Gazi Medical Journal http://medicaljournal.gazi.edu.tr/index.php/GMJ 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> Bir Üniversite Hastanesinde Ameliyathane Radyasyon Güvenliği: Çalışanların Maruz Kalma Durumu, Farkındalıkları, Korunma ile ilgili Bilgi ve Davranışları http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1445 Amaç: Skopinin yaygın kullanımı ile birlikte ameliyathane personeli iyonizan radyasyona maruz kalmaktadır. İyonizan radyasyon maruziyetinin akut ve kronik dönem sağlık etkileri mevcuttur. Bu çalışmada ameliyathane personellerinin radyasyona maruz kalma durumları, farkındalıkları, radyasyondan korunma ile ilgili bilgi ve davranışları saptanmak amaçlanmıştır. Yöntem: Tanımlayıcı kesitsel tipteki bu çalışma Şubat-Mart 2016 tarihlerinde anket ile veri toplanarak gerçekleştirildi. Tanımlayıcı istatistikler ve ki-kare analizi yapıldı. Bulgular: Çalışmaya skopiye maruz kalma olasılığı olan 60 kişi katıldı. Çalışmaya katılan personellerden son bir yıl içinde skopiye maruz kalanların %61,5’i skopiye günde en az bir kez maruz kalıyordu. Radyasyondan korunmaya ve skopi kullanımına yönelik eğitim alanlar sırasıyla katılımcıların %25,0’i ve %28,3’üydü. Katılımcıların %40,7’si koruyucu donanımları her zaman kullanmaktaydı. En sık kullanılan kişisel koruyucu donanım kurşun önlüktü (%98,2). Koruyucu donanımların kullanılmamasının en sık sebebi yeterli donanım olmamasıydı(%66,7). Kurumda bulunan radyasyon güvenlik komitesinin varlığından katılımcıların %80,0’i haberdar değildi. Katılımcıların sadece %10,0’u çalıştıkları kurumda bir radyasyon korunma sorumlusu olduğunu biliyordu. Koruyucuların kullanım sıklığı ile meslek, mesleki deneyim, ameliyathane deneyimi, skopi kullanım eğitimi ve radyasyondan korunma eğitimi alma arasında ilişki bulunmadı. Sonuç: Çalışanların radyasyona yönelik hizmet içi eğitimlerinin artırılması, koruyucu donanım kullanma sıklığının artırılması gereklidir. Elif Özçöllü Ayşe Taş Burak Çapacı Ali Kalkan Emine Didem Evci Kiraz Pınar Okyay Copyright (c) 2019-06-21 2019-06-21 30 3 Congenital Hydrocephalus in Northern Bukovina: Probability and Risk Factors http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1511 Background. Despite the degree of scientific development of the medical science CNS congenital malformations are about 25% of all congenital malformations in children and their proportion in the structure of perinatal and infant mortality to date is about 30%. Therefore, prenatal diagnosis, prevention and prediction of this pathology have a high profile in many countries of the world. Etiologically in addition to genetic disorders the embryogenesis disorders subject to the action of exo- and endotoxins, the infectious factors are factors of their occurrence. Hydrocephalus is one of the most common congenital malformations of the nervous system in young children. It is diagnosed in 0.1–2.5% of newborns. Subjects and Methods. The analysis of the congenital hydrocephalus incidence in the Chernivtsi region for 2007–2016 and the comparison of this indicator with some countries according to EUROCAT data were carried out. Results. According to EUROCAT the population congenital hydrocephalus incidence ranges from 0.11 to 0.57 %. The congenital hydrocephalus incidence in the Chernivtsi region did not exceed the statistics for Ukraine over the studied period, only in 2012 and 2014 this statistic was higher than the national one. Among the analyzed countries the highest overall incidence over the studied period occurred in Ukraine (0.57 ‰) and the lowest – in Portugal (0.11 ‰). Conclusions. Probable risk factors of the development of congenital hydrocephalus are the presence of TORCH infection in the pregnant woman, spouses living near motorways, unregistered marriage, influence of chemical factors on both male and female, father's rough labour before pregnancy, smoking and serving in the army. Probable factors for preventing congenital hydrocephalus in children are higher education of the parents and folic acid intake in the first trimester of pregnancy. These factors need to be taken into account when planning pregnancy to prevent fetal congenital hydrocephalus. Ryznychuk Mariana Alesandrovna Lastivka Iryna Vladimirovna Kryvchanska Mariana Ivanivna Luchko Ekaterina Nikolayevna Copyright (c) 2019-06-21 2019-06-21 30 3 Intussusceptive Growth of Vascular Bed in Human Placenta http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1586 Objective: Normal embryonic and fetal development is strictly bound to maternal health and functioning placenta. Besides the invasion and differentiation of trophoblastic cell lineage; development of effective vasculature is crucial for the function of placenta. Placental vessels first arise by vasculogenesis in early development of villi and then succeeded by angiogenesis during fetal life. In the recent decades a new form of