ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 28 (3)
Volume: 28  Issue: 3 - 2023
1.Evaluation of the antiseptic efficacy of 4% chlorhexidine gluconate and 10% povidone iodine on Methicillin-Resistant Staphylococcus Aureus-infected wounds in White Rat (Rattus Norvegicus)
Fanny Evasari Lesmanawati, Agus santoso Budi, Lobredia Zarasade
doi: 10.5505/ejm.2023.25901  Pages 378 - 387
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA), an opportunistic bacterium that harms immunocompromised hosts, was 8.1% at our hospital in 2014, with 8.2% of cases in the surgical wards. Chlorhexidine gluconate (CHG) and povidone iodine (PVP-I) are excellent antiseptics for MRSA-infected wounds.
METHODS: Groups of male Wistar rats (n=15) were wounded and inoculated with MRSA then divided into three groups of intervention; 4% CHG, 10% PVP-I, and saline (control). After a six-hour incubation, each wound was intervened. Swab samples were taken before (first result), after intervention (second result), and 24 hours after intervention (third result), followed by a tissue sample taken in the end (fourth result). Using colony-forming units (CFU)/ml, the bacterial colonies were divided into three logarithmic groups: log10 1, ≤ log10 5 (≠ 0), and > log10 5. All data were analysed using a statistic with a significance level of P < 0.05%.
RESULTS: Only the second result of all groups showed a reduction in colony number, while the other results showed > log10 5 CFU/ml. Sixty percent of the second result of PVP-I group showed no bacteria, the rest, 40%, showed ≤ log10 5 (≠0) CFU/ml. All of the second result of CHG group showed no bacteria. We found a significant difference in the second results of all groups (P = 0.009) and in the comparison between CHG versus control group and PVP-I versus control group (P = 0.003 and 0.049, respectively).
DISCUSSION AND CONCLUSION: The effectiveness of 4% CHG and 10% PVP-I is equivalent in MRSA-infected wound care in this study.

2.The Role of Virtual Touch Tissue Quantification Technique in Differentiating Between Benign Prostatic Hyperplasia and Prostatic Carcinoma
Zülküf Akdemir, Adem Yokuş, Kerem Taken, Muhammed Alpaslan, Harun Arslan, Hüseyin Akdeniz
doi: 10.5505/ejm.2023.66742  Pages 388 - 394
INTRODUCTION: Virtual Touch Tissue Quantification (VTTQ) is a promising new implementation of the acoustic radiation force pulsed ultrasound technique that has gained popularity in recent years. The present study compares the performance of the VTTQ technique in distinguishing between prostate cancer (PCa) and benign prostatic hyperplasia (BPH).
METHODS: VTTQ was performed on 91 prostate nodular lesions in 72 patients with BPH and suspected PCa prior to a prostate histopathologic examination, while 35 healthy volunteers were included in the study as controls. The mean shear wave velocity (SWV) values of the central and peripheral prostate zone were measured in the healthy volunteers, with the SWV at each nodular lesion quantified through the implementation of an acoustic radiation force impulse (ARFI). The performance of VTTQ in discriminating between PCa and BPH was compared, and the diagnostic value of VTTQ for PCa was evaluated in terms of sensitivity, specificity and cut-off value.
RESULTS: Histopathological examinations detected PCa in 21 of the 91 nodular lesions and BPH in 70. The SWV values (m/s) were significantly higher in prostate cancer than in the BPH and central-peripheral prostate zones (3.85±0.78, 2.29±1.03, 1.65 ±0.95, 1.14±0.56). The mean SWV values of the central-peripheral prostate zones were found to be significantly different from each other. We determined an SWV cut-off value of 3.09 m/s for differentiating between benign and malignant nodules, with a sensitivity and specificity of 90.5% and 80%, respectively.
DISCUSSION AND CONCLUSION: VTTQ can effectively determine the stiffness of prostate nodular lesions, with significantly higher performance discrimination between PCa and BPH.

3.How Did the Covid-19 Pandemic Effect the Anxiety Levels of Individuals Undergoing Orthodontic Treatment?
Murat Tunca, Emre Naiboglu, Serap Keskin Tunc
doi: 10.5505/ejm.2023.65148  Pages 395 - 402
INTRODUCTION: In this study, it is aimed to evaluate the problems and anxiety levels of individuals who receive orthodontic treatment in a certain patient group during the pandemic period.
METHODS: For this research, a questionnaire with 20 questions about the treatment process in pandemic conditions was designed. The questionnaires were conducted on 560 individuals who started orthodontic treatment six months before the declaration of the pandemic and continued their treatment throughout the pandemic. While evaluating the study data, descriptive statistical methods were used. Fisher-Freeman-Halton exact test was used to compare qualitative data.
RESULTS: In our research, it was observed that 16,4% of the individuals participating in our study could not go to their routine controls for 1 to 1,5 months, 6.1% of them for 1.5 to 2 months, 7% of them 2 to 2.5 months and 28.4% for 3 months or more. It was observed that 44.1% (n=247) of the individuals did not need to communicate with their doctor. In addition, it was observed that while 19.1% of individuals do not think that they have concerns about the prolongation of the treatment process due to the pandemic process; 15.2% of them rarely, 28% of them sometimes, 14.3% of them often, 23.4% of them always worry about this issue.
DISCUSSION AND CONCLUSION: It has been determined that individuals who receive orthodontic treatment during the pandemic period often disrupt their routine controls, and individuals generally experience anxiety about the prolongation of the treatment process during the closure period.

