Medical Science and Discovery

The relationship between metabolic stress and Anti- Müllerian hormone (AMH) in women hospitalized in intensive care units

2023-09-01T05:11:39+03:00

Objective: Our study aimed to investigate the levels of anti-Müllerian hormone (AMH) to determine ovarian reserve in women in intensive care units experiencing metabolic and physiological stress.

Materials and Methods: For this purpose, 37 women were hospitalized in the intensive care unit (ICU) of Siirt Training and Research Hospital between November 2022 and February 2023. The same number of healthy control groups were included in the study. Patient selection was based on acute physiology and chronic health assessment (APACHI II) score and injury severity score (ISS).Anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) thyroid stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4), adrenocorticotropic hormone (ACTH), cortisol. , prolactin, C-reactive hormone (CRP) serum levels were examined

Results: There was no significant difference in mean age between intensive care patients (29.3±8.3 , n=37) and control group (28.0±0.0, n=37) (p=0.349). A statistically significant difference was found between the AMH values between the patients hospitalized in the intensive care unit and the control group (p=0.012).AMH values were significantly lower in ICU patients. However, the T3 value was observed to be significantly lower in ICU patients compared to the control group (p < 0.0001). Additionally, prolactin, CRP, and cortisol values were found to be statistically significantly higher.

Conclusion: This study revealed a significant decrease in anti-Müllerian hormone (AMH) levels among women experiencing metabolic and physiological stress in intensive care units. The lowered AMH levels suggest a potential impact on ovarian reserve in such conditions. Additionally, the observation of reduced T3 levels in ICU patients could indicate thyroid function alterations during times of stress. The elevated prolactin, CRP, and cortisol levels further underscore the physiological disruptions experienced by ICU patients. These findings emphasize the importance of considering hormonal and metabolic changes in critically ill women, particularly in relation to their ovarian health. Further research is warranted to elucidate the intricate mechanisms underlying these hormonal alterations and their potential long-term implications.

Assessment of HPV Vaccine Knowledge Levels Among Medical Faculty Students: A Comprehensive Examination in the Turkish Context

2023-09-01T05:11:29+03:00

Objective: The primary objective of this study was to measure medical students' knowledge, attitudes, and future professional intentions regarding HPV and its vaccines. This study aims to identify the factors that impact these variables within Turkey's distinctive sociocultural and healthcare landscapes. The insights derived from data analysis can be employed to guide focused educational interventions, aiming to enhance HPV vaccination rates and mitigate HPV-related health outcomes in Turkey.

Material and Methods: Carried out between November and December 2022, this study employed a descriptive and comparative research design to evaluate HPV-related knowledge, attitudes, and intentions among 687 medical students enrolled in the Medical Faculty of Afyonkarahisar Health Sciences University. A comprehensive 20-question survey was administered, covering demographic details, HPV awareness, and attitudes towards vaccination, followed by statistical analysis.

Results: The study population exhibited a mean age of 20.6 years and was predominantly female (60.1%). Overall, 91.6% of the participants were aware of HPV, primarily through their medical education (52.1%) and social media (42.3%). However, only 3.5% of the patients were vaccinated against HPV. Factors influencing vaccine uptake included having close contacts diagnosed with HPV or cervical cancer (p=0.001), gender (p=0.01 for females, p=0.02 for males), and prior HPV awareness (p=0.03). Significant misconceptions existed, notably regarding HPV's association with specific cancers and the vaccine's inclusion in the regular schedule.

Conclusions: According to our study, medical students' attitudes and knowledge about HPV and HPV vaccination are critically important for future healthcare providers and policymakers. HPV-related cancers beyond cervical cancer are poorly understood, and vaccine counselling training is inadequate. Students who had been in close contact with HPV or cervical cancer exhibited a significantly higher likelihood of receiving the vaccine. It is crucial to formulate focused educational strategies that enhance HPV vaccine adherence and provide future medical professionals with the skills to educate patients effectively.

