Selçuk Tıp Dergisi Arşiv

Background and Aim: Carotid artery stenting (CAS) is an alternative approach to carotid endarterectomy in cerebrovascular diseases. The applicability of this procedure has increased as a result of development of cerebral protection devices. In the trial, the clinical and radiological characteristics and early and late outcomes of patients who received CAS were investigated.

Methods: The study had a retrospective design. The clinical and radiological characteristics and early and late outcomes after CAS of 76 patients (54 male, 22 female) who were admitted to a university hospital between 2008 and 2014 due to a diagnosis of internal carotid artery stenosis (ICA) were retrospectively reviewed.

Results: All patients were symptomatic during their admissions, and after their workups were completed, ICA stenosis was determined. Unilateral (Right ICA 34.2%, left ICA 47.4%) stenosis in 62 patients and bilateral stenosis (18.4%) in 14 patients were determined. The mean degree of stenosis was 82.1 (SD:11.36, range: 60-99%). All patients were treated with stenting for ICA stenosis (technical success rate: 100%). No complications occurred during these procedures. During the one-year follow-up, no recurrent ischemic attack occurred in any patients. Carotid artery disease is highly associated with hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, a history of cerebrovascular accidents and transient ischemic attack.

Conclusions: Carotid artery disease is a critical factor with co-morbidities and history of cerebrovascular incidents. The carotid artery stenting (CAS) procedure is a method that can be used safely because its serious complication rate is low in cases that are well-selected and have had risk analyses performed regarding medical treatments.

The hydatid cysts that are common geographically over the world; causing serious complications and considered as a high recurrent average disease . In spite of the infective nature of the disease; the primary treatment is a surgical one . And in this point the surgery techniques and the using of the scolicidal agents is important to increase the chances of the successful treatment.

In the literature, there is not enough information about the determination of the most effective scolicidal substances. Therefore clinically there are different opinions in the using of the different agents

In this study, in –vitro we investigated the activity of some frequent used scolicidal substances related to the time . All the agents that used in our study for 20 minutes were successful. But we have seen that the earliest and the most effective response is noticed with praziquantel. These findings that demonstrate the success of praziquantel to kill E. granulosus are proposing to support the medical treatment.

To determine the ideal scolicidal material that will be used in the medical and the surgical E.granulosus treatment, and its side effects more efficiencies-study analysis must be performed

Purpose:

Primary and metastatic digestive system malignant melanomas are extremely rare. In our study, we aimed to compare lymph node metastasis with clinical and pathological parameters in gallbladder, stomach, small intestine and anorectal region malignant melanomas.

Materials and methods:

This retrospective study included 20 cases diagnosed with malignant melanoma in the gastrointestinal tract organs between January 2010 and January 2020 at XXXXXXXXXXXX. In our study, we wanted to evaluate the relationship between regional lymph node metastasis and age, gender, tumor localization, tumor size, extraintestinal melanoma history, melanin pigment, neutrophil-lymphocyte ratio and post-diagnosis life span in primary and metastatic malignant melanoma cases. We also reviewed the origin and literature of the cells from which melanoma originates in the digestive system.

Results:

There was a statistical relationship between tumor diameter and regional lymph node metastasis (p =0.000). As the tumor diameter increased, the lymph node metastasis rate increased. There was a relationship between survival and gender, tumor localization, distant metastasis, primary and metastatic digestive system melanoma (all p <0.05). Most of the men and those who did not metastasize away from the digestive system were alive. All patients with melanoma metastases to the digestive system and all patients with gallbladder and small intestine localization were alive. Our 70 year old patient with gallbladder primary malignant melanoma was the oldest patient we could identify in the literature.

Conclusions:

Regardless of cutaneous or origin, all melanomas originate from melanocytes, cells derived from embryological nerve crest. Malignant melanoma can be primary in every region, more frequently in the anorectal region in the gastrointestinal tract. The most common metastasis is to the small intestine. Accurate diagnosis is vital in places where it is rarely seen, such as the digestive system. Recently, in metastatic melanoma, immuno-oncological agents are used in adjuvant therapy to help prevent metastatic spread of the disease. Thanks to these treatments, it is reported that more than half of patients with melanoma who have the risk of metastasis after surgical resection provide recurrence-free survival. Although it is very rare, it should be kept in mind that there may be primary or metastatic malignant melanoma in the evaluation of digestive system biopsies.