4.Obsessive–Compulsive Disorder During the COVID-19 Pandemic: Effects of COVID-19 Fear and Health Anxiety
Onur Gökçen, Merve Akkuş, Süleyman Keleş
doi: 10.5505/ejm.2023.01212  Pages 403 - 412
INTRODUCTION: The impact of the COVID-19 pandemic on obsessive-compulsive disorder (OCD) has been a particular concern for the last two years, but the published evidence on the subject has remained contradictory and unclear thus far. This study was aimed to be a contribution to the research about the effects of COVID-19 fear and health anxiety on OCD symptoms.
METHODS: OCD patients who were admitted to the psychiatry outpatient clinic were evaluated with the Padua-Inventory-Washington-State-University-Revision (PI-WSUR), The Fear of COVID-19 Scale and Health Anxiety Inventory (HAI) and the interview form prepared for this study.
RESULTS: Of the 54 patients diagnosed with OCD; 34 (62.9%) reported that their complaints had increased over the past year, PI-WSUR total scores and HAI total scores were found significantly related to the total scores of The Fear of COVID-19 Scale. The subscales of “obsessive impulses to harm self/others” and “dressing/grooming compulsions” from PI-WSUR were found significantly related to both HAI total scores and The Fear of COVID-19 Scale total scores. However, the subscale of “contamination obsessions and washing compulsions ” was not found significantly related to either HAI total scores or The Fear of COVID-19 Scale total scores.
DISCUSSION AND CONCLUSION: This study shows that the pandemic period negatively affected a significant population of OCD patients and that there is a significant relationship between the severity of OCD symptoms and health anxiety/COVID-19-related fear. Our study also indicates that COVID-19-related stress does not necessarily cause symptoms of contamination but rather shows specific symptoms based on the themes of OCD itself in one patient.

5.Evaluation of the analgesic effect of caudal anesthesia in pediatric lower extremity orthopedic surgery
Abdullah Dusmez, Asuman Sargin, Cengiz Sahutoglu, Nezih Sertoz, Sacittin Taner Balcioglu
doi: 10.5505/ejm.2023.32391  Pages 413 - 418
INTRODUCTION: The aim of this study is to evaluate the preoperative and postoperative effects of caudal analgesia in pediatric orthopedic lower extremity surgery.
METHODS: A total of 92 children who underwent orthopedic lower extremity surgery under general anesthesia were retrospectively included in the study. For caudal analgesia, 0.5 ml/kg 0.25% levobupivacaine and 20 mcg/kg morphine were used as our routine. The effect of caudal analgesia on hemodynamic parameters (heart rate, mean arterial pressure), oxygen saturation, sevoflurane concentration and procedural success rates using objective pain scale scores (OPS) were evaluated.
RESULTS: The mean age of the patients was 5.6±3.7 (1-13) years, and 54.3% of them were male. The mean operation time was 100±94 minutes. Caudal block suppressed the response to the surgical incision, and caused a decrease in heart rate, mean arterial pressure, and sevoflurane values (p <0.05). The OPS’s were found to be >4 in 8.7% of the patients, and in these patients’ caudal block was considered to be unsuccessful for achieving a satisfactory analgesic effect. The mean time to the first analgesic administration to the patients was 526 ± 242 (85-1110) minutes after caudal analgesia. In the first 24 hours, 40.2% of the patients did not need additional analgesics.
DISCUSSION AND CONCLUSION: Caudal block is an anesthesia technique with high success rate, easy application, and low complication rate. In addition, it can provide long-term analgesia both perioperatively and postoperatively in pediatric patients undergoing orthopedic lower extremity surgery with a single injection technique.

6.Evaluation of amoebiosis, giardiosis, and blastocystosis infections in patients over 18 years of age followed-up with a diagnosis of gastroenteritis
Esra GÜRBÜZ, Şehriban YÜREKTÜRK, Selahattın AYDEMIR, Abdurrahman Ekici
doi: 10.5505/ejm.2023.40360  Pages 419 - 424
INTRODUCTION: To evaluate amoebiosis, giardiosis, and blastocystosis infections in patients over 18 years of age followed-up with the diagnosis of gastroenteritis.
METHODS: The study included 3848 patients with a diagnosis of gastroenteritis who were admitted to the XXX Training and Research Hospital with the complaint of diarrhea between 2016 and 2019 and were hospitalized.
RESULTS: Of the 3848 patients included in the study, E. histolytica was found in 6.8% (3848/262), G. intestinalis was found in 3.6% (3848/137), and Blastocystis spp. was found in %3 (3848/117). When the incidence of parasites according to the age groups of the patients was examined, it was determined that G. intestinalis and E. histolytica were mostly seen in the age range of 50–65 years, and the difference in the incidence of E. histolytica was statistically significant (p = 0.026). It was determined that the incidence of Blastocystis spp. increased with age (p = 0.001). A statistically significant correlation was found between E. histolytica and the presence of leukocytes and erythrocytes in the stool.
DISCUSSION AND CONCLUSION: It was concluded that G. intestinalis and E. histolytica are the leading parasitic infections that are still important and need to be combated in the XXX region, and that the increase in the frequency of B. hominis over the years should not be ignored.

