ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 29 (1)
Volume: 29  Issue: 1 - 2024
1.Relationship between upper extremity pain and ultrasound use between Perinatologist and Obstetricians and Gynecologists
Gulnur Tasci Bozbas, Fedi Ercan, Ahmed Sinan Alpaydın, Niyazi Alper Seyhan, Nefise Nazlı Yenigül, Ceren Sağlam, Yunus Emre Purut, Imran Kurt
doi: 10.5505/ejm.2024.90947  Pages 1 - 6
INTRODUCTION: To compare the frequency and severity of upper extremity pain between perinatologists and obstetricians and gynecologists (OG) and to investigate the factors that may affect it.
METHODS: This study was conducted as a prospective study between June-July 2023. The online questionnaire prepared by the researchers was filled by volunteer perinatologists and OG physicians. The questionnaire inquires information such as age, gender, specialty experience, average weekly number of patients examined, duration of examination for each patient and other demographic data, frequency and severity of upper extremity pain, and need for examination and treatment. In addition, perinatologists with upper extremity pain and OG physicians were compared and factors that may have an effect on this situation were evaluated.
RESULTS: One hundred and twenty four perinatologists and 210 OG physicians participated in this study. Upper extremity pain was present in 91 (73.4%) perinatologists and 77 (36.6%) OG physicians. The median value of the number of weekly ultrasound examinations was 100 (50-140) for perinatologists, while it was 70 (45-90) for OG physicians (p <0.001). The examination time for each patient was 16 (15-20) minutes for perinatologists, while it was 10 (7.5-10) for OG physicians, which was significantly longer (p<0.001). The need for treatment was 24.2 and 5.2% for perinatologists and OG physicians, respectively, and was significantly higher for perinatologists (p: 0.001).
DISCUSSION AND CONCLUSION: We found that upper extremity pain is more common in perinatologists than OG physicians. We thought that this was due to the fact that perinatologists had a higher frequency of ultrasound and longer examination times.

2.The Efficacy and Safety of Intradetrusor Botulinum Toxin Injection in Urinary Incontinence in Geriatric Patients
Burak Elmaağaç, AYDIN YENILMEZ
doi: 10.5505/ejm.2024.79735  Pages 7 - 13
INTRODUCTION: Antimuscarinic agents play an important function in the treatment of urinary incontinence. Intradetrussor onabotulinum toxin (Btx-A) injection is recommended if antimuscarinic drugs fail. This study examined Btx-A injection efficacy and adverse effects by age.
METHODS: The study has 54 patients who did not respond or tolerate two antimuscarinic drugs were injected with Btx-A. Before operation, urodynamics, voiding diary, International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF) and Incontinence Quality of Life (IQoL) were assessed. Six weeks after operation, these values were repeated. In light of these findings, the treatment efficacy of the Btx-A injection was assessed. A two-way ANOVA test was performed for repeated measurements.
RESULTS: The study included 54 patients, 37 female and 17 male. Twenty patients were 65 or older, 34 were under 65. Most patient groups benefited from Btx-A injections.
Age doesn't affect Btx-A injection effectiveness. In 54 patients, maximal bladder capacity increased 50%, maximum detrusor pressure decreased 42%, incontinence quality of life score increased 71%, and average daily incontinence decreased 69%. Nine patients (16%) had urinary tract infections and one had urine retention (1.8%).

DISCUSSION AND CONCLUSION: IntradetrussorBtx-A injections should be favored due to their adequate efficacy and low incidence of side effects. Injection of intradetrussorBtx-A is a reliable, tolerable, reproducible, and effective invasive treatment for resistant urinary incontinence or overactive bladder.
Considering the adverse effects of antimuscarinic agents in OAB patients 65 and older who are resistant, Btx-A injection should be recommended due to its low rate of complications and efficacy.

