P-ISSN 2587-2400 | E-ISSN 2587-196X
EJMO: 2 (3)

Volume: 2  Issue: 3 - 2018

INVITED REVIEW
1.Enzalutamide and Cancer
Bulent Erdogan, Osman Kostek, Muhammet Bekirhacioglu
doi: 10.14744/ejmo.2018.72098  Pages 121 - 129 (103 accesses)
Prostate carcinoma is androgen-dependent, and therefore the main target of treatment is lowering androgen levels. Medical or surgical castration, androgen receptor-blocking agents, androgen-synthesis inhibitors, chemotherapy, sipuleucel-T, and radium-223 are treatment options. Enzalutamide is a relatively new androgen-signaling inhibitor that has 5 to 8 times greater affinity for the androgen receptor (AR) than bicalutamide. Enzalutamide does not demonstrate agonistic activity on ARs. Enzalutamide induces apoptosis of prostate cancer cells. Enzalutamide is effective in metastatic castration-resistant prostate cancer in patients with progression after docetaxel treatment and in chemotherapy-naive patients. Enzalutamide is also superior to the commonly used AR blocking agent bicalutamide in chemotherapy-naive metastatic and non-metastatic castration-resistant prostate cancer patients. Its efficacy has been proven in hormone-naive patients, and several trials are ongoing. Enzalutamide has a favorable side effect profile and improves quality of life and pain scores.

RESEARCH ARTICLE
2.Relationship between Plasma Homocysteine and Obstructive Sleep Apneasin Children: A Preliminary Study
Marco Zaffanello, Emma Gasperi, Giuseppe Lippi, Laura Tenero, Michele Piazza, Luca Sacchetto, Giorgio Piacentini
doi: 10.14744/ejmo.2018.93685  Pages 130 - 134 (94 accesses)
Objectives: Plasma homocysteine concentration is increased adult patient swith obstructive sleep apneas, whilst it is still unknown if its plasma levels may also be enhanced in obstructive sleep apneain childhood. We investigated the possible relationship between plasma homocysteine and obstructive sleep apnea in children.
Methods: A total number of 199 children were studied between July 2016 and June 2017. All children underwent an overnight respiratory polygraph study. Laboratory data were retrospectively reviewed, in clusing plasma homocysteine, folate and vitamin B12.
Results: Twenty children were finally included in ourstudy. Linear regression analysis showed that plasma homocysteine was positively correlated with age (β=2.930; p=0.010), and inversely correlated with folate (β=-4.830; p<0.001), vitamin B12 (β=-3.844; p=0.002) and haemoglobin (β=-3.503; p=0.003). No significant correlation was found with platelet count (p=0.578) and apnea-hypopnea index (p=0.272). After age adjustment, homocysteine levels remained inversely correlated with folate, but no association was found with sleep respiratory parameters.
Conclusion: This retrospective study suggests that serum homocysteine levels is not increased in children with obstructive sleep apnea, whilst, a folate-enriched diet seems advisable in children with obstructive sleep apnea to counteract oxidative stress. Further controlled studies are needed.

3.Evaluation of 1808 Newborns Hearing Screening Outcome
Ahmet Hamdi Kepekci
doi: 10.14744/ejmo.2018.58076  Pages 135 - 137 (80 accesses)
Objectives: We evaluated the results of hearing screening tests performed at our center during the study.
Methods: In this descriptive study, 1808 newborns at our center between October 2015 and November 2017 were examined. Hearing screening tests were done according to the National Hearing Screening Protocol without discharge from the baby hospital.
Results: In this study totally 1808 babies were designated for hearing screening test. According to the hearing screening tests, the percentage of babies who are suspected of hearing loss and referred to the reference center is 0.11%.
Conclusion: Early detection of hearing the loss in newborns is important for early treatment. All newborns should be assessed in terms of their risk factors and all those involved in the risk group should be screened. In this respect, treatment of hearing loss children can be started for language and speech development can be achieved.

