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ERCİYES MEDICAL JOURNAL - Erciyes Med J: 41 (3)
Volume: 41  Issue: 3 - 2019
EDITORIAL COMMENTS
1.Pericarditis: Are There Any Changes Since 1761? A Panoramic View of Pericarditis
Deniz Elcik, Ali Ergin
doi: 10.14744/etd.2019.04274  Pages 235 - 237
Abstract | Full Text PDF

INVITED REVIEW
2.Spreading of Antimicrobial Resistance Across Clinical Borders
Elisavet Stavropoulou, Christine Tsigalou, Eugenia Bezirtzoglou
doi: 10.14744/etd.2019.99075  Pages 238 - 243
Spreading of antibiotic resistance is effective via many routes and is dependent on the setting. Moreover, poor hygiene conditions, poor sanitation, as well as inadequate infection control contribute to the spreading of resistant bacteria in health care and industrial facilities, in the community as well as in animal production. Bacteria are present in any environment and bacterial resistance disseminate across the world. Animals receiving antibiotics, they carry antibiotic resistant bacteria and are spread to humans through food or animal contact. Vegetables may be contaminated with antibiotic-resistant bacteria coming from animal manure fertilizers. Overuse or misuse of antibiotics by humans is another major issue. Production of safe food especially of animal origin is important. In this vein, a holistic controlling in all different steps of the production line must be done as microorganisms manifest their presence in foods. Bacterial biofilms dominion our lives, as they are ubiquitous in every environment. Conjugation seems to be the mechanism related in biofilms transfer genes within biofilms or between bacterial communities. Eradicating the problem of antibiotic resistance could be approached by collaboration of authorities, bodies, industrials, veterinarians and doctors as the economic and social challenges emerging from AMR are important. Hereby, we expose the major ways across clinical borders resistant bacteria can sprea.

REVIEW
3.Adverse Effect of the Neuronal Cells and the Coronary Artery Endothelium in Extreme Environments—Roles of Advanced Molecular Imaging Markers
Fathinul Fikri Ahmad Saad, Subapriya Suppiah, Shazreen Shaharuddin
doi: 10.14744/etd.2019.12499  Pages 244 - 249
Extreme environment is an inhabitable ambience affecting the normal physiology of the human body. Radiation personnel who travel to low earth orbit for long space journey may face a detrimental effect of the influx of radiation source during extravehicular activities that lead to chronic endothelial injury of the underlying cells. In addition, the low pressure oxygen (hypobaria) of the space station environment could potentially underpin cellular changes in sensitive organ, i.e., the brain cells. These factors could pose a threat to the reconditioning of the vital functioning organs. Spatial oxygen concentration will decrease to >20% to a higher altitude of 5300 m, whereas insulin and C-peptide concentrations are increased by 200% during the endurance stay at the altitude for 2 weeks. Therefore, the potential increase in fasting insulin, homeostatic model assessment of insulin resistance, and glucagon influences the elevation of markers of oxidative stress and the inflammatory markers. The use of advance molecular imaging biomarkers that range from the inflammatory markers, hybrid imaging markers, such as functional magnetic resonance imaging, and genetic markers could discover the early changes of the cellular reprogramming in cells that could avert the ongoing process of oxidative stress injury via mitigation programs and preventive measures. In this review, specific documentation on the various ambiences of the physiological environment, i.e., hypobaria, chronic ionizing radiation, and hypergravity pull, would be discussed with the potential molecular imaging markers used to exploit the early physiological, inflammatory, and genetic deconditioning that underpin the cellular changes leading to the untoward effect on oxidative stress.

ORIGINAL ARTICLE
4.Investigation of the Methylenetetrahydrofolate Reductase Gene C677T and A1298G Polymorphism in Chronic Periodontitis
Gülhan Kocaman, Recep Orbak
doi: 10.14744/etd.2019.39259  Pages 250 - 254
Objective: This case control study examined the frequency and distribution of the C677T and A1298C single-nucleotide polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene in Turkish patients with chronic periodontitis.
Materials and Methods: This study included 89 subjects: 49 patients with chronic periodontitis and 40 healthy persons. Medical and periodontal histories were taken, and PD, CAL, PI, and BOP were recorded as the clinical parameters. The blood samples were taken from the subjects, and their DNA was obtained. The MTHFR gene’s single nucleotide polymorphisms 677C→T and 1298A→C genotyping were analyzed using the RFLP assay, then PCR.
Results: There was a significant difference between the groups except for age when the clinical findings. Single-nucleotide polymorphisms in the MTHFR gene C677T and 1298C regions were not found to be significantly different between the groups.
Conclusion: The study revealed no association between the MTHFR polymorphism and the risk of chronic periodontitis; however, increasing the number of patients is useful when performing further studies. This present study is important because it is, to the best of our knowledge, the first study to research the interrelation between the MTHFR gene and chronic periodontitis.