Objectives: The aim of this study was to compare the fibrin tissue adhesive technique with vicryl suture technique in autograft pterygium surgery.

Material and Methods: Seventy two patients (Group 1) who underwent autograft pterygium surgery with vicryl suture technique (Primary pterygium Group 1a, recurrent pterygium Group 1b) and 58 patients who underwent autograft pterygium surgery with fibrin tissue adhesive technique (Primary pterygium Group 2a, recurrent pterygium Group 2b) were included in this retrospective study. Duration of the surgery and complications were analyzed from the file records. Statistical analyses of the data were performed using the SPSS 20.0 software. Independent samples – t test was used for the comparisons between groups.

Results: The mean age of the patients was 47.04±5.70 years (ranging between 37-65) in Group 1 and 47.10±4.88 years (ranging between 38-57) in Group 2. There was not a statistically significant difference in terms of age between two groups (p=0.95). The mean duration of the surgery was 24.91±3.08 min, 25.60±2.20 min, 17.62±2.57 min, and 18.84±2.83 min in groups 1a, 1b, 2a and 2b, respectively. There were statistically significant differences in terms of the duration of the surgery between groups 1a and 1b (p=0.021), groups 2a and 2b (p=0.001), groups 1 and 2 (p<0.001). Recurrence pterygium was found to require more surgery time in both techniques. Postoperative recurrence was not observed in any of the patients.

Conclusion: Pterygium surgery with conjunctival autograft is a reliable surgical method with low recurrence rates. The duration of surgery in recurrent pterygium was found to be longer in both surgical techniques. It is concluded that autograft pterygium surgery with fibrin tissue adhesive is the preferred surgical method that shortens the duration of the surgery.

Objective: The aim of this study was to evaluate the effects of smartphone / social media use and sleep related variables on academic achievement in pre-clinical medical students.

Material and Methods: 226 students receiving pre-clinical medical education at the same institution were included in the study. All participants completed the Pittsburg Sleep Quality Index (PSQI), Social Media Addiction Scale - Adult Form (SMAS-AF), Smartphone Addiction Scale (SAS) and Personal Information Form prepared for the study. All participants were questioned Average Academic Marks (AAM).  The participants were categorized as low / medium / high risk according to the scores of smartphone addiction scale.

Results: According to the risk of smartphone addiction, the mean score of AAM of the group with low dependency risk was 71.8 ± 8, the mean score of AAM of the group with the middle risk dependency risk was 68.4 ± 8.77, and the mean score of AAM of the group with the high dependency risk was 67.4 ± 9.75. The mean scores of AAM of the low-risk group in terms of smartphone addiction were significantly higher than the high-risk group (p = 0.035). Similarly, when the total scores of the participants' social media addiction are examined; the average of the low-risk group was 40.4 ± 11.17, the average of the medium-risk group was 51.7 ± 9.2, and the average of the high-risk group was 50.8 ± 12.9. Social media addiction total scores of the high risk group in terms of smartphone addiction were significantly higher than the medium and low risk group (p <0.001). There was no significant difference between sleep times and PDQI total scores between groups. When the factors associated with AAM were analyzed by Pearson correlation analysis, a positive statistically significant relationship was detected with sleep efficiency (r = 0.19, p <0.001), while a significant negative correlation was observed with total SAS score and hours spent in bed (r = -23, p <0.001; r = -27, p <0.05, respectively). A multivariate hierarchical regression analysis model suggested that gender, sleep efficiency, SAS and SMASAF scores affected AAM.

Conclusion: Use of social media / smartphone by medical students can affect sleep habits and academic success during the period of pre-clinical education. Inclusion of training on conscious use of social media and smartphone and emphasizing the importance of sleep habits in medical education have the potential to contribute to the development of better-equipped physicians.

Objective: To compare the effects of full-time patching, minimal patching and Cambridge visual stimulator (CAM) treatment on visual acuity in amblyopic patients.

