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Düzce Tıp Fakültesi Dergisi / Duzce Medical Journal
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  This is an Open Access Journal Open Access journal
ISSN (Print) 1307-671X
Published by Düzce Üniversitesi Homepage  [4 journals]
  • The Relationship of Liver Stiffness with Liver Size, Age, Gender, and Body
           Mass Index in Child and Adult Age Groups by 2-D Shear Wave Elastography

    • Authors: Eda ALBAYRAK; Ergün SÖNMEZGÖZ, Meral Gizem AKBAŞ, Osman DEMİR
      Abstract: Aim: The study aimed to evaluate the normal liver stiffness value (LSV) with shear wave elastography (SWE) in children and adults, and reveal the relationship between LSV and age, gender, body mass index (BMI), and liver size.Material and Methods: A total of 173 healthy volunteers, 92 female and 81 male, aged between 4 and 50 years were included in this study. LSV measurements were performed in the supine position during normal breathing and from the right intercostal space where the acoustic window is best. The mean of the five valid measurements was accepted as the mean LSV. The relationship between the mean LSV and age, gender, liver size, and BMI was evaluated.Results: There was a moderate positive correlation between LSV and age (p<0.001, r=0.609), LSV and BMI (p<0.001, r=0.512), and LSV and liver size (p<0.001, r=0.485). However, the multivariate linear regression analysis revealed that the effects of liver size and gender on LSV were not significant (p=0.091, and p=0.759, respectively), while the effects of age and BMI were significant (p<0.001, and p=0.019, respectively).Conclusion: 2-D SWE is an effective imaging method to evaluate LSV both in children and adults. LSV increases with increasing age and BMI, however, it is not affected by gender and liver size. The normal LSV obtained in the present study can be used as reference values in the evaluation of various liver diseases with 2-D SWE.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • The Effect of Manual Detorsion on Testicular Salvage Rates in Adult
           Testicular Torsion Patients: Single Center Experience

    • Authors: Ediz VURUŞKAN; Hakan ERÇİL, Kadir KARKİN, Umut ÜNAL, Ömer Faruk AKGÜN, Lokman AYHAN, Hakan ANIL
      Abstract: Aim: The aim of this study was to reveal the effect of manual detorsion on testicular salvage rates and the factors affecting the success of manual detorsion in adult testicular torsion.Material and Methods: The records of patients who applied to the emergency department with pre-diagnosis of acute scrotum were examined. A total of 62 adult patients diagnosed with testicular torsion were included in the study. Manual detorsion was attempted in all patients before surgery. Demographic characteristics of the patients, time from onset of scrotal pain to hospital admission (<24 hours/>24 hours), physical examination and ultrasonography findings, type of surgery performed, and long-term results were evaluated. The data were statistically compared between patients with manual detorsion considered successful and unsuccessful.Results: Manual detorsion was considered successful in 36 (58.1%) patients and unsuccessful in 26 (41.9%) patients. Orchiopexy was performed in 35 (97.2%) of the successful patients and in 11 (42.3%) of the unsuccessful patients (p<0.001). When subgroup analysis was performed, although there was no significant difference in pain duration between patients with and without successful manual detorsion for patients with pain duration of less than 24 hours (p=0.648), there was a statistically significant difference in testicular salvage rates. While the rate of orchiectomy was 1/35 (2.9%) in patients with successful manual detorsion, this rate was 8/19 (42.1%) in unsuccessful patients (p<0.001).Conclusion: Manual detorsion increases testicular salvage rates in adult patients diagnosed with testicular torsion, and it should be attempted especially in patients with pain duration less than 24 hours.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Relationship between the Empathy of Emergency Personnel and Their Approach
           to Acute Stroke Patients

