ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 28 (2)
Volume: 28  Issue: 2 - 2023
1.Measurement of postoperative liver volume changes in patients with gastric cancer by computed tomography
Adem Yokuş, Harun Arslan, zülküf Akdemir, İbrahim Akbudak, Necat Almalı, çetin kotan, Erkan Doğan
doi: 10.5505/ejm.2023.12129  Pages 206 - 210
INTRODUCTION: One of the most prevalent cancer worldwide is gastric cancer. Surgical treatment is the only curative method. In this study, we aimed to investigate the changes in liver volume before and after open gastrectomy in patients diagnosed with gastric cancer.
METHODS: We retrospectively analyzed the computed tomography scans of 70 patients who underwent gastric cancer surgery between June 2013 and December 2020. Preoperative and postoperative total liver volume, the volume of segments II-III, and segment IV were measured. The data obtained from volume measurements were compared statistically.
RESULTS: Of the 70 subjects included in the study, 48 were male and 22 were female, with an average age of 64.2±11.8 years. In the postoperative phase, the volume of segments II-III and IV dropped significantly compared to the preoperative period (p=0.001 for both). Total liver volume exhibited a mild decrease in the postoperative period, but the total volume loss was not statistically significant (p=0.744).
DISCUSSION AND CONCLUSION: In this study, we detected significant volume loss in segments II-III and segment IV after open gastrectomy. However, the total liver volume reduction was less.

2.Examination Of Health Fatalism And Health Literacy In Patients With Heart Failure
Gülcan Bahçecioğlu Turan, Bahar Çiftçi
doi: 10.5505/ejm.2022.91298  Pages 211 - 218
INTRODUCTION: This research was conducted to determine the level of health fatalism and health literacy in patients with heart failure and to examine the relationship between them.
METHODS: The population of the research consisted of patients with heart failure who applied to the cardiology clinic and outpatient clinic between February and December 2021. The sample consisted of 210 patients who met the research criteria between the specified dates. The data were collected face-to-face using the “Patient Introductory Information Form”, “Religious Health Fatalism Scale" and "Health Literacy Scale". Data were analyzed using frequency, percentage, mean, standard deviation, Pearson correlation and multiple linear regression analysis.
RESULTS: The mean score of religious health fatalism was 57.19±12.38 and the mean score of health literacy was 70.49±14.27. It was determined that there was a negative relationship between religious health fatalism and health literacy of patients with heart failure at p<0.01 level and this relationship was statistically moderate. As a result of the regression analysis, it was found that religious health fatalism was a statistically significant and negative predictor of health literacy.
DISCUSSION AND CONCLUSION: It was concluded that patients had high religious fatalism and poor health literacy. In addition, it was determined that health literacy of heart failure patients decreased as religious health fatalism increased.

3.Evaluation of Patients Identified with Polycystic Ovary Image on Ultrasonography
Mustafa Bağcı, Ahmet Başar Tekin
doi: 10.5505/ejm.2023.28003  Pages 219 - 227
INTRODUCTION: The present study investigates the clinical, hormonal and biochemical differences between patients with polycystic ovary syndrome (PCOS), patients with polycystic ovary image (PCO-like) and a normal control group with no polycystic image syndrome.
METHODS: Included in the study were 238 patients who presented to the Department of Obstetrics and Gynecology of Eskisehir Osmangazi University between December 2012 and December 2013 with complaints of infertility. A physical and pelvic examination of all patients was performed and their ovaries were evaluated with TVUS, and blood samples were taken for hormonal tests. The patients were categorized into three groups based on their clinical and endocrinological characteristics as: 77 cases with PCOS, 74 cases with PCO-like findings and 87 cases recruited as normal controls.
RESULTS: BMI and the rate of android obesity was found to be higher in patients with PCOS. Clinical and laboratory findings of hyperandrogenism were more commonly encountered in patients with PCOS. FG scores were found to be increased, and correlated with BMI, waist / hip ratio, free blood testosterone (fT) and total testosterone (TT) (p<0.001). AFC decreased in the control group with increased age (p=0,003) but no such association found in the PCOS (p=0.216) and PCO-like group (p=0.876).
DISCUSSION AND CONCLUSION: Not every patient identified with a PCO image on ultrasonography has PCOS, and so clinical, hormonal and biochemical properties should be evaluated in detail when patients with PCO-like findings are encountered, and they should be differentiated from patients with PCOS. Patients with PCOS should be evaluated in detail and followed-up to prevent long-term complications.

4.Clinical Analysis Of Traumatic Isolated Rectal Injuries
Serhat Doğan, Bahadır Öndeş, Ali Aksu, Feyzi Kurt
doi: 10.5505/ejm.2023.11129  Pages 228 - 231
INTRODUCTION: In this study, we aimed to evaluate the approach to patients who applied to our clinic due to isolated rectal injury.
METHODS: Patients treated for isolated rectal injury in our clinic between January-2017 and December-2021 were retrospectively reviewed.
Ten patients were examined and 7 patients were included in the scope of the evaluation. The patients were evaluated under the headings such as age, gender, injury site, and whether or not diversion was performed.

RESULTS: All patients were male and the mean age was 26.5±9.46 years.
There were middle rectal injuries in two patients, upper rectal injuries in one patient, and lower rectal injuries in four patients. Except for one patient with lower rectal injury and no rectal contamination, the other six patients underwent diversion. One patient who underwent transanal repair was followed up with tomography in the postoperative period.

DISCUSSION AND CONCLUSION: Rectal injuries are high-risk injuries due to their neighborhood in the pelvic region. Intestinal diversion is a serious option to prevent pelvic sepsis. It should not be forgotten that transanal primary repair can also be performed after the location of the injury is determined and the perirectal area is cleaned.

