ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 42 (2)
Volume: 42  Issue: 2 - 2020
EDITORIAL COMMENTS
1.Current Approach to Neutropenic Enterocolitis
Umran Sümeyse Ertürk, Esra Ermis Turak, Leylagul Kaynar, Elias Fadel
doi: 10.14744/etd.2019.34341  Pages 119 - 120
Abstract | Full Text PDF

INVITED REVIEW
2.Fever of Unknown Origin (FUO): Towards a Uniform Definition and Classification System
Mile Bosilkovski, Magdalena Baymakova, Marija Dimzova
doi: 10.14744/etd.2020.56667  Pages 121 - 126
Despite the great advancements seen in medicine in recent years, fever of unknown origin (FUO) remains a serious diagnostic challenge. Regardless of the etiological elucidation in many cases of FUO and the progress seen in the management of these patients, there are currently many weaknesses in this area as a result of inconsistency in the definition and interpretation of key terminology and the utilization of different definitions and classifications. As a result, there is confusion among medical practitioners about FUO, which leads to laborious and difficult comparisons among different case series. This study outlines the mismatch in terminology and diversity found in the classification of the conditions that cause FUO and emphasizes the discrepancies between what some terminology intends to represent and what it actually represents in reality. Thus, we attempted to determine an appropriate solution for established inconsistencies.

SYSTEMATIC REVIEW
3.Effect of Therapeutic Play Methods on Hospitalized Children in Turkey: A Systematic Review
Gülşah Kapkın, Gülay Manav, Gonca Karayağız Muslu
doi: 10.14744/etd.2019.94940  Pages 127 - 131
Objective: This systematic review aims to examine the effect of therapeutic play methods on hospitalized children in Turkey.

Methods: Medline/PubMed, ScienceDirect, YÖK (higher education institution) National Thesis Center, Ovid, Web of Science, Wiley Online Library, Turkey Clinics, and Google Academic databases were searched for relevant data from 2009–2019 using the keywords therapeutic play, play therapy, child, and pediatrics. Ultimately, 36 studies published in English and Turkish conducted in 2006–2018, which reported the impact of game methods and whose full text can be reached, were included herein. The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 guideline and Patient, Intervention, Comparison, Outcomes, Study Design model were used in analyzing the studies.

Results: Among the studies included herein, 25 were randomized controlled trials, seven were semi-experimental studies, two were qualitative and quantitative mixed pattern studies, one was a semi-experimental and cross-sectional study, and one was a case–control study. Our findings showed that distraction cards have been the most frequently used therapeutic game method, with durations varying between 3 min and 1 h depending on the attempt, and that therapeutic play has mostly been utilized during the bloodletting process. Moreover, our results revealed that therapeutic play generally reduces pain, anxiety, and fear and increases the child’s adaptation to the hospital environment.

Conclusion: The present review showed that therapeutic play among hospitalized children in Turkey was effective in relieving pain and anxiety and helped them adapt to the hospital environment. These results suggest that therapeutic play may aid medical personnel during painful procedures and throughout the hospitalization process.

ORIGINAL ARTICLE
4.The Protective Role of Poplar Propolis Against Alcohol-Induced Biochemical and Histological Changes in Liver and Testes Tissues of Rats
Numan Baydilli, Emre Can Akınsal, Züleyha Doğanyiğit, Oğuz Ekmekçioğlu, Sibel Silici
doi: 10.14744/etd.2020.83097  Pages 132 - 138
Objective: This study evaluated the biochemical and histopathological effects of propolis oil extract on liver and testicular
tissue in rats subjected to alcohol toxicity.

Materials and Methods: Sixty Wistar albino rats were randomly assigned into 6 groups: Control, Ethanol (EtOH: 20% ethanol) Propolis-1 (PR1: 100 mg/kgbw) Propolis-2 (PR2: 200 mg/kgbw) EtOH+PR1, and EtOH+PR2. Rats were administered ethanol and propolis by gastric tube for 15 days. Hematological, biochemical, and histopathological (liver and testes) parameters were examined. In addition, sperm concentration and motility were determined.

Results: Increased deterioration of complete blood count parameters was statistically significant in the EtOH group when compared to the control group. Propolis was preventative for some effects of EtOH. The most pronounced preventive effect of propolis on ethanol-induced damage was observed in nucleated red blood cells (NRBC) and mean corpuscular hemoglobin concentration (MCHC) parameters (p<0.01). Cholesterol and triglyceride levels were found to be highest in the EtOH group, and propolis was found to reduce these effects of ethanol (p<0.01). While the highest value for the testosterone hormone was seen in the PR2 group, propolis was found to decrease the hormone level decline caused by ethanol especially in the EtOH+PR2 group. Although it was not statistically significant, giving rats ethanol showed reduced sperm motility and epididymal sperm concentration, whereas co-administering propolis and ethanol showed an increase in these values.

