ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 28 (1)
Volume: 28  Issue: 1 - 2023
1.Evaluation of Apoptotic and Autophagic Effects of Thioridazine in Monolayer and Spheroid Cell Cultures
Ezgi ERSÖZ, Rehime Yapar, Burak ÇELİK, Mehmet Korkmaz
doi: 10.5505/ejm.2023.73555  Pages 1 - 14
INTRODUCTION: Glioblastoma (GBM) is the most frequently seen brain tumor in adults. It is clear that new therapeutic agents are needed in this area. Spheroid cell cultures have advantages on imitating in vivo environment. Therefore, we investigated apoptotitac and autophagic effects of Thioridazine (THZ) which is a potential anti-cancer agent on GBM cell lines, T98G and U-87 MG, comparatively in monolayer and spheroid cell cultures.
METHODS: The cytotoxic effect of THZ on cells was evaluated by MTT method. Besides, apoptotic and autophagic effects of THZ were determined by Annexin V and LC-3 antibody based methods. Validation performed also by assessment of apoptosis and autophagy with specific inhibitors.
RESULTS: The analysis has revealed that IC50 values at 24 h were 12,67 μM (T98G) and 12.80 μM (U-87 MG) in monolayer cell culture, 29.30 μM (T98G) and 28.68 μM (U-87 MG) in spheroid cell culture. While apoptotic cell rate was determined at 24 h approximate 15% in both cell lines and cell cultures, autophagy induction rate was increased by 6.5- (T98G) and 5.6- (U-87 MG) fold in monolayer cell culture and by 3.3- (T98G) and 4.5- (U-87 MG) fold in spheroid cell culture.
DISCUSSION AND CONCLUSION: In our study THZ stimulates mostly autophagy rather than apoptosis. In addition, it can be suggested that in vitro cytotoxicity studies should perform with not only monolayer cell cultures but also with spheroid cell cultures for obtaining in vivo-like data. When all the evaluations are considered, THZ might be thought as a potential chemotherapeutic agent in the treatment of GBM.

2.Fluoroscopy free Flexible Ureteroscopy: The report of 248 cases
kerem taken, recep eryılmaz, Rahmi Aslan, Kasım Ertaş, Murat Demir, Berat Deniz, ARİF MEHMET DURAN
doi: 10.5505/ejm.2023.99896  Pages 15 - 19
INTRODUCTION: The goal of this study was to assess the results of 248 patients who underwent fluoroscopy-free retrograde intrarenal surgery
METHODS: Between January 2017 and March 2020, 248 cases of retrograde intrarenal surgery (RIRS) were conducted using an access sheath and guidewire. Using ureteroscopy, two hydrophilic guide wires were inserted into the renal pelvis under direct eyesight (URS). When the ureter could not be entered with the 9.5 Fr URS, the ureter was first entered using the 7.5 Fr URS. Then, without flouroscopy, an access sheath was pushed up to the proximal ureter while examining the opening with URS. When an access sheath could not be placed, a double J stent was implanted.. The operation was repeated after 3 weeks. The procedure's success rate was determined by the absence of stones or the presence of leftover fragments smaller than 3 mm
RESULTS: The study included 161 (64.9%) male and 87 (35.1%) female patients with a mean age of 44.03 (± 16.04), (range 18-81) years. Mean stone size was 14.7 (± 3.7)mm. The mean operation time was 62.34 (± 8.2)minutes. Stone-free rate was 88.7% (n: 220). 28 of the patients had residual stone. Twenty patients (8%) had minor complications, including hematuria and fever and in 2 patients (0.8%) subcapsular hematoma was developed.
DISCUSSION AND CONCLUSION: Kidney stones can be treated successfully with minimal morbidity and mortality. The insertion of an access sheath under urs guidance is possible without the need of fluoroscopy. Patients and surgeons are exposed to less radiation as a result of this procedure

3.Effect of early aneurysm surgery on prognosis: Calm down in a hurry!
Ufuk Erginoglu, Burak Ozaydin, HAKAN KINA, Ilker Kiraz, ALİ FATİH RAMAZANOĞLU, erhan celikoglu
doi: 10.5505/ejm.2023.34682  Pages 20 - 28
INTRODUCTION: This study investigates effects of early surgery in aneurysmal subarachnoid hemorrhage (SAH) on outcome and postoperative complications.
METHODS: This retrospective study includes 250 patients presented to a teaching hospital with SAH and underwent aneurysm clipping during a 10-year period. 212 (84.8%) underwent early and 38 (15.2%) underwent late surgery. Presenting symptoms, clinical and neuroradiological findings, and outcomes were reviewed. Severity of SAH was assessed using World Federation of Neurosurgical Societies (WFNS) SAH scale and Fisher’s grading system. Glasgow Outcome Scale (GOS) was used for postoperative outcome measure.
RESULTS: Patients consisted of 142 (56.8%) female and 108 (43.2%) male with mean age of 52.5 years and female-to-male ratio of 1.3. Most common presenting symptoms were headache and vomiting (n=164; 65.6%). The incidence of SAH was highest in fall and spring, respectively. Patients fell under grade 1 on WFNS scale and grade 2 on Fisher’s scale. Significant correlation was found between WFNS and Fisher’s grades and GOS. Majority of patients underwent early aneurysm surgery and re-bleeding occurred in 4.3%. Mortality was 10.3% and vasospasm-related morbidity and mortality occurred in 6% and 6.8% of the patients, respectively. 84.8% of patients had favorable outcomes and 15.2% of patients had poor outcomes.
DISCUSSION AND CONCLUSION: Results showed that early surgery led to reduced morbidity and mortality. Patients admitted with SAH should be promptly evaluated and undergo angiography. Subsequently, the aneurysm should be promptly excluded from circulation to prevent rebleeding thus enabling the team to concentrate on managing other complications.

