.5505/ejm.2022.26539  Pages 112 - 118
INTRODUCTION: JT and JTp intervals are among the ventricular repolarization parameters and prolongation, just as the QT interval is related to ventricular arrhythmias. This study aims to examine the effect of hydroxychloroquine on JTc and JTpc intervals in individuals hospitalized with COVID-19.
METHODS: We involved 130 COVID-19 patients divided into two groups as the hydroxychloroquine treatment group and the control group, in this study. ECGs of the patients were recorded at admission and after a median of 48 hours following the initiation of hydroxychloroquine treatment. Then, QTc, JTc, and JTpc intervals were measured.
RESULTS: Patients’ average age was 48 (37-66 IQR), and 53% of the individuals were female, while 47% are male. The median basal JTpc interval was 215 ms(195-230 IQR), while JTpc-Day 3 was 220 ms(195-238 IQR). The median basal JTc interval was 320 ms(301-334 IQR), while JTc-Day 3 was 328 ms(306-343 IQR). JTpc and JTc interval in the hydroxychloroquine group have prolonged significantly (p<0.001), while there were no significant changes in the control group for both values (p>0.05).
There was a significant prolongation in the multivariable linear regression analysis in JTc-Day 3 and JTpc-Day 3 after hydroxychloroquine treatment. (ß=-2.589, 95%CI, 2.384-17.894, p=0.011, ß=2.195, 95%CI, 759-14.752, p=0.030, respectively).

DISCUSSION AND CONCLUSION: In this study, we found significant prolongation in JTc and JTpc intervals in the patients who take hydroxychloroquine treatment.

18.Psychological Well-being among Refugee Pregnant Adolescents: A Controlled Study from Turkey
Utku Akgör, Özalp Ekinci, Burcu Soyak, Oguzhan Kuru
doi: 10.5505/ejm.2022.98975  Pages 119 - 125
INTRODUCTION: This study aimed to compare psychiatric profiles and self-concept between Turkish and refugee pregnant adolescents, and to investigate the associated factors of psychiatric problems and low self-concept among pregnant refugee adolescents
METHODS: A total of 100 pregnant adolescents participated in the study. Beck's Depression Inventory (BDI), The Rosenberg Self-Esteem Scale, and The State-Trait Anxiety Inventory (STAI) tests were administered to the study sample.
RESULTS: Education level (p<0.05), and the frequency of living without a husband (p<0.05) in daily life were lower in refugees. BDI total score was significantly higher in refugees (p<0.05). Regarding the Rosenberg subcategories; self-esteem (p<0.05), faith in people (p<0.05), and daydreaming (p<0.05) scores were significantly lower in refugees. Among Turkish and refugee pregnant adolescents, high BDI score was found to be associated with living without a husband (p<0.05), low income (p<0.05) and Rosenberg subscores of interpersonal threat (p<0.05). Rosenberg subscores of interparental interest (p<0.05), smoking and STAI Trait score were associated with high BDI score among refugees. A binary logistic regression analysis showed that living without a husband (p<0.05), STAI state score (p<0.05), Rosenberg subscores of interpersonal threat (p<0.05), and parental interest (p<0.05) were found as predictors of a high BDI score among refugees. The pregnant refugees who were living without their husbands had lower self-esteem than the pregnants who were living with their husbands (p<0.05).
DISCUSSION AND CONCLUSION: Pregnant adolescent refugees have a higher risk of depression and low self-esteem. Living without a supportive social, economic and familial environment results to low self-esteem and depression in refugee pregnant adolescents

19.Prophylactic effects of silver nanoparticles in a rat model of spinal stabilization and infection
Abdurrahim Tas, Feyza Karagoz Guzey, Azmi Tufan, Nuray Kuvat, Özgür Yusuf Aktaş, Murat Yücel, Asli Kahraman Akkalp
doi: 10.5505/ejm.2022.56254  Pages 126 - 132
INTRODUCTION: Several factors increase the risk of postoperative infection. Some experimental studies have shown that silver nanoparticles (AgNP) have a protective effect from surgical infection. This study aimed to determine the effectiveness of AgNP in preventing the development of infection in the spinal stabilization rat model.

METHODS: In this study, 32 Sprague-Dawley rats weighing 300–350 g were used. Subjects were randomly divided into four groups. Titanium screws were placed in the spine in all groups. In Groups 2, 3, and 4, S.aureus and P.aeruginosa were cultivated in the surgical site at a concentration of 106 CFU/10 μL. Additionally, 0.5 mg/kg AgNP in maltose solution in Group 3 and maltose solution in Group 4 were used. The histopathological examinations were then done.

