2021 - Cilt 5 - Sayı 3
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Öğe Very late and subacute right ventricular lead perforation presenting as cardiac tamponade(2021) Göçer, Kemal; Yıldırımdemir, HalilVentricular lead perforation (VLP) is a rare and life-threatening complication of permanent pacemakers. Generally, VLP emerges in acute and subacute periods after cardiac electronic devices are implanted. Late VLP is unexpected and occurs less frequently. There is an uncertain approach to the treatment of VLPs. Collaboration with cardiovascular surgeons is recommended. Herein, we present two cases of cardiac perforations who were successfully managed. One of them was admitted with cardiac tamponade four years after dual-chamber pacemaker (DCP) implantation, and the right ventricular lead was successfully removed with an open surgical method. The other was admitted with cardiac tamponade two weeks after DCP implantation. Ventricular lead was extracted by a simple traction method without surgical support and successfully re-implanted in the correct location.Öğe The pitt-hopkins syndrome: Report of 5 patients and literature comparison(2021) Kutluk, Gültekin; Kadem, Elif Naz; Randa, Nadide Cemre; Öz, AyşePitt-Hopkins syndrome (PTHS) is characterized by developmental delay, intellectual disability and behavioral changes, distinctive facial gestalt, and breathing abnormalities. PTHS is caused by deletions or pathological variants in the TCF4 gene located at 18q21.2. In this report, we aimed to describe the clinical and genetic findings of patients diagnosed with PTHS and compare our patients with the literature. Patients who were followed up with severe intellectual disability and a variable association of features previously described as characteristic of the PTHS phenotype in the pediatric neurology clinic of Antalya Training and Research Hospital were screened for TCF4 mutations using next-generation sequencing (NGS)-based tests, between 2017 and 2020. A genetic mutation associated with PTHS was detected in five patients. This paper emphasis on mutational and clinical spectrum of PTHS and its significant part in the differential diagnosis of severe mental retardationÖğe The Effects of NLR on the Diagnosis and Pharmacological Management of Brain Abscesses(2021) Çalışkan, Tezcan; Yılmaz, İbrahim; Hacıoğlu, Fatma; Ersöz, Emel; Doğan, Mustafa; Karaarslan, NumanAim: The present study aims to examine the effectiveness of the neutrophil-tolymphocyte ratio in the treatment and diagnosis of patients with brain abscesses. Methods: In this retrospective study, radiological, neurological, and surgical data obtained from the medical records of healthy volunteers (n = 10) who presented to the hospital for check-ups and patients with brain abscesses who were treated (n = 10) were evaluated statistically. Alpha significance value was accepted as <0.05. Results: Comparisons between groups revealed that the erythrocyte sedimentation rate, C-reactive protein, leukocyte, and neutrophil values were statistically significant (P <0.05) while lymphocyte value was not statistically significant (P >0.05). The preoperative neutrophil-to-lymphocyte ratio in cases diagnosed with brain abscesses showed statistical significance compared to that in the healthy volunteers (P <0.05) and the neutrophil-to-lymphocyte ratio increased 3.31-fold in the study group compared to the healthy volunteers. Conclusion: A strong positive strong relationship between the neutrophil-tolymphocyte ratio and abscess size (r = 0.662; P = 0.037) was observed. An increased neutrophil-to-lymphocyte ratio may serve as an early warning signal of brain abscesses.Öğe Endoscopic findings of the gastrointestinal tract and conjunctions with preceding tomography findings(2021) Avcı, Mehmet Alperen; Ölçücüoğlu, Engin; Kaya, İsmail Oskay; Özbal Güneş, Serra; Aydın, MetinAim: Abdominopelvic computed tomography is commonly used for delineating the causes of abdominal pain. While its popularity has increased, the rate of nonspecific findings like gastrointestinal wall thickening has also increased. We aimed to determine whether a CT finding of thickened wall predicted a pathological finding on subsequent endoscopic evaluation. Method: This retrospective study was conducted on adult patients who underwent endoscopic or colonoscopic evaluation at our center in 2019 and had a preceding abdominopelvic CT within a month before this investigation. Patients’ gastric or colonic wall thicknesses