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> Evaluation of Effectiveness of Laser Assisted Hatching Pregnancy Rates on Fresh IVF / ICSI Cycles <p><strong>Objectives:</strong> To investigate the effects of laser assisted hatching (LAHA) implantation rates, clinical pregnancies, and live births of the patients enrolled in a fresh <em>in vitro</em> fertilization and intracytoplasmic sperm injection-embryo transfer (IVF/ICSE-ET) program.</p> <p><strong>Material and Methods:</strong> A total of 315 patients who underwent at least two unsuccessful ETs or had a baseline follicle-stimulating hormone (FSH) level of ≥10 mIU/mL and who underwent IVF/ICSE-ET at IVF Center. The patients were divided into two groups: patient group (n=100) who underwent LAHA and control group (n=215) who did not. The beta human chorionic gonadotropin (βhCG) positivity, clinical pregnancies, and live births of both groups were compared.</p> <p><strong>Results:</strong> There was no significant difference in the clinical pregnancy and implantation rates between the groups including those with an advanced maternal age or recurrent implantation failure. In the patients with elevated FSH levels (FSH ≥10 mIU/mL), these rates were significantly lower in the study group, compared to the control group.</p> <p><strong>Conclusion:</strong> Our study results show that laser assisted hatching does not improve the&nbsp; biochemical, clinical, and take home baby rates in IVF / ICSI – ET patients.</p> İshak Artar Pervin Karlı Alper Başbuğ Derya Basbug Elif Gül Yapar Eyi Muammer Doğan Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Labor Force Participation in Patients with Hemodialysis and Peritoneal Dialysis Treatment <p><strong>Background</strong>: The prevalence of End-Stage Renal Disease (ESRD) has significantly increased in developing countries and similar to the worldwide trend, the number of incident Chronic Kidney Disease (CKD) stage 5 patients is also increasing in the Iran. This study aims to compare the Labor force participation in patients with hemodialysis and Peritoneal Dialysis (PD) treatment.</p> <p><strong>Method</strong>: The cross sectional study was conducted on 208 patients referred to dialysis centers of north of Iran and Tehran, between January 2015 and January 2016. A checklist was designed to gather data of labor participation and socio-economic status of patients. In addition Kidney Disease Quality of Life (KDQOL) questionnaire was used to calculate mental and physical health of patients. All statistical analysis were done using STATA SE software version 13.1.</p> <p><strong>Results</strong>: The study highlights several findings including the higher mental and physical health quality of life, higher average monthly income in PD employed patients. Also, the type of treatment had significant relationship with labor force participation and it was higher for patients using peritoneal dialysis.</p> <p><strong>Conclusion</strong>: It seems the government and especially ministry of health and medical education should give more attention to inform the public about the advantages of PD and especially its positive impact on employment of patients</p> Nazila Javadi-Pashaki Rasoul tabari-Khomeiran Amjad Mohamadi Bolbanabad Hakimeh Mostafavi Enayatollah Homaie Rad Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Stereotaksik Biyopsi Deneyimi <p><strong>Amaç: </strong>Beyin ve Sinir Cerrahisi Kliniğinde yapılan stereotaksik biyopsi uygulamasının sonuçlarının değerlendirilip literatür ile karşılaştırılması.</p> <p><strong>Gereç ve Yöntem: </strong>Merkezimizde Beyin ve Sinir Cerrahisi Kliniğinde 1996-2018 yılları arasında stereotaksik biyopsi işlemi uygulanan 151 hastanın tıbbi kayıtları geriye dönük gözden geçirildi. Olgular yaş, cinsiyet, patolojinin intrakranial lokalizasyonu ve örnek alınan dokuların patoloji sonuçları değerlendirildi.</p> <p><strong>Bulgular: </strong>Biyopsi yapılan olguların 84'ü (%55,6) erkek, 67'si (%44,4) kadındır. Yaş ortalaması 47.7, yaş spektrumu 26-84'dür.&nbsp; Olguların 102'sinde (%67,55) lezyon lobar yerleşimli, 42 olguda (%27,82) derin yerleşimlidir. Yedi olguda (%4.6) çoklu lezyon saptanmıştır. Patolojik tanıya 125 (%82.78) olguda erişilmiş buna karşın 16 (% 10.59) olguda patoloji sonucu beyin dokusu, 10 (% 6.62) olguda gliozis olarak gelmiştir. Sekiz olguya ikinci kez, bir olguya üçüncü kez biyopsi yapılmıştır. Serideki 13 olguda kraniotomi ile tümör eksizyonu gerçekleştirilmiştir.</p> <p><strong>Sonuç: </strong>Stereotaksik yolla beyin biyopsisi almak güvenli, basit ve yüksek tanı değeri olan bir yöntem olup karşılaşılan sorunlar patolojik tanıya ulaşamama, tümörlerin değişik bölgelerindeki bulguların farklı olduğu durumlarda alınan örneğin tümörün bütünü hakkında bilgi vermesinin mümkün olmayışı ve tekniğe bağlı bazı hatalardır.</p> Ümit Akın Dere Fikret Şahintürk Erkin Sönmez Salih Gülşen Cem Yılmaz Mehmet Nur Altınörs Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 The Effects of Taurine, Melatonin and N-Acetylcystein on Cadmium Exposure Bone Changes “The Surprising Effect of Taurine” <p><strong>Background:</strong> Chronic environmental and occupational exposure to cadmium can result in skeletal system changes. The main objective of the present study was to investigate and compare the effects of taurine, melatonin and N-acetyl cysteine on cadmium exposure induced bone density loss.</p> <p><strong>Methods:</strong> 90 adult male Sprague-Dawley rats were allocated into four main groups: Group I was the control group; Group II was the “cadmium exposure” group; Group 3 was “cadmium exposure for 3 months + concurrent antioxidant administration” group. The concept of Group 4 was cadmium exposure for 3 months + subsequent antioxidant administration. Bone mineral density values were evaluated in all the groups. Serum calcium, phosphorus, alkaline phosphatase (ALP) enzyme activities and 24 hours urine calcium excretion levels were measured. Kruskal–Wallis test was used to compare the all groups. Between two group comparisons, the Mann–Whitney U test was used.</p> <p><strong>Results:</strong> There was no significant difference in terms of bone mineral density values only between control group and cadmium exposure group (p&gt;0.05). Mean bone mineral density values obtained in “cadmium + concurrent taurine” and “cadmium + subsequent taurine” groups were significantly lower than all the other groups (p&lt;0.05). 24 hours urine calcium excretion levels were significantly higher in groups which taurine and n-asetylcystein were administered after cadmium exposure.</p> <p><strong>Conclusion: </strong>Taurine, which is thought to have protective effects as an antioxidant caused a marked bone damage after exposure to cadmium. Further studies are needed to clarify this effect of taurine.</p> Nurettin Tastekin Nurettin Aydogdu Gulay Altun Durmus Hakan Erbas Kaan Uzunca Murat Birtane Mustafa Kaplan Murat Erem Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 What is the Optimal Cutoff Point of Rapid Shallow Breathing Index Calculated by the Mechanical Ventilator Parameters? A Retrospective Observational Study <p><strong>Background:</strong> The discontinuance of mechanical ventilatory support (MVS) is identified as weaning and weaning process is started whenever escalating factor for respiratory failure resolves. Although all weaning criteria were fulfilled, 20% of weaning attempts were unsuccessful. The Rapid Shallow Breathing Index is one of the most studied indices. In this study, we aimed to find out the optimal cutoff point of the RSBI measured in MVS.