ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of İstanbul - North Clin Istanb: 6 (4)
Volume: 6  Issue: 4 - 2019
RESEARCH ARTICLE
1.The effects of obesity on sedation-related outcomes of advanced endoscopic procedures
Ebru Tarikçi Kiliç, Süleyman Sayar, Resul Kahraman, Kamil Ozdil
doi: 10.14744/nci.2019.93763  Pages 321 - 326
GİRİŞ ve AMAÇ: Literatürde, obez hastalar için ileri endoskopik işlemlerde uygulanan sedasyonun güvenilirliğini gösteren veriler sınırlıdır. Çalışmamızın amacı, ileri endoskopik işlemlerde obezite ile sedasyona bağlı komplikasyon sıklığı arasındaki ilişkiyi ortaya koymaktır.
YÖNTEM ve GEREÇLER: Endoskopik ultrason (EUS) ve endoskopik retrograd kolanjiopankreatografi (ERCP) olan ileri endoskopik işlemlerde, ketamin-propofol (ketofol) karışımı uygulanan 1172 hastanın kayıtları retrospektif olarak incelenmiştir. Tüm hastalar vücut kitle indeksine (VKİ) (kg/m2) göre üç gruba ayrılmıştır. Grup I, VKİ 25-30 arasında olanlar, Grup II, VKİ 30-35 arasında olanlar ve Grup III, VKİ 35-40 arasında olanlar diye tanımlanmıştır. Sedasyon ile ilişkili yan etkiler ve havayolu müdahaleleri açısından gruplar karşılaştırılmıştır.
BULGULAR: Hastaların 1172’inin kayıtları incelenmiş olup, 289’unun VKİ’i 35-40 arasında olup, çoğunluğu ise erkeklerden oluşmaktaydı. Obez hastalarda sedasyona bağlı yan etkiler daha sık görülmekte olup; apne ( grup I: 5.5%, grup II: 5.7%, grup III: 22.8% p < 0.000), oksijen desaturasyonu (grup I: 7.7%, grup II: 9.4%, grup III: 27.7%, p < 0.000),ve hava yolu obstruksiyonu (grup I: 4.9%, grup II: 5.4%, grup III: 22.8%, p < 0.000) sıklıklarda görülmüştür. Obez hastalar daha sık hava yolu müdahalesi, aspirasyon ve maske ile ventilasyon gerektirmiştir.
TARTIŞMA ve SONUÇ: Sedasyona bağlı yan etkilerin sıklığı VKİ ile doğru orantılı artmaktadır, ancak ileri endoskopik işlemlerde obez hastalarda deneyimli anestezistler tarafından uygulanan ketofol sedasyon rejiminin güvenilir olduğu kanaatindeyiz.
OBJECTIVE: Current literature covers limited data on the safety of sedation in advanced endoscopic procedures in obese patients. The present study aims to evaluate the association between obesity and the frequency of sedation-related complications in patients who were undergoing advanced endoscopic procedures.
METHODS: A retrospective chart analysis of 1172 consecutive patients, meeting the inclusion and exclusion criteria for this study and undergoing intravenous ketamine-propofol (ketofol) sedation for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) procedures were evaluated. The patients were classified into three groups according to their body mass index (BMI) (kg/m2). Group I comprised patients with a BMI between 25 and 30, group II with a BMI between 30 and 35, and group III with a BMI between 35-40. The sedation-related outcomes in the form of adverse events, and airway interventions were compared between the groups.
RESULTS: For analysis, out of the 1172 available records, 289 patients had a BMI between 35-40 and were predominantly male patients. The total adverse events were more common in obese patients, with apnea (in 5.5% patients in group I, 5.7% in group II, 22.8% in group III p<0.000), oxygen desaturation (in 7.7% patients in group I, 9.4% in group II, and 27.7% in group III p<0.000), and airway obstruction (in 4.9% patients in group I, 5.4% in group II, 22.8% in group III, p<0.000). Moreover, the obese patients more frequently required airway interventions, including airway placement, suctioning and bag-mask ventilation.
CONCLUSION: Higher BMI was associated with an increased frequency of sedation-related complications. However, we concluded that ketofol sedation regimen could be used safely in obese patients during advanced endoscopic procedures by skilled anesthesia providers.

