ISSN: 2149-2247 | E-ISSN: 2149-2549

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Erciyes Med J: 40 (4)

Volume: 40  Issue: 4 - 2018

EDITORIAL COMMENTS
1.Does the Brain Work While Resting? Resting State fMRI
Niyazi Acer
doi: 10.5152/etd.2018.18133  Pages 175 - 176
Abstract | Full Text PDF

INVITED REVIEW
2.Community-Acquired Pneumonia in Adults: What’s New Focusing on Epidemiology, Microorganisms and Diagnosis?
Sofia Tejada, Anabel Romero, Jordi Rello
doi: 10.5152/etd.2018.18128  Pages 177 - 182
Community-acquired pneumonia (CAP) is one of the most common causes of hospital admissions and death worldwide. The incidence and mortality of CAP are associated with the presence of comorbidities and increasing age. Streptococcus pneumoniae is the most frequent causative microorganism of CAP, although in many patients with CAP, the causative microorganism remains unknown. Currently, antimicrobial resistance is increasing, so the accurate diagnosis and determination of the causative microorganism are even more important. This is a key point in reducing both morbidity and mortality from CAP, and appropriate antimicrobial stewardship is now a global priority. This review summarizes on the epidemiology, microbiological etiology, and diagnosis of CAP in adults.

3.Navigating through Mutations in Acute Myeloid Leukemia. What Do We Know and What Do We Do with It?
Deniz Peker
doi: 10.5152/etd.2018.18136  Pages 183 - 187
A clonal hematopoietic disease, acute myeloid leukemia (AML) is characterized by abnormal proliferation of early precursors of myeloid cells and blasts. It represents a heterogeneous disease group with a considerably complex biology and pathophysiology. Various translocations, chromosome copy number changes, and mutations have been described in AML, and a few of them help define the diagnosis, prognosis, and management. Cytarabine and anthracycline-based combination regimens followed by the allogeneic stem cell transplant remain the optimal treatment in most cases. However, older age and decreased tolerance to conventional therapies pose a major challenge for the conventional therapies, leading to the development of effective and less toxic therapy modalities as reviewed in this article.

4.Functions of the Human Intestinal Microbiota in Relation to Functional Foods
Elisavet Stavropoulou, Christina Tsigalou, Eugenia Bezirtzoglou
doi: 10.5152/etd.2018.18169  Pages 188 - 193
Interest in functional foods has increased due to their relationship to diet and health. A healthy nutrition preserves the intestinal ecosystem and enhances health. Probiotic Lactobacillus appears to be highly sensitive to diet, environmental factors, stress, and antibiotics. Functional foods are known to play an important role in the stability of a human intestinal ecosystem. Moreover, dissemination of antibiotic resistances into consumed dairy and meat products could select some bacterial species. However, awareness of the relationship between food and health must be constant through permanent surveillance systems. The European Union guidelines should be imposed for the safe use of functional foods as foods or either as biotherapeutic agents. Functional foods are foods that surpass classic nutritional habits and have usually beneficial action for their host. They are classified into three main classes: probiotics, prebiotics, and symbiotics. The use of genetically modified probiotics could provide further chances for the industrial and pharmaceutical exploitation of probiotic microorganisms. In contrast, prebiotics are not microorganisms but non-digestible components. They stimulate the growth and/or the activity of several bacteria in a beneficial way. Their action contributes to a healthy and balanced intestinal microbiota. Systematic administration of prebiotics decreases blood lipid counts, as well as blood pressure, but increases the synthesis and absorption of foods and maybe has an anticarcinogenic action. They are also used extensively in the food industry. Last but not the least is the class of symbiotics, which combines a mixture of probiotics and prebiotics with both effects.

ORIGINAL ARTICLE
5.Treatment Outcomes of Postmenopausal Osteoporosis in Patients with Stable Hypothyroidism: A 5-Year Follow-up Retrospective Study
Volkan Yılmaz, Ebru Umay, Ibrahim Gündoğdu, Nihal Tezel
doi: 10.5152/etd.2018.17065  Pages 194 - 199
Objective: The aim of this study was to evaluate the effects of hypothyroidism on the treatment outcomes of the postmenopausal osteoporosis (PMOP) treatment.
Materials and Methods: A total of 50 patients with hypothyroidism who were also diagnosed with PMOP according to the lumbar and femur neck bone mass density (BMD) evaluation with dual X-ray absorptiometry who did not receive any treatment for PMOP, including calcium and vitamin D, were included in the study. The control group consisted of 47 patients with PMOP but had no comorbidity. Demographic features including age, height, weight, occupation, the level of education, menarche and menopause age, clothing style, daily calcium intake, tobacco and/or alcohol consumption, daily physical activity level, personal (or maternal) history of fragility fracture, and duration of hypothyroidism were recorded. Biochemical parameters including the BMD scores, calcium, phosphate, alkaline phosphatase, parathormone, calcidiol, osteocalcine, urine calcium, phosphate levels, and creatinine clearance were also recorded. Patients were treated with bisphosphonate, calcium, and vitamin D, and same parameters were evaluated at the end of the first and fifth year.
Results: The average age of all individuals was 58.25±8.89 years, and the average duration of hypothyroidism diagnosis was 4.00 years. The demographic features and biochemical parameters before the PMOP treatment were not different between the patient and the control groups (p>0.005). The BMD scores of both groups were significantly improved at the end of the first and fifth years of the treatment (p<0.005), but the variations of the scores were not different.
Conclusion: Hypothyroidism with stable or unstable thyroid functions does not affect the PMOP treatment prognosis in Turkish population.