Assessing the relationship between Tooth Heavy Metal Deposition and Periodontal Disease in Smokers and Non-Smokers

2023-09-01T05:11:49+03:00

Objective: Heavy metals threaten life by accumulating in the body via various sources as water,air and foods. Smoking is one of the important factors that causes this problem. Despite there is an abundant number of studies showing the detrimental effects of smoking on periodontal health, the mechanisms that cause these harmful effects is not clearly known yet. The main aim of our study is to discover whether heavy metal deposition on the tooth surface is related to the disease-causing potential of smoking.

Materials and Method: Total of 80 individuals consist of 43 women and 37 men were included in this study. The participants were divided into 4 groups of 20 individuals each according to the results from clinical examination and anamnesis. Plaque index, gingival index, pocket depth, bleeding on probing and clinical attachment level were recorded clinically. The teeth indicated for extraction were collected. Cd, Pb, Ni, Cr and Fe depositions on teeth were measured by ICP-OES device. Kolmogorov-Smirnov, Student T, Mann Whitney U, One way ANOVA, Kruskal Wallis, Ki-Kare, Pearson, and Spearman tests were performed for the statistical analysis.

Results: Smoking increases the accumulation of heavy metals such as Cd, Ni, Cr, and Pb. The Pb level was higher in both the smoking group and the periodontitis group, compared with the control group. Fe levels were found high in the non-smoking healthy group. Cr and Fe levels were found higher in women while Cd level was higher in men. Positive correlations were found between Pb and plaque index, gingival index, pocket depth and bleeding on probing; and also between Ni and plaque index. ( p=0.000, p=0.009, p=0.025, p=0.011, p=0.019)

Conclusion: In conclusion, our study explored the connection between heavy metal deposition on tooth surfaces and the disease-causing potential of smoking. Smoking has been identified as a significant factor in the increased accumulation of heavy metals, including Cd, Ni, Cr, and Pb. The higher Pb levels seen in both the smoking and periodontitis groups, compared to the control group, suggest a potential link between Pb accumulation and periodontal health. Additionally, differences based on gender were observed, with women showing higher Cr and Fe levels, while Cd levels were more elevated in men. The positive correlations between Pb and various periodontal indices, along with the correlation between Ni and plaque index, shed light on the potential influence of heavy metal deposition on periodontal health. While our findings enhance our understanding of the interplay between smoking, heavy metal deposition, and oral health, further research is needed to fully comprehend the underlying mechanisms. Such insights could lead to interventions aimed at minimizing the adverse effects of heavy metal accumulation on oral health.

Exploring the Interplay of Hypoxia-Inducible Factors: Unveiling Genetic Connections to Diseases Through Bioinformatics Analysis

2023-09-02T05:11:35+03:00

Objective: Hypoxia-inducible factor (HIF) is a transcription factor that is effective in the ability of cells to sense and adapt to changes in oxygen levels. HIF1α gene is located in the 14q23.2 chromosome region and consists of 15 exons and 14 introns. It is a transcriptional regulator of metabolic processes such as angiogenesis and erythropoiesis and is required for immunological responses.

Material and Methods: Our study examined the function of HIF1α and its relations with other genes and diseases using various bioinformatics database tools. GENEMANIA/GeneCard databases were used to detect the relationship of HIF gene with other genes, miRDB to show target miRNAs, STRING to detect protein-protein interaction, and GWAS databases to show its relationship with diseases. In addition, organs and tissues in which it is expressed were determined using the UniProt database.

Results: The bioinformatic analysis yielded significant results, revealing that 189 miRNAs target HIF1α and exhibits close interactions with 10 genes, among which important genes like STAT3, MDM2, TP53, SMAD3, and VHL were identified. The most predominant pathway utilized by the HIF1α gene was determined to be the HIF-1 signaling pathway. A co-expression relationship was also established with proteins EPO, PLIN2, BNIP3, and the enzyme ENO1. Furthermore, it was ascertained that HIF1α exhibits the highest expression levels in the kidney and the perivenous region of the liver. Moreover, close associations have been established between HIF1α and diseases such as renal cell carcinoma and bladder cancer.