were measured during CT scans. Endoscopy or colonoscopy results of these patients were retrieved, and their correlation with wall thicknesses was analyzed. Results: The study cohort included 647 patients. While 106 (16.38%) underwent endoscopy, 541 (83.62%) underwent colonoscopy. The endoscopic biopsies were malignant in 101 patients (95,3%) and benign in 5 (4,7%) patients. The CT sections showed thickened wall in 93 (87.7%) patients. Comparison of the patients with and without a thickened wall revealed no difference concerning malignancy rates. Increased colonic wall thickness was detected in 506 (93,5%) of the CT sections. Normal or benign colonoscopic biopsy findings were reported in 19 (3,5%) patients. Adenocarcinoma was detected in 456 (84,2%) patients. Comparison of the patient groups with or without wall thickening did not reveal any significant differences regarding malignancy rates. Conclusion: Endoscopic-colonoscopic evaluations should be performed in patients with gastrointestinal wall thickening in CT scans since the diagnostic and predictive accuracy are limited when a single test like CT is used.Öğe Clinical outcomes of laparoscopic treatment of non-palpable testis in children at a tertiary pediatric surgery center(2021) Kılıç, Şeref Selçuk; Özden, Önder; Türker Çolak, Selcan; Tutuş, Kamuran; Alkan, Murat; Tuncer, RecepAim: Non-palpable testis is defined as the absence of the testis in the inguinal canal and scrotum in a male patient. It is important to define the condition and location of the non-palpable testis, to prevent the risks of infertility and malignant transformation of the testis in patients. We aimed to evaluate the results of the laparoscopic approach we applied in the treatment of pediatric patients with non-palpable testes. Methods: Patients with non-palpable testes, diagnosed and treated by the laparoscopic approach in a tertiary pediatric surgery center, were evaluated retrospectively. In the treatment protocol, laparoscopic abdominal exploration, two-stage Fowler-Stephens laparoscopic orchiopexy, primary laparoscopic orchiopexy and inguinal exploration surgical approaches were applied according to the case characteristics. Results: Data from 54 testes in 45 pediatric patients were evaluated. Intra-abdominal testis was detected in 46.2% of the cases, with 88% of them at the entrance of the internal inguinal ring. After laparoscopic abdominal exploration, two-stage Fowler-Stephens in 7 (28%), primary laparoscopic orchiopexy in 18 (72%) were applied of testes. Inguinal exploration was performed in 27 (50%) whom no testis could not found. Seventeen (73.9%) of 23 testes that were descended into the scrotum remained viable, while atrophy occurred in 6 (26%) of them. Viable testis cells were not detected in the histopathology of 27 excised nubbins. Conclusion: The laparoscopic approach is a reliable and effective method in the diagnosis and treatment of non-palpable testis. Localization of intra-abdominal testes may support consideration of the inguinal exploration approach as the primary surgical intervention.Öğe Psychological conditions of patients whose infertility treatment was postponed due to the novel coronavirus pandemic lockdown(2021) Günakan, Emre; Tohma, Aytaç; Özçürümez, Gamze; Önalan, Göğşen; Cok, Tayfun; Zeyneloğlu, HulusiAim: In this study, we planned to examine the psychological status of patients who were required to postpone their infertility treatment, by means of an online survey. Methods: Sixty patients who were in the follow-up were informed and an access link of online survey, which included questions about age, infertility status, Beck’s depression inventory(BDI) and Hamilton’s anxiety rating scale (HAM-A), were sent to them. Three different grouping systems were used based on (i-) age, (ii-) fertility treatment status and (iii-) indications for assisted reproduction technology treatment. Results: Mean scores of BDI and HAM-A in the whole group were 39.2(25-67) and 22.1(11-45), respectively. In the evaluation of survey scores according to indications of fertility treatment, BDI scores were between 34.2-44.7 and there was no statistical significance between the groups (p:0.182). HAM-A scores were between 18.7-38.0 and there was no statistical significance between the groups (p:0.185). In addition, there was no statistical significance between groups for BDI and HAM-A (p: 0.962 and 0.423, respectively) according to patients’ ART treatment status at the time the 2019-nCoV outbreak began in our country. Conclusion: Infertile patients will be more prone to depression and anxiety, and it should be noted that potential treatment postponements may increase their depression and anxiety.