3.The Effect Of Laparoscopic And Laparotomic Surgery On Post-Op Mortality And Morbidity In The Repair Of Peptic Ulcer Perforation
Fırat Aslan, Ali Riza Karayıl
doi: 10.5505/ejm.2024.64188  Pages 14 - 17
INTRODUCTION: Our aim is to examine the signifance of laparotomic repair (OR) and laparoscopic repair (LR) on postoperative morbidity and mortality in peptic ulcer perforation (PUP) surgery, to explore the postoperative complications, and to determine the effectiveness of LR.
METHODS: Patients operated for PUP in our hospital between January 2015, and December 2022, were evaluated retrospectively. Gastric perforations from stab wounds and blunt traumas, patients with diseases for which LR is contraindicated, patients with repeated abdominal surgery, and pregnant patients were excluded from the study. 142 patients were included in the research including 37 patients who underwent LR for PUP and 105 patients who underwent OR. Patients were grouped as LR and OR. Infective parameter values, demographic characteristics, postoperative hospital stay, presence of surgical site infection, reoperation, and additional complications of all patients were examined before and after the operation.

RESULTS: The rate of postoperative decrease in leukocyte count was significantly higher in the LR group (p<0.05). Postoperative hospital stay and surgical site infection were lower in the LR group (p<0.05). Although there were no patients in the LR group who were reoperated due to postoperative leakage, the rate was 1.9% in the OR group, although the differences was not significant (p>0.05). The development of postoperative atelectasis was found to be significantly higher in patients who underwent OR (p<0.05).
DISCUSSION AND CONCLUSION: Our data suggests that the LR method can be safely performed in suitable patients as the postoperative morbidity and mortality rates are lower in laparoscopic surgical repair compared with OR.

4.Esculetin induce apoptosis in Human Cervical Cancer Cells (HeLa)
TUĞÇE DURAN, GOZDE SAHİN, aysegul kebapcılar, cetin celik
doi: 10.5505/ejm.2024.25564  Pages 18 - 21
INTRODUCTION: Despite the development of effective HPV screening and vaccination programs in women, cervical cancer ranks first in cancer-related deaths. In order to prevent the side effects of chemotherapeutic agents, studies on the use of natural compounds in the treatment of cervical cancer are becoming increasingly common. Esculetin, a coumarin derivative from natural compounds, is a pharmacological substance with anti-inflammatory, antioxidant, anti-tumor, neuroprotective effects. In various studies, esculetin has been found to induce apoptosis in colon cancer, breast cancer, and cervical cancer via JNK, ERK, ROS mediated mitochondrial pathway or ER stress activation pathways
METHODS: HeLa cells and HEK cells were cultured. MTT analysis was performed to determine the IC50 dose of the esculetin. Expression levels of apoptotic genes (BAX, BAK, BAD, APAF-1 and p53) and antiapoptotic genes (BCL-2, BCL-XL) were detected by qPCR.
RESULTS: The IC50 dose at which esculetin inhibited the viability of HeLa cells was determined as 800 μM.In addition, esculetin down-regulated antiapoptotic genes BCL-2 and BCL-XL, while up-regulated apoptotic genes such as BAK, APAF-1, p53, BAD, BAX.
DISCUSSION AND CONCLUSION: Current findings showed that esculetin has apoptotic effects on HeLa cells.

5.Superficial Temporal Artery: A Cadaveric Feasibility Study for Cerebral Bypass Surgery
Ulaş Cıkla
doi: 10.5505/ejm.2024.48640  Pages 22 - 28
INTRODUCTION: The superficial temporal artery (STA) is one of the most encountered vessels in neurosurgery and has a significant importance in cerebral bypass surgery. In cerebral bypass surgery, a suitable donor vessel to create the bypass graft close to the recipient artery with suitable size, is essential. The STA can be harvested easily and is readily accessible, minimizing surgical complexity. Using the STA as the donor artery has shown to have lower rates of complications compared to other graft options. It has a low risk of spasm and thrombosis, which could lead to graft failure. Additionally, harvesting the STA does not cause significant damage to surrounding tissues, reducing the risk of postoperative complications. The STA has a robust and consistent blood flow, making it an ideal candidate for grafting during cerebral bypass surgery.

METHODS: Understanding the variations of the STA is important to surgeons who encounter it during an operation. In this cadaveric study, we obtained length and internal elastic lamina diameter measurements of the STA trunk and its branches.
RESULTS: Our cadaveric internal elastic lamina diameters were consistent with the literature’s as well as the STA trunk and frontal branch lengths but the parietal branch length measurements were significantly different from the related literature’s.
DISCUSSION AND CONCLUSION: Further cadaveric studies of the STA must be conducted as a better understanding the anatomy of this vessel by cerebrovascular surgeons.

