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Medeniyet Med J: 35 (2)
Volume: 35  Issue: 2 - 2020
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1.Cover

Page I

2.Contents

Pages II - III

3.Editorial Board

Pages IV - VI

4.Publication Policies and Writing Guide

Pages VII - IX

ORIGINAL ARTICLE
5.Validity Of The Korebalance Balance System In Patients With Postmenopausal Osteoporosis
Bilinc Dogruoz Karatekin, Seyhmus Yasin, Yasemin Yumusakhuylu, Fethullah Bayram, Afitap Icagasioglu
doi: 10.5222/MMJ.2020.18828  Pages 79 - 84
Amaç: Postmenopozal osteoporoz hastalarında denge bozulmuştur. Denge çeşitli test ve denge sistemleri ile değerlendirilmektedir. Çalışmamızda Korebalance Denge Sistemi© ve denge testleri ile hastalarımızı değerlendirip Korebalance Denge Sistemi’nin geçerliğini araştırdık.
Gereç-Yöntem: 52 postmenopozal osteoporoz hastası denge testleri (Berg Denge Testi (BDT) ve Zamanlı Kalk&YürüTesti (ZKY)) ve Korebalance Denge Sistemi ile değerlendirildi. Korebalance Denge Sistemi bir denge değerlendirme ve egzersiz sistemidir. Skor değeri ne kadar artarsa dengedeki bozulma da aynı oranda artmaktadır. Statik ve dinamik denge değerlendirme sonuçları skor değeri olarak kaydedilmektedir. Çalışmamızda Korebalance Denge Sistemi, BDT ve ZKY testleri ile ve demografik ve klinik diğer parametrelerle (yaş, 25OHvitD düzeyi, menopoz yaşı, son 1 yıl içinde düşme, kırık öyküsü) karşılaştırılmıştır.
Bulgular: 52 postmenopozal osteoporotik hastanın yaş ortalaması 65.48 ± 9.11, ortalama BKI 26.97 ± 5.06, ortalama menopoz yaşı 46.09 ± 5.57 ve ortalama 25OHvitD düzeyi 23.84 ± 12.43 idi. Pearson r korelasyon analizine göre Korebalance dinamik testi BDT ile orta derecede negatif korelasyona (r = -.38, p <.01), ZKY testi ile orta derecede pozitif korelasyona (r = -.42, p <.01) sahipti. Spearman rho korelasyon analizine göre Korebalance statik denge testi BDT ile orta derecede negatif korelasyona sahipti (r = -.30, p <.05). Yaş ile korebalance statik test (r =.33, p <.05) ve dinamik test (r =.31, p <.05) orta derecede korele bulundu. Diğer parametreler ile anlamlı ilişki saptanamadı. Diskriminant geçerlilikte, bakılan diğer fonksiyonel olmayan demografik ve klinik parametrelerle korelasyon saptanmadı. Sınıf içi korelasyon analizine göre Korebalance statik test (.987) ile dinamik test (.965) mükemmel sınıf içi korelasyona sahipti.
Sonuç: Korebalance Denge Sistemi, Berg Denge Testi ve ZKY ile kıyaslandığında orta derecede konverjan geçerlilik gösteren, iyi sınıf içi korelasyona sahip bir denge değerlendirme aracı olarak bulunmuştur.
Objective: Balance is impaired in postmenopausal osteoporosis. Balance can be assessed with several tests and balance assessment systems. In our study, we investigated validiy of Korebalance Balance System (KBS).
Methods: 52 postmenopausal osteoporotic patient evaluated with balance tests ( Berg Balance Scale (BBS) and Time Up&Go Test (TUG)) and Korebalance Balance System. KBS is a balance evaluation and exercise system. The higher the score, the greater the deterioration in the balance. Static and dynamic balance evaluation results are recorded as score values. KBS, BBS and TUG compared with demographic and clinic parameters ( age, 25OhvitD, menopausal age, fall history in last year, fracture history).
Results: According to Pearson r correlation analysis, Korebalance Dynamic Test (KDT) and BBS had moderately negative correlation (r = -.38, p <.01), KDT and TUG had moderately positive correlation (r = -.42, p <.01). According to Spearman rho correlation analysis, Korebalance Static Test (KST) and BBS had moderately negative correlation (r = -.30, p <.05). Age and KST (r =.33, p <.05), age and KDT (r =.31, p <.05) had moderately positive correlation. No significant correlation was found with other parameters. In discriminant validity, there was no correlation between other nonfunctional demographic and clinical parameters.
Conclusion: Korebalance Balance System was found to be a convenient assessment tool with moderate convergent validity compared with BBS and TUG and has an excellent intraclass correlation.

