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EJMO: 1 (4)

Volume: 1  Issue: 4 - 2017

INVITED REVIEW
1.Foreign Body Ingestion, an Important Cause of Mortality and Morbidity
Erdal Uysal, Seyit Mehmet Ceylan
doi: 10.14744/ejmo.2017.25733  Pages 183 - 189 (84 accesses)
Foreign body ingestion (FBI) is a common clinical condition, especially in childhood age groups. The aim of this study was to analyze and discuss 118 articles related to FBI, to determine the clinical approaches used in FBI, and to emphasize the importance of subject. The data of this study were compiled through a search of the Web of Science (Clarivate Analytics, Philadelphia, PA, USA). “Foreign body ingestion” was the search term used to select relevant article titles from all years available. The analysis of 118 articles included the publishing journal, the medical specialty of the research, the country of origin, the institution that performed the study, and the date of publication. Pediatric and surgical studies were most common, numbering 37 (31.3%) and 25 (21.1%), in the respective fields of research. The greatest portion of articles, 39 (33%), was published in the United States of America, and the greatest quantity of articles was published in 2005. The mean age of the patient presenting with FBI was 3.1-5 years. FBI can cause asphyxia and mortality in situations affecting the aerodigestive tract. Conservative treatment was the most common approach used; however, at times endoscopy or surgical intervention is required. FBI should be kept in mind, particularly for pediatric patients, when there are complaints of shortness of breath, abdominal pain, and vomiting.

RESEARCH ARTICLE
2.Association between Vitamin D Level and Microvascular Complications in Patients with Type 2 Diabetes
Banu Boyuk, Hande Atalay, Serife Degirmencioglu, Murat Altay, Savas Guzel, Aslan Celebi, Ismail Ekizoglu, Yavuz Ayar
doi: 10.14744/ejmo.2017.69775  Pages 190 - 196 (84 accesses)
Objectives: The aim of this study was to further investigate the prevalence of Vitamin D deficiency in diabetes mellitus (DM) patients, as well as the association between hypovitaminosis D and the microvascular complications of type 2 (T2) DM.
Methods: This was a cross-sectional, case-control study of 206 T2DM patients and 34 healthy control subjects. Participants were evaluated for the presence of diabetic retinopathy, nephropathy, and neuropathy.
Results: The level of serum 25-hydroxyvitamin D (25(OH) D) was significantly lower in the T2DM patients (11.16±3.99 ng/mL vs. 15.58±3.16 ng/mL; p<0.05). Furthermore, 2.7% of the patients were found to have retinopathy (n=53), 3.6% had neuropathy (n=65), and 29.1% of the patients had microalbuminuria (n=60). Although serum 25(OH) D levels were significantly lower in the presence of retinopathy and neuropathy (p<0.05 for both), no significant association between Vitamin D level and microalbuminuria was found.
Conclusion: An inverse relationship between the circulating 25(OH) D level and the prevalence of retinopathy and neuropathy in T2DM patients was determined. However, there was no significant association between microalbuminuria and the 25(OH) D level.

3.A Comparison of Spinal and Epidural Anesthesia in Pilonidal Sinus Surgery: A Prospective Randomized Single-Center Clinical Study
Turgut Donmez, Adnan Hut, Vuslat Muslu Erdem, Duygu Ayfer Erdem, Doğan Yildirim, Sinan Uzman, Oguzhan Sunamak, Muzaffer Akinci, Ibrahim Halil Ozata
doi: 10.14744/ejmo.2017.30502  Pages 197 - 201 (72 accesses)
Objectives: Regional anesthesia techniques may be preferred to general anesthesia for pilonidal sinus surgery due to difficulties related to the prone position under general anesthesia. The aim of this study was to compare spinal anesthesia (SA) and epidural anesthesia (EA) with respect to perioperative and postoperative side effects and postoperative pain.
Methods: A total of 100 American Society of Anesthesiologist class I or II patients underwent pilonidal sinus surgery. The patients were randomly divided into 2 groups of SA (n=50) or EA (n=50). The perioperative and postoperative side effects related to anesthesia and postoperative pain level were compared between the groups.
Results: There was a significant difference with respect to the maximal sensorial height of block (EA: L1-L3; SA: T7-T11; p<0.001). The duration of the sensorial block was significantly longer in the EA group (290±23 minutes) compared with the SA group (215±6 minutes). No patient in the EA group developed motor block. There was no significant difference between the groups in the side effects related to anesthesia. The postoperative pain level was evaluated with the Visual Analogue Scale in the postoperative recovery room and at 6, 12, and 24 hours after surgery. None of the patients in either group required analgesic treatment for first 6 hours after the surgery. There was significantly less postoperative pain in the EA group compared with the SA group, except at the sixth hour, but the clinical difference was small.
Conclusion: EA may be preferred to SA due to better postoperative pain control and the absence of a motor block.

