Medical Science and Discovery

Non-Necrotizing Granulomas in Bone Marrow Biopsy of a Patient with Bicytopenia: Brucellosis Case

2022-04-30T00:43:44+03:00

Objective: Brucellosis has the ability to mimic a variety of multisystem illnesses, exhibiting a wide range of clinical polymorphism that frequently leads to misdiagnosis and treatment delays, thus raising the risk of complications. In cases of brucellosis, hematologic abnormalities might manifest as anemia, leukopenia, thrombocytopenia, lymphomonocytosis, hemolytic anemia, disseminated intravascular coagulation, and pancytopenia.

Material and Methods: In this study, we presented the bone marrow biopsy findings of a brucellosis case.

Case: For ten days, a 19-year-old male patient with fever, exhaustion, weight loss, loss of appetite, and stomach pain was taken to the emergency room. A bone marrow aspiration and biopsy were conducted because of the patient's indications and symptoms. Brucella melitensis was isolated in the blood and bone marrow cultures on the 7th day.

Conclusion: Brucellosis, one of the most common zoonoses in the world and our country, can occur with a wide variety of complications.

A case of Transvaginal NOTES (vNOTES) hysterectomy. Multidisciplinary minimal invasive approach for all aspects

2022-04-30T00:43:39+03:00

Umbilical single-port surgeries developed with advanced technological equipment like flexıble optics and reticulated graspers. Single-port surgeries decreased skin incision and multiple port-site pain concerns.

Case: In this study, a 74-years-old, postmenopausal female had P2G2 descensus uteri, subtotal uterine prolapse. Complaints were about vaginal mass disturbing life quality associated with bladder incontinence. vNOTES Hysterectomy performed. Case: vNOTES Hysterectomy was performed and spinal anaesthesia was used as a regional anaesthesia (RA) for the procedure. vNOTES allow for safe surgery for ovarian and adnexal structures and visual exploration in the abdominal cavity.

Conclusion: vNOTES Hysterectomy allows safe surgery, especially for elderyl and uterine prolapse cases.

Palliative Split-Course pelvic radiotherapy for symptomatic cervical cancer

2022-04-08T12:10:50+03:00

Objective: Palliative pelvic RT effectively relieves significant health issues such as bleeding from the tumor, pain, discharge, or mass effect on the rectum genitourinary tract vessels and nerves in cervical cancer patients. There is no exact conclusion about an ideal palliative radiation treatment dose regimen. Thus we share the results of a commonly used split-course palliative pelvic RT regimen in our hospital.

Material and Methods: For a retrospective study, 9 patients records treated between 2015 and 2019 were reviewed. The dose of prescribed irradiation for the target was 20Gy in 5 daily fractions. An additional 20Gy in 5 fractions was delivered after a 2-week time for recovery. Symptomatic improvement and treatment-related toxicity during and after RT were assessed from handwritten clinician reports.

Results: Vast majority of patients enduring, and rapid symptomatic improvement was observed. Grade 3 to 5 treatment toxicity was not examined. Maximum acute toxicity was grade 1 GI or GU toxicity in 4 patients and G2 in two patients. Three patients had no acute side effects. All patients had complete symptom remission after treatment, one patient did not complete the second course of therapy due to deteriorating performance status, but local symptom relief was achieved.

Conclusion: Split course regimen effectively improved symptoms without significant toxicity. The integrated 2-week break allowed doctors to assess patients for increased dose palliative radiation and balanced therapeutic benefits with possible adverse effects. This regimen is a reasonable strategy for patients who do not tolerate definitive treatment.

Asthma control and treatment steps in Turkish children with Asthma during the COVID-19 pandemic

2022-04-09T12:12:14+03:00

Objective: Since viral infections are one of the most important factors affecting asthma control, various precautions and recommendations for asthma patients came to the fore at the beginning of the COVID-19 pandemic. In our study, we aimed to evaluate the effects of the COVID-19 pandemic on asthma control and treatment steps of children with asthma.