Öğe Heparin titration protocol with tranexamic acid in cardiac surgery: a pilot study(2021) Soran Türkcan, Başak; Ünal, Ertekin Utku; Kiriş, Erman; Aytekin, Bahadır; Akkaya, Bekir; Demir, Z. Aslı; Aykut, Aslıhan; Aksöyek, Ayşen; Birincioğlu, LeventAim: Postoperative bleeding related to cardiac surgery is a clinically important condition. Consequently, re-exploration and increased blood utilization lead to adverse outcomes. The aim of this pilot study was to assess the effect of a newly adapted blood conservation strategy, including heparin titration protocol along with antifibrinolytics, regarding to mediastinal bleeding, re-exploration for bleeding and blood and blood products utilization. Methods: This study included 100 patients undergoing cardiac surgery with higher risk for bleeding, such as mitral valve replacement, aortic valve replacement, ascending / arcus aortic surgery, between January 2015 and August 2016. The study group consisted of consecutive patients who underwent new protocol (heparin titration protocol + tranexamic acid). The control group consisted of patients who were administered standard dose heparin(4 mg/kg). Fifty patients in each group (with the new protocol and the standard protocol) were compared by means of amount of heparin applied, blood utilization, mediastinal drainage and rate of re-exploration. Results: Twenty-eight of the 50 study group patients (56%) received a red blood cell (RBC) transfusion for the first 24 hours. RBC transfusion ? 3 units was lower in the study group (34% vs 54%; p=0.044). Moreover, mediastinal drainage and blood utilization was found to be lower at the study group, however re-exploration rates remained similar. Conclusion: Based on our study results, the suggested heparin titration protocol seemed to be beneficial for reducing postoperative bleeding and blood product usage. We consider that blood utilization protocols like our heparin titration protocol should be established to reduce the need for blood transfusion in cardiac surgery.Öğe Evaluation of inflammation in obesity and chronic kidney disease with hemogram parameters(2021) Bozacı, İlter; Tatar, ErhanAim: Chronic inflammation is involved in the pathogenesis of both obesity and chronic kidney disease (CKD). We aimed to evaluate the parameters derived from complete blood count (CBC) as inflammatory markers in obese patients and obese CKD patients. Methods: Individuals enrolled in the study were divided into three groups. Group-1 was composed of obese patients; group-2 was composed of obese CKD patients and group-3 was composed of healthy individuals as the control group. This study was conducted at a training and research hospital over 6 months period. Results: Forty-one patients were in group-1; 41 patients were in group-2 and 22 individuals were in group-3. White blood cell count (WBC) was significantly higher in group-1 and group-2 compared with group-3 (7,5±1,4 x103/µL vs 8,4±2,4 x103/µL vs 6,5±1,3 x103/µL, respectively, p<0.001) and neutrophile to lymphocyte ratio (NLR) was significantly higher in group-1 and group-2 compared with group-3 (1,9±0,7 vs 2,5±1,5 vs 1,7±0,4, respectively, p<0.001). NLR and WBC was found positively correlated with systolic blood pressure, urea, creatinine, uric acid, whereas negatively correlated with estimated glomerular filtration rate. Conclusion: It is important to determine significant results in CBC derived markers that are widely used in routine clinical practice as inflammatory markers.Öğe The effect of the COVID-19 pandemic on the epidemiology of hip fractures(2021) Aktı, Sefa; Çankaya, DenizAim: This study aimed to compare the epidemiology of hip fractures in an elderly population in 6 months of the COVID-19 pandemic and the same 6-month period in the previous year to be able to reveal how the decrease in community activity beyond normal seasonal habits because of the pandemic had affected the incidence of fractures in the elderly patient population. Methods: A comparison was made of the data of patients who presented at our hospital with a hip fracture between 1 April 2020 and 30 September 2020, and those who presented in the same 6-month period in 2019 before the pandemic. Comparisons were made in respect of epidemiology, treatments applied, complication