    • Authors: Cemile HAKİ; Hakan DEMİRCİ
      Abstract: Aim: The aim of this study was to investigate the relationship between the empathy level of emergency department physicians and nurses and the referral of patients for intravenous thrombolytic and/or endovascular thrombectomy treatment.Material and Methods: This cross-sectional study was carried out with the emergency department physicians and nurses of hospitals that did not have a stroke clinic in Bursa in July 2019, and included 198 emergency personnel.  Participants’ sociodemographic characteristics, professional working conditions, and stroke history in their immediate environment (friends and family) were recorded and empathy level was measured. The health professions version of the Jefferson Scale of Empathy was used in the assessment of empathy status among emergency physicians and nurses.Results: The mean empathy score of the study group, by the Jefferson scale of empathy, was found 98.63±14.83 points. In this study, no significant relationship was found between the empathy score and the number of referrals (p=0.962). The total empathy score did not differ by the role of the participants in the hospital (p=0.161) or observation of stroke cases in their family or their friends (p=0.694). Healthcare professionals who had received emergency education (p<0.001), were older (p<0.001), spent more time in their profession (p=0.005), and had observed stroke cases in their family or friends (p=0.005) transferred more stroke cases.Conclusion: This study suggests that interventions for increasing the empathy levels of emergency medicine specialists and nurses will not have a general effect on the referral of acute stroke cases for intravenous thrombolytic and endovascular thrombectomy treatment.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Endovascular Treatment of Acute Renal Artery Hemorrhages: Efficacy and
           Effect on Renal Functions

    • Authors: Alperen KAYALI; Sadık GÖRÜR
      Abstract: Aim: The aim of this study was to investigate the efficacy and complications of endovascular treatment of acute renal artery hemorrhage and the etiology of the condition.Material and Methods: Twenty-two patients who underwent endovascular embolization with renal acute artery hemorrhage between 2016 and 2020 were evaluated retrospectively. Etiologies of the acute renal artery hemorrhage were investigated. Laboratory and clinical follow-up information were analyzed for the efficacy and the complication of the treatment. The serum creatinine levels of the patients before and after the procedure were compared.Results: Selective renal artery embolization procedures were performed in a total of 22 patients. Of the 22 patients, 10 (45.5%) were male and 12 (54.5%) were female. The patients' ages ranged from 5 to 79 years, and the mean age of the patients was 51.5±18.6 years. Clinical success was achieved in 91.7% of embolization procedures. A statistically significant increase was seen in the serum creatinine levels of the patients after the procedure compared to 24 hours before the angiography procedure (median: 0.97 vs. 0.93, p=0.046). No significant change was observed in serum blood urea nitrogen and the estimated glomerular filtration rate levels (p=0.338, and p=0.067, respectively). Acute renal failure and postembolization syndrome were observed in only one patient as complications. The complication rate was found to be 4.5%.Conclusion: Selective embolization of the renal artery has high clinical success in acute renal artery hemorrhages without impairing renal function. The treatment has advantages such as no need for general anesthesia, and low complication rates.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Are High Urea Values before Intravenous Immunoglobulin Replacement a Risk
           Factor for COVID-19 Related Mortality'

    • Authors: Emel ATAYIK; Gökhan AYTEKİN
      Abstract: Aim: This study aimed to examine the data of the coronavirus disease 2019 (COVID-19) patients treated with intravenous immunoglobulin (IVIG) treatment and to investigate the effects of the patients' clinical, laboratory, and treatment characteristics and risk factors for mortality.Material and Methods: The study evaluated 81 adult COVID-19 patients who were hospitalized for the treatment of COVID-19 between April 2020 and September 2020 and were followed up, treated, and consulted in the immunology clinic for IVIG treatment, in a retrospective manner.Results: The univariate analyses revealed that the duration of hospitalization in service, being intubated, duration of IVIG treatment, and the urea value before IVIG treatment were related to mortality in COVID-19 patients treated with IVIG treatment. As a result of multivariate analysis, being intubated and urea value before IVIG treatment were found to be independent risk factors for mortality (p=0.001 and p=0.009, respectively). It was found that for the 60 mg/dL level of urea value before IVIG treatment to predict mortality, the sensitivity was 46.2%, and the specificity was 35.5%. The area under the curve was found as 0.647; 95% confidence interval 0.518-0.776 (p=0.029).Conclusion: The study found that urea values before IVIG treatment were a risk factor for mortality in patients who received IVIG treatment for COVID-19. This is important as it indicates that urea values should be closely monitored in patients given IVIG treatment for COVID-19. It also suggests that when resources are limited and risk stratification is required in COVID-19 patients, urea values can be helpful.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • While the Laparoscopic Appendectomy Is the Gold Standard in the Treatment
           of Acute Appendicitis, What Should Be the Preference for Closure of the
           Appendix Stump'