5.Role of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Prognostic Predictors Before Treatment for Metastatic Bladder Cancer Patients Receiving First-Line Chemotherapy
Oktay Bozkurt, Ender Doğan, Sedat Tarık Fırat, Ramazan Coşar, Mevlüde Inanç, Gözde Ertürk Zararsız, Metin Özkan
doi: 10.14744/etd.2019.74507  Pages 255 - 260
Objective: The correlation between neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the prognosis of different cancers has been determined by a series of studies. The role of these inflammatory markers as definitive prognostic factors in bladder cancer is controversial. This research was conducted to explore the prognostic worth of pretreatment inflammatory markers including NLR and PLR in metastatic bladder cancer (mBC) patients receiving first-line chemotherapy.
Materials and Methods: We retrospectively appraised 71 patients diagnosed with mBC from August 2005 to November 2017. According to the threshold values that were identified by receiver operating characteristic (ROC) curve analysis, the NLR and PLR were each divided into two groups: first, ≤2.93 and >2.93, and second, ≤168.9 and >168.9 respectively. The Cox proportional hazards model was applied to uncover the probable predictors of progression-free survival (PFS) and overall survival (OS).
Results: Findings obtained by univariate analysis determined that an elevated NLR, a high PLR, and the onset of anemia were significantly correlated with poorer OS. Additionally, a significant relationship was found between an elevated NLR and reduced PFS. In the multiple analysis, an elevated NLR was identified as an independent predictor for both, reduced OS (Odds Ratio (OR): 5.58, 95% Confidence interval (CI): 2.80–11.13, p<0.05) and PFS (OR: 3.43, 95% CI: 1.92–6.12, p<0.05).
Conclusion: Findings of this research revealed that NLR was an independent prognostic tool of PFS and OS in mBC patients undergoing first-line chemotherapy.

6.Surgery of Retrosternal Thyroid: Evaluation of 36 Cases
Alperen Vural, Emrah Gülmez, Ömer Faruk Demir, Kerem Kökoğlu, Imdat Yüce, Sedat Çağlı
doi: 10.14744/etd.2019.37542  Pages 261 - 264
Objective: Retrosternal thyroid is the presence of thyroid tissue in the mediastinum either by enlarging of the cervical or by an ectopic mediastinal thyroid. Surgery for a retrosternal thyroid has technical differences than conventional cervical thyroid surgery and has a higher risk of complications. This paper aims to analyze the cases with retrosternal thyroid and to evaluate the outcomes of the surgery.
Materials and Methods: Retrospective analysis in terms of age, sex, clinical course, thyroid hormone levels, parathormone (PTH) levels, diagnostic methods, and fine needle aspiration cytology (FNAC) results and complications of 36 cases that underwent surgery was performed.
Results: In addition to routine evaluation for thyroid pathology, computerized tomography was used for each patient. Thirty-four surgeries were completed with a cervical incision, one with a sternotomy and one with a thoracotomy. Four patients (11.1%) experienced temporary postoperative hypocalcemia, and one patient had a transient vocal cord immobility. Neither permanent hypocalcemia nor vocal cord paralysis was present in any of the patients postoperatively.
Conclusion: Planning surgery as early as possible is suggested to avoid compression symptoms and possible malignancy. Cervical approach is mostly enough for the majority of patients; however, in case of a need of an additional (transthoracic) approach, multidisciplinary planning with thoracic surgeons is proposed. The risk of complications in experienced centers is parallel to cervical thyroidectomy.