5.Examination of the Relationship Between Intermittent Fasting and Irisin Levels in Rats Fed on a High-Fat Diet
Nizamettin Günbatar, Bahattin Bulduk
doi: 10.5505/ejm.2023.81236  Pages 232 - 236
INTRODUCTION: In this study, the relationship between intermittent fasting and irisin levels has been examined in rats fed on a high-fat diet.
18 wistar albino breed male rats were determined as the 1st control group (standard nutrition, 2.8% crude fat, 23.1% crude protein, 5% crude fiber, 7.1% crude ash and 12.8% moisture), the 2nd group was determined as the high-fat diet group (300 g/kg margarine was melted and added to standard pellet feed, prepared daily to be applied for 8 weeks daily), and the 3rd group was determined as the high-fat diet and intermittent fasting group (with a non-successive diet2 days a week, interrupted for 24 hours and all foodwasrestricted except water). As a result of the analyses performed, it was found that the level of the irisin in the group fed on a high-fat diet was low compared to the control group, and the level of the irisin in the high-fat diet + intermittent fasting group was high compared to the group fed on a high-fat diet. As a result, it was concluded that the use of intermittent fasting increases the level of irisin, and it can be considered among the methods to be used in the treatment of obesity to prevent its occurrence.

METHODS: Prior to the study, an approval was obtained fromDirectorate of Animal Experiments Local Ethics Committee, decision number 08, dated 25.06.2015. This study was conducted according to the Declaration of Helsinki, as revised in 2000. The study was conducted on 18 male wistar albino rats. All other conditions, except for the experimental diet, were provided within the standards of laboratory animal care. With 6 rats in each group,1st group was the control group (CG) and a standard feeding program was applied to this group (2.8% crude fat, 23.1% crude protein, 5% crude fiber, 7.1% crude ash, and 12.8% moisture) and the 2nd group was the high-fat diet (HFD) group (300 g/kg margarine was melted and added to the standard pellet feed, prepared daily and applied for 8 weeksdaily) and a high-fat diet with intermittent fasting (HFD+IF) was applied to the 3rd group (24 hours breakafter non-successive diet for 2 days a week, and all food was restricted except water). The study continued for a total of 8 weeks. At the end of the 8th week, a blood sample was taken from the heart of rats euthanized with Ketamine (50mg/kg) and the serum irisin level was examined via the ELISA method.
Taking of the blood samples: At the end of the experiment period, with general anesthesia application with ketamine (50mg/kg),the abdominal region of the rats (control and experimental groups) was excised in the form of an inverted letter V from the anal (pubis) area to the chest cavity, the abdominal cavity was opened, and the required amount of blood was taken by penetrating the heart with an injector. The blood taken was transferred to biochemistry tubes and centrifuged at 4000 RPM (RCF=1240xg)’’ for 15 minutes and serums were removed. Serums removed were placed in Eppendorf tubes and stored at -80°C until study.
Quantitative measurement of the irisinfrom the rat serum samples was performed using a commercial enzyme-linked immunosorbent analysis (ELISA) kit (Phoenix Pharmaceuticals Inc, Burlingame, California, USA). The determination range of the kit was 0.781 - 50 ng/ml, and intra-variation coefficients <0.469 and sensitivity and94% recovery values were measured using commercial enzyme-linked immunosorbent analysis (ELISA) kits (20).

Statistical Analysis
Descriptive statistics of the groups were given as mean and standard deviation. The Shapiro-Wilk test was used to determine whether the data were distributed normally or not. For the same parameter, presence of significant differences between the groups was evaluated with theKruskal-Wallis Test. In order to determine which group causes the difference, post hoc analysis (Tukey HSD) was performed and results which have a p value of 0.05 or smaller were considered significant.

RESULTS: Serum irisin values were lower in the high-fat diet group compared to the control group. Serum irisin values were higher in the high-fat diet + intermittent fasting group compared to the high-fat diet group (p<0.05) (Table 1).
DISCUSSION AND CONCLUSION: Irisin is an anti-obesity hormone that increases fat burning and prevents the formation of adiposity (21). Irisin, which was first isolated by Boström et al. in 2012, is a new myokine consisting of 112 amino acids (22). Irisin is also secreted in small amounts from other tissues, including liver or adipose tissue (23). Irisin is induced by exercise in rats and humans (24). The level of the irisinis increased with exercise and plays a significant role in increasing energy consumption by converting white adipose tissue into brown adipose tissue, allowing energy to be converted into heat (25). Irisin is a thermogenic agent and has a significant effect on reducing fat mass (23,26).
In their study, Mazur-Bialyet al. reported that plasma irisin levels were significantly reduced in sedentary rats fed on a high-fat diet (HFD) with or without colitis (27). In another study, Jimenez- Aranda et al. noted that there were high levels of irisin in thin rats, compared to obese rats (28).
Kanget al. found that in an 8-week high-fat diet study they conducted, the level of irisin was significantly reduced in the high-fat diet group compared to the control group after 8 weeks (29). In another study, Lu et al. showed that a high-fat diet increases body fat mass and reduces serum irisinlevels in wistar albino rats (30). It has been shown that the levels of irisin in the skeletal muscle and plasma of obese rats are reduced (22). Studies have shown that irisine in men is has a negative correlation with BMI, waist/hip ratio and fat ratio, and that the levels of the irisin were lower in obese and overweight men (31).
In another study, it was determined that FNDC5 decreases in rats fed on a high-fat diet, and the level of irisine in skeletal muscle also decreases significantly (32). These findings are supported by studies showing that irisin levels decrease during obesity in both rodents and humans (33,34). Stengel et al. reported that there is a positive relationship between body weight and circulating irisin in obese people (35). The results in the present studysupport the above-mentioned results and it has been shown that the level of irisin in the group fed on a high-fat diet was decreased significantly compared to the control group.
In the 7-week intermittent fasting study conducted by Karraset al, they found that the level of irisin increased after 7 weeks compared to the control group (36). In another study conducted by Alzoughoolet al., they found that fasting irisin values were higher compared to postprandial values during Ramadan (37). As a result of the eight-week study byCrujeriaset al., aiming to provide weight loss in 93 patients (38), the 10-week study by Huerta et al.,aiming to provideweight loss in 79 female patients (39),and the 6-week study of de la Iglesiaet al., aiming to provideweight loss, they all reported that in obese patients, with the decrease in the body weight,serum irisin levels were also decreased(40). In the study we carried out, it was observed that the level of the decreased irisin in the group fed on a high-fat diet was increased significantly in the group fed on a high-fat diet+ intermittent fasting.
In the literature search, it was observed that there are studies with different results on the levels of irisin in obese people. It is believed that the factor that causes inconsistency in irisin results is the biochemical analyzes (41). It has been stated that since irisin is a sensitive molecule,different results can be obtained in different kits, and the discrepancy in the study results may also be due to this (42).
In conclusion: In the present study carried out, it was seen that the 8-week intermittent fasting application with 2 days a week, which was applied to the group that was fed on a high-fat diet, increased the level of irisin, and it is contemplated that intermittent fasting can be employedas one of the methods of preventing and treating obesity,under the control of a physician, if necessary, by being supported with further studies on intermittent fasting.

