Medical Science and Discovery

A case of Mullerian choristoma in extradural intra-extravertebral lipoma

Andronik Ishkhan Kalayjyan — 2023-03-21

Objective: Mullerian choristoma associated with spinal dysraphism is one of the rare cases.

Case: We present a case of heterotopic fallopian tube tissue found in an extradural intra-extravertebral lipoma. The patient, a 19-year-old woman, complained of swelling and pain in her lower back. Magnetic resonance imaging revealed spina bifida occulta at L3, a tethered cord, and an L3 lipoma. A L3-L4 laminectomy was performed, and the lipoma was removed. Histological examination revealed the presence of ectopic fallopian tube tissue within the lipoma.

Collateral miracle: adequate cerebral circulation with only right ICA

Işıl Aslan — 2023-03-21

Objective: Collateral circulation is essential for cerebral perfusion and the maintenance of cerebral metabolism and function. The clinical factors affecting the collateral circulation in the brain is still unknown. In the presence of slowly developing stenosis, the decrease in cerebral blood flow can be compensated by adequate collateral circulation, and signs of cerebral hemodynamic deterioration may not be observed.

Case: This case with a 6-year retrospective record and adequate cerebral circulation with only right Internal Carotid Artery (ICA) is presented.

Intra-articular Synovial Sarcoma of the Knee with Extension to the Distal Thigh: A case report

Teodora Delibašic — 2023-03-21

Objective: We present a case of intra-articular synovial sarcoma of the knee with expansion to the distal thigh with developed metastatic lung disease. The case was complicated by the detection of primary pulmonary adenocarcinoma.

Case: A 70 year age woman reported pain in the right knee during a routine check–up. Ultrasound (US) finding was inconclusive since the detected intra–articular tumor, appeared to be a partially organised haematoma. Magnetic resonance imaging (MRI) indicated the tumor corresponds to SS, and radical tumor resection was performed. Due to developed distant lung metastases, the patient received two different chemotherapy protocols. Good response to the second chemotherapy enabled video–assisted thoracoscopic surgery and removal of the remaining deposits in the left lung. Unexpected detection of primary adenocarcinoma of the lung and its metastases required a new chemotherapy protocol, which the patient is currently undergoing.

Conclusion: SS's insidious onset and infrequency often delay the diagnosis. Common occurrences of lung metastases require the selection of adequate chemotherapy, and continuous follow – up. Laboratory and radiographic monitoring remain mandatory to ensure the absence of both primary diseases and to detect recurrent metastatic activity.

Preoperative predictions of severe postoperative pain in the patients who underwent cholecystectomy: A systematic review and meta-analysis

Suzan Güven — 2023-03-05

Objective: The present study aims to investigate the impact of preoperative pain predictions on postoperative pain evaluation in patients who underwent cholecystectomy surgery. Pain is a frequently reported complaint following cholecystectomy, and understanding the factors that contribute to pain perception can help improve patient outcomes. Therefore, the study seeks to identify any potential preoperative predictors of pain that may affect postoperative pain evaluation.

Materials and Method: A literature review was conducted between 2012 and 2022 using various combinations of keywords such as "postoperative pain," "postoperative pain management," "cholecystectomy," and "preoperative pain prediction." The inclusion criteria for the study were articles published in peer-reviewed national or international journals in Turkish or English that examined preoperative pain predictors for patients who experienced severe postoperative pain.

Results: In the meta-analysis study, nine databases were searched, resulting in 7151 articles. However, only three full-text articles met the inclusion criteria and were included in the analysis. The combined results of these studies showed that the preoperative prediction rate of postoperative pain was 32%, the rate of postoperative pain without any symptoms in the preoperative period was 33%, and the preoperative prediction rate of post-laparoscopic pain was 38%. It was found that the rate of pain prediction after classical surgery was 15%, while the rate of pain prediction for surgeries lasting less than 30 minutes was 37%, and for surgeries lasting more than 30 minutes, it was 38%.

Conclusion: The preoperative prediction of the factors causing pain is an important component of effective pain management and enhancement of patient care quality.