6.Comparison of Sternum Closure Techniques with Sternal Cable and Simple Wire After Open Heart Surgery
Rıfat Özmen, Ali Tekin
doi: 10.5152/etd.2018.18072  Pages 200 - 203
Objective: Median sternotomy is the most commonly used method for open heart surgery. Poor sternal healing after median sternotomy can cause a significant increase in morbidity and mortality and prolong hospital stay. Although several techniques are available for sternal closure, it is practically limited, and the most common technique is the simple wire technique. There is insufficient scientific study on the comparison of alternative techniques. The aim of the present study was to compare the follow-up results of the sternotomy closure techniques: sternal cable and simple wire.
Materials and Methods: Overall, 246 (141 male and 105 female) adult patients who underwent sternotomy closure with sternal cable (99) and simple wire (147) after open heart surgery were examined retrospectively. Patients' postoperative length of hospitalization, sternal dehiscence, local infection, mediastinitis, and mortality rates were evaluated. Resternotomy requirement due to sternal decomposition and surgical site infections was also evaluated. Statistical comparisons were made in terms of the parameters mentioned above.
Results: When the groups were compared in terms of age, gender, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF), and smoking status, there was no statistically significant difference (p>0.05). The percentage of the patients' coronary artery bypass grafting+mitral valve replacement (9.09%) was higher (p=0.028) in the sternal cable group than in the simple wire group. The cross-clamp time was longer in the sternal cable group (81.24±31.91) than in the simple wire group (74.08±17.67) (p=0.044).
Conclusion: Postoperative complications in the sternal cable group were less frequent but statistically not significant in our study. According to our results, sternal cable is effective and can be used as a good alternative to simple wire.

7.Knowledge, Attitude, and Practices About Wet-Nursing and Human Milk Banking in Kayseri, Turkey
Müge Yılmaz, Mualla Aykut, Habibe Şahin, Dilek Ongan, Elçin Balcı, Iskender Gün, Ahmet Öztürk
doi: 10.5152/etd.2018.18080  Pages 204 - 209
Objective: The aim of the present study was to determine the knowledge, attitude, and practices of mothers about wet-nursing and human milk banking in Kayseri, Turkey.
Materials and Methods: This descriptive study was conducted in the family healthcare centers of four community health care centers in Kayseri Province. The questionnaire form was fulfilled with face-to-face interviews of 614 participants.
Results: Of the mothers, 88.9% had heard about wet-nursing, 10.9% had a wet-nurse of her own, 5.2% had a wet-nurse of her child, and 5.0% had been a wet-nurse of another child. Wet-nurses were chosen mostly from relatives. Of the mothers, 93.6% stated that they had not heard about milk banking, whereas 97.2% did not know its purpose and services. More than half of the mothers (61.6%) thought human milk banking as a right application, whereas 75.4% of the mothers who thought that it was not right were against it because they believed marriage between foster milk siblings was religiously forbidden. Most of the mothers (79.8%) stated that they could milk for another child, and 56.2% identified that they could donate breast milk to the human milk bank.
Conclusion: More than half of the mothers thought that milk banking was a correct application. Mothers who were opposed to milk banking showed religious justifications as reasons. Placing the subjects “milk banks” and “human milk donorship” during education on breast milk in hospitals is important in terms of increasing the awareness of mothers.