Conclusion: It was found that ethanol caused negative effects on the biochemical parameters studied, and histopathological assessments also showed negative effects on liver and testicular tissue. Propolis (200 mg/kgbw), on the other hand, was found to have a mitigating effect on these values.

5.Should We Use a Staged or Ad hoc Approach in Percutaneous Coronary Interventions Through the Radial Artery to Avoid Radial Artery Spasm?
Gültekin Günhan Demir, Ekrem Güler
doi: 10.14744/etd.2020.94752  Pages 139 - 142
Objective: Transradial approach has recently been adopted as the default strategy for percutaneous coronary interventions due to benefits which include reduced all-cause mortality, major access-site complications, and hospital stay, as well as increased patient comfort and early ambulation. However, radial artery spasm (RAS) is still a major drawback. The impact on RAS of an ad hoc compared with a staged intervention strategy has not previously been investigated. In this study, we sought to investigate the effect of ad hoc and staged percutaneous coronary intervention (PCI) on RAS in patients undergoing elective transradial coronary interventions.

Materials and Methods: In this retrospective study, patients with symptoms suggestive of ischemia who were scheduled for coronary angiography and candidates for elective PCI were enrolled and divided into two equal groups: ad hoc group and staged group. RAS was clinically identified and established based on the existence of two or more of predefined clinical features.

Results: A total of 60 patients was enrolled in the study: 30 in the ad hoc group and 30 in the staged group. The mean time between coronary angiography and intervention in the staged group was 2.5 [1–30] days. RAS rates were similar between the ad hoc and staged PCI groups (16.7% [n=5] vs. 31% [n=9], p=0.233), but post-procedural pain was more frequent in patients in the ad hoc group (64.5% [n=20] vs. 33.3% [n=10], p=0.021). Radial artery occlusion did not differ between the ad hoc and staged PCI groups (10.7 % [n=3] vs. 11.1 [n=3], p=1).

Conclusion: Use of ad hoc or staged strategies in patients undergoing transradial PCIs is not associated with reduced incidence of RAS. Post-procedural pain is more common in patients undergoing ad hoc PCI through radial artery.

6.Fetal Echocardiography Characteristics in a Tertiary Center
Elif Erolu, Özlem Sarısoy
doi: 10.14744/etd.2020.76009  Pages 143 - 146
Objective: Fetal echocardiography is an important and growing diagnostic tool for early detection of congenital heart diseases and rhythm problems. In this study, we evaluated retrospectively indications and prenatal and postnatal diagnoses for fetal echocardiography.
Materials and Methods: Prenatal and postnatal echocardiographic diagnoses of the newborns and data of pregnant women who were referred to the Pediatric Cardiology Clinic of Ümraniye Training and Research Hospital between October 2018 and October 2019 and newborns were obtained from medical recordings.
Results: In this study, 138 patients were included. Eighty-one (58%) indication was suspected congenital heart disease, twenty-four indications (13%) was screening test positivity, 10 hyperechogenic focus, two advanced age pregnancy, six diabetes mellitus. Two were hydrops fetalis (immune/nonimmune), five dysrhythmias, one fetal anomaly. Hereditary causes were congenital heart disease in seven previous pregnancies. Sixty-eight patients with normal fetal echocardiography were normal in the postnatal period. Diagnosis of cyanotic congenital heart diseases was 24.2% of all patients, and 47.1% were acyanotic congenital heart disease in our study population. Four of the patients had arcus aorta anomalies. One patient had sustained supraventricular tachycardia with hydrops fetalis resolved with sotalol and digoxin treatment. One patient had neonatal thyrotoxicosis because of maternal graves disease
Conclusion: Fetal echocardiography is a useful and noninvasive method for early diagnosis and treatment, especially in rhythm problems. Also, diagnosis of congenital heart diseases antenatally is useful for planning the management of the disease.