</p> <p><strong>Methods:</strong> This retrospective, non-interventional cohort study was conducted at a tertiary care hospital in Ankara, Türkiye. After collecting all data, the study population was divided into two group according to weaning failure (WF). Statistical analysis included Mann Whitney U-test, Youden index, and ROC-curves to predict WF.</p> <p><strong>Results:</strong> 46 patients fulfilled the inclusion criteria, and nine patients could not tolerate extubation and required reintubation [WF (+)group, 19.5%] within 72 hours. Not only the RSBI but also the other parameters like Static compliance (Cstat) and PaO<sub>2</sub>/FiO<sub>2 </sub>differed among groups. In this study, the discriminative power which was appraised using the AUC was high enough with RSBI (AUC= 0.962).</p> <p><strong>Conclusion:</strong> MVS may decrease RSBI and lower predictive value in classical original cutoff point (105). However, the discriminative power with 40 as the threshold level was proven to be effective in our study.</p> İbrahim Mungan Şerife Bektaş Sema Sarı Sema Turan Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Çocukluk Çağı Non-Parazitik Dalak Kistlerine Cerrahi Yaklaşım <p><strong>Amaç:</strong> Bizler çalışmamızda çocukluk çağı non- parazitik dalak kistlerine cerrahi yaklaşımlarımızı karşılaştırmalı olarak ortaya koymayı ve değerlendirmeyi amaçladık.</p> <p><strong>Yöntem</strong>: 2012-2017 tarihleri arasında non- parazitik dalak kisti nedeniyle cerrahi girişim yapılan olgular geriye dönük olarak incelendi. Yaş, cinsiyet, uygulanan cerrahi metod, patolojik tanı ve takip açısından olgular değerlendirildi.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong>Bulgular:</strong> Non-parazitik dalak kisti nedeniyle cerrahi girişim uygulanan sekiz olgunun (5 kız, 3 erkek) yaş ortalaması 15 yıl ( minumum-maximum: 9-18 yaş) idi. Beş olguya (% 62,5) parsiyel splenektomi, üç olguya (% 38,5) ise total splenektomi uygulandı. Ameliyat süreleri total splenektomilerde 75-90 dakika; parsiyel yapılanlarda 60-75 dakika arasında değişmekteydi. Hiçbir olguda komplikasyon görülmedi ve kan transfüzyonuna ihtiyaç olacak kadar kanama olmadı. Patoloji sonuçlarına bakıldığında dört olgumuzda (% 50) epitalyal kist, üç olgumuzda(%37,5) pseudokist ve bir olgumuz (%12,5) mezotelial kist olarak rapor edildi. Olgulara altı aylık periyotlarla ultrasonografi kontrolü önerildi şu ana kadar nüks görülmedi.</p> <p><strong>Sonuç:</strong> Dalak, özellikle çocuklarda immune sistem için çok önemli bir organdır ,bundan dolayı non parazitik dalak kistinin cerrahi tedavisinde kistin lokalizasyonu ve boyutları uygun olması durumunda dalak koruyucu cerrahi seçeneği öncelikli olarak düşünülebilir.</p> Sefa Sağ Hatice Sonay Yalçın Cömert Halil İbrahim Çakmak Mustafa İmamoğlu Haluk Sarıhan Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Changing Aspect in Adult Kidney Biopsies: Ten Years Single Center Experience <p><strong>Objective: </strong>Glomerular diseases can result from many inherited or acquired disorders and could lead to chronic kidney disease.&nbsp; Glomerular disease frequency varies between countries. Glomerular diseases have a dynamic structure and may change over years. According to the data in Turkey, the most common glomerulonephritis is membranous nephropathy. But last published data belongs to 2014. The aim of this study is to determine the frequency of kidney biopsy proven glomerulonephritis (GN) in Turkey</p> <p><strong>Methods:</strong> Retrospective observational study was conducted in Gazi University. We evaluated 1273 native kidney biopsies from 2008 to 2017. Renal disease were divided into five major categories: primary GN, secondary GN,&nbsp; tubulointerstitial nephropathies (TIN), vascular nephropathies (VN) and acute tubular necrosis (ATN).</p> <p><strong>Results:</strong> 756 (59.4%) patients had primary GN, 353 (27.7%) patients had secondary GN, 101 (7.9%) patients had TIN, 32 (2.5%) patients had VN and 31 (2.4%) patients had ATN. While, the most frequent pathological diagnosis was focal segmental glomerulosclerosis (FSGS) (31.35%), followed by membranous GN (27.65%) in primary glomerulonephritis, amyloidosis (27.2%) was the most frequent pathological diagnosis followed by systemic lupus erythematosus (SLE) (20.68%) in secondary glomerulonephritis. FSGS is the most common kidney pathology until 50 years old (18-30 years old, 22% and 31-50 years old, 20%). Membranous glomerulonephritis (MGN) is the most common kidney pathology after the ages 50 years old (50-64 years old, 20% and &gt;65 years old, 17%).</p> <p><strong>Conclusion:</strong> FSGS is the most common primary GN in Turkish population and the frequency is gradually increasing.</p> Hasan Hacı Yeter Elif Gecegelen Vural Baştuğ Berfu Korucu Farabi Fettahoğlu Ipek Gönül Ülver Derici Turgay Arınsoy Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Clinical Characteristics and Treatment Approach of Idiopathic Granulomatous Mastitis <p><strong>Objectives:</strong> The purpose of this study was to evaluate the clinical characteristics, treatment approaches, and outcome of the patients with idiopathic granulomatous mastitis (IGM).</p> <p><strong>Methods:</strong> The patients with IGM were reviewed retrospectively from 2011 to 2017. Event free follow up rate was estimated by using Kaplan-Meier analysis, and follow up differences for prognostic factors were compared by using the log-rank test. Multivariate analysis was performed by using Cox-regression method.</p> <p><strong>Results:</strong> There were 69 patients with histologically proven IGM with median age 34 years (range, 21-68 years) at diagnosis. The majority of the symptoms and signs were breast lump, pain, erythema and axillary lymphadenopathy. The most common extramammary finding was eritema nodosum. The most common treatment approaches were only antibiotic or antibiotic plus drainage. The estimated event free follow up rate was 74.7%. It varied according to parity distribution, erythema, extramammary manifestation, and treatment modalities. Cox regression analysis showed that parity distribution, extramammary manifestation and treatment.</p> <p><strong>Conclusion:</strong> This is one of the largest series in a single center. Factors affecting event free follow up rates were parity, erythema, extrammamary manifestations and treatment modalities.</p> Emet Ebru Ateş Ayşegül Kayhan Derviş Ateş Hande Köksal Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Artroskopik Diz Cerrahisinde Kombine Siyatik Femoral Blok Uygulanan Hastalarda Bupivakain ile Alkalinize Bupivakainin Etki Başlangıç Sürelerinin Karşılaştırılması <p><strong>Giriş:</strong> Artroskopik diz cerrahisinde kombine siyatik femoral blok uygulanan hastalarda bupivakain ile alkalinize bupivakaini,&nbsp; motor blok ve duysal blok etki başlangıç süreleri açısından karşılaştırmayı amaçladık.</p> <p><strong>Materyal Metod:</strong> ASA I/II grubundan 20-60 yaşları arasında 40 hasta çalışmaya alınıp, hastalar rastgele yöntemle siyatik sinir bloğunun 20 ml %5’lik bupivakain+0,1 ml %0,9’lık NaCl, femoral sinir bloğunun 20 ml %0,5’lik bupivakain+0,1 ml %0,9’luk NaCl ile yapılacağı grup (Grup 1) ve siyatik sinir bloğunun 20 ml %0,5’lik bupivakain+0,1 ml % 8,4’lük sodyum bikarbonat, femoral sinir bloğunun 20 ml %0.5’lik bupivakain+0,1 ml % 8,4’lük sodyum bikarbonat ile yapılacağı grup (Grup 2) olarak &nbsp;iki eşit gruba ayrıldı.