4.Short- and Long-Term Predictive Value of CCI in the Older Adult Patients with Hip Fracture
doi: 10.5505/ejm.2023.53367  Pages 29 - 34
INTRODUCTION: The present study aimed to evaluate the relationship between Charlson Comorbidity Index (CCI) and 1-year mortality in surgically treated the older adult hip fracture population and to compare the predictive values among patients with different CCI scores.
METHODS: We retrospectively analyzed 352 patients (114 men, 238 women) aged ≥60 years (range, 60–100 years) who underwent surgical treatment for hip fractures in our clinic between February 2017 and February 2020. Necessary information such as age, sex, and diagnosed comorbidities were obtained through archive records. In addition, the date of death—if deceased—was learned by telephonically contacting the patients’ relatives. Patients were divided into deceased and surviving groups, i.e., those who died within 1 year after surgery and those who survived, respectively, and were comparatively analyzed in terms of factors affecting mortality.
RESULTS: The postoperative 1-year mortality rate of the 352 patients included in this study was 36.4%. The deceased group (83.5 ± 7.8 years) had a significantly higher mean age than the surviving group (80.2 ± 9.7 years; p = 0.001). Men had significantly higher 1-year mortality rates than women (p = 0.044). Chronic kidney failure, congestive heart failure, and dementia had significant predictive effects on mortality (p = 0.002, 0.022, 0.037, respectively). Compared with other categories, CCI category 3 had a statistically significant odds ratio of 2.021 (95% CI: 1.014– 4.025; p = 0.045).
DISCUSSION AND CONCLUSION: The correlative abilities of CCI appeared to affect mortality categorically and were also effective over a period of 1 year.

5.Close Contact Review in COVİD-19: Examples of Three Families Living in a Small Town
Pınar Yürük Atasoy, MERVE SEFA SAYAR, Onur Mahmutoğlu, Mahmut Sunnetcioglu
doi: 10.5505/ejm.2023.25932  Pages 35 - 39
INTRODUCTION: The SARS-CoV-2 epidemic, which has spread rapidly around the world since December 2019, could not be stopped despite all vaccination and quarantine practices. In addition, with the mutations in the SARS-COV-2 strain, the virus has gained the ability to be transmitted much faster and easily. In this study, first of all, it has been tried to focus on the type of transmission route of the virus among close-contact family members. In this way, it is aimed to show the importance of social distance, infected person isolation, contact tracking and quarantine practices.
METHODS: The research was planned, with a large number of people infected in three interconnected families living in the rural area where the virus was infected. The retrospective findings of the COVID-19 case cluster identified during the fieldwork were evaluated.
RESULTS: SARS-CoV-2 PCR test was positive in 40 members of 3 families included in the study. It was determined that index cases belonging to all families (Family B1, Family C1) had direct or indirect contact with the family (A1) who was detected as the first positive case in the village. The age range of all cases ranged from 1-79, while the age range of symptomatic cases was 18-79. The most common symptoms were cough, fever, fatigue and shortness of breath. The cases were mostly kept under hospital follow-up for 3-11 days.
DISCUSSION AND CONCLUSION: Early isolation of COVID-19 cases is important and effective in preventing the clustering and further spread of the epidemic.

6.The prevalence of gynecomastia and its relationship with age in 1589 Turkish patients who underwent CT scans due to various reasons
Nusabe Kaya, Mehmet Akif Aydın, Remzi KIZILTAN
Pages 40 - 45
INTRODUCTION: In this study, we aimed to contribute to the literature on the prevalence of gynecomastia and its relationship with age in Turkey by examining patients who underwent chest CT scans ordered for various reasons in male patients in our hospital.
METHODS: A total of 1589 male patients who underwent chest CT scans due to various reasons between 01/01/2019 and 31/12/2019 were included in the study. If a patient underwent multiple chest CT scans, only the first examination was used for the analysis. Patients’ age, presence of gynecomastia (GM) and laterality were recorded. Furthermore, the patients were divided into age decades. The correlations between GM, laterality and age decades were investigated.
RESULTS: A total of 1589 patients who underwent CT scans with various indications were included in the study. In CT examinations, GM was detected incidentally in 439 (27.6%) of the patients. Of all GMs, 234 (53.3%) were bilateral, 117 (26.6%) were left unilateral and 88 (20.0%) were right unilateral. GM peaked in the age range of 60-70 years and 70-80 years. A significant positive correlation was found between bilateral GM and age (r=0.115, p<0.001).
DISCUSSION AND CONCLUSION: In our study, the prevalence of GM was found as 27.6%. Bilateral GMs were more common by 53.3%, while left unilateral GMs were more frequent. The prevalence of GM peaked to times in the age ranges of 60-70 years and 4 70-80 years. There was a statistically significant correlation between bilateral GM and age.

7.Patients Admitted To Our Center With Methanol Poisoning: Retrospective Analysis
Esra Akdas Tekin, Cansu Kılınç Berktaş, Müslüm Akkılıç, Rabia Gülsüm Aydın, Sinan Mutlu, Fethi Gültop, Onur Okur, Namigar Turgut
doi: 10.5505/ejm.2023.75983  Pages 46 - 51
INTRODUCTION: Methanol poisoning is caused by the production of toxic metabolites by the alcohol dehydrogenase enzyme;metabolic acidosis is a serious condition that can lead to life-threatening complications such as kidney failure, blindness, and death.In our study, it was aimed to examine the methanol poisoning cases admitted to the hospital terms of mortality and morbidity.
METHODS: Following the approval of the Ethics Committee(03/12/2019,Number: 1497),16 patients were retrospectively analyzed.The patients were divided into 2 groups as Group I(Survivor,n=11)and Group II(Nonsurvivor,n=5)and possible risk factors for mortality were examined.
RESULTS: No statistically significant difference was found in terms of mortality,age,gender,GCS at admission,HR,MAP,urea,creatinine, and GFR values(p>0.05).In patients with nonsurvivor;In terms of pH values;A statistically significant increase was found at the12thhr compared to the 1sthr(p=0.046).It was determined that the 1st hr PaCO2 were lower than Group I.(p=0.020).No significant difference was found in terms of HCO3 values at 1.,3.,6.,12.,24. and according to mortality(p>0.05).In Group I;the increase in HCO3 values at the 12thhr compared to the 1st hr was found to be statistically significant(p=0.046).The methanol level was measured in 6 patients(5-249mg/dl).Ophthalmological findings were detected in 62%of the patients.The blood sugar of Group II was 132.8mg/dl(95-210)and the Group I was 216mg/dl(70-395).Hemodialysis was performed in 56.3%of the cases from the time of diagnosis.The total mortality rate is31.2%.
DISCUSSION AND CONCLUSION: On admission to the hospital due to methanol intoxication; here is no relationship between methanol blood level at admission and mortality but coma,GCS<7,seizures and metabolic acidosis(pH<6.9)are prognostic factors for fatal and permanent sequelae. Hemodialysis is considered the key element in the treatment of methanol intoxication.

