ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 42 (3)
Volume: 42  Issue: 3 - 2020
EDITORIAL COMMENTS
1.COVID-19: A Short View of Intensive Care Management
Aliye Esmaoğlu
doi: 10.14744/etd.2020.22208  Pages 239 - 241
Abstract | Full Text PDF

INVITED REVIEW
2.Coronavirus Disease 2019 (COVID-19): Diagnosis and Management
Öner Özdemir
doi: 10.14744/etd.2020.99836  Pages 242 - 247
Family of coronavirus has significant human and animal pathogens. In the end of December 2019, a new coronavirus was recognized as the reason of a group of pneumonia cases of unidentified etiology in Wuhan, a city in the Hubei Province of China. It has rapidly become widespread, resulting in an epidemic throughout China, followed by a pandemia, increasing number of cases in various countries throughout the world. Coronavirus disease 2019 (COVID-19) is spread through large droplets produced during coughing and sneezing by symptomatic patients as well as asymptomatic individuals before starting of their symptoms. The incubation period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is assumed to be 14 days succeeding exposure, mostly around 4 to 5 days. Individuals of all ages can acquire SARS-CoV-2 infection, although middle age and older individuals are the majority. The usual clinical characteristics involve fever, dry cough, fatigue, sore throat, rhinorrhea, conjunctivitis headache, myalgia, dyspnea, nausea, vomiting and diarrhea. Hence, there are no unique clinical features that yet dependably differentiate COVID-19 disease from other upper/lower airway viral infections. In a subgroup of cases, by the end of the first week COVID-19 disease can develop to pneumonia, pulmonary failure and death. Aim is here to discuss the COVID-19 disease beginning from virology, epidemiology and continuing with clinical manifestations, diagnosis, its complications and to finish with available therapeutic options and conclusion.

3.Medical Planning and Care in Radiation Accidents
Semra Ince, Nuri Arslan
doi: 10.14744/etd.2020.63904  Pages 248 - 251
To date, many major radiation accidents have occurred worldwide, mostly in nuclear reactors, and some other minors in radioactive isotope production facilities and during the transport of radioactive materials. Similarly, the majority of the radiation accidents in Turkey occurred in industrial radiology or during the use of sealed radioactive sources for the purpose of non-destructive testing. However, only a few of them happened in medical practices. In case of fire in buildings with radioactive material, terrorist incidents using radioactive materials, or accidents during transportation of radioactive materials, emergency response teams, first aiders and firefighters may be exposed to low-level radiation while performing their duties. Fortunately, very few victims of radiation accidents develop acute radiation syndrome and require medical intervention. On the other hand, some victims of radionuclear accidents may require urgent medical intervention since the adverse health effects may occur years after the event due to internal contamination and following incorporation. In this report, we aimed to define the basic concepts of radionuclear emergency and medical management of radionuclear victims.

REVIEW
4.Convalescent (Immune) Plasma Therapy with all Aspects: Yesterday, Today and COVID-19
Öner Özdemir, Hacer Efnan Melek Arsoy
doi: 10.14744/etd.2020.36528  Pages 252 - 259
At the end of 2019, the pandemic, which originated in China, has become a major concern all over the world. A new coronavirus, severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), has been defined as the reason for a cluster of unknown pneumonia. Thus far, no precise therapy or vaccine has been shown to be effective against SARS-CoV-2 infection. Mild cases can be treated by supportive care although symptomatic treatment is not enough for critically ill patients. However, extracorporeal membrane oxygenation, convalescent (immune) plasma (CIP) and certain specific antiviral drugs for this disease are still being investigated for improving the survival rate of cases with SARS-CoV-2 infection whose condition continued to deteriorate. The use of passive immunization, for the prophylaxis and therapy of human contagious diseases, has been gone back to the 20th century. Human whole blood is also a source of antibodies. CIP consists of collecting blood plasma from someone who has recovered from a specific infection. Recent literature data show that human CIP may be an alternative option for managing coronavirus disease 2019 (COVID-19) and will be accessible when adequate numbers of individuals have improved. However, such donors should have a high titer of neutralizing immunoglobulin-containing plasma. CIP can be administered to improve the survival rate for COVID-19, together with other drugs and preventive measures, when specific management is not obtainable. On the other hand, randomized clinical trials are still necessary to assess the safety and efficiency of CIP in the therapy of COVID-19. In this article, we want to address the special role of CIP therapy in various infectious diseases from yesterday to today, including COVID-19.