7.The Effect of Lymph Node Dissection on Gallstone Formation in Patients Undergoing Total Gastrectomy for Gastric Adenocarcinoma
Ismail Cem Eray, Uğur Topal, Erdem Kakil, Ahmet Gökhan Sarıtaş, Ahmet Rencuzogullari, Orçun Yalav, Kubilay Dalcı
doi: 10.14744/etd.2019.36024  Pages 265 - 268
Objective: Formation of gallbladder stone is frequently observed after resection for gastric cancer. Extended lymph dissection
is shown to be among risk factors.
Materials and Methods: We compared patients with limited lymphatic dissection (D1) and extended lymphatic dissection
(D2) in terms of gallstone formation and complications.
Results: We observed gallbladder stone formation in 13 (12.8%) patients. Gallbladder stone formation was observed in
11.1% of patients in the D1 group and in 14.3% of patients in the D2 group, but no statistically significant difference was
found between lymphatic dissections. Of 13 patients, 5 (38.4%) were symptomatic and 3 (23.1%) developed choledocholithiasis.
Five patients who were symptomatic were operated without any problems. The groups did not show a statistically
significant difference in terms of cumulative survival times. While patients who underwent D2 dissection had more formed
gallbladder stone, there were no significant differences between the groups.
Conclusion: The complications related to gallbladder stone developed after gastrectomy can be safely managed.

8.The Turkish Version of the Infant Feeding Intention Instrument (IFI-T)
Sezer Er Güneri, Gonca Karayağız Muslu, Özlem Güner
doi: 10.14744/etd.2019.70487  Pages 269 - 274
Objective: The purpose of this research was to translate the Infant Feeding Intentions Scale (IFI) into Turkish, modify it according to the Turkish cultural state, and detect the reliability and validity of the translated version.
Materials and Methods: The research data was collected in the pregnancy polyclinic from 128 healthy pregnant women at a university hospital. A personal information form and a Turkish version of the IFI scale (IFI-T) were used for data collection. Language equivalence, content validity, construct validity, and predictive validity were used in the validation research of the IFI-T Scale. In the reliability research, Cronbach’s alpha coefficient, item analysis, split-test, and re-test methods were used. The t-test was used for the dependent groups to test the time invariance of the scale.
Results: The consistency of specialist opinion on the scale, translated into Turkish and back-translated, was revealed (Kendall W=0.600; p>0.05). The factor loading values resulting from the factor analysis that was directed at the construct validity of the scale were between 0.69 and 0.89 and the items were collected under one factor. The scale total correlation value of all items was over 0.20. In the reliability research, the Cronbach’s alpha value was 0.86. The test-retest and split-half test results also supported the reliability of the scales.
Conclusion: We found that the IFI-T scale can be used as a valid and reliable tool for evaluating the infant feeding intention in pregnant women.

9.Phonatory-Aerodynamic Characteristics of Drama Students
Fatma Esen Aydınlı, Rıza Korhan Sezin, Esra Özcebe, Ayşen Köse, Rıza Önder Günaydın
doi: 10.14744/etd.2019.48108  Pages 275 - 281
Objective: Theater actors are considered as elite vocal performers whom quality of voice is of utmost importance. It was thought that speech breathing characteristics of theater actors were different compared with those of lay talkers. However, findings on this issue were generally based on studies conducted by the respiratory kinematics and muscular activity via using indirect air volume measures. These measures were by no means related with the respiratory– phonatory interaction. One of the objective methods that is used for evaluating voice quality is the phonatory-aerodynamic characteristics. Phonatory-Aerodynamic System (PAS) primarily examines the respiratory–phonatory interaction. The aim of the present study was to search the phonatory-aerodynamic characteristics of drama students.
Materials and Methods: A total of 37 vocally healthy participants aged between 21 and 30 years were separated into two groups; the first group included drama students (n=19), and the second group comprised lay talkers (n=18). Phonatory-aerodynamic evaluations were done via PENTAX Medical PAS Model6600.
Results: During the phonation of vowel [a], female and male drama students used greater percentage of vital capacity (VC) than public speaker couples. Similarly, findings indicated that female drama students used greater percentage of VC while producing syllables [papapapapa]. As for connected speech, female participants of both groups completed reading in similar durations, but they inspirated faster and they needed lesser number of inspirations.
Conclusion: It is concluded that the phonatory-aerodynamic characteristics of theater students are different compared with those of lay talkers predominantly for female participants. The present study’s results may serve clinicians’ basic objective data regarding the speech breathing characteristics of theater actors.