8.Investigation of correlations between joint health, functionality, and MRI score in hemophilic arthropathy of the elbow joint: Cross-sectional study
Ayşe Merve Tat, Sezai Özkan, Necati Muhammed Tat, Kamuran Karaman, Ahmet Faik Öner
doi: 10.5505/ejm.2023.43179  Pages 52 - 58
INTRODUCTION: Hemophilic arthropathy (HA) of the elbow joint should be examined separately from the knee and ankle because of the anatomical and biomechanical differences of the elbow. The aim is to investigate possible correlations between age, range of motion (ROM), muscle strength, upper extremity functions, joint health and radiological findings.
METHODS: Twenty-seven joints of 20 patients aged 11-30 years with findings of HA in elbow were evaluated. International Prophylaxis Study Group Magnetic Resonance Imaging (IPSG MRI) score was used in the radiological evaluation. In physical evaluations, ROM and muscle strength were measured by goniometer and digital dynamometer, respectively. Joint health was evaluated with Hemophilia Joint Health Score-Elbow Point (HJHS-EP) and upper extremity functionality with Quick-Disability of Arm Shoulder and Hand (Q-DASH).
RESULTS: The age was strongly correlated with HJHS-EP, loss of extension and pronation ROM and moderately correlated with IPSG MRI score. HJHS-EP showed strong correlation with loss of extension. There were a moderate correlation between Q-DASH and muscle strength of the elbow. The IPSG MRI scores were not significantly correlated with physical examinations.
DISCUSSION AND CONCLUSION: The elbow joint should be evaluated both radiographically and physically and these assessments cannot be alternatives to each other. Even goniometric assessment of elbow extension alone may provide important information about joint health. Functionality can be improved by increasing muscle strength. Since the deterioration in physical and radiographic examinations with age, it is recommended to conservatively or surgically treat of the elbow joint with physiotherapy at early ages.

9.The Impact of Diabetes Mellitus on the Course of COVID-19 Pneumonia
Dilek Bulut, Merve Sefa Sayar
doi: 10.5505/ejm.2023.57984  Pages 59 - 67
INTRODUCTION: Diabetes mellitus (DM) is one of the most commonly encountered chronic diseases throughout the world. We aimed to reveal the association between such a common disease and COVID-19-related pneumonia posing a global threat, and its impact on the course of the disease.
METHODS: In our study, 125 patients diagnosed and treated due to COVID-19 pneumonia were analyzed in our hospital within two months. While 25 patients were in the group with DM,there was no comorbidity in 100 patients.The main goal of our study was to evaluate isolatedly the effect of DM on COVID-19 pneumonia when other comorbidities were excluded. For this purpose, we compared the demographic characteristics, symptoms, and signs of the disease, laboratory parameters, computerized tomography(CT) findings, and some data about the clinical course of the disease between two patient groups.
RESULTS: Based on the findings of the analyzes, those in the case group were seen to be older. Such respiratory symptoms as cough and shortness of breath were found to be more common in the case group.Inflammatory parameters, such as c-reactive protein (CRP), white blood cell count (WBC), neutrophil count, and D-dimer were also higher in the case group. As well as the poor progression of the disease, the requirements for intensive care unit (ICU) andoxygen (O2), hospitalization period, and mortality rates were also higher among diabetic patients.
DISCUSSION AND CONCLUSION: The existence of DM poses a risk in terms of requiring care in ICU, severe pace ofthe disease, and higher mortality in those with COVID-19 pneumonia.

10.A Light To Our Darkness: Bioluminescence And Its Uses In Medical Research
Asli San Dagli Gul, Okan ARIHAN
doi: 10.5505/ejm.2023.59862  Pages 68 - 74
Bioluminescence refers to the production of light without the need for an external light source, and as such, it differs from the concept of fluorescence. After this phenomenon became reproducible and measurable, bioluminescence began to be used as an investigation and research method in scientific research. Today, bioluminescence is used in most of the medical research fields, especially in cancer and cell culture. Improvements in brighter luminescence and imaging provides much wider areas of non-invasive research in different fields of medical research. Currently research articles can be found in the subjects of neuroscience, immunity, muscular regeneration, dermatology, surgery, microbiology, drug discovery, cardiovascular research and aging. In this review, the concept of bioluminescence and examples of its use in medical research are presented. Scientific literature was reviewed in June 2022. The articles were scanned according to their titles and abstracts, and articles from 2018 and later were included for findings on the use of bioluminescence in medical research. Only English articles are considered for the review. A total of 59 articles were selected and included.

11.Effect of Anakinra and Infliximab on Oxidative Stress and Caspase Activation in PTZ-Induced Acute Seizure in Rats
Kenan YILDIZHAN, Handan Güneş, Ahmet Sevki Taskiran
doi: 10.5505/ejm.2022.84669  Pages 75 - 81
INTRODUCTION: We aimed to examine the effects of Anakinra (AKR) and Infliximab (IFB) on increased oxidative stress (OS) and pro-apoptotic pathway parameters after an epileptic attack.
METHODS: The rats were divided into four groups; Control, pentylenetetrazol (PTZ), PTZ+Anakinra, and PTZ+Infliximab groups. AKR and IFB treatment was done 30 minutes after PTZ administration and rats were sacrificed after 24 hours. The acute epilepsy model we created with PTZ in the rats and seizure symptoms were evaluated using the Racine classification and the delay time to the first myoclonic jerk. We also examined the levels of total antioxidant status (TAS), total oxidative stress (TOS), neurotrophin brain-derived neurotrophic factor (BDNF), Caspase 3 and Caspase 9 in the cortex and hippocampus.
RESULTS: Post-treatment of AKR and IFB decreased PTZ-induced OS in the cortex and hippocampus while TAS levels also increased. In addition, it was observed that AKR and IFB decreased the levels of BDNF, Caspase 3 and Caspase 9 compared to the PTZ group.
DISCUSSION AND CONCLUSION: These findings showed that AKR and IFB may be used as important therapeutic agents to inhibit OS and apoptosis mechanisms that may occur after PTZ-induced epileptic attacks.