ORIGINAL ARTICLE
5.Can Hematological Parameters Indicate Possible Inflammatory Mechanisms in Children with Intellectual Disability?
Pembe Soylu Üstkoyuncu, Ahmet Sami Güven, Mehmet Akif Dündar, Fatma Türkan Mutlu, Yasemin Altuner Torun
doi: 10.14744/etd.2020.22844  Pages 260 - 263
Objective: This study aims to interpret the hematological parameters of children with the intellectual disability and to show the relationship between hematological parameters and possible inflammatory mechanisms of intellectual disability.
Materials and Methods: In this study, 50 children with the intellectual disability (32 males, 18 females) and 40 healthy individuals (25 males, 15 females) were retrospectively screened. Lymphocyte and platelet count, white blood cell count, neutrophil, platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), red cell distribution width (RDW) and mean platelet volume (MPV) were recorded for both groups and compared.
Results: Neutrophil to lymphocyte ratio and neutrophil counts in the intellectual disability group were elevated than control. Mean platelet volume in the intellectual disability group was higher than the control and red cell distribution width in children with the intellectual disability was elevated than control. We did not detect any statistical difference in neutrophil to lymphocyte ratio between the groups with or without inborn error of metabolism.
Conclusion: The findings obtained in this study suggest that we can use mean platelet volume, neutrophil to lymphocyte ratio and red cell distribution width as inflammatory markers for the intellectual disability of children.

6.Evaluation of Family Satisfaction Level at Erciyes University Medical Faculty Intensive Care Units with a Validated Survey
Zeynep Yüksel Turhan, Aynur Karayol Akin, Sevda Onuk, Kürşat Gündoğan
doi: 10.14744/etd.2020.85594  Pages 264 - 270
Objective: This study aims to investigate the validity and reliability of the FS-ICU 24 survey in the Turkish language, to evaluate the satisfaction of ICU patients’ relatives, and to determine the factors affecting satisfaction.
Materials and Methods: In this study, the Turkish version was prepared based on the FS-ICU 24 survey applied to the relatives of ICU patients (Anesthesiology, Internal Medicine, General Surgery and Neurosurgery) at the Erciyes University in the Faculty of Medicine between April 2015 and June 2015. The Turkish version was tested and proven to be reliable and valid. Relatives of patients that were hospitalized for at least 48 hours, who had visited the patient at least once, were included. In this study, 369 surveys were completed.
Results: FS-ICU 24 survey was found reliable and valid in Turkish. Patients’ relatives were unsatisfied with physical conditions, waiting room setting and frequency of communication with nurses the most. The relatives were highly satisfied with the skills and competency of ICU doctors/nurses, setting of the ICU, completeness of treatment provided. Among the intensive care unit departments, there were not any statistically significantly different satisfaction results (p>0.05). The satisfaction level was found to decrease with increasing education levels and increasing duration of hospitalization (p<0.05). The satisfaction in the group who knew the diagnosis was higher (p<0.05).
Conclusion: Even though the general satisfaction level of the patients’ relatives was high, satisfaction level can be increased by improving physical factors, such as the waiting room setting, and by training on the communication skills of all staff that have contact with the patients’ relatives on communication skills.