7.Effects of Written and Visual Briefing on Parents’ State and Trait Anxiety in Newborns with Pes Equinovarus (PEV) Treated by Ponseti Method: A Randomized Trial
Ibrahim Karaman, Mithat Öner, Ibrahim Halil Kafadar, Ali Eray Günay
doi: 10.14744/etd.2019.79663  Pages 147 - 149
Objective: To assess the effects of written and visual briefing on parents’ state and trait anxiety in newborns with newly diagnosed pes equinovarus (PEV) who were treated using the Ponseti method during the neonatal period.
Materials and Methods: Eighty parents (mother and/or father) of neonatal PEV patients who were treated using Ponseti Method between September 2014 and July 2017were included in this study. Participants were assigned into two groups according to the written and visual briefing. Participants in both groups were asked to complete the State-Trait Anxiety Inventory (STAI) before the procedure. Then, written and visual briefing was given to the participants. All participants repeated the inventory after briefing to assess changes in state and trait anxiety.
Results: After visual and written briefing, parents’ response was evaluated. In both groups, a significant decline was observed in trait and state anxiety after both written and visual briefing (p<0.05). However, no significant difference was detected between groups regarding the effects of written and visual briefing on state anxiety.
Conclusion: The provision of detailed written and visual information about the risk of complications of the illness and treatment method increased the parents’ knowledge but did not increase their levels of anxiety.

8.Frailty and its Correlates in Older Adults: A Challenging and Preventable Geriatric Syndrome
Hacer Doğan Varan, Mustafa Kemal Kılıç, Muhammet Cemal Kızılarslanoğlu, Rana Tuna Doğrul, Güneş Arık, Özgür Kara, Gürkan Güner, Gözde Şengül Ayçiçek, Büşra Can, Meltem Halil, Mustafa Cankurtaran, Burcu Balam Yavuz
doi: 10.14744/etd.2019.26504  Pages 150 - 156
Objective: Frailty syndrome, defined as increased vulnerability to stressors, is an important cause of the negative health consequences of older adults. Defining related factors and struggling with these factors can be an important way for the prevention of frailty. This study aims to investigate the related factors of frailty using comprehensive geriatric assessment in community dwelled older adults attended the geriatric medicine outpatient clinic.
Materials and Methods: A total of 1001 patients aged 65 years and over were included in this study. Demographical characteristics, chronic illnesses, medications, were evaluated and recorded. Comprehensive geriatric assessment and anthropometric measurements were performed for each patient. The frailty status of patients was determined using the Edmonton frailty scale (EFS) and Fried’s frailty index (FFI). The rate of frailty and associated factors were examined.
Results: Frailty rate was detected as 15.4% and 11.8% according to the FFI and EFS, respectively. Advanced age, educational status lower than university level, having dementia, depression, diabetes mellitus, coronary artery disease, higher malnutrition risk, lower activities of daily living scores, lower handgrip strength and absence of hyperlipidemia were the independently associated factors of frailty by FFI or EFS.
Conclusion: Frailty is a common geriatric syndrome that has interaction with other geriatric syndromes and cardiovascular diseases. Most of the related factors of frailty are reversible or preventable. A comprehensive assessment is essential for the prevention of frailty.

9.Can Mean Platelet Volume be Used as a Thrombosis Marker in Subjective Tinnitus?
Deniz Avcı
doi: 10.14744/etd.2019.57355  Pages 157 - 162
Objective: To investigate the relationship between subjective tinnitus and red cell distribution width (RDW), platelet distribution width (PDW), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) levels.
Materials and Methods: This retrospective research included a total of 91 patients with subjective tinnitus and a control group of gender- and age-matched 65 healthy volunteers. Ear, nose, throat examination followed by pure tone audiometry, tympanometry, complete blood count, and magnetic resonance imaging of the temporal bone was performed. The clinical features and duration of tinnitus were recorded for each patient. The MPV, NLR, PDW, PLR and RDW levels were compared between tinnitus and control groups.
Results: Mean RDW was 15.49±2.43% in the patient group and 15.42±2.04% in the control group (p=0.831). Mean PDW was 16.13±2.51% in the patient group and 15.99±9.94% in the control group (p=0.901). Mean MPV was 8.95±0.77 fL in the patient group and 8.55±0.75 fL in the control group (p=0.002). Mean NLR was 1.89±0.63 in the patient group and 1.88±0.75 in the control group (p=0.916). Mean PLR was 113.93±33.91 in the patient group and 120.90±33.23 in the control group (p=0.204). Only MPV established a significant difference between tinnitus and control groups.
Conclusion: Only MPV was found to have an important role in the clinical prognosis and diagnosis of tinnitus. Elevated MPV indicates a possible role of thrombosis and vascular diseases in the etiology of subjective tinnitus, so increased MPV can be used as a thrombosis marker in subjective tinnitus.