Materials and Methods: The date of March 11, 2019, was accepted as the beginning of the pandemic. The application deadline to our outpatient clinic of patients within one year after the onset of the pandemic (AOP) was determined. After that, the period of the same season before the beginning of the pandemic (BOP) was determined. We recorded the asthma treatment steps, asthma control test (ACT) scores, and the number of applications to our outpatient clinic during the BOP and AOP periods of the patients.

Results: In our study, 384 patients, 64.8% of whom were male, with a median age of 11 years, were evaluated. SARS-CoV-2 PCR positivity was detected in 6 (1.6%) patients. BOP, patient treatment steps, and the number of outpatient clinic applications were higher (p <0.001). AOP, there was no significant change in ACT scores (p = 0.059). Whereas asthma control was worse in patients susceptible to house dust mite (p = 0.01).

Conclusions: Although measures such as home quarantine and mask use have been reported to have positive effects on asthma control, increased exposure to house dust mites in susceptible patients may pose a risk of uncontrolled asthma.

Evaluation of postpartum depression and maternal attachment scale in a low socioeconomic level region: How was it affected during the Covid-19 pandemic period?

2022-04-12T12:13:22+03:00

Objective: We aimed to investigate the frequency of Postpartum Depression (PPD) and maternal attachment status in a region with a low socioeconomic level during the Covid-19 pandemic.

Materials and Methods: Two hundred women who gave birth in our hospital were evaluated on postpartum 10th day with Edinburgh Postnatal Depression Scale (EPDS) and Maternal Attachment Inventory (MBI).

Results: The mean EPDS in the group with Normal Body Mass Index (BMI) was lower than in the other two groups. Average EPDS was higher in the group with sleep problems than those without sleep problems. Women who received support from their spouses had lower EPDS scores and higher MBI scores. EPDS scores were lower in the group with a good income. MBI scores were found to be lower in people within the increased length of hospital stay.

Conclusion: In the study, we conducted with a group with a low socioeconomic level during the pandemic. We determined that PPD rates increased considerably, and this situation

Short term blood pressure variability and diastolic function in middle-aged normotensive individuals

2022-04-12T12:13:36+03:00

Objective: Blood pressure variability (BPV), a non-conventional blood pressure parameter, has been shown to contribute hypertensive target organ damage but its association with diastolic dysfunction is unknown. The present study investigates the association of BPV and left ventricular diastolic dysfunction (LVDD) in middle-aged normotensive individuals.

Materials and Methods: 264 normotensive patients aged between 45 and 65 were enrolled. 24-hour ambulatory blood pressure monitoring were performed and BPV was defined as the standard deviation of systolic blood pressure measurements. Patients were divided into 3 groups according to BPV tertiles. Echocardiographic and tissue doppler diastolic function parameters were compared among the groups.

Results: Mean age of the patients were 50.41 and similar among groups. Mitral inflow E/A (Tertile 1 vs 2 vs 3: 1.10[0.33] vs 1.05 [0.22] vs 1.02 [0.30], p=0.02) and average tissue doppler mitral annular E’ velocity (12 [2] vs 10.5 [1.85] vs 10 [1.55], p=0.02) were highest in the tertile 1 and lowest in the tertile 3. Average E/E’ (Tertile 1 vs 2 vs 3: 7.2 [2.2] vs 8.1 [3.2] vs 9.3 [2.9], p<0.001) was lowest in the tertile 1 and highest in the tertile 3. In addition, there was a positive correlation between BPV and Average E/E’ (R_s =0.401, p<0.001). In contrary, E/A (R_s =- 0.286, p<0.001) and average E’ (R_s =- 0.451, p<0.001) were negatively correlated with BPV.

Conclusion: BPV is positively correlated with average E/E’ and negatively correlated with E/A and average E’. Further studies are required to elucidate the relationship of BPV and LVDD.