Material and Method: Ninety five patients with functional amblyopia were divided into three groups so that age and initial visual acuity did not make any significant difference. Those who received CAM treatment in the first group, those who underwent full-time patching in the second group, and those who had minimal patching in the third group were included. Patients with a follow-up period of less than six months were excluded from the study. The increase in visual acuity of the patients were compared between the groups. In addition, the participants were classified according to presence of foveal fixation, cause of amblyopia and age, and these data were compared for all patients.

Results: 31 patients who received CAM treatment, 30 patients who underwent full-time patching and 34 patients who underwent minimal patching were included in the study. The mean age of the groups was 5.50 ± 2.05; 5.96 ± 1.59 and 6.57 ± 2.31 respectively (p = 0.105). While the mean visual acuity was 0.45 ± 0.28logMAR before the treatment in the CAM treatment group, it was 0.31 ± 0.25 logMAR after the treatment. It was changed from 0.50 ± 0.16logMAR to 0.27 ± 0.16logMAR in the full-time patching group and it was increased from 0.52 ± 0.25 logMAR to 0.30 ± 0.21logMAR in the minimal patching group. While the increase in visual acuity revealed no significant difference between the full-time patching and minimal patching groups(p = 0.994), the increase in both groups was more than the CAM treatment group and the difference was statistically significant. (p = 0.029 for full-time patching-CAM and p = 0.032 for minimal patching-CAM). When various groupings were made with all patients regardless of treatment methods, these groups had more succesful results than opposing groups: those have foveal fixation, those with amlyopia casused by only anisometropia and those whose treatment was initiated before six years old. (p=0.004, p=0.021, p=0.002, respectively) Conclusion: According to the data in this study, more successful results are obtained with patching treatments than CAM treatment.

Aim: Mesenchymal tumors of the gastrointestinal tract other than gastrointestinal stromal tumors are rare and most of them are benign. The aim of this study to reveal the clinical and pathological features of non-gastrointestinal stromal tumor mesenchymal tumors of the gastrointestinal tract.

Materials and Methods: All gastrointestinal endoscopic and surgical resection materials, between 2008-2018, were retrospectively reviewed. Cases diagnosed with mesenchymal tumor other than gastrointestinal stromal tumors were included.

Results: Twenty four lipomas, 14 inflammatory fibroid polyps, six leiomyomas, four lymphangiomas, four hemangiomas, four schwannomas, two neuromas, two malignant melanomas, one leiomyosarcoma, one granular cell tumor and one Kaposi sarcoma were detected. The median ages of the cases were 61 years (29-87), the median tumor size was 1.5 cm (0.2-14). Thirty seven (58.7%) cases were female and 26 (41.3%) were male. They caused nonspecific symptoms. No recurrence or metastasis was detected after excision in benign tumors regardless of the pathological diagnosis.

Conclusion: Non-gastrointestinal stromal tumor mesenchymal tumors of the gastrointestinal tract are mostly small and benign tumors that can be seen at any age and are frequently seen in women. The most common ones are lipomas and inflammatory fibroid polyps. Most gastric tumors cause dyspeptic complaints and intestinal tumors cause abdominal pain, nausea or vomiting, as well as some of the intestinal tumors lead to serious, even fatal clinical situations such as acute and chronic bleeding, obstruction, perforation, volvulus or intussusception. For benign tumors’ treatment, excision is sufficient, they do not exhibit recurrence or metastasis.

Aim: The aim of this study was to investigate the relationship between the seriousness of the clinical condition of the patients in intensive care unit (ICU) and acute stress symptoms of family members.

Patients and Methods: After local ethic committe approval and written informed consent was obtained, we carried out a prospective, descriptive study at a universty hospital in patients’ relatives. Clinical characteristics (APACHE II score) of patients was recorded. First degree relatives  of 60 ICU patients provided demographic data and completed the State-Trait Anxiety Inventory Form  (STAI) and Pittsburgh Sleep Quality Index (PSQI) within 24 h of ICU admission and 21 days later.

Results: There were a moderate correlation between APACHE 2 and STAI scores on  day 1 (r =0.477)  and a strong correlation (r = 0.503) on day 21 (p<0.05). A moderate correlation (r = 0.503)  was found between APACHE 2 score and PSQI on day 21. STAI scores were not different between genders on day 1. There was an increase in both sexes in STAI scores on day 21), and the scores ere significantly more in females (p=0.003). While there was no statistically significant difference in PSQI scores on day 1, an increase was found in both sexes on day 21 (p <0.001). Female family members  had more sleep disturbances  (p=0.008). STAI scores were higher in both mothers and fathers on day 1 and 21 (p<0.001).