8.Knowledge, Attitude, and Practice Regarding Osteoporosis Among Allied Health Sciences Students in a Public University in Malaysia
Nabilah Ramlı, Nor Azlina A Rahman, Mainul Haque
doi: 10.5152/etd.2018.18103  Pages 210 - 217
Objective: Osteoporosis is usually asymptomatic until the first fracture occurs. The tendency of developing osteoporosis is higher in postmenopausal women. The purpose of the present study was to analyze the knowledge, attitude and practice (KAP) regarding osteoporosis among Allied Health Sciences students in a public university in Malaysia, its associated sociodemographic factors, and association between the KAP.
Materials and Methods: This was a cross-sectional study. The participants who were selected using convenience sampling were given a questionnaire that comprised four sections on sociodemographic and KAP regarding osteoporosis. Descriptive statistics, independent t-test, and correlation test were used accordingly to analyze data using SPSS version 20.
Results: The total KAP scores were 39.62 (SD=2.87), 35.82 (SD=4.72), and 20.34 (SD=2.86), respectively. There was no significant association between KAP regarding osteoporosis with sexes (p=0.063, p=0.723, and p=0.162, respectively) of the participants, neither between knowledge and attitude with age (p=0.784 and p=0.366, respectively), or year of study (p=0.833 and p=0.468, respectively) of the participants. However, there was a minimal significant negative correlation between practice with age and year of study of the participants (r=-0.230, p=0.017 and r=-0.238, p=0.014, respectively). Finally, there was also a significant fair positive correlation between attitude and practice regarding osteoporosis (r=0.339, p<0.001).
Conclusion: The participants in the present study had moderate/fair level of knowledge and attitude but poor practice regarding osteoporosis. Only age and year of study were found to be significantly negatively associated with practice, in addition to the fair positive correlation between attitude and practice.

9.Functional Constipation in Health Care Professionals at a University Hospital
Derya Altay, Yaşar Doğan
doi: 10.5152/etd.2018.18104  Pages 218 - 221
Objective: The objective of this study was to determine the frequency of functional constipation, which is a common functional gastrointestinal disorder, in health care professionals.
Materials and Methods: In this study, a survey based on the Rome III criteria was conducted with personnel working at the Fırat University to determine the frequency of functional constipation. The survey mainly focused on the nightshift personnel. For statistical analysis, p<0.05 was considered to be significant.
Results: A total of 217 individuals participated and were evaluated in the survey. The mean age of the participants was 30.08+7.83 years, and 148 of them were females (68.2%). Seventy-three of these participants (33.2%) complained of constipation, and 47 (21.7%) stated that they were smokers. Fifty-seven of the participants (79.2%) who complained of constipation were females (p<0.05); 41 of them were married (56.9 %; p<0.05). One hundred and fifteen participants (53%) had nightshift on average 7.63+2.72 nights a month, and 42 of them (36.5 %) complained of constipation (p>0.05). However, only one-fourth of participants with constipation used laxatives. A total of 23.6% of participants with constipation stated that their family members had similar issues (p<0.05).
Conclusion: The results of this study showed that one-third of the health care personnel at the university hospital had constipation. We concluded that the productivity of the health care personnel, who play an important role in the examination and treatment process of the patients, will increase with training about functional constipation.

10.Uncontrolled Blood Pressure in Patients with Hypertension and Associated Factors: The Role of Low Health Literacy
Kevser Tarı Selçuk, Yeliz Mercan, Tuba Aydın
doi: 10.5152/etd.2018.18102  Pages 222 - 227
Objective: The aim of this study was to determine the prevalence of uncontrolled blood pressure, associated factors and evaluate whether or not low health literacy (HL) is a risk factor.
Materials and Methods: This cross-sectional study was conducted in 556 patients who met the inclusion criteria, and were aged 18 years or above. The data were collected using the Personal Information Form prepared by the researchers, Morisky Medication Adherence Scale, and European Health Literacy Survey Questionnaire (HLS-EU-Q). In the analysis, descriptive statistics, Chi-square test, and multivariate logistic regression analysis were used. p<0.05 was considered as statistically significant.
Results: In the study uncontrolled blood pressure prevalence was 69.8%. According to the multivariate logistic regression analysis uncontrolled blood pressure was higher in those who were aged 65 years and over (OR: 1.60, 95% CI: 1.12-2.78), had primary and lower education (OR: 1.72, 95% CI: 1.41-2.71), had any comorbidity (OR: 2.09, 95% CI: 1.42-3.11), were current smokers (OR: 2.40, 95% CI: 1.35-3.11), overweight/obese (OR: 2.13, 95% CI: 1.64-3.17), had no medication adherence (OR: 2.98, 95% CI: 1.94-3.32), and had low health literacy (OR: 2.06, 95% CI: 1.34-2.94).
Conclusion: In the study, it was determined that nearly three out of four patients receiving treatment had the uncontrolled blood pressure. Smoking, overweight/obesity, nonadherence to medical treatment, and low health literacy were alterable risk factors for uncontrolled blood pressure.

