Gazi Medical Journal Gazi University Medical Journal en-US Gazi Medical Journal 1300-056X <p>All opinions and reports within the articles that are published in the Gazi Medical Journal are the personal opinions of author(s). Gazi University, Editors and the publisher do not accept any responsibility for these articles. The journal is printed on acid-free paper.</p> Seat-Belt Use and Related Factors Among High School Students in a Semi-Rural Area of Western Turkey <p><strong>Objective: </strong>Traffic injuries are a public health issue that costs millions of death and injuries each year. The majority of all traffic deaths and injuries occur in rural and semi rural areas of developing countries as Turkey. The aim of present study was to determine seat belt use and related factors in high school students living in semi-rural area of Eskisehir.</p> <p><strong>Methods:</strong> This cross sectional study was carried out in four semi-rural area of Eskisehir in 2014-2015 academic season. Students from 14 high schools were included into the study. A two part questionnaire was prepared to collect data.</p> <p><strong>Results:</strong> In our study 22.9% of students do not use seat-belt in traffic. According to the multivariate logistic regression analyses no seat-belt use behaviour associated with being male 1.48 (1.02-2.13), having unemployed father 1.76 (1.20-2.58), no helmet use 1.64 (1.11-2.42), exhibiting violent behaviour at school 1.90 (1.36-2.65) and smoking 1.50 (1.01-2.25).</p> <p><strong>Conclusion:</strong> An effective traffic education program must be planned and enforced in all high schools to improve students’ negative behaviours about the seat-belt use. More effective school health programs and other policy and programmatic interventions are needed to address this issue.</p> Egemen Ünal Burcu Işıktekin Atalay Muhammed Fatih Önsüz Burhanettin Işıklı Selma Metintaş Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Estimation of Platelet Parameters and Liver Enzymes During the Ramadan Fasting among Healthy Subjects <p><strong>Background/aim: </strong>The aim of this study is to investigate Platelet Parameters and liver enzymes during the fasting in Ramadan month on among healthy subjects.</p> <p><strong>Materials and methods:</strong> Twenty eight subjects (20 female and 8 male) participated in this study. Blood samples from healthy subjects were collected before 5 days of the fasting of Ramadan month and 28<sup>th</sup> day of the fasting of Ramadan month. Platelet Parameters were analyzed by using fully automatic hematological analyzer and liver enzymes were analyzed spectrophotometer (Biolab kits).</p> <p><strong>Results:</strong> The study in female subject discovered no difference in MPV, PCT, ALT activity, and AST activity, while PLT count, PDW and LPCR decreased during the fasting of Ramadan month. In other hand, the study in male subject discovered a decrease in platelet parameters (PLT, MPV, PDW, PCT and LPCR), while ALT activity increased during the fasting of Ramadan month. Also this study in male subject discovered no difference in AST activity during the fasting of Ramadan month.&nbsp;&nbsp;</p> <p><strong>Conclusions:</strong> This study shows that fasting in the Ramadan month had effect on platelet parameters in males while had effect on PLT, PDW and LPCR in female health. This study shows fasting Ramadan had effect on ALT activity in male.&nbsp;</p> Osamah Awad Ahmed Luay Awad Ahmed Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 The Effects of Memantine on Cognitive Function and Pain after Sevoflurane and Desflurane Anesthesia in Streptozotocin Induced Diabetic Rats <p><strong>Objective: </strong>Postoperative cognitive dysfunction (POCD) refers to a wide range of alterations which effect memory, information processing and executive function after anesthesia and, the mechanism is still not properly defined. Diabetes is a chronic metabolic disease which has a negative impact on cognitive function and leads to impairment of perception of pain by causing peripheral neuropathy. Sevoflurane and desflurane are anesthetic agents which are shown to cause POCD in many studies. Memantine is an agent which has a positive contribution on memory and learning; also known as neuroprotective and used in chronic pain treatment. In this study, we aim to investigate the effects of memantine, after sevoflurane and desflurane anesthesia on cognitive dysfunction and pain levels in diabetic rats.</p> <p><strong>Materials and Methods:</strong> In our study, we used 42, old (&gt;12 months) Wistar Albino rats, 6 of them were grouped as control group (Group C). We have injected 55 mg/kg streptozotocin (i.p) in the other wistar rats and measured blood glucose and weight. Diabetic 36 rats were randomized into 6 groups (n=6) and groups were defined as Group DC, Group DM, Group DS, Group DD, Group DSM, Group DDM and control group Group C. During 30 days we added 20 mg/kg memantine into the drinking water of Group DM, Group DSM and Group DDM’s rats. We measured radial arm maze (RAM) and hot plate values of 30 days-followed up rats weekly. At the end of 30 days we gave anesthesia to sevoflurane and desflurane groups in 2 hours-long period and after that we measured 0. 1. and 2. hours RAM and hot plate values of this rats and other rats.