RESULTS: In the fascia, muscle, bone, and screws in all groups, except in Group 1 (control group), S. aureus and P.aeruginosa reproduced. In blood cultures, there was growth of S. aureus and P. aeruginosa in 1 subject in Group 2, 6 subjects in Group 3, and 2 subjects in Group 4. The growth of S. aureus and P.aeruginosa was significantly increased in Group 3. The degree of inflammation was significantly lower in Group 1. No accumulation of silver was detected in any organs histopathologically.

DISCUSSION AND CONCLUSION: Application of 1 eucal AgNP decreased the severity of infection. This dose was not toxic. However, administration of AgNP at this dose did not decrease the local infection rate. Therefore, new studies should be conducted to determine the ideal effective dose.

20.Choroidal thickness and serum asymmetric dimethylarginine levels in patients with systemic sclerosis
Umut Dağ, Selahattin Balsak
doi: 10.5505/ejm.2022.59219  Pages 133 - 137
INTRODUCTION: In addition to skin and visceral organ involvement, various ocular manifestations have also been described in patients with systemic sclerosis (SSc). In recent years, optical coherence tomography (OCT) has been introduced into use as a beneficial imaging method in determining macular changes and in measuring choroidal thickness. Asymmetric dimethylarginine (ADMA) is a marker investigated in critical patients due to its proven reductive effect on nitric oxide synthesis. The present study aimed to evaluate serum ADMA levels and changes in choroidal thickness in SSc patients.
METHODS: The study included 20 adult SSc patients and 23 age- and sex-matched healthy subjects. Patients’ demographic characteristics and medical histories were recorded. Choroidal thickness was measured using OCT in the both eyes of the patients and controls. ADMA levels were measured in the serum samples.
RESULTS: The mean choroidal thickness was lower in the SSc group than in the control group; however, the difference reached the level of statistical significance only in nasal measurements (251.7±78.6 µm for the SSc patients and 279.2±50.7 µm for the control group; p=0.044). The ADMA level was found to be significantly higher in the SSc group than in the control group (0.545±0.130 µMol/L and 0.130±0.155 µMol/L, respectively;p=0.034).
DISCUSSION AND CONCLUSION: İn this study outcomes, the serum ADMA level was significantly elevated in the SSc patients in the period when choroidal changes were not evident yet.A better understanding of the data about SSc etiopathogenesis and the role of ADMA in this process would make a contribution to the studies performed to develop new treatment strategies.

21.Long-Term Outcomes of Patients Presenting with Acute Coronary Syndrome and Implanted with Bioresorbable Scaffold
Ersin Ibisoglu, Haci Murat Gunes, Filiz Kızılırmak, Beytullah Çakal, Oguz Karaca, Mehmet Onur Omaygenc, Ekrem Güler, Gültekin Günhan Demir, Fatih Erkam Olgun, Ümeyir Savur, Deniz Dilan Naki, Bilal Boztosun
doi: 10.5505/ejm.2022.67674  Pages 138 - 145
INTRODUCTION: A bioresorbable scaffold (BRS) has been used in the latest stages of stent technology and is a less-known material than drug-eluting stents (DES). In this study, we aimed to evaluate the long-term clinical outcomes of BRS in patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI), a type of acute coronary syndrome (ACS).

METHODS: 39 patients and 53 lesions who applied to Istanbul Medipol University Faculty of Medicine Hospital between June 2015 and April 2016 with a diagnosis of NSTEMI and were treated with BRS were included in the study. The 4-year follow-up of the patients between 2016 and 2020 was recorded. Endpoints for the study were device success, treatment success, stent thrombosis, restenosis, and major adverse cardiac events (MACE).

RESULTS: Operations were performed with a device success rate of 98.1% and a treatment success rate of 98.1%. No death or stent thrombosis was detected in any patient, and target lesion revascularization (TLR) occurred in one patient. The total rate of MACE was found to be 1.9%. Complications developed in two patients during the procedure and hospitalization and in four patients during the 4-year follow-up.

DISCUSSION AND CONCLUSION: If BRS are implanted by experienced surgeons in NSTEMI patients, it has been observed that the complication rate in the early period is low, and the complication rate increases depending on the type of stent chosen in the late period. To obtain better results, a BRS with good radial strength, thinner strut thickness, and rapid deployment should be achieved.

