ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of İstanbul - North Clin Istanb: 6 (3)
Volume: 6  Issue: 3 - 2019
RESEARCH ARTICLE
1.The hepatoprotective effect of Aloe vera on ischemia-reperfusion injury in rats
Müşerref Hilal Şehitoğlu, Ihsan Karaboga, Aslı Kiraz, Hasan Ali Kiraz
PMID: 31650105  PMCID: PMC6790936  doi: 10.14744/nci.2018.82957  Pages 203 - 209
GİRİŞ ve AMAÇ: Aloe vera, antioksidan özellikleri ile bilinmektedir. Bu deneysel çalışmada sıçanlarda karaciğer I/R hasarında Aloe vera'nın etkinliğini araştırmayı amaçladık.
YÖNTEM ve GEREÇLER: Erkek Wistar Albino sıçanları 3 gruba ayrıldı: Sham grubu (n = 7) ilaç veya cerrahi prosedür uygulanmadı. I/R grubu (n = 7) kontrol grubu ve 45 dakika boyunca abdominal aort iskemisi uygulandı ve reperfüzyondan 24 saat sonra sıçanlar sakrifiye edildi. I/R+AV grubu (n = 7) tedavi grubu, 45 dakikalık abdominal aort iskemisinden önce bir ay boyunca her gün gastrik gavaj ile Aloe vera (30 mg / kg) verildi ve reperfüzyondan 24 saat sonra sıçanlar sakrifiye edildi. Sakrifiye edilmeden önce tüm karaciğer dokuları çıkarıldı. Dokular histopatolojik inceleme, iNOS immünoreaktivitesi ve doku biyokimyası, malondialdehid (MDA), katalaz (CAT), süperoksit dismutaz (SOD) ve glutatyon peroksidaz (GSH-Px) aktiviteleri açısından incelendi.
BULGULAR: I/R+AV grubunun SOD, CAT ve GSH-Px aktivite düzeyleri sham grubundan anlamlı olarak farklı değildi (p>0,05) ancak I/R grubuna kıyasla anlamlı derecede yüksek bulundu. I/R+AV grubunda karaciğer dokularının MDA düzeyleri I/R grubuna kıyasla anlamlı olarak düşüktü (p <0,05). I/R grubunda hepatik kordlar, sinüzoidal dilatasyon, hemoraji, hepatositlerin sitoplazmik vakuolizasyonu ve yoğun İNOS immünreaktivitesi saptandı. I/R+AV grubunda, I/R grubuna göre azalmış histopatolojik değişim skoru ve iNOS immünoreaktivite skoru fark edildi.
TARTIŞMA ve SONUÇ: Sonuç olarak, Aloe vera'nın I/R hasarına karşı hepatoprotektif bir etki gösterdiği bulunmuştur. Etkili doz, uygulama yöntemi ve Aloe vera'nın karaciğer transplantasyonu için etkilerini belirlemek için daha fazla araştırma gereklidir.
INTRODUCTION: Aloe vera is known for its antioxidant properties. In this experimental study, we aimed to investigate the efficacy of Aloe vera in ischemia-reperfusion (I/R) liver injury in rats.
METHODS: Male Wistar Albino rats were divided into three groups, where the sham group (n=7) underwent no medication or surgical procedures, the I/R group (n=7) was the control group that received 45 minutes of applied abdominal aorta ischemia and rats were sacrificed 24 hours after reperfusion, and the I/R+AV group (n=7) was the treatment group that was given Aloe vera (30 mg/kg) every day followed by gastric lavage for a month before applying ischemia and performing sacrifice as in the previous group. Before sacrifice, all the liver tissues were removed. Tissues were examined for histopathological investigation, iNOS immunoreactivity and tissue biochemistry, malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activities.
RESULTS: The SOD, CAT, and GSH-Px levels of the I/R+AV group were not significantly different from the sham group (p>0.05) but were significantly higher when compared to the I/R group. MDA levels of liver tissues were significantly lower (p<0.05) in the I/R+AV group as compared to the I/R group. Disrupted hepatic cords, sinusoidal dilatation, hemorrhage, cytoplasmic vacuolization of hepatocytes, and intensive iNOS immunoreactivity were detected in the I/R group. Decreased histopathological change score and iNOS immunoreactivity score were noticed in the I/R+AV group as compared to the I/R group.
DISCUSSION AND CONCLUSION: It was found that Aloe vera showed a hepatoprotective effect against I/R injury. Further research is required to determine the effective dose, administration method, and effects of Aloe vera for liver transplantation.