Edi Mod Spectral Domain Optical Coherence Tomography Evaluation of The Choroid in Retinitis Pigmentosa: A Case-Control Study

Bilge Yurdakul — 2023-03-21

Objective: The evaluation of choroidal thickness measurements became possible after the developments in optical coherence tomography (OCT) technology. This study aimed to evaluate choroidal features in Retinitis Pigmentosa subjects with EDI (Enhanced depth imaging) mode spectral domain optical coherence tomography (SD-OCT).

Material and Method: A hundred and three eyes of 54 RP subjects underwent scanning with EDI-OCT for central retinal and choroidal thickness measurements and were compared with 40 healthy controls. Submacular choroidal thickness measurements were obtained beneath the fovea and at 500 µm intervals for 2.5 mm nasal and temporal to the center of the fovea.

Results: Mean subfoveal choroidal thickness measurements were 253.2±74.9 µm in RP patients and 336.2±91.7 µm in control (p<0.0001). There was no correlation between subfoveal choroidal thickness and visual acuity in RP patients. The choroid had an irregular shape in 85 % of RP patients. The thickest point of the choroid was not subfoveal as in healthy eyes, and excessive nasal thinning of the choroid was observed in 93 % of RP patients.

Conclusion: Submacular choroidal thickness was significantly reduced but did not correlate with the visual acuity in RP patients.

Effects of Fluoride Exposure on Thiol/ Disulphide Homeostasis, Testicular Oxidative Stress and Histopathological Changes in Rats

Yilmaz Kocak — 2023-03-11

Objective: This study investigated the effects of fluoride-induced toxicity on the reproductive system. For this purpose, testicular oxidative stress, thiol/disulpide homeostasis, sperm motility, density, and histopathology of testicular tissue were evaluated.

Material and Methods: In the experiment, 4 groups were formed, with eight animals (n=8) in each group. Group 1, control/saline, groups 2, 3, and 4 were administered orally sodium fluoride (NaF) at doses of 25, 50, and 100 ppm, respectively, for 30 days. Then the rats were sacrificed and testicular tissue samples were evaluated by sperm examination and histopathologically. Biochemical parameters malondialdehyde (MDA), catalase (CAT), advanced oxidation, and protein products (AOPP) were measured spectrometrically. Thiol/disulphide homeostasis was studied with a fully automated analysis method.

Results: NaF exposure increased MDA and AOPP levels and decreased CAT levels. Disrupted thiol/disulphide homeostasis. Histopathological examination revealed integrity between germinal cells and tubular atrophy. NaF showed reduced sperm motility and density and increased abnormal sperm count. The findings of the NaF 100 ppm group were statistically significant when compared with the Control and other NaF groups (p˂0.05).

Conclusion: The findings concluded that fluoride might cause pathological conditions and infertility in testicular tissue.

Evaluation of Demographic and Clinical Characteristics of Celiac Patients: A Single Center Experience

Hulya Gozde Onal — 2023-03-12

Objective: Celiac disease (CD) is an autoimmune disorder among genetically predisposed subjects exposed to gluten-containing foods. It is now appreciated that CD is now recognized as a common condition among persons of various ethnic groups and both adults and children, and that affects many organ systems. This study was conducted to evaluate the demographic and clinical characteristics of pediatric celiac patients.

Patients and Methods: A total of 122 individuals diagnosed with CD by serologic and histologic assessments between January 2010 and December 2016 were enrolled in the study.

Results: : Forty-three patients were boys (35.2%), and seventy-nine were girls (64.8%). The mean age was 12.6±5.7 years, and the mean age at diagnosis was 8.8±5.1 years. The most frequent presenting symptoms were abdominal pain (41%), failure to thrive (36.1%), and diarrhea (34.4%). Adherence to a gluten-free diet was 67.2%. Family history of CD was positive in 2.5% of patients. The most frequent comorbidities were iron deficiency anemia (36.1%), vitamin D deficiency (12.3%), and type-1 diabetes mellitus (7.4%). Endoscopic assessments revealed dentations in 61.5% of cases, and histologic evaluations told that Marsh 3b was the most frequent histologic grade (27.9%). IgA and IgG transglutaminase antibody levels were decreased significantly following the initiation of the gluten-free diet.

Conclusion: Celiac disease faces a very varied picture in terms of clinic and laboratory at the time of diagnosis and in the follow-up. Early diagnosis of CD is critical to prevent long-term complications; currently, the only effective treatment is a lifelong gluten-free diet.

