ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 27 (2)
Volume: 27  Issue: 2 - 2022
1.Pregnancy outcomes of patients diagnosed as having cleft lip or/and cleft palate in antenatal screening
Ozge Yucel Celik, Mehmet Obut, Ayse Keles, Gulsah Dagdeviren, Neval Cayonu Kahraman, Gulsah Aynaoglu Yıldız, Ozgur Arat, Cantekin Iskender
doi: 10.5505/ejm.2022.43765  Pages 204 - 211
INTRODUCTION: Our study aimed to evaluate the obstetric outcomes of extra ultrasonographic anomalies in patients with CL±P palate.
METHODS: This retrospective study was conducted in a tertiary referral hospital between December 2017 and March 2021. The patients were analyzed under three groups as follows: isolated CL±P (group 1), CL±P with ultrasonographic anomalies with mild fetal and neonatal consequences (group 2), and CL±P with ultrasonographic anomalies with severe fetal and neonatal consequences (group 3).
RESULTS: Fourty cases were analyzed. The abnormal karyotype result (16.7%) were 46,x,t(t15;16)(q26;24), monosomy 18, trisomy 13, 46, XX, 21ps +. In the central cleft, ultrasonographic anomalies were seen in nine patients, which was statistically significantly higher than in isolated CL±P (p=0.004). Seven patients with extra ultrasonographic anomalies underwent termination, one patient with anencephaly died in utero. Preterm birth was the most common obstetric complication in all groups (n=9, 27.2%). In group 3, polyhydramnios was observed statistically significantly more frequently than in group 2 (p=0.033), and the first minute APGAR score was statistically significantly lower than in group 1 and 2 (p=0.003). The fifth minute APGAR score was statistically significantly lower and the need for the neonatal intensive care unit was statistically significantly higher than group 1 only (p=0.004 and p=0.007, respectively).
DISCUSSION AND CONCLUSION: Polyhydramnios is not found in isolated cases, but only in cases with additional anomalies. Patients with CL±P with either major or minor additional ultrasonographic anomalies have worse fifth minute Apgar results and a greater need for the NICU.

2.Features of endoscopic and histopathological findings of the gastrointestinal tract in patients with blepharitis
Kamil Yavuzer, Beyza Yavuzer, Emin Oguz, Guner Kilic, Serap Tas, Yusuf Kayar
doi: 10.5505/ejm.2022.00236  Pages 212 - 216
INTRODUCTION: Helicobacter pylori (H pylori) leads to gastric diseases as well as causing many extra-gastric involvements. Although contradictory findings are reported in some studies; it is indicated that some eye-related diseases are linked to H pylori. In our study, we aimed at investigating the relationship between presence of blepharitis and H Pylori positivity.
METHODS: Demographic data, drug, smoking and alcohol use, endoscopic, histological findings and presence of blepharitis were documented. Endoscopic and histopathological findings are compared between patients with blepharitis and control group. The data is analysed statistically. Values with p>0.05 were considered significant.
RESULTS: 36 patients with blepharitis and 84 patients without blepharitis were included in the study. Presence of helicobacter pylori was found significantly in higher rate at patients with blepharitis. Esophagitis, gastric ulcerand bulbitis were found significantly in higher rate atpatients with blepharitis. There is no difference between the groups in terms of other endoscopic findings.
DISCUSSION AND CONCLUSION: While causing gastro duodenal diseases, particularly peptic ulcer and stomach adenocarcinoma by interaction between bacterial virulence factors and host and/or environmental factors, H pylori is known to be related to many extra-gastric involvements. Thus, in the presence of eye diseases such as blepharitis, we consider that; it is necessary to investigate presence of H pylori and treatment shall be done when positivity is detected.

