Medical Science and Discovery

Recommendations for oncological orthopaedics in the Covid-19 pandemic; Review of the literature and clinical experiences

2020-07-29T19:42:39+03:00

Objective: The Covid-19 pandemic which arose from Wuhan city in December 2019 led to some changes in the treatment and follow-up of orthopedic patients to protect both the patients and the health workers and their relatives from the contagion. Long-term settings for the sake of patients and health workers have been made to decrease the viral load and the Covid-19 transmission risk. The specialist opinions and the data coming from Italy and Spain where the pandemic affected earlier than most countries facilitated the necessary steps to take in oncologic orthopedics. These steps in general, it should be limited to acute cases such as pathological fractures and malignant tumors. During the acute phase of the pandemic; it requires postponement of all other oncological orthopedic cases and outpatient controls. All surgeries where delaying 3 months will not be a big problem in the long term should be kept waiting.

The effect of paricalcitol on Hepatitis B immunization in hemodialysis patients

2020-07-29T19:42:34+03:00

Objective: Hepatitis B virus (HBV) infection has high morbidity and mortality. Therefore vaccination for HBV is crucial, especially for risk groups. In this study, we aimed to determine the effect of paricalcitol on HBV immunization in maintenance hemodialysis (HD) patients.

Methods: Forty-two maintenance HD patients enrolled in the study. Group 1 was the control group who didn't receive paricalcitol treatment (n:28, control group). Group 2 was the paricalcitol treatment group for secondary hyperparathyroidism (n:14, paricalcitol group). Anti-HBs titers were measured with a three-month interval for two times.

Results: The mean age of the patients in Group 1 was 58.50(18-80) years, while of the patients in Group 2 was 46.50 (23-81) years. There was no statistically significant difference between the groups in terms of age and gender (p = 0.200, p = 0.508, respectively). Baseline anti-HBs titer in the control group was 190.32 IU/L (20.18-1000), and 187.89 IU/L (38.77-1000) in the paricalcitol treated group. After 3 months of follow-up, anti-HBs titers decreased to 114.72 IU/L (13.68-1000) from 190.32 IU/L (20.18-1000) in the control group and to the 175.27 IU/L (14.25-1000) from 187.89 IU/L (38.77-1000) in the paricalcitol group. The decrease in anti-HBs titers was significant in the control group, whereas it was not significant in the paricalcitol group (P = 0.001, 0.209, respectively).

Conclusion: The protective effect of paricalcitol on hepatitis B seroconversion in HD patients was observed. We think that paricalcitol may be used as an adjuvant for hepatitis B seroconversion.

Comparison of the effects of sagittal versus transvers 25-gauge quincke needle insertion on post-dural puncture headache development

2020-07-29T19:42:32+03:00

Objective: Post-dural puncture headache (PDPH) is one of the most important complications after spinal anesthesia. This study aimed to investigate the effect of the sagittal or transverse application of 25-gauge Quincke spinal needle on PDPH development in patients undergoing cesarean section.

Material and Methods: A total of 295 patients with a planned cesarean section between the ages of 18-40 years with an American Society of Anesthesiologists score of 1 or 2 were included in the study. For the spinal intervention, 25-gauge Quincke spinal needle was used in all patients. Patients were included in one of two groups according to the spinal needle cutting direction of the dura mater fibers as sagittal (parallel to dura mater fibers, Group S; n=145) or transverse group (perpendicular to dura mater fibers, Group T; n=150).

Results: PDPH developed in 27 (9.2%) patients. Patients in Group T had significant higher ratio of PDPH compared to patients in Group S (16% vs. 2.1%, p<0.001). Additionally, patients with PDPH had a significantly higher frequency of ≥2 spinal puncture attempts compared to patients without PDPH (22.2% vs. 4.5%, p=0.003). Multivariate logistic regression analysis demonstrated that transverse needle direction (OR: 11.40, 95% CI: 2.73-34.71; p<0.001) and ≥2 spinal puncture attempts (OR: 9.73, 95% CI: 3.13-41.55; p<0.001) and were independent predictors for PDPH development.

Conclusion: Transverse insertion of the 25-gauge Quincke needle into spinal cord fibers and repeated interventions are independently associated with the development of PDPH in cesarean section patients undergoing spinal anesthesia

The relationship between anxiety and satisfaction level in women who had cesarean section with spinal or general anesthesia

2020-07-29T19:42:37+03:00

Objective: Although regional anesthesia is frequently used in cesarean section, patient satisfaction and comfort can change with the anesthesia method preference. Our aim is to determine the level of anesthesia satisfaction in women with cesarean surgery with Spinal (SA) and General anesthesia (GA) and to examine its relationship with anxiety level.