</p> <p><strong>Results: </strong>In the groups of which only variant was diabetes (until the study day Group C and Group DC, Group DS and Group DD, groups which weren’t given memantine), we compared the results and we conclude that diabetes has negative impact on cognitive function. Similarly, in the groups of which only variant was sevoflurane (Group DS and Group DC) or was desflurane (Group DD and Group DC) we compared the results and we conclude that our inhaler agents effect cognitive functions negatively. And yet, in the groups of which only variant was just inhaler agents (Group DS and Group DD; Group DSM and Group DDM), inhaler agents have similar effects on cognitive function and recovery. And finally, in the rat groups of which only variant was memantine (Group DC and Group DM, Group DSM and Group DS, Group DDM and Group DD), we observe that memantine fasten recovery time and has a positive effects on cognitive functions. In addition to that, we compared the hot plate measurements between 30 days followed-up diabetic rats which were not given memantine (Group DC, Group DS and Group DD) and diabetic rats which were given memantine (Group DM, Group DSM, Group DDM) and between the groups on the study day which had only variant memantine (Group DSM and Group DS; Group DDM and Group DD). The hot plate values show us memantine has an analgesic effect.</p> <p><strong>Conclusion: </strong>In conclusion, administration of memantine in diabetic rats has positive effect on recovery, cognitive functions and pain levels after anesthesia with sevoflurane or desflurane.</p> Ünal Taş Mehmet Akçabay Mustafa Arslan Yusuf Ünal Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 The Effects of Memantine on Recovery from Propofol Anesthesia, Cognitive Function and Pain in Elderly Rats <p><strong>Objective:</strong> Postoperative cognitive dysfunction (POCD) is a frequent complication after anesthesia and propofol is an intravenous anesthetic agent that has been proved to cause cognitive dysfunction. There are many risk factors such as age for POCD. Memantine has beneficial effects on memory deficits and learning process. Besides, it has neuroprotective effects and can be used in treatment of chronic pain syndromes. This study was designed to determine the effects of memantine on recovery, cognitive functions and pain in aged rats undergoing general anesthesia with propofol.</p> <p><strong>Materials and Methods:</strong> Thirty aged (&gt;12 months) Wistar rats were divided into 5 groups randomly. For Group C 0,9% NaCl (1 mL i.p.) was administered at, for Group P propofol (100 mg/kg i.p.) was administered at 21<sup>st</sup> day, for Group (oral memantine+propofol) OMP propofol (100 mg/kg, i.p.) was administered after 20 days of treatment with 20 mg/kg/day oral memantine, for Group (oral memantine) OM memantine (20 mg/kg/day oral) was administered for 20 days, for Group (intraperitoneal memantine+propofol) IPMP propofol (100 mg/kg) was administered &nbsp;after 30 minutes memantine (1 mg/kg i.p. in 1 mL 0,9% NaCl)&nbsp; were applied. Recovery was evaluated by tail pinch test, cognitive functions were evaluated by radial arm maze (RAM), S100 β and neuron-specific enolase (NSE) and pain was evaluated by hot-plate.</p> <p><strong>Results:</strong>&nbsp; In this study recovery times were shorter&nbsp;&nbsp; in Group OMP and Group IPMP when compared to Group P (p=0,011, p=0,034, respectively). Cognitive functions of rats in Group OMP and Group IPMP were better than Group P for the first value of recovery (p&lt;0,05<strong>). </strong>Hot-plate test values in all groups, except group C were longer at all time points when compared to control values (p&lt;0,05).&nbsp; NSE and S100 β levels were higher in Group P when compared to Group C. The levels of S100 β and NSE levels were comparable in Groups C, OMP and IPMP.</p> <p><strong>Conclusion:</strong>&nbsp; This study showed that memantine has beneficial effects on negative effects of propofol on recovery, cognitive functions and pain.</p> Büşra Sözen Yusuf Ünal Ülkü Sabuncu Hatice Paşaoğlu Mustafa Arslan Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 An Alternative Low-Cost Solution for Tracking Laboratory Animals <p><strong>Objectives</strong>: Monitoring animal behavior under various conditions can provide important information on their neuropsychological status, including learning, memory, and cognitive activity. Several commercial tracking systems are available, but they may be too expensive for low-budget projects. This study developed an alternative solution for automated animal tracking in behavioral experiments.</p> <p><strong>Methods</strong>: The proposed system was designed to analyze a set of images sampled from a recorded video file in chronological order. The instantaneous location of the animal in each image frame was defined automatically, using a feature-extraction algorithm. Distances traveled were calculated using the coordinates of the successive instantaneous locations. The algorithm was tested using two arenas: the Morris water maze and open field test. The calculated measures were compared with those obtained manually. The internal consistency of the dataset was checked using Cronbach’s alpha. The accuracy of the results was evaluated using the paired samples<em> t</em>-test and Pearson correlation, with the level of statistical significance set at <em>p</em>&lt;0.01.