6.Comparison of atorvastatin and simvastatin modulation on adiponectin and insulin resistance in non-diabetic dyslipidemic patients
Megawaty Megawaty, Muzayyidah Muzayyidah, Yulia Yusrini Djabir, Idar Mappangara, Bogie Palinggi
doi: 10.5505/ejm.2023.80912  Pages 237 - 243
INTRODUCTION: Statins are the first-line treatment of dyslipidemia but their use is associated with an increased risk of impaired glycemic control. In this study, the effects of atorvastatin and simvastatin on adiponectin levels and insulin resistance index were compared in non-diabetic dyslipidemic patients.
METHODS: Thirty-nine dyslipidemic non-diabetic outpatients were included in this study. The patients were prescribed with either simvastatin 20 mg or atorvastatin 20 mg. Blood sampling was carried out before and two months after statin treatments to measure the adiponectin, insulin, and fasting blood glucose (FBG) levels. The insulin resistance index was calculated based on the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR).
RESULTS: Most patients had low baseline adiponectin levels (<3 µg/dl) and were not significantly changed after two months of atorvastatin or simvastatin treatment. The fasting insulin levels significantly increased in the simvastatin group (p=0.033), but not in the atorvastatin group. The HOMA-IR index was also increased in the simvastatin group from 1.89 ± 4.51 before to 2.72 ± 5.86 after treatment but did not reach statistical significance. Further analysis found a positive correlation between fasting insulin level and HOMA-IR value and the simvastatin group's adiponectin level (p=0.001).
DISCUSSION AND CONCLUSION: There is an indication that simvastatin, but not atorvastatin, stimulates an increase in fasting insulin levels after two months of treatments. The increase in the insulin resistance index correlates to the plasma level of adiponectin. Further study with a longer duration of observation is required to address this potential side effect.

7.Evaluation of ABSI Score for the Prognosis and Length of Hospitalization of Burn Patients
Nihan Turhan, Abdulkadir Ciğer
doi: 10.5505/ejm.2023.82609  Pages 244 - 249
INTRODUCTION: The aim of our study is to investigate the usability of the ABSI score in predicting the prognosis and length of hospital stay of the patients.
METHODS: In our study, the data of burn patients who were hospitalized and treated in our burn units between January 2018 and December 2020 were evaluated retrospectively. The effects of burn agent and the factors that make up the ABSI score on the prognosis and length of hospital stay of the patients were investigated.
RESULTS: 331 burn patients were evaluated. It was found that the percentage of total burn surface area, presence of full-thickness burn and inhalation injury, among the variables constituting the ABSI score, were significantly higher in the burn non survivor group (p<0.001). Mortality risk of the patients were increased with the increase in the ABSI score (p<0.001).
When the effects of the ABSI score on the length of hospital stay were evaluated, it was found that the higher the ABSI score, the longer the hospitalization duration (p<0.001).
The hospitalization duration of the patients with flame and electrical burns were significantly longer than other kinds of burns (p<0.001).

DISCUSSION AND CONCLUSION: We think that a new scoring system that includes the percentage of burn area, presence of full-thickness burn, inhalation damage, which are components of the ABSI score and patient groups with difficult burn recovery as well as the burn agent, will be more effective in determining mortality, prognosis and hospital stay of burn patients.