4.The Prevalence of Insulin Resistance in the Turkish Population: A Study Conducted with 3331 Participants
Ahmet Kaya, Elif Turan, Mehmet Uyar, Fahri Bayram, Yasar Turan
doi: 10.14744/ejmo.2017.02886  Pages 202 - 206 (58 accesses)
Objectives: The aim of this study was to apply the homeostasis model assessment of insulin resistance (HOMA-IR) and examine the relationships between age, sex, and body mass index (BMI) and the prevalence of diabetes mellitus (DM) and insulin resistance (IR) in the Turkish population of different regions of the country.
Methods: This was a cross-sectional, observational study designed in the framework of a multicenter study to analyze the Turkish prevalence of insulin resistance. The study sample consisted of volunteers from the 7 different regions of Turkey. Weight, height, and waist circumference were measured. BMI, blood pressure, fasting blood glucose, and fasting blood insulin levels were calculated. IR was determined using the HOMA-IR.
Results: The prevalence of DM, impaired fasting glucose, and IR was 11.1%, 21.3%, and 26.2%, respectively, in all 7 regions of Turkey. IR was detected in 28.9% of women and 25.1% of men. The difference between men and women was significant (p=0.04). The prevalence of IR in postmenopausal women (30.8%) was higher than premenopausal women (25.1%) (p<0.04). A comparison of age groups revealed that the prevalence of IR among those aged 50 to 59 (33.8%; p<0.001) was higher than in the other age groups. IR was also more prevalent in those with a BMI >25 kg/m2, those with hypertension, and those living in city centers (p<0.05).
Conclusion: The high prevalence of IR and DM in Turkey is an important public health problem. This study provides a large-sample representative study of the Turkish population. The prevalence of IR was highly correlated with central obesity, hypertension, and a more sedentary lifestyle, such as is often seen in city centers. There is an urgent need to institute more aggressive, nationwide public health measures and screening programs regarding obesity.

5.A Randomized, Prospective, Double-Blind Clinical Trial on the Optimal Dose of Oral Midazolam Premedication in Pediatric Day Case Surger
Sinem Ordu, Zeynep Nur Orhon, Melek Celik
doi: 10.14744/ejmo.2017.18480  Pages 207 - 211 (53 accesses)
Objectives: Anxiolysis and sedation with oral midazolam are common practice in pediatric anesthesia. The aim of the present study was to evaluate the efficacy and safety of 3 different doses of midazolam as a premedication agent in day case pediatric surgery patients.
Methods: This prospective, randomized, double-blind clinical investigation was designed at Medeniyet University Göztepe Education and Training Hospital Department of Anesthesiology and Reanimation. In all, 90 children aged 6 months to 6 years with American Society of Anesthesiologists physical status of class I or II, who were scheduled for inguinal hernia repair or hydrocele operation were included in the study. Patients were randomly allocated into 3 groups to receive midazolam premedication 0.3 mg kg-1 (Group I), 0.5 mg kg-1 (Group II), or 0.75 mg kg-1 (Group III). Psychological, behavioral, and physiological parameters (heart rate, mean arterial pressure, arterial oxygen saturation, respiratory rate, sedation, anxiolysis score and mask toleration score) were recorded at particular time intervals and special stressful events (separation from parents, induction of anesthesia). Adverse events were also noted.
Results: Satisfactory sedation was achieved in all groups. At the end of the operation, the sedation score was higher in Group III. The anxiety rating of face mask application was satisfactory in Group II. There were significant differences between groups in hemodynamic variables, oxygen saturation, and respiratory rate. However, they were accepted as clinically insignificant. There was no significant difference in separation scores between the 3 groups. Postoperative vomiting occurred in 3 patients in Group II and in 2 patients in Group III. Also in Group III, recovery was late in 2 patients and agitation was seen in 2 patients.
Conclusion: A dose of 0.3-0.75 mg kg-1 oral midazolam can be used safely for the premedication of pediatric patients to provide sufficient sedation, a pleasant separation from the parents, and fair tolerance of face mask application.