3.A New Technique for Prevention of Postoperative Complications after Gastropancreaticoduodenal Resections
Resul Nusretoğlu, Hakan Sarsılmaz, Yunus DÖNDER
doi: 10.5505/ejm.2022.47113  Pages 217 - 226
INTRODUCTION: Pancreaticoduodenal resection- is the only radical method of treating the tumour of the biliopancreaticoduodenal zones and chronic pseudotumour lesions of the head of the pancreas. The aim of our work is to increase good results of the gastropancreaticoduodenal resections.
METHODS: From 1984-2006 in the Syzganov A.N. National scientific center of surgery, 138 pancreaticoduodenal resections were carried out due to tumors of the pancreaticoduodenal zones and chronic bulbous pseudotumourous pancrearitis. For finding out the specific complication of the gastropancreaticoduodenal resection, 103 patient’s medical records of the control group were analyzed. Based on our experiences, we have the following indications before carrying out our methods of pancreatodigestive anastomosis.
RESULTS: Our method of the gastropancreaticoduodenal resection has reduced the post-surgical complications: acute pancreatitis of the pancreatic stump –from 49 incidence (47,5%) to only one (2,8%), pancreonecrosis -16 (15,5%) to 0, indehiscence of the pancreaticojejunal anastomosis –from 25 (24,2%) to 2 (5,7%), indehiscence of the hepaticojejunal anastomosis – from 14 (13,6%) to 1 (2,8%), indehiscence of the gastrointestinal anastomosis – from 2 (1,9%) to 0. Gastrointestinal bleeding –from 6 (5,8%) to 1 (2,8%), intestinal fistulas – from 2 (1,9%) to 0, pancreatic fistulas – from 4 (3,9%) to 0, gastro stasis- from 10 (9,7%) to 0.
DISCUSSION AND CONCLUSION: After all, we can conclude that, the newly developed method of invaginating pancreaticojejunal anastomosis “end to end” with adequate drainage of the anastomosis zone through microjejunostomy provides decompression of the zone of the pancreaticojejunal anastomosis through microjejunostomy, hence reduced the indehiscence of the pancreaticojejunal anastomosis.

4.Analysis of Patients with a Suicide Attempt Presenting to the Emergency Department of two Hospitals in Van, Turkey
Ramazan Sami Aktaş, Mesut IŞIK, gizem gizli, Sevdegül Karadaş Bilvanisi, MEHMET REŞİT ÖNCÜ
doi: 10.5505/ejm.2022.84429  Pages 227 - 234
INTRODUCTION: Suicide is a serious problem affecting public health all over the world. Suicide-related mortality and morbidities requiring lifetime care have economic, social and psychological repercussions. Considering that reasons for suicide vary by geography, we aimed to investigate the demographic characteristics of patients presenting to the emergency departments located in a province in eastern Turkey following a suicide attempt.
METHODS: After obtaining ethical approval, the records of two hospitals where the study was conducted were screened and 4,096 patients who had attempted suicide were identified using the international diagnostic codes X44, F19, T14.9, X80, Y24, W16, Y17, Y26, Y20 and Y85. Of these patients, 2,456 with incomplete records were excluded, and the data of the remaining 1,640 were analyzed with the Kolmogorov-Smirnov test using SPSS.
RESULTS: Seventy percent of the patients included in the study were women, and 43.3% were married. The incidence of suicide showed a generally increasing trend over the years. The rate of suicide rate was higher in summer. Women most frequently attempted suicide due to family problems and men due to psychiatric reasons. The most commonly used method in both genders was the ingestion of drugs or toxic substances.
DISCUSSION AND CONCLUSION: We consider that after a detailed examination by psychologists in the emergency department, the rate of future admissions due to attempted suicide will decrease, especially through the solution of family problems and treatment of psychiatric conditions.

5.Comparative evaluation of upper airway dimensions with acoustic rhinometry and cone-beam computed tomography
Gökçenur Gökçe, Burçin Akan, Sercan Göde, Ilknur Veli
doi: 10.5505/ejm.2022.58224  Pages 235 - 241
INTRODUCTION: The aim of this retrospective study was to correlate the narrowest area and volume of nasal cavity assessed by acoustic rhinometry (AR) with the oropharynx area and volume assessed by cone-beam computed tomography (CBCT).
METHODS: This retrospective study was performed on CBCT images and AR records of 45 mouth-breathing individuals (27 male and 18 female) aged between 12-14 years. The examinations assessed: (a) acoustic rhinometry: nasal volume and minimum cross-sectional area 1 and 2 of nasal cavity; (b) cone-beam computed tomography: oropharyngeal volume and area. The results were evaluated by Pearson correlation analysis. p<0.05 was considered statistically significant.
RESULTS: There was no statistically significant relationship between airway volume and nasal cavity parameters (MCA1, MCA2 and nasal volume) (p>0.05). There was a weak negative correlation between airway area and nasal volume (r=-0.394; p=0.013).
DISCUSSION AND CONCLUSION: The highest correlation was found only between the airway area and the nasal volume when the AR results were compared with the data obtained from the CBCT imaging technique.