2.The role of thiol levels in predicting contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention
Ahmet Korkmaz, Burcu Özyazgan, Arzu Kösem, Ozgul Ucar Elalmis, Umit Guray, Mehmet Ileri, Salim Neselioglu, Ozcan Erel
PMID: 31650106  PMCID: PMC6790934  doi: 10.14744/nci.2018.72335  Pages 210 - 218
GİRİŞ ve AMAÇ: Kontrast nefropatisi (KN) tanısal veya girişimsel işlemlerde intravasküler kontrast maddelerin uygulanmasından kaynaklanabilen sık bir komplikasyonudur. Son çalışmalarda, tiyol-disülfit oranının yeni bir oksidatif stress belirteci olduğu bildirilmiştir. Bu nedenle, primer perkütan koroner girişim (PKG) uygulanan ST segment yükselmeli miyokard enfarktüsü (STYME) hastalarında KN öngörülmesinde tiyol düzeylerinin rolünü araştırdık.
YÖNTEM ve GEREÇLER: Çalışmaya toplam 302 hasta dahil edildi.KN, bazal ile karşılaştırıldığında serum kreatinin konsantrasyonunda ≥0.5 mg / dL'lik bir artış veya işlemden sonraki ilk 48-72 saat içerisinde göreceli artışın >% 25 olması şeklinde tanımlandı.Tiyol düzeyleri ile KN arasındaki ilişkiyi değerlendirmek için hastalar KN+ grubuna ve KN - grubuna ayrıldı.
BULGULAR: KN 44 (% 15) hastada gelişti. Native tiyol (274.8 ± 84.7 μmol / L vs 220.8 ± 97.1 μmol / L, p = 0.001) ve toplam tiyol (305.4 ± 89.7 μmol / L vs 260.1 ± 102.1 μmol / L, p = 0.009) düzeyleri, KN olmayan gruptaki hastalarda daha yüksekti. Disülfid (15.8 ± 6.6 μmol / L vs 19.6 ± 8.4 μmol / L, p = 0.002) düzeyleri ve ortalama disülfid / toplam tiyol oranları (8.4 ± 3.7'e karşı 5.9 ± 3.1, p = 0.001) KN' li hastalarda daha yüksekti. Tek değişkenli analizde; başvuru native tiyol, toplam tiyol, disülfid seviyeleri ve disülfid / toplam tiyol oranı, KN gelişiminde prognostik öneme sahipti. Çok değişkenli regresyon analizinde sadece disülfid / toplam tiyol oranı (OR = 1.190;% 95 CI, 1.090-1.300; p = 0.001) KN ile anlamlı ve bağımsız olarak ilişkiliydi.Başvuru disülfid / toplam tiol oranı için 7 kesme değerinin primer PKG uygulanan STYME hastalarında KN tahmininde, sensitivitesi% 68.2, özgüllüğü% 79.8 idi.
TARTIŞMA ve SONUÇ: Sonuçlarımız, primer PKG uygulanan STYME hastalarında tiyol / disülfid dengesinin KN için iyi bir biyokimyasal risk belirleyicisi olabileceğini düşündürmektedir.
INTRODUCTION: Contrast-induced nephropathy (CIN) is a common complication of diagnostic or interventional procedures that may arise from administration of intravascular contrast media. Recent studies have reported the thiol-disulfide ratio as a novel oxidative stress marker. Therefore, we investigated the role of thiol levels in predicting CIN in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (PCI).
METHODS: A total of 302 patients were enrolled in the study. CIN was defined as an increase in serum creatinine concentration ≥0.5 mg/dL compared with the admission value or a >25% relative rise during the first 48–72 hours after the procedure. To evaluate the relationship between thiol levels and CIN, the patients were divided into a CIN group and a non-CIN group.
RESULTS: CIN occurred in 44 (15%) patients. Native thiol (274.8±84.7 μmol/L vs. 220.8±97.1 μmol/L, p=0.001) and total thiol (305.4±89.7 μmol/L vs. 260.1±102.1 μmol/L, p=0.009) levels were higher in patients within the non-CIN group. Disulfide (15.8±6.6 μmol/L vs. 19.6±8.4 μmol/L, p=0.002) levels, and mean disulfide/total thiol ratios (8.4±3.7 vs. 5.9±3.1, p=0.001) were higher in patients with CIN (+) group. In univariate analysis, the initial native thiol, total thiol, disulfide levels, and disulfide/total thiol ratio were found to have prognostic significance in the development of CIN. In the multivariate regression analysis, only the disulfide/total thiol ratio (OR=1.190; 95% CI: 1.090–1.300; p=0.001) was significantly and independently associated with CIN. The cutoff value of the disulfide/total thiol ratio to predict CIN on admission in patients with STEMI who underwent primary PCI was 7, with a sensitivity of 68.2% and a specificity of 79.8%.
DISCUSSION AND CONCLUSION: Our results suggest that thiol/disulfide homeostasis could be a good biochemical risk marker for CIN in STEMI patients who underwent primary PCI.

3.Relationship between brain computed tomography findings and bispectral index score in patients presenting with head trauma
Özlem Küsken, Tuba Cimill Ozturk, Aysel Hünük, Ebru Unal Akoglu, Rohat Ak, Cansu Arslan Turan, Ozge Ecmel Onur
PMID: 31650107  PMCID: PMC6790924  doi: 10.14744/nci.2018.89266  Pages 219 - 225
GİRİŞ ve AMAÇ: Kafa travmalı hastaya yaklaşım günümüzde acil servislerin en kapsamlı problemlerinden biridir. Bizim bu çalışmadaki amacımız izole kafa travması olan hastalarda bilinç durumu için kullanılan BİS ile bilgisayarlı beyin tomografi bulguları arasında bir ilişki olup olmadığını ortaya koymaktır.

YÖNTEM ve GEREÇLER: Çalışma 01.03.2014 / 01.09.2014 tarihleri arasında prospektif olarak Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi Acil Tıp Kliniği'nde yapılmıştır. Ortalama BİS değerleri; GKS puanı, CCHR major ve minör kriterleri, ve BT’de patoloji olup olmaması durumu ile karşılaştırılmıştır. Bunun dışında olguların demografik özellikleri, geliş vital bulguları ve hastaneye varış süreleri incelenmiştir.

BULGULAR: Çalışmamızdaki olguların 64’ü (%31,7) kadın, 138’i (%68,3) erkek tespit edilmiştir. BT’de patoloji tespit edilen olguların BİS değerleri ortalaması 84,99±11,20 (86,05), BT’de patoloji görülmeyenlerin BİS değerleri ortalaması 93,78±3,80 (95,05). BT patolojisi ve BİS değerleri karşılaştırıldığında istatistiksel olarak anlamlı olduğu görülmüş olup BT patolojisi olanların BİS değerleri düşük bulunmuştur (p=0,001; p<0.01). BİS değeri ile GKS puanı, Spearman’s rho Korelasyon analizi ile incelendiğinde pozitif yönlü, %45.6 düzeyinde ve istatistiksel olarak anlamlı bir ilişki bulunmuştur (p< 0,05).

TARTIŞMA ve SONUÇ: Çalışmamızın sonuçları değerlendirildiğinde kafa travmaları sıklıkla tehlikeli kazalar sonucunda olduğu ve erkekleri daha fazla etkilediğini söylemek mümkündür. CCHR majör kriterlerinden biri olan 65 yaş ve üzeri olma durumu olguların 40'ında (%19.8) tespit edilmiştir. Çalışmamızın diğer önemli bir sonucu ise BT’de travmatik patoloji tespit edilen hastaların BİS değerlerinin BT’si normal olan hastalara göre anlamlı derecede düşük olmasıdır. Bu sonuca göre BİS değeri düşük tespit edilen hastaların beyin BT’lerinde patoloji tespit edilebileceği öngörülebilir.

INTRODUCTION: Head trauma is one of the most important emergency health problems both in the world and in our country. The objective in our study is to (i) state the correlation between the findings of bispectral index score (BIS) and computed tomography (CT), which are used to evaluate the level of consciousness of patients with isolated head trauma, and (ii) investigate objective results about the patient’s level of consiousness/alertness according to the CT modality, which is used frequently.
METHODS: This prospective study was carried out between 03.01.2014 and 09.01.2014 in the emergency department of Fatih Sultan Mehmet Education and Research Hospital. The average BIS scores were correlated with the Glasgow Coma Scale (GCS) point, the Canadian CT Head Rule major and minor criteria, and the pathologic findings in CT imaging. The patients’ demographic features, vital signs at admission, and arrival times at the hospital were investigated.
RESULTS: In our study, 64 (31.7%) patients were female, and 138 (68.3%) patients were male. The mean BIS scores were 84.99±11.20 (86.05) and 93.78±3.80 (95.05) in patients with and without CT pathologies, respectively. The correlation between CT pathology and BIS scores was statistically significant: BIS scores were lower in patients with CT pathologies (p=0.001; p<0.01). There was a statistically significant positive correlation between the BIS and GCS scores (45.6%) (p<0.05).
DISCUSSION AND CONCLUSION: We showed that most head traumas occur after dangerous accidents, and according to the results, we can predict that males are more frequently affected than females.There was a statistically significant positive correlation between BIS scores and GCS points. In our study, the BIS scores were statistically significantly lower in patients with CT pathology than in patients without. We can predict that if the BIS score of the patient is low, then there will be the presence of pathology on CT imaging.

