Medical Science and Discovery

Breast Cancer: Treatment Effects on Fertility and Subsequent Pregnancy Outcomes

2021-08-30T11:09:13+03:00

Objective: Breast cancer is the most common cancer type in women of reproductive age. Given that most women postpone childbearing, breast cancer occurrence possibly perplexes their plans for starting a family. The treatment for breast cancer can affect their fertility and have adverse effects on a pregnancy that occurs during that period. The aim of this narrative review is primarily to explore the influence of breast cancer therapy on the ability of a woman diagnosed with breast cancer to gestate. Moreover, to determine the safer timing for childbearing after being treated for breast cancer and investigate the pregnancy outcome when conception is succeeded.

Childbearing after treatment for breast cancer is considered safe and pregnancy outcomes are favorable if conception happens 1 year after chemotherapy or at least 2 years after chemotherapy and radiation therapy. Counseling is of great significance and fertility preservation methods should be thoroughly discussed with women diagnosed with breast cancer, even prior to commencement of the treatment

Clinical evaluation of intravenous sedation in pediatric endoscopic procedures: A retrospective observational study

2021-08-30T11:09:35+03:00

Objective: The main benefits of sedation are to reduce the patient’s anxiety and discomfort, to improve their tolerability. The aim of study was evaluate intravenous sedation for pediatric gastrointestinal endoscopic procedures

Materials and Methods: We analyzed patients’ data, who underwent gastrointestinal endoscopic procedures in our pediatric endoscopy unit, retrospectively. All gastrointestinal endoscopic procedures were performed by a pediatric gastroenterologist and sedations were managed by an anaesthesia team, including two staff anesthesiologists.

Results: During the study period, 530 gastrointestinal endoscopic procedures were performed. 461 (87%) were esophagogastroduodenoscopy, 56 (10.6%) were both esophagogastroduodenoscopy and colonoscopy and 13 (2.5%) were percutaneous endoscopic gastrostomy. Propofol was given all of the patients either as a single drug (6 patients, 1%) or in combinations (77.4% with midazolam; 12.3% with ketamine and 9.2% with fentanyl). Overall adverse event rate due to sedation was 19.6%, but no serious side effects were documented. The most frequent side effects were injection pain (10.4%), and nausea (7.5%). Allergic reactions were experienced in 1.3% patients and resolved with methylprednisolone and antihistaminic medications. Respiratory depression was observed in only two girls (3 and17 years old) and did not need advanced interventions to control the problem. Seven patients’ gastroscopies were interrupted by gastroenterologist due to gastric content in order to prevent vomiting and aspiration.

Conclusions: Intravenous sedation for pediatric gastrointestinal endoscopic procedures can be applied safely and successfully with a trained team and organized endoscopy unit.

Epigenetic Regulation of the Tumour Suppressor RASSF1A in Bone Cancer Cells: DNA Methylation Study

2021-08-30T11:09:33+03:00

Objective: Osteosarcoma is a bone cancer that affects children and adolescents. The RASSF1A is a tumor suppressor capable of mediating the regulation of cell cycle arrest, migration, including apoptosis. It is the most continually silenced gene that contributes to human cancer. Furthermore, RASSF1A functions as a scaffold protein that can regulate microtubules network and bind apoptotic kinases MST1 and MST2 via the Sav-RASSF-Hippo domain. Epigenetic inactivation of genes by DNA methylation is a key factor regulating gene expression and genomic stability. Our aim was to study the RASSF1A gene promoter methylation in three osteosarcomas (U2OS, Saos-2, and MG-63), two Ewing Sarcoma (A-673 and SK-ES-1), and one-fibrosarcoma (HT-1080) cell lines.

Materials and Methods: Three osteosarcomas (U2OS, Saos-2, and MG-63), two Ewing Sarcoma (A-673 and SK-ES-1), and one-fibrosarcoma (HT-1080) cell lines were used to study RASSF1A gene promoter methylation, using bisulphite conversion of DNA, followed by methylation-specific polymerase chain reaction (PCR)

Results: The RASSFIA’s gene promoter methylation was established as a frequent event. Hypermethylation of RASSF1A promoter, was detected in five out of six studied cell lines.

Conclusions: These results demonstrated that altering the Sav-RASSF1-Hippo may be accomplished through hypermethylation of RASSF1A and may play an essential role in Ewing’s sarcoma and Osteosarcoma. The methylation pattern of Sav-RASSF1-Hippo tumor suppressor pathway in human bone cancer along with RASSF1A expression with its effector proteins merits further investigation. This may reveal how the RASSFIA has a physiological signal transduction, including how the process of its deregulation can contribute to transformation of the cell, eventually leading to the incorporation of novel therapeutic options with improved prognosis for bone cancer.

Effect of intermittent hypoxic intervention on aerobic and anaerobic performance of the elite athletes

2021-08-30T11:09:29+03:00

Objective: The use of hypoxic training has increased to improve the performance of endurance athletes in recent years. Due to not having the suitable conditions and environment for each athlete and team, intermittent hypoxic training has been noted. The purpose of this study is to investigate the effect of intermittent hypoxic training on aerobic and anaerobic performance of elite athletes.