Role of the inflammatory activity in haemodialysis patients with COVID-19

2022-04-14T12:14:03+03:00

Objectives: It is known that haemodialysis (HD) patients are older and have more co-morbidities, and therefore they are very susceptible against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Inflammatory activity plays an important role in coronavirus disease 2019 (COVID-19), and the intensity of inflammatory response makes the severity of COVID-19 worse. Biomarkers related to infection such as procalcitonin (PCT), C-reactive protein (CRP), ferritin, albumin, troponin I, D-dimer, white blood cell (WBC), neutrophil, lymphocyte, and platelet play an important role in the inflammatory response of COVID-19. Our objective is to compare these biomarkers between healthy individuals with COVID-19 (HI-COVID-19) and haemodialysis (HD) patients (HP-COVID-19).

Methods: 50 patients diagnosed with COVID-19 were included in this cross-sectional and monocentric retrospective study. The population of this study was separated into two groups: Group 1 consisted of HI-COVID-19 (n=27), and Group 2 consisted of HP-COVID-19 (n=23). Demographic data, basic clinical characteristics, and laboratory tests were recorded during the application. Group 2 participants were chosen from those whose biomarkers such as ferritin (<200 ng/mL), CRP, PCT, ferritin, albumin, D-dimer, troponin I, WBC, neutrophil, lymphocyte, and platelet were within the normal range three months before (prior to having COVID-19).

Findings: When Group 2 and Group 1 were compared in terms of gender, age, presence of lung uptake, and fever, there was no difference. Five HP-COVID-19 patients lost their lives. There were no deaths in the other group. There was a statistically significant difference. Comorbid diseases such as diabetes mellitus (DM), coronary artery disease (CAD), and hypertension (HT) were significantly higher in Group 2. It was observed that CRP, PCT, troponin I, D-dimer, and ferritin from biochemical parameters were higher in Group 2, and platelet and albumin were higher in Group 1. Although WBC and neutrophil elevations and low lymphocytes were detected in Group 2, it was statistically not significant. Tocilizumab and convalescent plasma use were significantly higher in Group 2.

Conclusions: The strength of inflammatory activity in HP-COVID-19 can be estimated by observing serum levels of biomarkers such as CRP, PCT, ferritin, albumin, D-dimer, troponin I, WBC, neutrophil, lymphocyte, and platelet.

Evaluation of Efficacy and Failure of High Flow Nasal Cannula Therapy in Paediatric Emergency Service and Paediatric Intensive Care Unit

2022-04-06T01:02:27+03:00

Objective: High-flow nasal cannula oxygen therapy (HFNC) improves gas exchange and decreases work of breathing in patients with acute respiratory distress. We aimed to discuss the indications for HFNC in children of all ages and diagnoses and to evaluate the efficacy and risk factors for failure of HFNC therapy in children with acute respiratory distress and failure in a paediatric emergency service and paediatric intensive care unit (PICU).

Material and Methods: A total of 191 patients aged one month to 18 years treated with HFNC between October 1, 2018, and July 1, 2020, in the Paediatric Emergency Service and PICU were included in the study. Demographic and clinical characteristics, underlying chronic diseases, HFNC treatment success, and treatment failure of the cases were recorded.

Results: One hundred ninety-one children were included in the study, of whom 70 (36.6%) were female, and the median age was 13 months (1-204). The most common indication of HFNC treatment was bronchopneumonia (n=83, 43,5 %). HFNC treatment succeeded in 81.7 % (n=156) of the patients. It was observed that the two most successful patient groups were acute bronchiolitis and pneumonia. The failure rate was 18.3 % (35 of 191 children). The most common underlying comorbidity was bronchopulmonary dysplasia (BPD) (19, 9.9%). There was a statistically significant difference seen on Glasgow Coma Scale (GCS) and lactate value in blood gas in the first hour of the treatment in the group with unsuccessful results (p<0.05). During the HFNC treatment, 28 patients (14.7%) required invasive mechanical ventilation (IMV), and seven patients (3.7%) required non-invasive mechanical ventilation (NIMV).

Conclusion: HFNC is a reliable non-invasive treatment modality that is easily tolerated by children and has effective use in many critical diseases. Our study found that HFNC therapy could be initiated as the first-line therapy for various aetiologies of acute respiratory distress in a paediatric emergency service and PICU and all age groups. It was emphasized that transition to other treatment modalities should not be delayed in the cases predicted to be unsuccessful.

