DOI: 10.4328/JCAM.6116 Received: 24.12.2018 Accepted: 07.01.2019 Published Online: 14.01.2019 Printed: 01.03.2019 J Clin Anal Med 2019;10(2): 188-92 Corresponding Author: Serhat Karaman, Department of Emergency Medicine, Gaziosmanpasa University, Faculty of Medicine, 60100, Tokat, Turkey. T.: +90 3562149444 F.: +90 3562133179 E-Mail: drserhatkaraman@hotmail.com ORCID ID: 0000-0003-4554-1364 Abstract Aim: The advent of digital radiology and computerized workstations renders it very easy to measure cardiothoracic ratio (CTR) and cardiothoracic area ratio (CTAR) on chest radiographs. The aim of this study was to assess whether CTAR correlates with the left ventricular ejection fraction (EF) better than CTR in healthy individuals and patients with congestive heart failure. Material and Method: The study included 156 healthy individuals and 98 heart failure patients undergoing echocardiography and digital chest radiography. The CTR was calculated in the traditional manner, and the CTAR was taken as the ratio between the pixel counts of the cardiac area and whole thoracic area. Results: The traditional CTR showed an inverse correlation with ejection fraction in both healthy individuals (r = -0.13) and heart failure patients (r = -0.19). The CTAR showed an improved correlation (r = -0.32 for healthy individuals and r = -0.37 for heart failure patients). If it is assumed that an ejection fraction of 55% or more indicates normal cardiac function, a value of 50% or less for CTAR can be taken as normal. Discussion: Digital chest radiography is widely used as a popular technique for diagnosing various thoracic and cardiac diseases. Cardiomegaly is associated with an adverse outcome in patients with heart disease. Therefore, evaluation of heart size is an important clinical variable, and changes in heart size may be used to monitor and grade cardiac disease severity. Conclusion: Our findings suggest that the CTAR correlates better with cardiac function as assessed by the ejection fraction than the traditional CTR.
DOI: 10.4328/JCAM.5916 Received: 30.05.2018 Accepted: 16.06.2018 Published Online: 19.06.2018 Printed: 01.05.2019 J Clin Anal Med 2019;10(3): 354-8 Corresponding Author: Serhan Çimen, Malatya Education and Research Hospital Urology Clinic, 44280, Malatya, Turkey. GSM: +905057952994 E-Mail : drserhancimen@hotmail.com ORCID ID: 0000-0002-6612-0166 Abstract Aim: The aim of this study is to determine the urinary incontinence (UI) subtype of women who present with complaints of urinary incontinence to our clinic, to identify risk factors related with this type and to determine the effects of sociodemographic features. Material and Method: This retrospective study was approved by Clinical Trials Ethics Committee in Malatya and included 386 patients who presented to Urology Clinic of Malatya Research and Education Hospital. Classification of the UI subtypes was performed using Turkish Version of International Incontinence Questionnaire-Short Form (ICIQ-SF) which was validated by Cetinel et al. Comorbidities and other data of the patients were evaluated by asking the patients. Results: The mean age of the patients was 51.4 years (range: 18-92 years). The mean number of births was 4.1 (range 0-10) and 90.2% of the women were married. The mean BMI was 27.24 kg/m2. Stress urinary incontinence was found in 24 (6.3%) patients, urge type urinary incontinence was found in 94 (24.3%) patients and mixed type urinary incontinence was found in 268 (69.4) patients when the type of incontinence was questioned. From the comorbid diseases, diabetes mellitus was present in 74 patients (19,1%) while hypertension was present in 84 (21,8%) patients. There were statistically significant differences among UI and age and BMI. Discussion: Such diseases as diabetes mellitus, hypertension, lumbar disc hernia, and multiple sclerosis, birth trauma, past urogynecological surgery, age, BMI, and the number of births are risk factors for UI.