6.Clinical Characteristics of Hospitalized Patients with Viral Pneumonia Between October 2017 and April 2018
Mihrican Yeşildağ, Bengü Özkan Bakdık, Zühal Şentürk, Taha Tahir Bekçi
doi: 10.5505/ejm.2024.33716  Pages 29 - 38
INTRODUCTION: Respiratory viruses are among the potential seasonal causes of community-acquired pneumonia (CAP) and can lead to severe diseases and deaths in patients at risk. In this study, we aimed to present the clinical features of hospitalized patients who underwent RT-PCR during the seasonal period of October 2017-April 2018.
METHODS: One hundred patients (male, 61%; mean age, 58.37±16.8) were included in the study. Demographic data and clinical and laboratory findings of patients were evaluated retrospectively using medical records.
RESULTS: Multiplex RT-PCR test was positive in 76 (76%) patients. The most found virus type was Influenza A (H1N1). Pneumonia was present in 68 of 100 patients. Bilateral infiltration was significantly higher in pneumonia patients (p<0.0001). Influenza A(H1N1) was found to cause pneumonia significantly higher than other viruses, (p<0.0001). Mortality in all pneumonia patients and those with positive viral cultures was 13.3% and 7.9%, respectively.
DISCUSSION AND CONCLUSION: Viral agents were high in the etiology of CAP causing hospitalization in the seasonal period. Influenza A (H1N1) is seen as the most common cause of viral pneumonia. Bilateral lung infiltration was radiologically observed as the predominant finding of viral pneumonia. Early etiological diagnosis can be achieved with multiplex RT-PCR.

7.Unraveling Oxidative Stress in Moyamoya Disease: Exploring Thiol-Disulfide Dynamics and Ischemia-Modified Albumin
Göksal Günerhan, Özgür Öcal, Emin ÇAĞIL, Zeynep Dağlar, Ayberk Karaman, Uğur Kemal GÜNDÜZ, Harun Demirci, Esra Fırat Oğuz, Ozcan EREL, Ahmet Deniz Belen
doi: 10.5505/ejm.2024.87003  Pages 39 - 46
INTRODUCTION: This study aimed to explore the potential association between oxidative stress markers and Moyamoya Disease (MMD), a complex cerebrovascular disorder characterized by vascular constriction and collateral vessel formation. The study focused on thiol-disulfide homeostasis and ischemia-modified albumin (IMA) levels as indicators of oxidative stress.
METHODS: A total of 23 MMD patients and 23 control subjects were included in the study. Clinical assessments and comprehensive blood analyses were conducted to evaluate factors including age, gender, disease duration, treatment history, and biochemical parameters. Thiol-disulfide homeostasis parameters were measured using an automated method. Ischemia-modified albumin levels were also analyzed. Statistical analyses, including chi-square tests and ROC curve analysis, were performed to determine differences and potential diagnostic cut-off points.
RESULTS: Elevated levels of native thiol, total thiol, and disulfide were observed in the MMD patient group compared to the control group, statistical significant. Ischemia-modified albumin levels were notably higher in the patient group, corroborating the association between oxidative stress and ischemic events. ROC curve analysis identified potential diagnostic cut-off points for these markers. The study also highlighted clinical differences, including BMI, CRP levels, and the frequency of various symptoms, between the patient and control groups.
DISCUSSION AND CONCLUSION: Our study offers insights into the intricate interplay between oxidative stress and Moyamoya Disease. The statistically significant elevated levels of thiol-disulfide markers and ischemia-modified albumin suggest potential links to oxidative stress dynamics within MMD. These findings contribute to our understanding of oxidative stress in cerebrovascular diseases and open avenues for further research.