6.Investigation of the Optimum Time for Intravenous Access After Anesthesia Induction with Sevoflurane in Pediatric Patients Without Premedication
Zeynep Nur Orhon, Cem Orhon
doi: 10.5222/MMJ.2020.22309  Pages 85 - 90
Amaç: Damar yolu olmayan pediyatrik hastalarda, anestezi indüksiyonu genelikle sevofluran ile yapılır. Amacımız, sevofluran indüksiyonundan sonra pediyatrik hastalarda optimum intravenöz girişim süresini ve bu süreye karşılık gelen bispektral indeks (BIS) değerini araştırmaktır.
Yöntem: Bu prospektif çalışmaya, 1 Ocak 2017 ile 1 Ocak 2018 tarihleri arasında XXXXXXXXX kayıtlı 100 çocuk dahil edilmiştir. Anestezi indüksiyonu % 8 sevofluran ve oksijen ile yapıldı. Ölçümler, maske uyum zamanı, siliyer refleksin kayıp süresi, düzenli solunuma ulaşma süresi ve bunlara karşılık gelen BIS değerleri ile optimal intravenöz girişim süresini ve BIS değerinin 60'ın altına düşmesi için geçen süreyi içermektedir.
Bulgular: Ortalama maske uyum süresi 27.8 ± 28.4 s, siliyer refleks kaybına kadar geçen süre 39.7 ± 10.3 s, düzenli solunuma ulaşma süresi 88.5 ± 116.9 s, ve bunlara karşılık gelen ortalama BIS değerleri sırasıyla 80.4 ± 16.9, 70.2 ± 10.4 ve 52.4 ± 12.1 idi. BIS'in 60'ın altına düşmesi için ortalama süre 72.54 ± 24.41 s, optimal intravenöz girişim için gereken ortalama süre 104.92 ± 36.45 s ve bu sıradaki ortalama BIS değeri 30 ± 10.1 idi.
Sonuç: Çocuklarda sevofluran ile anestezi indüksiyonunu takiben, cerrahi anestezi için üst sınır olan 60'ın altındaki BIS değerinin intravenöz müdahale için yetersiz olduğu görülmüştür. Sevofluran indüksiyonu uygulanan pediyatrik hastalarda optimal intravenöz girişim için 30'un altındaki BIS değerinin veya ortalama 104.9 s'lik bekleme süresinin ideal olduğu sonucuna varılmıştır.
Objective: In pediatric patients with no vascular access, anesthesia induction is usually achieved with sevoflurane. Our aim was to investigate the optimum intravenous access time and the corresponding bispectral index (BIS) value in pediatric patients after sevoflurane induction.
Method: This prospective study included 100 children enrolled between 1 January 2017 and 1 January 2018 at XXXXXXXXXX. Anesthesia was induced with 8% sevoflurane and oxygen. Measurements included mask adjustment time, time for loss of the ciliary reflex, regular breathing time, and optimal intravenous access time with the corresponding BIS values, as well as the time elapsed for the BIS value to fall below 60.
Results: The mean mask adaptation time was 27.8±28.4 s, time to loss of the ciliary reflex was 39.7±10.3 s, and time to reach regular respiration was 88.5±116.9 s, with mean BIS value of 80.4±16.9, 70.2±10.4, and 52.4±12.1, respectively. The mean time for BIS to fall below 60 was 72.54±24.41 s. The mean time required for optimal intravenous access was 104.92±36.45 s, with a mean BIS value of 30±10.1.
Conclusion: Following anesthesia induction with sevoflurane in children, the BIS value below 60, the upper limit for surgical anesthesia, was found to be insufficient for intravenous intervention. It has been concluded that for pediatric patients undergoing sevoflurane induction, the BIS value below 30 or an average waiting time of 104.9 s is ideal for optimal intravenous access.