10.The Effect of Complete Excision of the Hyoid Bone Corpus from the Cartilage Margins on the Success of Sistrunk Procedure in Children: The Preliminary Results
Ali Erdal Karakaya, Ahmet Burak Doğan, Ahmet Gökhan Güler
doi: 10.14744/etd.2019.32812  Pages 163 - 166
Objective: To analyze the effects of the hyoid bone excision magnitude and Z-shaped extra stitches, putting in the base of the mouth on the success of the surgical treatment of thyroglossal duct cyst (TGDC).
Materials and Methods: A retrospective analysis of 19 patients who underwent Sistrunk procedure between October 2013 and November 2018 was performed, and 16 patients with sufficient data were included in this study. In surgical procedures, we modified the Sistrunk procedure with a broader excision of mid-portion of hyoid bone, and Z-shaped extra stitches were put in the floor of the mouth. The patients were evaluated for age, sex, preoperative examinations, surgical findings, complications, and recurrence.
Results: The mean age of the patients was 5.12 years (range, 2 to 9 years), and 11 (69%) were female, and five (31%) were male. Twelve (75%) and three (19%) patients were presented with cyst and fistula formation, respectively. One (6%) patient referred to us as a result of recurrence with her previous sonographic results, which indicated TGDC. Only one patient (6%) experienced disease recurrence, and it was achieved a success rate of 94%. All the patients were followed for a mean of 12.81 (range, 6 to 21 months) months.
Conclusion: Extensive removal of the hyoid bone and Z-shaped sutures ligating possible ducts associated with the oral cavity may increase the rate of success in the surgical treatment of TGDC in children. However, this suggestion should be supported by further investigations.

11.Is Non-Vascularized Fibular Grafting an Effective Choice in the Treatment of the Upper Extremity Pseudarthrosis?
Yakup Ekinci, Kaan Gürbüz
doi: 10.14744/etd.2019.80148  Pages 167 - 173
Objective: To examine the efficacy of non-vascularized fibular grafts (NVFGs) in cases of isolated upper extremity pseudarthrosis, a subject covered by few publications in the literature.
Materials and Methods: Twelve long bones of 11 patients treated with NVFGs for upper extremity pseudarthrosis between January 2014 and July 2018 in our clinic were included in this study. Demographic data, length of the NVFG, postoperative complications, postoperative recovery period, radiographic bone union, joint range of motion measurements, Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) score for functional evaluation, and Lower Extremity Functional Scale (LEFS) or donor site morbidity were recorded.
Results: Of the 11 cases (three females and 8 males; median age 42.5 years; range 11 to 54 years; mean follow up 24.58±9.31 months), five cases involved the humerus, three cases involved the radius, two cases involved the ulna, and two cases involved the clavicle. The mean amount of graft harvested from the donor site was 39.7±8.87 mm, while the graft union time was 6±0.50 months. Satisfactory Q-DASH [median 6.8 (2.28-29.50)] and LEFS scores (mean 76.5±2.81) were obtained
Conclusion: Reconstruction with NVFGs is still an effective method in patients with problematic treatment of upper extremity long bone pseudarthrosis.

12.The Effects of Peritoneal Dialysis Catheter Insertion Using Paramedian Versus Midline Approach on Children
Masoud Jamshidi, Davoud Badebarin, Amir Asadloo, Sara Akhavan Salamat, Seyed Ehsan Mousavi Toomatari
doi: 10.14744/etd.2020.71463  Pages 174 - 177
Objective: There are several methods for dialysis in children with chronic renal failure. One of the methods is the insertion of a peritoneal dialysis (PD) catheter, which can be embedded with para-median and midline approaches. In this study, we aim to compare the complications and the success rate of these two approaches.
Materials and Methods: In this retrospective study, 41 patients under seven years who had undergone PD due to renal failure were included in this study. PD catheter was inserted via the paramedian approach in 15 and midline approach in 26 cases. Any early or late complications, as well as success rate, were compared between two approaches.
Results: Paramedian compared to midline approach had a significantly lower rate of catheter obstruction (20% vs. 53.8%, p=0.03), leakage (13.3% vs. 46.2%, p=0.03) and local infection (13.3% vs. 50%, p=0.02) from early complications and lower rate of late fluid leakage (13.3% vs. 46.2%, p=0.03) and tunnel or exit site infection (6.7% vs. 38.5%, p=0.02) from late complications. The paramedian approach had a significantly higher rate of success (80% vs. 42.3%, p=0.02).
Conclusion: Paramedian is a better approach for PD catheter insertion due to lower early and late complications, as well as a higher success rate.

