ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 28 (4)
Volume: 28  Issue: 4 - 2023
1.Unveiling the Safety and Efficacy of Bariatric Surgery in Geriatric Patients: A Comprehensive Analysis of Three Years' Experience
Talar Vartanoglu Aktokmakyan, Caghan Peksen, Osman Anıl Savaş, Aziz Sumer
doi: 10.5505/ejm.2023.37431  Pages 544 - 547
INTRODUCTION: Bariatric surgery has gained popularity as an effective method for achieving and maintaining weight loss. Despite higher mortality/morbidity risks and uncertain long-term outcomes due to age-related factors, bariatric surgery can also be beneficial for geriatric obese patients. In this study, we aimed to examine the outcomes of bariatric surgery performed on geriatric patients in our clinic.
METHODS: A retrospective analysis was conducted on 14 patients aged 65 and above who underwent bariatric surgery between March 2019 and 2021. Patients were evaluated preoperatively through a multidisciplinary approach.
RESULTS: Among the 14 patients included in the study (11 females, 3 males), the mean age was 67 [65-74]. The mean Body Mass Index (BMI) was 42 kg/m² [40-60.4]. Comorbidities included hypertension (HT) in 11 patients, diabetes mellitus (DM) in 8 patients, and hyperlipidemia in 11 patients. A total of 9 patients had a history of antiplatelet use due to Chronic Arterial Disease (CAD). Among the patients, 10 underwent Laparoscopic Sleeve Gastrectomy, while 4 underwent Mini Gastric Bypass. The mean hospital stay was 3 days, and all patients were discharged smoothly after this period (100%). No patient required postoperative intensive care (0%), and there were no observed mortalities (0%). At the 6th postoperative month, the mean BMI was 31.6 kg/m².
DISCUSSION AND CONCLUSION: In well-selected geriatric obese patients, bariatric surgery can be an effective and safe method. Further research with larger samples is warranted to validate our findings and improve patient care in this population.

2.The Effect Of Rational Drug Use Training Given To Parents On Parental Attitudes
Arzu Sarialioğlu, Semra Köse, Ayda Çelebioğlu
doi: 10.5505/ejm.2023.47639  Pages 548 - 555
INTRODUCTION: The study aims to examine the effect of rational drug use education given to parents on parental attitudes.
METHODS: The pretest-posttest randomized controlled experimental study was carried out in Erzurum between June 2020 and September 2021. The study population comprised parents of children aged 0 to 12 who were registered a Family Health Center in Erzurum. The study sample consisted of 100 parents who came to the FHC on the specified dates and matched the research criteria. "Parent Introductory Form", "Parental Attitude Scale for Rational Drug Use (PASRDU)" and "Rational Drug Use Education" were used to collect research data.
RESULTS: The post-test mean score of the parents in the education group increased after the educational intervention compared to the pre-test mean score, and the difference between the two scores was statistically significant (p<.001). The difference between the post-test mean scores of the parents in the education and control groups was found to be statistically significant (p<.001).
DISCUSSION AND CONCLUSION: Parents' rational drug use was found to have improved as a result of the education provided during the study. It is advised that education and counselling services be provided at regular intervals to raise parents' understanding of rational drug use and to help them develop the proper behaviour.

3.Surgical Approaches to Iatrogenic Vascular Injuries in Adults
Sinan Gocer, Ekin Ilkeli, Ali Kemal Gür, Ali Cemal Düzgün, Salih Fehmi Katırcıoglu
doi: 10.5505/ejm.2023.44522  Pages 556 - 561
INTRODUCTION: Surgical procedures can result in unforeseen vascular injuries. In cases of severe vascular injuries, the involvement of an experienced vascular surgeon in the operation can be life-saving. The aim of this study is to elucidate the surgical approaches and outcomes in vascular injuries that occurred during elective operations of various branches within our institution.
METHODS: Between April 2019 and October 2021, 18 patients required surgery due to unexpected severe vascular injuries. Gender, age, injury site, elective operation, intervention to vascular injury, hemodynamic status, type of anesthesia, mean operation time, and post-operative status of the patients were retrospectively obtained from hospital database. The intensive care unit and service follow-ups of the patients as well as their post-discharge controls were collected from hospital records.
RESULTS: Among the patients undergoing vascular intervention, 60% (n=11) experienced arterial injuries, while 40% (n=7) had venous injuries. When examining the type of intervention, all patients, except for one, underwent intervention by placing a side or cross-clamp on the vascular structure. Primary repair was performed in 11 patients, end-to-end repair in 2 patients, PTFE graft placement in 1 patient, saphenous vein interposition in 3 patients, and ligation in 1 patient. Two patients (11%) died during the surgery.
DISCUSSION AND CONCLUSION: As a result, the surgeon should accurately and quickly evaluate findings such as unexplained hypotension, tachycardia, loss of pulse or heat loss during the operation, and should suspect vascular injury. It is possible to reduce mortality and morbidity rates when iatrogenic vascular injuries are diagnosed early.

4.Prognostic Value of Admission Lactate Level in Patients With Myocardial Infarction With ST Segment Elevation
Goksel Güven, Yusuf Ziya ŞENER, Adnan Duha Cömert, Serdar Söner, Cansu Özturk, Ercan TAŞTAN, Metin Okşul, Erkan Baysal
doi: 10.5505/ejm.2023.08068  Pages 562 - 567
INTRODUCTION: Lactate is a product of anaerobic metabolism and increases in states of tissue hypoxia. Furthermore, it is demonstrated that lactate level is correlated with the extent of infarct area and short term (30-day) mortality rates in patients with acute coronary syndrome with ST segment elevation (STE-ACS). Therefore, we aimed to test the prognostic value of this easily obtainable parameter on outcomes in patients presenting with STE-ACS.
METHODS: All adult patients who admitted with STE-ACS between 2019 and 2020 were screened. The cases with admission lactate levels were included. Patients were separated into two groups as low (<2mmol/l) and high (>2mmol/l) lactate groups.
RESULTS: A total of 70 patients were enrolled. The mean age of the study population was 62.3 ± 15.0 years and 53 (75.7%) of them were male. The most common infarct related artery was the left anterior descending (LAD) artery. The median lactate level was 2.5 (0.80-15.3) mmol/L. Malignant arrhythmia, contrast induced nephropathy (CIN), and in-hospital mortality rates were not different between the high and low lactate groups. However, all-cause mortality was significantly higher in the high lactate group during the follow-up (p=0.005). Among all included parameters; lactate level [OR: 1.76, (CI: 1.28-2.42);p<0.001] and age [OR: 1.10, (CI: 1.03-1.17); p=0.004] were predictors for all-cause mortality.
DISCUSSION AND CONCLUSION: Admission lactate level can predict all-cause mortality in patients with STE-ACS. In addition, high-admission lactate could help to raise more attention even if the patients have been discharged from the hospital.

5.Postpartum Sexual Function and Dyspareunia in Patients with COVID-19
Merve Aldikactioglu Talmac, Pinar Yalcin Bahat, Name Berfu Yumak, Aysegul Bestel, Izel Günay, Ibrahim Polat
doi: 10.5505/ejm.2023.30111  Pages 568 - 572
INTRODUCTION: The study aimed to better understand the influence of COVID-19 infection on the sexual health of postpartum women and to add new information to the literature, which lacks sufficient data on this subject.
METHODS: The study consisted of a control group of 70 postpartum women diagnosed with COVID-19 and 71 healthy postpartum women. The groups had similar demographics. The “Carol Postpartum Sexual Function and Dyspareunia Assessment Scale” was used in this study (NCT04389489).
RESULTS: The Carol Postpartum Sexual Function and Dyspareunia Assessment Scale, including the libido, lubrication area, pain area during penetration, and pain area during vaginal intercourse dimensions, was used to assess the two groups, which had similar demographic characteristics; scores were meaningfully lower in the case group (p <0.05). The discomfort or pain when touching the vulva and discomfort and pain after vaginal intercourse dimension scores did not vary significantly between the study and control groups (p >0.05).
DISCUSSION AND CONCLUSION: This study addresses the issue of insufficient data on the effect of COVID-19 infection on the sexual health of postpartum women. Health professionals should be aware of the effects of COVID-19 infection on women's sexual existence and provide appropriate therapy services.

