ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 29 (4)
Volume: 29  Issue: 4 - 2024
ORIGINAL ARTICLE
1.Assessment of the Effect of Glucocorticoid Injections on the Expression of Apoptotic Active CASP3 and ALDH1A1 Renal Cell Markers in New Zealand Rabbits
Khalida I. Noel, Nibras H. Khamees, Hayder H. Abdulateef
doi: 10.5505/ejm.2024.39049  Pages 397 - 405
INTRODUCTION: Acute kidney injury (AKI) is a suspected renal insult which developed from different causes, one of these causes is the administration of high doses of glucocorticoids for long period of time as dexamethasone, which has a wide variety uses in different types of illnesses, inflammatory or immunological problems.
Aim:
To examine the effect of different doses of dexamethasone in producing immunohistochemical changes on renal tissues in a different period of administration using cellular markers (Active CASP 3 and ALDH1A1) in rabbits.

METHODS: Eight groups of white New Zealand female rabbits were used, seven animals in each group. The first and second (G1 and G2) groups served as control groups. G3 and G4 groups are treated groups injected with (0.5 and 1.5 mg/kg body weight of dexamethasone respectively) for 10 days. G5 and G6 were also treated groups where they treated with (0.5 and 1.5 mg/kg body weight of dexamethasone respectively) for 15 days. G7 and G8 considered as follow up groups for G4 and G6 groups where they left without treatment for another 10 days for both groups. The renal tissue examined in all groups histologically by using H & E stain, and immunohistochemistry by Active CASP3 and ALDH1A1 markers.
RESULTS: Moderate expression of Active CASP 3 in most of treated and follow up groups with strong expression of ALDH1A1 in most of treated and follow up groups in comparison to control groups (G1 and G2) which was statistically significant.
DISCUSSION AND CONCLUSION: Dexamethasone produces a pseudo acute kidney injury healed after discontinuation of drug.

2.Association of abortion stigma and psychological flexibility in women who had termination of pregnancy due to fetal anomalies
Isil Ayhan, Esra Demiryürek, Ceren Unal, Lütfiye Uygur, Oya Demirci
doi: 10.5505/ejm.2024.87405  Pages 406 - 412
INTRODUCTION:
To assess factors associated with stigmatizing behaviour and beliefs in women who had termination of pregnancy due to fetal anomalies.


METHODS:
This was a cross-sectional study of women who had pregnancy termination due to fetal anomalies and age-matched pregnant women as controls, conducted between January – December 2023, at a tertiary fetal medicine center. The participitants completed the Turkish-validated version(1) of Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS)(2) and psychological flexibility scale(3, 4) upon admission. Maternal sociodemographic and obstetric history data were collected and analyzed with the questionnares.
RESULTS:
Abortion stigma was low in both groups (mean scores 30 vs. 31, out of the maximum score of 90, p=0.65). Psychological flexibility was higher among the control group (132 vs. 109, p<0.001). Higher education and higher economic status were inversely related to abortion stigma (26±7 vs. 33±9, p=0.0014 and 26±7 vs. 31±10, p=0.05, respectively). Women who had at least one child had more stigma towards pregnancy termination compared to women who do not have any children (32±9 vs. 27±8, p=0.02). Timing of termination of pregnancy (first vs. second trimester), maternal age, presence or absence of aneuploidy screening test, time from diagnosis to termination were not factors associated with abortion stigma.
DISCUSSION AND CONCLUSION:
We have shown that abortion stigma is low among women who had to terminate their pregnancy. Stigmatizing beliefs and behaviours are positively associated with having at least one child, and negatively associated with higher education and higher economic status.

3.Is it in our genes that we're going to have pulmonary embolism?
İbrahim Halil Uney, Ahmet Arisoy, Aysel Sunnetcioglu, Buket Mermit Çilingir, Hanifi Yıldız, Hulya Gunbatar, Selami Ekin, Selvi Asker
doi: 10.5505/ejm.2024.23911  Pages 413 - 418
INTRODUCTION: Pulmonary thromboembolism is a disease with high mortality and morbidity, which can be recurrent, difficult to diagnose, yet preventable and treatable. In this study, our aim was to evaluate comorbidities, risk factors, laboratory results, and clinical scoring in patients diagnosed with pulmonary embolism. Our primary goal was to detect genetic mutations in cases of pulmonary embolism with acquired risk factors.
METHODS: Our study is a prospective study that includes clinical information, laboratory tests, Wells scoring, admission, and the prospective history of 60 patients with no previous history of venous thromboembolism (VTE) and no history of anticoagulation use. These patients were admitted to the chest diseases outpatient clinic, emergency department, or hospitalized for another reason and diagnosed with pulmonary thromboembolism.
RESULTS: The mean age of the patients was 59.9 ± 18.7 years. There were at least one genetic/congenital risk factor in all cases and at least two risk factors in more than half of the cases. The most common mutations were plasminogen activator inhibitor type 1 (PAI-1) and Methylenetetrahydrofolate Reductase (MTFHR) heterozygote mutations.
DISCUSSION AND CONCLUSION: Pulmonary embolism continues to be a more prevalent disease with increasing age and associated risk factors. Since there is at least one acquired risk factor in all of our cases, we think that almost every patient may have acquired risk factor if the history is deepened. We also think that genetic or thrombophilic conditions may be detected in almost all cases diagnosed with pulmonary embolism.