7.Effects of Cognitive Load and State of Vigilance on Sympathetic Skin Response
Nazlı Karimi, Nazan Dolu, Erhan Kiziltan, Tuğçe Şirinoğlu, nimet gundogan
doi: 10.5505/ejm.2023.57070  Pages 425 - 431
INTRODUCTION: The skin conductance response is one of the noninvasive peripheral markers of the activity of sympathetic nervous system. Skin conductivity level monitorization during cognitive performance processes is used as a physiological indicator of task-related alertness and attention. In this study, it is aimed to investigate the relationship between task related sympathetic activity and reaction time in students 18–22 years of age.
METHODS: A total of 20 healthy male and female student were included into the study. Hand preference and color blindness test were applied to the participants. Electrodermal activity recordings were recorded as tonic and phasic recording during all tasks. Different colored 2-dimesional geometric objects were presented in fixed and random intervals through the computer system. The task performance of pressing the predefined button as soon as the stimulus appeared on computer screen was investigated in relation with cognitive load and sympathetic stress response.
RESULTS: Applying an increased amount of cognitive load increases sympathetic stress response (p<0.001). An increase in reaction time was observed with increasing amount of cognitive load (p<0.05). The similar task levels, on the other hand, cause statistically higher mean skin conductivity levels when visual stimulus is presented at fixed interval rather than random stimulus interval.
DISCUSSION AND CONCLUSION: Beyond the expectations, our novel findings highlight the importance of internal timestamp processes of individuals. Therefore, we may suggest that time estimation processes play critical role in generation of sympathetic stress response when compared to vigilance state caused by simply waiting for random stimuli.

8.Causes of Blindness and Visual Impairment in a Mediterranean Coast District of Turkey
Emin Utku Altındal, Ali Kurt
doi: 10.5505/ejm.2023.22804  Pages 432 - 441
INTRODUCTION: We aimed to evaluate the causes of visual impairment and blindness in adults who applied to Alanya Alaaddin Keykubat University Education and Research Hospital health board of disability.
METHODS: The records of 8924 patients were reviewed retrospectively and 887 adult patients were enrolled as two age-groups: 18-50 and ≥ 51 years. Using the United States criteria, three vision-based groups were formed; “blindness”, “low vision” and “unilateral visual impairment”.
RESULTS: Cataract (36.9%/55.9%), age-related macular degeneration (16.2%/19.4%) and diabetic retinopathy (15.8%/10.1%) were the leading causes of blindness/low vision. Retinal dystrophies (28.1%) and amblyopia (37%) were the main causes of blindness and low vision in the 18-50 age group, respectively. In the ≥ 51 age group, cataract was both the most common cause of blindness (42.6%) and low vision (62.3%). While amblyopia (22.2%) was the leading cause of unilateral visual impairment in the 18-50 age group, it was cataract (44.9%) in the ≥ 51 age group. The proportion of avoidable causes of blindness was 62.2% and 36.9% of them was treatable. Avoidable causes of low vision was 69.6%, of which 55.9% was treatable.
DISCUSSION AND CONCLUSION: Early interventions for preventive and educative health policies should be developed at younger ages for aiming to guide the lifestyle trends of individuals in order to reduce the avoidable causes of vision loss and maintain a visual disability-free lifetime.

9.Red Blood Cell Distribution Width (RDW) and Its Effect on Survival in Patients with Pulmonary Arterial Hypertension (PAH) and Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
Muntecep Askar
doi: 10.5505/ejm.2023.99836  Pages 442 - 448
INTRODUCTION: Red blood cell distribution width (RDW) has been reported as a predictive value of morbidity and mortality in many cardiovascular diseases. It is, however, unclear what the relationship is between RDW levels and survival in patients with PAH and CTEPH. We aimed to evaluate the RDW level in these patient groups, and to measure its relationship with mortality.

METHODS: Between 2018 and 2023, 170 patients followed up in a PAH center were retrospectively evaluated. Demographic information of the patients and RDW levels at the time of diagnosis were obtained from the hospital automation system. Blood-brain natriuretic peptide (BNP) levels, functional class level (WHO-FS) and systolic pulmonary artery pressure values were recorded. Patient follow-up times and survival were recorded from the hospital automation system.

RESULTS: Among the patients, 53 were male (31.2%), and 117 were female (68.8%). The number of PAH patients was 116(68.2%), and the number of CTEPH patients was 54(31.7%). During this period, 24.7%(n: 42) of the patients died. Statistical significance was found in RDW and BNP values when descriptive statistics were evaluated according to survival. RDW and BNP values were higher in patients who died (RDW: p=0.008, OR: 1.006- BNP: p=0.021, OR: 0,998). Clinical, functional class values of the patients were also positively correlated with RDW and BNP values (p<0.002-p<0.001). Patients with high functional class had poor survival (p=0.000).