6.Comparison of short-term outcome of late preterm and term infants
Ayten Beyar, Esin Aldemir, Mehmet Gökhan Ramoğlu, Müge Payaslı, Serdar Sander, Sultan Kavuncuoglu
doi: 10.5505/ejm.2022.87360  Pages 242 - 249
INTRODUCTION: Objective: Our aim was to compare the rate of morbidity and mortality of late preterm and term infants during hospitalization in the third-level neonatal intensive care unit (NICU).
METHODS: 743 late preterm and 489 term infants who were born and followed up in the third level NICU were evaluated retrospectively. The birth weight, mode of delivery, gestational week, gender, duration of hospitalization, problems in neonatal and post-discharge period and rate of mortality were investigated. The rate of mortality and morbidity were compared between the groups.
RESULTS: Respiratory distress (RDS) was the most common (40.3%) cause of hospitalization. The rate of necrotizing enterocolitis, RDS and bronchopulmonary dysplasia were significantly higher in late preterms. 62 (8.3%) of the late preterms and 88 (18%) of the term babies died. Congenital anomalies (55%) were the major cause of mortality in the term group, whereas RDS (35%), surgical interventions, long-term hospitalization, and infection were the main causes of mortality in the late preterm group.
DISCUSSION AND CONCLUSION: The high mortality rate in our study was due to the fact that our study included only the babies hospitalized in 3rd level NICU. It must be kept in mind that late preterms experience most of the problems of ongoing prematurity; therefore, they shouldn’t be delivered unless there is absolute obstetric and/or fetal indication.

7.Effects of thymoquinone on erythrocyte aggregation kinetics: an in vitro study
Savas Ustunova, Mehmet Uyuklu, Ismail Meral
doi: 10.5505/ejm.2022.65037  Pages 250 - 256
INTRODUCTION: Erythrocyte aggregation is associated with a series of physio-pathological processes in body and according to this, current study was designed to examine how the thymoquinone (TQ) and aggregation kinetics relation changes when the aggregation properties of erythrocyte suspensions are intervened using different approaches, such as changing the suspension environment or erythrocyte surface properties.
METHODS: Blood samples from, 40 male Wistar albino rats (three months old weighing 250-300 g) were randomly divided into four groups, as 1) whole blood (control), 2) 1/2 dilution (plasma was diluted with PBS), 3) dextran 500 (1% dextran 500 was dissolved in plasma) and 4) glutaraldehyde. Blood samples were taken from abdominal aorta under anesthesia. The erythrocyte suspensions were incubated at 37°C for one hour in the absence or presence of TQ, with a final concentration of 1 mg/ml. Then, the electrical properties of erythrocyte suspensions were recorded, and the electrical capacitance was monitored using an inductance, capacitance, and resistance meter (LCR meter) at 100 kHz.
RESULTS: It was found that TQ incubation decreased the aggregation index in control and dextran groups while increased it in 1/2 dilution and GA groups. It was also found that TQ incubation increased the time constant in whole blood and dextran while decreased it in 1/2 dilution and GA.
DISCUSSION AND CONCLUSION: The TQ can normalize the altered erythrocyte aggregation responses in both ways that is, it decreases the increased aggregation or increases the decreased aggregation. Therefore, it may have very critical role in rouleaux formation-induced circulatory disorders.