7.Comparison of Proximal Versus Total Gastrectomy in the Surgical Treatment of Proximal Gastric Cancers
Tutkun Talih, Mehmet Patmano, Fatih Dal, Erdoğan Mütevelli Sözüer, Hızır Yakup Akyıldız
doi: 10.14744/etd.2020.40036  Pages 271 - 275
Objective: The shift in stomach cancer localization has led to new perspectives in the treatment of proximal one-third of the stomach cancer, focusing on the type of resection between total gastrectomy and proximal gastrectomy. We compared the results of patients with proximal gastric cancer, which were treated either with PG or TG regarding postoperative complications, symptoms of reflux esophagitis, the number of dissected lymph nodes, short-term survival, and the compliance to the postoperative planned diet.
Materials and Methods: This study included 58 patients who underwent surgery for proximal gastric adenocarcinoma. Of the patients, 32 patients underwent total gastrectomy, while 26 patients underwent proximal gastrectomy. The total and proximal gastrectomy groups were retrospectively compared concerning the number of lymph nodes dissected, postoperative reflux symptoms, dietary compliance, and short-term survival.
Results: Reflux symptoms were seen in 10 patients (31.2%) who underwent total gastrectomy versus in 12 patients (46.1%) treated with proximal gastrectomy (p=0.08). Mean number of lymph nodes dissected was 24.6±13.5 in patients treated with total gastrectomy, whereas 18.8±6.1 in patients who underwent proximal gastrectomy (p=0.06). Dietary compliance was better in the PG group (p=0.03), while no significant differences were detected between groups about postoperative complications and short-term survival.
Conclusion: In the surgical treatment of proximal gastric cancers, proximal gastrectomy performed using an anti-reflux technique, maybe an alternative to total gastrectomy, providing better functional results without compromising oncologic principles.

8.Increased High Sensitive C-reactive Protein is Associated with Major Adverse Cardiovascular Events after STEMI
Edin Begic, Slobodan Obradovic, Slobodan Jankovic, Radoslav Romanovic, Nemanja Djenic, Boris Dzudovic, Zoran Jovic, Dragana Malovic, Vesna Subota, Milena Stavric, Farid Ljuca, Zumreta Kusljugic
doi: 10.14744/etd.2020.86429  Pages 276 - 280
Objective: This study aims to investigate whether the high sensitive C-reactive protein (hsCRP) is associated with an ejection fraction of left ventricle (EFLV) in the early phase of ST-elevation myocardial infarction (STEMI), treated with the primary percutaneous intervention (pPCI), and to establish whether there exists a relationship between its values and the presence of major adverse cardiovascular events (MACE) within six months of pPCI.
Materials and Methods: In this prospective study, 357 patients who were diagnosed with STEMI and who underwent pPCI within 24 hours of pain onset were included. The following were monitored and recorded: 1) hsCRP values, which were measured between 24 and 48 hours of pPCI, 2) EFLV values, which were measured five days after the pPCI, and 3) MACE, which was established within six months of pPCI.
Results: The EFLV values measured five days after the pPCI were significantly lower with increasing hsCRP values (rho=-0.384, p<0.0001). There was a significant difference in hsCRP values between patients who had MACE and those without it (38.35 [98.10] vs. 12.97 [23.80], p=0.0001). In addition, hsCRP values were significantly increased in patients who died during the first six months after the pPCI compared with patients who survived (115.00 [202.80] vs. 15.84 [31.5], p=0.001).
Conclusion: The hsCRP values in patients with STEMI who were treated with the pPCI are related to systolic function in the early phase of STEMI, as well as MACE during the first six months of follow-up.