Newborns born to mothers with a history of COVID-19 during pregnancy, delivery and/or postpartum: 52 cases of neonatal intensive care experience

Nevine Cambaz Kurt — 2023-03-12

Objective: The effect of the Covid-19 pandemic on the prenatal and neonatal periods is not yet fully understood. Therefore, this study aimed to prospectively evaluate and investigate the clinical features of newborns who were born to mothers with a history of Covid-19 during pregnancy, delivery, and/or postpartum.

Patient and Methods: The study prospectively evaluated 52 newborns born to mothers with a history of Covid-19 during pregnancy, delivery, and/or postpartum followed in our hospital's neonatal intensive care unit between November 2020 and May 2022.

Results: Unvaccinated mothers of 12 babies with Covid-19 IgG antibody positivity + severe pneumonia in their clinical course and/or chest X-ray stated that they did not have a history of Covid-19. It was found that attachment to intermittent mechanical ventilation (SIMV) in infants with a Covid-19 -infected father was statistically significantly higher than in infants with a non-infected father. The rate of being connected to synchronized intermittent mechanical ventilation (SIMV) in babies whose both parents had Covid-19 was statistically significantly higher than in the babies whose fathers did not have Covid-19 (p:0.030; p<0.05).

Conclusion: Newborns born to mothers suspected or confirmed to be Covid-19-positive are mostly asymptomatic, suspected cases or cases with a severe or unusual clinical course should be investigated for Covid-19 even if there is no maternal history. In newborns, not only the mother but also the father should be questioned for Covid-19, as both parents being infected will increase the viral load.

Subclavian Catheterization Procedure Performed by In-plane Technique Guided by Ultrasonography

Abdullah Kahraman — 2023-03-12

Objective: Central venous catheterization (CVC) is one of the most commonly performed interventional procedures in intensive care unit (ICU) patients. According to guidelines, it is recommended as the first choice because it is better tolerated by patients, and the infection rate is lower compared to other areas of CVC placement.. However, complications such as pneumothorax, arterial puncture, nerve injury and bleeding may be relatively higher. For these reasons, it has become increasingly common to perform subclavian CVC applications with ultrasonography (USG) to minimize the risks in recent years. Our study aimed to evaluate 53 patients who underwent subclavian CVC with the in-plane technique accompanied by USG.

Method: In this study, the system records of 53 patients with CVC indication, who were hospitalized in the ICU between January 1, 2020, and April 1, 2021, were reviewed retrospectively and subclavian CVC procedures performed using the USG-guided in-plane technique were analyzed.

Results: A total of 53 patients (25 women (47.2%), 28 men (52.8%)) with CVC indication followed in the ICU underwent subclavian CVC with the in-plane technique under USG guidance. The mean age of the patients was 69.98±11.29 years. The mean BMI of the patients was found to be 26,10 kg/m2. Of the 53 patients evaluated, 28 had chronic obstructive pulmonary disease (COPD), 5 had lung malignant neoplasm, 16 had pneumonia, 2 had acute renal failure, and 2 required ICU follow-up after cardiopulmonary resuscitation.. Catheter malposition and other complications were not observed in any of the patients.

Conclusion: Subclavian catheterization applied with an in-plane technique guided by USG is a method that experienced practitioners can safely apply.

Investigation of the changes in some elements that play an active role in MS disease

Soner Kılıç — 2023-03-14

Objective: In this study, we examined the role of several metals which extracted from the hair of patients who affected by multiple sclerosis (MS). The ICP-MS measurements were performed using an Agilent 7500 series. With this procedure, all elements can be simultaneously quantified.

Material and Methods: All studies were carried out at Kayseri City Hospital between August 9, 2021, and October 11, 2021. We measured five elements from hair in association with the clinical course in 40 male and female MS subjects, as well as 40 healthy volunteers, using 1 cm hair sections. Using a novel microwave digestion method coupled with ICP-MS, we were able to analyze large numbers of samples per day consisting of 0.5 g of hair in 5 mL of nitric acid. Following digestion, the aliquots were examined to determine the quantities of Hg, Pb, Cu, Cd, and Zn.