6.Opinions of Faculty Members on the Assistant Physicians’ Use of Leave of Absence After Night Shift: A Survey Study
Nurettin Kurt
doi: 10.5505/ejm.2023.51333  Pages 573 - 577
INTRODUCTION: This study was carried out to review the opinions of faculty members on the consequences of assistant physicians’ use of leave of absence after night shift.
METHODS: This single-center,cross-sectional survey study,based on voluntary participation,was conducted with the faculty members of Yüzüncü Yıl University Faculty of Medicine between February-March 2023.The study population consisted of faculty members in surgical and internal medical science departments.Faculty members in basic medical science departments were not included in the study since assistant physicians in basic medical science departments do not work the night shift.The survey consisted of nine items with checkboxes on participants' demographic data and the consequences of assistant physicians’ use of a leave of absence after night shift on the clinic's functioning,medical specialty training,patient turnovers,and relationships inside and outside the clinic
RESULTS: Of the 98 faculty members,46 in surgical medical science departments and 52 in internal medical science departments,participated in the survey between February-March 2023.Of the respondents,76(77.5%) were male,22(22.5%) were female.The mean age of the participants was 42.72±4.9(min.34,max.57) years.Of the 98 faculty members who participated in the survey,84.0% and 79.6% stated that assistant physicians’ use of leave of absence after night shift adversely affected the medical specialty training and the clinic's functioning,respectively.
DISCUSSION AND CONCLUSION: In general,faculty members expressed the opinion that assistant physicians’ use of leave of absence after night shift negatively affected the medical specialty training,the functioning of the clinic,and the work carried out in collaboration with other clinics.There is a need for more comprehensive studies on assistant physicians’ use of leave of absence after night shift.

7.In-vivo Comparison of The Efficacy of Nigella sativa, Thymoquinone and Capsaicin against Toxoplasma gondii with Pyrimetamine-Sulfadiazine
SAADET YILDIZ, Yunus Emre Beyhan
doi: 10.5505/ejm.2023.01205  Pages 578 - 584
INTRODUCTION: Toxoplasma gondii is estimated to infect one-third of the world’s human population. Pyrimethamine-Sulfadiazine is recommended for the treatment of toxoplasmosis. These drugs cannot eliminate dormant tissue cysts. It was aimed to evaluate the efficacy of Nigella sativa oil, thymoquinone and capsaicin in combination with PYR-SDZ for in vivo treatment of the toxoplasmosis, and to observe the survival time of mice and the number of tachyzoites.
METHODS: The study was carried out as two separate experiments. Balb/c mice were injected intraperitoneally with 105 and 103T. gondii. After 24 hours, treatment was started with different doses of Nigella sativa oil, thymoquinone and capsaicin for 10 days. The effects of these components were evaluated compared to the combination of PYR-SDZ. Mortality and tachyzoite amounts of the mice were calculated for 30 days.
RESULTS: In both experiments, mice in the PYR-SDZ group lived to the full, afterwards, the life expectancy of the capsaicin (50 mg/kg/day) group (5.625 days in experiment 1 and 7.125 days in experiment 2) was found to be higher than the other groups (p<0.05). Since early losses occurred in both experimental groups, tachyzoite count was not performed in groups other than PYR-SDZ. Tachyzoites were not observed in the PYR-SDZ groups after day 10. It was determined that after the PYR-SDZ group in the treatment of toxoplasmosis, capsaicin displayed the highest probability of survival.
DISCUSSION AND CONCLUSION: Based on the findings of this study, we believe that the combined use of capsaicin with PYR-SDZ can increase life expectancy by reducing the side effects of the drug.

8.Histological study of the effects of sodium fluoride and the protective role of vitamin E on the testis of albino rats.
Muna Zuhair Al hamdany, Faten Thanoon Al-tai
doi: 10.5505/ejm.2023.26429  Pages 585 - 594
INTRODUCTION: Sodium fluoride is a prophylactic agent against dental caries commonly used for water fluoridation, treatment of osteoporosis and as a disinfectant. Adverse effects on various organs were reported following exposure to sodium fluoride.
METHODS: forty male Wister albino rats (Rattus norvegicus), were used, their weight ranging from 250 to 350 gm, all animals were acclimatized for one week before the experiment in suitable cages with standard food pellets and fresh water adlibitum. The period lasted for doing the experiment was four weeks. The animals were grouped equally as following: Group I served as control group given normal saline by oral intubation once daily for one month
RESULTS: Analysis of the recorded data of body weight revealed very high significant reduction in the body weights of rats of group II equated to the control group. In group II, we observed a significantly higher Malondialdehyde with a significantly reduced Superoxide dismutase in comparison to the control group. Conspicuous alterations in the testicular histological architecture were observed in NaF recipient group as thickening of tunica albuginea, vacuolar degeneration of spermatogenic cells. A significant rise in the caspase-3 was observed in rats treated with fluoride alone. Concomitant treatment with vitamin E with fluoride showed a considerable improvement in the histological architecture, biochemical tests, and significantly reduced the caspase-3 activity to near normal.
DISCUSSION AND CONCLUSION: Such finding emphasizes the defensive antioxidant influence of vitamin E against oxidative toxicity induced by fluoride which encourages the use of vitamin E supplementation to minimize the harmful effects of fluorosis.

9.Global Trends in Genomic Data Analyses: A Bibliometric Study
Sadi Elasan
doi: 10.5505/ejm.2023.53179  Pages 595 - 602
INTRODUCTION: Genomic data analysis is a field that deals with the processing and interpretation of large amounts of genetic data. Studies in this field offer researchers the opportunity to work in many fields. In addition, bibliometric analyses are an important tool in identifying publications and trends in the field of genomic data analysis. The purpose of this bibliometric review is to analyse the current status and trends to identify trends and prevalence of worldwide research in the field of genomic data analysis and to guide the advancement of research in this field.
METHODS: In this bibliometric study, genomic data analysis studies conducted globally between 1993-2023 were examined. As a result of the searches made using the keyword "genomic data analysis", 258 studies were found and 173 articles were used by eliminating the unsuitable and non-article studies. The articles in the database were analyzed using information such as title, author names, publication year, journal name and number of citations. Web of Science and Scopus databases was used for systematic data collection and all text data of the publications included in the study were evaluated with VOSviewer software. These analyses were performed using text mining and data visualization methods (bubble maps and other graphical) to ensure the accuracy and reliability of the study.
RESULTS: In this article, information is given about 173 articles taken from the WOS and Scopus databases and 8706 citations to these articles. The average number of citations per article was calculated as 51 and the H index as 28. Since 2013, both the number of articles and the number of citations have increased. Most of the articles (60%) are devoted to mathematical biology, biochemical, genetic inheritance. The United States of America is the country that publishes the most (47%) articles on this subject. Most of the articles (59%) were published by publishers such as Springer Nature, Oxford University Press, Elsevier, Wiley. Most of the articles (91%) are in SCI-Expanded category.
DISCUSSION AND CONCLUSION: The findings of our study show that many researchers are active in the field of genomic data analysis and that the researches in this field are increasing. This bibliometric analysis reveals global trends and important work in the field of genomic data analysis and provides important insights into the future directions of research in this field. Since this analysis only aims to identify trends and trends in the literature, it is not intended to evaluate the applicability of this topic.

10.Factors Affecting Static and Dynamic Balance in Individuals with Pes Planus: A 45 Case Clinical Study
Mehmet Salih Tan, Ebru Yıldırım
doi: 10.5505/ejm.2023.10476  Pages 603 - 609
INTRODUCTION: Pes planus is one of the most common biomechanical disorders of the lower extremities caused by different intrinsic and extrinsic factors and negatively affects activities of daily living from mild to severe. Balance-based domestic or international studies give limited data on the diagnosis of flatfoot. For this reason, we aimed to give the view of the static and dynamic balance states of individuals with pes planus in our clinic.
METHODS: Twenty-two patients diagnosed with pes planus of deformity grade 2 and above according to the Feiss line and 23 volunteers without pes planus were included in the study. All participants were evaluated for static (30TST and single leg stance tests) and dynamic [Berg balance scale (BBS), Tinetti balance & gait test and timed up & go (TUG) tests] balance.
RESULTS: The distribution among the groups evaluated with nonparametric tests was significant in terms of both static {[χgroup*tandem(1)=17.107, p=0.000], [χ(1)group*single_leg=13.442, p=0.000]} and dynamic [(Ugroup*berg=60, p=0.000), (Ugroup*tinetti=30, p=0.000), (Ugroup*timed_up&go=7.5, p=0.000)] tests
DISCUSSION AND CONCLUSION: In all static balance and dynamic tests, the time to stay in balance was found to be lower in the pes planus group, as expected. Apart from this, when the relationship between demographic and clinical data, balance tests and groups was evaluated, no statistically significant relationship was found (p>0.05). Accordingly, static and dynamic balance tests were effective in evaluating flat feet, while factors such as obesity and gender did not affect the degree of disease.