9.Diagnostic Efficacy of Signal Intensity Ratio and Apparent Diffusion Coefficient Measurements in Differentiating Cerebellopontine Angle Meningioma and Schwannoma
Mustafa Bozdağ, Ali Er, Sümeyye Ekmekçi
doi: 10.14744/etd.2020.61580  Pages 281 - 288
Objective: To investigate the efficacy of Signal Intensity Ratio (SIR) measurements of T2-weighted imaging (T2WI) and Apparent Diffusion Coefficient (ADC) values of ADC mapping in the differentiation of schwannomas and meningiomas originating from the CPA.
Materials and Methods: A total of 30 patients who were pathologically diagnosed (16 meningiomas, 14 VS) were included in this retrospective study. SIR was calculated by proportioning regions of interests (ROIs) measurements of solid regions of the tumor and occipital subcutaneous adipose tissue in T2WI. In ADC maps, ADCmin and ADCmean values were obtained by placing ROIs inside the solid parts of the tumor. Groups were statistically analyzed using the Mann-Whitney U test, independent-sample t-test, receiver operating characteristic (ROC) curve analyses, and Pearson correlation test.
Results: SIR, ADCmean, and ADCmin values were 0.61±0.08, 0.858±0.101x10–3 mm2/s, 0.815±0.099x10–3 mm2/s for meningioma group; and 0.80±0.12, 1.272±0.148x10–3 mm2/s, 1.232±0.148x10–3 mm2/s for VS group, respectively. These parameters were statistically lower in the meningioma group compared to the VS group (p<0.001 for all). A positive correlation was observed between SIR and ADC values among the total group (r=0.694, p<0.001 for both). ROC analysis showed that the diagnostic performance of ADC parameters was better than the SIR parameter in differentiating meningioma from VS. The cut-off values in differentiating meningioma and VS were determined as 1.027x10–3 mm2/s for ADCmean and 0.980x10–3 mm2/s for ADCmin with 100% sensitivity.
Conclusion: While both ADC and SIR values are useful in differentiating between VS and meningioma, ADC values have higher diagnostic efficacy compared to SIR.

10.Can three-dimensional Reformatted Computed Tomography Scans be Useful to Avoid Misdiagnoses of Skull Fractures in Pediatric Emergency Cases?
Yasin Ertuğ Çekdemir
doi: 10.14744/etd.2020.48208  Pages 289 - 292
Objective: To investigate whether three-dimensional (3-D) reformatted cranial computed tomography (CT) scans may contribute to the avoidance of misdiagnosis of skull fractures in pediatric emergency cases.
Materials and Methods: This cross-sectional medical chart review was carried out in the pediatric emergency department of a tertiary care center. Data were derived from pediatric age group patients having head trauma patients whose conventional CT images were obtained at initial admission. Demographic, clinical, and radiological data, the location of the fracture, and possible causes of misdiagnoses were recorded.
Results: This study included 27 children (21 males and six females). The average age was 41.92±43.25 (range, 1 to 137) months. The most common etiology for admission to the hospital was fall from height (85.2%). The fractures were detected on the parietal (n=12, 44.4%), frontal (n=7, 25.9%), occipital (n=7, 25.9%) and temporal (n=1, 3.7%) bones. In 12 cases (44.4%), skull fracture could not be detected at their initial admission. Five of these 12 cases were consulted to the radiologist, and diagnosis could not be established even by the radiologist. In 15 pediatric head trauma patients (55.6%), the skull fracture was confirmed by the radiologist. In two cases with an initial failure of diagnosis, 3-D reconstruction allowed the identification of fractures.
Conclusion: The findings obtained in this study suggest that 3-D reconstruction of CT scans may increase the accuracy of diagnosis for pediatric skull fractures.

11.Comparison of the Medical Ethics Approaches according to Professional Experience and the Source of Medical Ethics Training: A Survey Study
Türev Demirtaş
doi: 10.14744/etd.2020.34793  Pages 293 - 299
Objective: This study aimed to compare the perspective on, the standard of knowledge and perceptions of medical ethics in the sixth-grade medical faculty students of a university hospital and the residents and academics working in the same hospital.
Materials and Methods: In the first step, the participants were divided into three groups as sixth-grade medical students, residents and academics. Each group included 100 participants. The participants were divided into groups according to the source of ethics training (from the person with ethical expertise or except for the ethics expert). The questionnaire, which consisted of 10 main questions, was applied to the participants one-to-one and face to face. The first five questions evaluate the demographic data of the participants, the questions 6, 7, 8 and 9 evaluate the participants’ perspectives on medical ethics education and the 10th question evaluates the associations of medical ethics.
Results: The most common age range was 20–24 (30%) years. The majority of the participants agreed that medical ethics training was necessary (92.7%). The findings showed that participants who received medical ethics education from an ethics specialist had more ideas about the distinction between deontology and medical ethics (86.3% vs. 76.1%, p<0.001). The findings showed that participants who received training from ethical experts had higher knowledge of medical ethics.
Conclusion: Providing ethical education by experts may ensure that healthcare professionals have a higher level of basic ethical knowledge. All groups agree on the necessity of medical ethics education.