11.Predictive Significance of Preoperative Neutrophil to Lymphocyte Ratio versus Platelet to Lymphocyte Ratio for Gleason Score in Prostate Cancer Patients
Giray Ergin, Burak Köprü, Mustafa Kıraç, Yusuf Kibar, Hasan Biri
doi: 10.5152/etd.2018.18107  Pages 228 - 233
Objective: Inflammation plays a critical role in the development and progression of cancer. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are easily accessible basic inflammatory parameters. In this study, we aimed to analyze the association between the NLR, PLR, and the Gleason score in prostate cancer, which is main parameter used in the prostate cancer prognosis.
Materials and Methods: A total of 173 patients with prostate cancer (mean age, 63±6.2 years) who underwent radical prostatectomy were included into this retrospective study. The NLR and PLR were derived from the complete blood cell count results from the preoperative period. Patients were divided into two groups, as the low grade prostate cancer (Gleason score≤7 [3+4]) and the high-grade prostate cancer (Gleason score≥7 [4+3]) group. A logistic regression analysis was performed to determine the association.
Results: A univariate logistic regression analysis showed that the Ln-prostate specific antigen (PSA) (1.83, 95% confidence interval [CI] [1.01, 3.3] p=0.04), Ln-lymphocyte (0.38, 95% CI [0.15, 0.94] p=0.03), and Ln-NLR (1.9, 95% CI 1.9 [1.13, 3.38] p=0.01) levels were significantly associated with the high-grade Gleason score. However, the Ln-PLR levels revealed the association with marginal statistical significance (2.06, 95 % CI [0.95, 4.4] p=0.06). In multiple analyses, after adjusting the analysis for age, Ln-NLR (1.96, 95% CI [1.12, 3.42] p=0.01) and Ln-lymphocyte levels (0.38, 95% CI [0.15, 0.97] p=0.04) were still statistically significantly associated with high-grade prostate cancer.
Conclusion: Higher NLR levels were significantly associated with high-grade prostate cancer. However, PLR levels were not a significant predictor of higher Gleason scores.

BRIEF REPORT
12.Assessment of the Visibility of Radiologists Through Structured Interview Approach: Our Experience in Low-Literacy Mammography Patients
Nuri Erdoğan, Hakan Imamoğlu, Serap Doğan
doi: 10.5152/etd.2018.18106  Pages 234 - 236
The present study reports our experience in detecting the visibility of radiologists to low-literacy mammography patients by using a structured interview approach. Mammography patients were specifically selected because their ability to discriminate between technicians, radiologists, and referring physicians can be tested more efficiently in an interactive encounter. A total of 74 women participated in the study. The percentage of patients who assigned the radiologist as a doctor was 41.8%. Of the patients, 77.4% were aware that a radiologist was a specialist. Considering the literacy level of patients, the potential value of a structured interview approach should be discussed in the development of measurement methods to assess the visibility of radiologists to patients. In addition, the face-to-face interaction provided by this approach may be valuable in giving hindsights about the content and the context of the relationship between patients and radiologists so that radiologists can become more visible.

CASE REPORT
13.Plasmodium Vivax Malaria Causing Cardiomyopathy and Thrombotic Microangiopathy: A Rare Association
Deepak Jain, Nitya Nand, Preeti Verma, Disha Saxena, Promil Jain
doi: 10.5152/etd.2018.18085  Pages 237 - 239
We report a case of dual comorbidities of thrombotic microangiopathy (TMA) and cardiomyopathy associated with Plasmo- dium vivax malaria. A 20-year-old girl presented with worsening anemia, persistent thrombocytopenia, acute kidney injury, and sinus bradycardia with ST–T changes. Hemolytic uremic syndrome was diagnosed based on schistocytes on peripheral blood lm, increased serum lactate dehydrogenase, and elevated reticulocyte production index. Kidney biopsy revealed TMA. Echocardiography initially revealed dilated cardiomyopathy with low ejection fraction that improved to normal on follow-up. The patient was kept on maintenance hemodialysis during acute illness, and later she became dialysis dependent. She has now been advised for renal transplantation.

IMAGE
14.Severe Herpes Zoster Ophtalmicus in an Immuncompromised Patient
Esma Eren, Leylagül Kaynar, Mehmet Doğanay
doi: 10.5152/etd.2018.18118  Pages 240 - 241
Abstract | Full Text PDF

AUTHOR INDEX
15.Author Index

Page 242
Abstract | Full Text PDF

SUBJECT INDEX
16.Subject Index

Page 243
Abstract | Full Text PDF

REVIEWER LIST
17.Reviewer List

Page 244
Abstract | Full Text PDF

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