ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 27 (3)
Volume: 27  Issue: 3 - 2022
1.Is Behçet's disease associated with adverse pregnancy outcomes?
Ayşe Keleş, Mehmet Obut, Harun Egemen Tolunay, Özge Yücel Çelik, Gülşah Dağdeviren, Neval Çayönü Kahraman, Şevki Çelen
doi: 10.5505/ejm.2022.33427  Pages 351 - 356
INTRODUCTION: In this study, we aimed to investigate the association between Behçet's disease (BD) and adverse pregnancy outcomes.
METHODS: This retrospective study was conducted in pregnant women diagnosed with BD who were treated at our hospital between January 2017 and November 2021. All pregnancies of the participants before and after the diagnosis of BD were analyzed. Maternal age, obstetric history, pregnancy complications, and neonatal outcomes were analyzed. Pregnancy outcomes were compared with those of healthy controls. Disease activity and history of drug use during pregnancy were evaluated. The relationship between the course of the disease and the outcome of pregnancy was analyzed.
RESULTS: During the study period, 26 pregnant women with BD were included in the analysis. There were 10 and 63 pregnancies before and after the diagnosis of BD, respectively. The rate of disease flare-up in pregnancy was 46.2%. At least one pregnancy complication occurred in 34.5% of pregnant women with BD. The incidence of preterm delivery (PD) and low birth weight (LBW) were found to increase in pregnant women with BD (p=.001 and p=.001, respectively). No difference was found in other adverse pregnancy outcomes. No association was found between adverse pregnancy outcomes and disease flare-up during pregnancy.
DISCUSSION AND CONCLUSION: Although BD generally tends to remission during pregnancy, it is characterized by an increase in PD and LBW rates.

2.Comparison of digital and extradigital glomus tumors
Merih Altıok, Feyzi Kurt
doi: 10.5505/ejm.2022.78466  Pages 357 - 363
INTRODUCTION: Glomus tumors(GT) are the rare neoplasms of soft tissue originated from mesenchymal origin. GT can be seen in throughout the body, finger pulp and subungual location are seen in ¾ of cases. In this study, we aimed to compare the clinical, radiologic and histopathological features of finger localized GT and GTs located outside the fingers.
METHODS: The diagnosis of GT was searched from the database of Adana Seyhan State hospital. Thirty-six patients with finger localized GT as group 1 and twenty patients with extra-digital GT as group 2 were included in the study. The groups were evaluated and compared with regards to the demographic characteristics, clinical findings, tumor size, the results of immunohistochemical analysis, the surgical margin status, clinical follow-up results and recurrences.
RESULTS: 56 patients were diagnosed with GT. The mean age of patients was 42 (±17), the mean follow-up time was 44 months (±24). The number of patients with pulp, subungal and distal finger localized GT was 36 (group1) and the number of patients with extradigital tumor was 20 (Group 2). The mean tumoral size was measured as 6 mm (±4.2). The results of αSMA, MSA, vimentin and calponin positivity in immunohistochemical analysis were found to be similar between groups.
DISCUSSION AND CONCLUSION: The finger localized tumors are diagnosed correctly with higher percentage clinically. The extradigital GT reaches higher size and usually misdiagnosed. The immunohistochemical staining for differentiating the malignant tumors seems non-beneficial. It is thought that giving attention to have negative surgical margin in digital GTs prevent the recurrences.

3.Coronary-pulmonary artery fistulas in children: A single-center experience
Mehmet Gökhan Ramoğlu, Selen Karagözlü, Ozlem Bayram, JEYHUN BAKHTIYARZADA, Alperen Aydın
doi: 10.5505/ejm.2022.82584  Pages 364 - 369
INTRODUCTION: This study aims to evaluate the characteristics and outcomes of children with coronary to pulmonary artery fistulas.
METHODS: The age, gender, duration of follow-up, indications for initial echocardiography, electrocardiography and echocardiography findings, catheter angiography indications, and the outcome of patients were evaluated. Echocardiographic data included additional cardiac anomalies, origin and drainage of the fistulas, presence of coronary artery dilatation, and changes in fistula flow.
RESULTS: The study involved 64 (66.7%) male and 32 (33.3%) female children. Additional cardiac anomalies were present in 34 (35.4%) cases. The origin of the fistula was defined in only 9 cases (by echocardiography and angiography) and the site of origin was: the left anterior descending (55%), the left circumflex (2.5%), and the right coronary (2.5%) artery. Two cases had very mild dilatation of coronary arteries. The drainage of the fistulas was to the anterior aspect of the pulmonary artery (78.7%), the aortic side of the pulmonary artery (4.3%), and the right pulmonary artery (17%). In only 2 cases, catheter angiography was performed with an indication (suspected coronary artery anomaly) related to coronary-pulmonary fistula, and one of them had right coronary artery dilatation. Rate of spontaneous closure was 9.4%. Surgical or percutaneous closure was not considered in any of the cases and none of the cases had any adverse events or symptoms related to the fistula.
DISCUSSION AND CONCLUSION: Coronary to pulmonary artery fistulas seldomly require further investigation. Clinical follow-up with echocardiography and ensuring bacterial endocarditis prophylaxis is usually adequate unless the fistulas are hemodynamically significant and/or symptomatic.