Conclusions: An increasing relationship was determined between patients' acute physiological condition and anxiety with sleep quality level of patients’ relatives as the time passed.

Purpose: It was aimed to present the clinical and functional results of the patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow.

Methods: 14 patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor in the elbow circumference between 2011-2018 in our clinic were included in the study. While 4 of the patients were primary tumors (1 fibromixoid sarcoma, 1 leimyosarcoma, 1 multiple myeloma and 1 ewing sarcoma), 10 were distant organ metastases (4 breast cancer, 3 lung cancer, 1 stomach cancer, 1 renal cell cancer and 1 thyroid cancer). Musculoskeletal Tumour Society (MSTS) score and Mayo elbow performance score (MEPS) and survival were evaluated.

Results: The minimum follow-up period of the patients was 7 months, and the maximum follow-up period was 55 months. The mean MEPS score of the patients was 67.5 ± 12.0 (range, 45-90), and the mean of the MSTS score was 19.4 ± 2.3 (range, 16-24). Recurrence occurred at follow-up in 3 patients and exitus at follow-up in 7 patients. In this study, the median survival time of the patients was 44 months. The 1-year survival rate was 70.1% while the 3-year survival rate was 54.5%.

Conclusion: Pain and functional results are satisfactory in patients who undergo tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow. In the future, studies with larger patient series are needed.

Aim: We aimed to report our experience of a digital artery perforator flap use in fingertip and pulp defects reconstruction

 Materials and Methods: 8 patients underwent reconstruction with digital artery perforator flap for their finger defects were enrolled in the study. The patients were evaluated in terms of etiology, sex, age, comorbidities and outcomes.  The size of the flaps ranged from 20 x10 mm to 25 x20 mm.

 Results: The average age of the patients was 43,6 (range:19-66) years. 6 of 8 flaps survived completely and healed uneventfully.1 flap was totally lost where as 1 flap had partial skin necrosis.  No patients complained of cold intolerance or residual joint contracture. Mild hooked nail deformity occurred in one of the patients.

 Conclusions:  The DAPF is a reliable and versatile flap for fingertip defect reconstructions in non smoker patients without comorbidities. Single-stage operating procedure, ease of harvest, rapid recovery and preservation of digital arteries are the most important advantages.

Objective: To determine the effect of COVID-19 infection on anxiety level in pregnant women.

Material and Methods: In this study, a questionnaire and Beck anxiety scale were applied to pregnant women who referred to outpatient clinic for routine pregnancy control in June 2020 to determine their concerns that may be related to COVID-19. Pregnant women admitted with obstetric emergencies and obstetric risk were not included in the study.

Results: 177 pregnant women were included in the study and the pregnant women were divided into four groups according to their score on Beck anxiety scale. Anxiety level of pregnant women was 44.6%. The possibility of not being with his family at the time of birth and the fear of death due to COVID-19 were statistically significantly associated with higher anxiety levels.

Conclusions: In this process, it is important to provide psychosocial support in addition to the follow-up of pregnant women by a multidisciplinary team consisting of perinatology, newborn and intensive care specialists.

Objective: To determine the frequency of subclinical vitamin D deficiency in patients with non specific musculoskeletal symptoms in a tertiary care hospital.

Study Design: Cross-sectional study

Place and Duration of Study: Department of Medicine, Bolan Medical Complex Hospital, Quetta from1^st July 2018 to 30^th June 2019.

Methodology: A total of 97 patients between 20 and 45 years of age were recruited after written consent. The subjects presenting with history of generalized body aches greater than six weeks were included in this study. The detail history was taken and clinical examination was done. Blood sample of each patient were collected to detect the vitamin D3 levels by radioimmunoassay kit.

Results: Mean age of the patients was 34.25±10.64 years. Mean duration of symptoms was 7.71±0.82 weeks. Male to female ratio was found to be 4:6. The frequency of vitamin D deficiency in patients with non-specific musculoskeletal symptoms was found to be 72(74.20%).