Results: The quantities recovered for all elements were in an acceptable certified value range of (97.60–99.49%). Cu, Zn, and Hg levels examined were higher in the patient group, and Cd and Pb were higher in the control group. In our patients, a positive correlation was found between age, Hg, Cd, Pb values, and the disability score of multiple sclerosis [EDSS], while there was a negative correlation between Zn and Cu values and EDSS. Additionally, female MS patients showed a higher average hair content than males for the elements studied. Both Cd and Hg levels in patients were increased compared to the controls. Lead content in hair is steadily increasing in individuals of two different age groups. Lead content in hair showed an increased trend with age in the 21-35 year and 36-60 age groups.

Conclusion: Our study shows some important changes and relationships with Pb. Also, it has been determined that the Pb element increases with age, and the Cd and Hg levels were noticeably different in the patient and healthy groups, and Cu and Zn values change in parallel. The study can be a guide for diagnosis and treatment of the MS.

Prevalence of Musculoskeletal Disorders and its Correlation to Physical Activity among Geriatrics Population in Rural Wardha- A Cross-Sectional Study

Banjari Sachin — 2023-03-16

Objective: Musculoskeletal disorders which leads to the pain in the neck, shoulder, upper back, lower back, knee or other skeletal areas, are instances of musculoskeletal strains. Musculoskeletal problem is the main region of morbodity and the seconldy cause of disability in all world. Any action of the body involving the skeletal muscles that results in a modest to high energy expenditure is referred to as physical activity (PA). This study's aim was to determine the prevalence of musculoskeletal illnesses and how physical activity among senior age groups relates to those disorders. This study aimed to determine the prevalence of musculoskeletal disorders, the level of physical activity using a short-form physical activity questionnaire, and the relationship between the prevalence of these disorders and physical activity.

Material and Methods: From October 2021 to August 2022, a cross-sectional study of 152 geriatric patients in a rural Wardha was conducted using pre-structured and pre-designed questionnaires. These included demographic information, a short form of the International Physical Activity Questionnaire to gauge the level of physical activity, and standardized Nordic questionnaires to examine musculoskeletal symptoms.

Results: Our survey shows 95.3% of elderly people reported musculoskeletal problems. The age groups 60-70 years of geriatrics had the highest prevalence of MSDs (55.19%), significantly higher than those of 70-80, 80-90, and 90-100 years of geriatrics (p 0.05). There is a substantial correlation between the degree of physical activity and the musculoskeletal disorder; the majority of the participant had a moderate level of physical activity (55.9%), with the knee being the most frequently reported region (61.18%).

Conclusions: In this study, there are more musculoskeletal diseases among female individuals from rural Wardha than among male participants. Geriatrics between the ages of 60 and 70 had a higher MSD prevalence than those between the ages of 70- 80 or 80-90. The body component most affected was the knee, followed by the lower back and upper back. The majority of the affected senior population engaged in moderate physical activity

Head Injury and Intracranial Hemorrhages: A CT Imaging Study of Trauma Patients

Abdul Maajid Khokhar — 2023-03-16

Objective: To find out how frequently patients who have experienced head trauma have intracranial bleeding on computed tomography imaging.

Materials and Methods: The study comprised 165 individuals with a history of trauma, all of whom had computed tomography. The brain was imaged using axial plane computed tomography without contrast, with slices 10mm thick from the foramen magnum to the vertex. SPSS version 22 was used for data analysis. All numerical values, including age, were given a mean and standard deviation. All qualitative variables, including gender, head injury, injury type, and cerebral hemorrhage, were calculated using frequencies and percentages.

Results: 25 (15.3%) of the 165 head injury patients had traumatic intracranial bleeding visible on a computed tomography scan. In the 25 patients, there were 9 (36%) subdural hemorrhages, 5 (20%) subarachnoid hemorrhages, 7 (28%) epidural hemorrhages, and 4 (16%) intraparenchymal hemorrhages. The 165 patients had 71 (43.1%) road traffic accidents, 39 (23.6%) history of falls, and 55 (33.33%) other types of traumatic injuries. It was found that the age range of 16 to 30 years had the highest frequency of cerebral bleeding. Intracranial hemorrhage was more common in men (72%) than in women.

Conclusion: According to this study, a CT scan revealed intracranial hemorrhages in 15.3% of head injury patients. The most frequent type of hemorrhage in this study was subdural. Compared to other traumatic injuries, the presence of cerebral bleeding was most frequently related to traffic accidents.