angiogenesis, “intussusceptive angiogenesis”, besides classical sprouting angiogenesis is well documented. The presence of intussusception was shown at multiple organs but in placenta, in recent literature. We aimed to determine whether intussusceptive angiogenesis is present in human placenta to obtain further evidence on the development of vascular bed. Methods: The term placenta samples were obtained from 10 healthy pregnancies following caesarean sections. Tissues were processed using routine plastic embedding technique; thin sections were contrasted with uranyl acetate & lead citrate; observed and photographed by transmission electron microscope. Results: Our examinations revealed that both sprouting and intussusceptive angiogenesis is present in floating villi of term placenta. Phases of intussusception were documented in various samples. Conclusion: The presence of intussusceptive angiogenesis will help our understanding of microvascular bed remodeling during pregnancy. We believe that this new finding will help us to determine the relation of microvascular bed development in normal and abnormal placentas. Pınar Ayran Fidan Fatma Helvacıoğlu Attila Dağdeviren Copyright (c) 2019-06-21 2019-06-21 30 3 Diagnostic Yield of Molecular Karyotyping of Idiopathic Intellectual Disability Patients Ended with One Causative Anomaly; Duplication 9q34 Syndrome http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1655 Objective: Clinical application of sequence comparative genomic hybridization has greatly contributed to the diagnosis of patients with multiple congenital anomalies, syndromic or non-syndromic intellectual disability. The idiopathic intellectual disability patients with normal karyotype and/or normal subtelomeric rearrangement analysis via Fluorescence in situ Hybridization (FISH), using genome-wide microarray platforms have detected chromosome abnormalities in up to 12% of cases. In this study, we aimed that evaluate the etiology of 9 patients with idiopathic intellectual disability and congenital malformations or dysmorphic features. Methods: We performed genom wide SNP 2.7 array, in the evaluation of 9 patients with idiopathic intellectual disability and congenital malformations or dysmorphic features as well as normal karyotype and normal subtelomeric rearrangement analysis by the usage of FISH technique. Results: As a causative anomaly, a 2.6 Mb microduplication on 9q34.2-q34.3 was observed only in one patient who has idiopathic mental retardation and multiple skeletal anomalies. Conclusion: Microarray technology is a highly diagnostic method that is recommended for individuals with intellectual disability and multiple congenital anomalies. Microarray analysis revealed a causal anomaly in one of nine patients (11%) consistent with the literature. Büşranur Çavdarlı Emriye Ferda Perçin Meral Yirmibeş Karaoğuz Mehmet Ali Ergün Copyright (c) 2019-06-21 2019-06-21 30 3 Onkoloji Hemşireleri, Kanser Hastaları ve Hasta Yakınlarının Tamamlayıcı - Alternatif Tedavi Yöntemlerine İlişkin Uygulama ve Tutumlarının Belirlenmesi http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1659 Amaç: Tamamlayıcı ve Alternatif Tedaviler (TAT), ülkeden ülkeye ve hastadan hastaya değişen oranlarda görülmekle birlikte yaygın olarak kullanılmaktadır. Bu yöntemlerin modern tedavi yöntemleri ile birlikte kullanımı konusunda hasta ve sağlık personelinin bilgi ve tutumları önem taşımaktadır. Çalışma, kanser tanısı almış hastaların, hasta yakınlarının ve bu gruba hizmet veren onkoloji hemşirelerinin TAT uygulamalarına yönelik bilgi, tutum ve uygulamalarının belirlemesi amacıyla yapıldı. Gereç ve Yöntem: Tanımlayıcı tipteki araştırmanın örneklemini, Şubat-Ağustos 2016 tarihleri arasında bir üniversite hastanesinin Ayaktan Kemoterapi Ünitesi’ne başvuran, kemoterapi almakta olan kanser hastaları ve hastaların birinci derece yakınları ile onkoloji bilim dalında çalışan hemşireler oluşturdu. Verilerin değerlendirilmesinde tanımlayıcı istatistikler ve varyans analizi testi kullanıldı. Bulgular: Hastaların %40’ının, hasta yakınlarının %39.7’sinin, hemşirelerin %64’ünün günlük yaşamında herhangi bir TAT yöntemi kullandığı belirlendi. Gruplar arası yapılan karşılaştırmada bütüncül sağlık alt boyutunda gruplar arasında anlamlı farklılık olduğu saptandı. Yapılan ikili karşılaştırmalarda hasta ve hemşire arasında bütüncül sağlık alt boyutu ortalama puanları açısından anlamlı fark bulunduğu saptandı. Sonuç: Hasta, hasta yakını ve hemşirelerin çoğunluğunun TAT konusunda bilgi sahibi olmadığı belirlenmekle birlikte her üç grubun günlük yaşamlarında sıklıkla TAT yöntemlerine başvurdukları saptandı. Bütüncül sağlık ortalama puanlarının hastalarda daha düşük olduğu belirlendi. Sağlık alanında, tamamlayıcı ve alternatif tedavi yöntemlerine yönelik eğitimlerin planlanması önerilmektedir. Filiz Ünal Toprak Neşe Uysal Ayten Şentürk Erenel Sevinç