Medical Science and Discovery

Acute and chronic toxicity of ethyl chloride insufflation in two patients

2021-11-30T00:23:46+03:00

Objective: Inhalant abuse has been a source of increasing concern because of its easy accessibility and affordability. Anecdotal reports have previously described ethyl chloride as a potential cause of altered mental state and neurologic symptoms. Its use has been thought to be found most often in adolescents and among men who have sex with men. Common acute symptoms include confusion, dizziness, headache, nausea, and fatigue. We describe two cases of adult patients who presented to one general hospital emergency department with ethyl chloride toxicity. The first presented with acute delirium; the second with a picture of chronic neurological symptomatology. It is important that clinicians become familiar with ethyl chloride intoxication because of its prevalence and potential to present with varying acute and chronic symptomatology.

Idiopathic scoliosis. Mechanisms of development

2021-11-30T00:20:18+03:00

Objective: One of the most complicated problems of Orthopaedics is the treatment of scoliosis. More than 90% of cases are attributable to Idiopathic deformation, the cause of which is unknown. We investigated the cause of pathogenesis of this disorder.

Methods: At our institution more than 6900 patients aged 1-89 years have undergone inpatient and outpatient treatment in connection with spinal pain syndrome and different neurological disorders associated with idiopathic scoliosis. This study was undertaken between February 1996 and February 2010. All patients had a clinical, radiography and laboratory examinations.

Results: The 29.6% of patients were aged 31-50 years old. 60% were men and 40% were women. While examining patients with scoliosis deformation, we noted symptoms of body asymmetry i.e. different volumes of the right and left halves of face body and limbs. These features were typical for all patients irrespective of sex, age, and ethnic origin. 83,2% of patients had underdevelopment of the left part of the body, and only 16,8% of the right side. Analysis of published work in anatomy, physiology, neurophysiology, vertebrology, done simultaneously with analysis of the clinical material, allowed us to make some conclusions.

Conclusions: First asymmetrical structure of the human body is based on laws of nature and is linked with difference of sizes of brain’s hemispheres, particularly of the right and left gyrus centralis anterior which controls the muscle’s function and our movements. Second asymmetrical tension of Erector spinae muscles, leads to inclination of the pelvis on a side of weak muscles; thus initiating development of the lateral spine curves. Since such a situation is typical for all people, this deformation is known as functional scoliosis. Third, further development of the bodies of vertebrae, their arches, processes, intervertebral discs, ligaments, and other anatomical elements in position of the deviation leads to one sided underdevelopment of these structures. As a result the areas of instability appear in each segment of spine ( neck, chest, lumbar and sacral areas ). Fourth, the muscles in a growing body misbalance and on the ground of rotating movement, start rotatory dislocation of vertebrae in zones of instability in all parts of the spine. As a result torsion of the deformed wedge-shaped vertebrae leads to formation of the structural scoliosis. The rotation of the vertebrae, described above, does not depend on sex, age and ethnic origin of the patient and has a character of the natural development. Thus from our point of view, the term idiopathic scoliosis, must be changed to spinal muscle asymmetrical deformation of a reflex origin. Understanding of this rotation allowed us to establish an effective non-surgical method of treatment of scoliosis and spinal pain syndrome in patients of all ages.

The clinical, laboratory and prognostic characteristics of haemorrhagic stroke cases related to COVID-19 infection

2021-11-30T00:20:21+03:00

Objective: Although ischemic and thrombotic vascular processes are more widely reported in COVID-19, the ratio of haemorrhagic cerebrovascular disease is lower. However, it needs to be evaluated because the mortality rate is higher in haemorrhages, and they may appear iatrogenically.

Material and Methods: Patients observed at the Prof. Dr. Cemil Taşçıoğlu City Hospital between March 11th, 2020, and March 11th, 2021, were included in the study. Cases diagnosed as consecutive full intracerebral haemorrhage and concomitant with COVID-19 were observed during the study period. This study is a cross-sectional, retrospective, and observational study.

Results: Within the 1-year period, 11 patients (7 men and 4 women) with a mean age of 64.45±18.68 years related to COVID-19 were recorded. Risk factors were high blood pressure at a frequency of 64%, diabetes mellitus at 45%, and the use of antiaggregants/anticoagulants at 36%. The ratio of male patients was 64% (n=7). The location of haemorrhage was intraparenchymal in 91% (n=10), and subdural in 9% (n=1). The mortality rate was 64%.

Conclusion: Neurologic findings that develop, especially in noncooperating and prone patients in wards and intensive care units, must be observed carefully. Caution must be exercised in prophylactic antiaggregant and anticoagulant treatment, especially in high-risk patients. Intracranial haemorrhages are important due to high mortality.

Abdominal wall skin lesions in adult morbid obese women

2021-11-30T00:20:23+03:00

Objective: To present only skin lesions in the abdominal wall that we detected in morbidly obese patients and to examine them in the light of the literature.

Material and Method: Patients who applied to the general surgery outpatient clinic for bariatric surgery and who also had dermatological complaints and were referred to the dermatology outpatient clinic with the detection of skin-related complaints were retrospectively evaluated in terms of age and breast skin findings. Normal skin findings were separated into intertrigo, chronic recurrent folliculitis, eczemas, acanthosis nigricans and striae.