4.Effects of Sedation Doses of Propofol and Midazolam on Levels of NGAL, Cystatin-C, KIM-1 in Rats
Celaleddin Soyalp, Ahmet Ufuk Kömüroğlu, Nureddın Yuzkat, Yildiray Basbugan, Yunus Emre Tunçdemir
doi: 10.5505/ejm.2022.76376  Pages 370 - 376
INTRODUCTION: Limited data are available regarding the impact of their sedation doses midazolam and propofol on early biomarkers of acute kidney injury (AKI). This study aimed to investigate the effects of sedation doses propofol and midazolam on early biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CyC) and kidney injury molecule 1 (KIM-1) of AKI.
METHODS: A total of 24 Wistar albino rats were separated into three groups (n = 8 per group): a control group (intraperitoneal injection [IP] saline injection once daily for 7 days), a propofol group (IP injection of 2.5 mg/kg propofol once daily for 7 days), and a midazolam group (IP injection of 5 mg/kg midazolam once daily for 7 days). For each group, urinalysis (for urea, creatinine, total protein, NGAL, CyC, and KIM-1) was performed on Day 0 and Day 7; serum analysis (for urea, creatinine, total protein, albumin globulin, ALT, AST, NGAL, CyC, and KIM-1) was performed on day 7.
RESULTS: No significant difference was noted between control, propofol and midazolam groups in terms of Day 7 serum KIM-1, CyC, and NGAL levels and Day 0 and Day 7 urinalysis findings (KIM-1, CyC, NGAL, urea, and creatinine levels).
DISCUSSION AND CONCLUSION: The findings revealed a similar safety profile for seven-day propofol and midazolam administration in rats in terms of the traditional (creatinine, urea) and early biomarkers (NGAL, CyC, KIM-1) of AKI

5.Endobronchial Ultrasonographic Practices with Rapid Onset Pathological Evaluation
Nevra Güllü Arslan, İlker Yılmam, Canan Demirci
doi: 10.5505/ejm.2022.80269  Pages 377 - 379
INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure to evaluate suspicious mediastinal lesions. The utility of rapid on-site evaluation (ROSE) during EBUS-TBNA is still controversial. The aim of this study is to assess the role of ROSE during EBUS-TBNA on the last pathologic diagnosis.
METHODS: 597 EBUS cases were included into the study. The records were analyzed retrospectively according to demographic characteristics, indications of the procedure, number of stations, ROSE diagnosis and final diagnosis.
RESULTS: 455 (76.2%) of EBUS cases could be applied by the pathologist, while ROSE procedure could not be applied to 142 (23.8%). In 43 (7.2%) cases, the result of sampling was not diagnostic. The rate of non-diagnostic patients was 3.7% in 455 cases with ROSE, whereas the rate was 18.3% for no-ROSE group. There is a statistical difference between these two rates (p <0.001).
DISCUSSION AND CONCLUSION: We think that ROSE of EBUS-TBNA improves efficiency of the biopsy and yield of the procedure if performed by an experienced cytopathologist or cytotechnologist. Our diagnosis rate increased when our pathologist guided us about the adequacy of the sample during the procedure and influenced our decision to terminate or continue accordingly.