</p> <p><strong>Bulgular: </strong>Siyatik sinir için duysal blok değerlendirmesinde uyluğun arka kısmında S<sub>1-2</sub> dermatom sahasına uygun alan ve femoral sinir duysal blok değerlendirmesinde uyluğun ön yüzünde L<sub>2-4</sub> dermatom sahasına uygun alan pinprick testi ile değerlendirildi. Motor blok bromage skalası ile değerlendirildi. Başlangıç, 1., 3., 5., 10., 15., 20., 30. dakikalardaki veriler kaydedildi.</p> <p><strong>Sonuç:</strong> Artroskopik diz cerrahisinde kombine siyatik femoral blok uygulanan hastalarda bupivakain ile alkalinize bupivakaini, motor blok ve duysal blok etki başlangıç süreleri açısından karşılaştırdık ve fark olmadığını belirledik.</p> Levent Ozturk Aslı Yılmaz Vural Tulin Gümüş Orhan Kanbak Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Klinefelter Sendromlu ve Normal Karyotipli Non-Obstruktif Azospermik Hastaların in vitro Fertilizasyon Sonuçlarının Değerlendirilmesi <p><strong>Amaç: </strong>Klinefelter Sendromlu (KFS) ile normal karyotipli non-obstruktif azospermik (NOA)&nbsp; infertil hastalarımızın testiküler sperm ekstraksiyonu (TESE) ile elde edilen spermatozolarla yapılan IVF işlemlerinin sonuçlarını karşılaştırmaktır.</p> <p><strong>Yöntem:</strong> TESE yapılmış 23 KFS’li ve 51 normal karyotipli NOA infertil&nbsp; hasta incelendi.&nbsp; Periferik kanda karyotip analizlerine&nbsp; göre KFS’li ve normal karyotipli NOA olarak iki gruba ayrılmıştır. İki grup&nbsp; yaş, hormon değerleri, TESE’ de sperm elde etme, klinik gebelik ve canlı doğum oranları bakımından karşılaştırılmıştır. KFS&nbsp; ve&nbsp; kontrol&nbsp; grubu arasında&nbsp; ortalama erkek yaşı ve&nbsp; kadın yaşı, infertilite süreleri ve deneme sayıları&nbsp; bakımından&nbsp;&nbsp; istatistiki anlamlı bir fark yoktur ve benzer gruplardır.</p> <p><strong>Bulgular: </strong>KFS grubunda kontrol grubuna göre foliküler uyarıcı hormon (FSH) ve&nbsp; luteinize edici&nbsp; hormon (LH) (p:0.05,P:0.06),&nbsp; kontrol grubunda ise KFS gruba göre&nbsp; klinik gebelik ve canlı doğum istatistiki anlamlı yüksek bulunmuştur.</p> <p><strong>Sonuç: </strong>KFS ve kontrol grupları arasında testiküler sperm elde etme açısından istatistiki anlamlı fark bulunmazken, klinik gebelik ve canlı doğum kontrol grubunda istatistiki anlamlı yüksektir.</p> Seyhan Gümüşlü Deniz Ercan Esra Karabay İsmail Güler Ahmet Erdem Nuray Bozkurt Mesut Öktem Mehmet Erdem Mehmet Ali Ergün Esra Tuğ Onur Karabacak Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Retrospective Comparison of the Effects of Centrifugal and Roller Pump Heads on the Hemostatic System During Open Heart Surgery <p><strong>Background and Aim:</strong> Technological developments and enhancement of knowledge level enable heart surgery with low mortality and morbidity rates in most centers. On the other hand, hemostasis management during cardiopulmonary bypass (CPB) plays a critical role in development of postoperative complications.</p> <p>We aimed to compare the effects of centrifugal pump and roller pump techniques on hemostatic system during CPB.</p> <p><strong>Material and Methods</strong>: One hundred patients, who underwent coronary artery bypass surgery by the same surgical team with CPB pump using either roller or centrifugal pump, at Department of Cardiovascular Surgery of Gazi University between June 2012 and June 2013 were enrolled. Patients over 40 years old and without any known immunologic, infectious or inflammatory diseases and hematological problems for the last 6 months were included. Two study groups (Group R: Roller pump group and Group C: Centrifugal pump group) were created. Platelet counts, albumin levels were measured before and after CPB (pump); the amount of blood used during&nbsp; CPB, total blood amount used, percentage of patients using five or more units of blood during CPB, percentage of patients who didn't receive f<em>resh frozen plasma (FFP)</em>or&nbsp; apheresis platelet concentrates were recorded.</p> <p><strong>Results:</strong>The amount of blood transfused during CPB was significantly lower in Group C than in Group R (0.28 ± 0.08 U; 0.68 ± 0.13) (p=0.010), while the total amount of blood transfused was significantly higher in Group R compared to Group C (p&lt;0.0001). Preoperative and postoperative platelet levels were similar between groups, but platelet levels were significantly lower in both groups compared to their preoperative levels (Group C, p&lt;0.0001, Group R, p&lt;0.0001). When the preoperative albumin levels were compared, the patients in Group R had higher albumin levels than in Group C, whereas postoperative albumin levels were significantly higher in Group C than Group R (p&lt;0.0001). The percentage of patients who didn't receive blood transfusion during CPB was significantly higher in Group C (p=0.011). While the percentage of patients who didn't receive FFP transfusion was significantly higher in Group C (p=0.002), the percentage of patients who didn't receive apheresis platelet transfusion was similar.</p> <p><strong>Conclusion:</strong> Our findings indicate that usage of centrifugal pump has clear superiority in terms of effects on hemostatic system during CPB when compared to roller pump. Nevertheless, we believe that our results should be supported by advanced clinical and experimental studies.</p> Hüseyin Demirtaş Erkan İriz Yiğit Kılıç Dilek Erer Gürsel Levent Oktar Mustafa Arslan Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Comparison of Outcomes of Open and Closed Surgical Procedures in Pilonidal Cysts Excision: A Randomized Clinical Trial Study <p><strong>Background:</strong> Treatment of pilonidal sinus involves the use of various surgical procedures, most of which are associated with many complications and problems. Meanwhile, open and closed surgical procedures are two common surgical procedures for the treatment of patients with pilonidal sinus disease. The aim of this study is to compare the outcomes of open and closed surgical procedures in pilonidal cysts excision.</p> <p><strong>Methods:</strong> This study was a randomized clinical trial that was performed on patients with pilonidal sinus referred to Shahid Beheshti Hospital of Yasuj University of Medical Sciences, Yasuj, Iran. Patients having inclusion criteria were assigned to 2 groups; first group for open surgical procedure (<em>n</em>:30) and second group for closed surgical procedure (<em>n</em>:30) using a simple randomized method. The data gathering tools were a demographic data form and a visual analog scale (VAS). Two types of open and closed surgery procedures were performed randomly on patients. Data were analyzed by SPSS-16 software using mean, standard deviation, independent t-test, Chi-square or Fisher exact test.</p> <p><strong>Results:</strong> The results showed that the outcomes of recurrence of the disease (<em>P</em> = 0.001), wound infection (<em>P</em> = 0.003), and duration of surgery (<em>P</em> = 0.001) in open surgical procedure were significantly lower than the closed surgical procedure.</p> <p><strong>Conclusions:</strong> Considering the better outcomes of open surgical procedure in terms of patient satisfaction after surgery and lower additional costs, the open surgical procedure is suggested for the treatment of pilonidal sinus - if one of these two methods should be selected by the surgeon.