    • Authors: Metin YEŞİLTAŞ; Ali ALEMDAR
      Abstract: Aim: While laparoscopic appendectomy is the gold standard in the treatment of acute appendicitis, there is no consensus on reliable closure of the appendix stump. The aim of this study was to examine appendiceal stump closure techniques and their reliability during laparoscopic appendectomy.Material and Methods: Between January 2019 and August 2021, 692 patients who underwent laparoscopic appendectomy with the diagnosis of acute appendicitis were included in the study. Demographic characteristics, length of hospital stay, pathology, appendix stump closure methods, operation time, complications, and cost results were analyzed retrospectively.Results: Intracorporeal knotting (ICK) was used in 66.9% (n=463), and endoclip (EC) was used in 33.1% (n=229) of the patients. There was no statistically significant difference between the two groups in terms of length of hospital stay (p=0.054). While the mean operative time was 55.1±15.6 minutes in the ICK group, it was 45.7±16.5 minutes in the EC group (p<0.001). The general complication rate was 1.7% (n=12). While the complication rate was 2.2% (n=10) in ICK group, it was 0.9% (n=2) in EC group (p=0.354). While pericecal hematoma and ileus were seen only in the ICK group, the fistula was seen only in the EC group. EC was found to be more costly than ICK (p<0.001).Conclusion: It was concluded that closure of the appendix stump with an EC in patients who underwent laparoscopic appendectomy is more useful, regardless of the severity of appendicitis, with a shorter operation time and shorter length of hospital stay, low complication rate, and ease of application.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Comparison of Intraoperative and Postoperative Outcomes of Proximal
           Femoral Nailing and Bipolar Hemiarthroplasty Techniques in
           Intertrochanteric Femur Fracture Treatment

    • Authors: Mehmet YETİŞ; Emre YURDAKUL
      Abstract: Aim: This study was undertaken with the purpose of comparing the short and long term surgical, clinical, and functional results between bipolar hemiarthroplasty and proximal femoral nailing in the same cohort of patients.Material and Methods: The retrospective scanning of two-year data of a tertiary care hospital has been carried out for patients with hip fractures undergoing proximal femoral nailing and bipolar hemiarthroplasty. 67 patients underwent proximal femoral nailing and 74 patients underwent bipolar hemiarthroplasty were included in the study. Each patient's short and long term outcomes were documented as well as their preoperative, intraoperative, and postoperative features.Results: There were no significant differences in the demographic features of both groups. The median intraoperative blood loss was significantly higher in the group who underwent bipolar hemiarthroplasty compared to the group who underwent proximal femoral nailing (450 cc vs 300 cc, respectively, p<0.001). It was found that the bipolar hemiarthroplasty procedure was associated with a greater need for intraoperative transfusion than the proximal femoral nailing procedure (p=0.007). Intraoperative complications were reported only in patients who underwent bipolar hemiarthroplasty. The need for intensive care unit was significantly higher in the bipolar hemiarthroplasty group than in the proximal femoral nailing group, with the rate of 86.5% (n=64) and 68.7% (n=46), respectively (p=0.011).Conclusion: According to the results of this study, the proximal femoral nailing procedure appears to be a more reliable surgical technique in patients with hip fractures in terms of both intraoperative complications and the postoperative need for an intensive care unit.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • STAT3 Expression and Correlation Between Ki-67 and PHH3 in Meningiomas: Is
           it Possible to Predict Recurrence'

    • Authors: Sinem KANTARCIOĞLU COŞKUN; Güven KILIÇ
      Abstract: Aim: The aim of this study was to investigate the correlation between PHH3 and ki-67 labeling index, and the association of STAT3 expression with mitotic index, grade by World Health Organization 2016 classification, and clinicopathological features of meningioma cases.Material and Methods: A total of 25 meningioma cases from the archives of the Department of Pathology, Düzce University School of Medicine, diagnosed between 2012 and 2021 were included in the study. The mitotic count from the ten fields with the highest number of mitotic figures was determined. Immunohistochemistry was performed on the formalin-fixed, paraffin-embedded tissue blocks to determine STAT3, ki-67, and PHH3 expression. STAT3 was scored between 0 and 3 points according to staining intensity. Staining percentages for STAT3 were determined using a manual count of stained cells and the total number of tumor cells. The ki-67 labeling index was determined as a percentage by a manual count. For PHH3, the total number of immunostained mitotic figures per 10 high-power fields were evaluated in each case.Results: A statistically significant difference was found in terms of the percentage of STAT3 staining between the tumor grades (p=0.047). STAT3 expression was significantly higher in cases with high tumor grades. A moderate positive correlation was found between ki-67 and PHH3 when calculated as a percentage in the area with the highest mitotic index by manual counting (r=0.621, p=0.001).Conclusion: A combination of ki-67, PHH3, and STAT3 will be useful in the grading of meningiomas and predict the recurrence.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Comparison of the Effect of Board Game and Tobacco Cessation Education on
           Nicotine Addiction in Adolescent Smokers