Material and Methods: In this prospective observational cohort study, 144 pregnant women who were admitted to the Obstetrics and Gynecology Clinic between January 2019 and April 2019 were included. Demographic information of the pregnant women including age, height, weight, gestational history and education level were recorded. Hospital Anxiety and Depression Scale (HADS), preoperative anxiety levels and which anesthesia method they preferred were questioned and recorded.

Results: 72 SA and 72 GA patients were included in the study. Age, BMI (Body mass index), obstetric history, preoperative HADS were similar in both groups (p> 0.05). Patients with SA were significantly higher satisfaction level than those who had cesarean with GA (p = 0.000). Anxiety level during cesarean was correlated positively with preoperative HADS (p = 0.001, p = 0.005, respectively). First analgesia requirement didn’t differ in both group (p=0.409).

Conclusion: The satisfaction score founded higher in those who were cesarean with SA. Evaluating anxiety levels of patients and providing support before surgery will increase postoperative comfort.

Is early-stage breast cancer a risk for marital-dissolution?

2020-07-29T19:42:30+03:00

Objective: The effect of breast cancer on family life and marital status is one of the issues to investigate. Our aim in this study is to evaluate the frequency of divorce of breast cancer survivors and to investigate the demographic, disease, and treatment-related factors that may affect the divorce.

Material and Methods: We performed this cross-sectional study between January 2020 and May 2020. Inclusion criteria were; women who were married at the time of breast cancer diagnosis, older than 18 years of age, and completed at least 6 months after breast cancer surgery and adjuvant chemotherapy/radiotherapy. The primary aim of this study was to find the marital dissolution rate of the patients after early-stage breast cancer diagnosis and adjuvant treatment. The secondary aim was to investigate the demographics and treatment-related factors affecting the marital status of breast cancer survivors.

Results: The median age of 583 women included in the study was 47 (28-72). The median time to stay married was 291.0 months (min-max: 32.5-654.6). The most preferred surgical method in these patients was total mastectomy (n = 364, 62.4%). Adjuvant chemotherapy was applied to 505 (86.6%) patients, adjuvant endocrine therapy to 499 (85.6%) patients, and adjuvant radiotherapy to 460 (78.9%) patients. 21 (3.6%) patients divorced after diagnosis. In univariate analysis, surgery type, adjuvant chemotherapy, adjuvant radiotherapy, and adjuvant endocrine therapy were found to not affect the divorce.

Conclusion: In our study, it was observed that the frequency of divorce was higher in breast cancer survivors than the general population, and breast surgery type and adjuvant treatments did not cause an increase in the risk of divorce.

Factors affecting general or regional anesthesia preference in patients with elective surgery

2020-07-29T19:42:26+03:00

Objective: This study aimed to investigate the factors that affect the preference of the anesthesia method in patients who were indicated for general or regional anesthesia.

Material and Methods: A descriptive questionnaire was used to evaluate the opinions of 123 patients who were planned to undergo elective surgery in the orthopedics and traumatology outpatient clinic between January 2018 and June 2019.

Results: 73 women (%59) and 50 men (%41) participated in the study. The mean age was 58.62±11 years. General anesthesia was preferred in 58% of the patients. The most common reason for rejection was that the patients who preferred general anesthesia did not want to receive visual and auditory stimuli during the surgical procedure. There was a significant positive correlation between education level and regional anesthesia preference rate. There was a significant positive correlation between the regional anesthesia preference rate of patients receiving hand and foot surgery indications.

Conclusion: The preference of the majority of patients was found to be general anesthesia method. Additionally, the type of surgery and education level of the patients was found to be effective in preference of the anesthesia method.

Renal colic secondary to ureteral metastasis: Rare presenting manifestation of prostate cancer

2020-07-29T19:42:24+03:00

Objective: Ureteral metastasis of prostate cancer is a very rare pathology, that can be confused with an upper urinary tract urothelial carcinoma, with great implications in the surgical management and therapy of the disease.

Case: A 56-years old male patient admitted to the emergency room with 2 weeks history of left flank pain without low urinary tract symptoms or hematuria. PSA level was 43,4 ng/ml. The patient underwent prostate needle biopsy and ureteral biopsy using flexible ureteroscopy, after the Lich-Gregoire ureterovesical reimplantation. In this case, renal colic as the first symptom of a ureteral metastasis secondary to prostate cancer is extremely rare which diagnosed in the patient.

Conclusion: Neoureterocystostomy is a safe and effective treatment for ureteral obstruction due to prostate cancer metastasis, with low morbidity and significant benefits in terms of quality of life for patients with life expectancy more than 10 years.