22.The Relationship Between Inflammatory Parameters and Mortality in COVID-19 Patients Treated in the Intensive Care Unit
Necla Dereli, Munire Babayigit, Filiz Koç, Özlem Özbek, Gokhan Yildiz, Merve Karasahin, Ozge Gursozlu, Nur Sena Çakar
doi: 10.5505/ejm.2022.00086  Pages 146 - 154
INTRODUCTION: We aimed to examine the relationship between hypoxemia, inflammatory parameters, cytokine storm and mortality in the COVID-19 clinic.
METHODS: COVID-19 patients followed in intensive care unit between 21 March and 1 June 2020 were retrospectively analyzed. Inflammatory parameters (CRP, ferritin, D Dimer, leukocyte and lymphocyte, LDH…) were measured in blood samples taken simultaneously. The relationship of these parameters with mortality was evaluated.
RESULTS: Of the 30 patients, 11 (36.7%) were female, 19 (63.3%) were male. When living (Group 1) and dead (Group 2) patient groups were compared, a statistically significant difference was found between the groups in terms of mean age (p = 0.013). It was observed that PaO2 / FiO2 ratios were lower in Group 2 in all measurements starting from the day of hospitalization in intensive care. While there was no difference between CRP and procalcitonin values in the first week, the 12th and last day measurements were found to be statistically significantly higher in Group 2 (respectively p2 = 0.050, p2 = 0.016; p2 = 0.050, p2 <0.001).
DISCUSSION AND CONCLUSION: When the patients with severe pneumonia treated in the intensive care unit with the diagnosis of COVID-19 were examined, it was observed that the patients who died were more hypoxic at the intensive care entrance and on the 3rd day compared to the survivors, the level of hypoxemia did not affect the cytokine storm, and there was no difference in mortality between those who experienced cytokine storm and those who did not.

23.Comparison of the anxiety and depression levels of pregnant women with COVID-19 and healthy pregnant women
Aysegul Bestel, Aybeniz Civan Kahve, Merve Aldikactioglu Talmac, Pinar Yalcin Bahat, Zübeyde Aytufan, İbrahim Polat, İsmail Özdemir
doi: 10.5505/ejm.2022.65982  Pages 155 - 163
INTRODUCTION: In our study, it was planned to examine the anxiety and depression levels of pregnant women diagnosed with covid 19, the sociodemographic characteristics that may be associated, and the change in anxiety and depression levels after the disease regressed.

METHODS: There were a total of 158 participants, including 63 patients and 95 controls participating in the study. The mean age was 28.61+/- 6.47 years. Pregnant women with COVID-19 and recommended follow-up and treatment between May 2020 and August 2020 were included in the study. Sociodemographic data form, Beck Depression Scale, Beck Anxiety Scale, State and Trait Anxiety Scale prepared by researchers were filled with patients who volunteered to participate in the study. The scales indicated were repeated when the patients came to their first check-up after fifteen days from discharge.

RESULTS: There is a statistically significant difference between the COVID-19 diagnostic groups in terms of Anxiety score (p <0.05). While the anxiety level was the highest in the COVID-19 positive diagnosis group (10.38), it was lower in the COVID-19 positive control group (5.7).
There is a statistically significant difference between the COVID-19 diagnostic groups in terms of Depression score (p <0.05). While the Depression level was highest in the COVID-19 positive diagnosis group (9.51), it was lower in the COVID-19 positive control group (5.8).

DISCUSSION AND CONCLUSION: This study showed us that COVID-19 infection increases anxiety and depression in pregnant women, and anxiety and depression are highest at the first diagnosis of the disease, especially in pregnant women with COVID-19.

24.Is There any Relationship between Painful Shoulder Disorders and Balance?
Mustafa Sahin, Gizem Ergezen
doi: 10.5505/ejm.2022.24381  Pages 164 - 172
INTRODUCTION: In spite of the increasing number of balance assessment studies, the relationship between painful upper extremity and balance disorders is not yet fully understood. The objective of this paper was to determine if balance was affected by painful shoulder syndromes.
METHODS: A total of 40 adults aged between 20-60, 20 with painful shoulder syndrome (study group) and 20 with healthy shoulders (control group). Stability tests and the risk of fall were evaluated with the help of a Biodex Balance device, the range of motion was evaluated with the help of a universal goniometer, and the intensity of pain was measured with the help of visual analog scale (VAS) in both groups.
RESULTS: While the overall stability index, one of the subgroups of the stability test, differed between the groups (p< 0.05), no difference was observed in the fall risk scores (p≥0.05). Stability test scores showed a positive significant correlation with the pain intensity, according to the VAS: pain during night (r2=0.452, p=0.045) and pain while doing any activity (r2=0.764, p=0.000).
DISCUSSION AND CONCLUSION: Individuals with painful shoulders may have a stability disorder. In addition to classical measurement methods in individuals with shoulder pain, emphasis should be placed on balance assessment and shoulder evaluations may be required in adults with atypical balance disorders.