11.Retrospective Evaluation of Patients Followed Up in the Pediatric Intensive Care Unit of Harran University Faculty of Medicine
Ali Ateş, Nur AYCAN, Kabil Shermatov
doi: 10.5505/ejm.2023.48642  Pages 610 - 617
INTRODUCTION: Pediatric intensive care practices have significantly changed in the last 30 years. Our knowledge about the pathophysiology of life-threatening processes and the follow-up and treatment of pediatric patients with life-threatening diseases continues to expand in this process. This study evaluated the outcomes, treatment modalities, treatment responses, and clinical characteristics of patients hospitalized in the pediatric intensive care unit(PICU).
METHODS: 497 patients who were hospitalized and followed up in Harran University Faculty of Medicine, PICU, between January 2016 and December 2016, were evaluated.
RESULTS: Our study included 276(55.5%) male and 221(44.5%) female patients. The patients' median age and median PICU stay were 23 months(1-212 months) and seven days(1-134 days), respectively. The reasons for admission to the intensive care unit were respiratory system diseases in 171 patients(34.4%), poisonings in 88 patients(17.7%), neurological diseases in 71 patients (14.3%), gastrointestinal system diseases in 59(11.9%) patients, 42(4%) patients were admitted to the intensive care unit. The need for mechanical ventilation developed in 35.6% of the patients. 49.3%(n=245) of the patients had a comorbid disease. Some factors affecting clinical outcomes and mortality were identified. As a result of the regression analyses of these factors, mechanical ventilation requirement (OR=192.8), multi-organ failure (OR=21.2), disseminated intravascular coagulation (OR=9.6), thrombocytopenia (OR=2.4) and positive inotropic drug requirement (OR= 2.3) were associated with mortality was found to increase.
DISCUSSION AND CONCLUSION: Our findings showed that there are some factors affecting clinical outcomes. Mechanical ventilation requirement, multiple organ failure, disseminated intravascular coagulation, thrombocytopenia, and need for the positive inotropic drug was found to be effective on mortality.

12.Comparison of carotis intima media thicknesses in gestational weeks 24-26 and 36-38 in pregnant women with gestational diabetes
Mehmet Kağıtcı, Gülşah Balık, Şenol Şentürk, Yeşim Bayoğlu Tekin, Ülkü Mete Ural, Figen Kır Şahin, Emine Seda Guvendag Guven, Işık Üstüner
doi: 10.5505/ejm.2023.57778  Pages 618 - 623
INTRODUCTION: The aim of this study is to investigate the differences between carotid intima media thickness (CIMT) of patients with gestational diabetes mellitus (GDM) and healthy pregnant women.
METHODS: In this prospective study, 30 patients diagnosed with GDM and 30 healthy pregnant women were included. Serum HDL, LDL, TG, HbA1C and CRP levels, body mass indexes (BMI), and CIMT were measured for all participants included in the study. Measurements were repeated at 36-38 weeks of gestation. The difference between the second and third trimester measurements of both groups was compared.
RESULTS: Second trimester CIMT measurements of GDM and healthy pregnant women were 5.483 ± 0.825 mm and 4.866 ± 0.642 mm, respectively, and the difference between the measurements of the two groups was statistically significant. Third trimester CIMT measurements of GDM and healthy pregnant women were 5.516±0.748 mm and 4.983 ±0.724 mm, respectively, and the difference between the measurements of the two groups was statistically significant (p=0.016). The difference between the second and third trimester CIMT measurements of the patients in the GDM group was not statistically significant (p=0.326). The difference between the second and third trimester CIMT measurements of the patients in the control group was not statistically significant (p=0.09).
DISCUSSION AND CONCLUSION: GDM patients are at risk for atherosclerosis. In treated GDM patients, the increase in CIMT can be prevented. These findings may indicate that with early diagnosis and treatment of GDM, our patients can be protected from the atosclerotic consequences of hyperglycemia.

13.Effect of Euthyroid Sick Syndrome Development on Prognosis in COVID-19 Patients
Yusuf Karadeniz
doi: 10.5505/ejm.2023.32309  Pages 624 - 631
INTRODUCTION: Thyroid function tests may deteriorate as a result of coronavirus infection. Low free triiodothyronine(FT3) levels are related to a poor prognosis in patients with coronavirus disease 2019 (COVID-19) presenting with euthyroid sick syndrome(ESS). In this study, it was aimed to examine the mortality and other events that developed in the hospital and within the 2-year follow-up in patients who developed ESS.
METHODS: In this retrospective study, 170 patients who were hospitalized as a result of COVID-19 were included. The patients were divided into two groups, as those with ESS and those without(non-ESS), according to the reference range of thyroid-stimulating hormone(TSH), FT3, or free thyroxine(FT4) levels. Secondary events that developed during the hospitalization and/or long-term follow-up (mean 24 months) were analyzed from the hospital registry system.
RESULTS: ESS developed in 97 of a total of 170 patients. Of those, 84 died during hospitalization or within the 2-year follow-up. The FT3 and FT4 hormone levels were significantly lower in the ESS group (P<0.001 for both). The COVID-19-associated mortality ratio was significantly higher in the ESS group (P<0.001). Moreover, the occurrence of acute respiratory distress syndrome and acute renal failure was higher in the ESS group(P<0.05). The frequency of complications, such as acute myocardial infarction, acute heart failure, and atrial fibrillation, was similar between the groups.
DISCUSSION AND CONCLUSION: The development of ESS with low FT3 levels was associated with disease severity, increased mortality, and risk of complications in COVID-19 patients. The development of ESS is an important prognostic indicator in the course of COVID-19 in long-term follow-up.

14.Calcium metabolism markers and their effects on mortality in COVID-19 patients admitted to intensive care unit
Muhammet Korkusuz, Sulbiye Karaburgu, Tayfun Et
doi: 10.5505/ejm.2023.24571  Pages 632 - 643
INTRODUCTION: To evaluate the status of serum calcium, parathyroid hormone (PTH), and 25 (OH) vitamin D and their effects on mortality in patients with COVID-19 who were admitted to the intensive care unit (ICU).
METHODS: This was a retrospective chart review. Laboratory data at ICU admission included serum creatinine, corrected calcium, phosphorus, albumin, magnesium, among others. Same laboratory measurements were repeated two more times during hospitalization. The length of ICU stay, mortality, and need for mechanical ventilation were also recorded. Hypocalcemia, hypomagnesemia, and hypovitaminosis D rates were examined along with independent predictors of in-hospital mortality.
RESULTS: A total of 100 patients were included. The median length of ICU stay was 11.0 days. Mortality rate was 52%. Rates of vitamin D insufficiency and deficiency were 29% and 52%, respectively. Thirty percent of patients had serum calcium levels less than normal. On admission, 11% of the patients had hypomagnesemia. Patients with hypomagnesemia had lower serum calcium levels compared to normomagnesemic patients (8.7±0.6 vs. 9.2±0.7 mg/dL, p=0.031). Serum PTH levels were significantly different between hypomagnesemic and normomagnesemic patients. In contrast, 25(OH)vitamin D levels were comparable in both hypomagnesemic and normomagnesemic patients. In multivariate analysis, only the need for mechanical ventilation remained as a significant predictor of in-hospital mortality.
DISCUSSION AND CONCLUSION: Hypocalcemia was less common compared to the literature, whereas Vitamin D deficiency was widespread. Serum magnesium level appeared as an important modifier of serum calcium levels in these patients. Hypocalcemia was not associated with COVID-19 disease severity or mortality.

15.Anti-inflammatory Potential of Thymoquinone in Tumor Necrosis Factor-alpha Stimulated SW982 Human Synovial Fibroblasts
Mehmet Berkoz, Oruc Yunusoglu, Miroslaw Krosniak, Renata Francik
doi: 10.5505/ejm.2023.92693  Pages 644 - 652
INTRODUCTION: Rheumatoid arthritis is a common systemic autoimmune disease characterized by chronic inflammation of the joints that can induce the formation of pannus tissue and ultimately leads to joint destruction. Thymoquinone, the major bioactive constituent of Nigella sativa seed oil has diverse pharmacological properties. Although there are some studies in the literature showing the anti-inflammatory activity of thymoquinone, it is not yet clear whether thymoquinone can prevent inflammation caused by rheumatoid arthritis. The goal of this study was to investigate the potential anti-inflammatory effects of thymoquinone treatment on synovial fibroblasts.
METHODS: In our study, we investigated the effects of thymoquinone on nitric oxide production, interleukine-6 (IL-6), IL-8, and prostaglandin E2 (PGE2) levels, inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), tumor necrosis factor receptor-1 (TNF-R1), and TNF-R2 protein expressions, extracellular signal-regulated protein kinases 1 and 2 (ERK1/2), Jun N-terminal kinase (JNK), p38 mitogen-activated protein kinase (MAPK), and Akt phosphorylation levels in tumor necrosis factor-alpha (TNF-α) stimulated SW982 human synovial fibroblasts.
RESULTS: Thymoquinone treatment (0-1 µM) resulted in significant and concentration-dependently reduced the TNF-α stimulated production of nitric oxide, IL-6, IL-8, and PGE2 levels compared to the untreated group (p<0.05). Also thymoquinone treatment in high concentrations exerted an anti-inflammatory effect by suppressing iNOS, COX-2, TNF-R1, and TNF-R2 protein expressions and the phosphorylation of JNK, p38 MAPK, ERK1/2 and Akt in SW982 synovial fibroblasts (p<0.05).
DISCUSSION AND CONCLUSION: Taken together, these results show that thymoquinone in high concentrations is able to play a beneficial role in TNF-α mediated signaling in rheumatoid arthritis synovial fibroblasts.