    • Authors: Remziye CAN; Özlem ÖRSAL
      Abstract: Aim: The aim of this study was to compare the effect of a board game and tobacco cessation education on nicotine addiction in adolescent smokers.Material and Methods: This randomized controlled study included 103 adolescents who declared to smoke at least one cigarette per day. For data collection, sociodemographic data form, Fagerstrom test for nicotine dependence, and stages of change scale were used. The study groups consisted of three intervention groups; board game, tobacco cessation education, and the combined use of these two interventions, and a control group. All interventions were compared with the control group. Follow-ups were conducted at baseline, 8th, and 12th week.Results: While 38.8% (n=40) of all participants were addicted to nicotine at a very low level, 6.8% (n=7) were very high. 37.9% (n=39) of the participants reported smoking the first cigarette of the day within the first 5 minutes. Groups had an effect on the nicotine addiction level of adolescents (p=0.031), while there was no significant difference for the period, and period*group interaction (p=0.472 and p=0.339, respectively). The difference was due to the board game group. In the post evaluation, three of the adolescents who played board games and two of the adolescents who received tobacco cessation training were in the action phase.Conclusion: The results showed that the board game group participants had a decrease in the level of nicotine addiction. Our suggestion is to use and disseminate games as an alternative method that will attract the attention of adolescents in tobacco cessation education.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • The Value of Fibrinogen/Albumin Ratio on Prognosis of COVID-19 Patients

    • Authors: Esen ÇİÇEKLİ; Saadet SAYAN, Elif SARICA DAROL, Dilcan KOTAN
      Abstract: Aim: Fibrinogen and albumin are proteins that play a role in inflammation. In this study, it was aimed to investigate the role of fibrinogen, albumin, and fibrinogen/albumin ratio (FAR) levels as markers of disease severity and prognosis in coronavirus disease 2019 (COVID-19) patients.Material and Methods: Seventy-one patients aged between 19 and 84 years diagnosed with COVID-19 who were hospitalized in Sakarya University Training and Research Hospital, Neurology Department between March and May 2020 were analyzed retrospectively. Fibrinogen, albumin, FAR, D-dimer, platelet, and C-reactive protein (CRP) levels of the patients were compared according to the length of hospitalization duration, survival, and clinical severity of COVID-19.Results: Twenty-eight (%39.4) of the patients were male and 43 (%60.6) were female, and the mean age was 55.7±20.7 years. There was a significant difference between the groups of COVID-19 clinical severity in terms of age, fibrinogen, albumin, FAR, D-dimer, and CRP values (all p values were <0.001). Also, significantly higher fibrinogen, FAR, D-dimer, and CRP values were found in patients hospitalized longer, while the albumin level was lower in these patients (all p values were <0.001). FAR values were higher and albumin values were lower in non-surviving patients compared to surviving patients (p=0.025 and p<0.001, respectively).Conclusion: FAR levels may be useful in predicting mortality risk in COVID-19 patients. In addition, it may be helpful and useful in determining the prognosis since it has higher levels as the severity of the disease and the length of hospital stay increase.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • The Effect of Antibiotic Resistance and Inappropriate Empirical Antibiotic
           Therapy on 3-Day and 28-Day Mortality in Bacteremic Patients in the
           Intensive Care Unit: 5-Year Retrospective Analysis