Materials and Methods: A total of 40 elite distance athletes were taken into our study and divided into two groups as hypoxia and normoxia. While using the intermittent intervention for the hypoxic group 5 minutes intervals for a total of 1 hour per day, 3 days per week for a-4 week period, the same normoxic training protocol was used for the normoxic group. Aerobic and anaerobic performance parameters were measured with venous blood samples of the athletes in the first three days before and after hypoxic intervention.

Results: When the hypoxia and normoxia groups were evaluated before and after intermittent hypoxia, there was no statistically change in aerobic and anaerobic performance values (p>0.05).

Conclusion: We observed that there was not a statistical change of intermittent hypoxic intervention for the performances of hypoxic group. However, the more dose and the duration of hypoxic training, the more amount of performance gain can be achieved.

The status of anatomy education in scope of the national core education program 2020: The case of Turkey

2021-08-30T11:09:18+03:00

Objective: Many branches of science are constantly changing and developing according to the innovations and the requirements of the era. Developments and medical information, especially in the field of medicine, renew itself every year. In this study, we aimed to analyze comparatively the place of anatomy education, which has an important place in undergraduate medical education, in the National Core Education Program (NCEP)-2020.

Material and Methods: In this study, the categories of basic medical practices in NCEP-2020, clinical symptoms/findings/situations, core diseases/clinical problems and the relationship between learning levels and anatomy education were evaluated one by one. Parameters were expressed in percentile using a descriptive statistical method. There are 157 Basic Medical Practices in 9 sub-categories (A-I) within the scope of NCEP-2020.

Results: It was determined that 48 of these were related to anatomy education. The number of basic medical practice was mostly in the E sub-category (n=23, 47.92%). The second sub-category with the highest number of basic medical practices was determined as B (n=16, 33.33%).

Conclusion: One of the important conclusions we have reached within the scope of the study is that NCEP-2020 has an important place in terms of scope in determining, developing and standardizing the educational curricula of medical faculties.

Acute pancreatitis and low ascites-serum albumin gradient ascites caused by Brucellosis

2021-08-30T11:09:27+03:00

Objective: Brucellosis is a zoonotic disease seen widely around the world. Although many aspects and treatment of this disease is well known, peritoneal involvement and ascites is not well established so far.

Material and Methods: This study retrospectively enrolled 346 adult patients (aged >17 years) with acute Brucellosis attending Hepatology Clinic, Van Yuzuncu Yil University, between April 2013 and May 2016. Characteristics of those with and without ascites were analyzed using Pearson correlation coefficients and Chi-Square test in SPSS software system.

Results: Of the 346 cases, 20 (5, 7%) had ascites. Those with ascites had significantly higher transaminase, cholestatic enzyme and amylase levels compared to those without ascites.

Conclusions: We conclude that acute Brucella infection can lead to a unique low gradient ascites probably resulting from pancreatic leakage followed by peritoneal accumulation of serum proteins.

The effect of different doeses of aspirin application on oxidative stress in ovarian tissue

2021-08-30T11:09:25+03:00

Objective: Aspirin is a non-steroidal anti-inflammatory drug with antioxidative properties. It is recommended to use different doses and durations according to the characteristics of the patient and the type of disease. Therefore, in this study, we aimed to investigate the effect of using aspirin at different doses and for different durations on oxidative stress in ovarian tissue.

Material and Methods: Female Wistar albino rats were divided into five groups. Group 1: control group, no special treatment was applied to the rats in this group. Group 2: 1 mg/kg aspirin was administered orally to the rats in this group every day for 28 days. Group 3: 3 mg/kg aspirin was administered orally to rats in this group every three days. Ggroup 4: 5 mg/kg aspirin was administered orally to rats in this group every five days. Group 5: 7 mg/kg aspirin was administered orally to the rats in this group once a week. After fasting overnight following the last application, the rats were sacrificed, and their ovarian tissues were collected. Malondialdehyde, catalase, total thiol group, and AOPP levels were studied from ovarian tissue.

Results: Group4 and group5 ovarian tissue MDA levels were found to be significantly higher than the other groups (p<0.05). There was no significant difference between group1, group2 and group3 ovarian tissue MDA levels (p>0.05). Group1 (control group) ovarian tissue AOPP level was found to be significantly lower than all aspirin-administered groups (p<0.05). Group2 ovarian tissue AOPP level was found to be significantly lower than group3, group4 and group5 (p<0.05). TSG level was found to be significantly higher in group 5 when compared to other groups (p0<0.05). Group4 ovarian tissue TSG level was found to be significantly higher when compared to group1, group2 and group3 (p<0.05). Group3 and group4 ovarian tissue CAT activity was found to be significantly higher than group1, group2 and group5 (p<0.05). When group1, group2 and group5 ovarian tissue CAT activities were compared, no significant difference was found (p>0.05).