4.Measuring Out-of-Field Dose to The Whole Brain in Radiotherapy
HİKMETTİN DEMİR, Osman VEFA GÜL, TAYLAN Tuğrul
doi: 10.5505/ejm.2024.25307  Pages 419 - 425
INTRODUCTION: Purpose: The aim of this study is to measure out-of-field lens and thyroid doses in whole brain radiotherapy with thermoluminescence dosimeters (TLD) and compare them with treatment planning system (TPS) calculation values.
METHODS: Materials and Methods: Before Computed Tomography (CT), TLDs were placed on the lens and thyroid surfaces of the random phantom and then the phantom was scanned with computed tomography. Data was transferred from CT to RayStation™ TPSs and then target volume and critical organs were determined. The treatment plan was created. TLDs were placed on the lens and thyroid for out-of-field dose measurement.
RESULTS: Results: For the right lens, the mean values of TLD measurement were 188.3±2.2 cGy and the mean values of TPS measurement were 192.0±0.2 cGy. The average TLD measurement for the left lens was 190.2±0.5 cGy, and the average TPS dose reading was 192.0±0.1 cGy. For doses in the thyroid region, which is further from the target, the TLD measurement and TPS reading averages were 44.9±5.2 cGy and 40.9 cGy, respectively. Accordingly, right lens point doses calculated from TPS were 1.93% higher than TLD measurements. For the left lens, this difference in the same direction was determined as 0.93%. Within the thyroid region, TLD measurements were observed to be higher than TPS readings.
DISCUSSION AND CONCLUSION: Conclusion: We measured out-of-field doses via TLDs and found that TPS calculations for thyroid were 8.90% lower than the measured dose. The results we obtained from our study are guiding in estimating out-of-field lens and thyroid doses in 3DCRT whole brain irradiation.

5.Comparison of Robson Classification in adolescent pregnant with adult pregnant
Samet Osman Gunkaya, Melih Bestel, Seher Koyuncu aydın, Esra AYANOGLU, Ismail Bağlar, Niyazi Tug
doi: 10.5505/ejm.2024.43799  Pages 426 - 432
INTRODUCTION: The number of cesarean sections performed worldwide is increasing day by day. Establishing a common classification system for cesarean births is important in understanding what factors lead to the increase in these procedures. The aim of our study is to identify trends in adolescent cesarean births by applying the Robson classification, compare them with the adult group, and examine the groups that make the most significant contribution to the increasing rates.
METHODS: This retrospective cohort study documented information on birth weight, mode of delivery, gestational age at birth, parity, maternal gestational age, cesarean indications, and ten-group Robson Classification in pregnant adults and adolescents.
RESULTS: The cesarean section rate in adult pregnant women was 39.4%, and the cesarean section rate in adolescents was 14.8%. Group 5 made the biggest contribution to cesarean section rates in both the adult group and the adolescent group. Group 5 was statistically significantly higher in adult cesarean deliveries (p <.001). Other groups where adult cesarean section was significantly more common were group 3 and group 8 (8%; p=0.009, 4.4% p=0.001, respectively). In adolescent cesarean delivery, significant cesarean contributions in group 1, group 2 and group 6 were higher in the adolescent group (23.5%; p< 0.001, 16.3%; p< 0.001, 16.3%; p< 0.001).
DISCUSSION AND CONCLUSION: The contribution of adult pregnant women and adolescent pregnant women to cesarean section rates varies. This study reveals the need for trained health personnel who are prepared and scheduled to attend teenage births.

6.Predicting Mortality in Status Epilepticus: Elixhauser Comorbidity Index and SOFA in ICU
Dilek Agircan, Adalet Gocmen
doi: 10.5505/ejm.2024.47887  Pages 433 - 439
INTRODUCTION: High mortality rates in status epilepticus (SE) within intensive care units (ICU) underscore the need for effective predictive scores to improve patient outcomes. While SE-specific scoring systems are commonly used, the role of comorbidity indices in mortality prediction is less explored. This study assesses the prognostic efficacy of various scoring systems in predicting hospital mortality among critically ill SE patients in the ICU.

METHODS: We conducted a retrospective analysis of 103 SE patients treated in the ICU at XXX University Medical Faculty Hospital from 2013 to 2023. Patients with myoclonic seizures due to cardiac arrest were excluded. The key scoring systems analyzed included the Elixhauser Comorbidity Index (ECI), Status Epilepticus Severity Score (STESS), Encephalitis, Non-convulsive SE, Diazepam resistance, Image abnormalities, and Time to first treatment (END-IT), Acute Physiology and Chronic Health Evaluation-II (APACHE Ⅱ), Sequential Organ Failure Assessment (SOFA), Modified Rankin scale (mRS) and Glasgow coma scale (GCS). Univariate and multivariate logistic regression, along with ROC curve analysis, were used to identify mortality predictors.
RESULTS: Out of 103 patients, 54 met the study criteria, with 29 (54%) hospital deaths. Univariate analysis identified ECI, mRS, GCS, STESS, END-IT, APACHE II, and SOFA as significant mortality predictors. Multivariate analysis showed that ECI and SOFA were strong independent predictors. SOFA had an AUC of 0.848, close to ECI's 0.875 in predicting mortality.
DISCUSSION AND CONCLUSION: ECI and SOFA scores emerged as superior predictors of mortality in ICU patients with SE, suggesting that a broader approach considering systemic illness and comorbidities is crucial for prognosis, beyond SE-specific scoring systems.

7.Prenatal diagnosis of congenital pulmonary airway malformation (CPAM) types: Case series
Neval Cayonu Kahraman, Nazan vanlı tonyalı, Gokcen Orgul, GULSAH AYNAOGLU YILDIZ, Yaprak Engin-Ustun
doi: 10.5505/ejm.2024.28913  Pages 440 - 445
INTRODUCTION: This study retrospectively aims to evaluate nine cases of congenital pulmonary airway malformation (CPAM) diagnosed during the prenatal period. Prenatal diagnosis of CPAMs is critical in the diagnosis of fetal thoracic malformations. Case studies provide a better understanding of the clinical course, treatment options, and outcomes of CPAMs.
METHODS: Cases with prenatally diagnosed lung lesions screened in the high-risk pregnancy category between October 2021 and February 2024 were analyzed retrospectively. The characteristics, location, and accompanying findings of the lesions were evaluated by perinatology specialists. The diagnosis of CPAM was categorized based on prenatal ultrasound images.
RESULTS: This study show the demographic characteristics and clinical findings of the patients with CPAM. In our study, the mean age was 33 years, and the median week at diagnosis was 21 weeks and 2 days. The median birth weight was 2970 gm. The rate of vaginal delivery was 55.6%, while additional anomalies were detected at a rate of 66.7%. Most lesions were located in the right lung and had a cystic or solid-cystic nature. The distribution according to CPAM type was 22.2% type 1, 33.3% type 2, and 44.4% type 3. According to the results obtained by analyzing nine cases, two cases resulted in termination, regression was observed in two cases, and postnatal surgery was performed in one case. One case was followed up postnatally.
DISCUSSION AND CONCLUSION: This study examined the clinical course, treatment options, and outcomes of rare cases diagnosed with CPAM. The results highlight the importance of prenatal and postnatal processes of diffeternt types of CPAM.