25.Investigation of the Relationship between Fear of Coronavirus, Coronaphobia and Personality Traits
Durmuş Gökkaya, Dilek Yıldırım Gürkan, Rukiye Yorulmaz
doi: 10.5505/ejm.2022.24992  Pages 173 - 181
INTRODUCTION: The COVID-19 pandemic, which emerged in Wuhan, China, has affected the world in all aspects (economic, social, cultural and health). During this pandemic period, people faced various psychological situations, especially anxiety, phobia, panic, and fear. With this descriptive study, it is aimed to reveal the relationship between the fear of Covid-19 and coronaphobia experienced by individuals and their personality traits.
METHODS: Sociodemographic data form, COVID-19 Fear Scale, Coronavirus Phobia Scale and Ten-Item Personality Scale were used as data collection tools. The data was collected through Google Forms. Throughout Turkey, 952 people participated in the study.
RESULTS: As a result of the study, a statistically significant difference was found between demographic variables such as gender, monthly income of the family, having a chronic disease, working status and regular exercise habits, and fear of COVID-19 and coronavirus phobia.
DISCUSSION AND CONCLUSION: It has been determined that there is a high positive correlation between fear of COVID-19 and coronaphobia. In addition, it was concluded that there is a weak and very weak positive relationship between fear of COVID-19 and coronavirus phobia and personality traits sub-dimensions.

26.Prevalence of Congenital Tooth Deficiency: Retrospective Cross-Sectional Study
Can Özükoç
doi: 10.5505/ejm.2022.24444  Pages 182 - 186
INTRODUCTION: This study aims to determine the prevalence of congenitally missing permanent teeth in children between the ages of 5-14 and resident in İstanbul.
METHODS: The clinical and radiological records of patients aged 7-14 years were evaluated retrospectively by examining the presence of tooth deficiency, localization and distribution on gender. The data obtained were evaluated statistically by the Fisher-exact Chi-Square test.
RESULTS: It was determined that 1604 of a total of 19218 children whose records were examined had congenitally missing permanent teeth, 51.37% of these missing teeth were hypodontia and 0.18% were oligodontia. Congenital tooth deficiency was found more in female (51.99%) than male (48.01%). The most common congenitally missing permanent teeth were maxillary second premolar (40.19%), maxillary lateral incisor (25.20%), and maxillary 2nd premolar teeth (20.06%) respectively and the least common were maxillary and mandibular 2nd molar teeth (0.03%). Mandibular 2nd premolar missing teeth were more frequently incident in females (54.48%) compared to males and there was a statistically significant difference (p<0.05). Similarly, maxillary lateral incisor missing tooth was found to be more frequent in females (54.03%) and there was a statistically significant difference (p<0.05).
DISCUSSION AND CONCLUSION: Detailed clinical and radiological examinations play a major role in the diagnosis and treatment of congenitally missing teeth and are of the essence in terms of early diagnosis of congenitally missing teeth and treatment planning.

27.Thyroid Nodules Colon Polyps And Gallbladder Polyps In Acromegaly Patients
Sevde Nur Fırat, Nazli Gülsoy Kirnap, Şerife Mehlika Kuşkonmaz, Murat Kekilli, Cavit Çulha
doi: 10.5505/ejm.2022.56833  Pages 187 - 191
INTRODUCTION: Acromegaly is a pituitary disease characterized by excess growth hormone (GH) secretion in adults which results in several comorbidities and increased mortality. Studies suggest an increased prevalence of both benign and malignant tumors including thyroid nodules, breast diseases and colon polyps in acromegaly. The risk of gallbladder polyps also seems to be increased in acromegaly Coexistence of thyroid nodules, colon polyps and gallbladder polyps in acromegaly remains uninvestigated.
In this study we aimed to investigate the risk factors for the development of thyroid nodules, colon polyps and gallbladder polyps and we aimed to see whether the presence of thyroid nodules is associated with colon polyps or gallbladder polyps in patients with acromegaly.