10.The Effect of Aminoglycosides on Colistin-Containing Regimens in the Treatment of Carbapenem-Resistant Gram-Negative Infections in Pediatric Intensive Care Units: A Two-Center Experience
Zümrüt Şahbudak Bal, Fulya Kamit, Muhterem Duyu, Pınar Yazıcı, Ayşe Berna Anıl, Dilek Yılmaz Çiftdogan, Nisel Özkalay Yılmaz, Feriha Çilli, Bülent Karapınar
doi: 10.14744/etd.2019.76093  Pages 282 - 287
Objective: This study aimed to assess the outcomes including morbidity and mortality of carbapenem-resistant gram-negative (CRGN) infections in pediatric critical care setting. The second aim was to investigate the impact of aminoglycosides on colistin-containing regimen in CRGN-infected pediatric critical care patients.
Materials and Methods: We retrospectively evaluated medical records of 82 patients who had received colistin in combination with an aminoglycoside (CA group) or another antibiotic (CO group) at two reference pediatric intensive care units (PICUs) between February 2011 and February 2016.
Results: We enrolled 82 CRGN-infected patients who were admitted to PICUs of two hospitals. The median age of the patients was 24 (25th–75th percentile; 8–78.75) months, and the median duration of hospital stay was 30 days (25th–75th percentile; 16.7–57.7). No statistical difference was observed in the variables, including microbiological response, attributable mortality, crude mortality, and the duration of achieving first negative culture (p>0.05). Clinical response was significantly more observed in the CA group (85.5% vs. 63.2; p=0.048), and attributable mortality was higher in the CO group (12.7% vs. 31.6%; p=0.055). Nephrotoxicity did not show statistical difference between groups (p=0.357), and neurotoxicity was not observed.
Conclusion: Colistin-containing regimen in combination with an aminoglycoside may be an effective and safe antimicrobial agent without a significant increase in side effects.

11.Nail Digital Dermoscopy in Onychomycosis: A Correlation with Clinical Type, Gender, and Culture Examination
Zeynep Gizem Kaya Islamoğlu, Abdullah Demirbaş, Mehmet Ünal, Duygu Fındık
doi: 10.14744/etd.2019.94210  Pages 288 - 294
Objective: Onychomycosis (OM) is a common disease that covers both tinea unguium and those remaining cases caused by yeasts, mainly of the Candida and various non-dermatophyte molds. Diagnosis is usually confirmed with direct microscopy and fungal culture. Nail dermoscopy is a non-invasive tool to diagnose various nail disorders and also to avoid time-consuming investigations. The aim of the present study was to determine the dermoscoping findings in OM and to correlate this with clinical type, gender, and culture results.
Materials and Methods: This was a cross-sectional study of 100 patients diagnosed with OM according to clinical findings and direct microscopic examination. Nail dermoscopy was performed using a FotoFinder Digital Dermoscope, and images were recorded. A part of the samples was cultured in all patients.
Results: The most frequent clinical type was distal lateral subungual onychomycosis (80.0%). The culture was negative in 72.0% of the samples. In the positive group, 48% of Trichophyton rubrum was cultured. The most common dermoscopic findings were longitudinal stria, ruin appearance, and longitudinal leukonychia. In culture-negative samples, irregular termination was most commonly seen. Ruin appearance, brown discoloration, hematoma, and transverse leukonychia, such as brushing, were compatible with total dystrophic OM.
Conclusion: Determinative dermoscopic findings for OM, clinical types, and fungus forms were identified. These signs can avoid unnecessary mycology in selected cases.