8.The prenatal use of KANET scoring in fetal isolated mild ventriculomegaly: A single center study
Orkun Çetin, Tuba Bozhüyük Şahin, İpek Dokurel Çetin
doi: 10.5505/ejm.2024.48753  Pages 47 - 50
INTRODUCTION: Kurjak Antenatal Neurodevelopmental Test (KANET) was developed for the assessment of fetal neurobehavior and the detection of neurological disorders. We aimed to evaluate the prenatal use of KANET scoring in fetuses with isolated ventriculomegaly in the third trimester of pregnancy.
METHODS: The present study was planned as a prospective and cohort trial. A total of 75 pregnant women; 41 healthy controls and 34 pregnancies with isolated mild ventriculomegaly fetuses were included to the study. All pregnant women were assessed with KANET scoring by 4 dimension ultrasound in the third trimester of pregnancy. The obstetric outcomes of the pregnant women were also recorded.
RESULTS: The study and control groups exhibited no significant difference with respect to maternal age, body mass index, delivery week and other obstetric outcomes. The KANET scores of the fetuses (16±2 versus 15±2, p: 0.241) were similar between the study and control groups.
DISCUSSION AND CONCLUSION: Prenatally diagnosed isolated mild ventriculomegaly has not any effect on fetal neurobehavior which was assessed by KANET scoring in the third trimester gestation. The frequent and widespread use of 4 dimension ultrasound in obstetric routine practice would improve the early diagnosis of fetal neurological disorders.

9.Adverse Effects of Quarantine on Maternal and Neonatal Vitamin D Levels
Başak Kaya, Hasan Akduman, Nurdan Dinlen Fettah, Dilek Dilli, Seda Aydogan, Ayça Kılıç, Ayşegül Zenciroğlu
doi: 10.5505/ejm.2024.25714  Pages 51 - 55
INTRODUCTION: Vitamin D deficiency, which is considered a global pandemic, has become an even more important problem during the COVID-19 quarantine period. Our aim with this study is to investigate the change in vitamin D levels in babies of pregnant women who could not benefit from UV-B rays during the quarantine period.
METHODS: Retrospective study, and infants with hypocalcemia and low vitamin D levels (<20 ng/mL) hospitalized in the neonatal intensive care unit for any reason were included in the study. The patients were divided into two groups (study group and control group) and compared statistically. Study group of infants affected by the quarantine period (n: 94); The control group was infants (38 infants) who were hospitalized in the neonatal intensive care unit for any reason before the quarantine.
RESULTS: After the coronavirus quarantine period, annual hospitalization rates with the diagnosis of vitamin D deficiency increased from 1.4% to 3% (p: 0.035). There was a significant decrease in serum vitamin D levels of the babies in the study group (p: 0.001). Calcium treatment durations of the babies in the study group were higher than the babies in the control group (p: 0.045).
DISCUSSION AND CONCLUSION: Although it is known that the application of vitamin D and calcium supplementation to women before pregnancy, during pregnancy, and lactation period leads to positive results, especially in newborns during the quarantine period, we should be alert to vitamin D deficiency especially, in newborns in this period.

10.Impact on Medicolegal Responsibilities of High Workload of Emergency Physicians
Yasin Etli, Uğur Demir, Mahmut Aşırdizer
doi: 10.5505/ejm.2024.09582  Pages 56 - 65
INTRODUCTION: High workload, fatigue, and burnout have been found to be associated with increased medical errors and impaired performance. The aim of this study was to evaluate whether medico-legal reports, which are a legal responsibility for doctors in Turkey, could be neglected on days with excessive high workload.
METHODS: In this retrospective cross-sectional study, the daily total number of patients who presented at the emergency department of a state hospital and the number of medico-legal cases reported in a 1-year before and during the Covid-19 pandemic were analyzed. By using a workload score proposed and calculated for this study, the data of the days with and without excessive workload were compared.
RESULTS: As a result, it was determined that the number of medico-legal cases reported by doctors significantly decreased on days when the workload increased excessively. There was a significant correlation between the number of medico-legal cases and the total number of cases on days when the workload score was significantly reduced and it allowed a certain degree of modelling.
DISCUSSION AND CONCLUSION: An excessive workload seems to be caused doctors to neglect their legal medicine responsibilities, which poses a risk to both doctors and patients.