DOI: 10.4328/JCAM.6003 Received: 13.08.2018 Accepted: 28.08.2018 Published Online: 04.09.2018 Printed: 01.01.2019 J Clin Anal Med 2019;10(1): 35-40 Corresponding Author: Fatma Ceyla Eraldemir, Department of Biochemistry, Kocaeli University Facultyof Medicine, Kocaeli, Turkey. T.: +9
Aim: Primary dysmenorrhea is one of the most common complaints of women and is also the most common gynecological problem worldwide. The cramps of dysmenorrhea are recurrent and 90% of adolescent girls and about 50% of women suffer from it. This study was aimed to determine which is more effective in alleviating primary dysmenorrhea: pulsed electromagnetic field (PEMF) or diclofenac drugs. Material and Method: Fifty adult females with regular menstrual cycle 21-35 days lasting 3-7 days and having the same ordinary daily living activities participated in this study. They were recruited from the students of the Faculty of Physical Therapy, Cairo University, Egypt, and the study was conducted in the Outpatient Clinic of the Faculty of Physical Therapy. Group A received PEMF applied on the pelvic region, 3 times per cycle for 3 consecutive cycles, 20 minutes per day. Group B received diclofenac tablets, 50 mg, only with onset of menstrual pain for 3 consecutive cycles. All subjects in both groups were assessed through measuring the progesterone level in the blood, pain using the Visual Analogue Scale, and physical as well as psychological symptoms using a menstrual symptom questionnaire. Results: The present study revealed a statistically significant improvement (P<0.05) in pain, physical, and psychological symptoms associated with dysmenorrhea and progesterone blood level in Group A compared to Group B. Discussion: PEMF was more effective than diclofenac drugs in relieving pain and associated symptoms with dysmenorrhea.
Aim: Cerebrovascular diseases (CVD) are among the major causes of mortality and morbidity worldwide. Cystatin C is considered as an important risk factor for stroke and its increase is considered to be due to inflammation or alterations in renal functions. The Aim of the present study is to evaluate the role of cystatin C in diagnosis and prognosis of stroke patients. Material and Method: The study group was composed of 52 acute cerebral stroke patients admitted to hospital during first 24 hours of occurrence and 42 age and sex-matched healthy controls. Cystatin C levels were measured in Roche Cobas autoanalyzer by Dako Cytomation LX002 cystatin C reactive with an immunoturbidimetric method. Results: Serum cystatin C, sedimentation (ESR), urea, creatinine, eGFR ve CRP levels were higher in the patients when compared to control group (p<0.001 for all). No significant difference in cystatin C levels among the groups constituted according to NIHSS (North Scandinavian Stroke Scale) score was found. Cystatin C levels were found to be moderately correlated with urea, creatinine, eGFR and ESR levels (p<0.001). Levels of cystatin C were still found to be significant in ischemic stroke patients after the effects of kidney function tests (urea, creatinine, eGFR) and inflammatory marker(CRP, ESR, Fibrinogen) were adjusted (p<0.001). Discussion: Cystatin C levels are elevated in acute ischemic stroke. The analyses made to determine if this increase is caused by inflammation or renal dysfunction showed both processes to be correlated with cystatin C, but cystatin C is also an independent risk factor in acute ischemic stroke.