6.The Importance of Hemogram Parameters in Family Medicine for Coronary Artery Disease
Suleyman Ozsari, Emine Ozsari
doi: 10.14744/ejmo.2017.26818  Pages 212 - 215 (48 accesses)
Objectives: The present study was an investigation of the relationship between the hemogram parameters of mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), and the severity of stenosis observed in patients with coronary artery disease (CAD).
Methods: A total of 240 patients, 163 with CAD (85 male, 78 female) and 77 controls with no stenosis were included in the study. Patients were divided into 3 groups based on their Gensini score.
Results: It was determined that the mean MPV of the severe stenosis group and the mean NLR of the severe stenosis group were statistically significantly higher than in the control group (p=0.023, p=0.014).
Conclusion: This study established an association between the Gensini score and the MPV, NLR, and PLR for the first time. The aim of this research was to assist with the early diagnosis of cardiovascular diseases. Regular recording and analysis of the MPV, NLR, and PLR of patients by family physicians can increase early detection and treatment, thereby decreasing morbidity and mortality.

7.Adolescent or Advanced Age Pregnancy: What About Quality of Life?
Elif Yilmaz
doi: 10.14744/ejmo.2017.74046  Pages 216 - 223 (51 accesses)
Objectives: The aim of this study was to evaluate the impact of age and other socio-demographic factors that may be associated with poor health status during pregnancy.
Methods: Of a total of 300 pregnant women included in the study, 100 were adolescents (≤19 years), 100 were average-aged (20 to 34 years), and 100 were of advanced age (≥35 years). After obtaining sociodemographic and obstetric information in a face-to-face interview, the women completed the Short Form 36 Health Survey (SF-36) questionnaire. The SF-36 scores were compared between groups.
Results: It was determined that the quality of life (QoL) scores in pregnancy were generally lower when compared to non-pregnant women. All of the QoL subscores were found to be significantly higher in the average-aged group (p=0.000). The physical component summary (PCS) scores were found to be lowest in the advanced-age group, and the mental component summary (MCS) scores were lowest in the adolescent group (p=0.000). Except for the PCS, which was higher in the adolescent group, no statistically significant difference in the other subscores was found between the adolescent and advanced age groups (p=0.000). According to multivariable regression analysis, age, unplanned pregnancy, lack of sharing problems with spouse/relatives, and uneasiness within the family were found to be associated with poorer PCS and MCS scores.
Conclusion: Both healthcare professionals and the individuals closest to pregnant women need to be aware of the importance of both physical and mental factors in maternal well-being, especially in adolescent and advanced-age groups.

8.Assessment of Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio in Ulcerative Colitis: A Retrospective Study
Kemal Fidan, Mehmet Zahid Kocak
doi: 10.14744/ejmo.2017.30075  Pages 224 - 227 (47 accesses)
Objectives: The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are markers of subclinical inflammation already used to determine outcomes in coronary artery disease and some malignancies. The aim of this study was to investigate the NLR and the PLR as possible indicators of ulcerative colitis (UC) disease activity.
Methods: Of a total of 67 patients included in the study, 36 had active UC and 31 were in a remission period. The NLR and the PLR were calculated using complete blood count parameters. The modified Truelove-Witts Severity Index was used to group the patients: remission (n=31), mild activation (n=21), moderate activation (n=6), and severe activation (n=9).
Results: The mean NLR of the active and remission UC patients was 4.78 and 2.01, respectively (p<0.002). The cut-off value for NLR to discriminate an active phase in UC patients was calculated to be ≥2.2 using receiver operating characteristic (ROC) analysis (sensitivity: 62%; specificity: 70%). The mean PLR of the active and remission UC patients was 209.52 and 131.27, respectively (p=0.005). The cut-off value for PLR to discriminate an active phase in UC patients was calculated to be ≥133.87 using ROC analysis (sensitivity: 63%; specificity: 68%).
Conclusion: The NLR and the PLR of active UC patients were significantly higher than those of remission patients. The NLR and the PLR may be independent, noninvasive markers of disease activity in UC.

9.The Human Papilloma Virus Vaccination: Turkish Mothers’ Views
Bahire Ulus, Gizem Sahin, Ükke Karabacak, Fatma Eti Aslan
doi: 10.14744/ejmo.2017.44127  Pages 228 - 233 (42 accesses)
Objectives: This study was conducted in order to analyze the knowledge and opinions of mothers of daughters in Turkey regarding the human papilloma virus (HPV) vaccine.
Methods: This descriptive study was conducted at 8 public family health centers at primary health care institutions affiliated with the Ministry of Health located in Ataşehir, in Istanbul province. A total of 252 mothers of daughters participated. A sociodemographic characteristics form and an HPV vaccine evaluation questionnaire were used to collect the data. The data were analyzed using percentage, frequency distribution, a chi-square test, and Fisher’s exact test.
Results: Most of the participating mothers were between the ages of 28 and 47 years (68.7%), had a high school graduate education or less (82.5%), were not employed (67.9%), and had a low family income (57.6%). The majority (95.6%) had no experience with cervical cancer in their family, 60.7% had never heard of HPV infection, 72.2% did not know that HPV infection is related to cervical cancer, 54.8% had never heard of the HPV vaccine, 89.7% had not been advised to have their daughters vaccinated, and 98.8% had not yet had their daughters vaccinated. Among the factors influencing the mothers’ information about HPV infection were age (p=0.021), education level (p<0.001), work status (p<0.001), mothers’ marriage age (p<0.001) and family income level (p=0.009). It was determined that a greater education level positively influenced the mothers’ intention to get the HPV vaccine for their daughter (p=0.044).
Conclusion: This study revealed that the mothers had very limited knowledge of the HPV vaccine and that health professionals do not sufficiently inform parents on this subject. It was also found that the high cost of the vaccine and other influences had a negative impact on intention to pursue obtaining the vaccine.

