Medical Science and Discovery

Demographic and clinical characteristics of traumatic shoulder dislocations in an eastern Anatolian city in Turkey: A retrospective single-centre analysis of 181 patients

2021-05-28T14:46:59+03:00

Objective: This study aims to investigate demographic and clinical characteristics of traumatic shoulder dislocations in an Eastern Anatolian city (Muş) in Turkey.

Material and Methods: Digital patient database was reviewed to identify the glenohumeral shoulder dislocations admitted to the emergency department between January 2017 and December 2018. Incidence, demographics, recurrence, associated injuries, and mechanism of injury were evaluated.

Results: One hundred and eighty-one patients (140 males, 41 females; mean age: 39.98±20.41 years) experienced traumatic shoulder dislocation during the study period. The incidence was 18,9 per 100,000 person-years. Age distribution peaked between 21 and 30 (94.5% male) and between 61 and 70 years. Primary shoulder dislocation occurred in 153, recurrent dislocations in 28, and anterior dislocations in 177 patients. The mechanism of injury included falls in 144 and sports injuries in 18 cases. The reduction was achieved in 154 patients in the emergency department.

Conclusion: The incidence of traumatic shoulder dislocations in Muş was higher than the study conducted in Turkey but similar to those in Europe, the UK, and the USA. Risk factors included young age (21-40) and participation in sports in men but fall and being in the 6th decade in women.

A Comparison of vitamin D deficiency with neutrophil lymphocyte ratio and CRP levels in Covid-19 patients

2021-05-28T14:46:43+03:00

Objective: Objective: We aimed to evaluate the association of neutrophil-lymphocyte ratio (NLR) and C reactive protein (CRP), ferritin, sedimentation levels with vitamin D concentrations in Covid-19 patients and to investigate their effect of levels on Covid-19 patients.

Materials and Methods: Forty-six patients aged 18-85 were included in our study. Our study is a retrospective study. Patients were divided into 2 groups with the first group consisting of those with vitamin D level 20 and below and 2nd group consisting of those with vitamin D level above 20. After Vitamin D, CRP, neutrophil, and lymphocyte values were retrospectively investigated with the hospital database, vitamin D levels were compared to CRP and neutrophil/lymphocyte ratio.

Results: A positive correlation between CRP and SED, CRP and ferritin, NLR, and ferritin was observed in Covid-19 positive patients with Vitamin D level > 20. A positive correlation between NLR and CRP was observed in Covid-19 positive patients with Vitamin D level ≤ 20.

Conclusion: In patients with Vitamin D levels >20, there was a significant correlation between vitamin D and NLR and a moderate correlation between Vitamin D and CRP. In patients with Vitamin D levels <20, there was a positive correlation of Vitamin D with CRP and NLR.

Is There A Relationship Between The Umbilical Cord Coiling Index And Oxidative Stress Markers And SGA Fetuses?

2021-05-28T14:46:48+03:00

Objective: We aimed to investigate the relationship between umblical coiling index and thiol/disulfide balance in SGA newborns to compare with AGA newborns.

Material and Methods: Fetal umbilical cord serum samples were collected during labour and the thiol/disulfide homeostasis was measured. After birth, umbilical cords were collected and cord parameters were examined including, length, number of coils, umbilical cord index.

Results: Significant decrease in native thiol, total thiol, and a significant increase in disulfide, disulfide/native thiol ratio and disulfide/total thiol ratios were observed in the study group while native thiol/total thiol ratio levels of the two groups did not reach to a statistical significance.

Conclusion: The results of this study showed that SGA babies had altered thiol homeostasis in favor of oxidative stress.

Determination of scatter radiation to the breast during lumbosacral x-ray examination using thermoluminescence dosimeter

2021-05-31T00:38:19+03:00

Objective: Exposure to ionizing radiation during radiographic examination is associated with some biological effects. The study was aimed to determine the amount of scatter radiation to the breast during lumbosacral x-ray examination.