4.The frequency of alopecia and quality of life in high-school students in rural areas (Sivrihisar, Mahmudiye, Alpu, and Beylikova) of Eskisehir
Ozkan Ozay, Didem Arslantas, Alaettin Ünsal, Işıl Bulur
PMID: 31650108  PMCID: PMC6790931  doi: 10.14744/nci.2018.59365  Pages 226 - 235
GİRİŞ ve AMAÇ: Bu çalışma, Eskişehir ili kırsal yerleşim bölgesinde öğrenim görmekte olan lise öğrencileri arasında alopesi görülme sıklığının saptanması, ilişkili olduğu düşünülen faktörlerin incelenmesi ve sağlıkla ilgili yaşam kalitesinin değerlendirilmesi amacı ile yapıldı.
YÖNTEM ve GEREÇLER: Çalışma 2 Mart-30 Nisan 2015 tarihleri arasında yürütülen kesitsel tipte bir araştırmadır. Çalışma grubunu 1662 (%74.9) öğrenci oluşturdu. Çalışmanın amacına uygun olarak önceden hazırlanmış 4 bölümden oluşan anket form gözlem altında öğrencilerin kendileri tarafından dolduruldu. Öğrencilerin yaşam kaliteleri Short Form-36 (SF-36) ölçeği ile değerlendirildi. Saç ve saçlı deri muayenesi dermatoloji uzmanıi tarafından yapıldı. Elde edilen veriler, IBM-SPSS 20 İstatistik Paket Programı kullanılarak değerlendirildi. Verilerin analizlerinde Ki-kare testi, Mann Whitney U testi ve Lojistik Regresyon Analizi kullanıldı. İstatistiksel anlamlılık değeri olarak p≤0.05 kabul edildi.
BULGULAR: Bu çalışmada alopesi görülme sıklığı %37.4 (n=622) olarak saptandı. Erkeklerde, saçlı deri şikayeti olanlarda ve yağlı saçlı deri tipine sahip olan öğrencilerde alopesi görülme sıklığı daha yüksek saptandı. Çalışma grubunda alopesi saptananlarda SF-36 Ölçeği’nin genel sağlık, canlılık ve mental sağlık alt alanlarında yaşam kalitelerinin daha kötü olduğu saptandı.
TARTIŞMA ve SONUÇ: Alopesi sıklığının azaltılması ve öğrencilerin yaşam kalitelerinin arttırılabilmesi için erken tanı ve tedavinin sağlanabilmesi gerekmektedir. Öğrencilerde farkındalığın arttırılabilmesi için sağlık eğitimi çalışmaları yapılmalıdır. Ek olarak okul taramaları içine saç ve saçlı deri muayenelerinin entegre edilmesi, alopesi saptanan öğrencilerin dermatoloji uzmanına yönlendirilmesi ve yağlı saçlı deri tipine sahip öğrencilerin saçlarını düzenli olarak yıkamaları uygun olacaktır.
INTRODUCTION: The aim of the present study was to determine the incidence of alopecia and related factors and the health-related quality of life (HRQoL) in high-school students in rural areas of Eskisehir. This was a cross-sectional study.
METHODS: The study was performed between March 2, 2015 and April 30, 2015. A total of 1662 (74.9%) students were included in the study. The questionnaire performed for the purpose and consisted of four sections was filled out by the students themselves under supervision. The HRQoL was evaluated by Short Form—36 (SF-36). Students’ hair and scalps were examined by a dermatologist. The acquired data were analyzed by SPSS 20 statistical package program. Chi-square test, Mann–Whitney U test, and logistic regression analyses were used for statistical analyses. A p value ≤0.05 was accepted as statistically significant.
RESULTS: In the present study, the incidence of alopecia was found to be 37.4% (n=622). Alopecia was more frequently seen in male students who have complaints about their scalps and those with a fatty scalp. In the study group, students with alopecia had poor HRQoL in general health perception, vitality, and mental health of SF-36.
DISCUSSION AND CONCLUSION: There is a need to provide early diagnosis and treatment to decrease the incidence of alopecia and to improve the quality of life. Health education studies must be performed to increase the awareness of students about alopecia. Integrating hair and scalp examination into school health screening studies, steering the students who have alopecia to the dermatologists, and suggesting students who have fatty scalp regular hair washing will be appropriate.