DISCUSSION AND CONCLUSION: In addition to known factors such as functional class level and BNP,RDW can be used as a potential biomarker for predicting survival in patients with PAH and CTEPH

10.Effect of Preeclampsia on Fetal Cardiac Output
Derya Uyan Hendem, Deniz Oluklu, Hakkı Şerbetçi, Atakan Tanacan, Dilek Şahin
doi: 10.5505/ejm.2023.79106  Pages 449 - 454
INTRODUCTION: We hypothesized that there may be a change in fetal cardiac output due to the increase in placental vascular resistance in pregnancies with preeclampsia. We aimed to compare fetal cardiac output values in pregnancies with preeclampsia and healthy pregnancies.
METHODS: This prospective case-control study involves 32 pregnant women with preeclampsia and 32 healthy women between the 32-34 gestational weeks. Right and left ventricular outflow systolic peak flow velocities (PSV) were measured and the velocity-time integral (VTI) was obtained by manually tracing the area under the PSV waveform. Stroke volume (SV) was obtained by multiplying the aortic and pulmonary valve cross-sectional area by the VTI. Cardiac output (CO) was found by multiplying the right and left SV with the fetal heart rate per minute (FHR). Right and left cardiac output values were compared between the study groups.
RESULTS: The left CO value was lower in the PE group, but this difference was not statistically significant. Right cardiac output was found to be significantly lower in the PE group (p<.001). Although umbilical artery and ductus venosus pulcatility index (PI) were higher and middle cerebral artery PI was lower in the preeclampsia group, these differences were not statistically significant.
DISCUSSION AND CONCLUSION: The presented study shows that the right ventricular output significantly decreased due to abnormal placentation, increased placental vascular resistance and high afterload in pregnancies with preeclampsia.

11.Anatomical landmarks that can be used for localization in common femoral artery puncture
Veysel Kıyak, Fatih Ersay Deniz, Erol Öksüz, Özgür Demir, Yunus Emre Kuyucu
doi: 10.5505/ejm.2023.32396  Pages 455 - 460
INTRODUCTION: The rate of endovascular interventions for diagnosis and treatment is increasing in many medical fields, such as neurosurgery and cardiology. This situation increases the probability of vascular complications.This study was designed to identify bony anatomical structures in a more standardized manner and minimize the rate of complications related to CFA puncture procedures.
METHODS: In the angiograms of the 85 patients, the superior and medial borders were determined as the borders of the acetabulum, whereas the lateral and inferior borders were determined as the borders of the femoral head. The images were divided into six equal parts, including three in the cranial-caudal plane and two in the medial-lateral plane.
RESULTS: No significant difference was observed in the intervention side based on catheters or the inside or outside of the femoral head based on age (p > 0.05). Moreover, no significant difference was observed between patients with both hypertension and diabetes mellitus and those without (p > 0.05). Regarding sex-related differences, more interventions in the region numbered 4 were observed among male patients (p < 0.05).
DISCUSSION AND CONCLUSION: Moreover, no significant difference was observed between patients with hypertension, diabetes mellitus, and other diseases and those without these diseases in terms of their localization of catheter placement or whether their catheter placement was inside or outside the femoral head. It was thought that the reason for the intervention being made in regions other than those reported in the literature could be the unsuitable position of the patient (patient lying asymmetrically) or anatomical variations.

12.How reliable are thyroid hormone levels for predicting mortality before amputation?
doi: 10.5505/ejm.2023.35119  Pages 461 - 464
INTRODUCTION: The aim of this study was to investigate the correlation between thyroid hormone (TH) levels before amputation and mortality.
METHODS: The 30-day and 1-year mortality rates of 194 patients (84 females and 110 males) who underwent lower extremity amputations in our clinic were retrospectively analyzed. To evaluate the relationship between TH levels and mortality, archival records were used to obtain necessary information such as age, gender, and TH levels. Patients were divided into six groups according to TH levels: control, overt hyperthyroidism, subclinical hyperthyroidism, euthyroid sick syndrome (ESS), subclinical hypothyroidism, and overt hypothyroidism.
RESULTS: The 30-day and 1-year mortality rates were 22.7% (44/194) and 52.6% (102/194), respectively. The log-rank test of the Kaplan–Meier curves revealed statistically significant differences in 30-day and 1-year survival rates between patients with different thyroid status. Univariate analysis showed that thyroid status was significantly associated with both 30-day mortality and 1-year mortality rates. In terms of 1-year mortality, ESS, overt hypothyroidism, subclinical hypothyroidism, overt hyperthyroidism, and subclinical hyperthyroidism were associated with an increased risk of death compared to patients with normal thyroid function in the control group.
DISCUSSION AND CONCLUSION: The current study found that impaired TH levels were associated with 30-day and 1-year mortality after amputation in a geriatric population. Increasing age and overt hyperthyroidism were associated with a higher rate of postoperative complications.