6.The Psychometric Evaluation of the Immune Status Questionnaire in Indonesia during Covid-19 Pandemic
Gilang Fachri Maulana, Novita Intan Arovah
doi: 10.5505/ejm.2022.93764  Pages 380 - 388
INTRODUCTION: Immunity is one of the key factors in COVID-19 transmission, thus, assessments of immune status are essential for evaluating transmission risks. This study aimed to assess the validity and reliability of the Immune Status Questionnaire (ISQ), a recently developed immune status measure, among Indonesian adults, during COVID-19 Pandemic.
METHODS: Online Indonesian translated version of the ISQ and the Short Form 12 (SF-12) for measuring health-related quality of life were completed by 296 Indonesian adults (58% female, mean age=45±19 years old). Out of those, 102 (34%) completed a second survey one week later for the test-retest reliability assessment. The internal consistency reliability was assessed in both surveys. Confirmatory factor analysis was conducted to assess the construct validity. Correlations among ISQ items and between ISQ with SF-12 component summary were computed to assess the instruments’ convergent and divergent validities.
RESULTS: Acceptable internal consistency reliabilities for the ISQ were found in the first and second surveys (α=0.87 and 0.82, respectively). Each ISQ item demonstrated excellent test-retest reliability, with intraclass correlations ranging from 0.70 to 0.88. A good fit of the data was found with a root mean square error of approximation of 0.069, after a model modification. Correlations among ISQ components and between ISQ with SF-12 components provided sufficient evidence for convergent validity of the scale while divergent validity was partially supported.
DISCUSSION AND CONCLUSION: The validity and reliability of the Indonesian translated version of the ISQ for use in Indonesian adults are sufficiently demonstrated. The algorithm for computing ISQ in Indonesian adults, however, warrants further investigation.

7.Effect of Couch Grass (Agropyrum Repens) on Gentamicin-Induced Nephrotoxicity.
SALIH ÇIBUK, Bayram Yurtkulu, Nihat MERT, Handan Mert
doi: 10.5505/ejm.2022.48154  Pages 389 - 393
INTRODUCTION: Couch grass is used to clean the urinary tract during infections due to its diuretic and antimicrobial effects. The aim of this study was to investigate the possible protective or therapeutic effects of couch grass on gentamycin-induced nephrotoxicity in rats.
METHODS: Four groups of 10 rats were formed in the study. First group, Control: Rats were fed with standard rat feed and water. Second group (couch grass): 3 gr / L couch grass was added to the drinking water of rats for 7 days. The third group (gentamicin): Gentamicin 80mg / kg / day / i.p. was given for 7 days. The fourth group (gentamicin + couch grass): Gentamicin 80mg / kg / day / i.p. and 3 g / L couch grass was added to drinking water for 7 days. One week after the experimental application, blood samples were taken and serum was separated albumin, BUN, creatinine, urea, GGT, ALP, Na, Cl and K levels were determined in autoanalyser. Cystatin C was measured by ELISA.
RESULTS: Serum BUN, creatinine, urea, Na, K levels were highest in the gentamicin group. Na, K and Cystatin C levels differences between groups were not statistically significant. The increase in BUN, urea and creatinine after gentamicin administration was statistically significant (p<0.05). The use of gentamycin and couch grass caused BUN, urea and creatinine levels to decrease. The difference between the groups was found to be statistically significant (p<0.05). The administration of gentamycin and couch grass decreased Cystatin C levels, statistical significance was found between the groups (p<0.05). No statistically significant difference was found between the groups in albumin, Cl, GGT, ALP levels (p>0.05).
DISCUSSION AND CONCLUSION: As result, positive changes in serum parameters of gentamycin-induced nephrotoxicity when couch grass were given, showed that couch grass had a kidney protective effect and decreased nephrotoxic damage.

8.Introduction of Nonlinear Principal Component Analysis with an Application in Health Science Data
Canan Demir, Sıddık Keskin
doi: 10.5505/ejm.2022.09068  Pages 394 - 402
INTRODUCTION: Nonlinear Principal Component Analysis is one of the explanatory dimension reducing technique and presents numerical and graphical results for variable set included linear or nonlinear relationships. In this study, Nonlinear Principal Components Analysis was introduced and the relationship between students' sexual and physical trauma stories and demographic characteristics was examined with this method.
METHODS: In the study, the relationship between trauma and 9 variables obtained by questionnaire from 548 students was evaluated by non-linear principal components analysis.

RESULTS: The total eigenvalue of first dimension has been found to be 1.766 and the total eigenvalue of second dimension has been found to be 1.504 The variance explanation rate of these eigenvalues are 17,656% and 15,044% respectfully. The total explained variance is seen as 28,550%.
DISCUSSION AND CONCLUSION: With nonlinear principal component analysis, categorical variables are scaled to the desired size in the most appropriate way, and thus, nonlinear relationships can be modeled as well as linear relationships between variables. With this analysis, gender, age, marital status and suicide variables were found to be effective on trauma.