The contribution of preoperative MRI evaluation to emergency surgical management of perianal abscesses

Defne Gurbuz — 2023-03-16

Objective: Perianal abscesses occur as a result of an infection in the anal gland due to the obstruction of the anal gland ducts opening to the anal crypts. Preoperative use of MRI reduces the risk of recurrence, fistula formation, and postoperative fecal incontinence as it allows detailed anatomical imaging. The aim of this study is to investigate the contribution of preoperative MRI to reducing recurrence and surgical complications in patients who underwent emergency surgery for perianal abscess.

Material and Methods: A total of 206 patients with perianal abscess evaluated and not evaluated with MRI between January 2016 and 2021 were included in this retrospective study. The patients had no history of surgery or local drainage applied to the perianal region. In addition to demographic data of patients, postoperative complications, hospitalization duration, recurrence ratio, and MRI findings are evaluated.

Results: In the preoperative period, recurrence was found in 16 (%13.2) of 121 cases evaluated with MRI, while the disease recurred in 24 (%28.2) of 85 cases who were operated without MRI evaluation. The presence of a fistula was significantly higher while the presence of recurrence was significantly lower in the group that underwent MRI in the preoperative period (p=0.033, p=0.012 respectively).

Conclusion: Contrary to popular belief, surgical treatment of abscesses is not that easy due to the high risk of recurrence, the high rate of association with perianal fistula, and the different types and spreads of abscesses. Therefore, preoperative MRI is the most useful diagnostic method for detecting perianal abscesses and additional pathologies.

HLA DQ2 and HLA DQ8 genetic evaluation in children with Type 1 Diabetes Mellitus and Celiac Disease

Aysun Ata — 2023-03-16

Objective: Celiac disease (CD) is an autoimmune disease, and other autoimmune diseases co-existence is very high, like type 1 diabetes mellitus (T1DM). Our study aimed to determine the genetic structure of HLADQ2 and HLADQ8 in pediatric patients with T1DM and CD.

Materials and Methods: Our study was conducted retrospectively in patients aged 1-18 years with CD and T1DM, who were followed up in the Pediatric Endocrinology Outpatient Clinic in Adana, Turkey.

Results: A total of 876 patient records with a T1DM diagnosis were reviewed, and the genetic testing of 41 patients with CD and T1DM was evaluated. In 27 of these 41 patients, genetic analysis was performed by the same method and could be evaluated. Of the cases, 12 (44.4%) were female and 15 (55.6%) were male. The mean follow-up duration for the patients was 3.12 ± 1.75 years. The current age of the patients was 12.7± 3.71 years. While 7 (25.9 %) patients were symptomatic, 20 (74.1%) patients were asymptomatic when diagnosed with CD. The highest rates of HLA DQ2 and HLA DQ8 were found in patients with T1DM and CD.

Conclusion: In this study, we investigated, for the first time in our country, the HLA characteristics and clinical findings of a group of pediatric patients with both type 1 diabetes mellitus (T1DM) and celiac disease (CD). The rate of patients with HLA-DQA1* 05-DQB1 * 02-DQB1 *03:02 co-existence (HLA DQ2 and DQ8 co-positivity) was found to be as high as 40.7%, and this carrier was thought to be the riskiest group for T1DM and CD co-existence.

Retrospective analyses of antibody titers in the diagnosis of pediatric Celiac Disease

Didem Gülcü Taşkın — 2023-03-16

Objective: We aimed to evaluate the relationship between Tissue Transglutaminase IgA titer (tTGIgA) and Endomisium antibody (EMA) positivity and the stage of duodenal mucosal damage at Celiac disease (CD).

Material and Methods: The study group consisted of 233 children (2-18 years old) who were diagnosed with CD and admitted to our XXX Hospital, Pediatric Gastroenterology Outpatient Clinic, between September 2017 and November 2022. All patients underwent an endoscopy, and a histopathological diagnosis was made. In upper gastrointestinal endoscopy, one biopsy sample were taken from the duodenum bulb and four samples from the second part of the duodenum. Histological patterns were evaluated according to the Marsh-Oberhuber classification.