13.Evaluation of the effects of AB0 blood types on the severity of peri-implant diseases
Yasemin Beliz Önder, Nazlı Zeynep Alpaslan
doi: 10.5505/ejm.2023.74240  Pages 465 - 470
INTRODUCTION: Peri-implant diseases are inflammatory conditions with a complex etiology including host-related risk factors and genetic traits which may affect the soft and hard gum tissues around dental implants. The aim of this study was to evaluate the effects of blood types on the severity of peri-implant diseases.
METHODS: A total of 77 dental implants of 39 patients with peri-implant diseases were included. Demographic data of the patients such as age, sex, frequency of tooth brushing and interdental cleaning and blood types were recorded. Clinical variables such as probing depth (PD), gingival index (GI), and plaque index (PI) and radiographic bone loss level were also noted.
RESULTS: Dental implants were divided into two groups as Group 1 (n=19) including those diagnosed with peri-implant mucositis and Group 2 (n=20) including those diagnosed with peri-implantitis. The PD and GI scores and radiographic bone loss level were significantly higher in Group 2 than Group 1 (p<0.005). The frequency of tooth brushing was significantly higher in Group 1 than Group 2 (p=0.002). There was no significant difference in the distribution AB0 blood types between the groups (p>0.05). However, the majority of the patients had A Rh (Rhesus factor) (+) blood type in Group 1 and 0 Rh (+) blood type in Group 2.
DISCUSSION AND CONCLUSION: In conclusion, the blood types have no significant effect on the severity of peri-implant diseases.

14.The effects of detailed preoperative information on postoperative pain and anxiety levels in rhinoplasty surgery
Meliksina Rahime Çelik, Hacı Yusuf Güneş
doi: 10.5505/ejm.2023.34022  Pages 471 - 476
INTRODUCTION: Many patients who will undergo surgery experience varying degrees of anxiety and fear in the preoperative period. The aim of this study is to investigate the effects of preoperative detailed information on postoperative pain and anxiety levels in rhinoplasty surgery.
METHODS: A total of 64 patients between the ages of 18-65, in ASA I-II class, and undergoing rhinoplasty surgery were included in this study. The patients were randomized into two groups as group B and group N. Patients in Group B were informed in detail about the anesthetic and surgical procedure. Only routine information was given to the patients in Group N. Preoperative anxiety levels of all patients were measured with the STAI FORM TX-1 anxiety scale. Anxiety levels were re-measured at the 3rd postoperative hour and pain levels were evaluated with the VAS score and recorded.
RESULTS: Preoperative anxiety levels and 3rd hour VAS scores were found to be similar in both groups. The anxiety level measured at the 3rd postoperative hour was found to be lower in the group that received detailed information, compared to the group that was not informed.
DISCUSSION AND CONCLUSION: Informing patients about anesthetic and surgical procedures in the preoperative period can reduce their perioperative anxiety. In this study; we found that preoperative detailed information in aesthetic nose surgery did not affect the level of postoperative pain, but reduced anxiety levels.

15.Clinical outcome of childhood immune thrombocytopenia: Experience from a single tertiary center in Turkey
Kamuran Karaman, Eser Doğan
doi: 10.5505/ejm.2023.26675  Pages 477 - 483
INTRODUCTION: Immune Thrombocytopenic Purpura (ITP) is the most common hemorrhagic disease in children. Intracranial hemorrhage is the most severe complication requiring the administration of treatment for immune thrombocytopenic purpura. The present study aims to determine the clinical outcomes and factors affecting remission in childhood ITP.
METHODS: Method. The study included 503 children diagnosed with ITP in a Pediatric Hematology Polyclinic. Patient files and electronic registries were accessed retrospectively to obtain sociodemographic details, and diagnostic and therapeutic characteristics.
RESULTS: Results. Among all the cases, 446 (88.7%) were in remission. When the first treatments applied in cases with remission were evaluated, 190 (83.4%) patients had IVIG, 25 (56.8%) IVIG + pulse steroid, 34 (79%) pulse steroid, 7 (58%) IVIG + low dose steroid and 20 (83%) had low dose steroid treatment. Four cases developed intracranial hemorrhage during follow-up. The remission rate was significantly higher among the cases with low MPV values, high platelet counts and sedimentation values in the blood test at diagnosis (p<0.05). The responses to pulse steroids, low-dose steroids and IVG for the initial treatment at diagnosis were similar, with none showing statistical superiority over any of the others (p>0.05).
DISCUSSION AND CONCLUSION: Conclusion. This study features the largest single-center study in pediatric ITP. The frequency of remission was higher in the ITP-diagnosed cases who were male, who were diagnosed at a younger age, who had no epistaxis on admission, who had a history of URTI, and who had a high platelet count and sedimentation value and a lower MPV value at diagnosis.