8.Comparison of the Results of Sacrospinous Fixation and Abdominal Sacrocolpopexy Surgery
Derya Uyan Hendem, Hasan Cemal Ark
doi: 10.5505/ejm.2023.89588  Pages 250 - 257
INTRODUCTION: The present study aims to compare the objective and subjective success rates, perioperative and postoperative complications, and results of abdominal sacral colpopexy (SP) and sacrospinous fixation (SSF) operations applied in the treatment of apical pelvic organ prolapse.
METHODS: Between November 2007 and April 2013, among the patients with the apical organ prolapse, 34 patients who underwent abdominal sacral colpopexy (SP) and 39 patients who underwent vaginal sacrospinous fixation (SSF) were included in the study. The physical examination, sonographic evaluation, stress test and urodynamic test had been performed preoperatively. The patients were assessed average 35 month after abdominal sacral colpopexy and average 8 month after sacrospinous fixation, all parameters were compared with preoperative values. We compared objective and subjective success rate, operating time, inpatient day, return to activities of daily living and complication of abdominal and vaginal groups.
RESULTS: Mean follow-up time was 35 months for abdominal group and 8 months for vaginal group. Objective anatomic success rate was 76,9% in the vaginal group and 85,3% in the abdominal group(p=0,365); Subjective success rate was 84,62% in the vaginal group and 91,18% in the abdominal group(p=0,395). There was no major complication perioperatively in both groups.
DISCUSSION AND CONCLUSION: Abdominal sacrocolpopexy and sacrospinous fixation are the surgical procedures in the treatment of apical pelvic organ prolapsus which have high success rate and low complication rate.

9.Do Mortality Risk Scores Predict The Severity Of Coronary Artery Disease In Patients With Myocardial Infarction With St Elevation?
Selim Aydemir, Emrah AKSAKAL, İBRAHİM SARAÇ, SİDAR ŞİYAR AYDIN, REMZİYE DOĞAN, Oktay GÜLCÜ, Faruk Aydinyilmaz, Kamuran kalkan, Selim topcu
doi: 10.5505/ejm.2023.81557  Pages 258 - 264
INTRODUCTION: Acute coronary syndromes (ACS), which also include ST Elevation Myocardial Infarction (STEMI), are most responsible for cardiac deaths. With the correct, rapid diagnosis and appropriate treatment option, all adverse events, including death, can be reduced. For this purpose, risk scoring has been developed and used in daily practice. In our study, we aimed to evaluate the place of risk scores used to evaluate mortality in STEMI patients in predicting coronary artery disease (CAD) severity.
METHODS: In our study, 293 STEMI patients were enrolled. All of these patients underwent coronary angiography, and GRACE, TIMI, Zwolle, PAMI, CADILLAC risk scores and SYNTAX score (SS) were calculated. The distinguishing ability of mortality risk scores was assessed using the area under the curve or the C statistical method.
RESULTS: The number of patients with high SS was 112 (%38.2). Compared to the ROC curves of the risk scores in determining the presence of severe CAD, all of the results were significant, similar, and had a high predictive value. The ‘area under the curve’ values of severe CAD, TIMI, Zwolle, PAMI and CADILLAC were found to be 0.658, 0.675, 0.716, 0.679 and 0.703, respectively (p<0.001).
DISCUSSION AND CONCLUSION: Mortality risk scores were similar, significant and effective in predicting high SS, the highest rate being Zwolle score, in patients admitted to our clinic with STEMI. Using these risk scores in a simple and fast way before and after coronary angiography, it will provide us an important benefit for predicting mortality and predicting the presence and severity of CAD.

10.Comparison of Loose and Cutting Seton Methods in Anal Fistula Treatment
Haluk Tümer, Merih Altiok
doi: 10.5505/ejm.2023.46578  Pages 265 - 271
INTRODUCTION: The main objective in anal fistula surgery is the protection of continence. The incontinence rates after surgical treatment in cases with fistulas that contain more than 30% of external anal sphincter are increasing. In our study, we used the loose seton application with aim of comparing to the primary treatment like cutting seton. We aimed to determine the efficacy of treatment while comparing the results of patients treated with loose seton and cutting seton.
METHODS: The diagnosis of anal fistula in medical records between the date of January 2010-January 2020 was searched. The patients were divided into two groups as cases treated with loose seton(group 1, n: 126) and cases with cutting seton (group 2, n: 64). The groups were evaluated for demographic characteristics, clinical findings, complications, pain scores, clinical follow-up results, and recurrences.
RESULTS: 190 patients were included in the study and their mean age was 38.7 years. 145 cases were male and 45 were female. 115 cases were operated for lower transphincteric fistula and 75 ones for higher transsphincteric fistula. The mean length of the fistula tract was 2,2 cm (2-5,5). 39(20,6%) patients had a diagnosis of diabetes. The mean operation time was 19,8 minutes (13-35). 24(12,6%) patients had complications. The mean falling time of setons was 51.1 days(21-77) in 59 cases; whereas, 73(34-122) days in the loose seton group and 44 days (21-93) in the cutting seton group.
DISCUSSION AND CONCLUSION: No significant meaningful difference was found for treatment success despite a higher incidence of pain and incontinence in cutting seton applications.

11.Essential Trace Element Levels in Patients with Cutaneous Anthrax
Irfan Binici, Mehmet Parlak, Mahmut Sunnetcioglu, Ali Irfan Baran, Mehmet Reşat Ceylan, Ali Rıza Kul, Halit Demir, Sevdegül Bilvanisi, Gizem Gizli, Zübeyir Huyut
doi: 10.5505/ejm.2023.90699  Pages 272 - 278
INTRODUCTION: The causative microorganism in anthrax is Bacillus anthracis and this disease is more common in some regions of Turkey. Changes in trace elements other than Fe in anthrax infection have not been studied. In this study, levels of some trace elements (iron [Fe], copper [Cu], zinc [Zn], magnesium [Mg], manganese [Mn], cobalt [Co], cadmium [Cd], lead [Pb]) were investigated in patients with cutaneous anthrax.
METHODS: Fifteen patients with cutaneous anthrax and 15 healthy individuals matched for age/sex were included in the control group. Anthrax was diagnosed according to contact status with animals, symptoms, examination, and microbiological results. Determination of the levels of the trace elements and heavy metals was performed by Atomic Absorption Spectrophotometer (UNICAM-929 spectrophotometer).
RESULTS: Serum iron, lead, and cadmium levels were significantly higher in the patients than in the control subjects (p<0.001). Serum magnesium, manganese, zinc, copper, and cobalt levels were significantly lower in the patients than in the control subjects (p<0.001, Co<0,05). The Cu/Zn molar ratio was not significantly increased in the patients with cutaneous anthrax than in the control subjects.
DISCUSSION AND CONCLUSION: It has been reported that Fe, Cd, and Pb levels are low and Cu level is high in infectious diseases. But we determined the opposite situation in the patients with cutaneous anthrax. As a result, it can be said that the detection of high Pb and Cd levels in the cell in anthrax disease suppresses the immune system. Also, Zn can be used as a marker for this disease.