12.Effects of Thymoquinone and Citalopram on Oxidative Stress in Gastric and Duodenum Tissue in Reserpinized Rats
Dilek Kuzay
doi: 10.14744/etd.2019.77527  Pages 295 - 299
Objective: Medicaments used in the therapy of GIS diseases have many detrimental impacts. Therefore, antioxidant effective molecules can help in the treatment process. This study aimed to examine the oxidant and antioxidant activity of thymoquinone (TQ) and citalopram in gastric and duodenum tissues of reserpinized rats.
Materials and Methods: In the study, we split the rats in six groups of six rats each: 1) Control (C) 1; 2) Control (C) 2; 3) reserpine (R); 4) Reserpine+citalopram (R+C); 5) Reserpine+thymoquinone (R+T); 6) Reserpine+citalopram+thymoquinone (R+C+T). Reserpine (0.2 mg/kg) was intraperitoneally administered. TQ (10 mg/kg) and citalopram (10 mg/kg) were intragastrically administered 30 min before reserpine injection. The rats were treated for 14 consecutive days. At the end of the experiment, we examined total antioxidant status and total oxidant status in gastric tissue; and total nitric oxide, malondialdehyde, and glutathione levels in duodenum tissue.
Results: There was a reduction on total oxidant status in gastric tissue in the R+C group in comparison with the R group (p<0.01). The decrease in total oxidant status in the R+C+T and R+T groups was more significant (p<0.01). An increase in total antioxidant status was observed in the R+C, R+T, and R+C+T groups when compared to the R group (p<0.01). In comparison to the R group, there was a reduction in malondialdehyde and nitric oxide levels and a rise in glutathione level in duodenum tissue in the R+C+T and R+T groups (p<0.01).
Conclusion: Reserpine increased oxidative stress and decreased antioxidant capacity in gastric and duodenum tissues. TQ and citalopram+TQ treatment decreased oxidative stress and increased antioxidant capacity in gastric and duodenum tissues. TQ and citalopram+TQ treatments proved to be more effective in protection from oxidative stress caused by reserpine in gastric and duodenum tissues than citalopram treatment.

13.Cardiovascular Risk Factors and Metabolic Syndrome in Rheumatoid Arthritis and Spondyloarthritis: Correlation With Uric Acid Levels
Ezgi Ağadayı, Fatma Gül Yurdakul, Sıtkı Ağadayı, Hatice Bodur, Rabia Kahveci, Adem Özkara
doi: 10.14744/etd.2019.23434  Pages 300 - 306
Objective: We aimed to investigate cardiovascular disease (CVD) risk and risk factors and evaluate the relationship among disease activity, inflammation markers, and uric acid levels in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).
Materials and Methods: In this study, 98 patients with RA, 41 patients with SpA, and 95 controls were included. Participants’ demographic features, levels of body mass index (BMI), blood pressure (BP), waist circumference, glucose, cholesterol, uric acid, disease activity, and metabolic syndrome (MetS) prevalence were recorded. The 10-year CVD risk and heart age were calculated by using the Framingham risk score.
Results: The mean BMI, systolic BP, diastolic BP, and waist circumference were higher in RA patients. There was no difference among patients with RA, those with SpA, and controls in terms of MetS prevalence (43.9%, 41.5%, and 35.8%, respectively, p=0.510) and 10-year CVD risk (12.7±10.2, 9.2±8.7, and 11.4±10.8, respectively, p=0.174). Higher uric acid levels were indicated in patients with MetS in both RA and SpA groups. Uric acid levels were associated with the Framingham score in RA patients.
Conclusion: In patients with RA and SpA, CVD risk was determined to be similar to that of the general population. On the other hand, the uric acid level was found to be correlated with the risk of MetS, and uric acid is associated with CVD risk, especially in patients with RA.

14.Vitamin D Levels in Children with Sleep Terror: Analytical Cross-Sectional Study
Ahmet Kağan Özkaya, Olcay Güngör
doi: 10.14744/etd.2019.57983  Pages 307 - 311
Objective: This study aimed to investigate 25(OH) vitamin D levels in children with sleep terror compared to those in normal controls.
Materials and Methods: In this study, we enrolled 81 children diagnosed with sleep terrors and 81 normal control children of similar ages. We analyzed plasma 25(OH) vitamin D, calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels. Levels of 25(OH) vitamin D less than 20 ng/ml were interpreted as representing vitamin D deficiency, while levels of 20–30 ng/ml indicated vitamin D insufficiency.
Results: The mean serum 25(OH) vitamin D level of children with sleep terror was 23.29±10.39 ng/ml, which was significantly lower than in the control group at 29.07±8.32 ng/ml (p<0.001). Children with sleep terror with frequent attacks had lower 25(OH) vitamin D levels than those without frequent attacks (p<0.001).
Conclusion: This study demonstrated a greater prevalence of vitamin D deficiency or insufficiency among children with sleep terror. We now need further studies with larger series investigating the effect of vitamin D replacement on sleep terror.