16.Anatomical and stereological examination of infected lung area volumes in CT images of COVID-19 positive patients by age and gender.
Necat KOYUN, Veysel AKYOL, Sadi ELASAN, Cemil GÖYA, Gizem Gizli
doi: 10.5505/ejm.2023.69320  Pages 653 - 659
INTRODUCTION: SARS-CoV-2 (COVID-19) infection is transmitted by droplets and causes several serious diseases characterized by acute respiratory distress syndrome (ARDS). We aimed to examine the changes in the volumes of lung regions infected with COVID-19, a new and highly pathogenic strain, according to age and gender.
METHODS: After obtaining ethical permission, 6700 patients who applied with positive COVID-19 test were selected between 01/03/2020 and 01/03/2021. Patients with asthma, bronchiectasis, obstructive pulmonary disease, pleurisy, allergic lung disease, lung tumor, and smokers were excluded from the study. After the excluded patients, computed tomography images of a total of 407 COVID-19-positive patients, 188 women, and 219 men, were obtained retrospectively. From the images taken, groups of 2 to 10 decads consisting of male and female patients were formed. Images were skipped at certain intervals from the lung CT images of each patient in the groups. By applying stereological methods to the images, the total volume of the lung and the volumes of the infected lung regions were calculated.
RESULTS: When the infected COVID-19 lung volume/total lung volume (%) ratio was examined according to gender and decades, a statistically significant difference was observed according to gender in the 2nd, 6th, and 9th decades. When the ratio of infected COVID-19 lung volume to total lung volume by decades was compared, a statistically significant difference was observed in both genders (p=0.001).
DISCUSSION AND CONCLUSION: Further studies and medical research are needed to better understand age- and sex-specific differences for effective intervention.

17.Can Delta Neutrophil Index Predict The Superimposed Preeclampsia?
Dilek Menekse Beser, Dilek Sahin
doi: 10.5505/ejm.2023.44687  Pages 660 - 665
INTRODUCTION: We aimed to determine the utility of delta neutrophil index(DNI) in predicting superimposed preeclampsia (SPE) in chronic hypertensive pregnant women.
METHODS: The study included pregnant women diagnosed with chronic hypertension. SPE group was defined as developing acute or worsening hypertension, new-onset proteinuria, and/or significant new end-organ dysfunction after 20 weeks of gestation in a pregnant woman with chronic hypertension. Demographic variables such as maternal age, gravidity, parity, previous history of abortus, gestational age at SPE, birth week, birth weight, and Apgar scores were obtained from medical records. First-trimester laboratory parameters, including maternal aspartate transaminase (AST), alanine transaminase (ALT), platelets, and delta neutrophil index (DNI), 24-hour urine proteinuria level were assessed.
RESULTS: A total of 203 pregnant women with chronic hypertension were included in the study. Eighty-three of them were complicated by SPE. There were statistically significant differences in 24-hour proteinuria levels, the gestational week at birth, birth weight, and Apgar score at 1 minute and 5 minutes in the groups with and without SPE. In addition, the median DNI values were higher in the SPE group (p= <.001). The optimal cut-off value of DNI was 0.15 (76.1% sensitivity, 96.7% specificity, p= <.001). While DNI showed a weak positive correlation with the week patients were diagnosed with SPE (r =.223, p=.043), no significant correlation was found with the level of proteinuria (r =-.113, p=.318).
DISCUSSION AND CONCLUSION: DNI can be used in predicting superimposed preeclampsia in addition to other parameters when used in the first trimester.

18.Effects of age and co-morbidities on complication rate in surgical treatment of lumbar degenerative diseases: a prospective clinical study
Azmi Tufan, Özgür Yusuf Aktaş, Burak Eren, Ebru Doruk, Ilker Gulec, Abdurrahim Taş, Sarper Kocaoglu, Murat Yucel, Mustafa Örnek, Eyüp Çetin, Abdurrahman Aycan, Feyza Karagoz Guzey
doi: 10.5505/ejm.2023.89646  Pages 667 - 678
INTRODUCTION: Surgery for lumbar degenerative diseases is increasingly more common due to ageing of the population. There were conflicting results on effects of complication rates of ageing and presence of comorbidities in these operations in literature.

METHODS: Presence of systemic co-morbidities, smoking, body mass index (BMI), American Society of Anaesthesiologists score, length of hospital before and after operation and in intensive care unit (ICU), number of decompressed levels (nD), addition of instrumentation, operation time, blood loss, presence of transfusion, surgical and systemic complications seen during the operation and during one month after operation, and requirement of a new operation were recorded in 277 patients (61.6±8.8 years of age, male/female ratio 78/199) operated for lumbar degenerative diseases between 2014 and 2016.
RESULTS: Total 96 out of 277 patients (34.6%) had complications and 1 patient died. The most frequent complications were dural tear (36 cases, 12.9%), wound problems without infection (34 cases, 12.2%), screw malposition (15 cases, 5.4%), and systemic complications (21 cases, 7.5%).
The risk factors were diabetes mellitus (DM) for major complications, BMI and nD for minor complications, and nD for systemic complications. All other factors including age did not affect the complication rate. Regression analyses revealed that the only efficient factor was BMI for presence of overall and minor complications.

DISCUSSION AND CONCLUSION: It was found that the advanced age did not cause to increase complication rates. The efficient factors for complication rates were DM, BMI and nD.

19.Prognostic Value of Serum Neuron Specific Enolase and Pentraxin-3 In Acute Pulmonary Embolism
Muhammed İkbal Şaşmaz, CUMHUR MURAT TULAY, Ekim Saglam Gurmen, AHMET ANGIN, Cevval Ulman
doi: 10.5505/ejm.2023.57355  Pages 679 - 685
INTRODUCTION: The aim of this study is to investigate whether serum neuron-specific enolase (NSE) and pentraxin-3 (PTX-3) values are effective in the diagnosis and prognosis of acute pulmonary embolism. In addition, in the light of significant results, we aimed to determine a cut-off value for NSE and PTX-3 in acute pulmonary embolism and to try to determine the sensitivity - specificity in the diagnosis of pulmonary embolism according to these values.
METHODS: In this prospective study, patients who applied to the Emergency Department of Manisa Celal Bayar University School of Medicine between September 2019 and January 2021 and were diagnosed with acute pulmonary embolism constituted the study group and healthy volunteers without any chronic disease or drug use constituted the control group. Serum NSE and PTX-3 values of the patient and control groups were compared. In addition, demographic data, vital signs, laboratory findings, PESI (pulmonary embolism severity index) scores and prognoses of the patients were investigated.
RESULTS: In this study 70 patients diagnosed with pulmonary embolism were included to the patient group. 36 (51.4%) of them were women and the mean age was 67.01 ± 14. 74 healthy volunteers were included to the control group; 45 of them (60.8%) were women and the mean age was 44.99 ± 12.85. In patient group the mean PTX-3 value of the was 1.753±1.91 ng/ml, the mean NSE value was 182.13±14.99 ng/ml. In control group, the mean PTX-3 value was 0.429±0.035 ng/ml, the mean NSE value was 166.51±5.14 ng/ml. While there was a statistical difference between two groups in terms of pentraxin-3 value, there was no difference in terms of NSE value. When the cut-off value of 1.115 ng/ml for serum pentraxin-3 in the ROC analysis in order to distunguish the patients with pulmonary embolism from the control group, sensitivity was found to be 58.6% and specificity to be 96%.
DISCUSSION AND CONCLUSION: In our study, we found that serum PTX-3 level is a powerful biomarker with high specificity in the diagnosis of acute pulmonary embolism and is positively associated with the severity and prognosis of the disease. Therefore, we believe that serum PTX-3 may be a guiding biomarker in the diagnosis and prognosis of acute pulmonary embolism in clinical practice.