8.Type and Fusion Identification by Age and Sex in Human Hyoid Bone Using 3D CT Images in a Turkish Sample
Gizem Demet Mutlu, Mahmut Asirdizer, Erhan Kartal, Sıddık Keskin, İsmail Mutlu, cemil göya
doi: 10.5505/ejm.2024.70370  Pages 446 - 454
INTRODUCTION: The morphometric measurement of the hyoid bone has been extensively studied in the literature, although morphological evaluations are covered in a limited number of studies. The aim of this study was to ascertain the fusion status and hyoid bone type and their relationships with age groups and sex.
METHODS: An examination was made of computed tomography scans of 320 patients. The types and degrees of fusion of the hyoid bone were determined.
RESULTS: Hyoid type-U was most frequently observed in males (25.6%), type-D in females (31.9%) and the overall population (30.8%). There was no statistically significant difference in fusion formation on the right and left sides (p>0.05). The number of bones with fusion increased in both sexes with age (p=0.000). The earliest fusion observed was in a case aged 16 years, and 50% of the cases did not have fusion at age 61 years or older. Unlike previous studies, hyoid type and fusion status were evaluated using discriminant function analysis.
DISCUSSION AND CONCLUSION: Hyoid type and fusion cannot be indicative criteria for sex and age determination, but it might be feasible to accurately identify a person younger than twenty years old. The data obtained in the current study can be considered to make an important contribution to future studies.

9.Evaluation of the Relationship Between the Degree of Coronary Collateral Circulation and Levels of Androgens in Male Patients with Coronary Artery Disease
Aslan Erdoğan, Ender Özgün Çakmak, AHMET KARADUMAN, Ahmet Güler, Cevat Kirma
doi: 10.5505/ejm.2024.25478  Pages 455 - 461
INTRODUCTION: Coronary collateral circulation (CCC) comprises vascular pathways that activate in severe coronary stenosis to preserve perfusion. This study investigates the relationship between CCC development and male sex steroids.


METHODS: A retrospective analysis was performed on 149 male patients with ≥95% stenosis in epicardial coronary arteries and 29 with normal coronaries, identified via coronary angiography between January 2017 and December 2023. The cohort included 29 control patients, 99 with well collateral flow (WCF), and 50 with poor collateral flow (PCF). Serum levels of total testosterone, free testosterone, dehydroepiandrosterone sulfate (DHEA-S), and sex hormone-binding globulin (SHBG) were measured. Logistic regression was used to analyze the relationship between sex steroid levels and collateral development.
RESULTS: The PCF group exhibited higher rates of diabetes mellitus (p=0.01) and smoking (p<0.001). The WCF group had significantly higher levels of total testosterone (350.6 ± 78.5 vs. 273.8 ± 59.9 ng/dL, p<0.001), free testosterone (12.1 ± 3.3 vs. 7.2 ± 2.0 pg/mL, p<0.001), DHEA-S (180.5 ± 69.5 vs. 131.9 ± 87.9 μg/dL, p<0.005), and SHBG (35.3 ± 11.0 vs. 24.8 ± 6.9 nmol/L, p<0.005). Multiple logistic regression revealed that DM [OR = 1.923, 95% CI (1.041–4.092), p = 0.012] directly predicted PCF, whereas free testosterone [OR = 0.689, 95% CI (0.557–0.851), p < 0.001] and SHBG [OR = 0.903, 95% CI (0.849–0.960), p = 0.001] were inversly predictors.
DISCUSSION AND CONCLUSION: The study highlights the important role of sex steroids in coronary collateral development, with free testosterone and SHBG as key predictors of CCC levels in men with coronary occlusion.

10.Case Series: 11 Cases of Hemolytic Disease of The Fetus And Newborn Due to Kell Blood Group Incompatibility
Eyyüp Yürektürk, Nur AYCAN, MURAT BAŞARANOĞLU, BİLAL ARSLAN, Oğuz Tuncer
doi: 10.5505/ejm.2024.55453  Pages 462 - 466
INTRODUCTION: Hemolytic disease of the fetus and newborn (HDFN) results from the destruction of the newborn's red blood cells or the fetus by the mother's immune globulin G antibodies. Although HDFN is often caused by RhD and ABO incompatibility, it can also be seen due to minor blood groups such as Kell, Kidd, Duffy, P, MNS, or Rh subgroup (C, c, E, e) alloantibodies. Our study aims to share our experiences regarding a rare cause of HDFN.
METHODS: The files of patients who were followed up with the diagnosis of jaundice in a third-level Neonatology Unit of a university hospital between January 2014 and September 2023 were retrospectively examined. Eleven patients with Kell incompatibility were included in the study.
RESULTS: There was no ABO/RhD incompatibility in any case. RhD subgroup incompatibility and Kell incompatibility were present in four cases. Phototherapy was applied to all patients. The patient, whose total bilirubin level was high despite phototherapy, was treated with an exchange transfusion. No complications were observed due to treatment or high total bilirubin. No significant difference was observed between the parameters evaluated according to the gender variable.
DISCUSSION AND CONCLUSION: It should be kept in mind that severe hemolysis and related deaths may occur due to Kell incompatibility. In order to reduce and prevent severe hemolysis due to Kell and other minor blood groups in newborns, transfusing blood products suitable for minor blood groups to women of childbearing age (especially pregnant women) may be a correct approach as a country policy.