Conclusion: The frequency of subclinical vitamin D deficiency was significantly high in patients with non specific musculoskeletal symptoms

Objectives:  In this study, the results of hearing screening tests were compared to explore the effects of iron deficiency anemia (IDA) on hearing in newborns whose mothers have IDA and who do not have any known risk factor for sensorineural hearing loss.

Methods: This retrospective cross-sectional study. The study included 6578 healthy neonates born to mothers who were beyond their gestational week 37, and who themselves or their family did not have hearing loss or any comorbid disease other than iron deficiency anemia.  The participating neonates’ birth characteristics and the maternal demographic characteristics, auditory brainstem response (ABR) results were obtained from the hospital database.

Results: A positive result was obtained from the second level hearing test in 174 newborns. An idiopathic hearing loss was detected in 25 (0.38%) newborns during their third line of hearing assessment. While anemia was present in the mothers of 17 (0.25%) newborns, no anemia was found in the mothers of 8 (0.12%) newborns (p:0,001).

Conclusions:  Knowing the impact of iron on myelination, and therefore, on hearing function is important to prevent any academic and behavioral problems that can be faced by these newborns in their future lives.

Acute pancreatitis is an important cause of acute abdominal pain in children and requires prompt treatment because it may become life-threatening. The incidence of acute pediatric pancreatitis is increasing. Although epidemiology of acute pancreatitis, clinical manifestations and acute pancreatitis course in children are generally different than in adults, information about etiology, management and results are obtained on the basis of adult studies. In most cases, inflammation may limit itself, but in some cases acute pancreatitis, acute recurrent pancreatitis or chronic pancreatitis may progress. It is necessary to provide optimal management in the acute period of pancreatitis in children, as this may prevent secondary conplications. In this review we summarise the epidemiology of acute pancreatitis, role of imaging and imaging findings in the diagnosis of acute pancreatitis, treatment methods and management and complications of acute pancreatitis.

Sport has been adopted by many people around the world and has been accepted as a way of life. It not only contributes to the consciousness of exercise required for healthy life, but also contributes to the solution of many problems that people face in their daily lives thanks to the principles such as brotherhood, interlocking and justice. The practice of sports medicine has some differences in terms of ethical conflicts compared to other medicine practices. In addition to the classical physician-patient relationship, managing the physician-patient-team relationship, especially sports team physicians, forms the basis of these differences. During the management of this relationship, sports physicians may face some ethical conflicts. The physician must act in an honest and conscientious manner in his approach to the athlete and in his decisions. However, it is another important ethical behavior that the physician provides sufficient information to the athlete and enables the athlete to decide on his own body and act freely. Particularly financial pressures on teams and athletes, as well as the competition and ambition of success that are at the core of sports, can create dilemmas that can affect sports physicians' decision making processes. However, sports physicians are people who are expected to comply with ethical principles without losing their professionalism. If these ethical principles are not followed, malpractice situations may arise and physicians may encounter judicial processes. With the development of technology, many innovations in the field of sports medicine, as in every field, come into practical use. The role of these innovations in the development of sports medicine practices is very important. However, it is important to keep professional information up-to-date in the process of possible ethical problems and optimal decision making that these developments can create. Sports physicians have a great role in dealing with ethical and legally inappropriate situations, especially the use of doping. This review will review possible ethical problems and malpractice situations that sports physicians may encounter.

Cancer is a serious genetic disease caused by a series of disorders in the genome. Development of hightroughput sequencing approaches as well as the publication of large-scale projects have enabled the identification of several non-coding RNA molecules that are differentially expressed in various types of cancer. It has been reported that ncRNA transcripts such as long non-coding RNAs (lncRNAs) and microRNAs (miRNAs) have critical roles in the development and progression of cancer and can be used in the diagnosis/treatment of cancer. In particular, miRNAs are small RNA molecules which control gene expression at the post-transcriptional level and play critical roles in the important hallmark capabilities of cancers such as metastasis, invasion, cell proliferation, differentiation, and angiogenesis. Similarly, lncRNAs have also been identified as RNA transcripts that have important roles in the understanding of the molecular mechanism of cancer. Accordingly, in this comprehensive review, functional ncRNA molecules without protein coding capacity such as miRNAs, lncRNAs, and T-UCRs and the hallmarks of cancer were discussed together with a current perspective.