8.Evaluation of effects of hydration and dehydration status on body composition analysis using bioelectrical impedance method
Sermin Algül, Oğuz Özçelik
doi: 10.5505/ejm.2022.39260  Pages 258 - 263
INTRODUCTION: We aimed to evaluate effectiveness of bioelectrical impedance analysis (BIA) method on the body composition analysis under the condition of acute water intake and excretion in young healthy male.
METHODS: Thirty male with normal body mass index were participated to this study. Each subject consumed 500 ml water every 30 minutes for three times (total of 1500 ml water). During study, body composition analysed five times using foot-to foot BIA, one at basal, then three times after each water consume and lastly after excretion of bladder. Body fat mass, fat percent, total body water and fat free mass were measured and recorded. Anova test used to analyse data and p<0.05 was accepted as significant.
RESULTS: There were systematic increases in body fat mass and fat percent following each 500 of water intakes. However, body water levels didn't changed at 500 ml and 1000 ml water intakes and significant changes observed at 1500 ml of water intakes. In addition, water excretion caused significant decrease in fat mass in all subjects while it did not occurred in water measurement. There was positive correlation between water intake and fat mass changes.
DISCUSSION AND CONCLUSION: As a results, BIA based body composition analysis failed to measure valid fat mass and water content under the condition of increased and decreased body water levels in healthy males. Thus, clinician or scientist should consider underestimation of water and higher estimation of fat mass values using BIA method in subjects who has high body water and fat mass contents for crucial clinical decision.

9.Evaluation of patients with uterine perforation after intrauterine device placement and determination of risk factors: A Retrospective Case-Control Study
Reyhan Gündüz, Elif Ağaçayak, Dicle Akkılıç Dönmez, Fatih Mehmet Findik, Mehmet Sıddık Evsen, Talip Gül
doi: 10.5505/ejm.2022.88155  Pages 264 - 271
INTRODUCTION: To determine the risk factors by evaluating patients with uterine perforation after intrauterine devices (IUD) placement. Also, it was to make suggestions and contribute to the literature in order to prevent uterine perforation after the IUDs placement and how we should behave when we encounter these patients.
METHODS: Twenty-two patients with uterine perforation after IUDs placement (patient group) diagnosed and treated at our clinic and 30 patients with IUDs in place in the uterine cavity (control group) were retrospectively evaluated and compared.
RESULTS: IUDs insertion by a midwife and during the breastfeeding and puerperal period significantly increased the frequency of uterine perforation after IUDs placement, while insertion during the menstrual period significantly reduced risk. Uterine perforation after IUDs placement were most frequently localized in the myometrium (54.5%) and the douglas (13.6%). Uterine perforation-related complications were absent in 59.1% of patients. Of patients, 40.9% underwent hysteroscopy, 18.2% laparoscopy. The diagnostic method was ultrasonography alone at a rate of 68.2%.
DISCUSSION AND CONCLUSION: IUDs could be inserted during menstruation where possible, and patients could be informed about the high risk of uterine perforation after IUDs placement associated with the breastfeeding and puerperal periods. We recommend that IUDs be inserted with ultrasonography in this period. Midwives should receive regular training in order to increase their knowledge and experience on this subject. We recommend ultrasonography as the primary diagnostic method. Those with IUDs embedded in the myometrium can primarily undergo hysteroscopy, and those with IUDs in the abdomen can undergo laparoscopy or laparotomy.

10.Investigation of prevalence of back pain and its risk factors (case study: female students of Babol University of Medical Sciences)
Elham Alamoouti, Rahmatollah Jokar, Seyyed-mokhtar Esmaeilnezhad- Ganji
doi: 10.5505/ejm.2022.60370  Pages 272 - 280
INTRODUCTION: Back pain is the most prevalent musculoskeletal complication. Due to inactive lifestyle and long hours of working in hospital, medical students are prone to back pain. Patients with back pain have a disturbed quality of life because of being affected by physical problems and functional constraints. Therefore, the present research investigates the prevalence of back pain and its risk factors in female students of Babol University of Medical Sciences (Iran).
METHODS: This research is a cross-sectional descriptive study, and data collection has been done by a pre-designed questionnaire and Oswestry questionnaire. 300 female students of medical subjects with the average age of 22.9 ± 2.4 years and the average body mass index (BMI) of 21.9 ± 3.2 were included in the study (2017-2018).
RESULTS: Twelve students were excluded from the study because of the background of back trauma. Among the 250 female students affected by back pain (86.8%), 169 people (58.7%) reported the background of back pain in at least one of the family members; 45.1% of this population lived in dormitory. The highest prevalence of back pain (29.2%) was reported in students of medicine. However, no significant relationship was observed between prevalence of back pain, living in dormitory, and university subject.
DISCUSSION AND CONCLUSION: Nevertheless, back pain had a significant relationship with the weight changes over the past six months, using computer, family background, and not exercising (P=0.000). Regarding the results suggesting the 86.8% prevalence of pack pain among female medical students of Babol University of Medical Sciences and their inactive lifestyle.