12.Protective Effects of Different Doses of Pycnogenol Extract against Gamma Radiation-induced Liver Damage in Rat
Fazile Cantürk Tan, Arzu Hanım Yay, Oğuz Galip Yıldız, Yusuf Caner
doi: 10.14744/etd.2020.12844  Pages 300 - 305
Objective: The study aims to investigate the protective role of pycnogenol extract against liver damage in whole-body gamma-irradiated rats by assessing DNA damage, histopathological changes and biochemical parameters.
Materials and Methods: Rats were irradiated to a single fraction 900 cGy dose of gamma radiation. The pycnogenol extract was dissolved 5% DMSO and daily administrated before starting irradiation. The pycnogenol was administered orally via a gastric tube at a dose of 37.5 mg/kg, 75 mg/kg, 150 mg/kg and 300 mg/kg in 24, 48 and 72 h before irradiation. Irradiation was applied single fraction using Cobalt-60 teletherapy device. The animals were divided into ten groups that included control, pycnogenol extract groups only irradiation group (γ-ray) and pycnogenol extract + γ-ray groups. DNA damage, histopathological changes, catalase (CAT) and superoxide dismutase (SOD) activities, and malondialdehyde (MDA) levels in the liver tissue of rats were evaluated three days after irradiation
Results: Our results obtained that pycnogenol extract was induced to liver damage depend on pycnogenol extract dose, but the pycnogenol extract + γ-ray groups were significantly ameliorated the changes induced in liver antioxidant system; CAT, SOD and MDA. Also, the P300+γ-ray was significantly reduced irradiation-induced liver injury and it was possible to observed significantly preservation in the histopathological evaluation. The pycnogenol extract groups were significantly increased to comet parameter depend on pycnogenol doses compared to control. The pycnogenol extract + γ-ray were significantly decreased the comet parameter compared to the γ-ray group.
Conclusion: The administration of pycnogenol extract might provide substantial protection against radiation-induced oxidative, DNA damage and histopathological changes in the liver.

13.Comparison of the Levels of Fear and Perceived Social Support Among the Women Having and Not Having Mammography
İlgün Özen Çınar, Ayla Tuzcu
doi: 10.14744/etd.2020.65031  Pages 306 - 311
Objective: Mammography rates are low and psychosocial factors may affect mammography behavior in Turkey. This study aims to compare levels of fear and perceived social support and to examine factors associated with mammography behaviour among women who did and did not have a mammography.
Materials and Methods: This is comparative- descriptive and cross-sectional study. Data were collected from women who were 40 years and older in two Family Health Centres in Denizli between April 1–July 1, 2018. Descriptive characteristics questionnaire form, Breast Cancer Fear Scale and Multidimensional Scale of Perceived Social Support (MSPSS) were used as data collection tools.
Results: Significant differences were found between marital status, knowledge about breast cancer, breast self-examination (BSE), clinical breast examination (CBE) status and mean MSPSS scores between both groups (p<0.05). There was not a statistically significant difference between groups concerning mean fear scores (p>0.05). LR analysis revealed that being married (OR: 0.08) and obtaining information about breast cancer previously (OR: 0.15) were found to affect mammography behaviour positively (p<0.05).
Conclusion: Being married and obtaining information about breast cancer positively affected their behaviours of having a mammography. Primary health care professionals should inform women over the age of forty about breast cancer and screening and refer them to mammography. In addition, it is also important to strengthen the referral of single people to mammography.