5.Echocardiographic assessment of children participating in regular sports training
Şeyma Kayalı, Fatma Tuba Yıldırım
PMID: 31650109  PMCID: PMC6790927  doi: 10.14744/nci.2018.40360  Pages 236 - 241
GİRİŞ ve AMAÇ: Bu çalışmanın amacı, düzenli spor katılımının, sağlıklı çocuklarda kardiyak fonksiyon ve yapılar üzerindeki etkilerini belirlemek ve spor ile ilişkili kardiyovasküler yanıtı, haftalık antrenman saati veya spor tipinin etkileyip etkilemediğini sorgulamaktır.
YÖNTEM ve GEREÇLER: Düzenli olarak en az 1 yıl spor yapan 126 çocuğun (Çalışma grubu) ekokardiyografik kayıtları toplanarak, aktif olarak herhangi bir spor aktivitesine katılmayan 62 normal çocukla (Kontrol grubu) karşılaştırıldı. İki grup, yaş, cinsiyet ve vücut kitle indeksi açısından benzerdi. Çalışma grubu katılımcıları kendi içerisinde, fiziksel aktivite sürelerine göre iki gruba (haftalık antrenman saati 8 saatten az ve 8 saatten fazla), ayrıca yapılan spor tipinin kardiyovaskuler ihtiyacına göre beş gruba ayrıldı. Tüm katılımcılara klinik muayene, istirahat EKG, iki boyutlu, M mod ve Doppler ekokardiyografi uygulandı.
BULGULAR: Sol ventrikül duvar boyutları, sol atrial çap ve aortik ölçümler çalışma grubunda anlamlı olarak yüksekti. Ortalama mitral E / A oranı, kontrol grubu ile karşılaştırıldığında çalışma grubunda yüksek tespit edildi (p <0.001). Ekokardiyografik ölçümler, çalışma grubundaki farklı spor türü katılımcıları arasında benzerdi. Bununla birlikte, aort kökü çapı, sol atriyum çapı ve sol ventrikül arka duvar diyastolik kalınlığı çalışma grubunda, antrenman süresi haftada 8 saatten fazla olan çocuklarda, antrenman süresi haftalık 8 saatten az olanlara oranla daha yüksek tespit edildi.
TARTIŞMA ve SONUÇ: Bu çalışma, düzenli spor antrenmanına katılan çocuklarda ekokardiyografik parametrelerin, sedanter çocuklara kıyasla istatistiksel olarak belirgin derecede yüksek olduğunu göstermiştir. Bu artış, spor tipinden çok haftalık antrenman süresi ile ilişkili bulundu.
INTRODUCTION: The aim of the present study was to determine the effects of a well-controlled endurance training program on cardiac functions and structures in healthy children and to define whether training hours per week and type of sports affect the training-induced cardiovascular response.
METHODS: Echocardiographic recordings were obtained in 126 children who systematically participated in sports training for at least 1 year (study group), and the results were compared with the values obtained in 62 normal children who did not actively engage in any sports activity (control group). The two groups were comparable for age, sex, and body mass index. Study group participants were divided into two groups according to the duration of physical activity (training hours per week, <8 h and >8 h) and five groups according to the cardiovascular demand of sports type. Clinical examination, resting electrocardiogram, two-dimensional, M-mode, and Doppler echocardiography were obtained in all participants.
RESULTS: Left ventricle wall dimensions, left atrial diameters, and aortic measurements were significantly higher in the study group. The mean mitral E/A ratio was also significantly higher in the training group than in untrained subjects (p<0.001). Echocardiographic measurements were similar between different sports type participants in the study group. However, aortic root diameter, left atrial diameter, and left ventricle posterior wall diastolic thickness were higher in children training >8 h/week than in children training <8 h/week in the study group.
DISCUSSION AND CONCLUSION: The present study showed that the echocardiographic parameters of children participating in regular sports training activities statistically significantly exceeded the parameters of untrained controls. These parameters were mostly dependent on the duration of training hours per week.

6.Lipid profile, atherogenic indices, and their relationship with epicardial fat thickness and carotid intima–media thickness in celiac disease
Zuhal Çalışkan, Kenan Demircioglu, Süleyman Sayar, Resul Kahraman, Ozge Caklili, Fatma Betül Özcan, Osman Köstek, Omer Faruk Baycan, Hamdi Levent Doganay, Mustafa Caliskan
PMID: 31650110  PMCID: PMC6790920  doi: 10.14744/nci.2019.54936  Pages 242 - 247
INTRODUCTION: Aim: In this study we aimed to investigate presence of subclinical atherosclerosis with measuring epicardial fat thickness (EFT) and carotid intima media thickness (c-IMT), to evaluate low level inflammation with hsCRP and to evaluate whether there is a relationship between lipid profile, atherogenic indices and hsCRP with these subclinical atherosclerosis markers in patients with celiac disease (CD).
METHODS: After exclusion and inclusion criteria were applied, 31 patients with CD (24 female, mean age: 39.4±12.3 years) and 32 healthy controls (21 female, mean age: 39.5±4.4 years), totally 63 cases, were recruited. Subclinical atherosclerosis was evaluated with EFT by transthoracic echocardiography and cIMT by ultrasonography. Inflammatory markers including erythrocyte sedimentation rate (ESR), hsCRP, and lipid profile were recorded. Also, atherogenic indices were calculated: Castelli risk index I and II (TG/HDL-c and LDL-c/HDL-c, respectively), atherogenic index of plasma (AIP; logarithm TG/HDL-c), non-HDL-c (TG-HDL-c), and atherogenic coefficient (AC; non-HDL-c/HDL-c).
RESULTS: EFT was significantly higher in the CD group (0.49±0.10 vs. 0.49±0.09; p-value: 0.02). Although cIMT was higher in the patient group, it did not reach statistical significance (0.51±0.08, 0.47±0.08; p-value: 0.10). HDL cholesterol level was found to be significantly lower (42.0±8.8 vs. 50.0±13.7; p-value: 0.01), and the plasma atherogenic index was found to be significantly higher in the patient group (0.98±0.50 vs. 0.62±0.64; p-value: 0.02). hsCRP (3.51±3.18 vs. 1.92±1.40; p-value: 0.02) and ESR (17.2±12.8 with 9.7±3.1; p-value: 0.01) were found to be significantly higher in the CD group. Although there was a significant positive correlation between EFT and hsCRP (r: 0.453; p-value: 0.01), there was a significant negative correlation between cIMT and HDL-cholesterol (−0.339; p-value: 0.05), and a significant positive correlation with the other components of the atherogenic index was found.
DISCUSSION AND CONCLUSION: The risk of atherosclerosis has been increased in patients with CD. Chronic inflammation may be responsible for this increase along with atherogenic indices.

7.Factors associated with diverticular bleeding and re-bleeding: A United States hospital study
Ala Abdel Jalil, Robyn Gorski, Salah Abdel Jalil, Ryan Cronin, Michael Comianos, Moss Mann, Hari Rajagopalan, Asem Abdeljalil, Veysel Tahan
PMID: 31650111  PMCID: PMC6790935  doi: 10.14744/nci.2018.23540  Pages 248 - 253
INTRODUCTION: Diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Arteriovascular disease, metabolic syndromes, non-steroidal anti-inflammatory drugs (NSAIDs), anti-thrombotics, and anticoagulants have been suggested as risk factors. There is a paucity of studies addressing factors associated with diverticular re-bleeding, especially in the United States. The aim of this study is to evaluate factors associated with colonic diverticular bleeding and re-bleeding in a US community-based hospital.
METHODS: We conducted a retrospective case-control study to analyze the factors associated with diverticular bleeding. Between January 2010 and July 2011, 93 patients were admitted to our hospital with a primary diagnosis of acute diverticular bleeding. We compared them to 152 patients who were admitted with a primary diagnosis of diverticulitis in the same period. We collected data from the medical records of each patient in relation to the demographics, comorbidities, medications, social habits, location of diverticulosis, length of stay in the hospital, and re-bleeding rate within 2 years of the first bleeding episode.
RESULTS: Factors such as cerebrovascular accident (p=0.009), coronary artery disease (p=0.037), diabetes mellitus (p=0.046), obstructive sleep apnea (p=0.033), NSAIDs (p=0.038), use of anti-thrombotics (p=0.001), anticoagulants (p=0.002) or calcium channel blockers (p=0.009), and bilateral diverticulosis (p=0.001) were significantly associated with diverticular bleeding as compared to diverticulitis. Recurrence of bleeding was noted in 26 out of 93 patients (28%) within 2 years of the first bleeding episode (p=0.001). Bilateral colonic involvement, anticoagulants, and elderly age (≥65 years) were found to have a closer relationship to diverticular re-bleeding, although it was not statistically significant.
DISCUSSION AND CONCLUSION: This study reveals that arteriovascular disease, diabetes mellitus, NSAIDs, the use of anti-thrombotics, anticoagulants or calcium channel blockers, and obstructive sleep apnea are factors that are significantly associated with diverticular bleeding. It also shows that bilateral colonic involvement, elderly age, and anticoagulants have a closer relationship to diverticular re-bleeding. More prospective studies in patients with diverticular bleeding should be conducted to shed light on the causality of these factors and the prevalence of diverticulitis.