rates and mortality. The demographic data of the patients were examined, and those presenting during the pandemic were evaluated in respect of the presence of COVID-19 infection. Results: A total of 78 patients were treated in the defined study period in 2020 and 71 in the equivalent period in 2019 before the pandemic. No statistically significant change was found in the number of hip fractures in 2020 (p>0.05). No statistically significant difference was observed between the demographic data of the patients, the ASA scores, the treatment methods, or the mortality rates in the two periods (p>0.05 for all). Conclusions: The most significant finding of this study was that there was no decrease in the number of patients with hip fracture during the pandemic in 2020, compared to the equivalent period in 2019. The increase in pulmonary complications during the pandemic period demonstrates the need for special care conditions in elderly patients with hip fractures, which are still seen at a high rate despite the pandemic.Öğe Investigation of Systemic Immune Inflammatory Index and Prognostic Nutritional Index in Prediction of Major Adverse Cardiovascular and Cerebral Events Occurring After Coronary Artery Bypass Operations(2021) Abanoz, Mustafa; Engin, MesutAim: The most valuable treatment method for coronary artery disease is coronary artery bypass graft (CABG) surgery. Major cardiovascular and cerebral events (MACCE) are important challenges, and it is particularly important to reveal possible risk factors in this regard. In this study, we aimed to investigate the predictive areas of the prognostic nutritional index (PNI) and the systemic immune inflammation index (SII) on early postoperatively developing MACCE, in patients who underwent isolated CABG operation. Methods: The patients between the ages of 20 and 85 years who underwent consecutive isolated CABG operation in our clinic between May 15th, 2016, and May 15th, 2020, were included in the study retrospectively. In the postoperative period (within a month), those who did not develop MACCE were recorded as Group 1, and those who developed MACCE as Group 2. Results: A total of 297 consecutive patients were included in the study. Group 1 had 263 patients with a median age of 63 (32-80), Group 2 had 34 patients with a median age of 70 (36-85) (P=0.008). There was no difference between the groups in terms of gender, history of cerebrovascular events, smoking, body mass index, hyperlipidemia, ejection fraction, and chronic obstructive pulmonary disease rates. As a result of multivariate analysis, advanced age (OR: 1.230 CI 95%: 1.050-1.319 P=0.024), NLR (OR: 1.974 CI 95%: 1.614-3.120, P=0.009), SII (OR: 3.880, CI 95%: 2.690-6.150, P<0.001) and PNI (OR: 2.424, CI 95%: 1.880-3.880, P=0.002) values were determined as independent predictors for predicting early postoperative MACCE. Conclusions: With this study we revealed that SII and PNI values, which are among the inflammatory parameters and which can be obtained cheaply and easily, may be good predictors for MACCE emerging after CABG operationsÖğe The Importance of the De Ritis Ratio and Glasgow Prognostic Score in prehypertensive patients(2021) Özcan Abacıoğlu, Özge; Yıldırım, Arafat; Doğduş, Mustafa; Dindaş, Ferhat; Yavuz, FethiAim: To evaluate Glasgow prognostic score (GPS) and De Ritis ratio in optimal blood pressure and prehypertensive patients, and investigate whether these parameters can predict antihypertensive treatment in the follow-up period. Methods: A total of 402 patients who were followed up with a 24-hour ambulatory blood pressure with a pre-diagnosis of hypertension between January 2018 and December 2018 were included in the study. Routine laboratory parameters of the patients were recorded in the hospital digital system. The common health system data of the patients was analyzed until June 2020, and those who were started on antihypertensive treatment were recorded. Results: 402 patients (mean age 40.16 ± 13.01 years, 49% male) were included in the study. 