Conclusion: Identifying the pathways associated with HIF1α, other genes, and epigenetic factors with the help of Bioinformatics Tools may enable experimental studies to be carried out with large cohorts and using a broad perspective. Thus, it may contribute to our understanding of how this gene affects diseases and anomalies and to accelerate the studies of targeted therapeutic treatment.

Organ and Cadaver Donation; Student Opinions from Different Cultures.

2023-09-02T05:11:54+03:00

Objective: Despite organ donations, the need for organs is increasing daily, and efforts to increase organ donation continue without slowing down. Cadaver donation, necessary for medical education, is an issue waiting to be supported worldwide. In our study, a questionnaire was applied to measure the knowledge and attitudes of Turkish and international students toward organ and cadaver donation.

Material and Methods: A total of 305 students, including 236 Turkish citizens and 68 international students, participated in the study. Students accessed the prepared questionnaires via a Google form.

Results: It was determined that there was a statistical difference between Turkish and international students regarding their knowledge about organ donation compared to cadaver donation (Turkish students 78.8 % (n=186) yes, international students 57.,4 % (n=39) yes). In the social circles of Turkish and international students, organ donations were more common than cadaver donations, and a statistically significant difference was found for both groups (Turkish students 42.8 % (n=101) yes, international students 48.5 % (n=33) yes). The reasons for donating their bodies (Turkish students 48.3% (n=114) ''For use in organ transplantation'', international students 35.3 % (n=24) ''Because your body is useless after death and decays''), and organs (Turkish students 35.6 % (n=84), international students 32.4 % (n=22) ''For use in organ transplantation'') of Turkish and international students differed significantly.

Conclusion: Based on the answers given by the students, it has been concluded that donations will increase when information is provided about the importance of organ and cadaver donation.

The Prognostic Nutritional Index in prediction of two-year mortality in patients undergoing Transcatheter Aortic Valve Replacement

2023-09-02T05:11:44+03:00

Objective: Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure employed to treat aortic valve disease in patients who are ineligible for open-heart surgery. Undergoing TAVR patients generally include the elderly and frail. Malnutrition is associated with high morbidity and mortality in patients with undergoing TAVR. The aim of this study was to investigate the prognostic value of the prognostic nutritional index (PNI) for two-year survival after TAVR.

Material and Methods: A cohort of 213 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve replacement between March 2019 and July 2021. The study population was divided into two groups according to the cut-off PNI level in a receiver operator characteristic (ROC) curve analysis. The two-year follow-up results of the patients were recorded retrospectively. PNI was defined according to the following formula: PNI = (10 x serum albumin [g/dl]) + (0.005 x total lymphocyte counts [1000/mcL]).

Results: Mean age of the patients was 76.15, and 93 (43.7%) of them were males. Patients with low PNI (group 1) were significantly older. The mean PNI of group 1 was 43.17 ± 4.04 and the mean PNI of group 2 was 54.23 ± 4.30. Mortality at two-year was 32.6% in low PNI group and 10.7% in high PNI group. Hypertension and PNI were independent predictors of mortality after TAVR. In ROC curve analysis, PNI at a cut off value of 48.325 predicted the mortality after TAVR with 63.5% sensitivity and 70.1% specificity. Kaplan-Meier curves for two-year mortality between low and high PNI groups showed worse outcomes in patients with low PNI.

Conclusion: PNI is a practical and useful nutritional index that predicts two-year mortality after TAVR.

Total Knee Arthroplasty: The Impact of Tourniquet Usage on Cement Penetration, Operation Time, and Bleeding Control

2023-09-06T05:15:16+03:00

Objective: The cementing technique employed in total knee arthroplasty (TKA) significantly influences the penetration of cement into the bone, ultimately affecting the stability of the joint. This study aimed to assess the impact of tourniquet usage on tibial cement penetration, operative time, bleeding, and functional outcomes following TKA.

Materials and Methods: A retrospective evaluation was conducted on 103 patients who had undergone TKA and had a minimum follow-up period of 2 years. The patients were categorized into three groups: Group 1 utilized a tourniquet throughout the entire surgery, Group 2 released the tourniquet immediately after prosthesis implantation, just before cement hardening, and Group 3 did not employ a tourniquet at any stage of the procedure. Tibial cement penetration was assessed via X-ray examination, following the Knee Society Scoring System criteria. Operative time, bleeding levels, and Lysholm and Oxford scores were compared among the groups. Statistical analysis was performed using SPSS version 22.0 software.