11.Comparison of the efficacy of auditory steady-state response (ASSR) and otoacoustic emission (OAE) in neonatal hearing screening
Mehmet Zeki Erdem, Mehmet Fatih Garça
doi: 10.5505/ejm.2024.22465  Pages 467 - 477
INTRODUCTION: To investigate the correlation among auditory steady-state response (ASSR) and transient evoked otoacoustic emission (TEOAE) and screening brainstem auditory evoked response (s-BAER) tests in children with sensorineural hearing loss (SNHL).
METHODS: TEOAE, multiple-ASSR, and click s-BAER recordings and analyses of 30 healthy newborns and 74 newborns with high-risk of SNHL were performed prospectively. The three techniques were compared between healthy and high-risk SNHL newborns. In addition, average test durations were calculated in minutes.
RESULTS: Hyperbilirubinemia requiring transfusion was the most common risk factor in the high-risk SNHL group. In the ASSR test, the rate of failure was higher at low frequencies and was dramatically lower at high frequencies. In both ASSR and TEOAE, the sensitivity and accuracy rates increased at high frequencies. Average test duration (including preparations) was 30.2±6.45 min for multiple-ASSR, 1.26±0.81 min for TEOAE, and 1.86±0.87 min for s-BAER.
DISCUSSION AND CONCLUSION: Multiple-ASSR was found to be more sensitive in predicting behavioral hearing status compared to TEOAE. Based on our findings, we consider that multiple-ASSR is an objective test that can be used safely in predicting rapid frequency-specific behavioral hearing of bilateral ears simultaneously without requiring practitioner’s interpretation, particularly in high-risk neonates. However, further evidence and studies are needed to ensure that the newborn’s hearing prediction alone is sufficient.

12.Prognostic implications of baseline and new-onset fragmented QRS complex in patients undergoing transcatheter aortic valve implantation
Aykun Hakgör, Atakan Dursun, Aysel Akhundova, Melike Zeynep Kenger, Ümeyir Savur, Emir Derviş, Muhammed Furkan Çeleğen, Bilal Boztosun
doi: 10.5505/ejm.2024.01979  Pages 478 - 486
INTRODUCTION: Fragmented QRS complex (fQRS), which can be easily detected by electrocardiography (ECG), is an indicator of myocardial fibrosis and has adverse prognostic impact in cardiovascular diseases. The aim of this study was to investigate the effect of the presence of both pre- and post-operative fQRS on short- and long-term prognosis in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS).
METHODS: Data of 615 patients who underwent TAVI from different risk categories in a single-center were retrospectively screened and 289 patients were included after exclusion criteria. The presence of fQRS was recorded on pre- and postoperative ECGs and the effect of the fQRS on in-hospital and 2-year all-cause mortality was investigated.
RESULTS: fQRS was detected in 85 (29.4%) patients before TAVI and also 24 (11.8%) patients had new-onset fQRS after TAVI. The presence of preop fQRS was found to be an independent predictor of in-hospital mortality. Postop fQRS, moderate or severe paravalvular aortic regurgitation and high systolic pulmonary artery pressure were associated with long-term mortality. In addition, patients with preop fQRS were more likely to need permanent pacemaker implantation after TAVI (14.1% vs. 2.9%).
DISCUSSION AND CONCLUSION: fQRS, which can be considered an indicator of subclinical left ventricular dysfunction due to myocardial fibrosis, is associated with decreased short- and long-term survival in patients undergoing TAVI. The presence of preop fQRS and postop new-onset fQRS is associated with a 3.8- and 3.2-fold increased cumulative mortality risk, respectively, at 24-month follow-up compared to patients without fQRS.

13.The relationship between Selvester QRS score and myocardial performance index in patients with STEMI treated by primary percutaneous coronary intervention
Serdar Söner, Gamze Yeter Arslan, Önder Özturk, ERKAN BAYSAL, Ercan Taştan, Adnan Duha Cömert, Metin Okşul
doi: 10.5505/ejm.2024.23355  Pages 487 - 493
INTRODUCTION: Electrocardiography (ECG) can be used to evaluate myocardial perfusion by using Selvester QRS score. The myocardial performance index (MPI), which is easily assessed by echocardiography (ECHO), is a technique that assesses both systolic and diastolic function regardless of ventricular shape. Our aim was to compare the association between MPI and Selvester QRS score in ST segment elevation myocardial infarctus (STEMI) patients.
METHODS: Prospectively and sequentially, 101 patients with STEMI who came to our hospital between December 1, 2015, and September 31, 2017 were included in the research. The echocardiographies and ECGs performed between 24-48 hours of admission. Based on MPI value we separated the population into two groups. We considered patients with MPI≥ 0.4 as group 1, and patients with MPI <0.4 as group 2.
RESULTS: The mean age of the patients was 57,6 ± 11 years with 17% being female. The MPI and Selvester QRS score showed a positive correlation (coefficient: 0.501, p<0.001). A negative correlation was found between MPI and EF (coefficient: -0.353, p = 0.001) and GFR (coefficient: -0.219, p = 0.028).In multivariable logistic regression analysis Selvester QRS score was an intependent predictor of MPI (%95 CI: 0.599-0.981, p=0.035). In the ROC-curve analysis performed for MPI and Selvester QRS score, 69% sensitivity and 60% specificity were found for the Selvester QRS score cut-ff value of 3.5 (%95 CI: 0.656-0.848, AUC: 0.752, p <0.001).
DISCUSSION AND CONCLUSION: Our study's findings indicate that we may predict left ventricular MPI in STEMI patients receiving primary PCI by using the Selvester QRS score.

14.Thyroid Function Tests and Thyroid Antibody Tests in Ectopic Pregnancies: A Prospective Cohort Study
Şerif Aksin, Mehmet Yilmaz, Deniz Balsak, Yasmin Aboalhasan, Adem Yoldaş, ibrahim batmaz
doi: 10.5505/ejm.2024.65768  Pages 494 - 502
INTRODUCTION: Thyroid hormone levels have been observed to induce structural changes in different regions of the fallopian tube. This study aimed to investigate the impact of thyroid hormones on ectopic pregnancy.