</p> Hossein Esfandiari Saadat Mehrabi Shirvan Salaminia Ali Mousavi Zadeh Reza Hosseinpour Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Morphometry of Common Carotid Artery and Internal Jugular Vein in Relation to Gender and Body Side <p><strong>Introduction:</strong> The common carotid arteries originate from brachiocephalic trunk on the right and directly from the aortic arch on the left.&nbsp; These arteries are contained within the carotid sheaths together with the internal jugular veins and vagus nerves. The structures enclosed in carotid sheath are of great importance, since they provide most of the vascular supply of the head and neck. They exhibit a great deal of variation and are related with a number of pathologic conditions and invasive procedures.</p> <p><strong>Objectives:</strong> Thus we focused on morphology of the common carotid artery (CCA) and internal jugular vein (IJV) to determine these possible variations.</p> <p>Methods: Neck magnetic resonance images of 81 individuals (38 females and 43 males) were evaluated retrospectively. Diameter of the lumen of the common carotid artery (CD) and the diameters of the lumen of the internal jugular vein (ID) were measured at the same level that is one slice inferior to the slice in which the bifurcation of the CCA is observed firstly. CCA intima-media thickness (CIMT), IJV intima-media thickness (IIMT), CCA-midline distance (CMD) and IJV-midline distance (IMD) were also measured at the aforementioned level. The measurements were evaluated in relation to gender and asymmetry.</p> <p><strong>Results:</strong> The values measured for Right CMD, Right IMD, Left CD, Left CMD and Left IMD of males were greater than those of females (p&lt;0.05). The results stressed various morphometric parameters and topography of the IJV and CCA.</p> <p><strong>Conclusion:</strong> The results are suggested to be helpful in determination of normal values in terms of diagnostic purposes and treatment planning.</p> Onder Ertem Mustafa Kemal Demir Cagatay Barut Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 the Dikkat Eksikliği Hiperaktivite Bozukluğu olan Bir Grup Hastada Görsel Dikkat Bileşenlerinin Değerlendirilmesi <p><strong>Amaç</strong><strong>: </strong>Dikkat eksikliği hiperaktivite bozukluğu (DEHB) okul çağı çocuklarında oldukça yaygın gözlenen bir nörogelişimsel bozukluktur ve erkek çocuklarında kızlara göre 2-10 kat daha sık görülür. Dikkat işlemleri farklı beyin bölgelerinin aralarında karşılıklı yoğun bağlantılar oluşturduğu sinir ağları sistemi tarafından yürütülmekte olup DEHB’de seçici dikkat, sürekli dikkat ve görsel-uzaysal dikkat bileşenlerin işlevlerinde yetersizlikler ve güçlükler gözlenmektedir. Bu çalışmada DEHB olan erkek çocuklarda görsel-uzaysal, seçici ve sürekli dikkati değerlendirmektir.</p> <p><strong>Yöntem</strong>: Çalışma çocuk psikiyatrisi ve çocuk nöroloji polikliniğine başvuran yaşları 6-10 arasında değişen&nbsp;DEHB tanılı 80 erkek olgu ve kontrol grubu olarak 73 erkek olgu ile yapılmıştır. Çocuk ve ailesi ile DSM-V’e göre yapılandırılmış bir görüşme yapılmıştır. Zekadan kaynaklanan karıştırıcı değişkenleri kontrol etmek amacıyla Wechsler Çocuklar İçin Zeka Ölçeği (WISC-R), analitik düşünme görsel, mekansal algılama becerilerini değerlendirmek için Raven Standart Progresif Matrisler Testi (RSPM), seçici ve sürekli dikkati değerlendirmek için İşaretleme Testi (İT) ve görsel-uzaysal dikkati incelemek için Çizgi Yönünü Belirleme Testi (ÇYBT) kullanılmıştır.</p> <p><strong>Bulgular</strong>: DEHB tanısı almış olan 80 erkek olgunun %41,25’i DEHB-DE, %30’u DEHB-HD ve %28,75’i DEHB-B olarak sınıflandırılmıştır. Yaş açısından incelendiğinde; tanı grubuyla (7.89±1.33 yaş) kontrol grubu (8.14±1.44 yaş) arasında anlamlı bir fark görülmemiştir (p&gt;.05). WISC-R, RSPM, ÇYBT ve İT’den elde edilen puanlar değerlendirildiğinde tüm testler de kontrol grubunun puanlarının tanı grubundan daha yüksek olduğu görülmüştür (p&lt;0.05).</p> <p><strong>Sonuç</strong>: Görsel dikkat bileşenlerinden seçici dikkat, sürdürülen dikkat ve görsel-uzaysal dikkat işlevselliğinin DEHB olan çocuklarda sağlıklı akranlarına göre etkilendiği görülmektedir. Bu nedenle DEHB olgularında hem yaşam kalitesi artırmak hem de tedavi izleminin değerlendirilmesinde nöropsikolojik testlerin kullanılması yararlı olacaktır.</p> Leman Tekin Orgun Ayşe Şebnem Soysal Acar Yasemin Tas Torun Kıvılcım Gücüyener Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 A Single Center Experience on Reproductive Outcome Following Hysteroscopic Treatment of Patients with Septate Uterus <p><strong>Objective:&nbsp; </strong>To determine the pregnancy rates after uterin septum resection, in an infertile women population.</p> <p><strong>Methods: </strong>We recruited 255 infertile women who have preoperative diagnosis of uterine septum and whom underwent hysteroscopic operation. We calculated the birth rates and the pregnancy rate between the primary and secondary infertile groups of women.</p> <p><strong>Results: </strong>The clinical pregnancy rate, the live birth rate, and the abortion rate were 35.4% (primer infertile [n=52, 35.6%], seconder infertile [n=31, 35.2%]), 30.7% (primer infertile [n=46, 31.5%], seconder infertile [n=26, 29.5%]) and 4.7% (primer infertile [n=6, 4.1%], seconder infertile [n=5, 5.6%]) respectively. Term birth rate and preterm birth rate were 22.6% and 8.1% respectively in all infertile patients.</p> <p><strong>Conclusion: </strong>The major finding of the current study is that septate uterus treatment improves obstetrical outcomes in infertile patients with an overall pregnancy rate of 35.4%.&nbsp;</p> Esra Isci Bostanci Meryem Kuru Pekcan Ümit Yasemin Sert Hüseyin Yesilyurt Dilek Uygur Sahin Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Low S100β Measurements via Jugular Venous Bulb Catheter During Pulsatile Perfusion in Coronary Bypass Grefting Operations <p><strong>Background/Aim:</strong> Although it has been thought that the complications due to non-pulsatile blood flow should decrease with the utilization of pulsatile perfusion during cardiopulmonary bypass (CPB), there is not enough literature about the probable beneficial effects on cerebral perfusion. In this study we aimed to determine whether the utilization of pulsatile or non-pulsatile CPB makes a difference on the cerebral circulation by the measurements of biochemical serum markers and the jugular bulb oxygen saturation (SjVO<sub>2</sub>) in addition to near- infrared spectroscopy (NIRS).</p> <p><strong>Material and Methods:</strong> Eighteen patients scheduled for coronary revascularization on CPB were included in the study. After aortic clamping, non-pulsatile and pulsatile perfusion were both performed for 10-minute periods. S100ß, adrenomedullin (ADM), NSE and SjVO<sub>2 </sub>measurements were performed 10 minutes before anesthesia, during non-pulsatile perfusion, during pulsatile perfusion and 10 minutes after CPB. Niroxope 401 was used for NIRS measurements.</p> <p><strong>Results:</strong> Fourteen patients were male (77.8 %) and four patients were female (22.2 %). The mean age was 59.06±10.40 and the mean ejection fraction was 50.67 ± 13.39 %. There were no statistical differences between the two perfusion regimes with regard to the mean arterial blood pressures (67.26±7.01/68.71±527 mmHg) and the serum hemoglobin levels (8.64±1.32/8.51±1.29 mg/dl). The postoperative neurocognitive dysfunction rate was 27.8 % and the cerebrovascular event rate was 11.1 %. The increasing values of s100β during non-pulsatile perfusion were decreased significantly with pulsatile perfusion. Off-pump NSE levels and ADM levels during pulsatile perfusion and after CPB were statistically higher. There were no statistical differences between the perfusion types for NSE, SjVO<sub>2</sub> and NIRS measurements.