9.Endoscopic findings in patients with chronic obstructive pulmonary disease
Sevki Konur, Ismet Kizilkaya, Ergin Turgut, Yasemin Özgür, Güner Kilic, Mehmet Ali Bilgili, Ramazan Dertli, Yusuf Kayar
doi: 10.5505/ejm.2022.92489  Pages 403 - 409
INTRODUCTION: Although the frequency of reflux esophagitis is increasing in patiens with chronic obstructive pulmonary disease (COPD), there is limited data on how other mucosal pathologies are affected. Therefore, we aimed to examine the various endoscopic findings in patiens with COPD for the first time in the literature.
METHODS: 46 patients (consisting of 22 women=47.8%) with diagnosis COPD who had dyspeptic complaints and underwent upper GI endoscopy for these complaints (COPD group), and 50 patients (consisting of 28 women=56%) with functional dyspepsia were included in the study as the control group (Non-COPD group). Data on demographic characteristics, taken treatments, smoking, alcohol use, endoscopic findings, histopathological findings were documented. Endoscopic findings were compared between COPD and non-COPD groups. In addition, the effect of disease severity on mucosa was investigated.
RESULTS: In the comparison, smoking was statistically significantly higher in COPD group than Non-COPD-group. There was no significant difference in terms of other characteristics (age, gender, body mass index, drug and alcohol use) and presence of helicobacter pylori (HP) between groups(p>0.05). When groups are compared in terms of endoscopic findings, the frequency of gastritis, esophagitis, gastric ulcer, duodenal ulcer and barret metaplasia was significantly higher in the COPD group (p<0.05). In addition, as the severity of COPD increased, it was observed that pathological mucosal findings increased significantly(p<0.05).
DISCUSSION AND CONCLUSION: Since pathological mucosal findings are significantly higher in patients with COPD, it is important to determine the current situation by performing upper-gastrointestinal system endoscopy and to treat HP infection and pathological endoscopic findings in COPD-patients with dyspeptic complaints.

10.Psychological Correlates of Acceleration Stress for Thrill Seekers
Dindar S Bari, Haval Yacoob
doi: 10.5505/ejm.2022.21703  Pages 410 - 417
INTRODUCTION: Recent development in technology and the release of powerful techniques among them virtual reality can help investigate various aspects of life. With 3D virtual reality technology, the effects of acceleration stress on heart rate (HR) and arterial oxygen saturation (SpO2) can be predicted. The aim of this study was to investigate the correlations among acceleration stress, HR and SpO2.
METHODS: HR and SpO2 were recorded from 20 healthy subjects (10 males and 10 females) during relaxation and positive and negative acceleration stress. They were university and secondary school students with the mean age (21.71± 2.54 yrs.) for university and (12.2± 1.1 yrs.) for secondary students.
RESULTS: It was found that, both HR and SpO2 are changed with acceleration stress, but that the change was not statistically significant (p>0.05). Females have higher HR and lower SpO2 than males, and children have higher HR and lower SpO2 than adults.
DISCUSSION AND CONCLUSION: The study findings suggest that acceleration stress, at least within the range studied in the present study, could produce effects on the HR and SpO2. Future studies could aim to better categorize stress levels in virtual reality for thrill Seekers based on more psychological variables.

11.Diagnostic value of IMP3 expression in colorectal carcinoma and adenoma
Hadice Akyol, İbrahim Hanifi Özercan
doi: 10.5505/ejm.2022.86619  Pages 418 - 423
INTRODUCTION: Colorectal carcinomas are the cause of high mortality and morbidity and are common in the world and in our country. The main mechanism emphasized in colorectal carcinogenesis is the adenoma-carcinoma sequence. However, carcinoma does not develop from all adenomas.
Many factors are effective in the prognosis of colorectal carcinomas. The most important prognostic parameter is TNM staging. Another is lymph node metastasis. In this study, we aimed to determine the expression of Insulin-like growth factor II m-RNA-binding protein 3 (IMP3), which is an immune marker in colorectal carcinomas, and its relationship with prognostic factors.
METHODS: 30 colorectal adenocarcinomas (10 well differentiated, 10 moderately differentiated, 10 poorly differentiated), 30 colon adenomas (10 tubular, 10 villous, 10 tubulovillous) and 10 normal colonic mucosa were included in our study. The diagnostic value of the extent and intensity of staining and the relationship between stage and lymph node metastasis in patients stained with IMP3 was investigated.
RESULTS: A significant relationship was observed between IMP3 and normal mucosa-adenoma, normal mucosa-carcinoma (p<0.05), but no significant correlation was found with lymph node metastasis and stage (p>0.05). Significant correlations were found between IMP3 staining intensity and adenoma-carcinoma groups and between villous adenomas and other adenoma groups (p<0.05). There was no statistical significance between differentiation degrees of carcinomas in IMP3 staining intensity (p>0.05).
DISCUSSION AND CONCLUSION: As a result, it was seen that IMP3 could be used in diagnosis, but the relationship between these markers and lymph node metastasis and stage was not significant.