Kutlutürkan Copyright (c) 2019-06-21 2019-06-21 30 3 Ülseratif Kolit Hastalarında Gen İfade Analizi http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1748 Amaç:Ülseratif Kolit (ÜK), genetik olarak duyarlı kişilerde çevresel faktörlere karşı abartılı bir immün yanıt sonucu oluşan ve etyopatogenezi henüz tam olarak aydınlatılamamış bir hastalıktır. Bu çalışma ile ÜK hastalarında inflamasyonun en yoğun olduğu bölge ve normal kolonik mukozadan alınan biyopsi materyalleri arasındaki gen ifade farklılıkları incelenerek hastalığın ortaya çıkışı ve ilerleyişi ile ilişkili olabilecek biyobelirteçlerin tespit edilmesi ve böylelikle patogenezinin anlaşılmasına katkıda bulunulması amaçlanmıştır. Yöntem:ÜK tanısı almış 16 hastadan alınan inflamasyonlu ve normal mukozaya ait biyopsi materyallerindeki gen ifade farklılıkları, kısmi transkriptom analiz yöntemi olan Differential Display-PCR (DD-PCR) kullanılarak araştırılmıştır. Bulgular:Farklı seviyede gen ifadesi olduğu tespit edilen ve dizin analizi yapılan aday transkriptler arasından üçünün genomda farklı genlerin intronik bölgelerine yerleşim gösterdiği belirlenmiştir. Bu üç transkript arasından biri için ise daha detaylı analizler gerçekleştirilmiştir. Öncelikle, bu transkriptin cDNA uçlarının dizilimini tespit etmek amacıyla Rapid Amplification of cDNA Ends (RACE) deneyleri yapılmış ve 5’ ucuna ait 920 bç’lik bölgenin dizilimi de tespit edilmiştir. Ardından, bölgeye ait tasarlanan primerler kullanılarak kısmi miktarlara dayalı gen ifade analizi yapılmış ancak inflamasyonlu ve normal kolonik mukozaları arasında gen ifade seviyeleri bakımından anlamlı bir fark bulunamamıştır. Ayrıca, ticari olarak satılan 20 farklı dokunun RNA’sı ve 11 farklı kanser hücre hattına ait RNA’lar kullanılarak gen ifade profillemeleri yapılmış, birçok doku ve kanser hücresinde ilgili transkriptin ifadesinin gerçekleştiği belirlenmiştir. Sonuç:Bu çalışma sonucunda, daha önce başka hiçbir grup tarafından tanımlanmamış yeni bir transkript tespit edilmiştir. İleriki çalışmalarda bu yeni transkriptin Northern Blot ile tam boyunun belirlenmesi ve işlevsel analizlerinin gerçekleştirilmesi hedeflenmektedir. Elif Pala Esra Bozgeyik Musa Aydınlı Copyright (c) 2019-06-21 2019-06-21 30 3 The Role of Atrial Myocardial Deformation Parameters in Determining Cardioversion Success in Atrial Fibrillation Patients http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1761 Aim: To investigate the role of left atrial myocardial deformation parameters measured by speckle tracking method in predicting cardioversion success in addition to conventional echocardiographic measurements in cardioversion (CV) planned patients with persistent atrial fibrillation (AF) . Material and Methods: 60 patients scheduled for cardioversion were evaluated and 40 patients with atrial fibrillation were included in the study. Patients with sinus rhythm continuing after 24 hour monitoring were classified as group 1, and patients with AF were classified as group 2. Group 1 patients are divided into 2 groups according to 1st month ECG, as sinus rhythm maintained group and AF detected group. Results: The global left atrial strain S ( LA S-S) and the global left atrial strain rate S ( LA SR-S) measured before and after cardioversion were found to be significantly lower in the group with failed cardioversion (group 2) than those with successful group (group 1). The predictive value of LAVI value in cardioversion success was found to be 39 mL/m². At first month; LA SR-S measured before and after cardioversion in the maintained sinus rhythm group was significantly higher than the atrial fibrillation recurrence group. Also; the LA S-S, measured after cardioversion, was found to be significantly higher in the maintained sinus rhythm group. Conclusion: We showed that atrial myocardial deformation parameters could play role in determining CV success in patients with persistant atrial fibrillation. In addition; we determined that the LA SR-S value was as sensitive and specific parameter as LAVI in predicting cardioversion success. Can Ramazan Öncel Murathan Küçük Aytül Belgi Yıldırım Copyright (c) 2019-06-21 2019-06-21 30 3 The Prophylactic and Protective Effects of Terfezia Claveryi Extracts on Ibuprofen Induced Oxidative Stress in Pregnant Rats http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1765 Objective: This study aimed to investigate the prophylactic and protective roles of Terfezia Claveryi extracts on Ibuprofen induced oxidative stress in pregnant albino rats. Methods: Thirty pregnant rats randomly divided in to five experimental groups, each group consist of six pregnant rats. Group 1 (control group): without any treatment. Group 2 (Ibuprofen group): Given Ibuprofen orally by gastric tube at dose of 40 mg/kg/day for 20 days. Group 3 (Terfezia Claveryi group): Received Terfezia Claveryi extracts via gavage at 250 