</p> <p><strong>Results</strong>: A statistical comparison of the distances traveled, which were derived from the coordinates of successive locations, did not differ significantly between the manual and automatic methods (r=0.954 and <em>p</em>=0.792 for the Morris water maze; r=0.996 and <em>p</em>=0.024 for the open field test).</p> <p><strong>Conclusions</strong>: These results suggest that the algorithm is reliable and valid for estimating coordinates and may serve as a high-resolution tool for animal behavior experiments. We intend to make this software freely available to interested readers and to open feedback channels for further development.</p> Erhan Kızıltan Leyla Aydın Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Evaluation of C-Reactive Protein in Iraqi Children Presented with Acute Enteropathogenic Escherichia Coli Associated Diarrhea with Special Emphasis to Age and Gender <p><strong>Background and Objectives:</strong>&nbsp; The aim is to determine the role of Enteropathogenic <em>Escherichia coli </em>(<em>EPEC</em>) serotypes (O111, O55, O26, O86, O119, O127, O114, and O142) in C- reactive protein (CRP) level in acute diarrhea among children; to determine the possible effect of age and gender in CRP level.</p> <p><strong>Methods:</strong> Culture of stool samples from 64 children in MacConkey agar for primary isolation of <em>E.coli </em>and&nbsp; confirmed via API20E . Sero-grouping of <em>E.coli </em>performed via specific antisera . CRP detected by latex agglutination.&nbsp;&nbsp;&nbsp;</p> <p><strong>Results:&nbsp; </strong>In this study, 64 children with diarrhea were involved.&nbsp; The mean age was 2.92 years. Males represent 34/64, 53.1%. The range of CRP level 12-96 mg/dl. <em>EPEC</em>1 and <em>EPEC</em>3 not detected. <em>EPEC</em>2 detected among 14/64, 21.9% and <em>EPEC</em>4 in 18.8%. Among the age group ˂1 year, <em>EPEC</em>2 detected in 9.38%, with mean CRP level 12mg/dl; 3.13%, 48 mg/dl 6.25% . <em>EPEC</em>4 detected in 2/64, 3.13%, with mean CRP level 12mg/dl. Age group 1-4 year, <em>EPEC</em>2 detected in 6/64 , 9.38% , with mean CRP level 24mg/dl. <em>EPEC4 detected in 6/64, 9.38%; </em>with mean CRP level 12mg/dl, 24mg/dl, 48mg/dl 3.<em>13% </em>in each. Among the age group&nbsp; 4.1-8&nbsp; year, <em>EPEC</em>4 detected in&nbsp;&nbsp; 4/64 ,6.25% , with CRP mean level&nbsp; 48 mg/dl. <em>EPEC</em> not detected in&nbsp; 8˃&nbsp; years age group .<em>EPEC</em>2 detected in&nbsp; male&nbsp; 28/64 , 43.75% and the CRP level range from 12-96mg/dl .<em>EPEC</em>2 detected in 22/64 females,&nbsp; 34.38% , CRP level range from 12-96mg/dl&nbsp; . No significant difference or correlation between gender and CRP level detected. <em>EPEC</em>4 detected in males 26/64 , 40.63% , CRP level range from&nbsp; 12-96mg/dl&nbsp; . <em>EPEC</em>4 detected in 26/64&nbsp; females , 40.63% , CRP level range from&nbsp; 12-96mg/dl&nbsp; . No significant difference or correlation between gender and CRP level was detected. <em>EPEC</em>2 and CRP level significantly correlated with patients age . while infection with <em>EPEC</em>2 inversely correlated <em>EPEC</em>4. No significant correlation between gender and <em>EPEC</em> serotypes.</p> <p><strong>Conclusion:</strong> Although <em>EPEC</em>2 and <em>EPEC</em><em>4</em> frequently detected in diarrhea cases of 1-8 years old, only <em>EPEC</em>2 positively correlated with age. Even with a fluctuation in CRP level, it was positively correlated with age and not correlated with <em>EPEC</em> serotypes and gender.</p> Ali Ibrahim Ali Al-Ezzy Akram Ahmed Hassan Al-Khalidi Marah Salim Hameed Copyright (c) 2020-03-10 2020-03-10 31 2 Perkütan Dilatasyonel Trakeostomi Uygulamasında Işıklı Stile Kullanılması <p><strong>Amaç:</strong> Yoğun bakım&nbsp; hastaların da uzun sure mekanik ventilasyona bağlı endotrakeal tüp ile ilgili gelişebilecek olası problemleri engellemek için trakeostomi tercih edilmektedir. Perkütan dilatasyonel trakeostomi en sık tercih edilen yöntemdir. Işıklı stile zor entübasyonda kullanılan çoğu merkezde bulunan bir alettir.</p> <p>Bu çalışmada, ışıklı stile’nin perkütan dilatasyonel trakeostomi işleminde işlem başarısındaki etkinliğini değerlendirilmeyi amaçladık.</p> <p><strong>Yöntem:</strong> Çalışma retrospektif olup hasta dosyaları geriye yönelik taranarak gerçekleştirildi. Çalışmaya yoğun bakım ünitesinde yatarak tedavi gören 20 hasta dahil edildi. Gerekli ön hazırlık sonrası ETT’ün içinden ışıklı stile distal ucu 1 cm dışarıda kalacak şekilde ilerletildi. Boyun ön duvarında ışık reflesinin optimum izlenebildiği 2.kartilaj aralık seviyesine kadar tüp geri çekildi ve işaretlendi.&nbsp; İğne ile dik olarak işaretli alandan girilerek trakeaya ulaşıldı ve içerisinden klavuz tel trakea içerisine ilerletilerek iğne çıkarıldı. Fiber optik bronkoskop klavuz telin yeri, orta hattaki konumu, vokal korta yakınlığı, trakea posterior duvara, kıkırdak dokuya ve damarsal yapıya hasar verip vermediği gibi parametreler değerlendirilerek kaydedildi.</p> <p><strong>Bulgular:</strong>Tüm hastalarda işlem başarı ile gerçekleştirildi. Işıklı stile ile işlemin yapılma esnasında 1 hastada geçici olarak desatürasyon, bradikardi gelişmiştir. İşlem süresi 20.2 ± 4.1 dakikadır. Komplikasyon olarak sadece 3 hastada endotrakeal tüp kafı delinmiştir.</p> <p><strong>Tartışma:</strong> Perkütan dilatasyonel trakeostomi’de ışıklı stile, çoğu merkezde bulunan ucuz, uygulanması basit ve kolay olup girişim yerinin tespitinde klavuz olarak kullanılabilmekte, olası koplikasyonları azaltarak işlem güvenilirliğini arttırmaktadır.