12.Micro and macrosurgical treatment of gingival recessions: a randomized clinical trial
tuğçe zeytinci, BEGUM ALKAN, Esra Guzeldemir-Akcakanat
doi: 10.5505/ejm.2023.50133  Pages 279 - 290
INTRODUCTION: The purpose of this single-center, parallel armed, an assessor and statistician blinded, 6-month randomized clinical trial was to compare the clinical results of micro and macrosurgical techniques in the treatment of localized gingival recession defects.
METHODS: Miller Class I and II gingival recession defects, at least 3.0 mm deep, were selected and randomly assigned to receive micro or macrosurgical techniques. Both techniques were performed using a coronally positioned flap with a subepithelial connective tissue graft. Plaque and gingival indices, gingival recession depth and width, pocket depth, bleeding on probing, clinical attachment level, width of keratinized gingiva, aesthetic score and percentage of root coverage, postoperative complaints, and satisfaction of the participants completing the study were evaluated at follow-up 1st, 3rd and 6th months.
RESULTS: A total of 20 defects at 17 individuals, aged 19-53 years, were evaluated. Defects were randomized to microsurgery (n=10) and macrosurgery (n=10) groups. The microsurgery was superior to the macrosurgery technique concerning a more significant amount of keratinized tissue at 6 months follow up (p<0.05). In contrast, no significant differences were observed between the groups in terms of the other clinical periodontal parameters, postoperative complaints, or self-reported aesthetic satisfaction at any of the follow-up periods (p>0.05). The percentage of the root coverage for the micro and macrosurgical techniques after 6 months were 92.0% and 71.0%, respectively (p>0.05).
DISCUSSION AND CONCLUSION: The clinical results of microsurgery do not show superiority over conventional surgical techniques in the treatment of localized gingival recession defects using a coronally positioned flap with a subepithelial connective tissue graft.

13.Seropositivity of Toxoplasma gondii among blood donors and patients with hematologic malignity
SAADET YILDIZ, Ramazan Esen, kamuran karaman, Yunus Emre Beyhan
doi: 10.5505/ejm.2023.76743  Pages 291 - 295
INTRODUCTION: Toxoplasma gondii (T. gondii) is an opportunistic parasite. Transmission from T. gondii-infected donors to recipients is possible through blood and organ transplantation.
METHODS: In this study, it was aimed to investigate the presence of T. gondii antibodies in healthy donors and in blood recipients with immunosuppressed hematological malignancies. A total of 92 patients included in the present study (46 donors and 46 patients). Sixteen of the hematological patients had lymphoblastic leukemia and 14 had acute myeloblastic leukemia. The presence of IgG and IgM Toxoplasma antibodies and IgG avidity values were investigated by ELISA.
RESULTS: Twenty-two (47.8%) of patients and 11 (23.9%) of the donors were found to be positive for T.gondii IgG antibodies. IgG positivity was detected in all patient groups except those with aplastic anemia. The highest IgG positivity was found in acute myeloblastic leukemia (8) and lymphoblastic leukemia (5). IgM seropositivity was detected totally three cases (3.3%), two of 46 patients (4.3%) and one 46 of donors (2.2%). Although the number was low, all patients with chronic myeloid leukemia were detected both IgG and IgM positive (100%). Low avidity was found in all three of the IgM positive cases.
DISCUSSION AND CONCLUSION: Considering that toxoplasmosis is an infection that causes severe clinical symptoms and death, routine diagnostic methods that detect the presence of parasites in donor and patient groups will be beneficial for the prevention of T.gondii transmission.

14.The effect of administration of methotrexate for ectopic pregnancy on ovarian reserve
Baris Boza, Mustafa Akşar, Harun Egemen Tolunay, Murat Api
doi: 10.5505/ejm.2023.77674  Pages 296 - 300
INTRODUCTION: Methotrexate(MTX) has an essential role in the treatment of ectopic pregnanct, and high success rates have been achieved. MTX acts on rapidly proliferating cells like ovarian germinal cells. The aim was to elucidate whether administration of MTX has a significantly adverse effect on ovarian reserve.
METHODS: 165 patients were included and divided into 3 groups. 38 patients having MTX treatment(50mg/m2) were group1, 45 patients having surgical treatment (laparoscopy or salpingostomy/salpingectomy by laparotomy) were group2, and 82 patients who admitted to gynecology outpatient clinic were group3, the control group of the study. The patients who had surgery because of rupture following MTX treatment were not included. The patients were investigated for ovarian reserve test 3 months after having negative b-hcg test. Basal levels of hormones FSH, E2 measured, and by transvaginal USG, we counted the number of antral follicles and measured ovarian volume.
RESULTS: The average age of all patients was 29.6±3.8; in group1 30.1±3.9, in group2 30±3.6, in group3 29.2±3.9. There is no statistical difference between groups(p: 0.31). FSH level was 7±1.7IU/L in group1, 7.4±1.6IU/L in group2, and 7±1.4IU/L in group3. There is no difference between groups(p: 0,77). Estradiol level was 44.5±24.2 pg/mL, 45.8±17.6 pg/mL, 48.5±16.4 pg/mL in groups respectively. There is no statistical difference between groups(p: 0.09). There is also no statistically significant difference between groups for basal antral follicle numbers and ovarian volumes(p: 0.11,p: 0.16, respectively).
DISCUSSION AND CONCLUSION: In unruptured ectopic pregnancies MTX treatment has advantages for cost effectivity and morbidity. There is no effect of MTX treatment on ovarian reserve.