12.Saffron and saffron ingredients like safranal and crocin’s cytoprotective effects on carbon tetrachloride induced liver damage
İbrahim Aras, İrfan Bayram, Gökhan Oto, Remzi Erten, Ayşe ÖTER ALMALI, Zehra AKMAN ILIK
doi: 10.5505/ejm.2022.34356  Pages 424 - 431
INTRODUCTION: This study aims to investigate the liver-protective effects of saffron and saffron components like crocin and safranal against acute liver injury induced by carbon tetrachloride (CCl4) in rats.
METHODS: 72 male Wistar Albino rats were used in the study. The rats were divided into nine groups: 8 in each group. The rats were sacrificed at the end of the seventh day with high excretion (exsanguination). The protective effect of saffron, safranal and crocin against CCl4-induced acute liver injury was evaluated histopathologically.
RESULTS: In the study, balloon degeneration, apoptotic cells and sub-massive necrosis were seen in hepatocytes as a result of- the effect of CCl4. These histopathological changes were hardly seen in groups in which CCl4 was administered with crocin and saffron. On the other hand, in the group where saphranal and CCl4 were given together, changes similar to the histopathological changes seen in the CCl4 group were observed.
DISCUSSION AND CONCLUSION: It was concluded that crocin and saffron have hepatoprotective effect in the experimental acute liver injury caused by CCl4, but the safranal has no protective effect on the liver.

13.Is Routine Brain Imagiing Necessary Before Electroconvulsive Therapy?
Mesut Işık, Mustafa Akın
doi: 10.5505/ejm.2022.39259  Pages 432 - 436
INTRODUCTION: Electroconvulsive Therapy (ECT) is a treatment method that creates controlled seizures by applying electrical current stimulation to the brain. Although the presence of an intracranial mass is not an absolute contraindication for ECT, it may pose risks that are associated with ECT. The aim of this study is to determine the prevalence of incidental abnormalities that may preclude the use of ECT through routine cross-sectional brain imaging.
METHODS: The medical records of all patients who underwent ECT between January 2010 and June 2021 were reviewed retrospectively. We examined the results of their routine neurological evaluations and any brain imaging reports. In addition, the patient’s sociodemographic characteristics, such as age and gender, and any reports of unexpected complications that arose from the ECT were examined.
RESULTS: A total number of 156 patients who underwent ECT between the dates were examined, of which 113 patients had brain imaging (CT: 58, MRI: 51, Diffusion MRI: 4) performed prior to ECT. The rate of normal findings was 47% in MRI, 86% in CT, and 100% in diffusion MRI. There was no findings that prevented ECT from being performed, and no report that showed increased intracranial pressure, and none of the patients developed an unexpected intracranial complication from ECT.
DISCUSSION AND CONCLUSION: Our results show that routine neuroimaging before ECT is not required. In the clinical examination, we recommend brain imaging before ECT only if there is a suspicion of intracranial pathology and examination findings that indicate this.

14.Evaluation of neurological imaging after hematopoietic stem cell transplantation in adults
Sevil Sadri, Burcu Polat, Berrin Balik Aydin, Hakan Kocar, Aliihsan Gemici, Huseyin Saffet Bekoz, Omur Gokmen Sevindik, Fatma Deniz Sargin
doi: 10.5505/ejm.2022.54765  Pages 437 - 445
INTRODUCTION: To investigate the risk factors for, and the incidence of, structural abnormalities in brain imaging among hematopoetic stem cell transplant (HSCT) patients and to correlate these findings with physical examinations.
METHODS: This study retrospectively reviewed all post-HSCT brain imaging taken in the researchers’ center between 2014 and 2020.
RESULTS: 87 of 627 transplant patients were imaged. 34.5% (n = 30) were female. Age at transplant ranged from 18 to 74 years (median: 45). The most common malignancies were acute myeloid leukemia (AML; n = 21; 24.1%), 51 (58.6%) patients received allogeneic transplantation, and 36 (41.4%) received autologous transplantation. The imaging techniques were dispersed as follows: magnetic resonance imaging (MRI): 83.9% (n = 73), brain computed tomography (CT): 37.9% (n = 33), diffusion MRI: 19.5% (n = 17). 39.1% of the radiological images were normal; 20.7% showed disease recurrence; and 14.9% detected ischemic gliotic lesions. According to the imaging results, there was a statistically significant difference between age values (p = 0.013). Patients with PRES were younger than those with no pathologies in their imaging, while patients with infarcts and ischemic gliotic lesions were older than those with normal imaging (p = 0.001). Patients with disease recurrence were older than those with PRES but younger than those with infarctions (p = 0.001).
DISCUSSION AND CONCLUSION: Neurological complications are not uncommon in transplant cases. In managing transplantations, it should be remembered that the presence of radiologically positive findings, especially positives for cerebrovascular complications, can significantly reduce survival.