</p> Seyfi Kartal Osman Yiğci Ali Alkan Yılmaz Yavuz Selim Akıntürk Özkan Orhan Ebubekir Esen Çağdaş Kahveci Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Examining First-Aid Knowledge Level of Mothers Living in Rural Areas and Factors that Affect this <p><strong>Aims: </strong>This study was conducted to determine the first-aid knowledge level of mothers living in rural areas and factors affect this.</p> <p><strong>Methods: </strong>This descriptive study was carried out in 14 villages in the province of Zonguldak and its sample consisted of 681 mothers. Data was collected using the Personal Information Form and First-Aid Knowledge Level Scale which were developed by the researchers.</p> <p><strong>Results: </strong>The mean age of participating mothers was 42.105±10.75 years, and 45.4% had two children, 64% were primary school graduates, and 95.7% were housewives. The majority of the mothers (86%) had not received education about first-aid and 44.9% of their information sources on this issue were television and radio. This study determined that these mothers had adequate knowledge on common injuries, but their knowledge about life-threatening injuries was insufficient. A higher education level, younger ages, having two children, and receiving first-aid education from health staff significantly raised the mothers’ first-aid knowledge mean scores.</p> <p><strong>Conclusions: </strong>This study found that there is a need for health staff to give education to mothers living in rural areas about first-aid for serious injuries and that their current knowledge levels are inadequate.</p> Elif Dirimeşe Nurten Taşdemir Sevim Çelik Mustafa Gümüş Tevfik Cem Akalın Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Efficiency of Platelet Rich Plasma in Prevention of Seroma Formation in Patients with Mastectomy <p><strong>Objective: </strong>Seroma is the most frequent complication after breast surgery which may sometimes lead to delay in wound healing and adjuvant therapies. We aimed to investigate the effect of platelet rich plasma in patients performed mastectomy which is proved to be effective on wound healing.</p> <p><strong>Methods: </strong>Forty-one patients with breast cancer were included. All of them were performed mastectomy by the same surgical team and using electrocotery for flap dissection. After mastectomies and placing the drains, platelet rich plasma was sprayed on pectoralis muscle, under skin flaps, and incisions were closed by sutures routinely in 13 patients (study group). The control group (28 patients) and study group were followed-up by a blind surgeon to the groups and the drainage measures, drain removal dates and wound complications were recorded.</p> <p><strong>Results:</strong> There were no differences between the groups in terms of mean axillary and flap drainage amounts, mean axillary and flap drains’ removal dates, and aspirated seroma amounts after drain removal. No other complications as infection or flap necrosis were recorded in both groups.</p> <p><strong>Conclusion:</strong> In breast cancer, some complications related to surgery like poor wound healing and prolonged seroma formation, may cause delay in setting of adjuvant therapy. Platelet rich plasma is known to be effective in wound healing and we wanted to adapt its good sides for patients undergoing mastectomies. Although the results are promising in the study group, there were no differences statistically between two groups.</p> Hande Köksal Emet Ebru Ateş Arif Atay Ersin Turan Serap Melek Doğan Osman Doğru Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 The Predictive Value of Inflammatory Markers in the First Year of Diagnosis in Ulcerative Colitis <p><strong>Objective</strong>: The aim of this study was to determine if the changes in inflammatory markers which were observed during the routine follow-up of patients with ulcerative colitis could predict the disease progression.</p> <p><strong>Methods: </strong>Levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin (Hb), white blood cell count (WBC), neutrophil-lymphocyte ratio (NLR), mean platelet volume (MPV) and albumin (alb), which were observed at the time of diagnosis as well as in the 3<sup>rd</sup>, 6<sup>th</sup>, 9<sup>th</sup> and 12<sup>th </sup>months, were recorded retrospectively. The area under the curve (AUC) of the variation of these values with respect to time was calculated.</p> <p><strong>Results: </strong>118 patients were subjects of this study, with a mean follow-up time of 3.4 years. The calculated AUCs for CRP, ESR, WBC, and NLO were significantly higher ( p&lt;0.001,p&lt;0.01,p&lt;0.01,p&lt;0.01 ); whereas the ones for Hb, alb, and MPV were significantly lower (p&lt;0.01,p&lt;0.001,p&lt;0.05) in patients who used an immunomodulator compared to those who did not. The calculated AUCs for CRP and ESR were significantly higher (p&lt;0.001,p&lt;0.05); whereas the AUCs for Hb, alb, and MPV were significantly lower (p&lt;0.01,p&lt;0.05,p&lt;0.01) in patients who used an anti-tumor necrosing factor-alpha inhibitor (anti-TNF) compared to those who did not<strong>.</strong> Additionally, in patients who used anti-TNF, the AUCs for CRP were significantly higher ( ), than in patients who only used immunomodulators.</p> <p><strong>Conclusion: </strong>The levels of inflammatory markers in the early course of the disease are helpful for predicting the disease progression and prognosis. We assume that, the higher the CRP, the worse the prognosis.