7.Does Upper Extremity Proprioceptive Training Have an Impact on Functional Outcomes in Chronic Stroke Patients?
Numan Melik Öcal, Nuray Alaca, Mehmet Kerem Canbora
doi: 10.5222/MMJ.2020.48752  Pages 91 - 98
Amaç: İnme sonrası, kronik hemipleji olan hastalarda üst ekstremite proprioseptif eğitimin spastisite, fonksiyonel motor beceriler ve günlük yaşam aktivitesi üzerine etkisini araştırmak amaçlanmaktadır.
Yöntem: XXXX Üniversitesi Fizyoterapi ve Rehabilitasyon Uygulama ve Araştırma Merkezine inme sonrası, kronik hemipleji tanısı ile başvuran 30 kronik hemiplejik birey (17 kadın, 13 erkek; 66.47±12,55 yaş) çalışmaya dahil edildi. Hastalar iki guba ayrıldı. Birinci gruba haftada 5 gün konvansiyonel fizyoterapi programı (FTR), ikinci gruba ise bu programa ek olarak haftada 5 gün proprioseptif eğitim programı (PE) eklenmiştir. Hastaların tedavi öncesi ve 6 hafta sonrasında; modifiye ashworth ölçeği (MAÖ), Fugl-Meyer Üst Ekstremite Motor Değerlendirme Ölçeği (FÜM), Action-Research-Arm-Testi (ARAT), Motor Aktivite Günlüğü-28 Ölçeği (MAG-28) uygulandı. İstatiksel olarak SSPS-22,0 programı kulanıldı ve p<0,05 anlamlı kabul edildi.
Bulgular: Hastaların grup içinde tedavi öncesi ve sonrası değerlerinde MAÖ üzerine bir fark görülmezken (p>0,05), FÜM, ARAT ve MAG-28 ölçeklerinde istatiksel olarak hem FTR (p<0,05) hem de FTR-PE grubunda (p<0,001) iyileşme yönünde anlamlılık vardı. Gruplar arasında FTR ve PE grubunun sonuçları; FTR grubuna göre daha iyi çıkmasına rağmen, sadece MAG-28 ölçeğinde FTR ve PE lehine anlamlı sonuç vardı (p<0,05). Etki büyüklüğünün değerlendirilmesinde, propriyosepsiyonu temel alan egzersizlerin tedaviye eklenmesinin FMA, ARAT ve MAL-28 üzerinde en büyük etkiye sahip olduğu belirlenmiştir (> 0.3).
Sonuç: İnme sonrası, kronik hemipleji olan hastalarda üst ekstremite proprioseptif eğitiminin üst ekstremitede hareket sıklığı ve kalitesini artırmada konvansiyonel tedaviye göre daha iyi sonuç gösterdiği görülmüştür. Bu sonuç inme rehabilitasyon yöntemlerine proprioseptif eğitim programlarının da eklenmesi gerektirdiğini bize göstermektedir.
Aim: To investigate the effect of upper extremity proprioceptive training on spasticity and functional motor skills in patients with chronic hemiplegia after stroke.
Methods: Thirty chronic hemiplegic patients (17 females, 13 males; 66.47 ± 12.55 years) admitted to XXX University Physiotherapy and Rehabilitation Application and Research Center with a diagnosis of chronic hemiplegia after stroke were included in the study. Patients were divided into two groups. The first group received a conventional physiotherapy program (PTR) 5 days a week and the second group added a proprioceptive training program (PTR-PT) 5 days a week. Before and after 6 weeks; modified ashworth scale (MAS), Fugl-Meyer upper extremity motor evaluation scale (FMA) and action-research-arm-test (ARAT) and motor activity log-28 scale (MAL-28). SSPS-22.0 program was used statistically and p <0.05 was considered significant.
Results: There was no difference in MAS before and after treatment in the groups (p>0.05). There was significant improvement in both PTR (p<0.05) and PTR-PT groups (p<0.001) for the FMA, ARAT and MAL-28. Although it was better than the PTR group, there was a significant result in favor of PTR- PT only on the MAL-28 (p<0.05). İt was determined that adding proprioception-based exercises had the greatest effect on FMA, ARAT and MAL-28 in the evaluation of the effect size (>0.3).
Conclusion: It was observed that upper extremity proprioceptive training showed better results in patients with chronic hemiplegia after stroke than conventional therapy in increasing the frequency and quality of movement in upper extremity. This result shows that proprioceptive training programs should be added to stroke rehabilitation methods.