METHODS: In pursuit of this objective, 31 patients with ectopic pregnancy were monitored at Siirt University Training and Research Hospital between July 2022 and December 2022. Additionally, a total of 31 patients with normal first-trimester pregnancies, matched for age, parity, and gestational week, were included in the control group. Various parameters, including patient age, pregnancy history, medical history, treatment methods, clinical and demographic data, TSH, fT3, fT4, TT3, TT4, Thyroglobulin, Anti-thyroglobulin Antibody, TSH receptor antibody (TrAB), Anti-Peroxidase Antibody, Anti-Tyroglobulin Antibody, hemogram, biochemistry, CRP, and sedimentation values, were compared.Clinical Trials no: NCT05446012


RESULTS: Statistically significant differences were noted in Free T3 (p = 0.011) and thyroglobulin (p = 0.018) values between the ectopic pregnancy and control groups. Subsequent ROC analysis was conducted for the significant parameters, determining the AUC (Lower and Upper Bound), sensitivity, specificity, and cut-off values for each parameter. Multivariate logistic regression analysis followed, wherein the "backward stepwise model" was applied to the Free T3 parameter. The apparent parameter indicating an increased risk in the disease was Free T3, with a 4.2-fold increase and a 95% CI of [1.3-13.5]. Lower Free T3 levels were associated with an elevated risk of ectopic pregnancy.


DISCUSSION AND CONCLUSION: The assessment of Free T3 levels during pre-pregnancy counseling may aid in identifying pregnant women at risk of ectopic pregnancy.



15.Efficacy of inthratecal therapy in breast cancer patients with Leptomeningeal Metastasis
Nijat Khanmammadov, Izzet Dogan, Melin Aydan Ahmed, Anıl YILDIZ, Nihan Nizam, Bayarmaa Khishigsuren, Abdulmunir Azizy, Sezai Vatansever, Pınar Saip, Adnan Aydiner
doi: 10.5505/ejm.2024.42890  Pages 503 - 508
INTRODUCTION: Leptomeningeal metastases ( (LM) occurs in approximately 5% of individuals diagnosed with metastatic breast cancer (BC). Both systemic and inthratecal (IT) agents can be used for treatment. However, data to support the effectiveness of IT therapy are insufficient. The primary aim of this study was to assess the efficacy and safety of IT therapy in BC patients with LM.
METHODS: This was a retrospective observational study. SPSS version 27 was used for statistical analysis. Kaplan–Meier and Cox regression analyses were used for survival analysis.
RESULTS: The study included 14 patients (median age, 52 years). The predominant histopathological types were invasive ductal carcinoma (57%) and invasive lobular carcinoma (36%). IT methotrexate was used in 9 (64%) patients, and IT trastuzumab was used in 5 (36%). Notably, 36% of patients achieved a partial response, 14% achieved a stable response, and 50% showed disease progression. It was found that approximately 50% of patients with positive cerebrospinal fluid (CSF) cytology became negative after treatment. Furthermore, toxicity of grade 2 or higher was observed in 49% of patients. The median progression-free survival (PFS) duration among patients who received methotrexate was 1.46 months (95% CI, 0.29–2.0) and among those who received trastuzumab was 5.1 months (95% CI, 0–13.1). The median overall survival (OS) duration among all patients was 3.8 months.
DISCUSSION AND CONCLUSION: LM is an indicator of poor prognosis among patients with breast cancer. However, IT therapy is one of the few treatment options. IT trastuzumab should be considered as a treatment option in HER2-positive BC patients with leptomeningeal metastasis.

16.The Relationship between Entrapment Level of the Nerve and Upper Extremity Function and Sleep Quality in Ulnar Neuropathy Patients
Volkan Şah, Caner Baydar, Muhammet Okay Örün, Sadi Elasan
doi: 10.5505/ejm.2024.03366  Pages 509 - 517
INTRODUCTION: There are few studies on sleep and upper extremity dysfunction in ulnar nerve entrapment neuropathy, despite previous demonstrations of deterioration in sleep quality and a decrease in functional activity level in carpal tunnel syndrome. This study aims, for the first time in the scientific literature, to compare sleep and dysfunction between clinical conditions that occur at the two levels where the ulnar nerve is most commonly entrapped (elbow/cubital tunnel and wrist/Guyon’s canal).
METHODS: 20 (twenty) patients diagnosed with 'Ulnar entrapment neuropathy' by clinical evaluation and EMG (Electromyelography) were included in the study. The values of motor and sensory conductions were recorded according to the entrapment levels in EMG. The Disabilities of the Arm, Shoulder and Hand (DASH) index was used to evaluate upper extremity function and the Pittsburg Sleep Quality Index (PSQI) was used to determine sleep disorders.
RESULTS: The average DASH score of patients with wrist entrapment (Guyon's canal) was found to be worse than the DASH score average of patients with cubital tunnel entrapment. The mean PSQI score of patients with entrapment in the wrist (Guyon's canal) was found to be higher than the mean PSQI score of patients with cubital tunnel entrapment. However, these differences were not statistically significant (p = 0.210 and p = 0.787, respectively).
DISCUSSION AND CONCLUSION: Symptom severity in ulnar entrapment neuropathy syndrome negatively affects functional status and sleep quality. In the treatment of ulnar entrapment neuropathy, treatments aimed at restoring not only entrapment symptoms but also upper extremity function and sleep quality should be considered.

17.Evaluation of Skin Prick Test Results in Erzurum Region
Fatih Öner, Ümran Öner
doi: 10.5505/ejm.2024.37891  Pages 518 - 523
INTRODUCTION: The skin prick test (SPT) is frequently used to detect allergen sensitivity in disorders such as atopic dermatitis, chronic urticaria, allergic rhinoconjunctivitis, and asthma. The study evaluated allergen sensitivity with SPT in the Erzurum region.

METHODS: Patients who underwent SPT diagnosed with atopic dermatitis, chronic urticaria, angioedema, idiopathic generalized pruritus, allergic rhinitis, and allergic conjunctivitis were prospectively included in our study. House dust mites, animal hairs, fungi, pollen, and cockroach epithelium were applied as aeroallergens. Chicken, fish, mutton, beef, milk, egg yolk, egg white, banana, kiwi, strawberry, peach, tomato, peanut, hazelnut, walnut, cocoa, and cereals were applied as food allergens.
RESULTS: The study included 110 patients. At least one allergen was positive in 58 (52.7%) patients. At least one of the aeroallergens was positive in 53 patients (48.2%), and the most common aeroallergen was house dust mites (26.4%). In 17 patients (15.5%), at least one of the food allergens was positive, and the most common food allergen was banana (8.2%). There was no statistically significant difference in allergen positive between patients with atopic dermatitis (17/27), chronic urticaria (13/25), angioedema (3/7), pruritus (16/34), and allergic rhinitis (16/30). However, in patients with allergic conjunctivitis (2/11), the rate of allergen positivity was found to be significantly lower (p<0.01).
DISCUSSION AND CONCLUSION: We detected the most common house dust sensitivity in patients with atopic dermatitis and chronic urticaria, and pollen sensitivity in patients with pruritus and allergic rhinitis. Studies involving more patients with angioedema and allergic conjunctivitis are needed.