    • Authors: İlker ÖDEMİŞ; Tuğba ARSLAN GÜLEN
      Abstract: Aim: The aim of this study was to examine the effects of antibiotic resistance, empirical antibiotic therapy, and comorbid diseases on 3-day and 28-day mortality in patients with bloodstream infections.Material and Methods: Files of the patients with positive blood cultures results, between January 1st, 2015, and January 1st, 2020 were analyzed retrospectively. The primary outcome was 3-day mortality and the secondary outcome was 28-day mortality.Results: A total of 515 patients, 208 (40.4%) female and 307 (59.6%) male, were included in the study. The median age of the patients was 73 (range, 18-95) years. Vancomycin resistance was detected in 8 (3.4%) of 233 gram-positive bacteria. Third-generation cephalosporin, meropenem, and colistin resistance rates of the 282 gram-negative bacteria were found to be 72.7% (n=205), 53.2% (n=150), and 9.9% (n=28), respectively. The 3-day and 28-day mortality rates were 14.4% (n=74) and 64.3% (n=331), respectively. Charlson comorbidity index score (CCIS) (p=0.001) and acute physiology and chronic health evaluation (APACHE) II score (p=0.019) were found to be risk factors for 3-day mortality. Risk factors for 28-day mortality were; age (p<0.001), CCIS (p<0.001), APACHE II score (p=0.001), chronic obstructive pulmonary disease (p=0.007), hospital-acquired infection (p=0.033), and inappropriate antibiotic therapy (p<0.001).Conclusion: There was no association between antibiotic resistance and mortality, but inappropriate antibiotic treatment was found to increase the risk of 28-day mortality. In addition, since high CCIS and APACHE II scores increase the risk of both 3-day and 28-day mortality, we think that considering these scoring systems will reduce the risk of mortality.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Morphologic Evaluation of the Glenoid Cavity on Dry Scapula

    • Authors: Mehmet ÜLKİR; Necati SALMAN, Mine FARIMAZ
      Abstract: Aim: The aim of this study was to determine the notch and shape variations of the glenoid cavity (GC), to emphasize its clinical importance, and compare it with the previous studies.Material and Methods: This study was performed with 157 (78 right sides, 79 left sides) adult Anatolian dry scapulae. The GCs were typed as oval, pear, and inverted comma shaped and noted the number of GC notch.Results: The most common GC shape was found as the pear shaped with 63 (80.8%) at the right side, 49 (62%) at the left side, and 112 (71.4%) in total. The second most common GC shape was found as oval shaped with 13 (16.6%) at the right side, 28 (35.5%) at the left side, and 41 (26.1%) in total. The glenoid notch was found at the right side, left side, and totally; 28 (35.9%), 19 (24.1%), and 47 (29.9%), respectively. All of the inverted comma shaped GCs had distinct glenoid notch, while the oval shaped GCs not. The pear shaped GCs had indistinct glenoid notch or no glenoid notch. The glenoid notch was found at the right side, left side, and totally on the pear shaped GC; 26 (41.3%), 17 (34.7%), and 43 (38.4%), respectively.Conclusion: Pear shaped GC was found as the most (71.4%) common shape in this study. Forty-seven (29.9%) of the scapulae had a glenoid notch. The notch and shape variations of the GC are important and this study will contribute to anatomists, orthopedists, and radiologists from this perspective.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • 17-year-old Selective Mutism Case without Treatment for A Long Time

    • Authors: Oya GÜLEŞEN; Süeda Aybike SÖNMEZ, Şahin BODUR, Ayhan CÖNGÖLOĞLU
      Abstract: Selective mutism is a rare childhood anxiety disorder characterized by the inability to speak in certain social situations in which speech is expected, despite speaking fluently in other situations. The average age of onset for selective mutism is 2 to 5 years old, but symptoms may not be noticed until starting school. The cause is still not known and the prevalence varies between 0.03% and 1%. Psychopharmacology and psychotherapeutic approaches are recommended in the treatment. Although the treatment is difficult, early diagnosis is one of the good prognostic factors. In this case report, we aimed to discuss the psychiatric and sociocultural functionality of a 17-year-old adolescent with selective mutism. Our case is remarkable as she has not been treated for many years. Her treatment continues with psychopharmacological and psychotherapeutic interventions. Recognition of selective mutism and getting support on this issue will help to solve the problem.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Evaluation of Clinical Features and Treatment Results of Pediatric
           Patients With Pre-Diagnosis of COVID-19