mg/kg every day dose. Group 4 (Ibuprofen +Terfezia Claveryi group): Received with Ibuprofen at dose of 40 mg/kg every day plus Terfezia Claveryi extracts 250 mg/kg /day by gastric tube along the experiment. Group 5 (Terfezia Claveryi + Ibuprofen): Received with 250 mg/kg every day of Terfezia Claveryi via gavage for two weeks before gestation (as a prophylactic) and then treated with Ibuprofen at the above-mentioned dose at zero day of gestation to twenty day of the experiment. Results: Ibuprofen increased serum AST, ALT, ALP activity, total bilirubin concentration, Liver tissue MDA levels and decreased liver tissue Catalase, Superoxide Dismutase and Glutathione Peroxidase. However, this modulation of the biological parameter is significantly ameliorated by the administration of the Terfezia Claveryi. Conclusion:In conclusion prophylactic and protective effect of Terfezia Claveryi against Ibuprofen induced oxidative stress was reported in pregnant rats. Mohammed Talat Abbas Copyright (c) 2019-06-21 2019-06-21 30 3 İlk Defa Sezaryen Geçiren Hastalarda Tek Kat ve Çift Kat Uterin Sütürün 3D Ultrasonda Uterin Niş Hacmine Etkisi http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1816 Giriş: Uterin niş, ultrasonografi ile tespit edilen sezaryen ameliyatı geçirmiş kadınlarda uterin kesi yeri hizasında bulunan, myometriyumun devamlılık göstermeyen bölgesi olarak adlandırılır. Mensturasyon sonrası lekelenme en sık semptomu olmakla birlikte, sonraki gebelikte uterin rüptür ya da invaziv plasentaya neden olabilmektedir. Sezaryen kesi yeri dikiş tekniği ile burdaki skar dokusunun iyileşmesi yani niş boyutları değişebilmektedir. Gereç ve Yöntemler: Çalışma prospektif vaka kontrol çalışması olarak düzenlenmiş ve Eylül 2016- Eylül 2017 tarihleri arasında Gazi Üniversitesi Kadın Hastalıkları ve Doğum bölümünde ilk defa sezaryen ile doğum yapacak hastalardan seçilmiştir. Çalışmaya dahil edilen hastaların yarısı çift kat (birinci kat kilitleyerek sürekli dikiş, ikinci kat kilitlemeden sürekli dikiş), kapatılırken, geri kalan yarısı tek kat kilitleyerek sürekli dikiş ile kapatılmıştır. 6 hafta sonra niş hacmi transvajinal 3D ultrason kullanılarak hesaplanmıştır. Bulgular: Hastaların 21 tanesinin uterin kesileri tek kat kilitleyerek kapatılırken, kalan 33 tanesinin uterin kesileri ise çift kat kilitleyerek yukarda belirtildiği şekilde kapatılmıştır. Tek kat ve çift kat uterin kapatma için ortanca niş hacim değerleri sırası ile 443,60 mm3 ve 66,53 mm3 tür (p<0.001). Sonuçlar: Çalışmada postpartum 6. haftada kontrole çağırılan tüm hastalarda niş saptanmıştır. Çift kat uterin kapatma ile niş boyutu tek kat kapatmaya oranla anlamlı ölçüde azalmıştır. Çift kat uterin kapatma kullanılarak, sezaryen geçirmiş hastaların niş boyutları ve dolayısıyla komplikasyonlar azaltılabilinir. Pinar Calis Merih Bayram Deniz Karcaaltincaba Copyright (c) 2019-06-21 2019-06-21 30 3 İatrojenik Femoral Psödoanevrizmaların Ultrason Eşliğinde Trombin Enjeksiyonu ile Tedavisi: Tek Merkez Sonuçları http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1843 Amaç: Bu çalışmanın amacı ultrason kılavuzluğunda perkütan trombin enjeksiyonu ile psödoanevrizma tedavisinin etkinliğini araştırmak ve kliniğimizin sonuçlarını literatür eşliğinde sunmaktır. Gereç ve Yöntemler: Ocak 2016 ile haziran 2018 tarihleri arasında iatrojenik femoral psödoanevrizma tanısı konulan toplam 58 hasta (28 erkek, 30 kadın, 64, 2 ± 7,8 yıl) çalışmaya dahil edildi. Toplam 62 lezyona ultrasonografi kılavuzluğunda perkütan thrombin (Tisseel, Baxter US) enjeksiyonu ile tedavi uygulandı. Demografik bulgular ve psödoanevrimaların özellikleri kaydedilerek, prosedürün etkinliği ve güvenilirliği incelendi. Bulgular: Psödoanevrizmaların %43’ ü (n; 27) ana femoral arterden, %52’ si (n; 32), süperfisiyal femoral arterden, % 5’i (n; 3) derin femoral arterden köken almaktaydı. Psödoanevrizmaların ortalama maksimum transvers çapı 41,4 ± 12,1 (21-76) mm idi. Ortalama boyun çapı 1,6 ± 0,49 (1-3) mm idi. Embolizasyon işleminden hemen sonra yapılan doppler kontrolünde renkle dolum izlenmediği için teknik başarı %100 olarak tespit edildi. İşlemden 24 saat sonra yapılan kontrolde 62 psödoanevrizmanın 6’ sında( % 9,6) kesenin tekrar dolduğu görüldü. Bunun sonucunda klinik başarı %90,4 olarak değerlendirildi. Renkle dolumun izlendiği lezyonlara işlem tekrarlandı. Rezidü doluş izlenen psödoanevrizma keselerinin tamamında gerçekleştirilen 2. işlem sonrasında komplet tromboz gözlendi. Embolizasyon işleminden sonra hiçbir hastada komplikasyon görülmedi. Sonuç: İatrojenik femoral psödoanevrizmaların tedavisinde ultrasonografi eşliğinde trombin enjeksiyonu yüksek başarı oranına sahip, kolay uygulanabilir, güvenli ve hastalar tarafından iyi tolere edilebilen bir yöntemdir. Mustafa Özdemir Muharrem Tola Fatma Ayça Edis Özdemir Rıza Sarper Ökten Copyright (c) 2019-06-22 2019-06-22 30 3 Clinical Evaluation