15.Economic Burden of Multidrug-Resistant Gram-Negative Infections in a Developing Country
Aysegul Ulu Kılıç, Gamze Kalin Unuvar, Fatma Cevahir, Emine Alp
doi: 10.14744/etd.2019.43179  Pages 312 - 315
Objective: Antibiotic-resistant infections represent a significant global public health threat due to their rising prevalence. The aim of this study is to identify risk factors for acquisition of multidrug-resistant gram negatives (MDR-GNs) in the first intensive care unit (ICU) infection episode of patients and also to calculate the economic burden of infection with MDR-GNs that the ICU patient faced.
Materials and Methods: This is a prospective observational study conducted over 1 year. The first ICU infection episode of the patients was included into this study. A case was defined as a patient who had an MDR-GN in his or her first episode of an ICU infection, and control was defined as a patient who had a non-MDR-GN in his or her first episode of an ICU infection.
Results: A total of 100 patients were included into the study. Sixty-two patients had the MDR-GN, and 38 patients had a non-MDR pathogen. Independent risk factors associated with the MDR-GN infection were the APACHE II score (OR=1.08, p=0.012), transfer from another hospital (OR=9.3, p=0.04), antibiotic use before ICU infection (OR=7.7, p=0.04), and arterial catheter (OR=2.8, p=0.03). The median antibiotic cost was significantly higher for patients in the case group [$663.50 (27–3,752) and $256.00 (0–2,716), respectively] (p<0.01). Also, a total hospital cost for patients was significantly higher in the case group ($8,895 [2,621–23,883] and $6,551 [1,441–20,425], respectively) (p<0.05).
Conclusion: Patients with a high APACHE II score transferred from another hospital and who use an antibiotic before the ICU infection and arterial catheter are at a greater risk of MDR-GN infections. Also, the infections pose a significant burden on health care facilities due to more prolonged and costly treatments.

16.Effect of Nd: YAG Laser Capsulotomy on Refraction and Anterior Segment Parameters in Patients with Posterior Capsular Opacification
Ender Sirakaya, Alperen Ağadayı, Bekir Küçük, Mustafa Hepokur
doi: 10.14744/etd.2019.65632  Pages 316 - 320
Objective: This prospective study aimed to determine the effect of neodymium-doped yttrium aluminum garnet (Nd: YAG) laser capsulotomy on spherical equivalent (SE), mean keratometry (Km), intraocular pressure (IOP), and changes in the anterior segment parameters, namely, anterior chamber depth (AChD), anterior chamber volume (AChV), anterior chamber angle (AChA), and central corneal thickness (CCoT).
Materials and Methods: Thirty-five pseudophakic eyes with posterior capsular opacification (PCO) of 35 patients (19 male and 16 female; mean age: 64.2±7.2 years) were included in this study. SE with automated refractometer, IOP with Goldmann applanation tonometry, Km, AChD, AChV, AChA, and CCoT measurements were performed using the Scheimpflug imaging system (Pentacam, Oculus) before laser capsulotomy and one day (first visit), one week (second visit), and one month (third visit) after laser capsulotomy.
Results: SE values significantly differed postoperatively over the course of the 3 visits (p=0.005, p=0.002, and p=0.002, respectively). IOP exhibited a statistically significant increase for the first and second visits, but not for the third visit (p<0.001, p=0.004, and p=0.44, respectively). AChD values significantly increased over the course of the 3 visits after laser capsulotomy (p=0.038, p=0.037, and p=0.022, respectively). No statistically significant differences were observed in the Km, AChV, AChA, and CCoT values before and after laser capsulotomy over the course of the 3 visits (p=0.91, p=0.41, p=1.00, and p=1.00, respectively).
Conclusion: Nd: YAG laser capsulotomy is a procedure with higher success rates that can change the anterior segment parameters. Our study revealed an increase in the SE, IOP, and AChD values after laser capsulotomy.