12.The Impact of COVID-19 Pandemic on Intestinal Parasite Frequency: A Retrospective Study
Selahattin Aydemir, Milad Torkamanian Afshar, Maksut Şahin, Zeynep Tas Cengiz, Sadi ELASAN, Fethi BARLIK, NURİZ ATEŞ, AHMED GALİP HALİDİ, Hasan YILMAZ
doi: 10.5505/ejm.2023.02800  Pages 82 - 86
INTRODUCTION: During the COVID-19 pandemic, Countries have closed their borders, banned travel, and restricted human mobility even outdoors in order to control the infection. It is not known whether the measures taken to control the pandemic in Turkey affect the prevalence of intestinal parasitic infections. This study was conducted to evaluate the effect of the COVID-19 pandemic on the prevalance of intestinal parasites.
METHODS: In the study, the parasitological data of 18,204 patients who applied to XXX Medical Center between June 2018 and December 2020 and whose stool samples were sent to the Parasitology Laboratory were evaluated retrospectively.
RESULTS: Intestinal parasites were detected in 1214(9.89%) of 12270 patients in the pre-COVID-19 period and in 866 (14.59%) of 5934 patients during the COVID-19 period.In the statistical evaluation, it was observed that there was a significant difference between the positivity rate in the pre-COVID-19 period and the positivity rate in the COVID-19 period. On species basis, there was a decrease in the rates of pathogenic parasites G. intestinalis and E. histolytica, but an increase in the rate of B. hominis, which is discussed to be pathogenic.
DISCUSSION AND CONCLUSION: It has been concluded that the decrease in the rate of pathogenic parasites transmitted by fecal-oral route is due to the fact that the general hygiene rules and the decrease in human-to-human contact are effective in the COVID-19 process.

13.Correlation between COVID 19 and selected risk factors: an ecological study
doi: 10.5505/ejm.2023.82474  Pages 87 - 93
INTRODUCTION: The World Health Organization (WHO), on March 11, 2020, has declared the novel coronavirus (COVID-19) outbreak a global pandemic. COVID-19 originated from Wuhan; China spread to 218 Countries and Territories around the world. We planned this study to assess the correlation between COVID-19 and selected risk factors.
METHODS: An ecological study was conducted in December 2020. Data regarding the COVID-19 confirmed cases and deaths per million populations were retrieved using Our World in Data until 28th November 2020. Data regarding socio-demographic related factors of countries and health-related factors were also extracted from the same database. We have categorized countries according to Global Burden of Disease(GBD) super regions and World Bank income levels. We have applied Spearman's rank correlation coefficient to assess the correlation between COVID-19 cases and deaths with various socio-demographic and health-related factors.
RESULTS: In this study, highest number of COVID-19 confirmed cases and deaths were reported in World Bank high-income groups. Globally, we found significant positive correlations between COVID-19 deaths per million with various socio-demographic related and health related factors like median age (r=0.543,p<0.001), percentage of population aged ≥65 years (r=0.546,p<0.001), GDP per capita (r=0.531,p<0.001), HDI (r=0.567,p<0.001), female smoking (r=0.509,p<0.001), availability of hand-washing facilities (r=0.608,p<0.001), diabetes (r=0.166,p<0.05) and hospital beds per 1000 population (r=0.383,p<0.001), whereas extreme poverty is negatively correlated (r= -0.490,p<0.001).
DISCUSSION AND CONCLUSION: Extra emphasis on high-income countries is required to reduce the burden of COVID 19 cases and deaths. A multi-centric study should be planned to know the reasons for the high burden of cases and deaths in high-income countries.

14.Serum Electrolyte Values and Blood Oxidative Stress Parameters in Patients with Focal and Generalized Epilepsy
Gamze Sarı, Aysu Kılıç, Ferda Ilgen Uslu, Şahabettin Selek, Savas Ustunova, Ismail Meral
doi: 10.5505/ejm.2023.93195  Pages 94 - 98
INTRODUCTION: Because epilepsy pathogenesis is affected by serum minerals and antioxidant enzymes, this study was designed to evaluate whether there was a relationship among electrolytes (Na, Ca, K, Cl, P, Mg), trace elements (Fe, Zn, Cu) and oxidative stress in patients with generalized or focal epilepsy.
METHODS: Twenty healthy individuals (control group), and 20 focal and 20 generalized epilepsy patients (patient groups) were included in the study. Control and patient groups were matched with age (30-40 years old), body mass index (25 -28) and sex (10 males and 10 females). Serum Na, Ca, K, Cl, P, Mg and Fe levels were analyzed in an autoanalyzer, serum Zn and Cu were analyzed in a mass spectrophotometer, total antioxidant status, total oxidant status and myeloperoxidase levels were measured spectrophotometrically.
RESULTS: The oxidative stress index increased (p<0.001) and the serum Na levels decreased (p<0.001) in focal epilepsy patients compared to the controls.
DISCUSSION AND CONCLUSION: It has been concluded these changes may make focal epilepsy patients more susceptible to seizures than generalized epilepsy patients.

15.Analysis of Antibiotic Resistance Profiles of Gram-Positive Bacteria Isolated from Blood Culture Samples in Patients with Catheter Infection
doi: 10.5505/ejm.2023.83604  Pages 99 - 106
INTRODUCTION: Bloodstream enfections, which is common and often lethal, is a serious public health problem. There is consensus that the incidence is increased in patients with sepsis due to an aging population, increased use of immunosuppressive therapy, and high-risk interventions.
METHODS: In this study, 750 patients with suspected sepsis hospitalized in intensive care units in the Health Education University Van Training and Research Hospital were evaluated. 750 patients were classified according to their age and sex. Bacteria were isolated from their blood cultures. Biochemical tests such as catalase test, oxidase test, Gram staining and Coagulaz test were performed. Vitek 2 Compact (Biomerieux, USA) device was used for identification of bacteria and evaluation of the antibiogram test. The mecA genes were analyzed by polymerase chain reaction (PCR).
RESULTS: Two hundred and four Gram-positive bacteria from 750 (375 male and 375 female) were isolated in the blood culture samples taken from the intensive care units. 101 (26.9%) and 103 (27.5%) bacteria were isolated from 375 each male and female patients, respectively. Slime factor was positive in 47 of the coagulase negative bacteria. Twelve methicillin resistant Staphylococcus aureus (MRSA) isolates were positive for mecA gene carriage.
DISCUSSION AND CONCLUSION: Identification of the bacteria causing sepsis in our hospital and determining the antibiotic resistance rates were found quite important. Among the causative agents of sepsis, effect of the presence of methicillin and multidrug resistance bacteria on humman health were found to be very important.