18.Esculetin improves chemotherapy-induced impaired anxiety-depression-like behaviors and learning activity
Filiz Taşpınar, Mehmet Öz
doi: 10.5505/ejm.2024.85353  Pages 524 - 530
INTRODUCTION: This study aimed to assess the neuroprotective effectiveness of esculetin in preventing cognitive and emotional impairments caused by chemotherapy.
METHODS: In order to cause cognitive impairment in mice, a single intraperitoneal dosage of methotrexate (Mtx) at a concentration of 40 mg/kg was administered. Esculetin (Elt) was administered orally at a daily dose of 40 mg/kg one week before the Mtx injection. The locomotor activity was assessed using the Pole (PT) and open field (OF) tests. Anxiety-like behaviors were evaluated using the open field and elevated plus maze (EPM) tests. Depression-like behaviors were assessed using the tail suspension test (TST). Learning and memory activity was evaluated using the novel object recognition test (NOR).
RESULTS: Mtx did not affect the locomotor activities of mice, but anxiety-like behaviors were found to be increased in the OF and EPM tests. It also increased the duration of immobility in the TST, causing a negative discrimination index in the NOR. Elt alleviated anxiety and depression-like behaviors generated by Mtx and enhanced cognitive function related to learning and memory. Elt significantly increased the time spent in the center zone in the OF test, the total time spent in the open arms in the EPM, and the immobility time in the TST. Moreover, it improved the discrimination index in NOR, which had been reduced by Mtx.
DISCUSSION AND CONCLUSION: Administering a single dose of Mtx at 40 mg/kg resulted in increased anxiety and depression-like behaviors, impaired learning and memory functions. Besides that, supplementing with Elt significantly mitigated the neurological impairments caused by Mtx.

19.Comparison of Tuberculosis Skin Testing and QuantiFERON-TB Gold Plus Test in Yazidi Refugees
Recep Tekin, Zehra Kılınç, İsmail Yıldız, Günay Saka
doi: 10.5505/ejm.2024.37630  Pages 531 - 534
INTRODUCTION: The aim of this study was to determine the diagnostic value and performance of of the QuantiFERON®-TB Gold Plus (QFT-Plus) test with the tuberculosis skin test (TST) as a screening test for tuberculosis in Yazidi refugees.
METHODS: The study involved 100 adults who had migrated to our country and were currently residing in refugee camp. The Purified Protein Derivative (PPD) screening test was conducted using the Monteoux method and the size of induration above 15 mm with BCG scars and above 10 mm without BCG scars were considered as positive. The QuantiFERON®-TB Gold Plus test was performed using the interferon-gamma release detection method.
RESULTS: In the study, 49 out of the included individuals (52.1%) tested positive for the QuantiFERON®-TB Gold Plus test, while 59 individuals (62.8%) tested positive for TST. Of the participants, 43 (45.7%) were positive for both TST and QFT-Plus, 9 (9%) were positive for TST but negative for QFT-Plus, and 6 (6%) were negative for TST but positive for QFT-Plus. The study found a positive correlation between the results of the QuantiFERON-TB Gold Plus and TST. The sensitivity and specificity of the test were 82.6% and 85.7%, respectively, when evaluated according to TST.
DISCUSSION AND CONCLUSION: We can recommend QFT-Plus test for the detection of latent tuberculosis infection as an alternative to TST in refugees populations.

20.The effect of cerclage procedure timing and placental localization on pregnancy outcomes in pregnant women who underwent cervical cerclage
Hüseyin Durukan, Yusuf Dal
doi: 10.5505/ejm.2024.33678  Pages 535 - 544
INTRODUCTION: This study aimed to determine whether an ideal week for cerclage treatment and placental location could affect pregnancy outcomes.
METHODS: Eighty pregnant women who underwent cervical cerclage were included in the study. In the timing evaluation, the patients were divided into two groups according to the week of gestation at which the cerclage procedure was performed: Group 1 (11-18 weeks of gestation), and Group 2 (19-27 weeks of gestation). They were also divided into groups according to indication status: History group, Ultrasound group, and Examination group. Age, gravida, parity, previous second-trimester pregnancy loss status, previous preterm delivery, placenta localization, delivery before 28 weeks, delivery between 28-34 weeks, preterm delivery, term delivery, prolongation of the gestational week, length of hospitalization stay, the status of take home baby, neonatal outcomes were recorded and compared between groups.
RESULTS: In timing and indication groups, no statistically significant relationship was determined between the groups regarding delivery before 28 weeks of gestation, delivery between 28-34 weeks of gestation, preterm delivery, term delivery, and take home baby. There was a significant difference between the mean duration of prolongation of pregnancy and the mean duration of hospital stay (p value 0.001 for both). No significant effect of placental location on the prolongation of the gestational week and gestational age was observed. We observed that there is no optimal week for applying cerclage.
DISCUSSION AND CONCLUSION: We determined that cerclage application can be performed in all working weeks within the indication and that placental placement will not change pregnancy outcomes.