11.Is the Use of Low Molecular Weight Heparin for 15 Days Adequate for Prophylaxis in Patients Undergoing Total Knee Arthroplasty?
Şehmuz Kaya, Abdulrahim Dündar, Mahmut Hudai Turgut, Yunus Can Ünal
doi: 10.5505/ejm.2024.53533  Pages 66 - 69
INTRODUCTION: Venous thromboembolic events, which can occur, if necessary, precautions are not taken after total joint arthroplasty, are a significant cause of mortality. One of the medical treatments used for prevention is low molecular weight heparin. Duration of low molecular weight heparin (LMWH) is used for prophylaxis can vary among physicians.In this study, we compared the effect of the duration of LMWH use on thromboembolic complications within patients, who had total knee arthroplasty.
METHODS: The study is retrospective and data is obtained from total of 224 adult patients over the age of 18. Age, gender, and post-operative complications were evaluated. The patients were separated into two groups as those who used LMWH for 15 days and those who used LMWH for 30 days and the development of thromboembolic complications between the two groups was compared statistically.
RESULTS: Of the 224 patients thrown in the study, %81.7 were women. Group 1 (those who used LMWH for 15 days) consisted of 116 patients, and group 2 (those who used LMWH for 30 days) consisted of 108 patients. The distinction between the two groups regarding deep vein thrombosis (DVT) did not display any statistically significant difference (p=0.943).
DISCUSSION AND CONCLUSION: In DVT prophylaxis in patients undergoing total knee arthroplasty, LMWH for 15 days is as effective as LMWH for 30 days. Therefore, it is sufficient to give LMWH for a short period of time as it is an invasive procedure.

12.The Effect of Movie-Watching on Depression, Anxiety and Stress in Hospitalized Patients with COVID-19: A Randomized Controlled Study
Vesile Eskici İlgin, Ayşegül Yayla, İbrahim Özlü
doi: 10.5505/ejm.2024.93196  Pages 70 - 80
INTRODUCTION: This study was carried out to determine the effect of watching a comedy movie on depression, anxiety, and stress levels in hospitalized patients with COVID-19.
METHODS: This was a randomized controlled study. The population of the study consisted of patients in the pandemic ward of a university hospital in a province located in the eastern region of Turkey. Power analysis was performed to determine the sample size. The study was completed with 53 in the experimental group and 53 in the control group. Patient information form and Depression, Anxiety and Stress Scale (DASS) were used for data collection.
RESULTS: Patients in the experimental and control groups were homogeneous in terms of descriptive characteristics. When DASS depression, anxiety, and stress scores were analyzed according to the descriptive characteristics of the patients in the experimental group, it was determined that patients with seven or more children and chronic diseases had higher anxiety and stress scores (p<0.05). A statistically significant difference was found between the mean depression, anxiety, and stress scores of the experimental and control groups, and it was determined that the depression, anxiety and stress scores of the experimental group were lower compared to those of the control group.
DISCUSSION AND CONCLUSION: In this study, it was found that watching comedy movies, which can be considered as a complementary practice for hospitalized patients with Covid-19, significantly decreased the depression, anxiety, and stress levels of the patients. It was determined that patients with seven or more children and chronic diseases had higher anxiety and stress scores.

13.Investigation of Rotenone Effects on Ovarian Tissue Using Stereological Methods
Neşe Çölçimen, Hülya Özdemir
doi: 10.5505/ejm.2024.37880  Pages 81 - 85
INTRODUCTION: This study aims to stereologically investigate the effects of rotenone on rat ovarian tissue.
METHODS: Within the scope of the study, eighteen female rats were taken and divided into 3 groups as control group, to which physiological saline was administered, vehicle group to which sunflower oil was administered, and rotenone group to which rotenone dissolved in sunflower oil was administered at a dose of 2 mg/kg subcutaneously (s.c.). At the end of the experimental, the right ovarian tissue was excised and removed, and kept in 10% formaldehyde for 72 hours. Then routine histological follow-up process were applied, and the tissues were embedded in paraffin. The sections of 5µm thickness were taken and stained with Haematoxylin-Eosin (H&E) and Masson's trichrome viewed under a light microscope and photographed.
RESULTS: When the histological structure of the ovarian tissue in the rotenone group was examined, it was observed that there was a remarkably decreased in the number of follicles. When the total ovarian tissue volumes of the groups were compared stereologically, it was determined that the total ovarian tissue volume decreased in the Rotenone group and this decrease was statistically significant(p<0.05).
DISCUSSION AND CONCLUSION: As a result, it was determined in our study that Rotenone has harmful effects on the ovary, which is a part of the female reproductive system.