Materials and Methods: The study was a prospective, cross-sectional study carried out among 60 women referred for Lumbosacral spine radiography from September 2019 to December 2019. Ethical approval was granted by the hospital ethical committee. A single-phase mobile X-ray unit was used to dispense the radiation while a thermoluminescent dosimeter (TLD) chip was used to measure the radiation dose. The TLD chip was attached to the peri-areolar region of the left breast and held in place by a transparent adhesive tape. The TLD was carefully enclosed in a black polythene sachet before and after the investigation to shield it from background radiation. After the investigation the TLD,s were sent to the Centre for Energy Research and Training (CERT) for reading and annealing.

Results: The mean age and BMI of participants were 55.32±12.35years and 29.70±7.09kg/m2 respectively. The cumulative mean (±SD) ESD to the breast was 3.87±0.87mGy. The highest scatter radiation dose was observed in the age group 60-69 years. Pearson’s correlation showed a week correlation between age and ESD.

Conclusion: The study showed that there were scatter radiations to the breast during lumbosacral X-Ray investigations which was was lowest among the age group 50-59years. No significant difference was seen between AP and lateral positions. The cancer risk was 1 in 6,000 indicating that there might be needed to shield the breast while performing lumbosacral X-ray.

Clinical Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Liver Transplantation

2021-05-28T14:46:54+03:00

Objective: Liver transplantation has been reported to be a predictor of patient survival in acute coronary syndrome and various malignancies, including hepatocellular carcinoma (HCC). In a previous study, it was demonstrated that high Platelet-to-Lymphocyte Ratio (PLR) values before treatment are an independent prognostic factor predicting poor survival in patients with large HCC. We aimed to investigate whether preoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and thrombocyte count are prognostic factors for posttransplantation mortality or graft function in patients who underwent liver transplantation in the clinic.

Material and Methods: The data of 40 patients who underwent liver transplantation in the clinic during January 2018–December 2020 were retrospectively analyzed and included in the study.

Results: The mean age of the 40 patients included in the study was 51.1 ± 11.7 years. Of these, 27 (67.5%) were male, and 13 (32.5%) were female. Living-donor liver transplantation was performed in 33 patients, whereas cadaveric liver transplantation was performed in seven patients. The mean ejection fraction (EF) was 56.7% ± 3.2%, and the mean model for end-stage liver disease score was 22.4 ± 5.4. After one year of follow-up, 10 out of 40 patients (25%) died after orthotopic liver transplantation. The mean preoperative neutrophil count was found to be 5.7 ± 2.4 × 109/l in non-surviving patients and 3.1 ± 2.05 × 109/l in surviving patients. It was found that mortality increased in patients with high preoperative neutrophil values (NLR > 3.7, p < 0.001) and preoperative platelet count (<79.52 × 109/L, p < 0.001).

Conclusion: Preoperative neutrophilia, thrombocytopenia and high NLR values may predict poor prognosis in patients undergoing OLT.

Do we need to enlarge emergency services or new emergency hospitals?

2021-05-28T14:46:52+03:00

Objective: It was aimed to obtain a notion about the needed hospital bed capacity by analyzing the number of hospitalizations and referrals from the ER in this study.

Material and Method: This study is a retrospective, analytical cross-sectional research. Patients admitted to a tertiary hospital’s adult emergency service in 2018-2019, hospitalized, or referred to another hospital were analyzed.

Results: Of the patients, 28036 were hospitalized; furthermore, this number corresponded to 38.4 patients per day. Of these cases, 15303 (54.6%) were male, and the mean age was 57.89 (±19.5); 8438 cases (30.1%) were admitted to the intensive care unit. The department with the most hospitalizations was internal medicine with 6105 patients (21.78%) and cardiology, with 4822 hospitalized, the most intensive care patients; moreover, psychiatry had the most prolonged length of stay service average of 28 days. The number of patients required to be hospitalized from the emergency room was an average of 48.5 patients per day. The average hospital stay was seven days.

Conclusion: Mainly in regions with several emergency admissions, it can be considered to establish emergency hospitals that serve particularly emergency cases to engage the number of patients to be hospitalized from the emergency room.