15.The influence of beliefs about medicines on medication nonadherence among hemodialysis patients: a multicenter study from Malaysia
Soik Fun Lee, Chee Ping Chong
doi: 10.5505/ejm.2022.57804  Pages 446 - 457
INTRODUCTION: Medication nonadherence can be caused by erroneous medication beliefs. This study aimed to assess the prevalence of medication nonadherence among hemodialysis patients and its association with beliefs about medicines.
METHODS: A cross-sectional multicenter study among hemodialysis patients was performed. Data was collected by using the 5 items-medication adherence report scale (MARS-5) and the Beliefs about Medicine Questionnaire (BMQ). The correlation of medication nonadherence with patients’ beliefs about medicine was assessed by multiple logistic regression.
RESULTS: A total of 325 patients were interviewed. The majority of patients were aged 55 years or more (69.0%) and received 6-10 prescribed medications daily (58.1%). The prevalence of medication nonadherence was 69.5% based on the MARS-5 score. Considering the BMQ score, the total mean score for the Specific–Necessity and Specific–Concern domain was 18.42 ± 2.30 and 13.16 ± 3.13 respectively. Whereas, the General–Overuse and the General–Harm domains showed a total mean score of 11.37 ± 1.98 and 9.44 ± 1.81 respectively. The patients with the belief of medication will protect them from becoming worse showed significantly less medication nonadherence (adjusted OR = 0.543). Medication nonadherence was significantly more prominent among patients who worried about taking medications (adjusted OR = 1.500) but less prominent among patients who perceived medications as addictive to them (adjusted OR = 0.637).
DISCUSSION AND CONCLUSION: In conclusion, medication nonadherence was prevalent among hemodialysis patients. There is a need to address hemodialysis patients’ necessity, concern, and harm perception towards their prescribed medication to overcome medication nonadherence.

16.Assessment of Clinical Features of Tinea Capitis Cases in Erzurum
Nurhan Döner Aktaş, Özlem Yılmaz, Emel Hazinedar, Melek Kadı
doi: 10.5505/ejm.2022.26566  Pages 458 - 464
INTRODUCTION: Tinea capitis is a common dermatophyte infection of the scalp in children. It is aimed in this retrospective study to evaluate 63 cases of tinea capitis, referred to dermatology outpatient clinics in Erzurum Regional Research and Training Hospital and in private Buhara Hospital.
METHODS: Datas were collected in saved files which had been noted demographic characteristisc: age, sexuality, residing place (rural, urban); disease history: duration, contact with animal, patient’s medical history, used drugs, family history; clinical findings: clinical classification, hair loss, fluctuation, lymphadenopathy, reflection with wood examination, id reaction and hyphae on microscopic examination.
RESULTS: Average age of 5,7 years, 69,8% male patients diagnosed tinea capitis were involved the study. Inflamatory tinea capitis 56,6%, hair loss 66,7%, lymphadenopathy 78,3%, presence of hyphae 85,5% and reflection with wood examination 78,6% rates were detected. The rate of 71,9% of patients were determined to live in rural ares. The Data obtained were argued with literature.
DISCUSSION AND CONCLUSION: As a result tinea capitis is important dermatophyte infection in children in our country and the role of clinical findings in diagnosis and in treatment should not be ignored.

17.Evaluation of root morphology and root canal configuration of mandibular and maxillary premolar teeth in Turkish subpopulation by using cone beam computed tomography
Hüseyin Gündüz, Esin Özlek
doi: 10.5505/ejm.2022.66743  Pages 465 - 471
INTRODUCTION: The aim of this study was to evaluate the root morphology and root canal configuration of the lower and upper premolars using cone-beam computed tomography (CBCT), according to gender and right-left position of the tooth in the Turkish subpopulation.
METHODS: 494 patients were used for the evaluation of root canal anatomy of mandibular and maxillary premolar teeth. In total, 3,880 premolar teeth were evaluated. CBCT images were examined in the coronal, sagittal, and axial planes.Number of roots, canals, and canal configurations of the teeth were determined according to Vertucci's classification. Qualitative data were analyzed with Chi-square, Fisher Exact, and Bonferroni tests (α=0.05%).
RESULTS: In maxillary first premolars, 64.5% two roots, 87.7% two canals, and 67.8% Type Ⅳ canal configuration; in maxillary second premolars 77.3% one root, 50.4% one canal, and 50.4 Type Ⅰ canal configuration; in mandibular first premolars 89.9% one root, 76.9% one canal, and 76.9% Type Ⅰ canal configuration; and in mandibular second premolars 98.4% one root, 95.9% one canal, and 95.9% Type Ⅰ canal configuration were observed.
DISCUSSION AND CONCLUSION: No statistically significant effect of the tooth position on the number of roots, canals, and canal configuration in maxillary and mandibular premolars was observed (p>0.05). Maxillary second premolar and mandibular first premolars showed a statistically significant effect on number of roots, number of root canals, and root canal configuration by gender (p=0.00, p=0.032). In addition, gender had a significant effect on number of roots in maxillary first premolars (p=0.017).