16.Comparative effects of Conventional Physical Therapy, Kinesio Taping and Extracorporeal Shock Wave Therapy in acute Upper Trapezius Myofascial Pain Syndrome
Volkan Şah
doi: 10.5505/ejm.2023.62558  Pages 107 - 114
INTRODUCTION: Conservative Physical Therapy (CPT), Kinesio Taping (KT), and Extracorporeal Shock Wave Therapy (ESWT) have been used to treat Upper Trapezius Myofascial Pain Syndrome (UTMPS). In a health center where all three treatments can be performed, it is important to choose the most effective one in UTMPS treatment. The aim of this study was to compare the effects of CPT, KT, and ESWT in the patients with UTMPS.
METHODS: 84 patients with acute UTMPS were randomised into three treatment groups: CPT, KT, and ESWT. All patients were evaluated at baseline (week 0), just after treatment (week 2) and one month after treatment (week 6). Visual Analog Scale (VAS), Neck Disability Index (NDI), Restricted Angel of Cervical Extansion (RACE), Restricted Angel of Cervical Lateral Flexion (RACLF) scores were used as outcome measures.
RESULTS: All outcome measures just after treatment (week 2) and one month after treatment (week 6) were found to be significantly lower within the three treatment groups compared with the baseline (week 0) (for all, p<0.05). All outcome measures one month after the treatment (week 6) were found to be significantly lower in the ESWT group than in the other two treatment groups (for all, p<0.05).
DISCUSSION AND CONCLUSION: CPT, KT, ESWT were found to be effective in the treatment of UTMPS. However, since ESWT has the most positive effect on outcome measures in the evaluation 1 month after the treatment (week 6), it can be preferred over the other two methods (CPT and KT) in the treatment of UTMPS.

17.Enterococcus species isolated from patients diagnosed with COVID-19 and comparisons of their antibacterial susceptibility with one-year period before the pandemic
Pınar Öner, Fatih ÖNER, Özlem Aytaç, Feray Ferda ŞENOL, Nuray Arı, Hatice Çağlar, Zülal Aşçı Toraman
doi: 10.5505/ejm.2023.22754  Pages 115 - 122
INTRODUCTION: In our study, the enterococci species isolated before the pandemic(BP)and the enterococci isolated fromCOVID-19 patients during the pandemic period(DP) and antibiotic susceptibility results were retrospectively analyzed.In these two periods,it was aimed to investigate the effects of antibiotics preferred for treatment on susceptibility status.
METHODS: The isolation and antibiotic susceptibilities of enterococci were defined by conventional methods and an automatized system(VITEK2).The antibiotic susceptibilities have been evaluated according toEUCAST.The amount of antibiotic use in our hospital during these periods was obtained from pharmacy data.
RESULTS: For the BPperiod221(7%) enterococci strains were included, and for the DP period, 146(5.9%) enterococcus species that have been isolated only from COVID-19 patients have been included in the study. In both periods, the most frequently isolated enterococcus species is E.faecalis.In DP, the susceptibilities for ampicillin, ciprofloxacin, linezolid, high-level streptomycin(HLS), teicoplanin, and vancomycin have increased when compared to BP.High-level gentamycin(HLG) and tigecycline susceptibilities have decreased in DP when compared to BP.
DISCUSSION AND CONCLUSION: It was observed that the increase in antibiotic use was reflected in the susceptibility rates. In theDP period,it was observed that ampicillin,vancomycin,teicoplanin, and ciprofloxacin were consumed less for the treatment,and accordingly, there was an increase in the sensitivity of these antibiotics. It was determined that the increase inthe consumption of aminoglycoside,tetracycline,and tigecycline caused to decrease in the susceptibility of gentamicin and tigecycline. It was concluded that strategies for rational antibiotic prescribing to COVID-19patients should be considered in order to prevent the negative effects of inappropriate antibiotic use from reaching levels that cannot be compensated for after the ongoing pandemic.

18.Which is more effective in determining the risk of mortality and complications after coronary artery bypass graft surgery; Body mass index or albumin?
Rukiye Derin Atabey, Şahin Şahinalp
doi: 10.5505/ejm.2023.12989  Pages 123 - 128
INTRODUCTION: Preoperative risk analysis is important in predicting postoperative outcomes in patients undergoing cardiac surgery..These analyzed risk factors influence both the mortality and the morbidity results of coronary artery bypass graft (CABG) surgery. The aim of this study is to emphasize that the serum albumin value is a predictor of survival during the preoperative period for the patients that we prepared for surgery, and to indicate whether body mass index (BMI) is as valuable as albumin in predicting survival and postoperative period results.
METHODS: This study included patients who underwent CABG surgery between 2019 -2020 at the Cardiac Surgery Center. Patient’s demographic information and all laboratory data were collected. Patients were grouped according to BMI and serum albumin values. Descriptive statistics for the continuous variables were presented as Mean, Standard deviation while count and percentages for categorical variables.
RESULTS: A total of 174 patients, who underwent CABG surgery were included in the study.While postoperative complications were seen in 3.2% of patients with high BMI (>30 kg/m2), these complications did not develop in patients with low BMI (<20 kg/m2) (P=0.034).Patients who have serum albumin levels below 2.5g/dL are 22 times more likely to exitus than patients who have normal albumin levels (p=0.001, OR=22.246) whereas patients with normal BMI, obese patients have 16 times higher risk of exitus after bypass (OR=15.952)

DISCUSSION AND CONCLUSION: When we compare albumin and BMI, more extensive studies are needed to determine whether low serum albumin or increased BMI can independently predict the risk factors for poor short-term surgical outcomes.