11.Late psychiatric consequences in disability patients injured in traffic accidents
Yavuz Hekimoğlu, Melike Sari, Burak Taştekin, Mahmut Asirdizer
doi: 10.5505/ejm.2022.62134  Pages 281 - 288
INTRODUCTION: The present study aimed to describe the late psychiatric consequences in road traffic accidents (RTAs) victims who were referred to us for disability examination months or even years after the injury, and to evaluate according to to the civil and penal laws in force in Turkey.
METHODS: A retrospective examination was made of the files sent by the courts to the expert committee chaired by the authors for the determination of applicants’ disability rate over the 7-year period between 2014 and 2020.
RESULTS: Of 774 victims of RTA, 3.6% (n=28) had late psychiatric outcomes, including 1.9% post-traumatic epilepsy (PTE), 1.0% post-traumatic stress disorder (PTSD), and 0.6% frontal lobe syndrome (FLS). The 28 cases comprised 18 males and 10 females with a mean age of 25.6±14.4 years. Of these patients, 10 were pedestrians, 12 were passengers and 6 were drivers. Disability rates ranged from 5% to 90% in the patients with PTE, were 40% or 60% in patients with PTSD, and were 25% or 40% in patients with FLS.
DISCUSSION AND CONCLUSION: In patients who have been exposed to serious traumas such as RTAs, providing psychiatric support during or after medical treatment is of undeniable importance for the patient’s full health. In addition, this support, which will be included in the medical records, will prevent much loss of rights of the victims in countries that do not have regular psychological examination records.

12.Prevalence of Depression and Malnutrition in Geriatric Patients with and without Diabetes Mellitus
Eyyüp Murat Efendioğlu
doi: 10.5505/ejm.2022.56588  Pages 289 - 294
INTRODUCTION: The elderly population is increasing both worldwide and in Turkey. Malnutrition and depression are important health problems in our aging world. The purpose of this study was to determine the prevalence of depression, malnutrition, and polypharmacy in geriatric patients with and without diabetes.
METHODS: A total of 253 patients, 143 with and 110 without diabetes, who admitted to the geriatric clinic, were included in the study. The weight and standing height of each participant was recorded, and their body mass index (BMI) values were calculated. Individuals with BMI values ≥25 kg/m2 were regarded as overweight, those with BMI ≥30 kg/m2 as obese, and those with BMI ≥40 kg/m2 as morbidly obese. Yesavage Geriatric Depression Scale was used to assess the mood, and the Mini Nutritional Assessment-Short Form was used to assess the nutritional status.
RESULTS: There was no significant difference between the groups in terms of depressive symptoms (p=0.610). However, the frequency of obesity and polypharmacy was statistically significantly higher in diabetic patients (p<0.05). The proportion of those with malnutrition or risk of malnutrition was higher in patients without DM (p=0.004).
DISCUSSION AND CONCLUSION: Approximately one-third of diabetic geriatric patients admitted to our clinic were overweight, while more than half were obese or morbidly obese. Malnutrition or risk of malnutrition was present in nearly half of the patients without diabetes. The presence of depressive symptoms in approximately one in two geriatric patients with and without diabetes is an issue requiring attention in terms of public health.