14.Evaluation of Patients Admitted to Intensive Care Unit with Drug Intoxication: Retrospective Analysis of 203 Patients
Ayşegül Bilge
doi: 10.5505/ejm.2024.56578  Pages 86 - 92
INTRODUCTION: The purpose of the present study was to retrospectively analyze the demographic and clinical characteristics of acute drug intoxication patients admitted to the emergency and Intensive Care Unit for follow-up and treatment.
METHODS: The records of the patients who were hospitalized in the Intensive Care Unit with the diagnosis of acute drug intoxication between 01.01.2018 and 01.01.2023 in the XXX Training and Research Hospital were scanned from the hospital data system.
RESULTS: A total of 203 patients (77 men and 126 women) were included in the study. The mean age was found to be 30.83±12.12. The number of patients who had suicidal intoxication was 183 (90%). It was determined that the most common agents of drug intoxication were analgesics (n=94, 46%), antidepressants (n=59, 29%), and antibiotic drugs (n=19, 9.4%). There was a history of depression in 113 (56%) of the patients. The median(IQR) GCS of the cases at the time of admission was 15 (0), and the mean APACHE II Score was 2.16±4.22. A significant relationship was detected between low GCS and increased APACHE II Scores and prolonged stays in the Intensive Care Unit.
DISCUSSION AND CONCLUSION: It was determined that acute drug intoxications occur to commit suicide with rapidly accessible drugs such as analgesics and antidepressants. It is considered that it would be more appropriate to follow-up patients who do not have an indication for Intensive Care Unit hospitalization in emergency departments or wards in terms of improving capacity management.

15.Single center experiences in gall stone ileus: analysis of six cases
Necat Almalı, İskan Çallı
doi: 10.5505/ejm.2024.76401  Pages 93 - 98
INTRODUCTION: Although gallstone-related ileus is rare, it is a serious cause of intestinal obstruction, especially in elderly patients, with a mortality rate of up to 30 %. It occurs when the stone in the gallbladder passes through the cholecysto-duodenal fistula into the gastrointestinal tract due to recurrent cholecystitis attacks and generally causes mechanical obstruction in the small intestines. Computed tomography is the gold standard in a patient whose general condition is not good. Most of the patients are diagnosed intraoperatively during surgery for ileus. Treatment; It is based on stone removal (enterolithotomy) by endoscopic, laparoscopic or open surgical methods.
METHODS: In this retrospective cross-sectional study, 6 patients who were operated for gallstone ileus in the general surgery clinic between May 2017 and May 2022 were included.
RESULTS: This study consists of 6 patients, 4 men and 2 women, who were operated for gallstone ileus within the specified date range.Five of the patients underwent a one-stage procedure, only one patient with poor clinical condition underwent enterolithotomy.
DISCUSSION AND CONCLUSION: Gallstone ileus is a rare and often difficult to diagnose condition. In the management of these patients, each patient should be evaluated individually, and the treatment method to be chosen should be evaluated by considering the general condition of the patient, patient age and the risks of surgery. Colonoscopy or laparoscopy should be preferred, if possible, rather than open surgery.

16.Effect of Bisphenol-A on Thyroid Hormones and Some Biochemical Parameters in Children with Juvenile Diabetes
Halit Diril, Murat Karaoglan, İclal Geyikli Çimenci, Hasan Ulusal
doi: 10.5505/ejm.2024.43650  Pages 99 - 107
INTRODUCTION: This study aims to investigate the effect of serum Bisphenol A (BPA) levels on thyroid hormones and some biochemical parameters in children with newly diagnosed Type 1 diabetes mellitus (T1DM).
METHODS: A total of 139 people, including 74 patients aged 0-18 years who were newly diagnosed with T1DM, 30 healthy siblings of these patients, and 35 healthy children, were included in the study. BPA, apelin, thyroid stimulating hormone (TSH), free T3 (T3), free T4 (T4), thyroglobulin antibody (anti-TG), thyroid peroxidase antibody (anti-TPO), total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, C-peptide and glycosylated haemoglobin (HbA1c) levels were measured in the samples obtained from the volunteers.
RESULTS: Serum BPA concentrations were higher in children with T1DM compared to their siblings and healthy children (p<0.05). The apelin levels in the patient group were observed to be lower than those in their siblings and the healthy children (p<0.05). In all three groups, a negative correlation was identified between BPA and apelin. There was no correlation between BPA and TSH, T3 and T4 levels in all three groups (p>0.05). Similarly, no correlation was detected between BPA and total cholesterol, LDL, HDL, triglyceride, C-peptide, HbA1c, anti-TG and anti-TPO (p>0.05).
DISCUSSION AND CONCLUSION: In summary, this study shows that BPA levels were increased and apelin levels were decreased in children with T1DM, with a negative relationship between the two. Taken together, our results suggest that BPA may have a role in the pathogenesis or progression of T1DM. Low apelin may be associated with the progression of T1DM.