20.Can Preoperative Complete Blood Count Parameters and Tumor Markers Predict The Differential Diagnosis of Mucinous Ovarian Tumors?
Elcin Telli, Tufan Oge, Omer Tarik Yalcin
doi: 10.5505/ejm.2023.87533  Pages 686 - 692
INTRODUCTION: Mucinous ovarian tumors are typically large masses that cause preoperative and intraoperative evaluation challenges due to their size. Our study aims to assess the effectiveness of routinely studied preoperative complete blood count parameters and tumor markers in differentiating between benign, borderline, and malignant mucinous ovarian tumors.
METHODS: Patients who had surgery for a suspected adnexal mass and were diagnosed with a mucinous ovarian tumor between January 2019 and June 2023 were included in this study. The surgeries were performed at a gynecological oncology unit in a tertiary referral center. Cases that met the study criteria were categorized into three groups: benign, borderline, and malignant, based on their pathology results. We evaluated various parameters from the complete blood count (hemoglobin, hematocrit, leukocytes, neutrophils, lymphocytes, platelets, mean platelet volume), ratios of these parameters to each other (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio), tumor markers (Ca 125, Ca 19.9, CEA), and proportions of tumor markers to each other (Ca125/Ca19.9, Ca19.9/CEA).
RESULTS: The serum levels of Ca125, Ca19.9, CEA, and the Ca125/Ca19.9 ratio were significantly different between the groups (p<0.05). When using the cut-off values of Ca125>39 U/ml, Ca19.9>24.5 U/ml, CEA>4.9 ng/dl, and Ca125/Ca19.9 ratio ≤0.97, these markers showed sensitivities of 64.7%, 82.4%, 52.9%, and 64.7% respectively in distinguishing between benign and malignant mucinous ovarian tumors.
DISCUSSION AND CONCLUSION: Ca19.9 was the most sensitive marker in distinguishing between benign and malignant mucinous tumors, as well as borderline and malignant mucinous tumors.

21.Pregnancies complicated by placental abruption occured at <34 weeks compared with ≥34 weeks
Ayşegül Atalay, Dilek Şahin
doi: 10.5505/ejm.2023.09699  Pages 693 - 697
INTRODUCTION: Our aim was to compare perinatal outcomes of pregnancies complicated by placental abruption in preterm with near-term and term period.
METHODS: A retrospective case-control study was conducted in singleton pregnancies complicated by placental abruption after 20 weeks of gestation. Information extracted from the obstetric records included demographic information, obstetric history, gestational age, major risk factors for placental abruption, perinatal outcomes, and macroscopic and microscopic histologic analysis of the placenta and results compared between groups.
RESULTS: Of the 74 cases of placental abruption, 46 cases (62%) occurred at preterm period (<34 weeks of gestation) and 28 cases (38%) at near term or term period (≥34 weeks of gestation). There was no significant difference between groups in terms of obstetric history, risk factors for placental abruption and perinatal outcomes (p>0.05). Macroscopically, the incidence of couvelaire uterus was significantly higher after 34 weeks of gestation (p<0.05), while that extent of placental separation was similar between groups (p>0.05). The incidence of histological chorioamnionitis and/or deciduitis in the preterm group was significantly higher than that in the near term and term group (p<0.05), while that of placental thrombosis, infarction and necrosis were similar between groups (p>0.05).
DISCUSSION AND CONCLUSION: The present results suggest that the possible processes leading to placental abruption in preterm deliveries are different from those in near-term and term deliveries.

22.What is the role of arterial and venous Doppler deteriorations in predicting neonatal outcomes in growth-restricted fetuses?
Ceren Sağlam, Ayşe Ender Yumru, Yunus Emre Purut
doi: 10.5505/ejm.2023.42492  Pages 698 - 706
INTRODUCTION: The study aims to evaluate the performing fetal arterial and venous Doppler to detect the optimal time for delivery in growth-restricted fetuses and its effect on perinatal outcomes.
METHODS: Forty-five pregnant women with intrauterine growth restriction were included in the study. Fetal umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) Doppler measurements were performed. Fetuses were investigated in three groups: normal Doppler findings, only arterial Doppler abnormality, and venous Doppler abnormality. Cord arterial gas was analyzed at the time of delivery. Neonatal information and complications (Apgar score, neonatal intensive care unit (NICU) necessity, mechanical ventilation, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH)) were noted.
RESULTS: A total of 45 growth-restricted fetuses consist of 15 (%33,3) normal Doppler findings, 22 (%48,8) abnormal arterial Doppler findings, and 8 (%17,7) abnormal venous Doppler findings. There was a statistically significant difference between the abnormal venous Doppler group and the normal Doppler group when compared for gestational age at delivery, birth weight, emergent cesarean section due to fetal distress, acidosis, neonatal complications (NICU necessity, mechanic ventilation time, RDS, NEC, İVH) (p<0,05). As well, there was a strong correlation between gestational age and duration of both NICU stay and mechanical ventilation.
DISCUSSION AND CONCLUSION: Several parameters should be performed for the surveillance and then the optimal delivery timing of growth-restricted fetuses. Our study supports that venous Doppler investigation is more predictive for fetal well-being and perinatal outcomes than the mild deterioration of the umbilical artery and middle cerebral artery.

23.Radiology, laboratory, clinical course and outcomes of COVID-19 in chronic hemodialysis patients: a retrospective case-control study
Şaban İncecik, Buket Mermit
doi: 10.5505/ejm.2023.86836  Pages 707 - 716
INTRODUCTION: Coronavirus disease 2019 causes higher mortality in chronic hemodialysis patients. Previous studies on this subject generally covered 30 days or a hospital stay. This study compares the 100-day mortality of chronic hemodialysis patients with patients without kidney disease with the same disease severity.
METHODS: This retrospective case-control study is conducted in a single center, including 24 chronic hemodialysis in-patients and 48 control in-patients without renal disease, all diagnosed with coronavirus disease 2019.
RESULTS: According to the findings, the 100-day mortality rate of the hemodialysis group was significantly higher than that of the control group (odds ratio 4,53; %95 confidence interval 1.17-17.47). Multivariable regression analysis in Model A showed that chronic hemodialysis and critical illness were significantly associated with 100-day mortality, while cardiovascular disease comorbidity was a significant factor only in univariable analysis. The pneumonia severity index score was beneficial in predicting the in-hospital mortality of hemodialysis patients (odds ratio 1.07; %95 confidence interval 1.01-1.14). In addition, while all the patients in the control group were alive in the 90-day follow-up after discharge, three hemodialysis patients died at home due to sudden cardiac death.
DISCUSSION AND CONCLUSION: Patients undergoing chronic hemodialysis are at a higher mortality risk than those without kidney disease, even with the same severity of coronavirus disease 2019. Monitoring deaths among chronic hemodialysis patients during their hospital stay and the first three months after discharge is crucial. Clinicians can predict in-hospital mortality and manage patients more effectively by evaluating the pneumonia severity index scores.

24.Investigation of Histopathological and Biochemical Changes in Rats Feeding Roasted and Raw Sunflower (Helianthus Annuus L.) Seed Extract
Mürşide Tuba SİNAN, Zübeyir Huyut, Kenan YILDIZHAN, OMER FARUK KELES, Zabit YENER
doi: 10.5505/ejm.2023.63239  Pages 717 - 725
INTRODUCTION: Today, sunflower seeds, which are in first place in the consumption of nuts, have many benefits. However, sunflower seeds are consumed mainly by roasting. In this study, the effect of roasted and raw sunflower seeds on the liver of rats fed with experimentally roasted and raw sunflower seeds was investigated histopathologically and biochemically.
METHODS: For this purpose, a total of 24 rats were with eight rats in each group; the control, roasted sunflower seed (ROSS), and raw sunflower seed (RASS) groups. At the end of the experiment, blood and tissue samples were taken from the rats for histopathological and biochemical examinations.
RESULTS: While degenerative-necrotic changes were detected in the livers of rats fed with roasted sunflower seeds, no significant morphological changes were detected in the raw sunflower and control groups. Furthermore, there was no significant difference between the groups in the biochemical parameters AST, ALT, CAT, GSH, BcL-2 and SOD. However, TAS levels in the ROSS group were significantly lower than in the other groups, while LDH, Bax and caspase-3 levels were high.
DISCUSSION AND CONCLUSION: Data showed that ROSS decreased antioxidant status in liver tissue and increased LDH levels compared to RASS and could damage liver tissue.

25.The timing of Granulocyte Colony-Stimulating Factor in Hematopoietic Stem Cell Transplant in the Pandemic
Murat Kaçmaz, Semih Başcı, Tuğçe Nur Yiğenoğlu, Merih Kızıl Çakar, Mehmet Sinan Dal, Fevzi Altuntaş
doi: 10.5505/ejm.2023.40121  Pages 726 - 731
INTRODUCTION: Granulocyte-colony stimulating factors (G-CSF) are used to shorten the duration of neutropenia after hematopoietic cell transplantation (HCT). However, there is no consensus on which days treatment should be started post-transplantation during the COVID-19 pandemic. In this study, we looked at the influence of G-CSF on clinical outcomes on the fifth (G-CSFd5) and tenth (G-CSFd10) days following allo-HCT.
METHODS: Our study includes the data of 60 patients (G-CSFd5, n=28 vs G-CSFd10, n=32) who underwent HCT with the diagnosis of acute lymphoblastic leukemia (ALL) between 2015 and 2022. Primary outcome is the effect of G-CSF on hospital stay. Secondary outcomes are the development and duration of febrile neutropenia (FEN), neutrophil engraftment (NE), platelet engraftment (PE), engraftment syndrome (ES), acute graft versus host disease (aGVHD), cytomegalovirus (CMV) viremia, and effects on antimicrobial use.
RESULTS: Length of hospital stay, 34.5 days vs. 30 days (p=0.19); median NE, 13.85 vs 15.03 days (p=0.007); median PE, 15.5 vs 12 days (p=0.12); ES, 28.5% vs 12.5% (p=0.12); FEN, 85.7% vs 84.3% (p=0.88); aGVHD, 39.2% vs 40.6% (p=0.92); were observed for G-CSFd5 and G-CSFd10, respectively.
DISCUSSION AND CONCLUSION: Although starting G-CSF in the early period after allo-HCT shortened the duration of NE, positive effects on clinical outcomes were not observed. On the contrary, the frequency of ES increased in the group that received GCSF early.