226 of these were in prehypertension group. The mean GPS and the De Ritis ratio, aspartate aminotransferase levels, mean systolic and diastolic blood pressures were different between the groups (p=0.035, p=0.023, p=0.039, p<0.001 and p=0.012, respectively). When patients whose antihypertensive treatment was started and those who did not receive antihypertensive treatment were compared; age, De Ritis ratio and mean diastolic blood pressure differed between the two subgroups (p<0.001, p=0.015 and p=0.040, respectively). Multivariate logistic regression analysis showed that De Ritis ratio and age were, independently, predictors for antihypertensive treatment (OR:3.064, p=0.015 and OR:1.050, p= 0.001 respectively). In ROC curve analysis, both age and De Ritis ratio were successful at predicting the initiation of antihypertensive treatment with an AUC:0.697 and p<0.001 and AUC:0.630 and p=0.018 respectively. Conclusions: Both GPS and the De Ritis ratio were found to be significantly higher in prehypertensive patients than those with optimal blood pressure. Moreover, the De Ritis ratio, an easily calculated laboratory parameter, can be used as a predictive value for antihypertensive treatment.Öğe The association between contrast associated acute kidney injury and direct bilirubin levels(2021) Kaya, Yasemin; Kaya, Ahmet; Karataş, Ahmet; Bektaş, Osman; Yenerçağ, Mustafa; Akkaya, FatihAim: In this study we aimed to association between bilirubin levels, which is known to have anti-oxidative, anti-inflammatory and anti-thrombotic effects, and contrast associated acute kidney injury (CA-AKI) in patients with acute coronary syndrome (ACS). Methods: Between 2017-2020, consecutive patients over 18 years of age who applied percutaneous angioplasty with the ACS diagnosis and met the exclusion and inclusion criteria (n:514) were retrospectively screened. Age, gender, chronic diseases and complete blood count parameters of the cases were recorded. Biochemical parameters, before applying contrast and 48 hours after applying contrast, were recorded. A 25% increase in creatinine level measured 48 hours after contrast application compared to basal creatinine was defined as CA-AKI. Results: CA-AKI rate was higher in females(p=0.011). In the CA-AKI positive patient group, the mean age was found significantly higher (p=0.04), hemoglobin (p=0.007), direct bilirubin (p=0.008) levels were found significantly lower. Direct bilirubin was found to be a predictor as a result of our statistical analysis to identify independent predictors of CA-AKI (Beta:0.051 OR 95% CI:0.007-0.392, p=0.004). It was found that the direct bilirubin value of 0.065 predicted CA-AKI with 90% sensitivity and 91% specificity. Conclusions: It was observed that the direct bilirubin values were significantly lower in the CA-AKI positive patient group, and the direct bilirubin value of 0.065 predicted CA-AKI with 90% sensitivity and 91% specificity.Öğe The potential role of uterine retroversion in pelvic pain symptoms and caesarean delivery(2021) Acar Şimşir, Meral Tuğba; Yıldız, Muhammet SerhatAim: Uterin Retroversion is a common status in the women population and assumed to be related with pelvic pain symptoms. The aim of this study is to investigate whether uterine retroversion is associated with pelvic pain symptoms and is a reason for cesarean delivery. Methods: One hundred thirty-three premenopausal women admitted in a Tertiary Education and Research Hospital, Department of Gynecology unit for pregestational counseling were evaluated for pelvic pain symptoms with a self-administrated questionnaire. Uterine position was assessed by pelvic examination and transvaginal ultrasound. Sixty-one women had a retroverted uterus (group1), and seventy-two had an anteverted or intermediate uterus (group2). Dyspareunia, dysmenorrhea, weight, Body Mass Index (BMI), cyclic pain, ovulation pain, premenstrual pain and mode of delivery were compared between the Retroverted group and the Anteverted or intermediate group. After successful conception and pregnancy survey, mode of delivery was also compared. Results: Dyspareunia, dysmenorrhea, weight, BMI, cyclic pain, ovulation pain, premenstrual pain, patients’ sexual activities restrictment due to dyspareunia, patients medical treatment requirement for dysmenorrhea, and mode of delivery was statistically significant between two groups. (p<0.05). However, PMS (premenstrual syndrome), height, gravid and parity were similar. (p>0.05) Conclusions: Uterine retroversion is associated with a higher prevalence of cesarean rate, pelvic pain and visual analogue scale for dyspareunia and dysmenorrhea in a population of unselected women.