</p> <p><strong>Conclusion:</strong> The decrease in s100β levels during pulsatile perfusion is the striking point of this study. We think that there is a need for more studies with extended patient series to prove that the neurologic complications due to CPB should decrease with pulsatile perfusion.</p> Emrah Ereren Gursel Levent Oktar Abdullah Özer Mustafa Hakan Zor Erkan Iriz Dilek Erer Harun Arbatlı Halim Soncul Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Investigation of ARHGEF12 Single Nucleotide Polymorphism in Hypercholesterolemia and Primary Open Angle Glaucoma <p><strong>Objective:</strong>To investigate the effect of single nucleotide polymorphism rs58073046 A&gt;G within the <em>ARHGEF12</em> gene in patients with hypercholesterolemia and primary open angle glaucoma.</p> <p><strong>Methods:</strong>&nbsp; Blood samples of 20 patients with high serum cholesterol and primary open angle glaucoma (Group 1), 20 sex and age matched healthy subjects (Group 2) as controls were enrolled to the study. The <em>ARHGEF12</em> gene polymorphism was determined by polymerase chain reaction and DNA sequence analysis. The data were assessed by descriptive statics and Fisher exact x<sup>2 </sup>test.</p> <p><strong>Results: </strong>The homozygous wild type genotype (AA)&nbsp; was identified in 95 % of Group 1 versus 100 % of Group 2. The homozygous mutant genotype (GG), presented the highest prevelance in Group 1 (5%),&nbsp; although the difference was not statistically significant between groups (p=0.5).</p> <p><strong>Conclusion: </strong>This is the first study to identify the role of <em>ARHGEF12</em> gene variant in the risk of hypercholesterolemia and POAG. Our results showed that there is no association between rs58073046 A&gt;G polymorphism and disease development.</p> Derya Yaman Tamer Takmaz Selin Akad Dinçer Feride İffet Şahin Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 HTK-Alcar, a Modified Organ Transplantation Solution, Decreases Ischemic Injury in the Rat Kidney Tissue <p><strong>Objectives:</strong> Histidine-tryptophan-ketoglutarate (HTK) solution is the storage solution used in organ transplantation. However, such solutions cannot completely eliminate tissue damage. Acetyl L-carnitine (Alcar) is a strong antioxidant. In this study we aimed to determine the protective effects of HTK solution prepared with Alcar in kidney tissue.</p> <p><strong>Methods:</strong> Twenty-four rats used in this study were divided into 4 groups. Kidneys of rats in groups 1 and 2 were stored for 4 hours in HTK and HTK+Alcar solutions, respectively. Kidneys of rats in groups 3 and 4 were stored for 24 hours in HTK and HTK+Alcar solutions, respectively. Histological and immunohistochemical examinations of the kidneys were performed. In addition, TUNEL analysis was performed for the evaluation of apoptosis.</p> <p><strong>Results:</strong> The findings of histomorphological damage in short-term HTK and HTK+Alcar groups were mild,&nbsp;but it was found widely in long-term HTK and ong-term HTK+Alcar groups on histologic evaluation. When histological scoring was made from kidney sections stained with H&amp;E, the scores in HTK+Alcar groups decreased significantly compared to HTK groups. It was also seen that the score level increased significantly in long-term groups. According to immunohistochemical evaluation, in short- and long-term HTK+Alcar groups, the acetyl-L-carnitine prevented the antiapoptotic mechanisms to be activated and the intense expression of Bcl-2 has not occurred. In short- and long-term HTK groups, osteopontin showed more immunopositive result.</p> <p><strong>Conclusion:</strong> It was determined that the modified HTK solution prevented the increase of the activation of the expected oxidant mechanisms resulting in ischemia. This contribution of acetyl-L-carnitine was also found in long-term group findings.</p> Gulistan Sanem Saribas Neslihan Coskun Akcay Seda Nur Akyol Duygu Dayanir Khadeejah Abraheem Mustafa Bilge Mustafa Kavutcu Candan Ozogul Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Bir İlçede Yaşayan 15 Yaş ve Üzeri Kişilerde Anksiyete Sıklığı ve İlişkili Risk Etmenleri <p><strong>Giriş:</strong> Anksiyete, gerginlik hissi ve endişeli düşüncelere sahip olma şeklinde tanımlanabilir. Bu durum günlük hayatta normal bir süreç olmakla birlikte anksiyete şiddetlenirse veya kişinin yaşam kalitesini ve işlevselliğini bozmaya başlarsa bir bozukluk veya hastalık olarak kategorize edilebilir .Çalışmamızın amacı Aksaray ilinin Ağaçören ilçesinde 15 yaş ve üzeri kişilerde anksiyete belirtileri sıklığı ile ilişkili risk etmenlerinin belirlenmesidir.</p> <p><strong>Yöntemler:</strong> Araştırmanın tipi kesitseldir. İlçede bulunan 15 yaş ve üzeri kişiler yaş ve cinsiyet gruplarına göre tabakalandırılıp, her grupta ulaşılması gereken kişi sayısı tespit edilmiştir. 364 kişiye ulaşılması hedeflenmiştir. Ulaşım yüzdesi %93,6 olmuştur. Araştırmada veri kaynağı olarak kişilerin tanımlayıcı özelliklerini sorguyalayan bir anket formu ve Beck Anksiyete Ölçeği kullanılmıştır.</p> <p><strong>Bulgular:</strong> Araştırmada 341 kişi incelenmiştir. Katılımcıların Beck Anksiyete Ölçeği puan ortalaması 8,52±8,63, ortancası 6 (min:0, max:42)’dır. İncelenenlerin %14,7’sinde anksiyete tespit edilmiştir. Kadınların %27,8’inde, erkeklerin %8,1’inde anksiyete tespit edilmiştir. Kadın olmak anksiyete varlığı için risk etmeni olarak belirlenmiştir.</p> <p><strong>Sonuç:</strong> Araştırmamızda her yedi kişiden birinde anksiyete bulgularının olduğu saptanmıştır. Ülkemizde yapılan araştırmaların çoğu çeşitli gruplara özeldir. Toplumu kapsayan çalışmalara ihtiyaç vardır. Anksiyete bozukluğu riski kadınlarda erkeklere göre üç kat daha fazla bulunmuştur. Risk faktörleri hakkında farkındalığın artması kadınlarda anksiyete gelişimini önleyici önemli adımlardan birini oluşturabilir</p> İrem Medeni Mustafa Necmi İlhan Volkan Medeni Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Nonalkolik Yağlı Karaciğer Hastalığı ile PNPLA3 Geni I148M Polimorfizmi Arasındaki İlişki <p><strong>Aim</strong>: The aim of the study is to evaluate the relationship between <em>PNPLA3</em> gene I148M polymorphism and nonalcoholic fatty liver disease (NAFLD) in nondiabetic subjects.</p> <p><strong>Materials and Methods: </strong>The study group consisted of 152 NAFLD patients who were detected by ultrasonography and 165 controls with ultrasonographically normal livers. Biochemical analyses were performed and body mass index was calculated for all subjects in the study. The samples were then genotyped&nbsp; for <em>PNPLA3</em> I148M polymorphism using Real-Time PCR method.</p> <p><strong>Results: </strong>The body mass index was significantly higher&nbsp; in patients with NAFLD than in controls (<em>p</em>&lt; 0.001). The low density lipoprotein (LDL) and high density lipoprotein (HDL) levels were similar in the two groups.