19.Eight Year Evaluation of HIV/Tuberculosis Co-infection in Patients Admitted to Our Hospital
Ilkay Bahçeci, Yunus Emre Alpdoğan, Ömer Faruk Duran, Yunus Emre Ibik, Nuray Arslan, Kazım Şahin
doi: 10.5505/ejm.2023.78477  Pages 129 - 132
INTRODUCTION: Human immunodeficiency virus (HIV) is a disease that causes serious mortality and morbidity worldwide. Due to the weakening of the immune system, opportunistic infections are common in HIV-positive patients. Tuberculosis, one of the most important of these infections, makes the clinical management of HIV-positive patients even more difficult. In this study, it was aimed to determine the frequency of HIV-tuberculosis coexistence
METHODS: Tuberculosis cultures of 95 HIV/AIDS patients with confirmed diagnosis between 2014-2021 at Recep Tayyip Erdoğan University Training and Research Hospital were retrospectively analyzed. The results of the patients whose anti-HIV Elisa test was reactive were confirmed at the Refik Saydam Institute of Hygiene and Public Health. The diagnosis of tuberculosis was made by detection of growth in Löwenstein-Jensen medium and Mycobacteria Polymerase Chain reaction.
RESULTS: We studied a total of 95 HIV positive patients consist of 87(%91.6) males and 8(%8.4) females. Positive tuberculosis culture was detected in 3 (3.1%) of these patients. One of the patients is a foreign national and two of them are Turkish citizens.
DISCUSSION AND CONCLUSION: Tuberculosis is an important cause of mortality in HIV/AIDS patients. Opportunistic infections in these patients are the cause of serious mortality and morbidity; therefore, early detection and treatment of these diseases is vital. In primary care, HIV-positive patients should be screened for Tuberculosis.

20.Prevalence of ectopic maxillary canine and its association with other dental anomalies in children: an observational study
Sahar Haghighi, Samane Gharekhani, Farida Abesi, Maryam Ghasempour, Karimollah Hajian-Tilaki
doi: 10.5505/ejm.2023.27037  Pages 133 - 138
INTRODUCTION: Ectopic eruption of canines can lead to further dental problems and discomforts for the patients. In this study, it was aimed to investigate the prevalence of ectopic eruption of maxillary canine and its association with other dental anomalies in children.
METHODS: In this cross-sectional study, we included children aged 9-13 year old who were referred to specialized radiology clinics in XXXXX and XXXXX Dental School affiliated to XXXXX University of Medical Sciences between 2016-2020. The prevalence of ectopic eruption of maxillary canine and its association with other dental anomalies was evaluated.
RESULTS: Of 472 children, 218 (46.1%) were male and others were female. Fourteen children (3.0%) had at least one ectopic canine in the maxilla, of whom nine (64.3%) were male and five (35.7%) were female (p=0.168). The ectopic canine was unilateral in 12 cases (85.7%) and bilateral in two cases (14.3%). Of 14 children with an ectopic eruption of canine in the maxilla, 12 cases (85.7%) had unilateral, and two cases (14.3%) had bilateral ectopic canines. Of 16 ectopic canines in maxilla, 81.3% (13 teeth) had palatal direction and 18.7% (three teeth) had buccal direction. According to the chi-squared test, a direct association was found between the ectopic eruption of maxillary canines and over-retained deciduous teeth (p<0.001).
DISCUSSION AND CONCLUSION: The frequency of unilateral ectopic canines was higher than bilateral, and frequency of maxillary palatal ectopic canines was higher than buccal ectopic canines. Over-retained deciduous teeth in individuals with maxillary ectopic canines were found to be more frequent.

21.The Association between platelet-derived growth factor receptor-β polymorphisms and idiopathic pulmonary fibrosis
Zehra Kaya, Seren Duran, Hulya Gunbatar, Elif Sena Sahin, Burak Mugdat Karan
doi: 10.5505/ejm.2023.03264  Pages 139 - 145
INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease with a dismal prognosis. Platelet-derived growth factor (PDGF) receptor-β (PDGFR-β) are a receptor tyrosine kinase that PDGFs activate. It has been reported that inhibiting PDGFR-β in IPF patients can slow and improve disease progression. However, the effects of PDGFR-β on IPF remain unknown, and no studies on PDGFR-β polymorphisms for IPF have been conducted. The purpose of this study is to look into the relationship between PDGFR-β gene polymorphisms (rs246395, rs2302273, rs3828610, rs138008832) and IPF disease.

METHODS: The study included eleven patients with IPF and twelve healthy controls. DNA was isolated from blood samples taken from all participants, and genotyping was performed using a StepOne plus real time PCR device.

RESULTS: There was no statistically significant difference between the variables (age, gender, smoking, alcohol, and gastroesophageal reflux GER). There was no statistically significant difference between the patient and control groups in the allele and genotype frequencies of these polymorphisms. Furthermore, no statistically significant difference was found between patients' smoking, forced vital capacity (FVC) (normal, low), and GER data, as well as PDGFR-β variants (rs246395, rs2302273, rs3828610 and rs138008832) (p>0.05).
DISCUSSION AND CONCLUSION: In order to determine the relationship between PDGFR-β gene polymorphisms and the risk of IPF, larger studies with more participants are required.

22.Oxidative Stress Status in Patients with Lumbar Disc Herniation
Abdurrahim Tas, Canan Demir
doi: 10.5505/ejm.2023.58908  Pages 146 - 149
INTRODUCTION: Lumbar disc herniation (LDH) is a degeneration process that causes nerve damage with mechanical and inflammatory effects. Data reflecting the role of oxidative stress in disease pathogenesis and prognosis are very limited. In this study, we analyzed oxidative stress parameters in LDH patients.
METHODS: The study included 63 patients who were diagnosed with LDH by magnetic resonance imaging and decided to operate and the same number of healthy controls. Oxidative stress parameters were measured from the patients preoperatively and at the postoperative sixth month. The obtained values were compared among themselves and with the control group.
RESULTS: Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSHPx) levels were found to be significantly lower in the preoperative period compared to the control group and postoperative period, meanwhile malondialdehyde (MDA) was higher (p=0.001). When postoperative patients were compared with the control group, it was revealed that SOD, CAT, and GSHPx were lower and MDA was higher than the control group (p=0.001).
DISCUSSION AND CONCLUSION: In this study, it was shown that surgery significantly improved the oxidative stress state in patients with LDH, but could not eliminate it. In other words, oxidative stress and cellular damage continue at the molecular level.