8.Nephrolithiasis in ankylosing spondylitis and its relationship with disease assessment scales
Aylin Rezvani, Ilknur Aktas, Nurettin Tastekin, Reyhan Çeliker, Selda Sarıkaya, Erbil Dursun, Senay Ozdolap, Nigar Dursun, Coskun Zateri, Lale Altan, Murat Birtane, Kenan Akgun, Necdet Süt
PMID: 31650112  PMCID: PMC6790921  doi: 10.14744/nci.2018.58219  Pages 254 - 259
GİRİŞ ve AMAÇ: Ankilozan spondilitli (AS) hastalarımızda böbrek taşı sıklığını araştırmak ve hastalık değerlendirme ölçekleri arasındaki ilişkiyi saptamak.
YÖNTEM ve GEREÇLER: Çalışma, retrospektif olarak Modifiye New York Kriterleri ile AS teşhisi almış 320 kişilik bir hasta grubu üzerinden planlandı. Aynı dönemde renal ultrasonografi (USG), eritrosit sedimantasyon hızı, C-reaktif protein, kalsiyum, fosfor, vitamin-D, parathormon ve üriner kalsiyum atılımı olan ve aynı zaman aralığında lateral servikal ve lomber konvansiyonel radyografisi de mevcut olan 119 hasta çalışmaya dahil edildi. Tüm hastaların demografik özellikleri, belirtilen kan düzeyi, idrar testleri ve ko-morbiditeleri kaydedildi. Tüm hastalarda Ankilozan Spondilit Hastalık İndeksi (BASDAI), Ankilozan Spondilit Fonksiyonel İndeksi (BASFI), Ankilozan Spondilit Mobilite İndeksi (BASMI) ve modifiye Stoke Ankilozan Spondilit Spinal Skoru (mSASSS) değerlendirildi.
BULGULAR: Yüz on dokuz (119) hastanın 13'ünde böbrek taşı USG verileriyle doğrulandı. AS hastalarımızda ultrasonografiyle saptanan böbrek taşı sıklığı %10.9 bulundu. Hastalık süresi böbrek taşı olan hastalarda [nefrolitiazis (+): 18.39 ± 8.72 yıl], renal taşı olmayanlara [nefrolitiazis (-): 12.02 ± 8.43 yıl] göre daha uzun bulundu (p = 0.01). Total BASMI skoru, renal taşı olanlarda istatistiksel olarak anlamlı derecede yüksek bulundu. Kan örnekleri, HLA-B27, komorbidite, BASDAI, BASFI ve mSASSS açısından iki grup arasında anlamlı farklılık bulunmadı.
TARTIŞMA ve SONUÇ: AS hastalarında böbrek taşı sıklığı sağlıklı popülasyona kıyasla artmaktadır. Özellikle uzun hastalık süresi ve yüksek BASMI değerleri olan AS hastaları, böbrek taşına daha yatkın görülmektedir. AS hastalarının değerlendirilmesinde böbrek taşı araştırılması unutulmamalıdır. Bu tarz çalışma sonuçlarının güvenilirliği, çalışma daha büyük hasta gruplarında ve nüfusa dayalı yaygınlıkta yapıldığında, arttığını belirtmekte yarar var.
INTRODUCTION: The aim of this study was to investigate the frequency of renal calculi in patients with ankylosing spondylitis (AS) and to determine its relationship with disease assessment variables.
METHODS: The study was designed retrospectively, and it included a cohort of 320 patients with AS diagnosed using the Modified New York Criteria. A total of 119 patients who underwent renal ultrasonography (USG), in who the erythrocyte sedimentation rate, C-reactive protein, blood calcium, phosphorus, Vitamin D, parathormone, and urinary calcium excretion were measured, and who also had lateral cervical and lumbar radiography in the same time period were extracted from the cohort. All patients’ demographic characteristics and the results of blood and urine tests were recorded. The Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Mobility Index (BASMI), and Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) were evaluated in all patients.
RESULTS: Thirteen of the 119 patients had renal calculi confirmed by USG data. The frequency of nephrolithiasis detected by USG was 10.9% in patients with AS. The disease lasted significantly longer in patients with renal calculi ([nephrolithiasis (+): 18.39±8.72 years; nephrolithiasis (−): 12.02±8.43 years, p=0.01]). The BASMI total score was significantly higher in the group of patients with renal calculi. There was not any significant difference in terms of blood samples, HLA-B27, BASDAI, BASFI, and mSASSS between groups.
DISCUSSION AND CONCLUSION: The frequency of renal stones is increased in patients with AS compared to healthy population. Especially patients who had AS for a long time and higher BASMI values are more susceptible to renal calculi. It is important to point out that the results of this type of studies would be more reliable if the study is conducted on large patient groups and population-based prevalence.