17.The Effect of Diffuse Muscle Uptake on SUVmax Levels in 18F-FDG PET/CT Imaging
Mahsun Özçelik, Aykut Kürşat Fidan
doi: 10.5505/ejm.2024.59319  Pages 108 - 111
INTRODUCTION: The aim of this study is to evaluate diffuse skeletal muscle uptake, which is a factor affecting the distribution of 2-[18F]-Fluoro-2-deoxy-D-glucose (FDG) in the body, and its effect on the SUVmax level of malignant lesions.
METHODS: Twenty-two patients (M/F=12/10) who underwent positron emission tomography-computed tomography (PET/CT) PET/CT scans with FDG and showed diffuse muscle uptake, and whose FDG PET/CT scans were appropriately repeated, were enrolled in the study. Maximised standardised uptake value (SUVmax) levels of malignant foci and normal liver parenchymal activity were measured in images with diffuse muscle uptake and normal uptake. The change in the SUVmax levels of the lesions between the two studies was calculated.
RESULTS: The mean dose of FDG administered to patients in each study was 248.7 (248.7±56.2) megabecquerels. When both images were compared, it was calculated that there was a 38.6% (Std. Deviation 18.7/min: 9%, max: 83%) change in the SUVmax level of the same lesion. While the mean rate of change in the lesion/liver SUVmax ratio for the same lesion was 31%, the median level was recorded as 29.4%.
DISCUSSION AND CONCLUSION: SUVmax and image quality are significantly affected by diffuse muscle uptake. For this reason, the study should be repeated with FDG PET/CT scans in diffuse muscle involvement.

18.Can Monocyte/HDL Ratio Predict The Mortality in Acute Pulmonary Embolism?
Selda Telo, Mutlu Kuluöztürk, Gamze Kırkıl
doi: 10.5505/ejm.2024.03206  Pages 112 - 117
INTRODUCTION: In recent times, monocyte/high-density lipoprotein cholesterol (HDL) ratios (MHR) surfaced as novel markers of inflammation and oxidative stress. This study aims to investigate the short-term prognostic role of the MHR ratios in patients who suffer from acute pulmonary embolism (PE).
METHODS: Two hundred patients who suffered from pulmonary embolism were included retrospectively in the current study. The demographic data along with the laboratory parameters of the patients were obtained from the digital archive system of the facility.
RESULTS: Mortality was seen in 42 (21%) of 200 patients with PE. It was determined that the mean age, mean troponin level, pulmonary artery pressure, monocyte value, and MHR ratios were statistically higher in exitus group compared to the survivor group. The mean MHR value was higher in patients with exitus in 1st month than patients with exitus between 1-6 months (p=0.009). 132 (66%) patients with acute PE had sPESI ≥1, while mean MHR was statistically higher in high-risk patients compared to low-risk PE patients (17.95±12.67, 11.54±5.66, p= 0.001, respectively). For the MHR ratio, when the cut-off value was considered 16.03 in the prediction of PE cases for survival, the sensitivity was 81% and the specificity was 62% (AUC=0.793, p=0.001, CI%= 0.722-0.865)
DISCUSSION AND CONCLUSION: The fact that MHR was higher in exitus group, in high-risk patients and in those patients with exitus in the first 1 month suggested that it may be an important factor in predicting mortality in patients with PE.