of a Portable System for Capturing Nystagmus (PSCN) as an Alternative to Videonystagmography http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1846 Objective: To develop a portable and affordable system for diagnosing pathological horizontal nystagmus (oscillatory rapid eye movement ) in remote clinics. It is aimed to be a temporary alternative to the golden standard tool which is the Video Nystagmography which is expensive and office-based equipment. Method: The team created a system composed of a hardware gadget and software application. The modified goggle with a built-in camera and microcontroller is used to record and analyze the induced nystagmus. The analyzed data is then transmitted via Bluetooth to the user portable device which displays the results. Programming PSCN, it was tested in the outpatient clinic. During the clinical evaluation of the gadget, the nystagmus was induced and recorded by the Video Nystagmography. Immediately, we repeated the experiment using the created system. Eventually, the two results were compared to set up the thresholds in the new system. After calibration, the amended algorithm of PSCN tested another ten recorded nystagmus videos to evaluate its accuracy. Results: The portable system showed high clinical reliability during the testing in comparison to golden standard Videonystagmography. In the second stage, it showed an accuracy ratio up to 80 % during testing the ten recorded videos. It also managed to differntiate the real nystagmus from the artifacts. Conclusion: This trial proofed the concept of portable system as an assistive diagnostic tool for pathological nystagmus. However, a more clinical trial is required to establish it as a portable alternative for the golden standard Maher Fouad Sefein Kenneth Teo Teze Kin Christopher Lim Mohamed Firdaus Patawari Bin Patawe Ong Cheng Ai Narayanan Prepageran Copyright (c) 2019-06-21 2019-06-21 30 3 Certain Anterior and Posterior Ocular Structure Measurements Acquired by Swept-Source Optical Coherence Tomography in Patients with Inflammatory Bowel Disease http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/2081 Objective: To measure some ocular parameters in inflammatory bowel disease and evaluate whether there are any differences between the measurements obtained from the patients and healthy subjects. Methods: Thirteen patients with inflammatory bowel disease referred from the gastroenteroloji clinic and 14 control subjects selected from the individuals with minor complaints who admitted the ophthalmology outpatient clinic were included in the study. Average and segmental retinal nerve fiber layer thickness in four quadrant, average and sectoral ganglion cell inner plexiform layer thickness in in six guadrant, foveal and parafoveal vessel density in four quadrant, optic nerve head parameters, including rim area, disc area, horizontal cup-to-disc ratio, vertical cup-to-disc ratio, cup volume and additionally superficial/deep foveal avascular zone areas, choroid thickness, and central corneal thickness of the patients and controls were quantified using the swept-source optical coherence tomography. Results: All measurements taken from the patients with inflammatory bowel disease and controls showed a great similarity and did not differ statistically. Conclusion: Even though several inflammatory systemic diseases affect the eye and alter the particular structures, this study revealed that inflammatory bowel disease has no inluence on neural and vascular layers of the eye. Arif Ülkü Yener Muhammet Yener Akpınar Evrim Karamanoğlu Ferdane Pirinçci Sapmaz Metin Uzman Yaşar Nazlıgül Copyright (c) 2019-06-21 2019-06-21 30 3 Association between Mindfulness with Depression and Anxiety in Patients with Diabetes in Gorgan http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1856 Introduction: This research was aimed to seek the association between mindfulness with depression and anxiety in patients with diabetes attended to diabetes ward in 5Azar hospital in Gorgan city. Method: A cross-sectional survey was done on 323 patients with diabetes attended to diabetes ward of 5Azar hospital in Gorgan city that were selected using convenient sampling and Krejcie and Morgan table. The current instruments were included mindfulness questionnaire, Beck Anxiety and Depression Scale and demographic questionnaire. To analysis, software (version 20), and inferential statistical test such as spearman correlation coefficient, independent t-test and Mann‐Whitney were utilized. Results: Stated that most patients (82%) were married, and 76.8 % were unemployed. There were negative and significant correlation between mindfulness and depression (r = -0.51, p=0.001) and between mindfulness and anxiety (r=-0.72, p=0.001). In addition, gender was remarkably associated with depression and anxiety (p=0.045). Conclusion: Medical and psychiatric