    • Authors: Nadide Melike SAV; Sevim TÜRAY, Şükriye ÖZDE, Şükrü ÖKSÜZ
      Abstract: Aim: The epidemiological characteristics and modes of transmission of coronavirus disease 2019 (COVID-19) in children are not yet fully understood. In this study, it was aimed to evaluate clinical, laboratory, and radiological findings and treatment approaches in patients with negative and positive PCR tests among those with suspected COVID-19 retrospectively.Material and Methods: This study was conducted with 317 patients under 18 years of age, who received outpatient or inpatient treatment with a pre-diagnosis of COVID-19. All patients were assessed for clinical course, disease severity, comorbidity, demographic characteristics, laboratory and radiodiagnostic tests, treatment characteristics, and outcomes.Results: The PCR test was positive in 133 (42%) and negative in 184 (58%) of the patients with suspected COVID-19. There was a history of contact in 78 (58.6%) and 51 (27.7%) of the PCR-positive and negative patients, respectively (p<0.001). While the PCR-negative group had a higher rate of hospitalization (p=0.020), hospital stay was longer in PCR-positive cases (p=0.037). The white blood cell count (p=0.001), platelet count (p=0.037), neutrophil count (p=0.015), and lactate level (p=0.025) were significantly lower in the PCR-positive group.Conclusion: Early detection and isolation of children with symptoms suggestive of COVID-19 are important to limit the spread of the disease. It can be challenging initially to clinically understand whether the case has COVID-19, especially in pediatric patients. PCR test is the gold standard in the diagnosis of COVID-19. Considering the prevalence, severity, and complications of the outbreak, it would be a proper approach to initially evaluate suspected patients as COVID-19 patients.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Prognostic Value of Chest CT in the Elderly Patients Admitted with
           COVID-19 Pneumonia

      Abstract: Aim: The late elderly, are the leading group of non-survivors infected with the coronavirus disease 2019 (COVID-19). Computed tomography (CT) imaging has been recognized as an important diagnostic method for COVID-19. This study aimed to determine the prognostic performance of CT imaging in patients above 75 years old.Material and Methods: After meeting the inclusion and exclusion criteria 56 elderly patients, 28 male, and 28 female were included in the study. Two radiologists interpreted CT imaging and a third experienced radiologist was in charge of reviewing the data and imaging findings in the controversial and disagreement cases. The lung score was determined for each patient, and radiologic signs were also examined.Results: The mean age of the patients was 81.4±5.0 years. Thirty-six patients survived, and 20 did not. 28 (50.0%) patients had central involvement, while 25 (44.6%) patients had diffuse involvement. Radiologic signs such as consolidation and air bronchogram were more common among non-survivors than survivors (both p=0.001). The mean lung score for the survivors was 8.75±6.21 and 13.45±6.41 for non-survivors, and the difference between the two groups was statistically significant (p=0.010). The area under the receiver operating characteristic curve for a cut-off score of 12 was 0.714 (95% CI, 0.577 to 0.827, p=0.003).Conclusion: It seems that using lung scores can play a very important role in predicting the condition of hospitalized patients over 75 years old.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Comparison of Tocilizumab and Anakinra in the Treatment of COVID-19: A
           Single-Center Experience

    • Authors: Murat ACAT; Özben ÇAVDAR, Ahmet TEZCE, Bengisu Pınar ACAT
      Abstract: Aim: The aim of this study was to examine whether a difference between endotracheal intubation, non-invasive mechanical ventilation, high flow oxygen therapy requirements and 28-day mortality rate in severe and critical coronavirus disease 2019 (COVID-19) patients receiving anakinra and tocilizumab treatment.Material and Methods: A total of 70 patients infected with COVID-19, who were treated with tocilizumab and anakinra from April 2020 to March 2021 at Karabük Training and Research Hospital, were recruited in this retrospective study. Data on patient demographics, comorbidities, treatments, clinical outcomes of the patients’ and hemogram findings were retrieved from hospital records.Results: The mean age of the patients was 61.34±11.8 years. Of the 70 patients, 12 (17.1%) were female and 58 (82.9%) were male. Severe and critical COVID-19 cases were evident in 48 (68.6%), and 22 (31.4%) patients, respectively. The mortality rate in 28 days was not statistically significantly different between the tocilizumab and anakinra groups (p=0.999). Both the necessity of high flow oxygen therapy and non-invasive mechanical ventilation were lower in the tocilizumab group than in the anakinra group (p<0.001, and p=0.002, respectively), while there was no statistically significant difference in the necessity of intubation between the two groups (p=0.999). The length of stay was also significantly shorter in the tocilizumab group (p=0.027).Conclusion: High flow oxygen therapy, non-invasive mechanical ventilation requirements, and length of stay were significantly lower than anakinra in the tocilizumab group. Excessive inflammatory response with cytokine storm features causes severe disease course and worsens prognosis in COVID-19.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Effects of Laboratory Parameters on Tear Tests and Optical Coherence
           Tomography Findings in Pediatric Celiac Disease