</p> Rezzan Eren Sadioğlu Tarkan Karakan Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Diş Hekimliğinde Monitörizasyon: Retrospektif Bir Çalışma <p><strong>Amaç:</strong> Sistemik hastalıklar ve anksiyete nedeniyle dental tedavilerin monitörizasyon, sedasyon ve genel anestezi altında yapılması gerekebilmektedir. Ancak sedasyon ve genel anesteziye bağlı riskler nedeniyle minör dental tedavilerin monitörizasyon altında yapılması daha güvenli olabilmektedir. Çalışmamızda monitörizasyon altında dental tedavileri gerçekleşen hastalara ait analizler bildirilmiştir.</p> <p><strong>Yöntem:</strong> &nbsp;Gazi Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi Kliniği’nde 2012-2017 yılları arasında &nbsp;dental tedavileri monitörizasyon altında gerçekleştirilmiş toplam 67 hasta (29 kadın, 38 erkek); sistemik hastalıkları, ASA sınıflandırması, kullandıkları ilaçlar, alerji varlığı, yapılan dental tedaviler, monitörizasyon süresi, komplikasyon varlığı, monitörizasyon sırasında ilaç uygulaması ve acil müdahale açısından retrospektif olarak değerlendirilmiştir.</p> <p><strong>Bulgular:</strong> Hastaların %64.2’si ASA II olarak sınıflandırılmış, %50.7’si mental retardasyon/motor mental retardasyon (MR/MMR) nedeniyle monitörize edilmiştir. Diş çekiminin en çok yapılan işlem olduğu tespit edilmiştir (%58.2). Hastaların&nbsp; %34.3’üne monitörizasyon sırasında oksijen desteği sağlanmış, % 6’sında ise astım ve alerji için ilaç enjeksiyonları&nbsp; yapılmıştır. Bir hastada komplikasyon bildirilmiştir (%1.5).</p> <p><strong>Sonuç:</strong> Monitörizasyon altında yapılan dental tedaviler; hekimin daha rahat çalışmasını, hastanın kendisini daha güvende hissetmesini ve oluşabilecek komplikasyonların erken dönemde farkedilerek acil müdahalelerin en kısa sürede yapılabilmesini sağlamaktadır. Bununla beraber sedasyon ve genel anesteziye bağlı oluşabilecek komplikasyonlardan ve getireceği mali yüklerden de kaçınılmış olur.</p> Zeynep Fatma Zor Şaziye Şahin Özgün Yıldırım Yeliz Kılınç Bekem Binler Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 The Effect of the Wound Healing Properties of Glutamine on Skin Toxicities and Esophagitis in Breast Cancer Radiotherapy <p><strong>Objective: </strong>Acute toxicities of breast cancer radiotherapy are weakness, skin reactions and esophagitis. Glutamine is an essential amino acid that forms the basic energy source of the immune system cells andthe intestine inner surface cells and plays an essential role in the delivery of acid-base balance and the nerve transmission. In our study, we aimed to evaluate the effect of the wound healing properties of glutamine on skin toxicities and esophagitis.</p> <p><strong>Materials and Methods</strong>: Fifty six patients were included in the study. The results of 28 patients who used 30 g(10g/8h) Glutamine during radiotherapy and 28 patients without glutamine usage were evaluated. 40-60 GyRT was given with a single fraction of 2-2.66 Gy per dayin five fractions weekly. Skin reactions and esophagitis status of the patients were evaluated weekly. Toxicities were recorded according to Radiation Toxicity Evaluation Criteria (RTOG).<strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </strong></p> <p><strong>Results: </strong>The mean age was 53 years (29-86). 42 patientshad&nbsp; underwent breast-conserving surgery and 14 patients had underwent modified radical mastectomy. 39 patients had stage 2, 17 had stage 3&nbsp; dissease. Dysphagia had developed in 23 patients (42.6%). Grade 1 dysphagia was detected in 20 patients and grade 2 dysphagia was detected in 3 patients. Skin reaction had developed in 38 patients (70.4%). 17 of these had grade 1, 20 had grade 2 and 1 had grade 3 skin reaction.Dysphagia (P &lt;0.001) and skin reaction (P = 0.014) were statistically significant lower in the group receiving glutamine. In premenopausal patients, significantly more dysphagia (p: 0.003) and skin reactions (p: 0.018) were observed than postmenopausal patients. Skin reaction and dysphagia were observed less in the group that received hypofractioned RT. Dysphagia was observed more in the MRM receiving group according to the surgery type.</p> <p>It was observed that there was no effect of stage, age, T-N stage, tumor side, pathological type on skin reaction and dysphagia.</p> <p><strong>Conclusion: </strong>The use of glutamine to reduce side effects during breast cancer radiotherapy is not a standard procedure. However, the use of glutamine in the treatment of dysphagia and skin reactions during breast radiotherapy may be useful in reducing the severity of the toxicities by it's wound healing effect.</p> Şule Karabulut Gül Huseyin Tepetam Beyhan Ceylaner Bicakci Fatih Demircioglu Gokhan Yaprak Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Branchial Cleft Anomalies; retrospective analysis of 84 cases <p><strong>Amaç: </strong>Brankial yarık anomalileri (BYA), en sık karşılaşılan konjenital boyun patolojileridir ve genellikle boynun lateralinde karşımıza çıkarlar. Genellikle benign karakterde lezyonlar olup, tedavide ilk seçenek cerrahi eksizyondur. Bu çalışmada, kliniğimizde BYA nedeniye opere olan hastalar analiz edilerek, bulgularımızın literatür eşliğinde değerlendirmesi hedeflenmiştir.