15.Is Fine Needle Aspiration Biopsy Effective in Detecting Malignancy in Giant Thyroid Nodules?
Zuhal Karaca Karagöz, Serhat Doğan, Feyzi Kurt, Burcu Özgür Çil, Burhan Hakan Kanat
doi: 10.5505/ejm.2023.05935  Pages 301 - 306
INTRODUCTION: Thyroid fine needle aspiration biopsy (TFNAB) is important diagnostic method to determine malignancy in thyroid nodules. However, its effectiveness in diagnosing malignancy in large thyroid nodules (greater than 4 cm) is controversial. We compared the postoperative histopathologic results of 147 patients who had thyroid nodules greater than 4 cm and underwent surgery with preoperative ultrasonography and FNAB findings. Our aim is evaluate the efficacy of FNAB in giant thyroid nodules
METHODS: 147 patients who were operated in our general surgery clinic for a thyroid nodule with a diameter of 4 cm and above were included in the study. The patients’ data including Gender, age, preoperative laboratory findings, thyroid imaging results, FNAB reports, and postoperative histo-pathology results were evaluated
RESULTS: Thyroid ultrasonography revealed isoechoic heterogeneity in 95 patients, hypoechoic in 32 patients, and hyperechoic heterogeneity in 20 patients. Microcalcification was detected in 44 patients, microcalcification in 32 patients, and peripheral calcification in 18 patients.
Biopsy results were reported as benign in 99 patients, aspiration of uncertain significance in 19 patients, follicular-nodular hyperplasia in 4 patients, suspected malignancy in 9 patients, and ma-lignancy in 4 patients.

DISCUSSION AND CONCLUSION: The preoperative FNAB could not detect the malignancy in 33 pa-tients whose postoperative histopathology results were malignant. The most significant parame-ters in detecting malignancy with ultrasonography were evaluated as increased vascularity, wall irregularity, and hypoechoic heterogeneity, respectively. Ultrasonography was found to be more significant than FNAB for the detection of malignancy in giant thyroid nodules in our study.

16.Investigation of Matrix Metalloproteinase-2, Matrix Metalloproteinase-9, Tissue Matrix Metalloproteinase Inhibitor-1, and Tissue Matrix Metalloproteinase Inhibitor-2 levels in preeclamptic and eclamptic pregnancy
Erdal Özmen, Hanım Güler Şahin
doi: 10.5505/ejm.2023.46872  Pages 307 - 313
INTRODUCTION: This study was designed to investigate the levels of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), and their respective tissue inhibitors, tissue matrix metalloproteinase inhibitor-1 (TIMP-1) and tissue matrix metalloproteinase inhibitor-2 (TIMP-2), in eclamptic and preeclamptic pregnant women.
METHODS: In this study carried out in the Department of Obstetrics and Gynecology of the Yüzüncü Yıl University Faculty of Medicine Health Practice and Research Hospital, eclamptic (n=28), preeclamptic, (n=28) and healthy pregnant women (n=24) were enrolled and their levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 were studied by micro enzyme-linked immunosorbent assay (ELISA) method.
RESULTS: There was no significant difference between the groups in terms of MMP-2 (p=0.786). When the three groups were examined in terms of the ratio of MMP-2 to TIMP-2, no significant difference was found (p=0.788). While there was no significant difference between the preeclamptic and eclamptic groups in terms of MMP-9 and TIMP-1, significantly lower levels of MMP-9 and TIMP-1 were observed in both groups compared to the control group (p=0.001 for MMP-9, p<0.000 for TIMP-1). When the groups were compared in terms of the MMP-9/TIMP-1 ratio, no significant difference was found between the preeclampsia and control groups; however, this ratio was statistically significantly higher in the eclampsia group compared to the preeclampsia and control groups (p=0.011).
DISCUSSION AND CONCLUSION: The imbalance between MMP-9 and TIMP-1 may be used as a marker in the prediction of preeclampsia and especially eclampsia. However, larger clinical studies are needed to reveal these interactions in more detail.

17.Is the Multifocality Rate in Thyroid Cancer Patients Increasing Over the Years
Muhammed Gömeç, Mustafa Asım Gedikli, Seyit Ahmet Ertürk, Zekiye Hasbek
doi: 10.5505/ejm.2023.18853  Pages 314 - 319
INTRODUCTION: Papillary thyroid cancer (PTC) is the most common type of thyroid cancer, and its incidence continues to increase. Multifocality is common in PTC, and it has been suggested in many studies that multifocality may be associated with poor prognosis. In this study, data of patients followed with multifocal PTC were evaluated.
METHODS: Following the approval of the local ethics committee, the data of patients who received total thyroidectomy and subsequent radioactive iodine (RAI) treatment for thyroid cancer between 2012 and 2020 were evaluated.
RESULTS: Multifocality was detected in 142 (19.88%) of the 714 PTC patients studied. The rate of multifocality among PTC patients was 3.29% in 2012, 7.2% in 2013, 10.1% in 2014, 10.5% in 2015, 38.15% in 2016, 31.6% in 2017, 33.33% in 2018, 32.58% in 2019 and 22.22% in 2020. Of these patients, 52.1% had 2 foci, 20.4% had 3 foci, 15.5% had 4 foci, and 12% had 5 or more foci. Multifocality was observed in the right and left lobe in 54.2% of the patients, the right lobe in 21.1% of the patients and the left lobe in 12.7% of the patients. Multifocality was not detected in the isthmus only. It was found that as the number of tumor foci increased, differentiation decreased. It was observed that multifocality was more common in microcarcinomas.
DISCUSSION AND CONCLUSION: In our clinic, it has been observed that the rate of multifocal PTC has increased in recent years. This significant increase may be the result of morphological changes as well as improvements in diagnosis and treatment.