26.Results of Continence Protective Levator Ani Urethral Suspension and Rhabdosphincter Remodeling Anastomosis Method in Radical Retropubic Prostatectomy
Emre Altıntaş, Ali Furkan Batur, Murat Gül, Mehmet Kaynar, Özcan KILIÇ, Serdar Göktaş
doi: 10.5505/ejm.2023.46762  Pages 732 - 738
INTRODUCTION: Radical prostatectomy is the gold standard method in the treatment of prostate cancer, one of the most common cancers in men. However, incontinence that may occur after radical prostatectomy significantly affects the quality of life of patients. Although many factors play a role in postoperative incontinence, the surgical method plays an important role. In our study, we aimed to investigate the effect of the urethral anastomosis method using levator ani muscle and rhabdosphincter remodeling method on continence in radical prostatectomy.
METHODS: We included 140 patients who underwent radical prostatectomy. Patients with and without postoperative urinary incontinence were compared in terms of ISUP grade, age, PSA, prostate volume, capsular invasion, seminal vesicle invasion and positive surgical margin.
RESULTS: Capsular invasion and seminal vesicle invasion were significantly higher in the group with urinary incontinence at the third, sixth and 12th postoperative months (p<0.001 and p<0.001). Continence rate was 71% at the third month, 87% at the sixth month and 91% at the 12th month.
DISCUSSION AND CONCLUSION: Incontinence after radical prostatectomy is an important problem for patients. In our study, we demonstrated the importance of levator ani and rhabdosphincter and urethral anastomosis in providing postoperative continence. The importance of this issue will be better understood in future studies.

27.Results of Cosmetic Gynecology Surgery of Our Clinic
Mehmet Yılmaz, Şerif Aksin
doi: 10.5505/ejm.2023.24382  Pages 739 - 744
INTRODUCTION: Despite the increasing demand for the female genital system, the data are insufficient. Our study aims to investigate the operations for female genital cosmetic surgery.
METHODS: Results of Cosmetic Gynecology Surgery of Our Clinic
Introduction: Despite the increasing demand for the female genital system surgery, the data are insufficient. Our study aims to investigate the operations for female genital cosmetic surgery.

Material and Method: 80 patients who underwent female genital cosmetic surgery within the indication in our hospital between 01.05.2018-31.09.2022 at Siirt University Training and Research Hospital were included in our study. Five types of operations were performed on the patients: labiaplasty, vaginoplasty, perinoplasty, hudoplasty, and hymenoplasty. Postoperative six-month satisfaction levels were measured.

RESULTS: Results: 80 patients were included in the study. 22 labiaplasty, 16 hudoplasty, 54 vaginoplasty, 64 perineoplasty, 3 hymenoplasty operations were performed. The mean age in the study was 36.2 ± 11 (20-75) and the mean parity was 3.4 ± 1.9 (0-8). The operation time was 49.8 ±9.1 minutes (35-80). No complications were observed in any of the patients. After the operation, these patients were followed up for an average of 6 months. Average patient satisfaction was 86% in labiaplasty, 100% in hudoplasty, 90% in vaginoplasty, 87 % in perinoplasty, and 66% in hymenoplasty.

DISCUSSION AND CONCLUSION: Conclusion: The results obtained in our study are that cosmetic gynecology can be performed within medical indications. It was observed that complication rates were low and patient satisfaction was good.

28.Evaluation of Peritonitis Attacks in Patients Applying Peritoneal Dialysis
Ali Irfan Baran, Mustafa Kasim Karahocagil, Yasemin Usul Soyoral, Gülsüm Mülayim
doi: 10.5505/ejm.2023.36418  Pages 745 - 752
INTRODUCTION: Peritoneal dialysis is one of the renal replacement therapies used to treat patients with end-stage renal disease. Peritonitis is a common complication of peritoneal dialysis. Although the incidence of peritonitis has decreased, it is still a problem and the most important determinant of hospitalization, mortality, and morbidity. The aim of this study was to evaluate the incidence of peritonitis in peritoneal dialysis patients, compare culture methods, and determine the causative microorganisms and antibiotic susceptibility.
METHODS: Patients who were on the peritoneal dialysis treatment program and developed peritonitis were included in the study. Demographic, clinical, and laboratory data of the cases were recorded. The growth rates of pathogens in the peritoneal fluid, causative microorganisms, and antibiotic susceptibility results were evaluated in the peritonitis cases.
RESULTS: During the study, 47 episodes of peritonitis occurred in 28 patients. The mean incidence of peritonitis was 0.57 attacks/patient-year. Growth rates in the blood culture system and solid media were 51% and 46.1%, respectively, and there was no significant difference between them. According to the culture results, 75% were gram-positive and the most common pathogens were coagulase-negative staphylococci.
DISCUSSION AND CONCLUSION: In our study, no significant difference was found between inoculation of peritoneal fluid into blood culture bottles and solid media. The most common pathogens were coagulase-negative staphylococci. As methicillin-resistant staphylococci are common, treatment with vancomycin seems appropriate. It was thought that ceftazidime, which is used for gram-negative bacteria, may not be sufficient due to resistance, and studies with more gram-negative cases are needed to evaluate this.

29.The Effect of Bone Mineral Density on Functional and Radiological Outcomes of Conservatively Treated Distal Radius Fractures
Serdar Menekşe
doi: 10.5505/ejm.2023.56563  Pages 753 - 759
INTRODUCTION: Distal radius fractures are among the most common fractures seen in clinical practice. These fractures usually occur due to trauma, and their management varies from conservative treatment with closed reduction and immobilization to surgical intervention. Several factors affect the outcome of distal radius fractures, including age, gender, fracture type, and bone quality. Bone mineral density (BMD) is a measure of bone quality and has been shown to affect the healing of fractures in various bones, including the distal radius. The purpose of this study was to evaluate the effect of BMD on the functional and radiological outcomes of conservatively treated distal radius fractures.
METHODS: This study was approved by the Adana City Hospital Ethics Committee, and written consent was obtained from all patients. A total of 56 patients (22 men and 34 women, mean age 59.2 (50-79)) with distal radius fractures were included in the study. Patients with additional complications, additional pathology, multi-trauma, and open fractures were excluded. Demographic information, including gender, age, and chronic diseases, was collected. Fractures were classified according to the Frykman and AO systems. BMD measurements were performed using dual-energy x-ray absorptiometry. Radial inclination and volar tilt values were measured on posteroanterior and lateral plane wrist radiographs. Casts were removed when a solid union was observed, and a home rehabilitation program was initiated. Gartland-Werley functional scoring was used for clinical evaluation.
RESULTS: There was no significant difference between the two groups in terms of fracture type, dominant side, gender distribution, and mean age. There was also no significant difference between the groups in terms of radial slope loss, volar tilt loss, or amount of radial shortening. Furthermore, there was no significant difference between the groups in terms of union time. However, functional scores were significantly lower in the low BMD group, and a significant positive correlation was found between BMD and functional outcomes. There was no significant correlation between functional scores and radial shortening amount, radial inclination, or volar tilt loss.
DISCUSSION AND CONCLUSION: This study suggests that low BMD values do not have a significant effect on the time of union and reduction loss in conservatively treated distal radius fractures but negatively affect the functional results. Therefore, BMD measurement may be considered in the management of distal radius fractures, especially in older patients or those with osteoporosis. However, further studies with larger sample sizes are needed to confirm these findings.

30.Sleeve Gastrectomy Pathologies: A Single-Center Retrospective Analysis
Çağhan Pekşen, Aziz Sumer
doi: 10.5505/ejm.2023.99076  Pages 760 - 764
INTRODUCTION: Sleeve Gastrectomy(SG) has emerged as a prominent surgical approach in the battle against obesity, gaining widespread recognition for its effectiveness in promoting significant weight loss and improving metabolic health. However, despite its increasing popularity, the impact of SG on the histological and pathological characteristics of the gastrointestinal tract remains a subject of intense research.
METHODS: This retrospective study, conducted at Istinye University, aimed to investigate the pathological outcomes of 530 SG procedures performed between June 1, 2022, and 2023. The study included demographic information, comorbidities, operative details, and both endoscopic and pathological findings.
RESULTS: Our analysis uncovered notable trends in post-SG endoscopic and pathological findings, where 65.4% exhibited endoscopic gastritis and 70.8% showed pathological gastritis, a known factor in gastritis development, was present in 27.9% endoscopically and 35.6%pathologically. Further investigation is warranted to explore the disparities between endoscopic and pathological detection rates and assess diagnostic accuracy. The presence of comorbidities was significantly associated with gastritis(p<0.05), highlighting the potential interplay between systemic health conditions and gastric pathologies post-SG.No significant relationship was identified between gender and pathological findings.
DISCUSSION AND CONCLUSION: This study provides significant insights into the pathological outcomes of SG and underscores the importance of postoperative surveillance and management of gastric health. Routine endoscopy remains a fundamental component of postoperative care for bariatric surgery patients, contributing significantly to their long-term well-being and optimizing surgical outcomes.