</p> <p><strong>Yöntemler: </strong>Çalışmamıza 2010-2018 yılları arasında BYA nedeniyle merkezimizde opere olan hastalar dahil edildi. Bu çalışmada, BYA nedeniyle opere olan hastaların geriye dönük; ilk başvuru şikayetleri, şikayetlerinin süresi, görüntüleme yöntemleri, operasyona ve kitleye ait özellikler, komplikasyon durumu ve hastanede kalış süreleri gibi verileri incelendi. Ayrıca nüks eden olgular detaylıca değerlendirildi. Demografik veriler ve hastalığa ait verilerin nüks ile olan ilişkisi istatistiksel olarak değerlendirildi.</p> <p><strong>Bulgular: </strong>Çalışmaya 84 hasta dahil edildi. Bu 84 hastanın, 61’i (%72.6) ikinci BYA olarak tespit edildi. En sık başvuru şikâyeti boyunda şişlik olarak bulundu. Yapılan muayene ve görüntülemeler sonucu 62 hastada (%73.8) kist, 22 hastada (%26.2) fistül tanısı konuldu. Fistül varlığı en sık birinci BYA olanlarda izlendi. Vaka serimizde nüks oranı %8.3 olarak bulunmuş olup, istatistiksel olarak anlamlı olarak 3 ve 4. BYA olanlarda nüks oranı daha fazla bulundu. Ayrıca revizyon vakalarda anlamlı olarak nüks oranı daha fazla bulundu.</p> <p><strong>Sonuç:&nbsp; </strong>Brankial yarık anomalileri kist ya da fistül olarak karşımıza çıkmaktadır ve en sık görülen konjenital boyun lezyonlarıdır. Yaş ve cinsiyete bağlı olarak farklı prezentasyonlar gösterebilir. Ayırıcı tanıda lenfadenopati ve birçok benign/malign kitleler ile karışabilir. Tanıda öykü, fizik muayene ve görüntüleme yöntemlerinden faydalanılır. Kesin tedavisi, kist, fistül ve sinüs hattının total olarak eksizyonudur. Anomali tipi ve revizyon durumu nüksü etkileyen parametreler olarak tespit edildi.</p> Muammer Melih Şahin Süleyman Cebeci Metin Yılmaz Mehmet Düzlü Eray Uzunoğlu İbtisam Mohammed Recep Karamert Alper Ceylan Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Lipoprotein (a) and preeclampsia Is Serum Lipoprotein (A) Level Elevated in Preeclampsia Patients? <p><strong>Aim</strong>: To examine the serum Lipoprotein (Lp) (a) levels in preeclamptic cases and its relation with the severity of preeclampsia.</p> <p><strong>Materials and Methods:</strong> Forty cases over 28 gestational weeks were included in this study, out of which 10 had mild preeclampsia (group 1), 10 had severe preeclampsia (group 2) and 20 were women with normal pregnancy (group 3). Platelet count, levels of total protein, albumin, fibrinogen, serum Lp (a) and prothrombin time were compared between the groups.</p> <p><strong>Results:</strong> Significant differences were found between the groups as regards total protein, albumin and platelet values (p&lt;0.001, p&lt;0.001, and p:0.03, respectively). In fibrinogen values and prothrombin time however, no significant differences were observed (p=0.8, and p=0.3, respectively). Significant differences were not observed between the groups upon evaluation of Lp (a) (group 1: 21.5±17.1 mg/dl; group 2: 15.7±8.5 mg/dl; and group 3: 27.6 ±20 mg/dl; p=0.1).</p> <p><strong>Conclusion:</strong> No marked differences were observed in the Lp (a) serum concentration between the preeclamptic patients and the control group; and it was shown that it was not associated with the severity of the disease.</p> Tolga Ecemiş Coşkun Şimşir Selen Sakar Ecemiş Özge Şehirli Kinci Orhan Gelişen Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Aortic Insufficiency due to Quadricuspid Aortic Valve <p>Quadricuspid aortic valve is an extremely rare congenital anomaly. Although it has a benign clinical features, some patients may present as with symptoms of severe aortic regurgitation. Herein, we showed an excellent view of a quadricuspid aortic valve with moderate aortic regurgitation in a young woman.</p> Huseyin Ozer Yakup Alsancak Hakan Akilli Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Cranial Diabetes Insipidus in Neuropsychiatric Systemic Lupus Erythematosus, a Rare but Treatable Association: A Case Report <p>Systemic lupus erythematosus has been rarely reported to be associated with cranial diabetes insipidus. It is a condition clinically manifest as severe polyuria and reactive polydipsia that may lead to electrolyte imbalance or acute kidney injury as a result of arginine vasopressin insufficiency. Here, we report a patient with systemic lupus erythematosus and lupus nephritis previously under control with medication presented with neuropsychiatric symptoms which responded to pulsed methylprednisolone, developed severe polyuria, polydipsia and hypernatremia which persisted after pulsed therapy. Serum and urine osmolarity were suggestive of diabetes insipidus and the polyuria resolved dramatically after trial of oral desmopressin which in keeping with the diagnosis of central cause. The objective of this case report is to share the uncommon occurrence of diabetes insipidus in neuropsychiatric systemic lupus erythematosus.</p> Alvin Oliver Payus Malehah Mohd Noh Constance Liew Sat Lin Justin Leow Wen Hsiang Ani Darwina Abdul Halim Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Cystic Ear Lobe Mass <p>Epidermoid cyst has been known as the most common cutaneous cyst. These slow-growing lesions can be found anywhere in the body commonly head and neck. Disfigurement caused by this lesion is usually taken into consideration for early excision. It is also noteworthy, malignant transformation has been reported.