A rare cause of breast masses in childhood: ALK positive anaplastic large cell lymphoma

2021-05-28T14:46:46+03:00

Objective: Non-Hodgkin's lymphomas (NHLs) are the result of malign proliferation of lymphoid cells. According to the morphological, immunological and genetic characteristics of childhood NHLs, they are classified as Burkitt lymphoma (BL), Lymphoblastic lymphoma (LL), diffuse large B-cell lymphoma (DLBCL) and anaplastic large cell lymphoma (ALCL). Anaplastic large cell lymphoma is a distinct form of non-Hodgkin lymphoma (NHL) which accounts for 15% of all childhood lymphomas. We report a girl presented with a breast mass and diagnosed with systemic ALCL.

Case: A 14-year-old girl was referred to our hospital with without a painless mass in the left breast. Physical examination, it was seen two painless mass was found in the left breast. Also, a 2x2 cm, painless lymphadenopathy was found in the left axilla. She had no systemic symptoms In laboratory tests; hemoglobin, white blood cell count, platelet count, liver and kidney function tests, LDH, and uric acid levels were normal. In the imaging and metastasis screenings made to the patient; ultrasound and computed tomography (CT) showed two masses breast region. A large number of lymphadenopathies were detected in the left axillary, which surrounded the paraaortic, the paracaval, and the celiac truncus. She was found to have a hypermetabolic two masses in the breast (SUVmax=33.05) and lymphadenopathies (SUVmax=27.04) in the left axillary, paraaortic, the paracaval, and the celiac truncus on Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) scan. Excisional biopsy of the tumor mass in the breast was done and immunohistochemical analysis showed CD30 and anaplastic lymphoma kinase (ALK) positive ALCL. The patient was diagnosed with stage III anaplastic large cell lymphoma with systemic involvement and she began chemotherapeutic treatment, according to the NHL BFM 1995 protocol. Bone marrow aspirate was normal, and no malignancy was observed in the cerebrospinal fluid. After V-phase, AM block, and BM block treatments evaluation were performed with ¹⁸F-FDG PET/CT according to protocol. In ¹⁸F-FDG PET/CT, it was seen that the lymph nodes in the abdominal and the small mass in the breast were completely retracted, and another lymph nodes had no detected. These results showed that the response to the treatment was complete and the patient's chemotherapy was completed by continuing with the protocol. ¹⁸F-FDG PET/CT taken after the completion of chemotherapy revealed no evidence of mass or lymph node. The patient's controls continue smoothly.

Conclusions: Anaplastic large cell lymphoma should also be considered in the differential diagnosis of children presented with a breast mass. Treatment procedures should be planned according to the involvement site and spread of the disease.

Geophagia: A cause of distal large bowel obstruction in a Sudanese woman.

2021-05-28T14:46:50+03:00

Objective: Geophagia is defined as the craving and deliberate consumption of dirt, soil, or clay that is practiced sometimes by pregnant ladies, mentally handicapped, or people with iron deficiency anemia. This disorder is seen frequently in people who are native to Africa all around the world. A grave surgical complication can result from the presence of this foreign material inside the intestine notably intestinal perforation, and obstruction

Case: A 34 years old female present with features of distal large bowel obstruction three weeks post-delivery underwent exploratory laparotomy were obstructing piece of clay was found, the patient confirmed after surgery a heavy consumption of river shore clay during the pregnancy.

Conclusions: The patient experienced an uneventful postoperative course, oral intake allowed by the third postoperative day, and the patient was discharged home on the fifth postoperative day. Follow-up at one month after surgery show a clean healed wound with no complaints.

Articulating Os Intermetatarsium with painful ganglion cyst

2021-05-28T14:46:40+03:00

Objective: Sesamoid and accessory bones are commonly found in the foot and ankle with varying incidence. The Os intermetatarsium, located between the medial cuneiform and the base of the first and second metatarsal, occurs rarely and is frequently asymptomatic. Few symptomatic cases of this condition are reported in the literature. The development of synovial ganglion cyst over an os intermetatarsium is a more occasional finding not clearly reported in the literature.

Case: Here we report the case of a 22 year old female presenting with pain and localized swelling in the dorsum of the midfoot who was found to have a ganglion cyst emerging from an articulating os intermetatarsium.

Conclusion: Although not a common entity, an Os intermetarsium, with its associated complications, can be one of the causes of dorsal foot pain.