21.Post Covid-19 Evaluation Of Patients With Cardiac Complaints By Using Echocardiography
Ramazan Duz, Naci Babat, Rabia Çoldur
doi: 10.5505/ejm.2024.37233  Pages 545 - 555
INTRODUCTION: Cardiac sequelae aren’t clearly known in people who recovered from COVID-19 disease.
METHODS: : In this study, we evaluated symptomatic patients by using echocardiography
RESULTS: In this study were included patients who recovered from COVID-19 disease and presented to the cardiology outpatient clinics. These patients were divided into two groups: those presenting within the first 30 days after recovery and those presenting between 30 and 60 days after recovery. Thirty patients who had not had COVID-19 before, who applied to the cardiology outpatient clinics, were selected as the control group
DISCUSSION AND CONCLUSION: The rate of dizziness, palpitations, chest pain and blood pressure dysregulation did not differ significantly between group I(patients presenting within 30 days after recovery), group II(patients presenting between 30 and 60 days after recovery), and group III(control group) (p> 0.05). Dyspnea rate in group I was significantly higher than group II and group III. There was a difference between groups in left ventricular ejection fraction. In group III, sPAP ≥ 35 mmHg ratio was significantly lower than group I and group II (p <0.05). sPAP ≥ 35 mmHg ratio did not differ significantly (p> 0.05) between group I and group II. While dyspnea was an important complaint in the first periods, it decreased over time. In addition, it was observed that right ventricular functions and left ventricular diastolic functions improved over time. It is noteworthy that there are more patients with pericardial effusion compared to the control group, which shows us that the inflammation process is continuing


22.Effect of first pregnancy age/teenager pregnancy or no pregnancy on bone mineral density in peri-menopausal women
Ali Ovayolu, Aylin Turan, Selver Güler, Ayla Yava
doi: 10.5505/ejm.2024.45722  Pages 556 - 566
INTRODUCTION: This study compares bone mineral density (BMD) scores in peri-menopausal women with and without a history of teenage pregnancy (TP) or pregnancies (TPs), for the femoral neck and lumbar spine.
METHODS: Obstetric history, history of menstruation, education, exercise, sex, marital status, residency, income level, and tobacco/alcohol use were assessed. After a DEXA scan, both groups were compared for variables.
RESULTS: A total of 485 patients were included in the study. Most of the analyzed demographic characteristics showed no significant difference between the research groups. The childless group had a higher incidence of femoral bone osteopenia than the group without a history of teenage pregnancy (non-TP) (p<0.05). However, there was no difference in the lumbar spine results between the TP(s), non-TP, and no pregnancy groups (p>0.05). The BMD, T, and Z scores of women's femoral neck/lumbar spine did not alter according to whether they had had one or more TPs.
DISCUSSION AND CONCLUSION: Despite numerous studies, modifiable variables that impact peri-menopausal women's bone health, such as TPs, have not yet been sufficiently identified. Further studies are still needed to find the causes of bone loss in peri-menopause and develop preventive measures/treatments.

23.Determination Of The Relationship Between The Tendency Towards Breast Reconstruction After Mastectomy And The Quality Of Sexual Life And Social Appearance Anxiety
Turgut Şöhret, zeynep karaman özlü
doi: 10.5505/ejm.2024.95695  Pages 567 - 575
INTRODUCTION: This study aimed to determine the relationship between the tendency among women to undergo breast reconstruction after mastectomy and the quality of sexual life and social appearance anxiety.
METHODS: This descriptive and cross-sectional study was conducted in 138 patients who underwent mastectomy at the general surgery and oncology department at ………………………………………. between May 2019 and July 2020. Data were collected using the “personal information form,” the “tendency to breast reconstruction after mastectomy scale (TBRAMS),” the “sexual quality of life-female (SQOL-F) scale,” and the “social appearance anxiety scale (SAAS).”
RESULTS: The mean scores on the TBRAMS, SQOL-F scale, and SAAS were 27.19 ± 2.68, 64.48 ± 9.26, and 46.10 ± 12.22, respectively.
DISCUSSION AND CONCLUSION: The results showed that the mean TBRAMS, SQOL-F, and SAAS scores of the patients were at a moderate level, and a negative relationship was observed between the mean TBRAMS score and the SQOL-F scale and SAAS scores.

24.Correlatıon of the Results of FNAC and Hıstopathologıcal Examınatıons in Thyroıd Nodules Running title: Effectiveness of FNAC
Abbas Aras, Ali Riza Karayıl, iskan çallı, Osman toktas, Remzi KIZILTAN, çetin Kotan
doi: 10.5505/ejm.2024.93899  Pages 576 - 578
INTRODUCTION: We aimed to evaluate the effectiveness of Fine Needle Aspiration Cytology(FNAC) in thyroid nodules by comparing the thyroid FNAC results and histopathological results of patients who underwent thyroidectomy surgery in our clinic.


METHODS: FNAC results of 1229 patients who underwent thyroidectomy for various indications in the General Surgery Clinic at Van Yuzuncu Yil University, Faculty of Medicine Hospital between January 2014 and December 2020 were categorized according to the Bethesda reporting system and compared with histopathological results.
RESULTS: The cases were between ages of 18-78 with the mean age of 45.22 years and the female/male ratio was 1032(%84) /197(%16). According to the FNAC results, 8% of the patients were Bethesda-3, 12% were Bethesda-4, 33% were Bethesda-5, and 47% were Bethesda-6. According to histopathological results, malignancy was detected in 9.2% of patients in Bethesda-3, 22.8% of patients in Bethesda-4, 78.8% of patients in Bethesda-5, and 97.9% of patients in Bethesda-6. Malignancy detection rates were compatible with Bethesda 4, 5 and 6, but were incompatible with the Bathesda 3 category. We found a sensitivity of 95.4%, a specificity rate of 67%, a positive predictive value of 90% and a negative predictive value of 82%, and an accuracy rate of 89%.
DISCUSSION AND CONCLUSION: FNAC is an effective and reliable method in the evaluation of thyroid nodule.