18.Clinical and Radiological Evaluation of Childhood Arachnoid Cyst Cases
Nesrin Ceylan, Halil Çelik, Fatih Mehmet Akif Özdemir, Ülkühan Öztoprak, Yasemin Taşcı Yıldız, Betul Derinkuyu, Erhan Aksoy
doi: 10.5505/ejm.2023.01112  Pages 320 - 324
INTRODUCTION: Intracranial arachnoid cysts are benign cavities surrounded by an arachnoid membrane containing cerebrospinal fluid-like fluid.
In this study, patients who applied to our clinic, underwent neuroimaging for different indications and were found to have arachnoid cysts were analyzed retrospectively.
METHODS: Pediatric patients who applied to the pediatric neurology clinic with different indications and were found to have arachnoid cysts after neuroimaging were analyzed retrospectively. Demographic characteristics of all patients, complaints at presentation, physical examination findings, additional anomalies or diseases accompanying arachnoid cyst and, the characteristics of the cysts were examined as well.
RESULTS: 190 patients younger than 18 years of age with different clinical complaints were found to have arachnoid cysts in their brain MRI. It was observed that 67.9% patients presented with acute neurological complaints. The most common complaint at admission was the seizure, followed by headache. Arachnoid cysts were located in the middle, the posterior, the anterior fossa and, in the spinal region.
DISCUSSION AND CONCLUSION: In conclusion, it is important to know the clinical features of cysts in terms of preventing unnecessary tests and treatments.

19.A Research of Emergency Service Admission Due to Home Accidents before and during the Covid-19 (Sars-Cov-2) Pandemic in Ankara (Turkey)
Yavuz Hekimoğlu, Burak Taştekin, Gülhan Kurtoğlu Çelik, Ahmet Emre Ay, Mahmut Aşırdizer
doi: 10.5505/ejm.2023.45336  Pages 325 - 333
INTRODUCTION: Home accidents can cause serious injuries, disabilities, and deaths. Approximately 40 million people were treated in hospitals annually because of injuries occurring in homes, and these injuries were responsible for approximately 76% of preventable deaths. The aims of this study are to compare the home accidents in the one-year period during the pandemic and the home accidents in the one-year period before the pandemic, and to reveal how the home accidents are affected in which part of the home and in which types of injuries.
METHODS: A retrospective study was made of the records of patients injured in home accidents between pre-pandemic and pandemic one-year periods. The patients were classified according to age groups, gender, season, day and time of the home accident, accident type, part of the home, trauma localization and type, and severity of injuries.
RESULTS: While 46.5% of the 581 injured patients were before the pandemic, 53.5% were in the pandemic period. The injuries increased as the number of households staying at home increased compared to the pre-pandemic period. Likewise, there was a significant increase in the number of falls from balconies and windows during the pandemic period.
DISCUSSION AND CONCLUSION: It is still not possible to make a definite prediction about the course of the pandemic. In this context, it is of great importance to provide information on prevention from home accidents, especially in television programs and distance education activities.

20.Evaluation Of Serum MicroRNA Levels And Mutations Using Next-Generation Sequencing Of Liquid Biopsies From Metastatic Pancreatic Cancer Patients: A Turkish Pilot Study
Atike Gökçen Demiray, Aydın Demiray
doi: 10.5505/ejm.2023.79446  Pages 334 - 351
INTRODUCTION: Pancreatic cancer is highly aggressive and at the time of diagnosis, 80% of patients are in the metastatic stage. Personalized therapy guided by genomic biomarkers for pancreatic cancer has only recently begun to be investigated.This study aimed to comprehensively identify possible activating and pathological mutations in metastatic pancreatic cancer with NGS of liquid biopsies and to investigate miRNAs and mutations as therapeutic targets as we evaluated their relationships and effect on prognoses
METHODS: Seventeen patients and 20 healthy volunteers were included in the study. Blood samples were taken from the patients, cell-free DNA was isolated from the serum, and mutation profiles were analyzed by NGS. Serum miRNA levels were analyzed by isolating circulating miRNA from the same samples from all groups.
RESULTS: In patients with G288G synonymous mutants in the HNF1A gene compared to non-mutant patients, miR-17, miR-24, and miR-150 levels were found to be statistically significantly lower;The miR-17 and miR-146a levels of patients with a TP53 gene Pro72Arg mutation were found to be statistically significantly higher than that of the non-mutant group Survival was lower with the c.2472 C>T mutation located in exon 18 of the PDGFRA gene; higher in patients with P72R mutations in the TP53 gene and those with miRNA 17 and 146 upregulation carrying this mutation.
DISCUSSION AND CONCLUSION: This study is clinically meaningful in revealing possible pathogenic mutations detected in tumor cells circulating in metastatic pancreatic cancer, both in terms of prognostic value and whether the information can be used to target treatment, including gene therapy.