counseling for early detection, developing programs related to prevention and promotion of diabetes, and also psychological training particularly mindfulness appeared to be likely useful. Mahboobeh Zahedi Arash Rezaei Shahmirzadi Mohammad Taghi Badeleh Reza Mohammadi Farzam Mirkamali Maryam Zahedi Copyright (c) 2019-06-21 2019-06-21 30 3 When a Common Symptom of a Neonate Become an Unusual Diagnosis: A Case Report of HMG-Coa Lyase Deficiency with a Novel Mutation http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1818 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) lyase deficiency is a rare inborn error of metabolism characterized by recurrent metabolic crises caused by fasting, intercurrent illness and excessive physical exercise. Non ketotic hypoglycemia is normally the cause of primary symptoms but without an immediate treatment the illness can evolve into a worsening metabolic state resembling the Reye's syndrome that may cause the patient's death. We report a neonate with some clinical and therapeutic features not previously described mutation in HMGCL gene. The genetic analysis revealed a novel homozygous c.272T>A(p.Val91Asp) mutation in HMGCL gene. HMG-CoA lyase deficiency should be thought in the patients with hypoketotic hypoglycemia, hyperammonemia, elevated liver function tests and metabolic acidosis. Cigdem Seher Kasapkara Melek Akar Mehmet Nuri Ozbek Heybet Tuzun Meltem Akcaboy Serdar Ceylaner Copyright (c) 2019-06-21 2019-06-21 30 3 Intranasal Extramedullary Plasmacytoma: A Rare Entity http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1844 Extramedullary or extraosseous plasmacytoma (EMP) is a rare neoplasm characterized by monoclonal proliferation of plasma cells arising outside the bone marrow. It shows a predilection for the head and neck region, primarily in the upper respiratory tract. The commonest site of occurrence are nasal cavities and nasal septum followed by oropharynx. Eventhough EMP of the nasal cavity is rare but it should be considered in the differential diagnosis of nasal cavity mass. This tumour may invade into the adjacent tissues and acts as a locally aggressive neoplasms. Thus, crucial attention to the clinical, radiological, and histopathological findings should be taken into consideration for accurate diagnosis. Furthermore, appropriate management must be carried out to prevent further dissemination of the disease. We report a case of a 54-year-old male who presented with a progressive nasal blockade for one-year duration, in which the biopsy of the left nasal cavity mass revealed EMP. He underwent endoscopic debulking surgery and then was subjected for radiotherapy. The clinical and histopathologic findings of plasmacytoma are discussed further. Wan Nur Anis Wan Draman Rosdi Ramli Rosli Mohd Noor Nurul Anis Mohd Fauzi Aniza Hassan Irfan Mohamad Copyright (c) 2019-06-21 2019-06-21 30 3 Acinar Cell Carcinoma (ACC) in a Patient with Hypoglycemia: A Case Report http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1880 Pancreatic acinar cell carcinoma is one of the rare conditions of the gastrointestinal tract. Here we report Acinar Cell Carcinoma (ACC) in an old man with Hypoglycemia. The patient was a 79-year-old man with history of seizure. In lab data, Blood Sugar was 40 mg/dl and Brain problems were ruled out. For the last 2 to 3 months, he had spells shaky, sweaty, and weak; past medical history (PMH): Low grade Transitional cell carcinoma (TCC) and Diabetes mellitus (DM): negative. The prognosis for patients with mixed acinar–neuroendocrine carcinoma did not differ from that for those with histologically pure pancreatic ACC. Hmaideh Akbari Arash Rezaei Shahmirzadi Hamed Jafarpour Morteza Fazlekhoda Ali Davoodi Seyed Arad Moselmaghili Copyright (c) 2019-06-21 2019-06-21 30 3 Which “P” Came First? The Parotid or the Pancreas? A Diagnostic Dilemma http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1890 Neoplasm of the salivary glands is rare and accounts for 3% to 6 % of all head and neck tumors, and about 85% occurs in the parotid glands. Metastatic disease to the salivary gland, in particular the parotid gland, is noted to be uncommon among solid tumors and has not been well described before. We report a patient who presented with an initial parotid swelling, only to ascertain, it was a metastatic lesion arising from an adenocarcinoma of the pancreas. Hanisah Hithayathullah Eyzawiah Hassan Siti Asmat Md Arepen Siti Soraya Ab Rahman Copyright (c) 2019-06-21 2019-06-21 30 3 Skeletal Metastases in Renal Cell Carcinoma: A Peculiar Occurrence after Treatment and Long Term Remission http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1903 Distant metastases are characteristic for renal cell carcinoma (RCC). Metastases has been observed years after removal of the primary tumor hence the need for surveillance. The most commonly