</p> Jeyasakthy Saniasiaya Shalini Ramasamy Zainal Azmi ZAinal Abidin Copyright (c) 2020 Gazi Medical Journal 2020-03-11 2020-03-11 31 2 It is Just a Humongous Mole <p>Basal cell carcinoma despite a rare entity is oftentimes overlooked following its vague presentation. This is to a greater extent when it mimics a more congenial lesion such as a skin mole. Herein, we would like to report on incidental finding of basal cell carcinoma of nasal dorsum in an elderly gentleman who reckon the lesion to be a skin mole. Excision biopsy with bilobed flap was carried our successfully with no evidence of recurrence till date.</p> Jeyasakthy Saniasiaya Jennifer Lee Peak Hui Zainal Azmi Zainal Abidin Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Gravid Nasal Mass <p>Pyogenic granuloma is a benign lesion of the mucous membrane and skin which commonly occurs in the oral cavity. Nasal cavity involvement is considered to be rare. Albeit uncommon, it has been linked with pregnancy, trauma and usage of oral contraception. Herein, we would like to report a rare case of pyogenic granuloma of the nasal septum in a pregnant female. We would like to highlight the presentation and management of this case in a pregnant patient. Pyogenic granuloma may be overlooked following its rarity and we would like to emphasize that management ought to be individualized. This case is to emphasize importance of awareness of Pyogenic granuloma of the nasal cavity in pregnancy as it is oftentimes misdiagnosed as maliganacy.</p> Jeyasakthy Saniasiaya Shalini Ramasamy Maasany Mansor Zainal Azmi Zainal Abidin Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Asymptomatic Primary Biliary Cholangitis in a Young Patient: An Incidental Finding <p>Primary biliary cholangitis (PBC) is an autoimmune disease that is increasingly recognized as an important cause of chronic liver disease. Incidental diagnoses are not uncommon. We report a case of a middle-aged female with persistently elevated ALP activity. During the investigation of cholestasis, anti-mitochondrial antibodies (AMA) were detected in her serum. Ductular reaction with cholestasis was observed in the liver biopsy sample. Based on these findings, a diagnosis of PBC was established and ursodeoxycholic acid therapy was commenced. After several weeks of treatment, biochemical improvement was noted.</p> Norhidayah Kamarudin Chuan Hun Ding Nurismah Md. Isa Suria Hayati Md Pauzi Asrul Abdul Wahab Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Sigmoid Volvulus Provoked by Severe Diarrhea <p>Here, we presented two sigmoid volvulus cases both presented after severe diarrhea episodes. A 69-year-old male with the symptoms of severe diarrhea for 2.5 months presented with left colonic obstruction. Sigmoid volvulus was diagnosed with plain abdominal X-ray, computed tomography and colonoscopy confirmed the diagnosis. After a successful colonoscopic detorsion, the patient underwent elective laparoscopic colon surgery. The second case was a 50-year-old male with mental retardation who complaint of diarrhea for four days. After sudden interruption of diarrhea, the abdomen was begun to swell. Sigmoid volvulus was diagnosed when a coffee bean sign was seen on his plain abdomen X-ray. Detorsion was applied by colonoscopy. The patient was planned for elective surgery but his relatives refused. Sigmoid volvulus is generally accompanied with constipation, whereas in our cases, diarrhea was the essential symptom before sigmoid colon volvulus. So far there has been only one reported case. Our aim was to underline that sigmoid volvulus can be seen after diarrhea.</p> Cemalettin Koc Ufuk Uylas Cuneyt Kayaalp Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Bartonella quintana Endocarditis of the Aortic Valve: First case report in Turkey <p>Endocarditis caused by <em>Bartonella</em> strains has been increasingly reported. While a few sporadic case reports associated with <em>B. henselae</em> were published in Turkey, no endocarditis cases caused by <em>Bartonella</em> spp. have been reported yet. Herein, a case of first <em>B. quintana</em> endocarditis in Turkey, diagnosed using molecular methods, was presented.</p> Hasan Selçuk Özger Zehra Demirbas Gulmez Bekir Celebi İrem Akdemir Kalkan Murat Dizbay Copyright (c) 2020 Gazi Medical Journal 2020-03-11 2020-03-11 31 2 The Neurosyphilis Related Acute Transverse Myelitis: A Rare Case and Clinical Evaluation <p>Syphilis is a bacterial inflammation of <em>Treponema pallidum</em>. Neurosyphilis is a poorly understood complication and might occur any time during the course of infection. Myelitis is an uncommon complication of neurosyphilis and have been infrequently reported in the literature. A 63-year old male patient was admitted to the hospital with the symptoms of upper and lower motor neuron diseases. Serological diagnosting tests were positive in both serume and CSF. His toracal spinal MRI revealed an intramedullary high-signal intensity lesion on T10 and diagnosed as syphilitic myelitis and treated 10 days with ceftriaxone 2g/day. During 6 months of the follow-up his neurological and neuroimaging findings were recovered. If the primary infection is untreated, inflammation of CNS arteries end up with store-mimic manifestations of meningovascular syphilis. Due to sphilitic myelitic cases are frequent in the literature, neurosyphilis should be in mind for the differential diagnosis the reason why it could be treatable.