18.Management Of Electrical Storm With Different Treatment Strategies Under Mechanical Support: A Single-Center Case Series
Şeyhmus Külahçıoğlu, Abdülkadir Uslu, Mustafa Emre Gürcü, Pinar Karaca Baysal, Mehmet Çelik, Ayhan Küp, Serdar Demir, Servet İzci, Kamil Gulsen, Atakan Erkılınç, Mehmet Kaan Kırali
doi: 10.5505/ejm.2022.44520  Pages 472 - 478
INTRODUCTION: Electrical storm (ES) is a lethal clinical situation that consists of ventricular tachycardia (VT) or ventricular fibrillation (VF) attacks, which is usually resistant to pharmacologic or electrical cardioversion. In patients with heart failure, refractory VT attacks, worsen organ perfusion and precipitate acute decompensation, multi-organ failure, and mortality. Extracorporeal membrane oxygenation (ECMO) is very successful for managing periprocedural acute decompensation and it facilitates RFCA by adequate mapping and more substrate ablation.
METHODS: Five patients were enrolled whose ES had been treated with either RFCA under ECMO support or other approaches (device setting changes, stellate ganglion blockade or sympathetic denervation).
RESULTS: One patient was treated with only ICD setting changes, three of the patients were under VA-ECMO support, one patient was under left ventricular assist device (LVAD) support. Two patients needed also sympathetic denervation after RFCA and stellate ganglion blockade was performed to one of them, before sympathetic denervation.
DISCUSSION AND CONCLUSION: ES should be managed with multidisciplinary and various treatment approaches. Although RFCA is central in treatment, the use of additional modalities including sympathetic denervation may be beneficial. Furthermore, RFCA under mechanical support especially with ECMO may be quite effective, and lifesaving.

19.Features of endoscopic findings in patients with hypothyroidism secondary to Hashimoto thyroiditis
Mehmet Ali Bilgili, Ismet Kizilkaya, Ergin Turgut, Güner Kılıç, Sevki Konur, Ramazan Dertli, Yusuf Kayar
doi: 10.5505/ejm.2022.25045  Pages 479 - 484
INTRODUCTION: The most common cause of hypothyroidism is Hashimoto's disease, Hypothyroidism slows down all metabolic events. Therefore, it has a motility-reducing effect on the intestine. In our study, we aimed to examine the differences between hypothyroid patients and the healthy control group who underwent upper-gastrointestinal system endoscopy for dyspeptic complaints.
METHODS: Demographic data, drug, smoking and alcohol use, endoscopic, histological findings, data on TSH levels were documented. Data were analyzed statistically. Values with p>0.05 were considered significant. Endoscopic findings were compared between patients and control group. In addition, the effect of disease severity on mucosa was investigated.
RESULTS: 61 hypothyroid patients, 50 non-hypothyroid patients with functional-dyspepsia, were included in the study. Alkaline reflux and gluten enteropathy were found with a significantly higher rate in hypothyroid patients. Alkaline reflux and gluten enteropathy were found with a significantly higher rate in the group with TSH level higher than 10 mIU/L. Atrophic gastritis was observed with a higher rate in the hypothyroid patient group and the group with high TSH, but it was not statistically significant. There was no difference between the groups in terms of other endoscopic findings.
DISCUSSION AND CONCLUSION: Hashimoto's thyroiditis is a common autoimmune phenomenon. It is closely associated with other autoimmune events. Since hypothyroidism slows down the metabolic rate, the intestinal passage time is prolonged. As a result, alkaline reflux occurs in patients. However, the results we found need to be supported by prospective studies conducted with larger patient groups.