13.The calculation of the femoral condyle cartilage volume and surface area in patients with osteoarthritis
Demet Ünalmış, Niyazi Acer, Seher Yılmaz, Adem Tokpınar, Serap Doğan, Hüseyin Demir
doi: 10.14744/etd.2020.75768  Pages 178 - 184
Objective: Osteoarthritis is non-inflammatory, degenerative, and chronic disease observed, especially as progressive in load-bearing joints. There are several studies that measure the volume and surface area of the knee joint cartilage in osteoarthritis patients. However, different methods were used in these studies.
Materials and Methods: Our study population consisted of 25 patients with osteoarthritis of the knee. Twenty-five healthy individuals were included in this study as a control group. In our study, planimetry and quadratic ruler method, which are among stereological methods, were used over magnetic resonance imaging (MRI) to measure the femoral condyle cartilage volume and surface area.
Results: The average cartilage volume measurement 6.54 cm3 in the female patient group and 13.51 cm3 in the female control group. In this measurement, 7.49 cm3 in male patients was measured in the control group 15.71 cm3. In the statistical comparison between the groups, it was determined that the values in the patient group decreased significantly compared with the control group (p<0.001).
Conclusion: When compared with the literature, it is concluded that our method may be used as a valid method because the survey results are close to each other and the average values.

14.An Analysis for the Predictors of ROSC Rate in Cardiac Arrest Patients
İrfan Aydın, Kasım Turgut
doi: 10.14744/etd.2020.84770  Pages 185 - 189
Objective: The present study aims to investigate the utility of femoral pulse examination as a feedback mechanism to evaluate CPR effectiveness in non-traumatic cardiac arrest patients.
Materials and Methods: The cases that were brought to the emergency department (ED) as non-traumatic cardiac arrest were included in this study. They were separated into two groups as follows: return of spontaneous circulation (ROSC) and died patients. Then, the groups were compared concerning age, gender, initial rhythm, CPR duration, arrest site, the presence of comorbidities, how to go to the ED, and the detection of the femoral pulse during CPR. The logistic regression analysis was carried out to investigate the factors that associate with the ROSC rate.
Results: A total of 130 patients were included in this study, and 23 of them become spontaneous circulation after CPR in ED. No significant difference was determined between cases in ROSC and died, concerning age, gender, presence of comorbid status and the way to go to the ED (p>0.05). The number of patients in which the femoral pulse was detected during CPR, patients with in-hospital cardiac arrests, patients with shockable initial rhythm, and patients with short CPR durations were significantly higher in ROSC group (p<0.001). No significant difference was observed between the patients who died and survived by one-month of surveillance (p>0.05).
Conclusion: The detection of the femoral pulse during CPR may provide us with advice about the effectiveness of CPR in non-traumatic cardiac arrest patients.

15.Monocyte to High-Density Lipoprotein Ratio: A Novel Inflammation Marker Related to Diabetic Retinopathy
Işıl Çakır, Hasan Basri Arifoğlu, Nahide Ekici Günay, Emine Pangal, Derya Şahin, Gökçen Alıcı Sert, Necati Duru
doi: 10.14744/etd.2020.32549  Pages 190 - 194
Objective: The most common microvascular complication of diabetes is diabetic retinopathy (DR). A new and recently emerged marker of oxidative stress and inflammation is monocyte to high-density lipoprotein cholesterol ratio (MHR). Platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) have also been shown as they are biomarkers of systemic inflammation in various diseases. The present study aims to assess MHR, its predictive value and relations between other inflammation markers in DR patients.
Materials and Methods: Sixty-eight patients with DR, fifty-four DM patients without DR and forty-two control subjects were included in this study. Complete blood count, lipoprotein and uric acid levels were recorded. MHR was calculated.
Results: MHR, NLR and PLR were statistically significantly higher in DR group than DM without DR group (p=0.008, p=0.042, p=0.003, respectively). Then, receiver operating characteristic (ROC) curve analysis was performed and pointed that MHR predicted DR using a cut-off level of 0.0156 with 63% sensitivity and 76% specificity.
Conclusion: In this study, we investigated MHR in DR patients and its relationship with other inflammatory markers, lipoproteins and uric acid. We suggested that an elevated admission of MHR may be of benefit to detect DR and to determine the CVD risk of these patients.