31.Impact of Altitude on Anemia, Erythropoietin-Stimulating Agent, and İntravenous Iron Requirement in Hemodialysis Patients
Cebrail Karaca, Selma Alagoz, Aydan Mutis Alan, Beyza Nur Aydın Keskin, Saadet Usakli, Mert Kantarci, Mehmet Erdem, Mahir Coşkun, Mevlüt Tamer Dincer, Nurhan Seyahi, Sinan Trabulus
doi: 10.5505/ejm.2023.06337  Pages 765 - 771
INTRODUCTION: Anemia is an important cause of morbidity and mortality in chronic kidney disease (CKD). Previous studies have shown the curative effects of altitude on anemia in hemodialysis (HD) and non-hemodialysis CKD. This study examined the effect of altitude on erythropoietin stimulating agent (ESA), İntravenous (IV) iron requirement in HD patients.
METHODS: This retrospective observational study was conducted between January and June 2023. The study group was divided into two groups according to altitude: HD patients living in Van Province (1,730 meters, 5,765 feet) in the high-altitude group (HAG) and HD patients living in Istanbul Province (sea level) in the low-altitude group (LAG). In addition to hemoglobin (Hgb) and ferritin levels, ESA and IV iron doses were recorded at monthly visits for six months. These values of the HAG and LAG were compared.
RESULTS: A total of 184 patients were included in the study (HAG: 108 patients and LAG: 79 patients). HD patients living at high altitudes had statistically significantly higher Hgb and ferritin values compared to low altitudes (HAG: 1.5 g/dL, 749 pg/L vs. LAG: 11.3 g/dL; 543 pg/L; p=0.04, p< 0.001, respectively). In addition, ESA (HAG: 53 IU/kg/week, 12000 IU/month vs. LAG: 100.6 IU/kg/week, 24000 IU/month; p<0.001) and IV iron (HAG: 208.3±151 mg/month vs. LAG: 364.9±300.8 mg/month; p=0.002) dose was significantly lower.
DISCUSSION AND CONCLUSION: HD patients living at high altitude needed lower doses of ESA and IV iron to reach higher Hgb values than patients living at lower altitude.

32.The Relationship Between Obesity and Self-Esteem
Okan İmre, Şükrü Salih Toprak
doi: 10.5505/ejm.2023.99710  Pages 772 - 777
INTRODUCTION: Obesity has recently emerged as a major public health concern around the world. Obesity's psychological causes and implications must be well studied before an effective treatment strategy can be developed. The purpose of this study was to look at self-esteem in obese people.
METHODS: The study comprised 71 morbidly obese adults who applied to the Karamanoglu Mehmetbey University hospital's General Surgery Clinic for bariatric surgery between August 2021 and July 2022. The subjects were given the Rosenberg Self-Esteem Scale. Morbidly obese respondents' self-esteem and other subscale ratings were compared to those of a healthy, normal-weight control group.
RESULTS: Compared to the healthy controls, the morbidly obese group had poorer self-esteem (z = -3.585; p = 0.001). The obese group had higher levels of daydreaming (z = -2.010; p = 0.044), sad affect (z = -2.237; p = 0.025), and psychosomatic symptoms (z = -2.497; p = 0.013). Depressive affect (r = 0.435 p = 0.001)and psychosomatic symptoms (r = 0.322 p = 0.006) decreased in obese patients as self-esteem increased.
DISCUSSION AND CONCLUSION: In our study, self-esteem was found to be low in obese patients. Low self-esteem was associated with other psychiatric problems. Our results indicate that while establishing an obesity treatment approach, interventions for psychological issues including low self-esteem and depression should be taken into account in addition to physical issues. Therefore, morbidly obese patients who are referred to the psychiatry clinic for bariatric surgery should undergo a thorough psychological examination in addition to being assessed for their appropriateness for surgery.

33.Analysis of The Clinical and Demographic Data of The Patients Diagnosed with Myastenia Gravis Followed-up İn Our Clinic
Abdullah Yılgör, Caner Baydar
doi: 10.5505/ejm.2023.15707  Pages 778 - 782
INTRODUCTION: The objective of this study is to evaluate the demographic characteristics as well as the clinical course, antibody, and electrophysiological characteristics of the patients diagnosed with Myastenia Gravis (MG) followed-up in our clinic.

METHODS: The demographic characteristics as well as the clinical course, antibody, electrophysiological and radiological (thoracic tomography) characteristics of 99 MG patients followed-up in our Neuromuscular and Muscle Diseases Outpatient Clinic for a period of 5 years are examined.
RESULTS: The mean age of the patients was 44,38±15,2. The number of patients followed-up as pure ocular MG was 22,22% (n=22). Acetylcholine receptor antibody (AntiAChRAb) was found positive in 53,54% (n=53) of the patients and thymus pathology (Thymoma + post-thymectomy thymic hyperplasia) was found in the thoracic tomography of 42,42% (n=42) of the patients.
DISCUSSION AND CONCLUSION: Although MG is a disease with well-known immunopathogenesis, in some cases, there may be complications in the follow-up and treatment of MG patients. Therefore, detailed patient follow-up and long-term clinical monitoring is important in MG patients. There are some limitations due to the fact that this is a hospital-based study. An example of such limitations is the lack of data related to responses to the treatment. More extensive epidemiological studies on this matter will be more informative. Detailed patient file recording and administration of individualized treatments will provide positive results in the long term in MG patients who suffer from a chronic disease which progress with flare ups

34.Assessment of clinical outcomes after percutaneous patent foramen ovale closure in adult patients diagnosed with cryptogenic stroke
Aslan Erdoğan, Ömer Genç, Ayşe Irem Demirtola, Duygu Inan, Furkan Şen, Yeliz Güler, Ahmet Güler, Ayça Ozkul
doi: 10.5505/ejm.2023.12245  Pages 783 - 789
INTRODUCTION: Our study aims to report the findings of transesophageal echocardiography (TEE), Risk of Paradoxical Embolism (RoPE) score, the Patent Foramen Ovale -Associated Stroke Causal Likelihood (PASCAL) classification analyses, and follow-up results after percutaneous PFO closure in patients diagnosed with cryptogenic stroke.
METHODS: The medical records of patients with acute arterial ischemic stroke who were diagnosed with PFO by TEE and applied percutaneous PFO closure between 2020-2023 were reviewed. The echocardiography (Echo) score, the RoPE score, and the PASCAL classification were calculated for all patients as indicated in the literature. Newly developed arrhythmia, recurrent stroke, and cardiovascular death were recorded during follow-up.
RESULTS: A total of 65 patients were included in the study. The median age was 41 years [range: 33-47]), the median RoPE score was 8, and the Echo score was 3. While 29.2% of the patients were in the possible group according to the PASCAL classification, 70.8% were in the probable group. We did not have any patients in the unlikely group. Recurrent ischemic stroke was detected in only two patients at a median follow-up of 12.1 months. No cardiac arrhythmia or cardiovascular death was observed.
DISCUSSION AND CONCLUSION: PFO closure in PFO-associated stroke patients was safe, with a low incidence of arrhythmia and cardiovascular and cerebrovascular events during the short-term follow-up.

35.The impact of different management options of ectopic pregnancy on future fertility
Aysegul Bestel, Osman Samet Gunkaya, Melih Bestel, Merve Aldikactioglu Talmac, Kubra Yazkan Erdoğan, Hale Goksever Celik
doi: 10.5505/ejm.2023.71809  Pages 790 - 796
INTRODUCTION: In this study, our aim was to evaluate the subsequent fertility status of women treated with different methods for ectopic pregnancy.

METHODS: Patients diagnosed with ectopic pregnancy between January 2012 and July 2020 were included in the study. Fertility outcomes of the patients treated with medical or surgical options were questioned.
RESULTS: In the study, 659 patients who met the eligibility criteria were included. A single dose of MTX was administered in 37 patients (32.2%) and two doses of MTX were applied in 14 patients (12.2%) and surgery was preferred in 64 patients (55.7%) in the infertile group. In 213 patients (39.2%) in the fertile group, MTX was administered as a single dose while two doses of MTX and surgery was preferred in in 49 patients (9.0%) and 282 patients (51.8%), respectively. No statistically significant difference was detected between the groups according to treatment approaches.
DISCUSSION AND CONCLUSION: There was no significant difference regarding fertility outcomes following different types of treatments for ectopic pregnancy. For this reason, the methods to be chosen for the treatment of ectopic pregnancy should be evaluated according to the individual factors of the patient.