9.Investigation of C5–C6 radiculopathy and shoulder rotator cuff lesions coexistence frequency
Çiğdem Arifoğlu Karaman, Bengi Oz, Aylin Sari
PMID: 31650113  PMCID: PMC6790919  doi: 10.14744/nci.2018.04796  Pages 260 - 266
GİRİŞ ve AMAÇ: Bu çalışmada C5 ve/veya C6 sinir köklerinin basısı ile omuz rotator manşon patolojilerinin birlikteliği ve bunun ağrı ile dizabilite üzerine etkisi değerlendirildi.
YÖNTEM ve GEREÇLER: Boyundan omuza yayılan ağrı şikâyeti ile başvuran 65 hastanın demografik verileri, boyun ve omuz ağrısı süreleri, baş üstü aktivite gerektiren işlerde çalışma durumu, fizik muayene verileri retrospektif olarak değerlendirildi. Ağrı ve fonksiyonellik vizüel nümerik skala (VNS), Quick DASH (Disabilities of the Arm, Shoulder and Hand) ve Omuz Ağrı ve Özürlülük İndeksi (OAÖİ) (Shoulder Pain and Disability Index, SPADI) verileriyle değerlendirildi. Servikal manyetik rezonans görüntülemelerde (MRG) C5-C6 kök basısı varlığına göre hastalar üst trunkus kök basısı (ÜTKB) olanlar ve olmayanlar olmak üzere iki gruba ayrıldı. Gruplar MRG bulgularına göre omuz patolojileri açısından karşılaştırıldı.
BULGULAR: Hastaların %12,3’ünde C5, %41,5’inde C6 kök basısı, %44,6’sında ÜTKB saptandı. Hawkins ve Neer testleri açısından gruplar arasında farklılık saptanmazken, Yergason ve Jobe testleri ÜTKB olmayanlarda istatistiksel olarak daha yüksek pozitifti. Omuz MRG’leri değerlendirildiğinde ÜTKB olanlarda yalnızca subskapularis kas yırtığı görülme sıklığı anlamlı olarak daha yüksekti. Diğer omuz MRG bulguları açısından farklılık saptanmadı. VNS-boyun ve OAÖİ-ağrı skorları ÜTKB olmayanlarda anlamlı olarak daha yüksekken, VNS-omuz, Quick DASH, OAÖİ-dizabilite ve OAÖİ-toplam skorları açısından gruplar arasında anlamlı farklılık yoktu.
TARTIŞMA ve SONUÇ: Bu çalışma servikal MRG’de saptanan ve boyundan omuza yayılan ağrıya neden olan C5-C6 kök basısının omuzda klinik, radyolojik ve fonksiyonel bir patolojiye predispozisyon yaratmadığını desteklemektedir. Sadece servikal veya omuz MRG bulgularına dayanarak ağrının kaynağının söylenmesi de güç görünmektedir.
INTRODUCTION: The aim of this study was to evaluate the coexistence of C5 and/or C6 root compression with rotator cuff pathologies and its effect on pain and disability.
METHODS: A total of 65 patients with pain radiating from neck to shoulder were retrospectively evaluated on the basis of demographic data, duration of symptoms, overhead activities, and physical examination. The visual numerical scale (VNS), Quick DASH (Disabilities of the Arm, Shoulder, and Hand), and Shoulder Pain and Disability Index (SPADI) were also used. Cervical magnetic resonance imaging (MRI) was used to evaluate C5–C6 root compression, which was separated into two groups as patients with or without upper trunk root compression (UTRC). These groups were compared according to the MRI findings of patients with rotator cuff pathologies.
RESULTS: According to our results, C5 root compression (12.3%), C6 root compression (41.5%), UTRC (44.6%) were detected. There was no difference between the groups regarding the Hawkins and Neer tests. The Yergason and Jobe tests were statistically higher in patients without UTRC. In the shoulder MRIs, the rate of subscapular muscle tear was significantly higher in patients with UTRC. Other shoulder MRI findings were not different between the groups. VNS-neck and SPADI-pain scores were significantly higher in patients without UTRC. There was no difference between the groups in the scores of VNS-shoulder, Quick DASH, SPADI-disability, and SPADI-total.
DISCUSSION AND CONCLUSION: Radiating pain from neck to shoulder that is caused by C5–C6 root compression does not create a predisposition for clinical, radiologic, and functional pathologies in shoulder joint. It seems difficult to diagnose the exact origin of pain in patients who present with neck pain radiating to shoulder based on the findings of cervical or shoulder MRI alone.

10.The prevalence of thyroid dysfunction and its relationship with perinatal outcomes in pregnant women in the third trimester
Hatice Dülek, Fisun Vural, Nurettin Aka, Sergul Zengin
PMID: 31650114  PMCID: PMC6790929  doi: 10.14744/nci.2018.51422  Pages 267 - 272
GİRİŞ ve AMAÇ: Bu çalışmada 3. trimester gebelerde tiroid fonksiyon bozukluğu sıklığının tespit edilmesini ve bunun perinatal sonuçlar ile ilişkisinin araştırılmasını amaçladık.
YÖNTEM ve GEREÇLER: Haydarpaşa Numune Eğitim Araştırma Hastanesi'nde Ocak 2014 ve Ocak 2015 tarihleri arasında doğum yapan 796 hasta retrospektif taranmıştır. Hastlardan verileri tam olan ve tiroid fonksiyon testleri yapılmış olanlar (n=573) çalışmaya dahil edilmiştir. Tüm hastalarda serum tiroid uyarıcı hormonu (TSH), serbest tri-iyodotironin (T3), ve serbest tiroksin (T4) düzeyleri çalışılmıştır. Hastalar tiroid fonksiyon testleri sonuçlarına göre hipotiroidi, subklinik hipotiroidi, hipertiroidi ve ötiroid olarak sınıflandırılmıştır. Perinatal sonuçlar( apgar skorları, doğum şekli ve doğum ağırlıkları)karşılaştırılmıştır.
BULGULAR: Gebelerin % 86.7’sinde (492/573) tiroid fonksiyon testleri normaldir. Gebelerin %0.5’inde aşikar hipotiroidi, %8.9’unda subklinik hipotiroidi ve %2.8’inde ise hipertiroidi mevcuttu. TSH seviyeleri maternal yaş ile pozitif korrele bulundu. Perinatal sonuçların gruplar arasında karşılaştırması benzer bulundu.
TARTIŞMA ve SONUÇ: Bizim populasyonumuzda gebelikte tiroid disfonksiyonu prevalansı %13.2’dir. Subklinik- hipotiroidi ve hipertiroidinin doğum ağırlığı, sezaryen operasyonları ve apgar skorları üzerine olumsuz etkisi saptanmamıştır.
INTRODUCTION: In this study, we aimed to investigate the prevalence of thyroid dysfunction in pregnant women in their third trimester and assess its relationship with perinatal outcomes.
METHODS: A total of 796 women who delivered babies at the Haydarpaşa Numune Training and Research Hospital between January 2014 and January 2015 were evaluated retrospectively. Women with complete data and relevant results from thyroid functions tests were included in the study (n=573). Serum levels of thyroid stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine (T4) were studied for all patients. Patients were classified according to thyroid function test results as having hypothyroidism, subclinical hypothyroidism, hyperthyroidism, or euthyroid state. The perinatal outcomes (Apgar score, birth type and birth weight) were compared.
RESULTS: A total of 86.7% of pregnant woman (492/573) showed normal thyroid function tests. Out of the remaining participants,0.5% had hypothyroidism, 8.9% had subclinical hypothyroidism, and 2.8% had hyperthyroidism. TSH levels correlated with maternal age. The perinatal outcomes were insignificant between groups.
DISCUSSION AND CONCLUSION: The prevalence of thyroid dysfunction was 13.2% in our population. Subclinical hypothyroidism and hyperthyroidism had no adverse effects on birth weight, cesarean section rates, and Apgar scores.