involved sites are the lungs (33-72%), intra-abdominal lymph nodes (3-35%), bone (21-25%), brain (7-13%) and liver (5-10%). Skeletal muscle metastases on the other hand are extremely rare. Our patient presented with uncommon metastasis of RCC to the left brachioradialis, which supports the unpredictable nature of this neoplasm. Fattah Abdul Hamid Zainal Adwin Zainal Abiddin Firdaus Hayati Fam Xeng Inn Zulkifli Zainuddin Copyright (c) 2019-06-21 2019-06-21 30 3 Severe Tracheal Stenosis with Stridor: An Uncommon Complication of Prolonged Ventilation http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1973 Post intubation (PI) and post tracheostomy (PT) tracheal stenosis are common among patients requiring prolonged ventilation. However, patients presented with symptomatic severe tracheal stenosis are rare. We report a middle aged man presented to us with a left basal ganglia bleeding secondary to hypertensive emergency with an initial Glasgow Coma Scale (GCS) of E2V5M5 (11/15). He was intubated for surgical aspiration of hematoma in the operating theatre and was sent to the Intensive Care Unit (ICU) for weaning. His stay was complicated with restlessness and aspiration pneumonia. A percutaneous tracheostomy was done in the ICU at day seven of hospitalization. After one week, the tracheostomy tube dislodged and developed noisy breathing; however patient was not tachypneic nor distress. An urgent Computed Tomography (CT) Thorax showed narrowing of trachea at level of thoracic inlet – sternoclavicular junction. An emergency tracheostomy and examination under anaesthesia was planned by the Otorhinolaryngology (ORL) team. Direct laryngoscopy showed one centimeter stenotic lesion with matured scar and granulations above the new tracheostomy site. The entire procedure was uneventful. We highlight (1) the importance of ETT cuff pressure monitoring, (2) urgent definitive management of impending total airway obstruction and (3) uncommon presentation of symptomatic severe tracheal stenosis. Subramaniam Gayathry Ling Ye Chan Tat Boon Yeap Hang Mooi Lily Ng Copyright (c) 2019-06-21 2019-06-21 30 3 Ruptured Ectopic Pregnancy with Hemothorax http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1975 Patients with an ectopic pregnancy commonly present with unilateral pain and vaginal bleeding between 6 to 10 weeks of gestation. However in our case, a patient presented at one week and 6 days of pregnancy which was complicated with right hemothorax. A right chest tube was inserted and drained out one liter of fresh blood. She successfully underwent an emergency laparotomy and left salphingectomy. Siang Kai Pua Angeline Mary Abdul Maei Binti Ngazraini Wan Kairuddin Binti Wan Siti Sarah Tat Boon Yeap Copyright (c) 2019-06-21 2019-06-21 30 3 Colonic Perforation due to Ventriculoperitoneal Shunt Catheter: A Case Report http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/2025 Ventriculoperitoneal shunt is the most common and most effective therapeutic modality for the management of hydrocephalus. While most frequent complication is shunt dysfunction, abdominal complications may also occur at a rate of 25%, where 0.01-0.07% consists of colonic perforation. Despite being rare, a delayed diagnosis and treatment has a relatively mortal course. Once the diagnosis is established, prompt treatment should be initiated with accompanying removal of the catheter. In this case report, we presented a patient who had a ventriculoperitoneal shunt catheter protruding from anus with diagnostic and therapeutic approach in the guidance of the literature. Aydın Yavuz Erkut Baha Bulduk Saygın Altıner Çağrı Büyükkasap Kürşat Dikmen Hasan Bostancı Hande Köksal Copyright (c) 2019-06-21 2019-06-21 30 3 Urinary Bladder Perforation by Ventriculoperitoneal Shunt Manifested as Spontaneous Per-Urethral Extrusion of Shunt Catheter http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/2046 Various complications of distal end of ventriculoperitoneal shunt (VPS) have been described in the literature, but bladder perforation by VPS is considered extremely rare. We report a case of 35-year-old man who had underlying recurrent 4th ventricle ependymoma and hydrocephalus. Five months prior to current presentation, he had VPS revision for dislodged peritoneal catheter. Intraoperatively the dislodged catheter had to be left in situ as it had completely gone intraperitoneally. He was apparently asymptomatic until he presented with spontaneous passage of VPS catheter per-urethra without signs of peritonitis or central nervous system (CNS) infection. Computed tomography (CT) revealed intact new VPS and no contrast extravasation from bladder. We postulated that the dislodged peritoneal catheter might have eroded into the bladder for a considerable period of time and the perforation had already spontaneously sealed. He was managed conservatively with an