13.Retrospective Evaluation of Term Neonatal Cases with Indirect Hyperbilirubinemia
Rezzan Ezgi Ekin, Sabahattin Ertuğrul, İbrahim Deger, ilyas Yolbaş
doi: 10.5505/ejm.2022.27870  Pages 295 - 301
INTRODUCTION: Although jaundice is very common in the neonatal period, it often recovers spontaneously without the need for treatment. In this study, it was aimed to retrospectively evaluate the patients hospitalized with the diagnosis of hyperbilirubinemia and to determine the risk factors, thus, to early diagnose and guide treatment of severe hyperbilirubinemia.
METHODS: In this study, 250 infants who were followed up and treated for hyperbilirubinemia in Neonatal Intensive Care Unit.
RESULTS: When all cases were evaluated etiologically, the highest reason was found to be AB0 incompatibility. In 30% of the cases, the direct Coombs test was positive and the most common reason in the cases with positive direct Coombs test was the association of Rh and subgroup incompatibility with a rate of 29.3%. When the treatments applied to the cases were evaluated, phototherapy was given to all patients. It was found that of the patients, 84% received only phototherapy treatment, 6.4% underwent exchange transfusion with phototherapy, 5.2% received IVIG treatment, 4.4% received exchange transfusion and IVIG treatment.
DISCUSSION AND CONCLUSION: If neonatal hyperbilirubinemia is not diagnosed and treated early, the morbidity and mortality of the brain damage that can occur is high. Today, while AB0 and Rh incompatibilities, which are an important etiologically important problem, are closely monitored, other etiological conditions such as infections, G6PD deficiency, subgroup incompatibility, hypothyroidism should also be kept in mind and early diagnosis and treatment should be performed.

14.The Effects of Rutaecarpine on Metastatic Prostate Cancer Cells
Mehmet Abdulkadir Şekeroğlu, Erdem Çokluk, Zeynep Özman, Asuman Deveci Özkan, Gamze Guney Eskiler, Mehmet Ramazan Şekeroğlu, Fatıma Betül Tuncer
doi: 10.5505/ejm.2022.10437  Pages 302 - 306
INTRODUCTION: Prostate cancer with an increased incidence in the world is one of the public health-threatening malignancy. Metastatic prostate cancer is an important cause of death in men despite of the combined use of more than one chemotherapeutic drug as well as radiotherapy and supportive treatments. Therefore, there is a need to develop novel treatment strategies in metastatic prostate cancer patients. The aim of this study was to investigate the potential therapeutic effects of Rutaecarpine (RUT) on metastatic prostate cancer cells.
METHODS: RUT induced cytotoxicity and apoptotic cell death were evaluated by WST-1, Annexin V, AO staining and ELISA assays in PC-3 human metastatic prostate cancer cell line.
RESULTS: The viability percentage of PC-3 cells after exposing to different concentrations of RUT treatment was significantly decreased in a time and dose dependent manner and the most effective concentrations of RUT was determined as 20 and 40 μM for 48 hours (p<0.05). Annexin V and AO staining revealed that the early and late apoptosis rate significantly increased compared to the control group (p <0.05). Additionally, the caspase-3 levels significantly increased after RUT treatment in PC-3 cells in a dose dependent manner (p<0.05).
DISCUSSION AND CONCLUSION: In this study, RUT exhibited a cytotoxic and apoptotic effects on PC-3 cells and therefore RUT could be a potential new therapeutic agent for the treatment of metastatic prostate cancer. However, the underlying mechanism of the apoptotic death caused by RUT in PC-3 cells should be further investigated through advanced analysis at molecular level.

15.The effects of cold application to trapezius muscle on the fibromyalgia
Emine Kıyak
doi: 10.5505/ejm.2022.81904  Pages 307 - 316
INTRODUCTION: This study aimed to assess the effect of cold application on trapezius muscles on fibromyalgia (FM).
METHODS: This randomised, controlled study was conducted at the Physical Medicine and Rehabilitation outpatient clinic of a university hospital, in 42 people who had been diagnosed with FM. The participants were randomly divided into intervention (n=22) and control (n=20) groups. Cold application was applied to the trapezius muscles of the participants in the intervention group for 10 minutes. The pain levels of the participants in both the intervention and the control groups were evaluated every day for a period of 1 week. A questionnaire, the visual analogue scale and Revised Fibromyalgia Impact Questionnaire (FIQR) were used to collect data.
RESULTS: The mean pain scores of the participants in the intervention group were measured before cold application, 30 minutes after application, and on Days 1, 2, 3, 4, 5, 6 and 7, and these scores differed significantly (p<0.001). Function, impact, symptoms and total FIQR scores decreased significantly after cold application in the intervention group (p<0.001).
DISCUSSION AND CONCLUSION: The pain levels of the people with FM, which were measured 30 minutes after they received cold application on the trapezius muscle and on Days 1, 2, 3, 4, 5, 6 and 7 post-application, decreased significantly. Their symptoms also decreased significantly and their functions, impact and general health status improved compared to the control group.