16.Evaluation of Immunoglobulin Levels in Children Aged 1-5 Years With Recurrent Lower Respiratory Tract Infections
Nur AYCAN, Soner Sazak, Nedim Samancı
doi: 10.5505/ejm.2023.35033  Pages 484 - 491
INTRODUCTION: Immunodeficiency plays a crucial role in the etiology of recurrent pneumonia. Humoral immunodeficiencies account for approximately 60% of all primary immunodeficiencies, and in such patients, antibody deficiencies are the leading cause of immunodeficiency. That study aimed to investigate the effect of immunoglobulin levels on the frequency of pneumonia episodes and the relationship between immunoglobulin levels and risk factors for pneumonia in children aged 1-5 years with recurrent pneumonia caused by humoral immunity.
METHODS: The prospective study included a total of 92 randomly selected children aged 1-5 years, comprising a group of 70 patients hospitalized due to pneumonia and a group of 22 healthy controls who had no chronic diseases and infections.
RESULTS: Body height and weight were significantly lower in the patient group compared to the control group (p=0.012 and p=0.022, respectively). The mean breastfeeding duration was significantly lower (p=0.001), the prevalence of exposure to environmental tobacco smoking (ETS) was significantly higher (p=0.018) compared to the control group. In the patient group, 65% of the participants had a deficiency of an immunoglobulin isotope and/or IgG subclasses in isolation or combination. IgG4 deficiency was the most common deficiency (38.5%), followed by IgG1 (21.4%), IgG2 (18.5%), IgA (15.7%), and IgG3 deficiency (12.8%), respectively.
DISCUSSION AND CONCLUSION: Our results indicated that inadequate breastfeeding and environmental tobacco smoking prepare the ground for pneumonia, a significant cause of morbidity and mortality in children, and contributes to the recurrence of this disease. Humoral immunodeficiencies, a significant underlying cause of recurrent pneumonia that leads to growth retardation, may have different clinical manifestations.

17.Importance of Prostate-Specific Membrane Antigen in Paget's Disease of the Breast
İsmail Zihni, Mehmet Zafer Sabuncuoğlu, İsa Sözen, Girayhan Çelik, Kemal Kürşat Bozkurt, Seda Arzuman Baştürk, Ahmet Dal
doi: 10.5505/ejm.2023.13914  Pages 492 - 494
INTRODUCTION: In this study, the relationship of prostate specific membrane antigen (PSMA), a type-2 transmembrane glycoprotein, with the Her-2 Receptor and prognosis of the disease in cases with Paget's Disease of the Breast was investigated.
METHODS: The data of 14 patients diagnosed and treated with Paget's disease of the breast between July 2013 and March 2020 in the General Surgery Clinic were evaluated retrospectively.
RESULTS: After the pathological diagnosis was made, all patients underwent modified radical mastectomy. Paget's disease was found together with invasive ductal carcinoma in one patient, and Paget's disease was found together with ductal carcinoma in situ in 7 patients (50%). Staining in malignant tissue with PSMA was detected in only two patients. The normal dermis venules of other patients were stained with PSMA. In the subsequent follow-ups, lung and bone metastases were detected. The other patient stained with PSMA showed weak PSMA expression in malignant epidermal cells in the epidermis (The patient's tumor invasion grade was T2, there was no axillary lymph node metastasis, ki-67 expression was 10%, estrogen, progesterone and HER2 receptor were positive.
DISCUSSION AND CONCLUSION: Although studies showing the relationship between PSMA and breast malignancies are limited and there is no literature information; In our study, two patients with staining with PSMA had high grade and distant metastases with ki-67. Larger studies are needed to establish a link between PSMA and Paget's disease of the breast.

18.Multiple Sclerosis: Does the Apparent Diffusion Coefficient Have a Diagnostic Efficiency ın Active - Inactive Demyelinating Plaques?
Harun Arslan, Muhammed Bilal Akıncı
doi: 10.5505/ejm.2023.69260  Pages 495 - 498
INTRODUCTION: In multiple sclerosis (MS) patients, in the evaluation of active and inactive plaques, the contribution of Apparent Diffusion Coefficient (ADC) measurements to the diagnosis was investigated.
METHODS: A total of 88 patients, 66 women and 22 men, were examined in this study. The patients’ ages ranged from 19 to 53; the median age was 30.5 ±8.1. ADC measurements were taken of every plaque from active and inactive plaques using contrast enhancement (CE) Magnetic Resonance İmaging MRI. ADC measurements were considered active (92) or inactive (230) in accordance to their contrast enhancement, and specificity and sensitivity values were checked.
RESULTS: We examined and comparison the descriptive statistics results of MS plaques in relation to the active and inactive groups in terms of ADC measurement values. Accordingly, the averages for the active and inactive groups, respectively, were found to be 1.011 and 1.245, and the difference was statistically significant between these two averages (p<0.01). Accordingly, our study shows that ADC measurements are higher in the inactive group.
DISCUSSION AND CONCLUSION: ADC measurements can be a useful imaging modality in the differentiation of MS plaques in diffusion-weighted imaging.