2.The behavioral and neurochemical effects of methylprednisolone or metyrapone in a post-traumatic stress disorder rat model
Ayşe Melek Tanriverdi Bademci, Banu Aydin, Berna Terzioglu Bebitoglu, Hulya Cabadak, M. Zafer Gören
doi: 10.14744/nci.2019.69345  Pages 327 - 333
GİRİŞ ve AMAÇ: Post travmatik stres bozukluğundaki (PTSD) mekanizmalar farklı fizyolojik sistemleri etkilemekte olup hipotalamik-hipofiz-adrenal (HPA) aks aktivasyonu PTSD patofizyolojisinde rolü olan sistemlerden biridir.
Bu çalışmada, saldırgan hayvan kokusu ile oluşturulan PTSD sıçan modelinde metilprednizolon ve metiraponun lokus seruleusu (LC) içeren rostral ponsta noradrenerjik sistemle ilişkili etkileri incelenmiştir.
YÖNTEM ve GEREÇLER: Sprague-Dawley sıçanlar kirli kedi kumuyla saldırgan hayvan kokusuna maruz bırakılarak sıçanlarda stres oluşturulmuş ve 1 hafta sonra temiz kedi kumuyla ile stres çağrıştırılmıştır. Sıçanlara metilprednizolon, metirapon veya fizyolojik tuzlu su tedavileri travma hatırlatıcından önce uygulanmıştır (her grupta n = 8). Rostral ponstaki noradrenalin (NA) konsantrasyonu ELISA ile analiz edilmiştir.
BULGULAR: Stres uygulanan sıçanlarda anksiyete indekslerinin kontrol grubuna göre anlamlı arttığı görüldü. Metirapon stres oluşturulmayan sıçanlarda anksiyete indekslerini anlamlı olarak artırırken, metilprednizolon stres olmayan sıçanlarda anksiyete indeksinde değişiklik yapmamıştır. Stres oluşturulan sıçanlarda metirapon tedavisi anksiyete indeksini artırmış olmakla birlikte kontrol grubundakinden düşük kalmıştır. Hem stres oluşturulmuş, hem de stres oluşturulmayan sıçanlarda metilprednizolon tedavisinden sonra donma süresinde azalma gözlenmiştir.
Stresli sıçanların rostral ponstaki NA içeriği, stress olmayan sıçanlara göre anlamlı olarak daha yüksektir. Stres olmayan sıçanlarda, metilprednizolon veya metirapon tedavileri, fizyolojik tuzlu su tedavisi ile karşılaştırıldığında NA içeriğinin düşük bulunsa da bu düşme anlamlı bulunmamıştır.
TARTIŞMA ve SONUÇ: Stres endokrin, otonom ve davranışsal etkiler doğurabilir. Travmatik stres anksiyete indeksini ve rostral ponstaki noradrenalin düzeyini artırmaktadır. Metilprednizolon tedavisi lokus seruleus ve HPA ekseni arasındaki etkileşimler yoluyla anksiyete indeksini baskılayabilmiştir.
OBJECTIVE: Mechanisms contributing to the post-traumatic stress disorder (PTSD) that involve several physiological systems, and the activation of the hypothalamic-pituitary-adrenal axis (HPA) is one of the most known systems in the PTSD pathophysiology. The present study investigates the potential effects of methylprednisolone, metyrapone and their association with the noradrenergic system within the rostral pons, a region containing the locus coeruleus (LC) in a rat model of PTSD induced with predator scent.
METHODS: In this study, Sprague-Dawley rats were exposed to the stress by exposure to the scent of dirty cat litter, which is a natural stressor of a predator. One week later, the rats were re-exposed to a situational reminder (clean cat litter). The rats were treated using either methylprednisolone, metyrapone or physiological saline before exposure to a situational reminder (n=8 in each group). Noradrenaline (NA) levels in the rostral pons homogenates were analysed using ELISA.
RESULTS: The anxiety indices of the rats exposed to the trauma were found to be significantly higher than the anxiety indices of the control rats. Metyrapone produced a significant increase in the anxiety indices of the non-stressed rats, and methylprednisolone did not produce a change in the anxiety indices of the non-stressed rats. Methylprednisolone treatment suppressed the anxiety in the stressed rats. Metyrapone treatment increased the anxiety indices in the stressed rats but still being lower than that of the saline-treated stressed rats. Significant decrease in the freezing time was observed following the methylprednisolone treatment both in the stressed and non-stressed rats. NA content in the rostral pons of the stressed rats was significantly higher than that of the non-stressed rats. Methylprednisolone or metyrapone treatments decreased the NA content in the non-stressed rats as compared to the saline treatment. However, these decreases were not significant.
CONCLUSION: In this study, findings suggest that stress may give rise to endocrine, autonomic and behavioural responses. The anxiety indices and NA levels in the rostral pons increased with the traumatic event. The methylprednisolone treatment may suppress anxiety through interactions between the LC and the HPA axis.

3.The relationship between serum vitamin D level and asthma
Mehmet Yasar Ozkars, Ozlem Keskin, Mehmet Almacioglu, Ercan Kucukosmanoglu, Mehmet Keskin, Onur Balcı
doi: 10.14744/nci.2019.82195  Pages 334 - 340
GİRİŞ ve AMAÇ: Birçok çalışma, düşük serum Vitamin D düzeyleri ile çocukluk çağında astımın başlangıcı arasında bir ilişki kurmuştur. Amacımız D vitamini ve astım arasındaki ilişkiyi değerlendirmektir.
YÖNTEM ve GEREÇLER: Çalışmaya 29 hafif ve 30 orta persistan astım ve 38 sağlıklı kontrol grubu çocuk dahil edildi. Serum D vitamini seviyeleri, Solunum Fonksiyon Testi (SFT) ve Egzersiz Provokasyon Testi (EPT) açısından 3 grubun değerlendirmesi yapıldı. Ayrıca iki astım grubuna, ekshale nefes havasında Nitrik Oksit (FeNO) seviyesi ve Astım Kontrol Testi (AKT) incelemesi yapıldı.
BULGULAR: Hafif ve orta persistan astım gruplarının D vitamini düzeylerinin, kontrol grubununkinden daha düşük olduğu belirlendi. Vitamin D düzeyleri ile bronko-reversibilite yüzdesi arasındaki tüm olgularda anlamlı negatif korelasyon saptandı. Vitamin D düzeyleri ve bronko-reversibilite yüzdesi arasındaki negatif korelasyon orta persistan astım grubunda daha belirgindi. Orta persistan astım grubunda, EPT'de zorlu ekspiratuvar hacim ve D Vitamini seviyesinin düşüklüğü arasında anlamlı pozitif korelasyon saptandı. Hafif astım grubuna kıyasla, orta astımlı grupta AKT skorları daha düşük ve FeNO seviyeleri daha yüksekti.
TARTIŞMA ve SONUÇ: Bu çalışmanın sonuçlarında, astımı olan çocuklarda düşük serum D vitamini düzeylerinin daha sık görüldüğünü ve SFT'de artmış bronko-reversibilite ve EPT'de artmış bronşiyal hiper reaktivite ile korelasyon olduğu gösterilmiştir.
OBJECTIVE: Several studies have established a relationship between low serum vitamin D levels and the onset of asthma in childhood. In this study, we aim to assess the relationship between vitamin D and asthma.
METHODS: This study included 29 mild and 30 moderate persistent asthma and 38 healthy control group. Evaluation of the three groups was carried out in respect of serum vitamin D levels, Respiratory Function Test (RFT), and Exercise Provocation Test (EPT). The two asthma groups were also examined using the Asthma Control Test (ACT) and Nitric Oxide in Exhaled Breath (FeNO) level.
RESULTS: The vitamin D levels of the mild and the moderate persistent asthma groups were determined to be lower than the vitamin D levels of the control group (p=0.007). A significant negative correlation was determined in all cases between the vitamin D levels and the broncho-reversibility percentage (p=0.0002). The negative correlation between the vitamin D levels and the broncho-reversibility percentage was more evident in the moderate persistent asthma group (p=0.0001). In the moderate persistent asthma group, a significant positive correlation was determined between the lowness of the maximum forced expiratory volume in EPT and a low vitamin D level (p=0.009). The ACT scores were lower, and the FeNO levels were higher in the moderate asthma group compared to the mild asthma group (p=0.0001).
CONCLUSION: The findings showed that low serum vitamin D levels were observed more often in children with asthma, and there was a correlation with increased broncho-reversibility in the RFT and increased bronchial hyper-reactivity in the EPT.