16.The Nutritional Habits And Relationship Between The Antioxidant Activity And Iron Deficiency Anemia During Pregnancy
Suzan Güven, Ismail Meral, Mertihan Kurdoglu, Halit Demir
doi: 10.5505/ejm.2022.48091  Pages 317 - 324
INTRODUCTION: The aim of this study was to investigate the changes in nutritional habits, and also relationship among oxidative stress, iron deficiency anemia and some antioxidant enzyme activities during pregnancy.
METHODS: Twenty pregnant women in the first trimester, 20 pregnant women in the last trimester and 20 non-pregnant women (control group) were included in the study. The study groups were similar in terms of age and body mass index. None of the participants had any systemic disease or smoked. After having filled out the questionnaire about nutritional habits, the blood samples were collected, and the malondialdehyde (MDA) level and activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) enzymes were measured together with hemoglobin (Hgb), hematocrit (Hct), iron, ferritin and the mean erythrocyte volume (MCV) levels.
RESULTS: The most frequent meat consumption was on every other day in controls, but once a week in the first and last trimester groups. In addition, the most frequent egg consumption was on every other day and once a week in controls, but rare in the first trimester group, and once a week in the last trimester group. Although iron and vitamin use was 10% and 30% in the first trimester group, it was 50% and 65% respectively in the last trimester group. The MDA level was higher, and the SOD, CAT and GSH-Px enzyme activities were lower in both pregnant groups than controls. The Hgb and Hct values were lower in the last trimester group compared to the controls and the first trimester group. The first trimester group and the controls were similar in terms of Hgb and Hct levels. There was no significant difference among groups in terms of ferritin, iron or MCV values.
DISCUSSION AND CONCLUSION: It was concluded that; a) the egg and meat consumption might decrease with the progress of pregnancy, b) the oxidative stress increased in pregnancy, c) Hgb and Hct values might be lower in the last trimester group despite increased intake of oral iron and vitamin supplements, and normal serum iron levels due to decreased CAT activity. Therefore, more studies are needed to demonstrate the relationship among oxidative stress, anemia and CAT enzyme activity in pregnancy.

17.Anterior stabilization application with odontoid screw in a patient with Type 2 Odontoid Fracture A Case Report
Abdurrahim Taş, abdurrahman aycan, OZKAN ARABACI, ADEM YOKUŞ, Harun Arslan
doi: 10.5505/ejm.2022.48295  Pages 325 - 329
The treatment of type II odontoid fractures has been discussed for many years. Due to the complex anatomy of the craniocervical junction, many- questions are encountered in the diagnosis and treatment of such fractures. However, in centers without Neuro-navigation and O-arm, free hand technique still remains a viable option for the surgical treatment of such cases. Although there is no neuronavigation and O-arm in our center, we will present our case of type II odontoid screw placement with free hand technique that we successfully applied in our elderly patient with a Type II fracture

18.Successful Treatment Of Bulky Abdominal Plasmacytomas With Radiotherapy and Pomalidomide
Ceren Barlas, Meltem Dağdelen, Tuğrul Elverdi, Ayşe Salihoğlu, Fazilet Öner Dinçbaş
doi: 10.5505/ejm.2022.02259  Pages 330 - 332
Extramedullary myeloma itself is a rare entity and treatment of recurrent extraosseous myeloma can be challenging during the prolonged disease course. We report a multiple myeloma(MM) patient with extramedullary bulky abdominal masses treated with palliative radiotherapy(RT) and concomitant pomalidomide.
A 59-year-old woman diagnosed with MM presented with pancytopenia, widespread lytic bone lesions and intraperitoneal implants.The patient received multiple series of chemotherapy.Following autologous stem cell transplantation(ASCT), imaging studies displayed bulky abdominal masses. Due to the rapidly progressing symptoms, palliative RT 30 Gy in 15 fractions with concomitant pomalidomide was administered.Post-RT imagings showed near-complete regression.
Extraosseous extramedullary MM has a poor prognosis and is an area of unmet clinical needs.Our report describes the treatment of a relapsed extramedullary myeloma case with RT and concomitant pomalidomide resulting in a near-complete response of disease inside the radiated area.To conclude, it was demonstrated that RT is an effective treatment modality to obtain symptom palliation and can be safely administered with an immunomodulatory drug.