19.Investıgatıon Of Kın Of Irre-Lıke Proteın Levels In Patıents Of Preeclampsıa
Yusuf Başkıran, İbrahim Polat
doi: 10.5505/ejm.2022.13911  Pages 499 - 503
INTRODUCTION: Preeclampsia is a hypertensive disorder of pregnancy that usually starts after the 20th week of pregnancy and affects 2-8% of pregnant women worldwide.In preeclampsia,glomerular endothelial damage,formation of podocituria and tubular hyperfiltration mechanisms play a role in the pathogenesis of proteinuria.
KIRREL(NEPH1) is a protein from the nephrin adhesion family.Prevents podocyte damage. In this way, it maintains glomerular filtration and glomerular function.
The aim of the study is to show whether the levels of KIRREL(NEPH1),an adhesion molecule protein,decrease in pregnant women with preeclampsia and to use it in the prediction of preeclampsia patients,to intervene in these patients beforehand.

METHODS: A total of 80 pregnant women,40 with preeclampsia and 40 with normotensive, who applied to the Gynecology and Obstetrics Clinic of Kanuni Sultan Süleyman Training and Research Hospital were included in our study.Our patients were diagnosed with preeclampsia according to the ACOG diagnostic criteria.
RESULTS: While the mean KIRREL level in the maternal blood of the pregnant women included in the study was 3.38 (mg/dl)in the study group,it was 6.46 (mg/dl)in the control group, and there was a significant difference between the groups. In the study group, the KIRREL level in maternal blood was lower than in normal pregnant women (p = 0.377).
DISCUSSION AND CONCLUSION: In our study, serum KIRREL levels were found to be significantly lower in the study group compared to the control group.However, KIRREL levels have been evaluated as an inadequate test in the prediction of preeclampsia.This may be related to the fact that there are many factors affecting the development of preeclampsia.

20.Assessment of Impulsivity, Circadian Preferences, and Job Satisfaction in Nurses working with Shift system
Hacire Bingöl, Pinar Guzel Ozdemir
doi: 10.5505/ejm.2023.55707  Pages 504 - 512
INTRODUCTION: Shift work, particularly night shifts may deteriorate many factors like impulsiveness and job satisfaction along with the impairment in physical and mental performance as well as familial and social relationships. In this study, our objective was to evaluate impulsiveness, circadian preferences, and job satisfaction in nurses and to compare their effects on the day and night shift work.
METHODS: For this purpose, a total of 100 nurses of a university medical center hospital (50 working day shift and 50 working night shift) were included in the study between March 2020 and May 2020. They were evaluated with socio-demographic information form, Barratt Impulsiveness Scale, Morningness-Eveningness Questionnaire, and Minnesota Satisfaction Questionnaire. Correlation coefficient was calculated to determine the relationships between scales.
RESULTS: In our study, for the shift working nurses, the mean scores of the Minnesota Satisfaction Questionnaire, Barratt Impulsiveness Scale and Morningness-Eveningness Questionnaire were 58.13±13.44, 68.62±10.64, and 53.00±7.19 respectively. The Barratt Impulsiveness total score and the sub-dimensions of scale attentional impulsiveness and motor impulsiveness were significantly higher in night shift workers (p values≤0.05). Job satisfaction was not statistically associated with sex and shift work type.
DISCUSSION AND CONCLUSION: It was found that impulsivity scale sores of night-shift workers were higher than daytime workers. Effective management of impulsivity and assessment of workers’ suitability for the shift system according to their chronotypes are important for preventing deficiencies in the health system.

21.The Analysis of Causes of Hospital Readmissions in The Patients who underwent Gastrectomy Because of Gastric Cancer in Van Province
Suzan Güven, Fatma Eti Aslan, Remzi Kızıltan
doi: 10.5505/ejm.2023.70457  Pages 513 - 518
INTRODUCTION: It was aimed to analyze the causes of hospital readmissions within the first 30 days after gastrectomy in the patients diagnosed with gastric cancer.
METHODS: The data of the patients who underwent gastrectomy with the diagnosis of gastric cancer between 01.01.2018 and 31.05.2022 were analyzed retrospectively using the hospital automation system. SPSS (Version 24) software package was utilized for comparison between patient data.
RESULTS: Totally 300 patients who underwent gastrectomy were included in the study. One hundred ten patients (36.7%) were female, 190 patients were (63.3%) male, and the mean age of the patients was 61. Within the first 30 days after gastrectomy and discharge, 65 patients readmitted to the hospital. The rate of hospital readmissions after gastrectomy was found to be 21.6%. The analysis of readmission causes revealed that headache, chest pain and abdominal pain were the most common rationales for readmissions. In the present study, the causes of readmissions were classified under three titles as pain, gastrointestinal symptoms and surgical site complications (SSC). No statistically significant relationship was found between the causes of readmissions and patient age, patient gender, type of the performed surgery and the fact whether neoadjuvant therapy was received (p>0.05).
DISCUSSION AND CONCLUSION: We conclude that providing a postoperative high quality healthcare for recovery in the patients who underwent gastrectomy will reduce the postoperative readmissions rates.