17.Pre- and Postoperative Evaluation of the Effect of Atrial Septal Defect on Systemic Circulation Via Pulse Wave Velocity
Şaban Keleşoğlu, Deniz Elcik, Aydın Tunçay, Ali Doğan, Mustafa Fehmi Bireciklioğlu, Zeki Çetinkaya, Mehmet Tuğrul Inanç, Nihat Kalay, Ramazan Topsakal, Abdurrahman Oğuzhan
doi: 10.14744/etd.2019.06888  Pages 321 - 326
Objective: The aim of the present study was to examine whether endothelial function is affected in patients with atrial septal defect (ASD) of secundum type and to determine the changes that might occur in endothelial function after the defect was closed by the transcatheter method by using the pulse wave velocity (PWV) technique.
Materials and Methods: A total of 54 patients with ASD type and 40 healthy individuals were included in the study. All patients underwent transthoracic echocardiography and PWV measurements to evaluate the endothelial function prior to and 1 month after the closure procedure.
Results: PWV values were significantly higher in patients with ASD than in healthy subjects (7.5±1.2 m/s vs. 6.1±1.0 m/s, p<0.001). Systolic pulmonary arterial pressure (PAP), right ventricular diameter, and PWV values were significantly lower at 1 month of follow-up after the procedure than at baseline (p<0.001). However left ventricular ejection fraction, left ventricular end-diastolic diameter (LVEDD), and tricuspid annular plane systolic excursion values increased significantly after the procedure component (p<0.001, p=0.002, and p<0.001, respectively).
Conclusion: It was observed that following closure of the ASD by the transcatheter route, the PWV values were significantly reduced in the right cardiac chambers, and the systolic PAP was improved. This result has shown us that ASD closure may benefit from endothelial dysfunction.

18.Residual Kidney Function in Hemodialyzed Patients and Related Factors
Halil Ibrahim Erdoğdu, Fatih Kara
doi: 10.14744/etd.2019.22230  Pages 327 - 332
Objective: Residual kidney function (RKF) is a strong marker of the remaining capacity of the kidneys in patients with end-stage renal disease (ESRD). The fact that RKF declines in the first year of hemodialysis (HD) has drawn more attention recently. The aim of this study was to determine and analyze the current RKF level and related factors in patients undergoing HD treatment.
Materials and Methods: The study was performed at Kars State Hospital with 73 HD patients. Residual renal urea clearance (KRU) was measured to determine RKF. Patient urine volume was determined during the period between the end of the first HD session of the week and the beginning of the next HD session. The patients were classified into 3 groups according to KRU level: <1, 1-2, and >2 mL/minute. The duration of HD treatment, biodemographic characteristics, biochemical and hormonal analyses, HD adequacy, ESRD etiology, and co-morbidities were compared between groups. A p value of less than 0.05 was considered statistically significant (confidence interval: 95%).
Results: There was a statistically significant difference between the KRU value and the duration of HD treatment (p<0.001), ESRD etiology (p=0.037), serum potassium level (p=0.028), phosphorus level (p=0.036), urine volume (p<0.001), ultrafiltration (UF) volume (p=0.002), and body mass index (p=0.002). Patients with a urine volume of <100 mL/day had a longer duration of HD treatment of 6.9±4.2 years (p=0.021), as well as a greater quantity of UF administered 723±230 mL/hour (p<0.001).
Conclusion: Rather than provide an explanation of a cause-effect relationship for RKF loss, the findings of this study may contribute to the monthly interpretation and regulation of HD therapy. Additional studies that include RKF measurement at certain time intervals and long-term observation are needed.

BRIEF REPORT
19.The Effect of Carbapenem Restriction Policy on the Rate of Hospital Infections Due To Resistant Microorganisms in the Intensive Care Unit
Zeynep Türe, Gökşen Öz, Tuğba Demirel Güğül, Şerife Çetin, Tuğba Bulut, Saliha Aydın, Ilhami Çelik
doi: 10.14744/etd.2019.00087  Pages 333 - 336
Introduction: In this study, the effect of carbapenem restriction on the infection rate and antibiotic susceptibility was investigated.
Method: The study period was divided into two periods called as: carbapenem free period (CFP) and carbapenem-restricted period (CRP). The usage rate of antipseudomonal carbapenem, the incidence of nosocomial infection, invasive device days, the causative microorganisms and antibiotic susceptibility were compared.
Results: In the CFP, the nosocomial infection density was 40.95 ± 19.02 in 1000 patient days, and 20.71 ± 4.28 in 1000 patient days in the CRP. No significant difference was observed between the two periods in terms of invasive devices use rates. Anti pseudomonal carbapenem usage rate was 2.73 in CFP and 1.67 in CRP. Of the 40 nosocomial infections due to Acinetobacter baumannii, 27 of them were found in the CFP.
Conclusion: Carbapenem restriction policy may contribute to decrease the rate of resistant bacterial infections.