CASE REPORT
10.Determination of Puncture Point for Spinal Needle with Ultrasound in a Morbidly Obese Patient
Ali Nadir Ozcekic, Sibel Devrim, Ibrahim Ozturk
doi: 10.14744/ejmo.2017.24633  Pages 234 - 236 (74 accesses)
Obesity, defined as a body mass index (BMI) ≥30 kg/m2, is an important clinical condition that affects many organ systems. In addition to the systematic effects, obesity can lead to complexity in the application of clinical anesthesia, such as regional anesthesia approaches. The use of ultrasound (US) may be necessary to ensure the success and reliability of neuraxial blocks, especially in patients with anatomical landmarks that are difficult to determine. Presently described is a case with a morbidly obese patient case for whom we had to determine the puncture point for a spinal needle using US due to pulmonary issues. In the preoperative evaluation of this 69-year old, 180 kg, 150 cm tall, female patient with a BMI of 75 kg/m2 who had a fracture of the left femoral diaphysis, it was observed that she presented with wheezy breathing and a cough. The physical examination found that end expiration was prolonged and wheezing was auscultated at the end of expiration. Spinal anesthesia was administered to the patient with US guidance as a result of the pulmonary issues. She was admitted to the intensive care unit with no observed problem and was discharged to the orthopedic clinic the following day.

11.A Case of Dysphagia and Dysphonia Caused by Diffuse Idiopathic Skeletal Hyperostosis
Ahmet Hamdi Kepekçi, Hidayet Sarı
doi: 10.14744/ejmo.2017.69188  Pages 237 - 239 (52 accesses)
This report describes a case of diffuse idiopathic skeletal hyperostosis (DISH) leading to dysphagia and dysphonia. DISH causes fibrosis in the ligaments, tendons, and joint capsules, and eventually, secondary osteophytes. DISH is more common in men than women, and is typically seen in those over the age of 50. A 75-year-old female patient who had been diagnosed with DISH presented at the ear, nose, and throat polyclinic for dysphagia and dysphonia, as well as back and neck pain. Endoscopic examination of the larynx revealed a protrusion at the posterior wall of the hypopharynx. Computed tomography (CT) scanning of the larynx and cervical region and a barium swallow were performed. The CT scan showed large osteophytes originating in the anterior part of the second and third cervical vertebrae that were suppressing the laryngeal structures and the epiglottis. The swallow graphy also indicated suppression and partial blockage of the esophageal passage. The protruding osteophytes had damaged the recurrent laryngeal nerve and caused recurrent laryngeal neuropathy and esophageal inflammation, and fibrosis led to dysphagia and dysphonia. Treatment with oral anti-inflammatory drugs and physiotherapy was initiated and surgical excision of the osteophytes was suggested. In the differential diagnosis of dysphagia and dysphonia, an endoscopic examination of the larynx and the posterior wall of the hypopharynx should be performed, and it is important to consider DISH. Furthermore, a multidisciplinary approach including physiotherapy, neurology, and other related clinics, is essential.

12.Emergency Coronary Bypass Due to a Pseudoaneurysm
Mazlum Sahin
doi: 10.14744/ejmo.2017.80299  Pages 240 - 242 (39 accesses)
The indications for immediate coronary bypass stated in the American Heart Association guidelines for percutaneous transluminal coronary angioplasty are: less than 6 hours after myocardial infarction (MI), ongoing or recurrent angina pectoris despite medical intervention within 12 hours, cardiogenic concussion, ongoing ischemia, or MI complications after thrombolytic therapy. Presently described is the case of a 52-year-old patient with a femoral pseudoaneurysm who required an immediate coronary bypass procedure.

ORIGINAL IMAGES
13.Cardiac Invasion of HCC: Clinical Image
Osman Kostek, Irem Karakaya Tosun, Hande Tecimen, Nil Su Kodal
doi: 10.14744/ejmo.2017.76486  Page 243 (49 accesses)
Abstract | Full Text PDF

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