14.Evaluation of Vitamin D Levels in the Course of Acute Rheumatic Fever with Active Carditis
Serkan Türkuçar, Özge Pamukçu, Mustafa Argun, Abdullah Özyurt, Nazmi Narin
doi: 10.14744/etd.2020.26429  Pages 312 - 316
Objective: Vitamin D is a hormone with immunomodulatory and anti-inflammatory effects besides calcium hemostasis. The present study aims to evaluate the relationship between acute rheumatic fever (ARF) attacks and vitamin D levels.
Materials and Methods: Acute phase reactants, vitamin D levels and echocardiographic parameters of 25 patients with active carditis were evaluated at the time of the acute attack and in 1, 2 and 6 months of follow-up and compared to a control group of 25 age-and sex-matched healthy children.
Results: At the time of diagnosis, WBC, ESR and CRP levels were significantly higher (p<0.05), and vitamin D levels were lower than the control group, not statistically significant (p=0.07). The mean vitamin D levels of the patients diagnosed in winter and spring-autumn seasons were 17.54±9.89 μg/L, and the rate of vitamin D deficiency was 47.3%. The mean vitamin D levels of the control group, in the same seasons, were 23.97±9.48 μg/L and the vitamin D deficiency rate was 19.1%. The vitamin D levels at the time of diagnosis of the ARF group were lower than the control group (p=0.038) and the attributed risk for vitamin D deficiency in ARF carditis in winter and spring seasons was found 3.46 (95% CI 1.1–5.14). Furthermore, cardiac parameters were significantly getting better, while vitamin D deficiency rates decreasing during the follow-up period.
Conclusion: ARF attacks were found to be more frequent in non-summer seasons when vitamin D levels were lower. Echocardiographic and laboratory parameters improved with increasing vitamin D levels. These findings suggest that anti-inflammatory and immunomodulatory effects of vitamin D.

15.Red Blood Cell Distribution Width Value as a Predictor for Mortality in Stroke Patients
Samad Shams Vahdati, Aysa Rezabakhsh, Ali Taghizadieh, Malihe Khosravi, Mohammad Mirza-Aghazadeh-Attari, Rouzbeh Rajaei Ghafouri
doi: 10.14744/etd.2020.37929  Pages 317 - 321
Objective: Acute ischemic stroke (AIS) is a clinical condition that generally arises from non-traumatic brain vascular disorders. In this regard, red blood cell width distribution (RDW) is considered as a biochemical factor that could be used for stroke diagnosis. The main purpose of this study is regarding the use of red cell width distribution (RDW) in predicting of stroke patients for optimal use of facilities.
Materials and Methods: In the current study, about 500 patients were included with a definitive diagnosis of cerebrovascular events that were referred to the emergency department of Emam-Reza hospital in 2015. Patients were randomly selected in the morning, evening and night shifts. The related analyses were performed according to the prepared checklist, including patient demographic information, outcomes and routine laboratory tests.
Results: Based on our results, there is not a significant difference between RDW and gender, stroke type and diabetes occurrence, while a direct relationship between patient clinical appearance, age and numbers of WBC was observed. In fact, the mean of WBC count was 8331 in patients with complete remission, 9736 in partial remission and 9640 in expired subjects (p=0.001). We also found that RDW changed according to patients’ outcomes.
Conclusion: Together, we conclude that WBC and age are able to affect the RDW significantly, which correlated with the outcome and mortality of stroke patients. By measuring these parameters early in stroke patients, further outcomes and disabilities in stroke patients can be predicted by on time interventions to prevent stroke-related complications and mortality.