Introduction Currently, in some countries, performance testing is used to assess hand skills in recruitment of staff and students. The Jebsen-Taylor Hand Function Test (JTT) is a standard hand function test measure widely used in clinical and practical applications. The purposes of this study are to evaluate the use of JTT template board in nursing students, to demonstrate the increased ease of placement of test items, and to establish a means of assessing nursing students in a test which requires coordination skills. Method Our study was performed with Trakya University undergraduate nursing students between the ages of 18-25. This study included 168 students between April 2017-June 2018. Age, gender, demographic characteristics, body mass index, anthropometric evaluations, and dominant hand were recorded to evaluate hand skills. Evaluation of skill and function was performed by the Jebsen-Taylor Hand Function test. Results The study showed the mean durations (in seconds) to complete JTT and subtests in males and females. In addition, p values were recorded for males and females for each subtest. A statistically significant difference was found only in “moving wide and light objects” (subtest 6). Durations for subtests 3 and 5 in our study for both dominant and nondominant hands were shorter than Harte et al study. Only duration for subtest 5 was shorter than the original article (Jebsen et al.). Anthropometric measurements in our study showed a significant relation only between forearm length and the JTT. We concluded that anthropometric measurements don’t affect hand function. Students graduated from health vocational high school completed the test in a shorter duration with dominant hand. Duration of test was shorter for both hands in subjects who used computer for more than 3 hours than subjects who used computer less frequently. Discussion This study gives new data for the JTT using a template board in a sample consisted of nursing undergraduate students. Our study demonstrated practical time benefit of using a template for JTT. It increased accuracy of subtests and provided time. In our study using a template board also enabled re-installation of subtests for each participant. In our study time to complete subtest 3 (small objects) and subtest 5 (checkers) were significantly low. In addition, subtest 5 was finished in a shorter time than the original study for the dominant hand. When a template board is not used a specialist should locate test material at a correct distance from sides of the table and from one another. Time loss is inevitable. Use of a template board helped installation of test especially for 5th, 6th and 7th subtests. In addition, it helped telling the test to students. Comparison of our study with normal data in other studies demonstrated that nursing students demonstrated similar hand function levels in JTT. Advantage of using a template board was better results in subtest 3 and 5. Conclusion Our study provides evidence that standard objective measures of hand function can be obtained in the educational and clinical settings. So, clinical skills of the students can be followed, insights are obtained about details that should be supported and these can be added to their education programs. At the same time, our data shows that there is no need for gender discrimination in the nursing profession, which requires hand skills and fine motor skills. In addition after determining level of hand skills, various training simulations and technological tools can be developed to increase such skills. The data obtained at the end of the study can be used to determine the training needs of employees to increase work efficiency and professional satisfaction. It will give an idea to work on hand force and function in other professions. Our findings may be helpful until reliable norms are established depending on a bigger and more representative sample in nursing profession. Evaluating hand functions in nursing profession will help in job selection, job performance evaluation, and improving job and staff health. Efforts should be made to improve hand functions and they should be supported by education in professions that require good hand function.
Aim: Pregnancy >= 35years may lead to different health problems in neonates. The present study was aimed to investigate the effect of pregnancy >= 35 on maternal and infant health. Material and Method: Mothers of the neonates in our neonatal unit were separated into two groups and compared: Group I comprised those between 18 and 35 years old, and Group II comprised those >= 35. Results: Out of 1.193 mothers, 22.1% (264) were above the age of 35 years, whereas 77.8 % (929) were under the age of 35 years. However, there was no significant difference between the groups regarding gender, number of previous delivery, gestational week, the rate of neonatal mortality, polyhydramnios, and oligohydramnios. A statistically significant increase in gestational diabetes, the rate of cesarean delivery and the rate of delivery meconium aspiration syndrome and occurrence of preeclampsia were found in the group for those with advanced age than the other group. Discussion: Much attention should be taken in terms of developing preeclampsia and gestational diabetes in advanced maternal age pregnancies. For a closer follow-up of pregnant women >= 35, establishing relevant units and referral of mother candidates at this age to experienced centers may help to decrease the higher feto-maternal risks for advanced maternal age population.
Aim: The aim of this study was to investigate the antimicrobial effect of essential oils obtained from Mediterranean region plants on microorganisms isolated as secondary skin infections in patients with Grade II and Ill acute radiation dermatitis. Material and Method: The antimicrobial activity of essential oils, Origanum vulgare (O. vulgare), Lavandula intermedia (L intermedia) and Thymus vulgaris (T. vulgaris) were evaluated by broth microdilution method on microorganisms isolated from 20 patients with Grade II and III radiation dermatitis. Microdilutions had modified according to The Clinical and Laboratory Standards Institute (CLSI) recommendations and lowest concentration which inhibited growth after incubation was identified as Minimal Inhibitory Concentration (MIC). The severity degree of acute radiation dermatitis was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. Results: Nine pathogenic strains were isolated from 20 samples of the patients. The pathogens isolated from skin swabs of the patients with Grade II and III radiation dermatitis were Methicillin-resistant Staphylococcus aureus (MRSA), rnethicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant coagulase-negative Staphylococcus (MRCNS), methicillin-sensitive coagulase-negative Staphylococcus (MSCNS), Klebsiella pneumoniae (K. pneumoniae) and Candida albicans (C. albicans). Minimal Inhibitory Concentration values of O. vulgare, L intermedia and T. vulgaris for each isolated microorganisms were found. These essential oils have been found effective on microorganisms isolated from secondary infections of radiation-related dermatitis. Discussion: Antimicrobial activity of O. vulgare, L intermedia and T. vulgaris essential oils on pathogenic microorganisms isolated from radiation dermatitis were determined. Future use of essential oils in the treatment of acute radiation dermatitis should be considered.