20.Knowledge, attitude, and depression assessment among healthcare workers during COVID-19 pandemic
Yunus Emre Purut, Burak Giray
doi: 10.5505/ejm.2022.47374  Pages 485 - 491
INTRODUCTION: The pandemic caused many psychological problems such as anxiety disorder, panic disorder, phobias, depression, post-traumatic stress disorder, and other mood disorders. We aimed to assess the level of information about COVID and the depression rate among the healthcare workers.
METHODS: Our study was conducted on 89 healthcare workers. This survey was held among healthcare workers who worked in COVID-19 service during the pandemic in Turkey. As a guideline to adequately identify depression rates we used Beck Depression Inventory. Each question was scored in the Beck depression questionnaire.
RESULTS: The service period length of the healthcare personnel participating in the study were 0-2 years in 34 (38.2%), 2-5 years in 25 (28.1%), 5-10 years in 12 (13.5%), and >10 years in 18 (20.2%) healthcare workers. There was a statistically significant difference between the service period of healthcare workers and their COVID-19 knowledge scores (p<0.05). Thirty (33.7%) of 89 healthcare workers had minimal depression, 30 (33.7%) had mild depression, 19 (21.3%) had moderate depression, and 10 (11.2%) had severe depression. There was no statistically significant difference between the knowledge levels of healthcare professionals and their depression scores (p>0.05).
DISCUSSION AND CONCLUSION: The survey results about COVID -19 highlighted that psychological support should be ensured, adequate education/training should be provided. Additionally, psychosocial needs should be determined, and psychosocial services should be given to healthcare workers.

21.Comparison of Functional and Radiologic Outcomes of Pilon Fractures Treated with Ilizarov External Fixator and Minimally Invasive Plate Osteosynthesis
Sinan Oguzkaya, Mehmet Halıcı, Ibrahim Halil Kafadar, Ibrahim Karaman
doi: 10.5505/ejm.2022.69376  Pages 492 - 499
INTRODUCTION: Pilon fractures involve the distal articular surface of the tibia. Gold standard surgical treatment remains controversial for pilon fractures. The purpose of this retrospective study was to compare the mid-term outcomes of tibial pilon fractures that were treated with the Ilizarov external fixator and Minimally Invasive Plate Osteosynthesis.
METHODS: Fifty patients included in the study with a minimum of 12 months follow-up. Patients divided into two groups according to the treatment method. The first group consisted of patients with the Ilizarov external fixator, and the second group was with MIPO. The American Orthopaedic Foot and Ankle Society (AOFAS) score, the Foot and Ankle Disability Index (FADI) and Visual Analogue Scale (VAS) score were used in the evaluation of functional outcomes. Ankle and subtalar joint range of motion (ROM) were evaluated at the last follow-up. The association between reduction quality and the development of ankle OA was analysed as well.
RESULTS: There was no significant difference between the two groups regarding AOFAS, FADI, and VAS scores (P>0.05). There was also no significant difference between groups regarding ankle ROM in the last follow-up (P=0.10). Also, there was no significant difference between the two groups regarding union rates and complications (p=0.22).
DISCUSSION AND CONCLUSION: Both MIPO and the Ilizarov techniques are effective and safe methods with low complication rates in the treatment of pilon fractures. Using definitive Ilizarov external fixation technique leads to lower treatment costs.

22.The laparoscopic management of the huge distal fibroepithelial polyp: A case report
Erdinç Dinçer, Ahmet Şahan, Alkan Çubuk, Sukran Sarikaya, Oktay Akça
doi: 10.5505/ejm.2022.97830  Pages 500 - 502
Fibroepithelial polyps are the most common benign neoplasm of ureter that originate from mesoderm. These polyps are one of the cause of hydronephrosis by obstructing the ureter. Etiology is not fully defined but there are some publications in the literature suggested that it is due to congenital, infectious, obstructive, traumatic, hormonal imbalances and irritative causes. A 36 years old male patient who admitted with left flank pain and fever. He had a history of endoscopic left ureteric stone surgery 3 years ago. In radiological evaluation with USG and CT, grade 3 hydroureteronephrosis was detected of the left kidney; however no stone was detected. Ureterorenoscopy detected a 5x1 cm ureteral polyp in the distal ureter and punch biopsy confirmed fibroepithelial polyp. We performed laparoscopic excision of the poliphoid segment and ureteroneocystostomy. Although it is rare, fibroepithelial polyp should be considered in hydronephrosis without any urinary stone or malignancy.

23.Utility of transbronchial lung cryobiopsy in diagnosing pulmonary Hodgkin’s Lymphoma
Chin Hou Tan, Mohamed Faisal, Nurul Yaqeen Md Esa, Noriah Othman, Jamalul Azizi Abdul Rahaman
doi: 10.5505/ejm.2022.65481  Pages 503 - 506
Lung involvement in Hodgkin’s Lymphoma is relatively uncommon. Diagnosis is made by histopathological examination of lung tissue samples. The need for detailed immunohistochemical studies to establish the diagnosis necessitates obtaining tissue samples of adequate size and quality. We present a case of recurrent Hodgkin’s Lymphoma in the lung, diagnosed from transbronchial lung cryobiopsy (TBLC).

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