</p> Buse Çağla Arı Nesrin Atiş Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Lomber Disk Cerrahisinde Gelişen Abdominal Aort Hasarı ve Yönetimi: Olgu Sunumu <p><strong>Abstract:</strong></p> <p>Vascular complications after spine surgery are rare but potentially fatal. The risk is usually related to the proximity of the surgical field to the retroperitoneal structures. Rapid diagnosis and treatment is essential in the management of this complication which has high mortality and morbidity. However, it may delay the management of this condition because the bleeding is retroperitoneal and limited by abdominal compression. Many clinicians may not be aware of this potentially fatal complication. Morbidity and mortality can be reduced with rapid diagnosis and treatment. Therefore, anesthesiologists and surgeons should be highly suspicious in all patients undergoing vertebral surgery. We report a 53-year-old woman with abdominal aortic injury during L2-L3 lumbar discectomy.</p> Çağrı Özdemir Damlasu Selcen Bağcaz İrfan Güngör Metin Alkan Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Castleman Disease of Adrenal Masquerades as Adrenal Carcinoma; Review Article on Current Treatment Modalities <p>Castleman disease is a rare lymphoproliferative disorder. Only few cases reported worldwide since first describe in 1956. Only 2 percent of CD involve pararenal location. We report on a 16 years old lady with solitary Castleman disease of hyaline vascular type, involving right adrenal. Patient underwent right open adrenalectomy and no evidence of disease recurrence in 1 year follow up after surgery. In addition, we also discuss on the pathogenesis of the disease, clinical features and option of treatment.</p> Nik Amin Sahid Nik Lah Firdaus Hayati Challa Venkata Nornazirah Azizan AK Khasnizal Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Reply on Comments on ‘A Lesson to Learn in an Iatrogenic Perforation of Sigmoid Volvulus after Endoscopic Derotation’ <p>Acute sigmoid volvulus is a surgical emergency, in which the initial treatment is endoscopic derotation in uncomplicated cases. Flatus tube dislodge is one of the common condition after endoscopic intervention. By performing a technique against the term of reference, management of a patient can skew towards a guarded outcome. I reply to comments on a paper concerning on iatrogenic bowel perforation after a successful endoscopic derotation of acute sigmoid volvulus.</p> Firdaus Hayati Nik Amin Sahid Nik Lah Nornazirah Azizan Fairrul Kadir Andee Dzulkarnaen Zakaria Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Ethical Issues Encountered within the Context of an Adrenoleukodystrophy Case <p>Adrenoleukodystrophy (ALD)&nbsp;is a disorder of&nbsp;peroxisomal fatty acid beta oxidation&nbsp;which results in the accumulation of very-long chain fatty acids in tissues throughout the body. The most severely affected tissues are the&nbsp;myelin&nbsp;in the&nbsp;central nervous system, the&nbsp;adrenal cortex&nbsp;and the&nbsp;Leydig cells&nbsp;in the testes. Clinically, ALD is a heterogeneous disorder, presenting with several distinct&nbsp;phenotypes, and no clear pattern of genotype-phenotype correlation. As an X-linked disorder, ALD presents most commonly in males, however approximately 50% of&nbsp;heterozygote&nbsp;females show some symptoms later in life.</p> <p>In the case presented in this paper, the subject is a 19-year-old woman who applied to the genetics polyclinic. Her grandmother, mother and two siblings have ALD. She wonders and is concerned about her status as a carrier. Her parents do not want their daughter to take a diagnostic test and the sick siblings in in the family are hidden from the person to whom she will get married. The patient applied to the genetic outpatient clinic without the knowledge of her family, the first tests were performed and the other sick patients at home were also suggested to take a test for the diagnosis to be confirmed. That the patient was prevented from taking a test, that her health information was not shared with the person she will get married to and the patient's wish to have her six-year-old sister/brother, who can not make his/her own decisions take the test, necessitated the discussion of the case ethically.</p> Seyhan Demir Karabulut Rıfat Vedat Yıldırım Zerrin Yılmaz Çelik Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 Kronik Miyeloid Lösemide Genetik Tanı <p>Kronik miyeloid lösemi (KML), erişkinlerdeki lösemilerin %15-20’sini oluşturan ve nadir hastalıklar grubunda yer alan bir hematolojik malignitedir. KML’de genetik tanı, genetik biliminin kendi alt disiplinleri arasındaki iş birliği ile yürütülmesi gereken ve hastanın klinik bilgilerinin de takip sırasında göz önünde bulundurulması elzem olan uzun bir süreci kapsamaktadır. Sitogenetik, floresan in situ hibridizasyon ve real-time PCR yöntemleri tanı ve takipte; Sanger dizileme ve yeni nesil dizileme yöntemleri ise özellikle prognoz tayini ve tedavi direncinin belirlenmesinde kullanılmaktadır. Gelecekte yapılacak ekzom, genom ve transkriptom düzeyindeki çalışmalar ile mevcut genetik tanı algoritmalarının revize edilerek tedavilerin daha etkin hale gelmesinin sağlanacağı düşünülmektedir.</p> Haktan Bagis Erdem Ayşegül Öztürk Kaymak Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2 1st Bursa International Genetics Days: Dermatogenetics Symposium <p><strong>1st Bursa International Genetics Days: Dermatogenetics Symposium</strong></p> Mehmet Ali Ergün, MD, PhD Copyright (c) 2020 Gazi Medical Journal 2020-03-10 2020-03-10 31 2