16.Prevalence of Chronic Obstructive Pulmonary Disease in Individuals Over 40 in Central Kayseri
Ahmet Timur, Elçin Balcı, Hasan Durmuş
doi: 10.14744/etd.2020.13245  Pages 322 - 328
Objective: The present study aims to investigate the prevalence of COPD using spirometry and examine related risk factors, such as exposure to cigarette and biomass smoke, in individuals over the age of 40, in the provincial capital of Kayseri, Turkey.
Materials and Methods: In this cross-sectional study, factors related to the prevalence of COPD were examined in subjects ≥40 years. Patients with airway obstruction (FEV1/FVC <0.70) were administered salbutamol inhaled at a dose of 400 mcg, and the test was repeated 15 minutes later. Research completed with 386/400, 96.5% participants.
Results: The average age was 53.3±10.9 years. The prevalence of COPD in this study was 17.6%. COPD was found in 13.0% of the women and in 22.0% of the men. The most common stage was GOLD Stage II at 70.6%. The rate of active smokers was 32.6% (27.7% of women and 37.7% of men). After multiple regression analysis, the COPD “at risk” levels for the following groups were determined: individuals with BMI <25, 3.33 times higher, individuals having suffered childhood pneumonia, 2.75 times higher, participants aged 50 and over were 2.41 times higher, patients with an education level of high school or lower were 2.38 times higher, and active smokers were 2.0 times higher.
Conclusion: Increasing health awareness and healthy lifestyles, more efforts to raise the general education level of the community are needed, “at-risk” patients 40 years and over should be screened for COPD, and studies aimed at smoking cessation should be conducted.

BRIEF REPORT
17.Trend, Incidence, Distribution, and Other Epidemiological Aspects of Cutaneous Leishmaniasis in Ilam Province-Iran From 2014 to 2017
Reza Jorvand, Rahmat Chatripour, Ali Jalilian, Salman Khazaei, Yousef Veisani
doi: 10.14744/etd.2020.97345  Pages 329 - 332
Abstract | Full Text PDF

18.Importation and Transmission Routes of COVID-19 into Northern Cyprus: Considerations and Challenges
Buket Baddal
doi: 10.14744/etd.2020.45144  Pages 333 - 335
Abstract | Full Text PDF

CASE REPORT
19.Gastric Duplication Cyst in an Infant Presenting with Melena
Derya Altay, Süreyya Burcu Görkem, Kemal Deniz, Keramettin Uğur Özkan, Duran Arslan
doi: 10.14744/etd.2020.43402  Pages 336 - 338
Background: Gastrointestinal duplication cysts are rare congenital anomalies that are most often localized in the ileum. The condition is usually diagnosed within the first year of life.
Case Report: Here, we report an infantile case presented with severe anemia and melena accompanied by a gastric duplication cyst.
Conclusion: Duplication cysts should be kept in mind in the differential diagnosis of melena.

20.Ganglioneuroblastoma: A Rare Tumor in Parapharyngeal Space
Şahin Ulu, Abdullah Kınar, Abdulkadir Bucak
doi: 10.14744/etd.2020.69822  Pages 339 - 342
Background: Ganglioneuroblastoma is a malignant tumor, usually found in the adrenal glands, retroperitoneal ganglions or posterior mediastinum. In the head and neck region, Ganglioneuroblastoma is presented as a sub-type of neuroblastoma that originated from the sympathetic chain. It is often found in the retropharyngeal area, and if it involves the neck region, it is often found in the carotid space posterior to vascular sheat.
Case Report: A 5-year-old girl was admitted to the pediatrics clinic with the complaint of a mass on the right side of her neck for about six months. Ultrasonography was carried out as an initial diagnostic tool, and it revealed a solid homogeneous mass. As a second-line diagnostic imaging method, Magnetic Resonance Imaging (MRI) was performed. The T2 weighted MRI sections showed a hyperintense mass was observed with an axial diameter of 37×40 mm and a craniocaudal diameter of 6 cm in the right parapharyngeal and prevertebral space. Although fine-needle aspiration biopsy (FNAB) was the first preferred biopsy method for neck masses, the FNAB report was inadequate. An incisional biopsy was carried out, and the pathology report described the tumor as ganglioneuroma. There were no immature/neuroblastic components in the serial sections. The patient was operated on transcervically. In the final pathology report, the tumor was described as ganglioneuroblastoma, intermixed type. After multidisciplinary consultations, the patient is still being followed with no further additional chemotherapy or radiotherapy.
Conclusion: Ganglioneuroblastoma is a rare tumor in the parapharyngeal region. A multidisciplinary approach is especially important in such kind of rare tumors.