Aim: It is important to increase the number of studies on genotype distributions from different centers and regions of the country in terms of identifying the HCV genotype distribution in the whole country in general and creating appropriate treatment algorithms. Our study aimed to identify the HCV genotype distribution in patients infected with HCV attending our hospital in Ordu Province in the Central Black Sea region. Material and Method: The study included a total of 196 patients whose samples were sent to our laboratory for HCV viral load measurements from January 2016 to May 2018 with HCV-RNA positivity identified. Genotype definition was completed with the real-time PCR method. Results: It was observed that 4 patients (2%) had genotype 1, 7 patients (3.6%) had genotype 1 a, 179 patients (91.4%) had genotype 1 b, 5 patients (2.5%) had genotype 3 and 1 patient (0.5%) had genotype 4. Discussion: The most common genotype observed among patients attending our hospital was genotype 1. Genotypes 3 and 4 were rarely observed in comparison to Turkish data, similar to other provinces in regions receiving little migration. As medication resistance and treatment failure is high for genotype 1, the risk of encountering treatment failure continues to be a serious problem in our region.
Aim: In this study,we aimed to investigate the usability of SOFA and qSOFA criteria in predicting the conditions by which the poor prognosis such as hospitalization in the intensive care unit, long length of hospital stay and death was observed for the patients receiving a diagnosis of acute pancreatitis in the emergency department Material and Method: The data of 98 patients with acute pancreatitis diagnosis which was verified by the computerized abdominal tomography in the university hospital emergency department between 2013 and 2018 were used in our study. that was designed as monocenteric retrospective study. The SOFA and qSOFA criteria of the patients were calculated during the application to the emergency department Results: Fifty-three percent (n=52) of the patients were female. Their age averages were 57.5 +/- 8.57/year. Forty-eight (%49.0) patients were detected to have any of the poor prognostic criteria. It was also detected that the qSOFA score of 17 (517.3) patients were 1 and above and the qSOFA score of 81 (582.7) patients was 0 during the application to the emergency department The SOFA (p<0.001) and qSOFA (p=0.004) values were significantly different for the patients having the good prognosis and poor prognosis. When we take the Cut-off as > 0 for the qSOFA criteria, we determined the AUC as 0.641, Sensitivity as %39.58, Specificity as %86, and CI% as 0.538 to 0.735, and p=0.001, respectively. Discussion: The SOFA and qSOFA criteria used in order to predict the organ failure in the sepsis can be a scoring system that will be able to be used in predicting the poor prognosis in acute pancreatitis in the emergency department.
Yeliz Mercan1, Seniha Bilge Hapcıoglu2, Halim Issever2 1Department of Health Management School of Health, Kırklareli University, Kırklareli, 2Department of Public Health, Faculty of Medicine, Istanbul University, Istanbul, Turkey Time series analysis of the admission to emergency department Time series analysis of the admission to the emergency department due to respiratory and cardiovascular diseases between 2010 and 2014 in Kırklareli, Turkey
Aim: This study aimed at determine the frequency of hemoglobinopathy, which is one of the hereditary blood diseases, in Kahramanmaras. Material and Method: In this study, which has been planned in the descriptive style, the scan records of the couples reported to the Kahramanmaras Provincial Directorate of Health, Maternal and Infant Health Unit with the purpose of scanning whether they carried hemoglobinopathy prior to getting married between January 2012 and December 2016, have been analyzed retrospectively and the results have been evaluated. Results: According to the records, it has been determined that 68.177 people's scans have been taken in five years in Kahramanmaras, the scanning rates varied between 70-90% and that 610 women and 573 men have hemoglobinopathy. Between the years 2012-2014, the percentage of people with hemoglobinopathy has been determined as 1.43% and this percentage has been observed to increase to 1.93% in 2015 and 2.50% in 2016. According to the data dated 2016, although there has been a decrease in the number of people who got married and the number of scans prior to getting married, there has been an increase in the number of people with hemoglobinopathy. Discussion: In the scan process carried out prior to marriage in Kahramanmaras, the rates of carrying hemoglobinopathy have been found similar to the rates in Turkey and the surrounding cities.