4.An investigation of serum irisin levels and inflammatory markers in fibromyalgia syndrome
Rümeysa Samancı, sarfinaz ataoglu, Mustafa Özşahin, Handan Ankaralı, Özlem Admış
doi: 10.14744/nci.2019.95676  Pages 341 - 347
GİRİŞ ve AMAÇ: Bu çalışmada, Fibromiyalji sendromu (FMS) olan hastalar ile sağlıklı kontrol bireylerinin serum irisin düzeyi açısından karşılaştırılması ve hastalarda irisin ile hastalık aktivitesi ve inflamasyon belirteçleri arasında ilişkinin incelenmesi amaçlandı.
YÖNTEM ve GEREÇLER: Çalışmaya, FMS tanısı konmuş 48 hasta ve 36 sağlıklı kontrol olmak üzere toplam 84 kadın alındı. Hasta ve kontrol grubunun demografik özellikleri kaydedildi. Ağrı için VAS, fiziksel fonksiyon için Fibromiyalji Etki Anketi, yaşam kalitesini değerlendirmek için SF36, depresyonu değerlendirmek için Beck Depresyon Ölçeği kullanıldı. Serum irisin düzeyi, inflamatuar belirteçlerden ESH, CRP, hsCRP ve nötrofil/lenfosit oranını (NLO) belirlemek için kan örnekleri alındı. Serum irisin düzeyleri ELİSA yöntemi ile değerlendirildi.
BULGULAR: FMS hastalarının serum irisin seviyesi ile sağlıklı kontrol grubu arasında anlamlı fark saptanmadı. Ayrıca bu iki grup arasında ESH, CRP, hsCRP ve NLO değerleri bakımından da anlamlı farka rastlanmadı. Hastalarda serum irisin seviyesi ile inflamatuar belirteçler arasında anlamlı ilişki bulunamadı görülmedi.
TARTIŞMA ve SONUÇ: Bir miyokin olan irisin, FMS patogenezinde belirgin bir rolünün olmadığı tespit edildi. İrisinin hastalık aktivitesi ve inflamatuar belirteçlerle anlamlı ilişkisi yoktu. Ayrıca FMS’de öne sürülen inflamatuar hipotezde desteklenmedi. Ancak, daha homojen ve geniş hasta gruplarıyla yeni araştırmalara ihtiyaç vardır.
OBJECTIVE: In the present study, we aimed to compare serum irisin levels in patients with fibromyalgia syndrome (FMS) and healthy control subjects and also investigate the relationship between irisin, disease activity and inflammation markers in patients.
METHODS: A total of 84 women, including 48 patients who were diagnosed with FMS and 36 healthy controls, were included in this study. The demographic characteristics of the patients and control group were recorded. VAS for pain and the Fibromyalgia Impact Questionnaire for the assessment of the physical function of the patients, SF36 was used for quality of life, and accompanying Beck Depression Inventory to assess depression was used. Blood samples were taken for analysis that irisin, and inflammatory markers of the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), high-sensitivity C-reactive protein (hs-CRP) and neutrophil/lymphocyte ratio (NLO). Serum irisin levels were determined using the Enzyme-Linked Immunosorbent Assay (ELISA) method.
RESULTS: Serum irisin level of the patients with FMS had no significant differences compared with the healthy control group. When we compared the values of ESR, CRP, hsCRP, NLO with FMS patients and healthy controls, there was no significant difference found between them (p>0.05). There was no significant correlation between inflammatory markers and level of serum irisin (p>0.05). In patients, there was no significant correlation between inflammatory markers and level of serum irisin (p>0.05).
CONCLUSION: Irisin, which is a myokine, was determined to have no significant role in the pathogenesis of FMS. Irisin had no association with disease activity and inflammatory markers. Also, the inflammation hypothesis was not supported, which suggested in FMS.