&nbsp; Mean fasting blood glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ -glutamyltransferase (GGT), triglyceride(TG) and total cholesterol levels were significantly higher in the patient group compared to controls (<em>p</em> &lt; 0.001). <em>PNPLA3 </em>I148M polymorphism was statistically significantly associated with the risk of NAFLD (χ2=23.846, <em>p</em>&lt;0.001). Moreover, individuals with the GG genotype had a 4.8 fold&nbsp; increased risk of NAFLD (χ2=18.190, <em>p</em>&lt;0.001, OR=4.807, %95 CI=2.215-10.430). The C allele was protective against NAFLD (χ2=23.426, <em>p</em>&lt;0.001, OR=0.442, %95 CI=0.317-0.617), whereas the G allele was a genetic risk factor for NAFLD (χ2=23.426, <em>p</em>&lt;0.001, OR=2.261, %95 CI=1.620-3.155).</p> <p><strong>Conclusion:</strong> This study is the first&nbsp; to reveal the association between <em>PNPLA3</em> gene I148M polymorphism and nondiabetic NAFLD&nbsp; subjects in Turkish population.</p> <p><strong>Key words: </strong>nonalcoholic fatty liver disease (NAFLD), <em>PNPLA3</em>, single nucleotide polymorphism (SNP), SNP genotyping</p> <p>&nbsp;</p> Emine Berrin Yüksel Ayşe Güldem Kilciler Betül Koyuncu Cem Balantekin Ufuk Kutluana Beyza Doğanay Erdoğan Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Diclofenac sodium Induced Nicolau Syndrome <p>Nicolau syndrome (NS) also known as livedo-like dermatitis, is an uncommon but important cutaneous drug reaction. It was first described in 1924 and since then many patients have been reported in the literature. The disorder is characterized by intense pain in the injection site and followed by a livedoid reticular patch or indurated plaque. In some patients, this condition may progress into extensive necrosis of the skin and ulceration as seen in our patient. Herein we presented a 52-year-old man and presented with a painful, large ulcer on his left buttock after intramuscular diclofenac sodium administration and diagnosed with NS to draw attention of physicians to this rare and preventable condition.</p> Engin Şenel Aynure Öztekin Ümran Muslu Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Stuve-Wiedemann Sendromu: Nadir Bir Klinik Antite <p>Stuve-Wiedemann sendromu boy kısalığı, uzun kemiklerde eğrilik, kamptodaktili ve eklem kontraktürleri gibi iskelet sistemi bulgularının yanısıra otonomik disfonksiyon, solunum yetmezliği ve yutma disfonksiyonu ile karakterize otozomal resesif geçişli bir bozukluktur. Etiyolojiden kromozom 5p13 bölgesinde yer alan leukemia inhibitory factor receptor genindeki mutasyonlar sorumludur. Bu yazıda Stuve-Wiedemann sendromu tanısı konulan ve moleküler analiz ile doğrulanan bir süt çocuğu sunuldu. Altı aylık kız hasta epizodik hipertermi, kamptodaktili ve bacaklar arasında uzunluk farkı nedeniyle değerlendirildi. Radyografik incelemede yaygın osteopeni ile alt ekstremitelerde skleroz artışı ve eğrilik deformitesi saptandı. Stuve-Wiedemann sendromu ön tanısı ile yapılan leukemia inhibitory factor receptor geni dizi analizinde hastada literatürde daha önce bu hastalık ile ilişkili olarak bildirilmiş c.2074C&gt;T (p.Arg692Ter) mutasyonu homozigot, anne ve babasında heterozigot olarak saptandı. Sonuç olarak uzun kemiklerde eğrilik ve osteopeni ile karakterize iskeletin genetik bir hastalığı olan Stuve-Wiedemann sendromu epizodik hipertermi, solunum sıkıntısı ve yutma disfonksiyonu ile başvuran hastaların ayırıcı tanısında mutlaka akılda tutulmalıdır.</p> Gizem Ürel Demir Pelin Özlem Şimşek Kiper Gülen Eda Utine Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 İnguinal Bölgede Portal Hipertansiyona Bağlı Kollateral Vasküler Yumak; İnguinal Herni ile Ayırıcı Tanı <p>İnguinal bölgede şişlik sık karşılaşılan bir klinik bulgu olup en sık nedeni inguinal hernilerdir. Herniler dışında; lenf nodları, hematom ve abse gibi yaygın sebepler ile spermatik kord tümörleri, endometriozis, leiomyoma, round ligaman varikozitesi ve retroperitoneal kitleler gibi nadir sebeplerle de inguinal şişlik oluşabilmektedir. Burada, inguinal şişlik yakınması olan ve daha önce portal hipertansiyon varlığı bilinmeyen 39 yaşında erkek hastada, paraumbilikal ven ile sol femoral ven arasındaki kollateral vasküler yapılara ait kontrastlı abdomen bilgisayarlı tomografi (BT) inceleme bulguları sunulmuştur.</p> Hakan Abdullah Özgül Işıl Başara Akın Canan Altay Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Granular Cell Tumor Seen in Buccal Sulcus: A Case Report <p>Granular cell tumor is a rare, benign tumor that usually occurs as a single nodule in the skin, tongue or oral cavity. Granular cell tumor is a rare tumor in the head and neck region and most commonly occurs in the oral cavity, especially in the tongue. Although the lesion is usually seen as a solitary nodule with no boundaries, it can be found in different parts of the body. Abrikossoff thought that the tumor is firstly originated from muscle tissue and was called granular cell myoblastoma. Recent ultrastructural studies and stains such as S100 and neuron specific enolase confirm that this tumor is derived from Schwann cells of the peripheral nerves. A 50 year old female patient was admitted to the Department of Oral and Maxillofacial Surgery of Gazi University Dentistry Faculty due to a yellowish white colored, nodular lesion in the left maxillary buccal sulcus area which has been for about 6 months. Histopathological examination of the excised lesion was revealed a granular cell tumor, which was especially seen on the tongue in the oral cavity. No recurrence was observed at postoperative sixth month.</p> Özgün Yıldırım Mustafa Öztürk Emre Barış Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 A A Branchiogenic Carcinoma: A Case Report on the Delivery of the Branchial Triplets and Literature Review <p>Branchiogenic carcinoma is an extremely rare condition, with its diagnosis being contentious and is of much debate till date. Due to its vexed clinicopathological entity, a meticulous histopathological examination is essential. Various criteria have been laid out to ensure that the exact diagnosis of branchiogenic carcinoma can be established. We report a 37-year-old male presented with unilateral left sided neck cystic swelling of almost one-year duration, which had gradually increased in size. Imaging showed three cysts altogether in which he underwent surgical excision of three cystic lesions. Histopathological examination showed possibility of a branchiogenic squamous cell carcinoma and the patient completed adjuvant radiotherapy. He was disease-free after 2 years under regular surveillance. Despite the history and clinical examination being strongly suggestive of a benign cervical disease, the differential of a more sinister entity such as branchiogenic carcinoma or cervical cystic metastatic squamous cell carcinoma should be considered. Exclusion of any primary elsewhere in the upper aerodigestive tract is of utmost importance.</p> Madhusudhan Krishnamoorthy Irfan Mohamad Shahrul Hitam Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Künt Göğüs Travması Sonrası Gelişen Triküspit Kapak Yetmezliği Olgu Sunumu <p>Travmatik triküspit kapak yetmezliği, künt göğüs travmalarında görülen nadir bir komplikasyondur. Biz burada yüksekten beton zemine düşme sonrası gelişen triküspit kapak posterior papiller kas rüptürü ve buna bağlı gelişen triküspit kapak yetmezliğinden bahsettik.