11.How successful is “pleural sound sign” in the identification of pneumothorax?
Saniye Göknil Çalık, Mustafa Çalık, Sadık A. Girişgin, Osman Karaoğlan, Zerrin Defne Dündar, Mehmet Ergin
PMID: 31650115  PMCID: PMC6790932  doi: 10.14744/nci.2018.46548  Pages 273 - 278
INTRODUCTION: In the present study, in thorax ultrasonography (USG) Doppler images obtained from cases with occult pneumothorax, we investigated the status of pulsatile pleural sounds over the pleural line and called these as the pleural sound sign (PSS). The purpose of the present study was to identify the efficacy of the proposed PSS in diagnosing pneumothorax and to compare it with the other USG findings including the sliding lung sign (SLS) and seashore sign (SSS).

METHODS: The present study included 66 consecutive patients who were referred to the emergency unit with a blunt trauma from October 2009 to January 2010 at a tertiary university hospital.

RESULTS: Of the 66 patients, 34 were in the patient group, and 32 were in the control group. Males accounted for 66.7% (n=44) of the study population. In predicting pneumothorax, the areas under receiver operating characteristic (ROC) curves of PSSmax and PSSdifference were 0.989 and 0.990, respectively. While the sensitivity of the SLS was 88% and the sensitivity of the SSS was 56%, the specificities of the SLS and SSS were 100%. Based on our findings, accuracy ranking was as follows: PSSmax = PSSdifference > SLS > SSS.

DISCUSSION AND CONCLUSION: New applications of thorax USG are rapidly growing. Our findings have to be confirmed in a large patient series. PSS is not a novel method, but it enhanced the importance of USG in the diagnosis of pneumothorax. We can stipulate that it can replace thorax computed tomography imaging particularly for the diagnosis of occult pneumothoraxes.


12.Comparison of intraoperative ultrasonography guidance with an open surgical method for venous port catheter placement in chemotherapy
Ozan Onur Balkanay, Süleyman Demiryas
PMID: 31650116  PMCID: PMC6790930  doi: 10.14744/nci.2018.76992  Pages 279 - 283
INTRODUCTION: One of the leading venous access methods in chemotherapy is the use of a venous port catheter (VPC). An open surgical or ultrasound-guided technique can be performed. In our study, the VPC placement via both of these techniques was compared.

METHODS: A total of 180 consecutive patients who underwent the VPC placement procedure either via the open or ultrasound-guided methods in two centers between January 2014 and January 2016 were included in the study. Patients’ data were reviewed retrospectively. Groups were compared in terms of intervention-related complication rates, a total procedure time, and the requirement of control imaging with ionizing radiation.

RESULTS: The mean total procedure time was significantly shorter (19.5±4.6 min, 46.7±19.6 min, p<0.001) in the ultrasound-guided group than the open method. The rate of catheter malposition was significantly less in the ultrasound-guided group than in the open group (p<0.001). The need for per-operative imaging with ionizing radiation and the need of reversion in the preferred technique were not observed in the ultrasound-guided group, whereas in the open group, they were observed in 90 (100%) and 6 (6.7%) patients, respectively (p<0.001, p=0.01).

DISCUSSION AND CONCLUSION: Intraoperative ultrasound guidance for the VPC placement shortens the processing time and eliminates the need for routine imaging methods that require the use of ionizing radiation. In accordance with the current guidelines recommendations, intraoperative ultrasonography should be preferred as much as possible during the VPC placement. However, the need for the surgical teams in centers to maintain the necessary educational processes for both techniques should not be overlooked.


13.Otorhinolaryngological symptoms among smokeless tobacco (Maras powder) users
Saime Sağıroğlu, Ayşegül Erdoğan, Adem Doğaner, Ramazan Azim Okyay
PMID: 31650117  PMCID: PMC6790918  doi: 10.14744/nci.2018.50024  Pages 284 - 292
INTRODUCTION: This study aims to investigate the relationship between smokeless tobacco (maras powder) consumption and otorhinolaryngological symptoms.
METHODS: This descriptive study was carried out on 599 participants. The participants were divided into two groups. Of these, 299 (49.9%) patients aged over 18 years were the first group; they used smokeless tobacco for at least 5 years. The remaining patients comprised the second group, which included 300 (50.1%) healthy volunteers who did not use tobacco or its products and demonstrated some similarities with the first group. For the purpose of data collection, a questionnaire consisting of 45 questions was administered to the participants.

RESULTS: Cough, sputum, shortness of breath, dysphagia, snoring, and apnea-hypopnea were found to be significantly increased in smokeless tobacco users. The highest odds ratio (OR) found was for sputum at 2.615. Similarly, other oral cavity symptoms such as mouth tickling, dryness of throat, mouth sores, halitosis, taste disorders, and toothache were found to be significantly increased in smokeless tobacco users. It is noteworthy that halitosis was 9.4 times more prevalent among smokeless tobacco users than in the non-tobacco users. Sinonasal symptoms such as sneezing, headache, facial fullness, and anorexia were found to be significantly increased in smokeless tobacco users. However, there were no differences between the groups in terms of ear symptoms.

DISCUSSION AND CONCLUSION: This study demonstrated that the negative effects of smokeless tobacco consumption were particularly higher in the oral cavity, which in turn gave rise to a number of serious upper respiratory tract complaints.