Results: In Group 1, bone penetration of cement was significantly higher than in both Group 2 and Group 3, except for zone 1 in the anterior-posterior (AP) view (p < 0.017). Group 3 exhibited significantly less bleeding compared to the other groups (p < 0.017). There was no significant difference in terms of bleeding between Group 1 and Group 2. The operation time was significantly shorter in Group 1 compared to the other groups (p < 0.017). The mean cement penetration depth across all groups was measured at 2.44 ± 0.27 mm. Bleeding volume and operation time did not have a significant effect on mean cement penetration (p > 0.05). Additionally, there were no significant differences observed between the groups in terms of the Lysholm and Oxford functional test results (p > 0.017).

Conclusions: The use of a tourniquet was found to increase cement penetration and reduce operation time; however, it did not have a significant impact on reducing bleeding. Based on our findings, we recommend considering a shorter tourniquet time and implementing effective bleeding control measures to mitigate potential complications associated with tourniquet usage.

Exploring Burnout and Depression Among Oncology Physicians: Impacts and Preventive Measures

2023-09-06T05:15:27+03:00

Objective: Our study aims to evaluate the depression and burnout states (according to their sociodemographic characteristic) of Turkish Oncology Physicians (both medical and radiation oncologists) who follow up and treat oncology patients.

Materials and methods: Actively working radiation oncology practitioners (n:267)who completed the questionnaire voluntarily were included to the study. A 13-item personal information form was prepared to determine the participants' sociodemographic characteristics. Data were transferred to the IBM SPSS Statistics 23 program using the Maslach Burnout Inventory (MBI), Beck Depression Inventory (BDE).

Results: A statistically significant relationship (with both positive and high levels) was found between the beck depression scale score and the emotional exhaustion subscale while a statistically significant association (with bothpositive and middle levels) was found between the Beck depression scale score and the depersonalization subscale, and a statistically significant relationship (with both positive and low levels) was found between the beck depression scale score and the personal success subscale (p<0,05).

Conclusion: In our study, depression status and burnout presence were detected in the doctors working in the field of oncology. It is important to take precautions before entering depression and before burnout begins. As a result, the quality of life for physicians will improve, leading to enhanced diagnoses and treatments for cancer patients, as well as fostering positive relationships with both patients and their families

Determination of Lesion Localization with Intraoperative Gamma Probe in the Presence of a Primary Parathyroid Lesion with Early Wash-Out in Radionuclide

2023-09-03T21:47:20+03:00

Objective: In this research, we aimed to evaluate the success of the minimally invasive surgical method performed with intraoperative gamma-probe despite early wash-out in solitary primary parathyroid lesions and to contribute to the literature on this subject.

Methods: This retrospective study included 48 adult patients diagnosed with hyperparathyroidism, with an average parathormone value of 105 pg/mL (range: 82-127 pg/mL). Radionuclide imaging was conducted using Tc-99m sestamibi and Tc-99m-pertechnetate. Minimally invasive surgery with an intraoperative gamma probe was planned for patients with primary parathyroid lesions and surgical indications. At the conclusion of the operation, count equalization was observed in all four quadrants.

Results: Minimally invasive surgery was performed on 42 patients with the assistance of an intraoperative gamma probe. In 6 patients, the procedure was extended to conduct a four-gland exploration due to early wash-out. Each patient had one pathological lesion removed, all of which were histopathologically confirmed as parathyroid adenomas. Among the 6 patients with extended surgeries, 4 experienced early wash-out, and all 6 had been diagnosed with multinodular goiter.

Conclusion: In cases with primary hyperparathyroidism, it is aimed to remove the pathological lesion with minimally invasive surgery and leave the glands that continue their normal function in place. Preoperative localization methods help the surgeon in this regard, but pathologies in the surrounding tissue can reduce the success of minimally invasive surgery.