METHODS: Thirty eight acromegaly patients who are being followed up in the outpatient clinics of Endocrinology and Metabolism in a tertiary care center were involved in the study. Thyroid ultrasonography (US) was performed by the same experienced observer,abdominal and hepatobiliary ultrasonography reports of all patients with acromegaly were reviewed retrospectively and the colonoscopy reports of all patients were reviewed retrospectively.
RESULTS: The present study showed that the presence of thyroid nodules colon polyps and gall bladder polyps in acromegaly does not depend on one another. In other words, the coexistence of one or two of these comorbidities in an individual patient does not seem to be associated with the other.
DISCUSSION AND CONCLUSION: We suggest each acromegaly patient should be evaluated for the presence of thyroid nodules, colon polyps and for gallbladder polyps on its own when clinically indicated.

28.Fine Needle Aspiration Biopsy And Comparison With Paraffin Section Results: A Prospective Cohort Study
Remzi Kiziltan, Çetin Kotan
doi: 10.5505/ejm.2022.83436  Pages 192 - 197
INTRODUCTION: In this study, we investigated the diagnostic value of fine needle aspiration biopsy (FNAB) to determine thyroid cancer in patients with multinodular goiter or solitary nodules/dominant nodules, and the results from intraoperative FNAB and paraffin sections were compared in order to determine whether intraoperative FNAB could be an alternative to frozen section analysis.
METHODS: 40 patients were included in the study. During thyroidectomy, intraoperative FNAB was performed and results were classified as malign, benign and suspicious/indeterminate. FNAB and paraffin section results were compared in all patients and evaluated in terms of FNAB sensitivity, specificity positive/negative predictive values and overall accuracy.
RESULTS: 40 patients were included in the study. During thyroidectomy, intraoperative FNAB was performed and results were classified as malign, benign and suspicious/indeterminate. FNAB and paraffin section results were compared in all patients and evaluated in terms of FNAB sensitivity, specificity positive/negative predictive values and overall accuracy.
DISCUSSION AND CONCLUSION: Thyroid nodules found to be malignant as a result of FNAB were also found to be malignant in histopathological evaluation. However, this was not the case for thyroid nodules found to be benign in FNAB. That is, with FNAB, some malignant nodules may be erroneously classified as benign. Therefore, although FNAB has an important role in the management of thyroid nodules, it is not sufficient in the detection of malignant cases.

29.Serum prohepcidin concentrations in preeclamptic pregnant women: An analysis concerning serum iron status markers and compared to healthy pregnant women
Fatma Ölmez, Süleyman Cemil Oğlak, Mustafa Behram, Zeynep Gedik Özköse, Esra Can, Ömer Ünal, Ozan Karadeniz, Seyhmus Tunc, Emin Üstünyurt
doi: 10.5505/ejm.2022.32659  Pages 198 - 202
INTRODUCTION: This study aimed to evaluate serum prohepcidin concentrations in preeclamptic pregnant women related to iron status markers and compared to healthy pregnant women.
METHODS: A total of 80 pregnant women admitted to a tertiary care obstetric clinic were included in this cross-sectional study. Pregnant women were divided into two groups based on preeclampsia screening results, including those with preeclampsia (n=40) and healthy pregnant women (n=40). Data on gestational week at the time of blood sampling, and blood analysis findings including complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), iron homeostasis parameters (serum iron, ferritin and total iron-binding capacity [TIBC]) and plasma prohepcidin levels were recorded in each women.
RESULTS: The presence of preeclampsia was associated with significantly higher WBC count (13.5±4.4 vs. 10.9±2.9 x103/µL, p=0.001) and serum iron (102.7±65.0 vs. 74.8±54.0 µmol/L, p=0.04) and ferritin (40.9±41.2 vs. 18.6±29.1 µg/L, p=0.007) and plasma prohepcidin (38.2±39.3 vs. 17.91±14.71, p=0.004) levels compared to the healthy pregnant woman.
DISCUSSION AND CONCLUSION: Our findings indicate an increase in serum iron and ferritin levels coupled with elevated prohepcidin levels in pregnancies complicated by preeclampsia. Further longitudinal researches are needed to clarify the role of prohepcidin and active hepcidin in preeclampsia and the potential mechanisms underlying the unregulated hepcidin-iron homeostasis.

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