22.Short-Term Outcomes of Aneurysmatic/Non-Aneurysmatic Patients Operated for Spontaneous Subarachnoid Hemorrhage: A Tertiary Referral Center
Abdurrahman Aycan, Abdurrahim Taş, Mustafa Arslan, Azmi Tufan
doi: 10.5505/ejm.2023.87894  Pages 519 - 526
INTRODUCTION: This study aimed to evaluate the short-term results of patients who presented with spontaneous subarachnoid hemorrhage due to vascular pathology and were operated on by the same team.
METHODS: Clinical data in patients files, Preoperative and postoperative neurological and radiological findings, age, gender, and treatment results were evaluated retrospectively.
RESULTS: The same team performed surgery on 38 (47.5%) patients. Twenty (52.6%) of the patients included in the study were female, and 18 (47.3%) were male. There were 33 patients with detected bleeding aneurysms, three with bleeding AVMs, and two patients with non-bleeding aneurysms.
It was determined that 5% of the patients had a Fisher score of 1, 34% had a Fisher score of 2, 24% had a Fisher score of 3, and 37% had a Fisher score of 4
Ten patients died. There were signs of vasospasm in 18 patients. Nine (50%) of 18 patients with vasospasm survived, and 9(50%) died.
Eleven patients had hydrocephalus. EVD was inserted in 10 patients. Lamina terminalis was opened in 29 patients.
The vessel with the most common aneurysm was the isolated AcomA aneurysm, with a rate of 31.5% (n=12). MCA aneurysm was found with the second frequency with a rate of 23.6% (n=9)

DISCUSSION AND CONCLUSION: Spontaneous subarachnoid hemorrhage is a disease with high mortality and morbidity in neurosurgery. Rebleeding, vasospasm, onset GCS,Fisher score, and experienced surgical equipment are among the factors affecting the treatment outcome. Multidisciplinary treatment in centers where diagnosis, treatment, and follow-up can be made by the same team will reduce mortality and morbidity rates.

23.Proposal for a Common Nomenclature and Risk-Based Approach to Pediatric Eye Health Screening and Examinations: Why, Who, and How?
Doğan Ceyhan, Erbil Seven, CAHİT BURKE
doi: 10.5505/ejm.2023.59376  Pages 527 - 535
Although the eye and visual system show structurally and functionally normal development in most infants, some may have pathologies that can result in moderate or severe vision loss. Many of these conditions can be treated if noticed in infancy or early childhood. Amblyopia is a relatively frequent entity and highly treatable, especially when recognized in the first years of life. Therefore, the early detection and timely treatment of all vision problems in infants, particularly amblyopia, is necessary to avoid preventable vision loss. Eye examinations in infants and children differ substantially from the standard adult eye examination. Therefore, the infant/child eye examination often cannot be performed with traditional methods. Describing all the procedures performed only as vision screening or eye examination is inadequate in some cases. Although the term “vision screening” is usually used, “eye health screening” is preferable for more comprehensive procedures. We recommend a new classification of infant and child eye screening and examinations into five distinct groups referred to as follows: eye health screening examination, instrument-based eye health screening, visual acuity screening, comprehensive eye examination, and preterm infant eye examination. We believe that this system can be implemented with little effort and may contribute to reduce preventable vision loss in future generations.

24.Chronic Constipation Caused by Giant Hiatal Hernia in an Elderly Patient
Tolga Kalayci, Serkan Tayar
doi: 10.5505/ejm.2023.20270  Pages 536 - 540
Hiatal hernia is a medical condition in which the upper part of the stomach or other intra-abdominal organs are displaced into the thorax through an opening in the diaphragm. This case report presents the diagnosis and treatment process of a case who presented with the complaint of chronic constipation and was diagnosed with a giant hiatal hernia. A 72-year-old female patient was admitted to our outpatient clinic in March 2021 with complaints of regurgitation, retrosternal pain and chronic constipation that had lasted for about three years. Nausea and vomiting have also been added to symptoms in the last few months. Physical examination was unremarkable except for tenderness in the epigastric region. Laboratory tests showed only mild leukopenia (3.5*103/mm3) and a high c-reactive protein level (21 mg/dL). Because of chronic constipation, screening endoscopy and colonoscopy were planned for the patient. Endoscopy revealed distal esophagitis and a giant hiatal hernia; colonoscopy revealed diverticula in the sigmoid colon. On computed tomography, a Type IV giant hiatal hernia, including stomach and intestinal loops, was present in the large diaphragmatic defect. Floppy Nissen fundoplication was performed. She was discharged on the 3rd postoperative day without complications.

25.Concurrent Acute Rheumatic Fever and Acute Poststreptococcal Glomerulonephritis: Case report
Mecnun Çetin, Arife Uslu Gökçeoğlu, Murat Başaranoğlu, Kamuran Karaman
doi: 10.5505/ejm.2023.04900  Pages 541 - 543
Acute poststreptococcal glomerulonephritis (APSGN) and acute rheumatic fever (ARF) are both postinfectious non-suppurative sequelae of group A beta hemolytic Streptococcus infections. Despite dramatic falls in the incidence, Acute Rheumatic Fever remains a major cause of morbidity and mortality associated with acquired heart disease in developing countries. APSGN still remains a frequent form of glomerulonephritis in third-world countries, particularly in areas where the disease occurs in epidemics. Both diseases have different epidemiology, immunology and bacteriology features and their concurrent development in the same patient is known, however, this is a rare condition. Here we present a case of a 6.5 year old child with concurrent APSGN and ARF.

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