Factors affecting preoperative sleep quality in patients undergoing myomectomy and hysterectomy

2022-04-21T12:20:52+03:00

Objective: In this study, preoperative subjective sleep quality (SP) and the factors which affect the SP were investigated in patients who underwent myomectomy and hysterectomy.

Material and Methods: A total of 172 patients were included in the present study; 67 patients undergoing myomectomy and 105 undergoing hysterectomies were evaluated. Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were used preoperatively to evaluate subjective sleep quality, anxiety, and depression, respectively. The patients were classified into two groups according to sleep quality score: good quality (PSQI ≤ 5) and poor quality (PSQI > 5).

Results: Overall, 56.4% of patients reported poor sleep quality with a PSQI score > 5. The total PSQI score, BAI score, subjective sleep quality, sleep latency, sleep duration, sleep disturbances, and the use of sleeping medication of the patients undergoing hysterectomy were significantly higher than those undergoing myomectomy (p < 0.05). Age (odds ratio [OR] = 1.082; 95% confidence interval [CI], 1.012–1.157; p = 0.021), operation type (OR = 1.071; 95% CI, 1.015–1.149; p = 0.035), and BAI score (OR = 1.097; 95% CI, 1.073–1.294; p = 0.001) were significantly associated with poor sleep quality. Logistic regression analysis showed that age, the BAI score, and the type of surgery were significantly associated with poor sleep quality.

Conclusion: The preoperative sleep quality of patients was significantly associated with the surgical procedure, patient age, and patient anxiety. Preoperative sleep quality of patients who underwent hysterectomy was worse than those who underwent myomectomy.

The effect of previous SARS-Cov-2 infection positivity on Gynecological Surgery: A Tertiary Hospital Experience

2022-04-26T12:24:04+03:00

Objective: The study aimed to investigate whether a history of preoperative SARS-CoV-2 infection differs in terms of peroperative complications and prognosis in patients who had undergone gynecological surgery in the last one year compared to patients who did not.

Materials and Methods: This retrospective case-control study included 632 patients who underwent laparotomic, laparoscopic, urogynecological and oncological surgeries for various indications between July 2020 and July 2021. The patients were divided into two groups according to positive and negative SARS-CoV-2 RT-PCR (Real-time Polymerase Chain Reaction) test results performed preoperatively. The two groups were compared in terms of demographic characteristics, the operation performed, the type of anesthesia applied during the operations, the status of blood transfusion, operation and hospitalization times, and intraoperative and postoperative complications.

Results: While 5.5% (n=35) of the patients had positive SARS-CoV-2 RT-PCR test results in the preoperative period (group 1), 94.5% (n=597) had negative SARS-CoV-2 RT-PCR test results preoperatively. The following parameters, including age, body mass index (BMI), gravida, parity, number of smokers, and number of patients with the comorbid disease, were similar between the two groups. Moreover, no difference was detected in terms of mean hospitalization time, mean operative time, and the number of patients with intraoperative-postoperative complications between the two groups. However, there was a significant difference between the groups in terms of blood product transfusion requirement [0 patients (0%) vs. 55 patients (9.2%) (p=0.05)].

Conclusion: History of SARS-CoV-2 infection in gynecological surgery does not affect intraoperative and postoperative complications except blood product transfusion requirement.

Medical providers should return the medical data ownership to the patient – a blockchain ledger solution. Opinion.

2022-04-30T00:43:36+03:00

Objective: Patients who paid for data generation, either privately or by public insurance or taxation systems, don't keep and don't have easy access to their health records. Furthermore, centralized databases that govern Big Data of health records are vulnerable to hostile breaches. Therefore, the current practice of medical data accumulation and sharing can potentially interfere with the fundamental personal rights of ownership, even endanger patients' health on one side, and provide uncompensated profit to third parties.

Material and Methods: The technical solution to this inherent problem might be storing personal medical data on the blockchain platform.

Conclusion: This method can decentralize the data accumulation, provide a high level of security of the collected data, and immutability of the stored data.