Osman Toktas1, Oztekin Cıkman1, Caghan Peksen1, Sadi Elasan2, Nurettin Yuzkat3 1Department of General Surgery, 2Department of Biostatistics, 3Department of Anesthesiology and Reanimation, Yuzuncu Yıl University, Faculty of Medicine, Van, Turkey Reducing the complications of laparoscopic cholecystectomy The effect of using a larger port on reducing the complications of laparoscopic cholecystectomy: A randomized trial
Emel Çiçek Bozkurt1, Hüseyin Bozkurt2, Ali Yılmaz3, Damla Atacan4 1Department of Dermatology, Ministry of Health Sivas Numune Hospital, Sivas, 2Department of Neurosurgery, Cumhuriyet University, Sivas, 3Department of Neurosurgery, Ordu University Medical School, Ordu, 4Department of Dermatology, Ministry of Health Dışkapı Education and Research Hospital, Ankara Turkey Serum-prolactin and vitiligo Serum-prolactin levels in patients with vitiligo
Aim: The present study aimed to detect and relate alteration in reaction of plasma leptin and pulmonary functions (forced vital capacity "FVC' and forced expiratory volume in the first second "FEV1") in obese adolescent schoolboys and schoolgirls to aerobic training. Material and Method: Sixty obese secondary school students with body mass index (BMI) of 30 kg/m2 or greater, with age range of 15 to 18 years participated in this study. Participants were allocated into two equal groups based on their gender: 30 schoolgirls (Group A) and 30 schoolboys (Group B). All subjects in both groups practiced moderate-intensity aerobic training program using a stationary cycle ergometer for a period of 4 months 5 days a week Plasma leptin levels and pulmonary functions (FVC and FEV1) were measured in all students' before and after the program started. Participants were chosen from thirteen Secondary Schools, Jeddah, Saudi Arabia. They received training program at Pediatric Out-Patient Clinic, King Abdul-Aziz Hospitals. The study was conducted between June 2015 and May 2016. Results: After 4 months of aerobic exercise program, there was a significant decrease (p < 0.05) in leptin and significant improvement in pulmonary functions in both groups. Moreover, there was a significant difference (p < 0.05) in both groups in leptin levels with favor to girls group. In contrast, there was a significant difference (p<0.05) in both groups in pulmonary functions with favor to boys group. Discussion: Following aerobic exercise program, pulmonary functions were improved in obese adolescent schoolboys more than in obese adolescent schoolgirls. In contrast, serum leptin hormone values were improved in obese adolescent schoolgirls more than in schoolboys.
Pulmonary vein thrombosis (PVT) is a rare, life-threatening, and difficult-to-diagnose condition. Most of the literature on PVT consists of case reports, and its actual incidence is unknown. It occurs especially as a complication of malignancy or pulmonary surgery. We present a case of PVT detected incidentally in a 25-year-old female who presented with dyspnea and left flank pain and underwent computed tomography pulmonary angiography with a preliminary diagnosis of pulmonary artery embolism. Further investigation revealed that the PVT was associated with the lung metastasis of ovarian cancer. The patient died one month after diagnosis due to malignancy-related complications. Because of its nonspecific symptoms and findings, PVT may easily be missed or misdiagnosed. An emergency physician should consider not only pulmonary artery embolism but also PVT when considering a thromboembolic event in the differential diagnosis regardless of etiology and use appropriate imaging modalities to confirm this diagnosis.