16.An Academic-Clinical Partnership Project: The Effects of a Scientific Research Skills Education Program
Aynur Çetinkaya, Damla Şahin Büyük, Dilek Özmen, Ali Tayhan, Fatma Uyar
doi: 10.14744/etd.2020.01205  Pages 195 - 200
Objective: The present study aims to reveal the effects of the education program provided to nurses on their perceived obstacles to conducting scientific research and attitude for scientific research.
Materials and Methods: This interventional study in the pre-test post-test model was carried out between February 2018 and August 2018. The universe of this study consisted of nurses working in three major public hospitals in Manisa (N= 1023). The sample was composed of nurses who worked in these hospitals and agreed to participate in this research (n= 106). The sociodemographic questionnaire, the nurse and presentation subscales of the barriers to research utilization scale and the attitude scale for scientific research were used in data collection. The scientific research skills education program was presented to the nurses participating in this research.
Results: There was a significant difference between pre and post scores of the participants in the reluctance to help researchers, negative attitude towards research and positive attitude towards researchers subscales of attitude towards scientific research scale (p<0.05), but there was no significant difference between the pre and post scores of the participants in the subscales of the barriers to research utilization scale and positive attitude towards research subscale of attitude towards scientific research scale (p>0.05).
Conclusion: After the educational program, the findings showed that the participants’ reluctance to help the researchers and their negative attitudes towards research decreased, and a positive attitude towards researchers increased. As a result, while education intervention affected nurses’ attitudes towards research, it had no effect on their perceptions of an obstacle to scientific research.

17.Comparison of Inflammatory Indexes in Patients Treated with Sorafenib in Advanced Hepatocellular Carcinoma: A Single-Center Observational Study
Havva Yeşil Çınkır, İlkay Doğan
doi: 10.14744/etd.2020.82246  Pages 201 - 206
Objective: Sorafenib has limited survival benefits with lower tumor response rates in hepatocellular carcinoma (HCC). Many researchers have attempted to identify predictors for sorafenib. In this study, we compared the role of lymphocyte/monocyte ratio (LMR), neutrophil/monocyte ratio (NMR), platelet/neutrophil ratio (PNR), systemic inflammation response index (SIRI) and systemic immune inflammation (SII) in patients with HCC received sorafenib treatment.
Materials and Methods: In this study, we retrospectively enrolled 80 patients who used Sorafenib in advanced stage HCC between January 2011 and December 2018. Baseline neutrophil, lymphocyte, monocyte and platelet counts were recorded. Cut-off points of LMR, NMR, PNR, SIRI and SII were calculated by the receiver operating characteristic (ROC) curve analysis. Overall survival (OS) and progression-free survival (PFS) were demonstrated by Kaplan-Meier analysis, and the log-rank test was used for comparing the curves
Results: Median OS was 29 weeks (95% CI 20.41–37.58), and PFS was 16 weeks (95% CI: 12.04–19.95). We found that only low SIRI value was associated with increased survival. OS were 19 weeks for SIRI ≥2.2 and 38 weeks (95% CI: 30.96–45.03 for patients with SIRI <2.2 (p=0.005). PFS was 12 weeks for SIRI ≥2.2 and 20 weeks for SIRI <2.2 (p=0.098). The life expectancy of patients with SIRI values less than 2.2 was 2.02 times higher than the other group.
Conclusion: To our knowledge, NMR and PNR indexes were evaluated for the first time in our study in HCC patients. Low SIRI value was related to increased survival in patients receiving sorafenib with HCC.

18.Seasonal Pattern of Acute Appendicitis in Central Anatolia
Mustafa Gök, Uğur Topal, Bahadır Öz, Muhammet Akyüz, Fatih Dal, Doğan Gürkan Islam, Kemal Deniz, Erdoğan Mütevelli Sözüer
doi: 10.14744/etd.2020.81226  Pages 207 - 212
Objective: The most common cause of acute abdomen requiring surgical intervention globally is acute appendicitis (AA). In this study, we aimed to investigate how AA diagnosis is affected by seasonal changes in Central Anatolia.
Materials and Methods: In this study, patients who underwent appendectomy with the diagnosis of (AA) between January 1, 2015 and January 1,2019 were evaluated retrospectively. We divided the patients into three groups based on their histopathological results: Group 1 Acute Appendicitis (AA), Group 2 Appendix vermiformis (AV) and Group 3 Perforated appendicitis (PA). Patients were evaluated concerning age, sex and season of operation.
Results: Seven hundred ninety-five patients participated in our study. They were separated into the following groups: Group 1 (n=614), Group 2 (n=125), and Group 3 (n=56). Concerning the sex variable, no statistically significant differences were found between the groups (p=0.061). The mean age of the patients in the perforated appendicitis group was higher when compared to the other groups (p=0.001). When evaluated by season, it was seen that during winter, the patients in Group 1 were significantly higher than the patients in the other groups (p=0.009). In our study, acute appendicitis was most frequently diagnosed during winter (28.7%); appendix vermiformis was most frequently diagnosed during spring (32%) and perforated appendicitis was most frequently diagnosed during summer (41%).
Conclusion: Although the diagnosis of acute appendicitis varies seasonally, age and seasonal changes may be effective in the frequency of acute appendicitis. In Central Anatolia, the incidence of acute appendicitis increased during winter, while the rate of perforated appendicitis increased in summer and the rate of negative appendectomy increased in spring.