4.Relation between Stress Hyperglycemia and Mortality in Patients with Acute Myocardial Infarction
Nazli Gormeli Kurt, Murat Orak, Mehmet Ustundag
doi: 10.14744/ejmo.2018.49469  Pages 138 - 141 (78 accesses)
Objectives: Acute myocardial infarction (AMI) is one of the leading causes of death in industrialized countries. Hyperglycemia and impaired glucose tolerance are common during AMI. We aimed to investigate the effect of stress (acute) hyperglycemia on mortality in patients with AMI who were not previously diagnosed with diabetes mellitus (DM).
Methods: We retrospectively reviewed 307 patients with acute coronary syndrome (ACS) who were admitted to the Emergency Department of Batman Regional State Hospital between January 1, 2014 and January 1, 2018. Stress hyperglycemia was considered to be present in patients with no DM history with a blood glucose level of >140 mg/dL or who had an HbA1c value of <6.5 in the last 3 months.
Results: Of the 307 patients in our study, 211 (68%) were male and 96 (32%) were female. Stress hyperglycemia was detected in 141 (45.9%) of the patients. It was found that 69% of patients with stress-related hyperglycemia had ST segment elevation myocardial infarction (STEMI) and 31% had non-ST segment elevation myocardial infarction (NSTEMI). We found that the rate of STEMI detection in patients with stress hyperglycemia was statistically significantly higher than that in NSTEMI (p<0.001). We found a significant relationship between the duration of hospital stay and hyperglycemia compared with the duration of hospitalization with stress hyperglycemia (p=0.01). In total, 24 patients (7.8%) died. Stress hyperglycemia was present in 66.1% of patients with exclusion, whereas 33.9% of patients did not have stress hyperglycemia. We found a statistically significant relationship between exclusion patients and stress hyperglycemia (p=0.002).
Conclusion: We found a significant association between stress hyperglycemia and mortality and duration of hospital stay in patients with AMI. We believe that prognosis and mortality of patients with AMI can be predicted using blood sugar level at the time of admission.

5.Outcomes of Surgery in Crohn’s Disease: A Single-Center Experience
Ibrahim Mungan, Sema Turan, Dilek Kazanci, Serife Bektas, Serdar Yamanyar, Erdal Birol Bostanci
doi: 10.14744/ejmo.2018.63935  Pages 142 - 145 (57 accesses)
Objectives: Crohn's disease (CD) is a chronic inflammatory condition that affects the entire gastrointestinal tract. Surgery is not curative and first-line treatment modality for patients with CD, but 75% of the patients require surgery. There are mainly four surgical options with different outcomes and recurrence rates. We aimed to investigate the postoperative results of different surgical interventions used to treat CD and their association with treatment modalities.
Methods: A retrospective study was performed through the analysis of patients treated with surgery involving bowel resection. A total of 76 patients were included and classified into four groups according to the type of surgery they underwent: segmental colectomy, total colectomy, segmental small intestinal resection or stricturoplasty, and ileocecal resection.
Results: 76 patients underwent a bowel resection for complicated CD. There was no significant difference in the rates of morbidity and mortality among the four surgical procedure groups. Regarding hospital stay and ICU stay, there was a statistically significant difference (p=0.03) among the groups, especially in the Total proctocolectomy (TPC) TPC group. There was no statistically significant difference in the mortality and morbidity rates between the surgery groups. Likewise, we did not find any statistical difference between laparoscopy and open resection or emergency and scheduled surgery.
Conclusion: We found that patients who undergo TPC for Crohn’s colitis exhibit a significantly longer length of hospital stay than those who undergo other surgical procedures, but there was no statistical significant difference in mortality and morbidity among the groups.