Conclusion: The application of aspirin at certain intervals rather than daily application may have more positive effects on the antioxidant system. especially taking aspirin at intervals of 3 or 5 days may be more effective

Do depression, anxiety, or stress have any effect on pain scores in patients undergoing colposcopy?

2021-08-30T11:09:22+03:00

Objective: In this study, we evaluated the effect of depression, anxiety, and stress on pain perception during colposcopy.

Material and methods: This study was performed at the gynecologic oncology department of Lutfi Kirdar Kartal Education and Research Hospital in Istanbul, Turkey between September 2017 and January 2018. After taking informed consent, Depression Anxiety and Stress Scale (DASS-42) were completed by women who were attended outpatient colposcopy unit. Patients were classified into three groups according to DASS-42 (Group 1: patients without depression, anxiety or stress; Group 2: patients with one or two of depression, anxiety and stress; Group 3: patients with all of depression, anxiety and stress). Patient characteristics were also recorded. The degree of pain perception was evaluated visual analogue scale (VAS) at the end of the procedure. The p values less than 0.05 were considered statistically significant.

Results: A total of 116 women were enrolled into this study. There was no statistically significant difference between the groups in terms of age, gravidity, parity, number of gynecologic examination, waiting time, BMI, VAS, having a partner, came alone to clinic, level of education, employment, indication of procedure, number of biopsies, ECC presence (p>0.05). There was no difference between the subgroups in terms of VAS. There was negative correlation between groups and VAS (r=-0.195, p=0.036).

Conclusion: According to our findings, depression, anxiety and stress have no impact on pain perception during colposcopy but there is a weak correlation between the absence of depression, anxiety, stress and the pain score.

A retrospective comparative cohort study on the routine pre-engraftment use of granulocyte colony-stimulating factor in allogeneic hematopoietic stem cell transplantation

2021-08-30T11:09:16+03:00

Objective: Myeloid growth factors have been often used in allogeneic hematopoietic stem cell transplantation settings. There are some controversies about increased graft versus host disease, relapse, and delayed platelet engraftment with those growth factors in the pre-engraftment period. In this study, we aimed to compare the transplantation outcomes of allogeneic hematopoietic stem cell transplantation recipients according to their myeloid growth factor support status.

Materials and Methods: Sixty-seven adult acute myeloid leukemia/myelodysplastic syndrome and acute lymphoblastic leukemia patients who underwent allogeneic peripheral blood stem cell transplantation from HLA-identical matched sibling donors were analyzed retrospectively. All-cause mortality at day 100, day 180, and at 1-year were the primary outcome measures. Secondary outcome measures were the engraftment kinetics, length of hospital stay, and graft-versus-host disease incidences.

Results: Growth factor supported group was younger (p=0.001), and the first complete remission status at transplantation was seen more compared to the unsupported group (p=0.04). Myeloablative conditioning was used more in growth factor supported group (p=0.004). Faster neutrophil engraftment (p=0.008) and delayed platelet engraftment (p=0.022) were seen in growth factor supported group. Graft-versus-host disease, relapse incidences, and all-cause mortality at day 100, day 180, and at 1-year were not different between groups. Steroid-resistant graft-versus-host disease was the only factor related with relapse (OR: 0.196, p=0.043).

Conclusion: This real-life study shows colony-stimulating-factors are safe in HLA-identical sibling allogeneic hematopoietic stem cell transplantation. Further prospective randomized controlled studies for different stem cell sources, different donors, and different conditioning and graft-versus-host disease prophylaxis regimens are mandatory.

One Disease, Two Approaches. Acute Post-Streptococcal Glomerulonephritis – A Case Report of Two Young Patients

2021-08-30T11:09:31+03:00

Objective: Acute post-streptococcal glomerulonephritis (APSGN) is the most studied immune-mediated glomerulonephritis, being caused by streptococcal infections such as pharyngotonsillitis or skin infections (impetigo, erysipelas). Globally it is the main form of glomerular suffering among pediatric patients, especially between the ages of 3 and 15, but in the developed countries, the incidence of this condition has decreased significantly in the last decades. The majority of the medical literature indicates that the treatment in such a disease is symptomatic (the major goal being controlling of the edema and hypertension) associated with antibiotics for streptococcal infection. Due to some situations where antibiotic treatment cannot be administered, this case report hypothesized that homeopathy is a possible alternative treatment method for conventional therapy. We presented two cases diagnosed with APSGN: a nine-year-old boy treated homeopathically at home and a three-year-old girl treated conventionally during hospitalization. Analyzing the two cases, we observed that the patients were cured regardless of the therapeutic method approached. This aspect has an advantage in situations where there are limitations in the administration of allopathic treatment. According to homeopathic understanding, the success rate is higher when there are clear homeopathic symptoms for choosing the right remedy. Many more cases and much more research is needed to conclude that classical homeopathy can be a treatment option for this pathology. In conclusion, it is important to find a personalized therapy (allopathy or homeopathy) for each patient that will bring the maximum benefit, depending on the particularity of the case