19.Gallic Acid Reduces Experimental Colitis in Rats by Downregulation of Cathepsin and Oxidative Stress
Gökhan Bayramoğlu, Hakan Şentürk, Güngör Kanbak, Mediha Canbek, Ayşegül Bayramoğlu, Eda Dokumacıoğlu, Selin Engür
doi: 10.14744/etd.2020.42713  Pages 213 - 217
Objective: Ulcerative colitis (UC) is an idiopathic inflammatory bowel disease (IBD) with common, repetitive inflammation of the colon and rectum, which is highly defined by loss of blood on colon mucosa, ulceration and acute inflammation. The present study aimed to investigate the potential protective effects of gallic acid (GA) through a 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis rat model, using biochemical and histopathological parameters.
Materials and Methods: The study consisted of four groups, each including seven rats, namely control group, colitis group, colitis-GA 50 mg/kg group and colitis-GA 100 mg/kg group. Colon tissue samples were analyzed for malondialdehyde (MDA), myeloperoxidase (MPO), cathepsin B and cathepsin L values.
Results: Tissue MDA, MPO, cathepsin L and cathepsin B values increased significantly in colitis group (p=0.028, p=0.038, p=0.024, p=0.019, respectively). However, MDA, MPO, cathepsin L and cathepsin B values showed a significant decrease in animals with GA (at a dose of 100 mg/kg) administration in TNBS-induced colitis in rats (p=0.021, p=0.026, p=0.019, p=0.031, respectively). Colitis group was defined by the severe detriment of surface epithelium, submucosal edema and inflammatory cell infiltration. Treatment with GA significantly decreased inflammatory cell infiltration.
Conclusion: GA can be used as an effective agent in the treatment of colitis due to its inhibitory properties in multiple pathways and its potent antioxidant effects.

20.The Impact of Healthcare Spending on Health Outcomes: New Evidence from OECD Countries
Sevilay Karaman, Duygu Ürek, İpek Bilgin Demir, Özgür Uğurluoğlu, Oğuz Işık
doi: 10.14744/etd.2020.80393  Pages 218 - 222
Objective: This study aimed to reveal the impact of the selected healthcare spending indicators on the selected health outcomes for OECD countries.
Methods: In the study, the data for OECD countries were analyzed by a stepwise multiple regression analysis. Healthcare spending as a share of GDP, public and private healthcare spending per capita and pharmaceutical spending per capita were used as independent variables; infant and maternal mortality, male and female life expectancy at birth and at 80 years and self-reported health were used as dependent variables.
Results: According to the results, it was found out that public healthcare spending per capita has a significant impact on maternal and infant mortality, male and female life expectancy at birth and at 80 years. Also, private healthcare spending per capita was found as an important determinant of self-reported health.
Conclusion: Based on the results, it can be suggested that it is necessary to increase the public support for mother-child health services to reduce maternal and infant mortality; and for services for improvement and promotion of health to increase life expectancy at birth and 80 years. It is considered that improvements in the minimum income levels of individuals and increasing government promotion within the scope of the complementary health insurance offered by the private sector will have a positive impact on the individuals’ perception of health status.

CASE REPORT
21.Therapeutic Plasma Exchange in G6PD Deficient Patient Complicated with Intravascular Hemolysis: A Case Report
Esra Ermis Turak, Rehab Helmy Mohamed Ibrahim, Fahir Öztürk, Koray Demir, Mehmet Fatih Karamustafaoğlu, Volkan Kahraman, Çiğdem Pala, Leylagül Kaynar, Mustafa Çeti&775;n, Dr. Elias Fadel
doi: 10.14744/etd.2019.63239  Pages 223 - 225
Glucose-6-phosphate dehydrogenase is an enzyme that protects the erythrocytes against oxidative damage. G6PD deficiency is a common disorder in Gulf Countries that may present with hemolytic anemia and acute renal failure after exposure to oxidative triggers, such as drug, infection or some foodstuffs. In this study, a severe and complicated case of a G6PD deficient patient was presented. A 65-year old G6PD deficient patient presented with acute renal failure and intravascular hemolysis after eating fava beans. Therapeutic plasma exchange was used in the patient for two consecutive days. Clinical and laboratory findings were improved with plasma exchange. Although supportive therapy is enough for mild cases, therapeutic plasma exchange can be life-saving in complicated cases.