6.Evaluation of the Attitude of Anesthetists About Anaphylaxis in Turkey
Sengul Ozmert, Emine Dibek Misirlioglu, Feyza Sever, Galip Ozmert, Fatih Misirlioglu, Can Naci Kocabas
doi: 10.14744/ejmo.2018.02997  Pages 146 - 151 (81 accesses)
Objectives: Anaphylactic reactions are important health problems encountered by anesthesiologists during anesthesia administration. The aim of the study was to determine the attitude of anesthesiologists regarding the management of anaphylactic reactions.
Methods: Anesthesiologists across the country were administered a questionnaire consisting of 24 questions that evaluated their attitude regarding anesthesia management in anaphylactic reactions.
Results: A total of 223 (70.4% female) anesthesiologists were included in our study. Participants’ level of knowledge for recognizing the signs of anaphylaxis was sufficient. Furthermore, 89.7% of the participants knew that anaphylaxis could occur without skin symptoms. The rate of using adrenalin for anaphylaxis treatment was 74.8%, and the proportion of participants who knew the dose correctly was 65%. The adrenalin administration route was stated as intravenous by 52.5% and intramuscular by 13.1% of the participants.
The rate of preoperative questioning of the patient’s history of a drug and food allergy was 91.5% and 81.2%, respectively. The answers revealed that 61% of the participants were worried when administering anesthesia to a patient with history of drug allergy.
Conclusion: Although the knowledge of anesthetists regarding anaphylaxis is generally sufficient, its importance emphasized during specialized training should be continuously updated.

7.Impact of an Onsite Occupational Health Clinic on Organisational Performance and Employee Wellbeing at a Southern African Maritime Port
Mbuso Mabuza
doi: 10.14744/ejmo.2017.24008  Pages 152 - 164 (60 accesses)
Objectives: The purpose of the study was to explore the perceptions of employees on the impact of an on-site occupational health clinic on organisational performance, and employee wellbeing at a southern African maritime port.
Methods: A qualitative research methodology was used in this study through employing an exploratory design. This qualitative research study comprised a sample population of fifteen purposively selected employees. Data was collected through semi-structured interviews using an interview schedule.
Results: The overall findings of the study indicate that 66.67 per cent of the respondents perceived the on-site occupational health clinic as having improved the organisation’s lost work time, employee morale and workforce productivity. There were 20 per cent of the respondents who perceived the on-site occupational health clinic as not having improved the organisation’s lost work time, employee morale and workforce productivity. Only 13.33 per cent of the respondents were uncertain about the impact of the on-site occupational health clinic on the organisation’s lost work time, employee morale and workforce productivity.
Conclusion: It could be discerned that the impact of the on-site occupational health clinic at the Southern African Maritime Port was largely related to its convenience and to the trust it was capable of engendering in the employees it served. A recommendation was that an on-site occupational health clinic should be regarded as an investment in human capital, in order to enhance organisational performance excellence and maintenance of a leading edge.

8.Computed Tomography Organ Dose Determination Using ImPACT Simulation Software: Our Findings In South-West Nigeria
Michael Onoriode Akpochafor, Akintayo Daniel Omojola, Muhammad Yaqub Habeebu, Jerry Clifford Ezike, Samuel Olaolu Adeneye, Mary-ann Etim Ekpo, Moses Adebayo Aweda, Abayomi Emmanuel Opadele, Temitope Aminat Orotoye
doi: 10.14744/ejmo.2017.75047  Pages 165 - 172 (262 accesses)
Objectives: The aim of this study was to estimate mean organ dose using the imPACT software, and to determine if dose vary significantly for similar organ among the 7 Computed Tomography (CT) units and to compare and correlate our findings with international studies with similar software.
Methods: Seven CT units denoted as A-G was randomly selected. An imPACT Patient Dosimetry Calculator Software was used to determine organ dose to the head, chest, abdomen and pelvic region from 210 patients' CT parameters retrieved from the CT monitor. Data analysis was done using SPSS 16.0 (SPSS Inc, Chicago, IL, USA).
Results: The mean dose to organs in the head (brain and eye lens) was 27.87±9.58 and 55.27±22.34mGy; chest (lungs, breast, thyroid and heart) was 30.63±8.21, 26.41±6.76, 10.21±7.00 and 29.93±9.65mGy; Abdomen (stomach and liver) was 34±12.8 and 33.05±9.93mGy and Pelvis (bladder and uterus) was 32.44±13.8 and 28.97±7.14mGy respectively. Similar organ show statistically significant difference: for brain (p<0.001), eye lens (p=0.001), lungs (p<0.001), breast (p<0.001), thyroid (p=0.008), heart (p<0.001), stomach (p<0.001), liver (p=0.001), bladder (p<0.001) and uterus (p=0.002) among the 7 CT units. There was no correlation in organ dose for this study and those of Tanzania, Turkey, Japan and Thailand.
Conclusion: Significant differences exist in similar organ doses among the 7 CT units in Lagos indicating that there was lack of harmonization in CT protocols.