    • Authors: Mustafa VATANSEVER; Özer DURSUN, Özlem TEZOL, Erdem DİNÇ, Esra DANACI VATANSEVER, Ayça SARI, Yusuf USTA
      Abstract: Aim: The aim of this study was to evaluate the tear parameters and optical coherence tomography (OCT) findings in children with celiac disease (CD) and to investigate the relationship between these findings and laboratory data.Material and Methods: The study included 100 eyes of 50 CD patients as well as 110 eyes of 55 healthy subjects with no ocular pathology as a control group. Best corrected visual acuity was evaluated, baseline tear volume was estimated using standard Schirmer’s test, and fluorescein tear film break-up time (TBUT) was determined for all participants. Pupillary dilation was induced and macular sections and optic disc sections were obtained with OCT.Results: The patient and control groups showed no statistically significant differences in terms of age and gender distribution (p=0.490, and p=0.930, respectively). Mean Schirmer’s test measurement was significantly lower in the CD patients compared to the control group (14.07±5.14 mm vs. 20.20±3.93 mm, p<0.001). TBUT was also shorter in the CD patients compared to the control subjects (10.86±3.51 s vs. 15.25±2.49 s, p<0.001). Mean total retinal thickness and outer retinal thickness values were significantly lower in the patient group than in the control group (p<0.001, for both parameters). In addition, the mean retinal nerve fiber layer (RNFL) thickness measurement was significantly thinner in the patient group than in the control group (p<0.001).Conclusion: In the presented study, it was observed that macular and RNFL thickness were decreased in children with CD compared to the control group, and tear tests were also impaired.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Comparison of Tension Band Wiring Method Applied with K-wire or Cannulated
           Screw in Mayo 2A Olecranon Fracture Fixation: A Biomechanical Study

    • Authors: Murat KAYA; Fatih ERTEM
      Abstract: Aim: The study aimed to compare the biomechanical stability and strength of the tension band wiring method used to treat mayo 2A olecranon fractures with Kirschner (K)-wire or cannulated screw configurations.Material and Methods: A total of 24 anatomical ulna models (Sawbones Model 1004, Pacific Research Laboratories, Vashon Island, WA) used in the study were divided into two equal groups of 12, tension band fixation with K-wire (Group 1) and tension band fixation with cannulated screw (Group 2), and groups were compared. The mechanical comparison was performed with a universal measuring machine (Shimadzu Autograph 50 kN; Shimadzu Corp).Results: Fixation methods comparison (K-wire/cannulated screw) were the main factors that determined the stability and the strength of the internal fixation. The median flexion strength of Group 1 was 107.92 (range, 94.22-121.72) N, and that of Group 2 was 109.67 (range, 105.07-113.86) N. The median varus strength of Group 1 was 100.02 (range, 83.24-102.18) N, and that of Group 2 was 76.32 (range, 68.44-78.43) N. Varus strength and stiffness were significantly higher in the K-wire group than in the cannulated screw group (both p values were <0.001). No significant differences were detected between the groups regarding flexion strength and stiffness (both p values were 0.999).Conclusion: Although no significant differences were detected between the two fixations in flexion bending cyclic loading, a significantly more stable fixation was achieved in tension banding applied with K-wire in varus bending cyclic loading. No reduction loss was detected during cyclic loading tests in either technique.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Clinical Results of Surgical Treatment of Giant Lipomas: A Single-Center

    • Authors: Ayşe Nur TOKSÖZ YILDIRIM; Tulay ZENGİNKİNET, Erhan OKAY, Arda AKKAYA, Korhan ÖZKAN
      Abstract: Aim: Lipomas are benign tumors, and generally present as small lesions. However, giant lipomas are less frequent. There are only a few studies regarding the surgical treatment of giant lipomas. Marginal or wide resection is usually performed; however, there is no standard surgical approach. The aim of this study was to evaluate clinical results after surgical treatment of giant lipomas and to present a differential diagnosis of lipomatous lesions.Material and Methods: A total of 42 cases (24 female, 18 male) admitted to our clinic between 2015 and 2020 due to giant lipoma with at least 10 cm dimensions were included in this study. A preoperative biopsy was performed for all cases. All patients were undergone wide excision followed by postoperative histopathological examination.Results: The mean age was 57.5±12.9 years. The median follow-up was 35 months. Anatomic localization was thigh in 16 (38.1%) patients, shoulder in 7 (16.7%) patients, hip in 5 (11.9%) patients, back in 4 (9.5%) patients, arm in 9 (21.4%) patients, and the iliac region in 1 (2.4%) patient. Wide resection was performed, and final pathology was consistent with lipoma in all cases. There was no complication except in one patient who had transient neuropraxia after removing a giant lipoma at the proximal femur. At the latest follow-up, all cases were asymptomatic with no recurrence.Conclusion: Preoperative biopsy and wide resection should be preferred for the diagnosis and treatment of giant lipomas. Wide resection may prevent a recurrence. Routine follow-up is necessary to detect possible malign transformation.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • The Relationship of Thyroid Hormone Levels and Motor Symptoms in
           Parkinson's Disease