22.Tick-Borne Encephalitis in Kazakhstan: A Case Report
Saule Maukayeva, Saya Karimova
doi: 10.14744/etd.2019.70431  Pages 226 - 228
Tick-borne encephalitis (TBE) exists over a wide geographical area worldwide. In here, a clinical case with TBE was presented. A 34 years old man complained of weakness, high fever with chills, body aches, headache, malaise. He was hospitalized in the Infectious Diseases clinic. He gave a history of the visit to an endemic area of TBE. Laboratory examination showed leukocytosis, neutrophilosis and ESR acceleration. Upon the clinical diagnosis of “Fever of unknown origin” levofloxacin and metronidazole, ceftazidime were started. On the third day of treatment, neurological symptoms of encephalitis developed. The patient was transferred to the intensive care unit. ELISA test for TBE virus IgM was positive. Cerebrospinal fluid (CSF) revealed serous meningitis. TBE was diagnosed. Treatment with human immunoglobulin TBE, glucocorticoid, and diuretics were administered. The outcome of the disease was favorable. The physicians should be aware about the clinical presentations of TBE in endemic areas.

23.An Atypical Case with Chronic Granulomatous Disease and Kabuki Syndrome
Mustafa Yavuz Köker, Zeynep Türe, Nezihe Köker, Gökhan Metan
doi: 10.14744/etd.2020.79577  Pages 229 - 232
Chronic granulomatous disease (CGD) is a rare inherited immunodeficiency that arises from defects in the NADPH oxidase complex, primarily affecting the respiratory burst in neutrophils. Kabuki syndrome (KS) is a rare genetic syndrome and often present with facial, skeletal, visceral and cardiac anomalies, immunological defects and varying degrees of mental retardation. A 20-year-old male was admitted with the complaints of the recurrent abscess. He had a history of recurrent abscesses and long-term antituberculosis treatment. Cytometric functional analysis, Sanger sequencing and whole-exome sequencing were used for the diagnosis of CGD. Both AR-CGD (p67phox defect) with homozygous c.229C>T nonsense mutation in NCF2 gene and heterozygous nucleotide change c.3983G>A in the KMT2D gene causing a novel missense mutation p. Arg1328Gln resulted in Kabuki syndrome. To our knowledge, this is the first report of both CGD and Kabuki syndrome combined in a single patient. CGD is always considered for the differential diagnosis during BCGitis history and recurrent skin abscess.

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24.Yellow Nail Syndrome
Saeed Hoseininia, Susan Mohammadi Kebar, Afshin Habibzadeh
doi: 10.14744/etd.2019.68915  Pages 233 - 234
Abstract | Full Text PDF

HISTORY OF MEDICINE
25.Theriac in the Persian Traditional Medicine
Ali Taghizadieh, Reza Mohammadinasab, Javad Ghazi Sharbaf, Spyros N. Michaleas, Dimitrios Vrachatis, Marianna Karamanou
doi: 10.14744/etd.2020.30049  Pages 235 - 238
Theriac is a term referring to medical compounds that were originally used by the Greeks from the first century A.D. to the nineteenth century. The term derived from ancient Greek thēr (θήρ), “wild animal”. Nicander of Colophon (2nd century BC) was the earliest known mention of Theriac in his work Alexipharmaka (Αλεξιφάρμακα), “drugs for protection”. During the era of King Mithridates VI of Pontus (132-63 BC), the universal antidote was known as mithridatium (μιθριδάτιο or mithridatum or mithridaticum) in acknowledgment of the compound’s supposed inventor or at least best-known beneficiary. It contained around forty ingredients, such as opium, saffron, castor, myrrh, cinnamon and ginger. Theriac was not only used as an antidote from poisoning but also for various diseases, such as chronic cough, stomachache, asthma, chest pain, fever, colic, seizures, diarrhea, and retention of urine. The present study aims to collect and discuss the mentions of theriac in Persian medical texts.

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