23.Comparison of delivery results of adolescent-age pregnant women and older pregnant women with those in normal age range
Burak Elmas, Aysegul Bestel, Ozge Sehirli Kinci
doi: 10.5505/ejm.2023.18942  Pages 150 - 157
INTRODUCTION: The negative results of adolescent (10-19 years) and advanced-age pregnancies (AMA) (>40 years) were compared with the results of the pregnancies considered to be within normal reproductive period (20-40 years) in our study. The complications and poor outcomes that might occur during and after pregnancies in these special periods were also uncovered in this respect.

METHODS: The data of the patients were scanned retrospectively through the automation system, and the patients were divided into 3 groups according to their ages at birth; adolescent (10-19 years), normal (20-40 years old), and AMA (>40 years). A total of 100 patients were evaluated in the adolescent age group, 99 patients in the normal age group, and 76 patients in the AMA group.
RESULTS: Statistically significant differences were detected between the groups in terms of age, weight, and BMI (p<0.05). Statistically significant differences were found between the groups in terms of active phase duration (p<0.05), which was the highest in women in the AMA group (268.5min). Although fetal distress was the cause in the majority of women in the normal and adolescent group (39.1%-56.3%), the reason was found to be maternal anxiety (patient demand) in the majority of women (25.0%) in the AMA group.
DISCUSSION AND CONCLUSION: Early and late pregnancies must be evaluated as a special group, and follow-ups must be planned in this respect. Increased cesarean section rates and decreased pregnancy follow-up status in adolescence may cause increased complications especially in advanced-age pregnancies.

24.What Happens with Liver in Critically ill COVID-19 Patients- Ultrasound and Elastography Findings
Derya Bako, Engin Beydoğan
doi: 10.5505/ejm.2023.46244  Pages 158 - 164
INTRODUCTION: The liver is the second potential target organ of COVID-19 after lungs. However, the COVID-19 induced liver injury's definition, clinical importance and even the real existence of a clinically important liver injury during the disease course is still unclear. Therefore, in seeking information about the existence of the liver injury we decided to evaluate sonographic findings and consecutive tissue stiffness alterations with shear wave elastography in critically ill COVİD-19 patients.
METHODS: A total of 28 critically ill COVID-19 patients from ICU were randomly enrolled in this study between October 2020 and December 2020. US and SWE findings, age, gender, comorbidities, previous liver disease history, aspartate transaminase (AST), and alanine transaminase levels (ALT) were recorded.
RESULTS: A total of 28 participants were included in this study, data for the 19 participants were evaluated. Hepatomegaly was detected in 12 (63%) cases. 2 patients had periportal cuffing while 1 patient had hepatosplenomegaly. The mean liver stiffness value was 4.73 kPa with a reference range between 2.55 and 8.49 kPa. Only one patient’s liver stiffness value exceeded normal limits.
DISCUSSION AND CONCLUSION: The mild increase of liver function biomarkers, the lack of typical sonographic findings for virus-induced hepatitis and lack of any significant increase in tissue stiffness expected in acute hepatitis, are not supporting the previous hypotheses of direct virus-mediated liver damage due to COVID-19. On the contrary, a mild liver injury seen in these patients may be attributed to the collateral liver damage mainly from dysregulated and severe immune response.

25.Prevalence of extended-spectrum beta-lactamase producing Klebsiella: cross-sectional study, 2000-2021
Neval Yurttutan Uyar, meltem ayaş, Sabahat Aksaray
doi: 10.5505/ejm.2023.85530  Pages 165 - 171
INTRODUCTION: Increasing resistance due to extended-spectrum ß-lactamases (ESBLs) and multiple resistance mechanisms in gram-negative hospital isolates restrict the role of ß-lactam antibiotics in empirical treatment of serious infections. As the prevalence of ESBL producing strains and resistance rates to antimicrobial agents can vary in each center, local surveillance studies are required to guide therapy. In this study, the prevalence of ESBL-K hospitilazed population and the change of prevalence through years from 2000 to 2022.
METHODS: Klebsiella strains isolated between 2000 and 2022 years, were included. 2000 data was collected from two hospitals; one state and private group hospitals. The other whole data were collected only form private group hospitals. ESBL tests were performed according to CLSI and EUCAST guidelines.
RESULTS: ESBL positive Klebsiella strains were mostly commonly isolated from intensive care units and from sputum + tracheal aspirate (%41). Total prevalence of ESBL positive Klebsiella strains were 51.29%. The prevalence of 2000 years was high probably due to the different hospital /patient profile. By excluding the 2000 data, the prevalence were increasing by years; 15.38% at 2001 to 61.50% at 2021.
DISCUSSION AND CONCLUSION: High prevalence of ESBL in Turkey was increasing by years. Our private hospitals data was lower than the other state hospitals in the Turkey. Diiferent hospital /patient profile could be the reason of low prevalence through precarity level, unnecessarily broad-spectrum antibiotic treatment, environmental contamination, kitchen hygiene and europian health turistic patients. More research must be done to clarify the reason of this differences.

26.Factors Affecting Levels of Cyberchondria in Mothers of Children with Food Allergies
Ahmet Kan, Gülşah Kartal, Masum Öztürk
doi: 10.5505/ejm.2023.34366  Pages 172 - 178
INTRODUCTION: Cyberchondria is a term used to assess the anxiety-inducing effects of online health-related searches. Most of mothers were found to have obtained information from the internet, but the influence of the internet on maternal anxiety has not been sufficiently investigated. Therefore, our aim in the present study was to evaluate the relationship between cyberchondria experienced by mothers of children with food allergies and sociodemographic factors.
METHODS: The study was carried out with mothers whose children had been diagnosed with a food allergy and mothers of healthy children. ‘The Cyberchondria Severity Scale’ was used to evaluate anxiety of the mothers. In addition, the sociodemographic status of the participants was evaluated with a questionnaire.
RESULTS: The cyberchondria severity scores of 60 mothers with food-allergic children and 60 mothers with healthy children were compared. The most common diagnosis was atopic eczema (51.8%). The cyberchondria severity scores of mothers with food-allergic children (59±23) were significantly higher than those for the healthy group (50±13) (p<0.001). The mean cyberchondria severity scores were significantly higher in working mothers (p=0.01), families whose monthly income was the minimum wage and above (p=0.02), and mothers who searched on the internet to choose a physician (p=0.03).
DISCUSSION AND CONCLUSION: Psychological problems in mothers of children with food allergies that may be caused by cyberchondria can often be overlooked in outpatient settings. To detect these problems, it is necessary to perform screening tests and to provide support to these mothers in a timely manner.