Incest sexual abuse is defined as any sexual behavior applied to a child by close relatives. Incest is often between biological or stepfather and child or between siblings, less frequently between other family members. Victims are often girls. But sometimes boys can be victims of incest as well. Dementia is a disease that causes loss of intellectual function. It is usually permanent and progressive, and it increases the risk of elderly abuse and neglect. This case report presents incest sexual abuse of a boy by his grandmother.
Aim: The clinical features and treatment modalities of ophthalmic Molluscum Contagiosum (MC) are presented in this retrospective study. Material and Method: Patient characteristics, history and ocular findings were recorded. Treatment was performed by extraction and curettage of the lesion by squeezing with a clamp or extirpation and cauterization of the base. Results: Twenty patients had MC lesions of the eyelids. Hyperemia, lacrimation and discomfort were the main complaints in 12 patients. Fourteen patients had eyelid margin lesions; follicular conjunctivitis was detected in 12 of them. Most of these patients had a history of unsuccessful treatment. In 50% of patients, there were also extraocular MC lesions. Complete treatment was achieved in 19, and relapse occurred in one case. Discussion: The diagnosis of ophthalmic MC is easy and the treatment is cheap. It should be considered in the etiology of long lasting follicular conjunctivitis or not responding to treatment and the lid margins should be examined carefully.
Aim: Superior mesenteric artery syndrome (SMAS) is a rare cause of upper gastrointestinal obstruction. As it is encountered infrequently, there have been only a few studies on it, mostly in the form of case series or just a case presentation in the literature. In this study, we aim to investigate common clinical features and radiological measurements between patients admitted with symptoms of gastric outlet obstruction due to SMAS and those without SMAS. Material and Method: This study was conducted prospectively on individuals admitted to our clinic presenting with symptoms of gastric outlet obstruction in the previous six months and who had undergone computerized tomography. (Here, SMAS is defined by a narrow aortomesenteric angle and a short aortomesenteric distance.) Demographic features and radiological measurements were compared between patients with and without SMAS. The results of a three-month follow-up of each subject with SMAS were recorded. Results: This study includes a total of 92 subjects, 14 (15%) of whom had a diagnosis of SMAS (Group 1) and 78 (85%) of whom did not (Group 2). Group 1 had a predominance of female and significantly younger patients (mean age: 31.1 +/- 10.2), compared to Group 2 (mean age: 44 +/- 11.7) (p < 0.001). Abdominal subcutaneous fat tissue thickness was thinner in group 1 than in group 2 (18.1 +/- 8.1 and 23.7 +/- 12.2, respectively; p = 0.039). Eleven of the 14 SMAS patients (78.5%) recovered with medical treatment, but in the other three cases, surgical intervention was considered. Discussion: SMAS is an important and preventable cause of small bowel obstruction. Although it is a rare condition in the general population, accurate diagnosis of the disease leads to improvement of symptoms; simple medical management can preclude the need for surgery.
Aim: In this study, we aimed to assess the incidence of postpartum depression, factors affecting the development of postpartum depression and to make a detailed analysis of intimate partner violence (IPV) during pregnancy and its effects on postpartum depression. Material and Method: This study enrolled 220 participants who were 2-6 months in puerperiumperiod. The ssociodemographic features of the participants and the levels of physical, economic, sexual, and psychological IPV exposed during pregnancy were rated using Edinburgh Postpartum Depression Scale (EPDS) that determines the risk of postpartum depression. A p-value less than 0.05 was considered statistically significant Results: The mean age of 220 participants was 30.84 +/- 6.032 years. Thirty-five (15.9%) participants scored 13 or higher in the EPDS score; these 35 participants were considered to have postpartum depression (PPD). There was a significant difference between the EPDS scores by the educational levels of the partners (p<0.05). EPDS score was affected significantly by having a delivery under urgent conditions, developing any infantile complication during delivery, physical and psychological IPV had a significant effect on EPDS (p<0.05). Marriage age and educational level had a significant correlation with physical IPV (p<0.05). Discussion: PPD is a highly prevalent disorder that adversely affects the quality of life of a mother, infant, and all family members. Mothers in the postpartum period should be more closely followed and PPD must be questioned in family health centers.