</p> Fatma İncedere Semiha Tokgöz Levent Gökgöz Erkan İriz Serdar Kula Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Perforated Acute Appendicitis with Accidental Mesodiverticular Band in a Southeast Asian Ovalocytosis: An Unfortunate Occurrences <p>Acute appendicitis (AA) is one of the commonest surgical emergencies. Perforation is one of the major complications of AA which can cause dreaded morbidity as well as mortality. Comorbidities, especially among endocrine, vascular or even haematological disorder, can mask postoperative complications. By having good knowledge of certain perioperative conditions, the patient can avoid more invasive intervention. Herein, a young lady with southeast asian ovalocytosis (SAO) presented with perforated AA and incidental mesodiverticular band developed postoperative jaundice and we discuss the possible outcomes of these unfortunate events.</p> Nurul Amira Kabul Nurul Najah Mohamad Kamal Andi Fauzi Andi Kadir Muhammad Budiman Zamhor Noralia Ain Mohd Zaid Koh Mohd Zaid Koh Yee Woon Chia Tharuni Chandrasegar Firdaus Hayati Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Advanced Triple Negative Breast Cancer in Pregnancy <p>Breast cancer is one of the most common prevalent malignancies in pregnancy. The management is challenging as it involves both maternal and fetal well-being. A 41-year-old lady was diagnosed with triple negative breast cancer in the second trimester pregnancy. Neoadjuvant chemotherapy was decided as she opted for a continuation of pregnancy and refusal for mastectomy. After completing the second cycle of chemotherapy, she developed preterm premature rupture of membrane and had fetal malposition requiring an emergency caesarean section. Computed tomography staging revealed an advanced disease, hence needing palliative treatment and support. The difficulties in managing this case arise in choosing the best treatment to preserve both maternal and fetal wellbeing.</p> Firdaus Hayati Tze Huat Chong Gunaseelan G. Durairaj Nornazirah Azizan Fatimah Ahmedy Nor Faezan Abdul Rashid Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Nodular Fasciitis of the Breast: Case Reports of a Male and a Female Patient <p>Nodular fasciitis (NF) is a benign lesion that originates from the excessive proliferation of fibroblasts. NF is rare in the breast. The majority of affected patients are female. In this presentation, NF imaging findings with elastography features of a male and a female patients are presented. A 41-year-old female patient had a lesion that the upper external quadrant of the left breast in the BI-RADS 3 category. 6 months later, the lesion sizes increased and lesion' edges were angular. The lesion was upgraded to BI-RADS 4B category. A 48-year-old male patient had a lesion in the BI-RADS 5 category. Both of the lesions were hard on strain elastography. US-guided core biopsies were not diagnostic and pathologist recommended total excision. After surgery, the both lesions were diagnosed as NF pathologically. NF is a very rare lesion that mimics breast carcinoma clinically and radiologically.</p> Nurullah Dağ Halit Nahit Şendur Serap Gültekin Güldal Esendağlı Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Massive PTE Following an Elective Arthroscopic Meniscal Repair: A Case Report and Literature Review <p>Venous Thromboembolism (VTE) is an unusual complication after arthroscopic meniscus surgery. There is no consensus for anticoagulant therapy following routine arthroscopic meniscus surgery. Here we present a case of near-fatal pulmonary thromboembolism after an elective arthroscopic meniscus repair.</p> Vivek Pandey Sandesh Madi Prajwal Mane Kiran Acharya Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 A Rare Case Report: Nasopharyngeal Pleomorphic Adenoma <p>Pleomorphic adenoma is the most common type of benign tumors of salivary glands. Pleomorphic adenoma commonly arises from the parotid gland and could also be located in larynx, pharynx, trachea, and lips. Pleomorphic adenoma rarely occurs in nasopharynx and may present with nasal onstruction. In adult patients, it can be confused with nasopharynx cancers. The risk of recurrence and squamous metaplasia should be kept in mind.&nbsp; The gold standard treatment method is transnasal endoscopic total excision.</p> Tijen Ceylan Muammer Melih Sahin Eray Uzunoğlu Alper Ceylan Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 A Rare OccuA Rare Occurrence of Suspected Delayed Malignant Hyperthermia in a Young Patient Undergoing an Orthopaedic Surgeryrrence of Suspected Delayed Malignant Hyperthermia On A Young Patient Undergoing An Orthopaedic Surgery. <p>Malignant hyperthermia (MH) is a rare but fatal anaesthetic emergency. It is an autosomal dominant (AD) inherited disorder which is characterized by a hypermetabolic response of an individual upon exposure to a certain type of anaesthesia. We report a rare case of desflurane-induced MH in a Malay descent immediately following an uneventful exposure to sevoflurane. The administration of dantrolene in the immediate management successfully treated the patient.</p> Hau Jett Lin Nadhirah Abdul Halim Cheow Joey Teah Kai Ming Farhana Katiman Nora Azura Dintan Yeap Boon Tat Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Successful Non-Surgical Management of Extensive Tracheal Injury <p>Tracheal injury following a blunt trauma is rarely encountered. Tracheal injury usually requires immediate airway intervention as it is life-threatening. Rarity of this entity along with lack of concrete evidence-based literature poses a great conundrum in managing such patients. Amongst the meagre reported cases, bridging of the defect is recommended either via an endotracheal or a tracheostomy tube. Herein, we report a case of a teenage boy post trauma who sustained an extensive posterior tracheal wall laceration and was successfully managed conservatively. Close monitoring alongside serial imaging and diligent involvement of multidisciplinary team led to a complete recovery in this patient. We suggest that management of patients with tracheal injury should include a multidisciplinary team discussion to gather input from other teams in keeping with the possibility of the non-surgical approach. Awareness of this entity and its management is prudent as to avoid further unnecessary procedures which may cause mortality.</p> Nur Syazwani Salehuddin Jeyasakthy Saniasiaya Suzina Sheikh Ab Hamid Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Successful Management of Acute Heavy Menstrual Bleeding with Foley’s Catheter of a Patient under Combined Antiplatelet Therapy for Cardiac Disease: A Case Report <p>Heavy menstrual bleeding(HMB) is one of the most common gynecological problems defined as a menstrual blood loss of 80 ml or higher.Here we described a case of a patient who applied with acute heavy uterine bleeding under anticoagulant therapy. Although the final management plan was hysterectomy as a definitive treatment for this patient, a silicone Foley catheter was used as an emergency treatment for active massive uterine bleeding.The report demonstrates that intrauterine balloon tamponade can be used for the patient with acute heavy uterine bleeding as a temporary rescue treatment modality.