27.Neuroendocrine Tumours Detected After Appendectomy: 5-Year Single Center Experience with 4888 Acute Appendicitis Patients
Ahmet Başkent, Murat Alkan, Ecem Memişoğlu, Okan Ok
doi: 10.5505/ejm.2023.78309  Pages 179 - 184
INTRODUCTION: This study is aimed to retrospectively examine the demographic characteristics, surgical procedure, histopathological results and survival of patients who underwent appendectomy with the diagnosis of acute appendicitis and were diagnosed histopathologically with neuroendocrine tumors of the appendix (ANET).
METHODS: A retrospective study was performed in patients undergoing surgery for acute appendicitis between January 2015 and December 2020. Demographic characteristics of the patients, tumor diameter, tumor grade, invasion, surgical margin, TNM stage, postoperative follow-up and survival time were obtained from the hospital database. In addition, the expression of synaptophysin, chromogranin-A, Ki-67, CD56 tumor markers and mitotic index of the cases were assessed from the pathology reports.
RESULTS: In the histopathological examination of 4888 appendectomy specimens, ANET was detected incidentally in 31 cases (0.63%). The median age in these cases was 33 years and the women/men ratio was 1.6. Twenty seven (87.1) cases were found to be Grade 1, 3 (9.8%) Grade 2 and 1 (3.2%) Grade 3. Only appendectomy was performed in 26 (83.8%) of the patients, and complementary right hemicolectomy (RH) was performed in 5 (16.2%) patients with Grade 2. Residual tumor was seen in only 1 (Grade 3) of the cases who underwent RH. No recurrence was detected in any of the cases.
DISCUSSION AND CONCLUSION: ANETs are very rare and are usually detected incidentally in pathological examinations after appendectomy. Therefore, routine appendectomy specimens should be carefully examined to determine the diagnosis. ANETs are a disease with a very good life expectancy and prognosis. Complementary right hemicolectomy should be recommended in advanced ANETs.

28.Investigation of the Predictive Value of Amino Acids for Tuberculous Meningitis, Aseptic Meningitis and Bacterial Meningitis
Irfan Binici, Zübeyir Huyut, hamit hakan alp, HALİL İBRAHİM AKBAY, HASAN KARSEN, Mehmet Parlak, Şükrü Akmeşe
doi: 10.5505/ejm.2023.49404  Pages 185 - 194
INTRODUCTION: In our study, we aimed to detect amino acid changes, if any, by comparing the levels of amino acids in cerebrospinal fluid (CSF) samples of patients with aseptic, bacterial, and tuberculous meningitis and healthy individuals.
METHODS: Patients diagnosed with aseptic meningitis (n=41), tuberculous meningitis (n=21) and bacterial meningitis (n=41) and a healthy control group consisting of 64 healthy individuals with similar gender and age characteristics were included in the study. 2 mL of cerebrospinal fluid specimens were obtained from all patients and healthy volunteers and stored at -80 °C until the study day. The amino acid measurements were performed using commercially available liquid chromatography-tandem mass spectrometry method (LC-MS/MS).
RESULTS: The levels of 1-methyl histidine, alanine, asparagine, histidine, isoleucine, lysine, methionine, norvaline, ornithine, phenylalanine, proline, sarcosine, threonine, tyrosine, valine in the aseptic, tuberculosis and bacterial meningitis groups were statistically higher than those of the healthy control group. The levels of all amino acids except cystine, glutamic acid, homo-citrulline, and taurine in the patients with aseptic meningitis were statistically significantly higher than in the healthy control group. The levels of all amino acids except homocitrulline, and tryptophan were statistically significantly higher in the patient group with tuberculous meningitis than in the healthy control group. The levels of all amino acids except glutamic acid were statistically significantly higher in the patient group with bacterial meningitis than in the healthy control group.
DISCUSSION AND CONCLUSION: Amino acid levels were impaired in these patients and that some amino acids showed promise as a biomarker in the differentiation of meningitis types.

29.The Role Of Matrix Metalloproteinases in Neural Tube Defect
Mehmet Edip Akyol, Farika Nur Denizler Ebiri, Filiz Taspinar, veysel yüksek, Oğuz Tuncer, Mehmet Arslan, mehmet taspinar
doi: 10.5505/ejm.2023.24356  Pages 194 - 202
INTRODUCTION: Neural Tube Defect (NTD) is one of the most common congenital malformations.The formation of the extracellular matrix (ECM) plays an important role in migrating neural crest cells. Matrix metalloproteinases (MMPs) play a major role in cell migration in ECM organization. This study aimed to investigate the roles of MMP-1, -2, and 9 gene expressions as biomarkers for NTD.
METHODS: Peripheral blood samples and NTD tissues were collected from 40 newborn babies diagnosed with NTD and peripheral blood samples from only 20 healthy babies were taken for control. After total RNA isolation from blood and tissues, MMP-1,-2,-9 gene expressions were analyzed by Quantitative Real-Time PCR (RT-PCR).
RESULTS: There was no difference between the control group and the NTD group in terms of MMP expressions in blood samples (p>0.05). A statistically significantly higher MMP-1 expression was found in Meningocele and Myeloschisis than in Encephalocele (p=0.014). A significant difference was found between the tissue and blood samples of the Meningomyelocele patient group regarding MMP-9 expression (p=0.019). There was no significant relationship between Ca2+, B12 and Folate levels, NTD and MMP genes expressions (p>0.05).
DISCUSSION AND CONCLUSION: Even though MMP genes were not different between control and NTD groups, they were found to vary between different subgroups and can serve as biomarkers.

30.Severe acute necrotizing pancreatitis after endoscopic biopsy of the minor duodenal papilla
Jun Hyuk Son, Yoon Suk Lee
doi: 10.5505/ejm.2023.99075  Pages 203 - 205
Endoscopic biopsies are occasionally taken from the minor duodenal papilla when abnormal appearance of the minor duodenal papilla is encountered during esophagogastroduodenoscopy. Minor complications such as bleeding could occur after biopsy, however acute pancreatitis is a very rare complication after biopsy of the minor duodenal papilla. We report a case of severe acute necrotizing pancreatitis following biopsy of the minor duodenal papilla.

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