indwelling urinary catheter for a week and given prophylactic antibiotics against CNS infection. Since dislodged pieces of shunt tubing in the peritoneal cavity are generally believed to be asymptomatic, it is a common practice to leave them particularly if they are deeply embedded in surrounding tissues. Nevertheless, clinician must be mindful that such practice may potentially lead to serious complications as exemplified in our case. Lai Jun Han Zainal Adwin Zainal Abiddin Fam Xeng Inn Hafidzul Jasman Zulkifli Zainuddin Copyright (c) 2019-06-21 2019-06-21 30 3 Lethal Very Long-Chain Acyl-Coa Dehydrogenase Deficiency with a Novel Mutation http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1679 Very long chain acyl-CoA dehydrogenase deficiency is an autosomal recessive genetic disorder in which the first step in the mitochondrial β-oxidation of fatty acids for 14-20 carbons is defective. Clinical presentation is heterogeneous ranging from the severe neonatal form presenting with hypo-ketotic hypoglycemia, liver dysfunction and rapidly fatal cardiomyopathy with episodes of hypo-ketotic hypoglycemia in infants. Herein we report a patient with novel homozygous missense mutation c.1391C>A in exon 14 with a severe neonatal onset type who presented with hypoketotic hypoglycemia, cardiomyopathy and hepatomegaly. Çigdem Seher Kasapkara Jean_Marc Nuoffer Gökhan Baysoy Bedri Aldudak Mehmet Nuri Özbek Meltem Akcaboy Carlo. R. Largiadèr Copyright (c) 2019-06-21 2019-06-21 30 3 Mucoepidermoid Carcinoma Ex-Pleormorphic Adenoma of Parotid Gland: A Rare Variant with Cytodiagnostic Handicap http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1981 Carcinoma ex pleomorphic adenoma is a rare malignant tumor predominantly arising from salivary glands. Mucoepidermoid carcinoma ex pleormorphic adenoma (MECxPA) is a rare subtype with only ten cases reported in literature. This is a case report of a 53- year-old female with three years history of parotid swelling mimicking clinical features of a benign tumor and even eluding fine needle cytology as pleormorphic adenoma. Histopathological examination reported malignancy of MECxPA variant following superficial parotidectomy. This cytodiagnostic pitfall has been widely reported in literature hence warranting a high index of suspicion and aggressive management in addressing parotid tumors to ensure prompt and adequate treatment. Steuphen Roy Norhafiza Mat Lazim Zubaidah Saizul Hasnan Jaafar Aniza Binti Hassan Nurul Syuhada Abdul Hamid Copyright (c) 2019-06-21 2019-06-21 30 3 A Case of Postanginal Internal Jugular Vein Thrombosis and Pulmonary Septic Emboli http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/1910 A 64-year-old woman was admitted to our hospital with a 10-days history of sore throat, fever and a 3-days history of painful left neck mass. She had been treated with Cefixime, owing to complains of sore throat and fever at another primary clinic. Her throat examination showed mild erythema. A painful neck mass on the left side was observed. Laboratory findings were as follows: white blood cell count, 11,220/L; and C-reactive protein, 16.9 mg/dL. No organism was isolated from blood culture. Enhanced cervical computed tomography (CT) revealed enlargement of the left internal jugular vein, in which hypodense lesions compatible with thrombosis could be seen. High-resolution chest CT revealed patchy opacities compatible with pulmonary septic emboli. Although septicemia was not demonstrated in blood culture, probably because she was already taking antibiotics, the patient was diagnosed with Lemierre’s syndrome. Masashi Ohe Haruki Shida Tetsuya Horita Ken Furuya Copyright (c) 2019-06-21 2019-06-21 30 3 Çocuk Yoğun Bakım Ünitelerinde Sedasyon ve ABCDEF Önlem Demeti http://medicaljournal.gazi.edu.tr/index.php/GMJ/article/view/2027 Son yıllarda, bilim ve teknolojideki ilerlemelerin de katkısıyla, yoğun bakım ünitelerinde takip edilen çocuk hastaların hayatta kalma oranlarında artış sağlanmıştır, fakat bu çocukların yaklaşık % 3-20’sinin nörolojik fonksiyonlarında azalma olduğu ortaya çıkmıştır. Mekanik ventilasyon desteği gereken ve yoğun bakımda uzun süre takip edilen hastalarda nörolojik sonuçların daha kötü olduğu dikkate alındığında, yoğun bakımda kalış süresinin uzamasına yol açabilen sedasyon ile ilişkili olumsuz olayların önemi daha iyi anlaşılır. Araştırmalar, yoğun bakımda izlenen hastaların nörolojik fonksiyonlarında olumsuz sonuçlara neden olabilecek ve düzeltilebilmesi mümkün olan risk faktörlerinin erken tanı ve tedavisi üzerine odaklanmıştır. ABCDEF önlem demeti, hastaların mümkün olan en kısa sürede ve güvenli bir şekilde fiziksel ve kognitif aktivitelere katılabilmelerini sağlamak amacıyla, yapılması gereken organizasyon değişikliklerinin değerlendirildiği kanıta dayalı bir rehber niteliğindedir. Yasar Bildirici Copyright (c) 2019-06-21 2019-06-21 30 3