</p> Yağmur Soykan Erhan Demirdağ Tuncay Nas Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Sportif Performans ve BDNF İlişkisi <p>Spor genetiği, günümüzde yeteneklerin belirlenmesinde, geliştirilmesinde ve uygun antrenman programlarının hazırlanmasında kullanılan önemli bir biyolojik belirteçtir. Bu derlemenin amacı, sportif performans ve BDNF ilişkisini özetlemek ve bu alandaki araştırmalar için veri kaynağı oluşturmaktır. Genetik farklılıklar kimilerini çok kısa bir dönem hedeflerine ulaştırırken, kimilerini de oldukça uzun bir dönem dilimi sonrası optimal performansa ulaştırabilmektedir. İnsan Genom Projesi (İGP), insan genomu hakkında bilim dünyasına önemli bilgiler kazandırmıştır. Bu projenin tamamlanması ile birlikte genlerin yaklaşık olarak sayısı, lokasyonları, yapıları ve fonksiyonları hakkında önemli bilgilere ulaşıldı. Genetik yapı ile performans arasındaki ilişkinin incelenmesi İGP’nin tamamlanmasının ardından daha da önem kazanmıştır. Bu proje sonrası yaklaşık 250 genin insan performansı üzerinde etkisi olduğu düşünülmektedir. Bu genlerden biri de sportif performansla ilişkisi olduğu düşünülen ve spor bilimcilerin son zamanlarda ilgi duyduğu beyin kaynaklı nörotrofik faktör (BDNF) genidir. BDNF’nin spor biliminde yeni bir araştırma konusu olması ve gelecekte sportif performans için önemli hedef genlerden biri olması düşünülmektedir. Sonuç olarak değişen egzersiz türleri BDNF serum etkisini farklılaştırabilmektedir. Buda bize egzersizin BDNF üzerinde etki oluşturabileceğini göstermektedir. Ancak Egzersizle artan BDNF nin performans üzerine etkisi ile ilgili henüz net bir ilişkinin belirlenmediği durumu da ortadadır.&nbsp;</p> Celal Bulgay Ebru Çetin Mehmet Ali Ergun Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 The Medical Importance of Hepcidin: Review <p>This review aims to study chemical, medicinal and functional properties of Hepcidin. Hepcidin (small bactericidal peptide) is considered a vital regulator of the iron entry in the blood of mammals. Hepcidin, a 25 amino acids long peptide hormone, has antimicrobial activity, especially in urine. Also, many remarkable results exhibited antibacterial, antifungal and anti-candidal activity against multidrug resistance pathogens, <em>in vitro</em>. The central of its formation is cells of the liver (hepatocytes). The expression of Hepcidin is low when iron stores of the human body are insufficient.</p> Jalal Abdulkareem Abbas Rasim Farraj Muslim Mustafa Nadhim Owaid Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Modulator Role of Oral Antidiabetic Metformin on Intestinal Microbiota <p>Metformin (1,1-dimetilbiguanidhidroklorür), tip 2 diabetes mellitus (T2DM) için birinci basamak tedavi olarak yaygın olarak kullanılmakta olup ABD'de en çok reçete edilen antidiyabetik ilaçtır. Metforminin karaciğer glikoz üretimini inhibe ettiği, hem karaciğer hem de iskelet kasındaki periferik glikoz alımını düzenlediği ve insülin duyarlılığını artırdığı gösterilmiştir. Metforminin karaciğerde adenozinmonofosfat (AMP) ile aktive olan protein kinaz (AMPK) bağımlı ve AMPK bağımsız yolakların aktivasyonu yoluyla hepatik glikoz çıkışını baskılayarak anti-hiperglisemik etki gösterdiği düşünülse de yapılan çalışmalar bağırsaktaki yolaklar aracılığıyla da etki gösterebileceğini ortaya koymaktadır. Metforminin hem terapötik hem de advers etkilerinin nedeni olduğunu öne sürülen mikrobiyota aracılı etkileri ve bu etkilerin mekanizmaları konu ile ilgili mevcut makalelere dayanarak incelenmiştir.</p> Azimet Yalçın Buğdaycı Mecit Orhan Uludağ Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Atypical Clinical Presentation of Syringomyelia: Review of Articles and a Case Report of Complete Unilateral Claw Hand Presentation <p><strong>Background: </strong>The typical presentation of syringomyelia is the combination of lower motor neuron signs at the segmental level, a dissociation sensory loss characterized by reduction of pain and temperature sensation with preservation of preserved light touch, vibration, and position sense in a cape pattern in the arms and upper trunk distribution. However, many clinical presentations do not conform to these typical features.&nbsp; The presentation may vary in the whole span of neurological signs and symptoms or can be non-specific.</p> <p><strong>Methods: </strong>To describe the clinical characteristic of reported atypical presentations of syringomyelia, its underlying cause and pathophysiology of its clinical presentations. <strong>: </strong>We reported a patient with syringomyelia presented with unilateral complete claw hand and case reports describing other atypical clinical presentations of syringomyelia published in the literature. We conducted a literature search on case reports and series describing atypical presentations of syringomyelia through PubMed/MEDLINE, Scopus, and Google Scholar databases. Demographic data, clinical characteristics, level of syringomyelia, underlying cause, surgical treatment, and outcome were extracted from selected article.</p> <p><strong>Results: </strong>A total of 23 case reports and case series were selected in this review based on the inclusion and exclusion criteria. The reported atypical clinical presentations could be themed into: 1) symptoms of peripheral neuropathy, 2) limb dystrophy, 3) limb hypertrophy, 4) movement disorder, 5) brainstem syndrome, 6) neuroarthropathy (NA), and 7) non-specific presentation.</p> <p><strong>Conclusion: </strong>Findings from this review article and case report would assist clinicians and physicians in the possibility of ruling in syringomyelia upon atypical clinical neurological presentation.</p> Natiara Mohamad Hashim Fatimah Ahmedy Mazatulfazura SF Salim Nor Faridah Ahmad Roslan Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Histopathologic Examinations and a Research Field of Endometriosis <p>Endometriosis is an estrogen-dependent diseases associated with pain and infertility with features of most frequently symptoms according chronic inflammation, dysmenorrhoea, deep dyspareunia, dyschezia and dysuria. Functional endometrial and stromal tissue implants exist outside the uterine cavity and causes inflammatory processes. Therefore, several undesirable reactions can occur. There are several diagnostic methods however histopathology is one of the gold standards. This review summarizes the histopathological indications of endometriosis disease with different researches.</p> Ayşe Köylü Suna Ömeroğlu Saadet Özen Akarca Dizakar Ferhat Yiğit Mürşide Ayse Demirel Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4 Infodemic Management in Iran: A Necessity to Control and response to COVID-19 <p>Coronavirus disease (COVID-19) outbreak has spread from Wuhan, China in December 2019. The world will be accompanied by a tsunami of information. Therefore, it can be stated that we have been encountered "infodemic" through the Covid-19 global crisis. <em>“We’re not just fighting an epidemic; we’re fighting an infodemic”</em>, said WHO Director-General Tedros Adhanom Ghebreyesus. COVID-19 epidemic has been spreaded in Iran, in February 2020. According to a general classifications, the <em>Ministry of Health and Medical Education (MoHME)</em> of Iran actions to manage infodemic presented in five major domains; a) Releasing guidelines and protocol; b) Launching systems, websites and applications; c) Allocation of call center; d) Educational program on national TV and the Media; e) Establishment of different national campaigns. In order to have effective infodemic management, two phases are recommended; 1) Disseminate accurate and timely information through official channels and resources. 2) Educate the necessary skills to the information stakeholders. These skills include information literacy, media literacy, and health literacy.</p> Sara Dakhesh Mojgan Zareivenovel Ali Hamidi Copyright (c) 2020 Gazi Medical Journal 2020-09-12 2020-09-12 31 4