Results: A total of 60 obese female patients were included in the study. The mean age of the patients was 32.4 ± 8.8 years (19-53), and the mean body mass index was 42.6 ± 2.4 (40-49). Normal skin findings were present in 28.3% of the patients (17 patients). The most common finding was striae, and 60% (36 patients) had it. Then respectively, intertrigo was detected in 14 patients (23%), chronic recurrent folliculitis in 12 patients (20%), eczema in 5 patients (8.3%), and acanthosis nigricans in 2 patients (3.3%).

Conclusion: The most common findings on the abdominal wall skin of obese individuals are striae and intertrigo, and similar findings have been found in many studies in the literature.

Vaccination rates among adults with sickle cell disease: a single-center study from the Eastern Mediterranean region of Turkey

2021-11-30T00:20:20+03:00

Objective: Being vaccinated against encapsulated bacteria is the most efficient way to reduce painful crises and mortality in patients with sickle cell disease (SCD). Although guidelines strongly recommend vaccination, vaccination rates remain under the desired levels. In this study, we aim to determine vaccination rates and understand the reasons for non-vaccination in patients with SCD.

Material and methods: We included 76 patients with SCD in this study. We administered a questionnaire consisting of 21 questions and examined the electronic vaccination records of these patients.

Results: The vaccination rates were 36.5% for the pneumococcal vaccine, 22.4% for the Hemophilus influenza type b vaccine, and 19.7% for the meningococcal vaccine. Residence in rural areas and annual control visits were found to increase the pneumococcal vaccination rates (OR: 11.90, 95% CI: 2.549–56.107, p = 0.002 and OR: 9.08, 95% CI: 1.120–73.624, p = 0.039, respectively) and meningococcal vaccination rates (OR: 2.75, 95% CI: 1.464–5.186, p = 0.002 and OR:1.36, 95% CI: 1.159–1.610, p < 0.001, respectively). Thirty-four (44.7%) of the cases stated that their doctors did not give any information about these vaccinations.

Conclusion: Vaccination rates are low in patients with SCD. Residence in rural areas, annual control visits, educational level, and doctor recommendations affect these vaccination rates.

Predictive value of the aspartate aminotransferase to platelet ratio index and aspartate aminotransferase to alanine aminotransferase ratio in early diagnosis of intrahepatic cholestasis in pregnancy

2021-11-30T00:20:12+03:00

Objective: We aimed to investigate the predictive value of the first-trimester aspartate aminotransferase/platelet count ratio index (APRI) and aspartate aminotransferase/alanine aminotransferase ratio for intrahepatic cholestasis in pregnancy (ICP).

Material and Methods: The clinical data of patients who admitted to the Obstetrics Department of Umraniye Training and Research Hospital, between 2015-2020 were analyzed retrospectively. The study group consisted of 44 patients with ICP and the control group consisted of randomly selected 92 healthy pregnant women.

Results: The two groups were similar in terms of age, BMI, first and third-trimester platelet count and third-trimester hemoglobin level. Patients with ICP had a significantly higher first-trimester APRI and a lower first trimester AST/ALT ratio than the healthy controls (p <0.001, p = 0.001, respectively). According to the ROC analysis, the optimal cut-off value of the APRI to predict ICP was 0.191, with the sensitivity of 0.66 and specificity of 0.66 (AUC: 0,727), and the optimal cut-off value for AST/ALT ratio was 1.07, with the sensitivity of 0.64, and specificity of 0.62 (AUC: 0,681).

Conclusion: The first-trimester APRI score and AST/ALT ratio is an easy, inexpensive, and non-invasive tool that may be useful in predicting ICP early.

The relationship between hopelessness and perceived social support levels of parents with children with congenital heart disease

2021-11-30T00:20:16+03:00

Objective: This study was conducted to evaluate the relationship between hopelessness and perceived social support levels of parents with children with congenital heart disease (CHD).

Material and Methods: This cross-sectional study was conducted with parents of children who underwent surgery for CHD, and data were collected from 100 parents who agreed to participate in the study. A descriptive information form for the sociodemographic characteristics of the parents, “Beck Hopelessness Scale (BHS)” and “Multidimensional Scale of Perceived Social Support (MSPSS)” were used to collect the data. Data were analysed using descriptive statistics and Spearman’s correlation tests.

Results: The mean score of the hopelessness level of the parents participating in the study was 6.15±4.23, and the mean perceived general social support score was 69.55±15.47. There was a significant negative correlation between the hopelessness levels of mothers and social support (SS) received from the family, from significant others, and general SS scores. There was a significant positive correlation between the hopelessness levels of the mothers and the SS level received from the family (p<0.05).

Conclusion: In this study, the parents of children with CHD have low levels of hopelessness and perceived SS levels are high. Moreover, the relationship between hopelessness and perceived SS levels varies according to the sex of the parents. In our study, the SS level of mothers had a higher effect on the hopelessness level. It is recommended that the SS levels of the parents of children with CHD should be increased to help them cope with hopelessness.