CASE REPORT
9.Castleman's Disease Associated with Pemphigus Vulgaris: Remains Retrospectively Diagnosed Entity
Dhaivat K Vaishnav
doi: 10.14744/ejmo.2018.14632  Pages 173 - 175 (52 accesses)
Castleman's disease is a rare, benign, lymphoproliferative disorder of unknown cause.[1] The disease can be occasionally associated with a paraneoplastic pemphigus (PNP), an autoimmune mucocutaneous disorder commonly seen in neoplasms of lymphocytic origin.[2] Castleman's tumor has been found in only 10 % of PNP patients,[3] so the diagnosis depends mainly on the pathological examination. For pathological examination, complete surgical excision biopsy of uni-centric disease remains best mode of treatment. We report a case of retrospectively diagnosed case of castleman’s disease with PNP after pathological examination.

10.Anesthetic Management of a Pregnant Woman with Heroin Addiction Under Emergency Conditions: A Case Report
Fatma Kavak Akelma
doi: 10.14744/ejmo.2018.57441  Pages 176 - 178 (48 accesses)
Heroin abuse and addiction is steadily increasing worldwide, particularly among young people and pregnant women. In the current report, we present the challenges encountered in the management of a pregnant patient with heroin dependence in the pre- and intraoperative stages and discuss the choice of anesthetic technique under emergency circumstances. We performed an emergency cesarean section (C/S) under spinal anesthesia in a 23-year-old pregnant woman who presented with fetal distress and who had a history of heroin abuse during pregnancy. After delivery, 1 mg midazolam and 50 μg fentanyl were administered to relieve maternal anxiety. We recommend the use of regional anesthesia, if not contraindicated, in pregnant women with opioid dependence requiring emergency C/S.

11.Effect of Alpha Lipoic Acid in the Treatment of Multiple Sclerosis-Induced Neuropathic Pain: A Case Report
Fazil Kulakli
doi: 10.14744/ejmo.2017.37929  Pages 179 - 181 (72 accesses)
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS) resulting in motor, sensory, and cognitive impairment. MS symptoms greatly affect the quality of life of patients with one of the most common symptom being pain. Neuropathic pain (NP) that develops secondary to demyelination, neuro-inflammation, and axonal damage in the CNS is the most distressing and difficult type of pain to treat in patients with MS. A patient with MS presented to our department with dysesthetic extremity pain that was characterized by burning and tingling predominantly in both feet and was worse at night. She was evaluated and diagnosed with MS-induced NP and treated with alpha lipoic acid (ALA) because of unresponsiveness and intolerance to amitriptyline, pregabalin, and gabapentin treatments. In this report, we present and discuss the ALA treatment in a patient with MS-induced NP.

12.Subacute Thyroiditis During Peginterferon Alfa Therapy for Chronic Hepatitis Delta
Fatih Kuzu, Elif Neslihan Akdemir
doi: 10.14744/ejmo.2017.43434  Pages 182 - 185 (50 accesses)
Subacute thyroiditis is a nonsuppurative inflammation of the thyroid gland. Although there are case reports on the formation of subacute thyroiditis in patients with hepatitis C virus (HCV) and hepatitis B virus (HBV) receiving interferon treatment, there are no reports regarding the development of subacute thyroiditis in patients with hepatitis D virus (HDV) receiving interferon treatment. Here, we present the case of a patient with subacute thyroiditis receiving peginterferon alfa-2a for chronic HDV and to our knowledge this is the first report in the literature.

LETTER TO THE EDITOR
13.The Effect of Levetiracetam on Insulin/Glucose Level
Gokhan Ozer
doi: 10.14744/ejmo.2017.72691  Pages 186 - 187 (42 accesses)
Abstract | Full Text PDF


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