25.Evaluation of the Results of Ganglion Impar Blockade in Patients with Chronic Coccydynia
Abdulkerim Gökoğlu, Hüseyin YİĞİT, Erdogan UNUR
doi: 10.5505/ejm.2024.22587  Pages 579 - 586
INTRODUCTION: The aim of our study was to evaluate the effects of bupivacaine and steroid injections, followed by Radiofrequency Thermocoagulation (RFT), on the improvement of symptoms in patients with coccydynia.
METHODS: We reviewed the medical records of eight patients with coccydynia who were referred to the neurosurgery clinic and underwent an impar ganglion block. The study retrospectively evaluated demographic data, time of pain onset, causes of pain, X-ray results, invasive procedures, and scores from the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). VAS and ODI scores were recorded before the procedure, on the first day after the procedure, and three months post-procedure.
RESULTS: The study included five females (62.5%) and three males (27.5%). The mean age of the patients was 40.5 ± 10.6 years, and the mean BMI was 26.21 ± 4.2 kg/m². Two patients had idiopathic neuralgia, two had trauma-related neuralgia, two had post-herpetic neuralgia, and one patient had persistent pain following previous anorectal surgery and S2 perineural cyst-related pain. The baseline VAS value was 10 (range: 9-10) and the baseline ODI score was 69 (range: 48-94). There was a significant improvement in both VAS [2.5 (range: 1-4)] and ODI scores [4 (range: 0-34)] on the first day after the procedure (p<0.001). These low scores were maintained at the third month [VAS: 1.5 (range: 1-10) and ODI: 1 (range: 0-78)].
DISCUSSION AND CONCLUSION: In patients with coccydynia, bupivacaine and steroid injections followed by RFT provide satisfactory long-term analgesia, as evidenced by decreased VAS and ODI scores.

26.Insights from a single-center study: Cessation of Anti-seizure Medication in Neonatal seizures
Ipek Dokurel Çetin, Mine Özdil, Atika Çağlar, Orkun Çetin
doi: 10.5505/ejm.2024.49225  Pages 587 - 594
INTRODUCTION: Seizure susceptibility is greatest during the neonatal period of life. Early termination of these seizures is recommended by studies to prevent unfavorable long-term outcomes. We investigated the factors for ceasing anti-seizure medication in infants who experienced seizures during the neonatal period.
METHODS: This retrospective, single-center, descriptive study was conducted in tertiary medical center between December 2020 and February 2023, and 157 neonates were recruited. The possible confounding factors identified by the univariate analysis and the multivariate studies' logistic regression analysis was used to identify independent predictors for cease anti-seizure medication (ASM) at the infancy. The sensitivity, specificity, positive, and negative predictive values were displayed when a significant cut-off value was found by Receiver Operating Characteristic curve analysis.
RESULTS: Having a younger age at the first seizure (younger than 45.5 hours), using poly-therapy at the neonatal intensive care unit discharge, the presence of structural abnormalities in the brain related to the etiology of seizures, increased spike activity and burst suppression in EEG records decreased the likelihood of cease ASM before 12 months. The probability of cease ASM before 12 months was increased with a normal EEG.
DISCUSSION AND CONCLUSION: Our findings support that EEG and neuroimaging findings are the key factors for making decisions in the follow-up of infants with neonatal seizures. The potential long-term negative effects of ASM consumption can be reduced by discontinuing its use, when EEG results are normal. However, the etiology of structural abnormalities and the use of poly-therapy at the NICU discharge require caution in making early ASM discontinuation decisions.

27.Evaluation of platelet distribution width(PDW) and mean platelet volume(MPV) in patients with obstructive sleep apnea syndrome(OSAS): A retrospective clinical study
Buket Mermit
doi: 10.5505/ejm.2024.87259  Pages 595 - 599
INTRODUCTION: This study aimed to evaluate the association between PDW and MPV with Obstructive Sleep Apnea Syndrome (OSAS).
METHODS: The study’s design is a retrospective evaluation of OSAS patients admitted to our pulmonology department between January 2022 and June 2024. The data and clinical-laboratory parameters of patients diagnosed with polysomnography were evaluated. The PDW and MPV measurements were retrieved from the complete blood counts’ of the patients. OSAS patients were divided into three groups according to the Apnea-hypopnea Index(AHI) score as mild, moderate and severe OSAS. Healthy subjects with no known chronic disease admitted to our outpatient clinic were enrolled as control group.
RESULTS: In total, 140 patients with OSAS and 120 healthy subjects as control group were included in the study. The OSAS groups consisted of as 60 mild, 45 moderate, and 35 severe. The mean age of OSAS group and control group were as 51.8±12 and 47.6±11, respectively which was not statistically significant. There was statistically significant difference between OSAS and control group with respect to the BMI(31.8±5.0 vs 26.4±4.2, p: 0.01). The male/female patients were 96/44 in OSAS and 86/34 in control group which was not statistically different (p: 0.04). The mean PDW and MPW were 18.8±2.5 and 10.7±1.2 in OSAS group. The mean PDW and MPV were 14.6±1.7 and 7.8±2.4 in control group. There was statistically significant difference between OSAS and control group with respect to mean PDW and MPV values (p: 0.02 and p: 0.01). The subgroup analysis showed that MPV increased statistically significant as OSAS severity got impaired.
DISCUSSION AND CONCLUSION: This study showed that increased PDW and MPV was associated with OSAS and also the activation of platelets has potential effect on the severity of OSAS.

28.Retrospective Evaluation of Hairy Cell Leukemia Patients: Single Center Experience
Ozlem Beyler, Cengiz Demir
doi: 10.5505/ejm.2024.08683  Pages 600 - 604
INTRODUCTION: Hairy cell leukemia (HCL) is a rare B-cell leukemia. This study aimed to investigate the clinical and demographic features and treatment responses of HCL patients diagnosed and treated at our center.


METHODS: Thirteen patients were diagnosed between March 2019 and February 2024. Morphology, immunohistochemistry, and flow cytometry were used for diagnosis. All patients received cladribine as first-line treatment. Patients with partial response or less and those who relapsed received salvage therapy.
RESULTS: The median age of the patients was 53. Seven patients (53.8%) had pancytopenia. BRAF V600E mutation was positive in 9 patients (69%). Splenomegaly was present in 10 patients (76.9%) at diagnosis. Cladribine treatment achieved complete response in 11 patients (84%), partial response in 1 patient (7%). One patient did not respond to treatment. Two patients relapsed and achieved complete remission with pentostatin or rituximab treatment. The 5-year overall survival (OS) rate was 92.3% and progression-free survival (PFS) rate was 84.6%.
DISCUSSION AND CONCLUSION: The demographic and laboratory features and treatment outcomes of HCL patients followed at our center are consistent with the literature. Cladribine is highly effective as a first-line treatment in HCL and provides high response rates. Pentostatin and rituximab monotherapy were found to be effective in relapsed patients.

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