CASE REPORT
20.Rhino–Orbito–Cerebral Mucormycosis Resistant to Amphotericin B: Two Diabetic Cases
Esma Eren, Ayşegül Ulu Kılıç, Mustafa Altay Atalay, Sare Merve Başağa, A. Nedret Koç, Emine Alp
doi: 10.14744/etd.2019.26032  Pages 337 - 340
Mucormycosis is a rare, life-threatening opportunistic infection caused by Mucorales. The most common organisms that cause mucormycosis in humans are Rhizopus, Mucor, Rhizomucor, Lichtheimia (Absidia), and Cunninghamella. Risk factors for the disease include diabetes mellitus, metabolic acidosis, hematologic malignancies, prolonged severe neutropenia, use of corticosteroids, and human immunodeficiency virus infection. Diagnosis and treatment of infection are difficult.

21.Necrotizing Soft Tissue Infection with Compartment Syndrome: A Case Report
Yekta Özkılıç, Kaan Gürbüz, Zeynep Türe, Ilhami Çelik
doi: 10.14744/etd.2019.97059  Pages 341 - 343
Necrotizing soft tissue infection (NSTI) is a rare infectious condition that spreads rapidly and may be associated with compartment syndrome. Group A β-hemolytic streptococcus is one of the most common causative organism of NSTI. Herein, we present a case of NSTI associated with compartment syndrome of the upper extremities following possible tonsillitis. The case was successfully treated after administering systemic antibiotics and performing emergency surgical debridement.

22.Evaluation of Cardiovascular Involvement in Pediatric Behcet’s Disease: Case Report and Literature Review with Intracardiac Thrombus
Serkan Türkuçar, Hatice Adıgüzel Dündar, Ceyhun Açarı, Erbil Ünsal
doi: 10.14744/etd.2019.24381  Pages 344 - 346
Behcet’s Disease (BD) is an inflammatory vasculitis with multisystem involvement. Typical manifestations such as oral-genital ulcerations, joint, skin, and ocular involvement usually occur during the initial period of the disease, whereas cardiac and vascular involvement may be seen in the later stages and in a more severe form of the disease. A 17-year-old male with a history of intracranial thrombosis due to BD was admitted with dyspnea and cough. A CT angiography revealed bilateral consolidation areas that were possibly compatible with pulmonary embolism. Further investigations conducted to find the origin of the embolism revealed one thrombus of 3x2 cm dimensions in the right ventricular apex (by echocardiography) and another one in the superficial branches of the right saphenous vein in the lower extremity. He responded well to early-onset immunosuppressive and steroid therapy. This case-based literature review was presented to emphasize the need for careful and detailed evaluation of thrombosis and vascular involvement in Behcet’s Disease.

IMAGE
23.A Dangerous Furuncle Involving the Nasal Vestibule
Satvinder Singh Bakshi
doi: 10.14744/etd.2019.34654  Page 347
Abstract | Full Text PDF

HISTORY OF MEDICINE
24.Physical Signs of Inspection and Medical Eponyms in Pericarditis Part III: 1900 to 1964
Fan Ye, Halil Tekiner, Eileen Yale, Joseph Mazza, Steven Yale
doi: 10.14744/etd.2019.75875  Pages 348 - 354
During the 20th century with emerging technological advancements including the development of fluoroscopy, radiography, and electrocardiography, physicians used these tools in patients with acute or chronic pericarditis with or without pericardial effusion to identify signs eponymously named to honor the person who first discovered, described, and reported the discovery. Hence, through meticulous observations, these signs complimented other findings found on physical examination to further assist in supporting the diagnosis of pericardial disease.

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