21.Can Adropin peptides be a biomarker for traumatic brain injury? A prospective study
Senol Arslan, Orhan Delıce, Mevlana Omeroglu, Engin Sebin
doi: 10.5505/ejm.2023.60376  Pages 352 - 356
INTRODUCTION: Traumatic brain injury continues to be a severe health problem worldwide due to its significant mortality and morbidity. Computed Tomography and Glasgow coma scale are the main diagnostic methods used to determine the severity of traumatic brain injury today. However, both methods have their limitations. Therefore, biomarkers that can reliably reflect the extent of post-traumatic brain injury and microscopic pathological events have been sought for a long time.Our study aims to investigate whether serum adropin levels can be a biomarker used in adult head trauma
METHODS: The study was designed as a prospective study of adult patients admitted to the emergency department with isolated head trauma. A demographic information form was filled for each individual participating in the study. All patient evaluations were made by emergency medicine specialists. The study population consisted of patients who required computerized brain tomography at the time of admission. The blood samples were obtained within the first hour of admission to the emergency room.
RESULTS: : Adropin levels in the patient group were statistically significantly higher than in the control group (p=<0.000). Besides, no statistically significant difference was found in serum Adropin levels between the patient group who had bleeding and fractures determined in the brain tomography and those with no pathological findings (p=0.723)
DISCUSSION AND CONCLUSION: We think that adropin may have protective or curative effects on the human brain.

22.Early Diagnosed Infant: Coffin Siris Syndrome by Novel Frameshift Mutation in ARID1B
Ipek Dokurel Çetin, Meltem Uzun, Mehmet Türe
doi: 10.5505/ejm.2023.20053  Pages 357 - 360
Coffin Siris Syndrome (CSS) is a rare neurodevelopmental disorder characterized by intellectual disability, developmental delay, and dysmorphic features. We reported an infant at 3 months of age, attended with unable to meet the milestones. He had thick-arched eyebrows, long eyelashes, bulbous nasal tip, hypertrichosis, thick and everted lips. We studied for different cardiac, genitourinary, gastrointestinal, and ophthalmological abnormalities. Whole exome sequencing of the patient revealed a gene responsible for CSS, a novel de novo frameshift mutation in ARID1B. We identified a novel heterozygote variant c.3955dupC in the ARID1B (p.Gln1319ProfsTer14).
Clinicians should consider the coexistence of genetic syndromes in patients with generalized hypotonia, dysmorphological features, and intellectual disability. Early diagnosis is crucial for alternative therapyies in neurodevelopmental diseases. For this reason, consultations should be requested from genetics departments for more comprehensive genomic testing.

23.Steroid Responsive Abdominal Cocoon Syndrome Secondary To Peritoneal Dialysis; A Rare Case Presentation
Mehmet Erdem, Yasemin Usul Soyoral, Azad Duman
doi: 10.5505/ejm.2023.17003  Pages 361 - 364
Abdominal cocoon syndrome is a rare condition that defines the total or partial encapsulation of the small bowel loops by a fibcrocollagenous membrane, primarily or secondarily, with inflammatory infiltrate that leads to acute or chronic obstruction. While this condition may become manifest in an idiopathic-primary form, it can also occur secondary to interventions such as abdominal surgery, chronic peritoneal dialysis, liver transplantation, ventriculoperitoneal shunt or medications.
We aimed to present a case diagnosed with abdominal cocoon syndrome induced by peritoneal dialysis, who showed a good clinical response to steroid treatment.

24.The Importance of Radiological Imaging in the Medicolegal Evaluation of Gunshot Wounds: A Case Report
Mehmet Sunay Yavuz, Volkan Zeybek, Gökmen Karabağ, Aylin Akın, İrem Erbaş
doi: 10.5505/ejm.2023.90592  Pages 365 - 368
Determining the shooting direction in gunshot wounds is very important, especially in cases where the number of suspects is more than one. In cases of gunshot wounds, a detailed anamnesis should be taken and an examination should be performed, it should be investigated whether the injury caused a bone fracture, and the diagnosis should be confirmed by radiological examinations. With the use of radiological examinations, the direction of the shot can be determined by evaluating the appearance of the metal fragments separated from the bullet core, which crashes into the bone tissue and bone fragments. Radiologic imaging of a 32-year-old male patient who was injured in the left leg area with a firearm and was sent to our department to determine the shooting direction was evaluated. The case, whose entrance-exit holes were distinguished and the direction of the shot was determined by radiological imaging, is presented to guide the medicolegal evaluation.

25.Autologous Platelet Concentrates: Their Generations, Forms, Preparation Protocols and Roles in Periodontal Regeneration
doi: 10.5505/ejm.2023.84758  Pages 369 - 377
The application of autologous platelet concentrates in wound healing and tissue regeneration, especially in the field of dentistry has been developing with time. There are different methods to produce various forms of autologous platelet concentrates by changing centrifugation speed and time used during preparation and, of course, there is a difference in regeneration capacity according to preparation protocol. In general, autologous platelet concentrates contain various growth factors such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insulin-like growth factors (IGF) and transforming growth factor (TGF-β) which are considered a key factor in the contribution of periodontal soft and hard tissue regeneration. Autologous platelet concentrates have become more efficient in periodontal and implant surgery due to their positive effects in healing acceleration and new soft and hard tissue formation capability in addition to their other favorable advantages, being inexpensive, timesaving and completely taken from patient. The aim of this review article is to briefly explain the forms and generations of autologous platelet concentrates, their applications, potential role in periodontal regeneration, and to compare between their uses, efficiency and preparation methods to qualify clinicians to use them properly according to the case to achieve a better result.

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