14.Evaluation of the predictive power of laboratory markers in the diagnosis of acute appendicitis in the elderly
Savaş Bayrak, Cihad Tatar, Ekrem Çakar, Sukru Colak, Mehmet Emin Gunes, Kemal Tekeşin, Bünyamin Gürbulak, Erdem Kinaci, Mert Mahsuni Sevinc
PMID: 31650118  PMCID: PMC6790928  doi: 10.14744/nci.2019.93457  Pages 293 - 301
INTRODUCTION: The aim of this study was to analyze the predictive value of preoperative laboratory findings in acute appendicitis in geriatric patients aged >65 years.
METHODS: We enrolled a total of 4121 patients. A retrospective evaluation of the demographic features was made using preoperative laboratory values such as the white blood cell (WBC), neutrophil, and lymphocyte counts; platelet counts; the mean platelet volume and bilirubin values; and postoperative pathological data of the patients from the electronic file system. The neutrophil-to-WBC and neutrophil-to-lymphocyte ratios were calculated. Patients were divided into two groups, as geriatric (≥65 years old, n=140) and non-geriatric (<65 years old, n=3981).
RESULTS: The white blood cell and lymphocyte counts, and the neutrophil-to-WBC ratio, were significantly higher in the non-geriatric group (p<0.001, p=0.013, and p=0.021, respectively). The neutrophil and platelet counts were higher in the non-geriatric group, but this difference was not statistically significant (p=0.073 and p=0.072, respectively). A higher neutrophil-to-lymphocyte ratio was determined in the geriatric group, but the difference was not significant (p=0.176). According to the optimumal cutoff value of 12.11×103/µL for WBC, specificity and sensitivity values of 65.4% and 57.9% were calculated, respectively; the AUC value was 0.632±0.024 (p<0.001). A receiver operating characteristic (ROC) analysis was used to calculate the optimum cutoff values of neutrophil-to-WBC ratio, lymphocyte, and the mean platelet volume, but the diagnostic accuracy of these tests was inadequate with an AUC of <0.6.
DISCUSSION AND CONCLUSION: WBC values >12.11×103/µL were predictive of acute appendicitis in geriatric patients. The other parameters were not predictive, and further studies are required.

ORIGINAL IMAGES
15.Ascariasis-associated perforated appendicitis: Computed tomography findings
Serdar Aslan, Mehmet Selim Nural
PMID: 31650119  PMCID: PMC6790917  doi: 10.14744/nci.2018.25991  Pages 302 - 303
Abstract | Full Text PDF

CASE REPORT
16.Unusual combined cause of Takotsubo cardiomyopathy: Hyponatremia and seizure
Ersin Çağrı Şimşek, Sadık Volkan Emren, Öner Özdoğan
PMID: 31650120  PMCID: PMC6790925  doi: 10.14744/nci.2018.65148  Pages 304 - 307
Takotsubo cardiomyopathy (TTC) is characterized by transient systolic dysfunction of the left ventricle and changes of electrocardiographic or cardiac markers, resembling an acute coronary syndrome. Although the etiology of TTC is still unknown, a wide variability in the psychological and physical triggers for TTC is present. In this article, we describe the case of 69-year-old female with a history of epilepsy and who presented in the emergency room with a new-onset generalized tonic–clonic seizure activity. After finding out that her biochemistry results indicated severe hyponatremia, a diagnosis of TTC was established through echocardiography and angiography.

17.46 XX male syndrome with hypogonadotropic hypogonadism: A case report
Mehmet M Yalçın, Çiğdem Özkan, Müjde Aktürk, Ferda Perçin, Alev Eroğlu Altınova, Ayhan Karakoç, Göksun Ayvaz, Nuri Çakır
PMID: 31650121  PMCID: PMC6790926  doi: 10.14744/nci.2018.57625  Pages 308 - 311
We report a 46 XX male syndrome diagnosed after failure of gonadotropin therapy taken for hypogonadotropic hypogonadism due to a pituitary macroadenoma. A 39-year-old man with a non-functioning pituitary macroadenoma was admitted to our clinic due to vision loss and infertility. After pituitary surgery, vision loss improved while infertility still existed. Low testosterone levels without elevated gonadotropins were established suggesting hypogonadotropic hypogonadism due to pituitary adenoma. Gonadotropin treatment was initiated. There was no response to treatment after 12 months. A karyotype analysis was ordered to investigate other causes of infertility. Karyotype analysis showed a 46 XX male syndrome that can explain the failure of gonadotropin therapy. Testosterone therapy was started instead of gonadotropin therapy. 46 XX male syndrome usually presents with hypergonadotropic hypogonadism. However, in our case, it presented with hypogonadotropic hypogonadism due to pituitary mass not responding to gonadotropin therapy. It is important to keep in mind to obtain a genetic analysis of patients whose gonadotropin therapy failed, even if their gonadotropin levels are not elevated.

18.Subperiosteal hemorrhage due to a distal femoral physeal fracture in a neonate
Mesut Öztürk, Alparslan Yurtbay, Davut Keskin, Ahmet Veysel Polat, Mustafa Bekir Selçuk
PMID: 31650122  PMCID: PMC6790922  doi: 10.14744/nci.2018.26566  Pages 312 - 314
Femoral physeal fractures have been rarely reported as a birth-related injury. As the plain radiograph findings are variable, the diagnosis may be challenging. In this case report, we describe a male neonate presenting with periosteal elevation at the left distal femur. A radiological evaluation demonstrated posteromedial displacement of the distal femoral epiphysis. The final diagnosis was subperiosteal hemorrhage due to a distal femoral physeal fracture.

19.Lansoprazole as an uncommon cause of anaphylaxis: What to give next?
Attila Aydın, Sedat Bilge, Tolga Düzenli, Harun Aslan, Güçlü Aydın
PMID: 31650123  PMCID: PMC6790933  doi: 10.14744/nci.2018.36539  Pages 315 - 316
Proton pump inhibitors (PPIs) are one of the most prescribed drugs worldwide. Anaphylactic reactions of PPIs are rare; however, several cases have been reported. Here, we report a rare case of anaphylaxis that occurred immediately following lansoprazole intake. Following the successful management in the emergency department, skin prick and oral controlled challenge tests were performed to evaluate cross-reactivity. Thereafter, lansoprazole was switched to pantoprazole, which was well tolerated. Skin prick and oral controlled challenge tests can be performed for determining the cross-reactivity of PPIs to prevent adverse reactions.

REVIEW
20.History of establishment and evaluation of Ottoman-Turkish urology inside the surgical science
Ayhan Verit, Ahmet Ürkmez, Sedat Tellaloğlu
PMID: 31650124  PMCID: PMC6790923  doi: 10.14744/nci.2018.52296  Pages 317 - 319
The first urological international organization occurred in Paris in 1908, and three Ottoman urologists were present among a total of 29. In that year, the Ottoman Urological society had only nine urologists, and almost all were from the Ottoman minorities with the exception of two under the main branch of General Surgery. Among them, Cemil Pasha who was the first dean and department chief of Surgery and Urology of the Medical School in a modern manner (1909) was the most dominant pioneer of the Turkish Surgery-Urology. Four beds out of 20 were separated for the urology clinic.

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