5.Evaluation of serum thiol/disulfide homeostasis in patients with ankylosing spondylitis by a novel method
Rabia Aydoğan Baykara, Ayça Tuzcu, Ahmet Omma, Günseli Karaca Acet, Erdal Doğan, Almila Aydın, Medine Cumhur Cüre, Erkan Cüre, Adem Küçük, Özcan Erel
doi: 10.14744/nci.2018.37123  Pages 348 - 354
GİRİŞ ve AMAÇ: Artmış reaktif oksijen türleri, Ankilozan Spondilit (AS) etiyopatogenezinde önemli bir rol oynayabilir. Tiyol grubu çok güçlü bir antioksidandır. Biz AS'li hastalarda tiyol/disülfit dengesini değerlendirerek oksidatif stres varlığını araştırmayı amaçladık.
YÖNTEM ve GEREÇLER: Bu çalışmaya toplamda 66 AS'li hasta (27 erkek, 39 kadın) ve 66 sağlıklı kontrol (21 erkek,45 kadın) dahil edildi. Son zamanlarda, yeni bir tiyol ölçümü yöntemi keşfedildi. Tiyol ve disülfit değerleri bu yeni metotla ölçüldü.
BULGULAR: AS hastalarının nativ tiyol (NT) (p<0.001) ve nativ tiyol/total tiyol (NTT) (p<0.001) düzeyi sağlıklı kontrol grubunun değerlerine kıyasla anlamlı olarak düşüktü. Ancak AS hastalarının disülfit (p<0.001), disülfit/nativ tiyol (DNT) ve disülfit/total tiyol (DTT) değerleri kontrol grubuna göre oldukça yüksekti. BASFI ve NTT arasında negatif korelasyon bulundu. Ayrıca, BASDAI ve NT, NTT seviyeleri arasında da negatif bir korelasyon bulundu. BASFI ve disülfit, DNT ve DTT düzeyleri arasında pozitif korelasyon bulundu. BASDAI ve disülfit, DNT ve DTT arasında pozitif korelasyon bulundu.
TARTIŞMA ve SONUÇ: Tiyol-disülfit dengesinin AS'li hastalarda disülfit seviyesi lehine bozulduğunu tespit ettik. Tiyol/disülfit dengesi AS’nin etiyolojisinde ve şiddetinde rol oynayabilir.
OBJECTIVE: Increased reactive oxygen species may play an important role in Ankylosing spondylitis (AS) etiopathogenesis. The thiol group is a very potent antioxidant. In this study, we aimed to investigate the presence of oxidative stress in patients with AS by evaluating thiol/disulfide homeostasis.
METHODS: In this study, a total of 66 AS patients (27 male, 39 female) and 66 healthy controls (21 male, 45 female) were enrolled. Recently, a novel method for the thiol measurement was found. Thiol and disulfide values were measured by the novel methods.
RESULTS: Native thiol (NT) (p<0.001) and native thiol/total thiol (NTT) (p<0.001) levels of AS patients were significantly lower compared to the values of the healthy group. However, disulfide (p<0.001), disulfide/native thiol (DNT) (p<0.001) and disulfide/total thiol (DTT) levels of AS patients were a strongly higher control group. A negative correlation was found between BASFI and NTT. Also, a negative correlation was found between BASDAI and NT, NTT levels. A positive correlation was found between BASFI and disulfide, DNT and DTT levels. A positive correlation was found between BASDAI and disulfide, DNT and DTT levels.
CONCLUSION: The findings revealed that thiol-disulfide homeostasis deteriorated in patients with AS in favor of disulfide amounts. Thiol-disulfide homeostasis can play roles in the etiology and severity of AS.

6.Our clinic’s first experience with HoLEP
Serkan Doğan, Kenan Yiğit Yıldız
doi: 10.14744/nci.2019.24855  Pages 355 - 360
GİRİŞ ve AMAÇ: Kliniğimizde yapılan ilk Holmium lazer ile prostat enükleasyonu (HoLEP) vakalarını ve sonuçlarını retrospektif olarak incelemek.
YÖNTEM ve GEREÇLER: Nisan 2017 – Kasım 2017 tarihleri arasında HoLEP cerrahisi uygulanan 24 hasta demografik özellikleri, operasyon süresi, kanama miktarı, kullanılan enerji miktarı, çıkarılan doku ağırlığı, kataterizasyon süresi ve komplikasyon yönünden incelendi. Operasyon öncesi ve sonrası IPSS ve üroflowmetri ile ölçülen işeme hızları karşılaştırıldı.
BULGULAR: Hastaların cerrahi öncesi ve sonrası hemoglobin, IPSS, üroflovmetri ile ölçülen işeme hızları (Q ort, Q max) karşılaştırıldı. IPSS, Q ort ve hemoglobin düzeyleri arasında anlamlı elde edilirlen Q max için istatiksel anlamlı sonuç saptamadık. Komplikasyon oranlarımız da literatürle uyumlu oranlardaydı.
TARTIŞMA ve SONUÇ: HoLEP benign prostat hiperplazisi tedavisinde oldukça güvenle uygulanabilecek, fonksiyonel sonuçları altın standart cerrahilerle benzer özellik gösteren ama daha az komplikasyona sebep olan, kısa kataterizasyon ve hospitalizasyon sebebiyle hasta konforunu artıran ve maliyet açısından daha avantajlı bir cerrahi yöntem olarak öne çıkmaktadır.
OBJECTIVE: The present study reports a retrospective evaluation of the first Holmium laser prostate enucleation (HoLEP) cases and their results in our clinic.
METHODS: Twenty four patients who underwent HoLEP surgery between April 2017 and November 2017 were evaluated for demographic characteristics, duration of operation, amount of hemorrhage, amount of energy used, tissue weight removed, catheterization time and complications. IPSS and uroflowmetry results were compared before and after the surgery.
RESULTS: Patients with hemoglobin, IPSS, uroflowmetry, and voiding speeds (Qmean, Qmax) were compared before and after the surgery. There was a significant difference in IPSS, Qmean and hemoglobin values but not in Qmax, statistically. Our complications rates were correlated with the literature.
CONCLUSION: HoLEP stands out as a surgical method that can be applied with high confidence in the treatment of benign prostatic hyperplasia and it has similar functional results to gold standard surgeries, causes fewer complications, improves patient comfort due to short catheterization and hospitalization and is more advantageous regarding cost.