36.Evaluation of Psychiatric Status and Quality of Life in Alzheimer's Patients and Carers
doi: 10.5505/ejm.2023.02212  Pages 797 - 803
INTRODUCTION: It is known that the incidence of Alzheimer's disease is increasing in every year and the demolition process is between 8 – 10 years. Individuals require advanced level of care and supervision. In this environment, the occurence of psychological and physical depression is inevitable in caregivers. All kinds of cognitive, behavioral and psychiatric disorders that can be observed in dementia decrease the quality of life of patients and caregivers.
METHODS: In this study, we found that quality of life and depressive status of caregiver were more affected by sociodemographic characteristics and degree of closeness to the patient. In addition, we concluded that the patient's daily independence and behavior disorder affected each other.
RESULTS: We found that patients with caregivers with different responsibilities had better instrumental functions other than basic care support.
DISCUSSION AND CONCLUSION: As a result of all our findings, we concluded that patients who were given more independence in a controlled way in daily life activities may be more functional and thus the psychological status of the patient is better and the caregiver burden may decrease simultaneously.

37.The Prediction Of Overall Survival With The Use Of The Sarculator In Operated Soft Tissue Sarcoma Of The Extremities: Monocentre Experience
Yasin Sezgin, OĞUR KARHAN
doi: 10.5505/ejm.2023.31644  Pages 804 - 809
INTRODUCTION: Soft tissue sarcomas are rare malignancies with poor prognosis and more than 100 histologic subtypes. Due to their poor prognosis, accurate prognosis cannot be made by staging system alone. Therefore, normograms have been developed for sarcoma patients. In this study, it was aimed to investigate the real-life data of prognosis prediction of sarculator normogram.
METHODS: Retrospective observational research was used in our study and the records of 146 patients were reviewed. The study included 50 patients who met the study criteria. The prognostic factors in sarcoma patients were analyzed in the study. Tumor size, tumor grade, age, and histologic subtype of the tumor were examined. In addition, all patients were graded using the sarcoma normogram and divided into percentile groups.
RESULTS: The study's patient population had a median age of 47 years. 37 months were the median overall survival time. Patients with tumor grade 3 showed a statistically lower overall survival than those with grade 1 according to univariate analysis. Among patients divided into three groups according to Sarculator scoring, the high-risk group had a statistically significant difference of 23 months, the intermediate-risk group of 39 months, and the good-risk group of 93 months.
DISCUSSION AND CONCLUSION: Increased tumor size and grade were statistically significantly associated with poor survival, which was consistent with the literature. Statistically significant 5-10 year survival data were obtained in patients divided into 3 groups and compared with sarcolator. Thus, the accuracy of the Sarcolator was confirmed with real-world data.

38.Evaluation of skin changes in patients undergoing obesity surgery: A retrospective observational study
Zekiye Kanat, Serhat Doğan, Bahadır Öndeş, Ali Aksu, Feyzi Kurt
doi: 10.5505/ejm.2023.84584  Pages 810 - 814
INTRODUCTION: Obesity surgery is performed with increasing frequency in recent days. Some problems develop after these surgeries. Changes in the skin due to weight loss, vitamin, and element deficiencies are among these problems. In this study, we aimed to discuss how the skin changes that occur after the surgery affect the patients and their satisfaction.
METHODS: Survey form were prepared to evaluate the changes in the skin of the patients who underwent bariatric surgery in our hospital and the changes in the skin of the patients were recorded by questioning one year before and one year after the surgery. Their satisfaction with the skin changes before and after the surgery was evaluated
RESULTS: A total of 51 patients, eight men (15.7%) and 43 (84.3%) women, were included in the study. The mean age of the patients was 32.8 years. The preoperative mean body weight of the patients was 119.7 kg. The mean follow-up time was 15.4 months. During this follow-up period, the mean postoperative body weight of the patients was 82.8. While the rate of those who were satisfied with the changes in their skin during this period was 78.4 on average, the rate of those who were not satisfied was 21.6 on average.
DISCUSSION AND CONCLUSION: Most of the patients included in the study stated that they had skin problems related to obesity on their skin. Despite this, patients stated that the changes in their skin after bariatric surgery were better than before the surgery.

39.Can the Public Image of Nursing Be Improved Via the Use of Photographs As a Symbolic Language?
Selver Bezgin, Şükriye İlkay Güner, Sevim Buzlu, Savaş Güner, Reyhan Orhun
doi: 10.5505/ejm.2023.79095  Pages 815 - 823
INTRODUCTION: The society’s opinion on the image of nursing is influence on various factors, including choosing the nursing profession and continuation in the profession. This study aimed to examine the effects of using the language of photography to explain the nursing profession as a professional occupation to society.
METHODS: Designed as a non-randomized quasi-experimental (One group pre-test-post-test) study, the research included a sample of 1088 participants who viewed 59 photographs specific to the nursing area. A personal information form and the “Nursing Image Scale” were used as data collection tools.
RESULTS: The participants’ mean score on the Nursing Image Scale was 65.33 before they attended the photo exhibition and 68.02 after attending it, indicating a statistically significant difference between the pre-test mean score and post-test mean score on the Nursing Image Scale applied to the participants before and after the exhibition (p=0.000).
DISCUSSION AND CONCLUSION: From these results, it was concluded that the participants’ image of nursing was higher than average, meaning that the photo exhibition improved their image of nursing.

40.The effect of varenicline on the ovarian follicle and hormones, and endometrial thickness in an experimental model
murat bulanık, nevin sagsoz, Şükrü Bakırcı, Mahmut İlkin yeral, pınar atasoy, hakan boyunaga
doi: 10.5505/ejm.2023.15045  Pages 824 - 831
INTRODUCTION: It was aimed to evaluate the histological, biochemical, and hormonal changes in the reproductive system of varenicline exposed female rats in an experimental model.
METHODS: : Forty female rats were randomized into 4 groups. (1) Control group (n = 10); (2) Smoking group (smoking exposure 30 minutes twice a day) (n = 8); (3) Varenicline group (1 ml/kg); (4) Smoking + Varenicline (varenicline treatment (1 ml/kg) after smoking exposure (30 minutes twice a day). After the experiment, ovarian follicle count and endometrial thickness were examined; biochemical hormones -include Anti-mullerian hormone- and free oxygen radical levels were calculated. AMH levels were significantly lower in group 4 than in group 1 (p = 0.049).
RESULTS: Group 2 and group 3 were significantly lower than group 1 (p = 0.038, p = 0.045, respectively). There was no statistically significant difference in endometrial thickness and free oxygen radical levels between the groups (p > 0.05).
DISCUSSION AND CONCLUSION: We found that varenicline is related to reduced AMH and PRMF levels. The difference in endometrial thickness between the groups was not detected. These findings show that varenicline may harm ovarian functions.

41.Mesenteric artery embolism during Coronavirus Disease-19 (COVID-19) in a patient previously diagnosed with Fabry: A case report
Nesim ALADAĞ, zülküf Akdemir, Iskan Çallı
doi: 10.5505/ejm.2023.80270  Pages 832 - 835
We report a unique case of superior mesenteric artery embolism that developed in a patient with COVID-19 who was followed up with the diagnosis of Fabry Disease. On the 12th day of COVID-19 illness, atrial fibrillation and superior mesenteric artery embolism were detected in a 56-year-old male patient who was previously diagnosed with Fabry Disease. We did not find a similar patient in the literature. In the coexistence of Fabry Disease and COVID-19, risk of arrhythmia such as atrial fibrillation, which is the most common arrhythmia in both diseases, increases further. COVID-19 can cause arterial and venous thrombosis. In the coexistence of Fabry Disease and COVID-19, care should be taken against increased thrombogenicity, arrhythmia (such as atrial fibrillation) and thromboembolism that may develop due to them.

42.Successful staged surgical repair of a rare association of cardiac rhabdomyoma, tuberous sclerosis and tetralogy of Fallot
Emrah Şişli, Serdar Epçaçan, Mehmet Gökhan Ramoğlu, Zerrin Karakuş Epçaçan, Osman Yeşilbaş
doi: 10.5505/ejm.2023.00018  Pages 836 - 838
We present a coexistence of cardiac rhabdomyoma, tuberous sclerosis and tetralogy of Fallot. A central shunt was emergently performed because of intractable cyanotic spells. After one-year of follow-up, total correction was performed as regression of the masses along with pulmonary artery growth was achieved. We suggest deferral of surgical total correction until regression of rhabdomyoma masses in these cases.

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