Results: A total 233 patients with CD were included in the study. The mean age of the patients at the time of diagnosis was 97.0 ± 57.1 months. The patients' mean tissue transglutaminase (tTG) IgA value was 172 ± 133. The most common Marsh-Oberhuber classification was found to be Marsh 3b (47.6%) in CD patients. According to the Marsh-Oberhuber classification, the mean tTGIgA values were significantly different compared to the groups.

Conclusion: We recommend starting a diet with a diagnosis of CD without endoscopy for patients with a tTGIgA value of 10 X ULN (upper limit of normal) or more recommended by ESPGAN, and we even support randomized prospective studies to reduce this value to 7-10 times or less.

Nutrition Knowledge, Attitude, Practice towards Breast Cancer Prevention among the Female Students of University of Hail, Saudi Arabia.

Shahida Banu Shamsuddeen — 2023-03-20

Abstract:

Background: There are limited studies conducted in Saudi Arabia to assess the Nutrition knowledge, attitude, and practice toward the prevention of breast cancer among the female students of Hail University.

Objectives: The purpose of the study was to assess the Nutrition knowledge, attitude, and practice toward breast cancer prevention among university students. The study aims at the following objectives:

To assess the Nutrition knowledge, attitude, and practice towards breast cancer of university students.
To compare the Nutrition knowledge, attitude, and practice (KAP) towards breast cancer between science and non-science students of the university.

Method: A cross-sectional survey was planned to assess nutrition knowledge, attitudes, and practice (KAP) toward breast cancer prevention among students of the University of Hail. The subjects were surveyed through a previously standardized self-administered questionnaire for questions related to nutrition knowledge, attitudes, and practice on the prevention of breast cancer. In addition, self-reported weight and height were collected and body mass index was calculated. The statistical analysis was done using Statistical Package for Social Sciences software (version 18.0).

Results: The general knowledge of nutrition, was self-perceived by the study population. 14.8% of the population perceived that they have a very good knowledge of nutrition, and about 66.7% of the population has an average or good knowledge. From the viewpoint of attitude among the study samples, it was clear that science students have a better attitude when compare to non-science students. The results were statistically significant (P<0/05) for the practice of exercise, consuming fruits and vegetables, and drinking green tea showing a higher number among science students than non-science students.

Conclusion: In conclusion, nutrition KAP towards BC prevention was found to be influenced by factors such as age, the field of study, and the familial history of BC. These results provide further support for the hypothesis that having proper nutritional knowledge improves an individual’s eating practice which will reduce the risk of any nutrition-related cancers such as BC. These findings need to be taken into account when designing breast health education programs. It is suggested to perform successfully design, organize, and implement nutrition education programs in the institutions which will promote the level of knowledge about nutrition, thereby improving their food habits and lifestyle.

Keywords: Nutrition; Knowledge; Attitude; Practice; Lifestyle.

Prevalence and risk factors of osteoporosis and osteoarthritis among Beta Thalassemia patients

Sevil Sadri — 2023-03-20

Objective: This study aims to examine the clinical and radiological features of skeletal changes in patients with thalassemia and provide a comprehensive overview of osteoporosis and osteoarthritis in these patients.

Materials and Methods: We conducted a retrospective analysis of patients with transfusion-dependent thalassemia, both adults and children, who received follow-up care at our thalassemia center between 2019 and 2020.. Thalassemia was diagnosed via hemoglobin electrophoresis. Transfusion-dependent patients were defined as those who received transfusions every 2-4 weeks, while the control group consisted of individuals with thalassemia trait/carriers.. Both groups were analyzed for clinical characteristics, and Dual-energy X-ray absorptiometry (DEXA) scans, and radiographic images of the knee and wrist were evaluated.

Results: DEXA scans of the femur and lumbar spine showed that the prevalence of osteoporosis , Synovial hypertrophy of the wrist joint , wrist effusion , knee effusion, and Power Doppler signals on wrist ultrasound scans was statistically significantly higher in transfusion-dependent thalassemia compared to patients with thalassemia carriers.

Conclusion: Beta thalassemia is an inherited multisystem disease that leads to various musculoskeletal abnormalities. Knowledge of the musculoskeletal manifestations of thalassemia allows clinicians to guide their treatment. Familiarity with the radiological features of beta thalassemia is crucial for physicians in the timely diagnosis and management of thalassemia and its complications