7.The efficacy of the electric patient hoist systems in mobilization
Tomris Duymaz, Levent Ozgonenel, Zeynep Erdoğan
doi: 10.14744/nci.2018.25986  Pages 361 - 367
GİRİŞ ve AMAÇ: Uzun süreli immobilizasyona bağlı organlar ve tüm sistemlerde fizyolojik ve biyomekanik negatif etkiler açığa çıkmaktadır. Hastanın en erken dönemde ayağa kalkması ve mobilize olabilmesi sistemik fonksiyonların iyileşme sürecini hızlandırmakta ve hastayı bağımsız hale getirmektedir. Bizim bu çalışmadaki amacımız da, ayağa kaldırma sistemi(James cihazı) ile erken dönemde mobilize edilen hastaların, konvansiyonel sistemlere göre hastane yatış süreleri, mobilite düzeyleri ve günlük yaşam aktivitelerine dönüş sürelerinde fark olup olmadığını araştırmaktır.
YÖNTEM ve GEREÇLER: Çalışmamızda 50-75 yaş arası 1 haftadan fazla immobil olan 30 hasta değerlendirilmiştir.Hastalar rehabilitasyon grubu ve rehabilitasyonla birlikte James ayağa kaldırma sistemi uygulanan olmak üzere 2 gruba ayrılarak 15’er seans tedavi uygulanmıştır. Tedavi öncesi ve sonrası değerlendirmelerde yaş, boy, kilo, hastanede yatış süresi, ilk mobilize oldukları gün kaydedilmiş,
klinik mobilite ile Rivermead mobilite indeksleri ve günlük yaşam aktivitelerini değerlendirmek için Barthel indeksi kullanılmıştır.
BULGULAR: Çalışmamızdaki verileri analiz ettiğimizde James cihazı ile ayağa kaldırılan gruptaki hastaların hastanede yatış süreleri kontrol grubuna göre ileri düzeyde anlamlı bir şekilde azalma göstermiştir (p=0.014). Klinik ve Rivermead mobilite indekslerinin tedavi öncesi ile sonrası gruplar arası karşılaştırıldığında James cihazı uygulanan gruptaki hastaların mobilite düzeylerindeki iyileşmenin daha fazla olduğu (p<0.001),Barthel indeksi ile günlük yaşam aktiviteleri değerlendirildiğinde ise yine erken mobilize edilen James grubu hastalarının istatistiksel olarak günlük yaşama daha fazla ve daha çabuk katılım gösterdikleri bulunmuştur (p=0.002)
TARTIŞMA ve SONUÇ: Hastane yatış sürecinin erken döneminde uyguladığımız James ayağa kaldırma sistemi sayesinde hasta alt ekstremite ve gövdesinden stabil hale getirilerek üst ekstremite gücüne hiç ihtiyaç olmaksızın mekanik kaldırma sistemi ile hastaya ve terapiste yük bindirmeden kolaylıkla, güvenli bir şekilde ayakta tutulabilmektedir. Bu sayede hastanın ayakta durma süresi artmakta ve bu süreyi en verimli şekilde kullanabilmektedir. Sonuç olarak, immobilize olan hastaların rehabilitasyon programına ek olarak ayağa kaldırma sistemi ile erken dönemde ayakta durma çalıştırıldığında, cihaz kullanılmayan hastalara göre daha kısa sürede mobilize oldukları, hastane yatış sürelerinin kısaldığı ve günlük yaşam aktivitelerine dönüşlerinin daha kolay oldukları bulunmuştur.
OBJECTIVE: Long-term immobilization brings about physiological and biomechanical adverse effects on organs and systems. For enabling patients to stand on their feet and to be mobilized in the early period, electric patient hoist system (EPHS) accelerates the recovery of systemic functions and allows the patient with neurological diseases to become independent. This study aimed to investigate whether EPHS differs from conventional systems in the duration of hospitalization, mobility level and return to activities of daily living by analyzing patients mobilized with EPHS in the early period.
METHODS: We analyzed 30 patients with neurological diseases, who were aged 50-75 years and immobile for more than one week. The patients were divided into two groups as EPHS patients and controls. Before and after the treatment, we recorded age, height, weight, hospitalization duration and time of mobilization. Mobility was assessed using the clinical and Rivermead mobility indexes while daily activities were evaluated with the Barthel index.
RESULTS: Our results indicated that the hospitalization duration decreased significantly in the patients practicing with EPHS in comparison with the controls (p=0.014). When the groups were compared regarding the pre- and post-treatment outcomes of the clinical and Rivermead mobility indexes, the mobility levels of the EPHS group showed more considerable improvement (p<0.001). The Barthel index demonstrated that the EPHS patients showed significantly higher participation in daily life within a significantly shorter time (p=0.002).
CONCLUSION: Applying EPHS in the early period of hospitalization extends the time patients stand on their feet, enabling them to spend this time effectively. In conclusion, intervening immobile patients with EPHS in addition to their early rehabilitation program achieved earlier mobilization, shorter hospitalization and easier return to daily life activities.