21.Arthritis in Hand Joints due to Acitretin: A Rare Case Report
Selami Aykut Temiz, Recep Dursun
doi: 10.14744/etd.2020.89083  Pages 343 - 345
Background: Lichen planus is a skin disease that may last for years, mainly affecting the skin surface and mucous membranes (such as the oral and genital mucosa), and more rarely, on the nails and hairs. Systemic acitretin is an effective therapeutic agent used in the treatment of lichen planus. The skeletal toxicity of retinoids is controversial. Because skeletal toxicity cannot be demonstrated with acitretin, radiological monitoring is not recommended.
Case Report: A 24-year-old male patient was admitted to our dermatology outpatient clinic with hand metacarpophalangeal, proximal interphalangeal joint swelling, and pain, who was in the third month of systemic acitretin treatment for oral lichen planus. In our case, another cause of etiologic could not be detected, and arthritis due to acitretin was considered.
Conclusion: As a result, it should not be forgotten that acute arthritis may rarely occur during the use of acitretin and should not be overlooked by the clinician

IMAGE
22.A Typical Chest CT Appearance of a Case with Coronavirus Disease 2019 (COVID-19)
Ayfer İmre
doi: 10.14744/etd.2020.67984  Pages 346 - 347
Abstract | Full Text PDF

23.Three Dimensional Thorax Computed Tomography Findings in COVID-19
Mehmet Atalar, Ömer Tamer Doğan
doi: 10.14744/etd.2020.81073  Pages 348 - 349
Abstract | Full Text PDF

HISTORY OF MEDICINE - REVIEW
24.Şerefeddin Sabuncuoğlu: A Pioneer Surgeon of the Ottoman Era
Spyros N. Michaleas, Gregory Tsoucalas, Georges Androutsos, Marianna Karamanou
doi: 10.14744/etd.2020.10476  Pages 350 - 353
Sharaf al-Dīn (Şerefeddin) Sabuncuoğlu (1385-c.1468) was an innovative surgeon and a prominent illustrator who lived in the Ottoman Empire during the 15th century. His medical treatise, Kitāb al-Jarrāhiyyāt al-Khaniyya (Kitâbü’l-Cerrâhiyyetü’l-Hâniyye [Book of Imperial Surgery]; 1465), is the first illustrated surgical textbook written in Turkish. His book also provides comprehensive information about ancient Greek and Asian knowledge of medicine, including topics on gynecology, neurology, obstetrics, ophthalmology, orthopedics, pediatrics, urology, and vascular surgery, as well as Sabuncuoğlu’s own contributions to the field of surgery. Despite not being well recognized in his era, his methods were revolutionary for his time, and many remain valid even today. This review seeks to highlight Şerefeddin Sabuncuoğlu’s medical treatise from a historical perspective and to shed light on its influence on modern surgery.

25.Filiation: A Historical Term the COVID-19 Outbreak Recalled in Turkey
Türev Demirtaş, Halil Tekiner
doi: 10.14744/etd.2020.54782  Pages 354 - 358
Originally derived from the Medieval Latin word, fīliātiō (from fīlius, son), filiation literally means paternity, descent-from-father, or line of descent. Concerning medicine, however, it refers to the connection of things resulting from one another, or contact tracing. The core idea behind filiation as a measure of precaution against outbreaks is to prevent the disease by interrupting the chain of transmission with a systematical tracing and isolation of susceptible individuals having contact with any confirmed cases. Filiation became a widely used medical term in the first quarter of the 19th century, primarily in French medical literature, soon adapted to English and some other languages. In the Ottoman Empire, it appeared in medical journals in the 1850s, used primarily by some European physicians practicing in the country. As part of various measures that have been taken to tackle the current pandemic of COVID-19, the method of filiation was also recalled by the medical community. Soon after the observance of the first confirmed case of COVID-19 in Turkey on March 11, 2020, the index case and its contacts were identified and the Turkish Ministry of Health launched the procedures of filiation at a national level with ad-hoc medical teams established around the country. Aiming to shed light on the etymological and historical aspects of filiation, the current review discusses the concept based on original resources.

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