Öğe Evaluation of anti-DFS70 antibodies and DFS pattern in ANA positive individuals and ANA Associated Rheumatic Diseases(2021) Uğur, Sevcan; Kula Atik, TuğbaAim: In this study we aimed to find the frequency of anti-DFS70 antibodies and DFS pattern in ANA positive individuals and ANA associated rheumatic diseases (AARDs). Methods: In this study, 337 subjects who were evaluated in a rheumatology clinic with prediagnosis of rheumatic diseases with positive ANA test and had concurrent anti-extractable nuclear antigen (anti-ENA) antibodies results were retrospectively analyzed. Clinical diagnosis of patients and demographic characteristics were obtained from the patients' medical records. Results: A total of 337 subjects (305 women, 32 men) were included in this study. The mean age was 49.8 ± 14.2 years. Of the 337 participants, 111 (32.9%) had an IIF-DFS pattern and 226 (67.1%) had a non-DFS pattern. Anti-DFS70 antibodies were positive in 20.1% of individuals. Sixty eight individuals had AARDs. An IIF-DFS pattern was observed in 22.1% and a non-DFS pattern was observed in 77.9% of individuals with AARDs (p <0.05). Anti-DFS70 antibodies were positive in 13.2% of patients with AARDs. The frequency of AARDs was significantly lower in individuals with anti-DFS70 antibodies compared to individuals with other anti-ENAs antibodies (p <0.05). Conclusion: Anti-DFS70 antibodies may be present in patients with AARDs but AARDs are less prevalent in patients who had anti-DFS70 antibodies, compared with patients who had other anti-ENAsÖğe The evaluation of sperm DNA damage in patients with different varicocele grades(2021) Göktepe, Özge; Cantürk Tan, Fazile; Narin, Figen; Yakan, BirkanAim: Varicocele, abnormal dilatation of pampiniform venous plexus, is classified into three groups: 1st, 2nd and 3rd grade. The aim of our research is to show the differences among the three different varicocele grades based on the results of their sperm DNA damage and blood biochemical parameters. Methods: We examined 30 patients which were classified into three groups: Group 1 (healthy), Group 2 (grades 1 and 2) and Group 3 (grade 3). The semen samples were examined in terms of DNA damage via comet assay. The blood samples were assessed using catalase (CAT), superoxide dismutase (SOD) enzyme activities and malondialdehyde (MDA) levels. Results: According to the comet findings, Group 2 and Group 3 parameters were significantly higher than Group 1 (p < 0.01). In the biochemical findings, we observed decreased CAT and SOD activities and an increased MDA level for Group 2 and Group 3. In our research, we showed that grades 1 and 2 had significant DNA damage in terms of infertility as much as grade 3. Conclusion: The results we derived indicate that the detection of DNA damage could be used as a predictor of infertility alongside routine semen and morphological analysis.Öğe Systemic immune-inflammation index and high-sensitivity cardiac troponin T in acute coronary syndromes(2021) Öztürk, Selçuk; Erdoğan, Mehmet; Turan, YaşarAim: Acute coronary syndromes (ACSs) are classified as ST-segment elevated myocardial infarction (STEMI), non-ST-segment elevated myocardial infarction (NSTEMI) and unstable angina pectoris (USAP). Cardiac troponins constitute the cornerstone biomarkers for the laboratory diagnosis of ACS. In this study, we aimed to investigate whether systemic immune-inflammation index (SII) is associated with peak cardiac troponin T (TnT) levels in ACS. Methods: Consecutive patients with ACS whose coronary angiography was performed were included in the present study (n=397). Admission SII was determined as platelet count x neutrophil count/lymphocyte count. Serum levels of cardiac enzymes, including high-sensitivity TnT and creatine kinase-myocardial band (CKMB), were measured at the time of admission and repeated daily during patients’ hospital stay. Results: Patients were categorized as namely STEMI (n=92) and NSTEMI/USAP (n=141). The findings obtained in this study showed that the median of SII levels was higher in STEMI than NSTEMI/USAP at a significant level. Correlation analysis of SII with various clinical and laboratory parameters demonstrated a significant correlation with C-reactive protein, peak CK-MB (r=0.52, p<0.001), peak TnT (r=0.49, p<0.001) and left ventricular ejection fraction (r= -0.48, p<0.001). Multivariate linear regression analysis identified age and log-SII (Beta Coefficient: 1.29, 95% Confidence Interval: 0.93-1.66, p<0.001) as independent predictors of peak TnT levels. Conclusion: SII is an independent predictor of peak TnT levels and significantly correlates with peak CK-MB levels in patients with ACS. SII significantly and inversely correlates with left ventricular systolic functions.