8.The efficacy of transversus abdominis plane block for post-operative analgesia after the cesarean section performed under general anesthesia
Halil Buluc, Arzu Yıldırım Ar, Güldem Turan, Güldem Turan, Mehmet Akif Sargın, Nur Akgun
doi: 10.14744/nci.2018.97059  Pages 368 - 373
GİRİŞ ve AMAÇ: Sezeyan sonrası ağrıyı önlemek için birçok yöntem bulunmaktadır. Son zamanlarda, mevcut yöntemlerden farklı olarak transversus abdominis plane block (TAP) önerilmiştir. Prospektif, randomize, doble-blind kontrollü çalışmada sezaryen sonrası TAP blokunun analjezik etkinliğini karşılaştırdık.
YÖNTEM ve GEREÇLER: Genel anestezi altında sezeryan sectio uygulanan 30 hasta iki eşit gruba ayrıldı. Grup T (n=15 )’ deki hastalara USG eşliğinde TAP blok % 0.25 bupivakain toplam 60 ml uygulandı. Grup C (n=15) ‘deki hastalara USG eşliğinde % 0.9 NaCl toplam 60 ml uygulandı. Postoperatif hasta kontrollü analjezi cihazı kullanılarak meperidin kullanımı kaydedildi.
BULGULAR: Kontrol grubunda (Grup C) ilk analjezik ihtiyacı anlamlı olarak yüksekti. Analjezi için kullanılan meperidin, tenoksikam, parasetamol total dozu grup C’de yüksekti. Emzirme başlama ve mobilizasyon zamanında gruplar arasında fark yoktu.
TARTIŞMA ve SONUÇ: Sezeryan sectio sonrası postoperatif ağrıda her iki sahaya 30 ml, toplam 60 ml % 0.25 bupivakain ile USG eşliğinde TAP blokla anlamlı olarak azaldı. TAP bloğun ciddi komplikasyonlara yol açmadan postoperatif analjezi ihtiyacını azaltmada konforlu ve uygulanabilir bir yöntem olduğunu düşünmekteyiz.
OBJECTIVE: Several methods are used to control the pain after cesarean operations. Recently, the transverse abdominis plane block (TAP) has been proposed to compensate for the problems developed by preexisting methods. In the present study, we compared the analgesic efficacy of the TAP block after caesarean section in a prospective, randomized, double-blinded controlled trial.
METHODS: In this study, thirty patients undergoing cesarean sections under general anesthesia were divided into two groups. Patients in Group T (n=15) on whom TAP Block with USG guidance was performed using 0.25% bupivacaine totally 60 ml. The patients in Group C were administered (n=15), 0.9% NaCl totally 60 ml (30 ml at each side) with USG guidance. Post-operative demand of meperidine using a patient-controlled analgesia device was recorded.
RESULTS: First time on the need for analgesia were significantly higher in the control group (Group C). The total dose of meperidine, tenoxicam, paracetamol used for analgesia was significantly higher in the Group C. The outset times of breastfeeding and mobilization did not change between the groups.
CONCLUSION: The USG-TAP block with 0.25% bupivacaine 60 ml (30 ml on each side) significantly reduced post-operative pain in patients undergoing the cesarean section. We think that TAP block is a comfortable and feasible method which reduces post-operative analgesia need and does not lead any serious complications.

9.Knowledge and approaches of married men applying to a primary healthcare center in Istanbul about IUD: A qualitative study
Muhammed Fatih Onsuz, Seyhan Hıdıroğlu, Melda Karavuş
doi: 10.14744/nci.2018.76093  Pages 374 - 378
OBJECTIVE: This study aims to determine the knowledge and approach of men applying to a primary health care center about IUD by adopting qualitative research methods.
METHODS: This study was qualitative research realized using an in-depth interview method. The interview was carried with 15 married men in a primary health care center in Umraniye, using 15 semi-structured interview questions.
RESULTS: Knowledge of the men in this study about IUD and family planning was inadequate. Participants generally determined the advantages of IUD with its superiority over other methods. Adverse effects of IUD on women and men during intercourse were stated. Knowledge of men about IUD, its side effects and disadvantages were generally composed of misinformation and rumours about the subject.
CONCLUSION: Men do not have adequate information and knowledge on family planning and IUD. Training provided by the health personnel might have a considerable role in demolishing misinformation and rumors and may augment the level of knowledge about IUD

10.IL-15 negatively regulates curdlan-induced IL-23 production by human monocyte-derived dendritic cells and subsequent Th17 response
Ahmet Eken, Zehra Okuş, Şerife Erdem, Zehra Büşra Azizoğlu, Yeşim Haliloğlu, Ayten Biçer, Tuğba Nur Gür, Ebru Yilmaz, Musa Karakukcu, Hamiyet Donmez Altuntas, Halit Canatan
doi: 10.14744/nci.2019.38802  Pages 379 - 387
OBJECTIVE: In this study, we aimed to assess the effects of long- and short-term IL-15 cytokine exposure of human monocyte-derived curdlan-matured dendritic cells (DCs) on the production of Th17 cell-polarizing cytokine IL-23 and subsequent Th17 cell activation.
METHODS: Peripheral blood mononuclear cells (PBMCs) were purified using Ficoll-Paque from healthy donors. Monocytes were magnetically selected using CD14 Miltenyi beads and differentiated into DCs with granulocyte-macrophage colony-stimulating factor (GM-CSF) and IL-4 for five days in the presence or absence of IL-15 (100ng/ml) for long-term exposure experiments. Then, DCs were matured with peptidoglycan (PGN), or curdlan for 24 hours. For short-term exposure experiments, IL-15 was added only during maturation of DCs. Then, DCs were characterized concerning the expression of MHC II and costimulatory molecules, production of cytokine subunits IL-23p19, IL-12p40, IL-12p35 and cytokine IL-23 via flow cytometry or real-time qPCR or ELISA. Finally, the phosphorylation of signaling molecules after curdlan stimulation was assessed using phospho-flow assays.
RESULTS: IL-15 exposure suppressed IL-23 production by DCs. As a result, IL-15-exposed DCs suppressed IL-17 production by allogeneic T cells. Importantly, we observed a reduction in the surface Dectin-1 receptor levels by IL-15-exposed DCs. In line with these observations, curdlan stimulation resulted in reduced phosphorylation of ERK1/2, NF-kB p65 and AKT by human DCs exposed to IL-15 compared with controls. These results may explain why IL-15-exposed DCs produce less IL-23 after maturation with curdlan, which is a ligand of Dectin-1.
CONCLUSION: Short- or long-term exposure to IL-15 of human DCs during their differentiation or maturation programs DCs against Th17 cell polarization, which suggests that IL-15 availability may affect CD4+ T cell-mediated protective immunity to fungal infections