19.Successfulness of the Bakri intrauterine balloon for uterotonic-unresponsive postpartum haemorrhage treatment: systematic review and meta-analysis.
Marco La Verde, Gaetano Riemma, Marco Torella, Nicola COLACURCI, Salvatore Annona, Anna Conte, Vittorio Simeon, Agnese MariaChiara Rapisarda, Pasquale De Franciscis, Maddalena Morlando
doi: 10.5505/ejm.2022.98624  Pages 333 - 342
OBJECTIVE: The main purpose of this meta-analysis was to evaluate the success rate of Bakri balloon in controlling postpartum haemorrhage (PPH) unresponsive to uterotonics.
MATERIALS AND METHODS: We performed a literature search using the MEDLINE (accessed via PubMed) database from inception to October 2019, for clinical trials and observational studies. Case reports with six or fewer patients, review articles, letters to editor, use of the device for purposes different than PPH, and non-English language publications were excluded. Two authors independently extracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale. Primary outcome was the efficacy of the Bakri balloon in the treatment of PPH unresponsive to uterotonics.
RESULTS: Twenty-eight publications (n=1868 applications of Bakri balloon) met the inclusion criteria for the meta-analysis. Ten reports provided the frequency of Bakri balloon used during the study period, with the overall rate being 0,335% (1004/299124; 95% CI, 0.2–0.4%). Success rate of the haemostatic balloon in controlling PPH without the need for additional procedures was 82% (1597/1868; 95% CI, 78–86%), while further procedures were needed for 271 patients (13,83%; 95% CI, 11–21%). Bakri balloon plus additional procedures were effective in the control of the PPH in the 95% of all cases (1645/1868; 95% CI, 93–98%). Hysterectomy was performed in the 5% (78/1597; 95% CI, 2–6%) of all women who needed a Bakri balloon.
CONCLUSIONS: Bakri balloon represents a successful therapeutic option for the treatment of postpartum haemorrhage unresponsive to uterotonics.

20.Management of patients with pulmonary hypertension in COVID-19 pandemic
Müntecep Aşkar, Selvi Aşkar, Medeni Karaduman, Rabia Çoldur
doi: 10.5505/ejm.2022.70846  Pages 343 - 350
The new coronavirus (COVID-19) epidemic caused by SARS-CoV-2 has emerged as perhaps the biggest medical problem of our century. Although COVID-19 mainly affects the lungs, it also affects many organs, especially the cardiovascular system. Pulmonary hypertension (PH) is a pulmonary vascular disease described by pulmonary arterial vasoconstriction and remodeling, which may lead to an increased pulmonary artery pressure with varying clinical course and severity depending on the etiology and eventually to right heart failure.
Because of associated comorbidities, patients with PH are likely to face a potential risk of severe complications and mortality and unfortunately, they may have worse outcomes compared to other patients. The COVID-19 pandemic has brought us new and different challenges in the follow-up and treatment processes of patients with PH. For patients admitting to the hospital, it is important to balance the risk of exposure to COVID-19 with ongoing care and treatment services. However, the COVID-19 outbreak has brought serious challenges to PH centers to weigh the risks and benefits of diagnostic research, including potential exposure to COVID-19, and the timing of initiation of PH specific treatment in high-risk patients.
In this article, the management of PH patients during the COVID-19 pandemic; problems encountered in diagnosis, clinical follow-up and treatment processes; the different difficulties experienced during hospitalizations have been compiled.

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