19.Detection of Right Ventricular Dysfunction Using LogNNet Neural Network Model Based on Pulmonary Embolism Data Set
Mehmet Tahir Huyut, Andrei Velichko, Maksim Belyaev, Şebnem Karaoğlanoğlu, Bunyamin Sertogullarindan, Abdussamed Yasin Demir
doi: 10.5505/ejm.2024.54775  Pages 118 - 128
INTRODUCTION: The high association of right ventricular dysfunction (RVD) with mortality in patients with acute pulmonary embolism (PE) remains an important health problem. In this respect, rapid, economical and highly-accurate detection of risk factors for early diagnosis of RVD in patients with PE is expected to greatly benefit the diagnosis and treatment of the disease and contribute significantly to the reduction of mortality.
METHODS: The aim of this study is to identify the most effective features from the PE dataset for RVD diagnosis, using a special-algorithm for the LogNNet reservoir neural-network. The cohort of patients diagnosed with acute PE in the last five years in our hospital was retrospectively analyzed and the data in accordance with our criteria were recorded. A total of 163 patients' data were accessed and the patients had 20 characteristics. RVD was diagnosed in 27 of these patients.
RESULTS: 78-79 years of age was found to be an important threshold for the diagnosis of RVD. The LogNNet model revealed that older age, comorbidities and coronary-heart disease greatly increased the risk of RVD. The model also found that individuals with diabetes and COPD were at higher risk of RVD, while individuals with malignancies were at lower risk of RVD. However, the model found that unilateral-thrombus increased the risk of RVD more than bilateral-thrombus.
DISCUSSION AND CONCLUSION: The risk of RVD is high in PE patients with unilateral-thrombus. In addition, PE patients with comorbidities such as coronary heart disease, diabetes and COPD are at high-risk for RVD and should be followed closely.

20.Oxidative Stress, Serum Mineral and Trace Element Levels in Patients with Multiple Sclerosis with or without Restless Legs Syndrome
Şeyma Akçin, Azize Esra Gürsoy, Şahabettin SELEK, Yasin Ali ÇİMEN, Fatmanur Köktaşoğlu, Savas Ustunova, Ismail Meral
doi: 10.5505/ejm.2024.56650  Pages 129 - 137
INTRODUCTION: Multiple sclerosis (MS) is an autoimmune central nervous system disease characterized by inflammation, axonal demyelination and multifocal plaques. Sleep problems due to restless legs syndrome (RLS) are seen at a higher rate in MS patients than in the normal population. In MS and RLS patients, changes in oxidative stress level and liver enzyme activity and deterioration of trace element homeostasis are observed. This study was conducted to determine serum oxidative stress parameters and trace element levels in MS patients with or without RLS.
METHODS: Thirty healthy individuals (control), 30 MS patients without RLS (MS group) and 30 MS patients with RLS (MS+RLS group) were included in the study (between April 2021-January 2022). Serum oxidative stress parameters (total antioxidant and oxidant capacities, myeloperoxidase and catalase activities), some liver enzymes (malate dehydrogenase and isocitrate dehydrogenase) activities, trace element (copper, zinc and iron) and mineral (calcium, chlorine, magnesium, sodium, potassium) levels were measured.
RESULTS: There was no difference among groups in terms of oxidative stress parameters and liver enzymes (P>0.05). Serum chlorine, potassium and sodium levels were higher (P<0.001, P<0.01, P<0.001, respectively) in MS+RLS group compared to controls. Although zinc level was lower (P<0.05), Na+ and Cu- levels were higher (p<0.01, 0.05, respectively) in MS+RLS group compared to controls.
DISCUSSION AND CONCLUSION: Based on these results, varying trace element levels may have value for early prediction of RLS in MS. In studies with larger sample sizes, changing element and liver enzyme activities in the context of oxidative stress may provide clearer information about the diagnosis of RLS.

21.The Real Ophthalmologic Emergency: Orbital Compartment Syndrome and its Management
Çağatay Çağlar
doi: 10.5505/ejm.2024.93653  Pages 138 - 140
Retrobulbar haemorrhage is a rare ophthalmic emergency observed following blunt eye trauma. Orbital compartman syndrome (OCS) may be due to a traumatic excessive retrobulbar hemorrhage. Early diagnosis and immediate lateral canthotomy/cantholysis must be performed to save the vision of the affected eye. Medical treatment can be considered in addition to surgical therapy. In this case report, we aimed to present a patient with orbital compartman syndrome and its management.

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