11.Early results of comparison of polypropylene mesh and 75% resorbable mesh (monofilament polypropylene and poly-L-lactic acid (PLLA) mesh) for laparoscopic total extraperitoneal (TEP) inguinal hernia repair
Birol Agca, Yalin Iscan, Kemal Memişoğlu
doi: 10.14744/nci.2018.91129  Pages 388 - 392
OBJECTIVE: Laparoscopic totally extraperitoneal (TEP) hernia repair has become increasingly widespread. Faster recovery than conventional open methods shortens the return to work. Polypropylene (PP) mesh is still in use in hernia surgery because it is an inexpensive and easily accessible patch. The post-operative chronic pain and foreign body sensation are the disadvantages of these PP patches. Poly-L-lactic acid and polypropylene (PLLA) were used in this study because of the good biocompatibility and low tissue inflammation response. We compared the early clinical outcomes of PP patch and PLLA patches.
METHODS: Between January 2013 and April, 2018,469 patients with inguinal hernia underwent TEP procedure. Patients were divided into two groups. PP mesh (n=211) in group 1, PLLA mesh (n=258) in group 2. Patients were compared regarding age, gender, hernia side, ASA scores, the duration of operation, pain, time to return to work, the sensation of foreign body, seroma and hematoma.
RESULTS: A total of 469 patients were analyzed retrospectively (426 male, 43 female). The mean age was 52.23±13.66 years. The operative times of the patients were 40.92±8.9 minutes in group 1, and 38.82±8.5 minutes in group 2 (p<0.05). The time to return to work was 10.2±1.47 days in Group 1 and 8.4±1.0 days in Group 2 (p<0.05). Visual Analog Scale (VAS) in group 2 was lower than in group 1 (p<0.005). In group 2, the feeling of the organic body decreased in the early and late period (p<0.005). Seroma and hematoma were less in Group 2 than in Group 1 (p<0.005). The mean follow-up period of the patients was 18 (3-63) months, two patients in Group 1, two patients in Group 2 recurred.
CONCLUSION: The PLLA patch used in the TEP method is thought to be a herniated patch that can be safely used because of its ease of application and less postoperative complication rates and more rapid return to work.

12.Association of monocyte to high-density lipoprotein ratio with bare-metal stent restenosis in STEMI patients treated with primary PCI
İlhan İlker Avcı, İrfan Şahin, Barış Güngör, Mehmet Baran Karataş, Kazim Serhan Özcan, Yiğit Çanga, Muhammet Keskin, Mert Hayıroğlu, Fatma Özpamuk Karadeniz, Aylin Sungur
doi: 10.14744/nci.2018.93653  Pages 393 - 400
OBJECTIVE: Monocyte to high-density lipoprotein ratio (MHR) has recently been postulated as a novel parameter related to adverse cardiovascular outcomes. In this study, we aimed to investigate the correlation of MHR with stent restenosis (SR) rates after the primary percutaneous coronary intervention (PCI) and bare-metal stent (BMS) implantation.
METHODS: In this study, patients who had undergone primary PCI for STEMI and had a control angiogram during follow-up were retrospectively recruited. Patients were categorized according to admission MHR tertiles, clinical and angiographic data were compared. In addition, predictors of SR were evaluated with logistic regression analysis.
RESULTS: A total number of 448 patients (240 patients with SR and 208 patients without SR) were included in this study. Patients were categorized into three groups according to tertiles of admission MHR. During a follow-up period of median 12 months, the rate of SR was significantly higher in patients with higher MHR levels (45% in tertile 1, 54% in tertile 2 and 62% in tertile 3, p<0.01). In multivariate Cox regression analysis, male gender, stent length, admission NLR levels and MHR levels (HR 1.03, 95% CI 1.02–1.06, p<0.01) remained as the independent predictors of SR in the study population.
CONCLUSION: Gender, stent length, higher MHR and NLR levels are correlated to SR after primary PCI.

ORIGINAL IMAGES
13.Dermoscopy of nevus comedonicus
Melek Aslan Kayıran, Filiz Cebeci, İlkin Zindanci, Mehmet Salih Gürel, Necmettin Akdeniz
doi: 10.14744/nci.2018.06926  Pages 401 - 402
Nevus comedonicus is a rare type of nevus originating from the epithelial part of the center of the pilosebase unit. It is characterized by the combination of the dilated follicular openings resembling comedones. It may be seen in any part of the body but especially face and neck. History and clinical examination leads to the diagnosis and there is no need to perform a histopathological examination in most cases. The diagnosis can be supported by dermoscopic findings.The dermoscopy of our case was similar to the findings of the present reports.This case is presented for emphasizing the point that dermoscopy can be supportive for the diagnosis of nevus comedonicus and for contributing to the literature with its dermoscopic findings.