    • Authors: Özgül OCAK; Erkan Melih ŞAHİN, Mustafa ÇAM
      Abstract: Aim: This study aimed to investigate the relationship between thyroid hormone levels and the motor symptoms of Parkinson's patients.Material and Methods: Neurology clinic logs of the patients diagnosed with Parkinson's disease and whose thyroid function tests were measured between 01.01.2018 and 01.04.2021 were selected. Those with primary thyroid hormone disorder were excluded. Motor symptom stages were determined according to the modified Hoehn and Yahr scale (mHYS) by records. According to the thyroid function test results, whether there was a difference in motor symptoms, duration of the disease, and effects of the drugs were examined.Results: Of the 93 patients included in the study, 53 (57.0%) were male and 40 (43.0%) were female. The median age of the patients was 71 years. The motor symptoms of the patients were classified as stage 1 in 21 (22.6%), stage 1.5 in 18 (19.4%), stage 2 in 29 (31.2%), stage 2.5 in 13 (14.0%), stage 3 in 4 (4.3%), stage 4 in 6 (6.5%), and stage 5 in 2 (2.2%) patients. The median levels of TSH, fT3, and fT4 were 2.075 uIU/ml, 2.925 ng/dl, and 1.235 ng/dl, respectively. There was no significant correlation between the mHYS stages of the patients and TSH (r=-0.148, p=0.164), fT3 (r=-0.073, p=0.623), and fT4 levels (r=0.075, p=0.491).Conclusion: There was no relationship between the severity of motor symptoms and hormone levels in patients with normal thyroid functions. Thyroid dysfunction may mimic many motor findings, but they do not affect the severity of motor findings in Parkinson's patients.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
  • Efficacy of Transarterial Chemoembolization with Drug-Eluting Beads in
           Hepatocellular Carcinoma: A Single-Center Experience

    • Authors: Gürkan DANIŞAN; Erbil ARIK
      Abstract: Aim: The aim of this study was to evaluate the efficacy of transarterial chemoembolization (TACE) with drug-eluting beads in hepatocellular carcinoma (HCC).Material and Methods: Twenty-nine patients with HCC who were treated with TACE with drug-eluting beads between 2019 and 2021 were included in the study. The success of the TACE procedure was evaluated using pre- and post-operative contrast-enhanced computed tomography/magnetic resonance images. Patient characteristics, embolizing-bead sizes, procedure-related complications, and pre- and post-procedure alpha-fetoprotein (AFP) levels were recorded.Results: The mean age of the patients was 65.6±10.4 years, and the objective response rate was 17.2% (5/29). 100-300 μm particles were used in 11 (37.9%) patients, and 300-500 μm particles were used in 18 (62.1%). The median target lesion number was 1 (range, 1-6). Six (20.7%) patients had non-target lesions. There were newly developed lesions in four (13.8%) patients. A significant decrease was found in the median target lesion size after (41; range, 0-116 mm) the procedure compared to the pre- (42; range, 22-188 mm) procedure (p<0.001). A significant difference was found between the median AFP levels before (343; range, 1.44-2000 ng/mL) and after (52; range, 0.95-1435 ng/mL) the procedure (p<0.001).Conclusion: Since most patients with HCC are diagnosed in the intermediate stage, curative treatment is not possible. TACE is an important treatment option for the local control of the disease in this patient group. However, the success of TACE treatment may vary depending on the cancer stage, number of patients, follow-up period, and type and size of the microsphere used.
      PubDate: Tue, 30 Aug 2022 00:00:00 +030
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762

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