14.Penetration of components of cervical fixation device into esophagus: An unexpected finding for the endoscopist
Murat Ferhat Ferhatoglu, Taner Kıvılcım
doi: 10.14744/nci.2018.33239  Page 403
Abstract | Full Text PDF

CASE REPORT
15.Epithelial-myoepithelial carcinoma of the supraclavicular region: An unusual cause of dyspnea
İbrahim Hıra, Mustafa Sahin, Ali Bayram, Altan Kaya, Hatice Karaman, İbrahim Özcan
doi: 10.14744/nci.2018.25932  Pages 404 - 406
Epithelial-myoepithelial carcinoma (EMC) is an extremely rare disease and usually develops in major salivary glands, such as the parotid gland. EMC is regarded as a low grade-malignancy tumor, and the treatment protocol involves wide surgical excision with secure clear margins although postoperative radiotherapy is generally performed to reduce local recurrence. The present study aims to report a case of EMC with a supraclavicular location due to its rare occurrence and atypical location.

16.Bilateral simultaneous non-arteritic anterior ischemic optic neuropathy with occlusion of unilateral cilioretinal artery: A case report
Utku Limon, Betül İlkay Sezgin Akçay, Erdem Akçay
doi: 10.14744/nci.2018.23230  Pages 407 - 411
A 45-year-old female patient consulted our hospital for bilateral visual loss. She was receiving hemodialysis for 15 years. At presentation ophthalmologic examination, her visual acuity was hand movements in the right eye and light perception negative in the left eye. The direct light response was weak in the right eye and absent in the left eye. A total afferent pupillary defect was detected in the left eye. Fundoscopy revealed bilateral sectorial pale, sectorial hyperaemia and swollen optic discs. On the left papilla, there were splinter haemorrhages. At the right eye, there was pale edema at superior maculo-papillary bunch that coherent with occlusion of the cilioretinal artery. She was diagnosed as non-arteritic ischemic optic neuropathy based on the clinical and funduscopic examination. Methylprednisolone intravenous 1000mg/day for three days, then, oral methylprednisolone 1 mg/kg/day were administered for one week. Simultaneous acetylsalicylic acid 325 mg/day and hydration with 0.9% 1000cc isotonic solution treatment started. After two months, visual acuities did not change in both eyes, and both optic disks were pale.

17.Coexistence of ankylosing spondylitis and discoid lupus: A case report
Ayşe Ünal Enginar, Hakan Nur, Cahit Kacar
doi: 10.14744/nci.2018.90922  Pages 412 - 414
Coexistence of ankylosing spondylitis with connective tissue diseases is very rare. Here, in this study, we describe a coexistence of ankylosing spondylitis and discoid lupus erythematosus in a 35-year-old man. He presented with a 5-year history of low back pain and concurrent development of a discoid rash. Inflammatory low back pain, HLA-B27 positivity and bilateral active sacroiliitis confirmed the diagnosis of ankylosing spondylitis. Discoid lupus erythematosus was diagnosed based on a skin biopsy. There are reports of discoid lupus associated with medications, particularly with tumour necrosis factor-alpha (TNF-α) blocking drugs. However, the patient presented here had coexistence of ankylosing spondylitis and discoid lupus before starting such treatments.

INVITED REVIEW
18.Current therapeutic strategy in osteoarticular brucellosis
Gamze Kalin Unuvar, Aysegul Ulu Kılıç, Mehmet Doganay
doi: 10.14744/nci.2019.05658  Pages 415 - 420
Brucellosis is a common zoonotic disease with high morbidity. In the majority of human cases, the causative agent is B. melitensis. Infection is transmitted to humans by direct/indirect contact with the contaminated animal products (e.g., consumption of unpasteurized milk), infectious aerosols and aborted fetus. Brucellosis often affects middle-aged adults and young people. Patients with brucellosis tend to have non-specific symptoms, including fever, chills, night sweats, joint pain and myalgia. Brucellosis affects various organs and tissues. The osteoarticular system is one of the most commonly described affected systems in humans. In several clinical studies, the prevalence of Osteoarticular Brucellosis (OB) is reported as 2-77%. Most important osteoarticular clinical forms osteomyelitis, spondylitis, sacroiliitis, arthritis and bursitis. Spondylitis and spondylodiscitis are the most frequent complications. Spondylodiscitis often affects the lumbar (especially at the L4- L5 levels) and low thoracic vertebrae than the cervical spine. Back pain and sciatica radiculopathy are the most common complaints about patients. Sacroiliitis is associated with severe pain, especially back pain in affected individuals. Spinal destructive brucellar lesions are also reported in adults in previous studies. Brucellosis is diagnosed with clinical inflammatory signs (eg. tenderness, pain) of the affected joints together with positive serological tests and positive blood/synovial fluids cultures. Serological test measures the total amount of IgM/IgG antibodies. Standard agglutination test (SAT) titer ≥1: 160 is in favor of brucellosis diagnosis. Enzyme-Linked Immunosorbent Assay (ELISA) and Polymerase chain reaction (PCR) are other types of diagnostic tests. Radiological assessments, such as joint sonography, computed tomography, magnetic resonance imaging, are the most helpful radiological methods to diagnose spinal brucellosis.
The agents commonly used in the treatment of brucella spondylitis are doxycycline, streptomycin, gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole and rifampicin. The recommended regimens for treatment of brucella involve two or three antibiotics combinations. No standard treatment, physicians prescribe drugs based on conditions of the disease. Patients need a long-term (usually at three months) antibiotic therapy for mainly aiming to prevent relapses. Surgery may be required for patients with spinal abscess. This review focused on physicians’ awareness for osteoarticular involvement, clinical presentation, diagnosis and current treatment of OB.

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