8.Aberrant SOCS3 Promoter Methylation as a Noninvasive Diagnostic Biomarker for Locally Advanced Prostate Cancer
Berna Tan, Turgay Turan, Burcu Yucel, Sedef Altundağ Kara, Seda Salman Yılmaz, Asif Yildirim
doi: 10.5222/MMJ.2020.58708  Pages 99 - 105
Amaç: Bu çalışmanın amacı tümör baskılayıcı genler Ras-associated domain family 1A (RASSF1A), O-6-methylguanine-DNA methyltransferase (MGMT), Phosphatase with tensin homology (PTEN) ve Suppressor of cytokine signaling 3 (SOCS3)’in promotör metilasyonlarını araştırmak ve bu genlerin Prostat Kanseri (PK) tanısı için noninvazif, kan temelli epigenetik biobelirteçler olarak klinik yararını değerlendirmekti.
Metod: 41 hasta ve 10 sağlıklı kontrol grubu çalışmaya kaydedildi. Dört tümör baskılayıcı genin promotör bölgelerinin metilasyon düzeylerini hastalarda sağlıklı kontrol grubuna kıyasla analiz etmek için Pyrodizileme gerçekleştirildi.
Sonuçlar: RASSF1A, MGMT, PTEN ve SOCS3 promotör metilasyon düzeyleri hasta ve konrol grubu arasında farklı değildi. Ancak SOCS3 promotör metilasyon düzeyi lokalize PK’lı hastalara kıyasla lokal olarak ilerlemiş PK’lı hastalarda önemli şekilde daha yüksekti (p<0.05).
Sonuç: Sonuçlarımız SOCS3’ün lokal olarak ilerlemiş PK tanısında elverişli, noninvazif kan temelli epigenetik biobelirteç olabileceğini gösterdi.
Objective: The aim of this study was to investigate the promoter methylation status of Ras-associated domain family 1A (RASSF1A), O-6-methylguanine-DNA methyltransferase (MGMT), Phosphatase with tensin homology (PTEN) and Suppressor of cytokine signaling 3 (SOCS3) tumor suppressor genes and evaluate the clinical utility of these genes as non-invasive, blood-based epigenetic biomarkers for Prostate Cancer (PCa) diagnosis.
Methods: A total of 41 consecutive patients and 10 healthy control groups were enrolled. Pyrosequencing was performed to analyze the methylation levels of the promoter regions of the four tumor suppressor genes in patients compared to healthy controls.
Results: The promoter methylation levels of RASSF1A, MGMT, PTEN and SOCS3 did not differ between the patient and control groups. However, SOCS3 promoter methylation level was significantly higher for patients having locally advanced PCa compared to those having localized PCa (p<0.05).
Conclusion: Our results indicated that SOCS3 could be a useful, noninvasive blood-based epigenetic biomarker for the diagnosis of locally advanced PCa.

9.Alterations of IL-1 and VEGF After Ischemia-Reperfusion Injured Uterus and Ovary in Rats
Yasemin Ersoy Canillioglu, Gözde Erkanli Senturk
doi: 10.5222/MMJ.2020.67026  Pages 106 - 115
Amaç: İskemi/reperfüzyon hasarından dolayı oluşan inflamasyon parenkimal ve endotelyal hücre hasarına neden olmaktadır. Vücuttaki her tip hücreden eksprese edilen Vaskuler Endotelyal Büyüme Faktörü (VEGF), anjiyogenez ve vaskülogenezde, endotelyal hücre geçirgenliğinde, çoğalma ve migrasyonda çok önemli bir role sahiptir. Sitokin ailesinin bir üyesi olan IL-1, hematopoezde, inflamasyon reaksiyonlarında ve immün sistem regulasyonunda önemli bir role sahiptir. Ayrıca, inflamatuvar hastalıklar terapatik ajan olan IL-1 ile tedavi edilmektedir. Bu çalışmanın amacı, İskemi/reperfüzyon yapılmış sıçanların over ve uterusunda VEGF ve IL-1 immunreaktivitesinde ki değişiklikleri araştırmaktır.
Yöntem: Sıçanlar iki gruba ayrılmıştır. Kontrol grubu ve 45dk iskemi/45 dk reperfüzyon yapılmış İskemi/reperfüzyon grubudur. Over ve uterus dokuları %10’lık nötral formaldehit ile tespit edilmiş ve H&E ile boyanmıştır. VEGF ve IL-1 immunohistokimyası uygulanmıştır.
Sonuçlar: Histopatolojik sonuçlar, İskemi/reperfüzyon grubunda uterus endometriyumunda ve over foliküllerinde ciddi derecede hasar göstermiştir. Uterus ve over dokusunda VEGF ve IL-1 immunreaktivitesi iskemi/reperfüzyon grubunda kontrol grubuna oranla artmış bulunmuştur.
Tartışma: Sonuç olarak, bu bulgular over ve uterus dokusunda iskemi/reperfüzyon hasarında VEGF ve IL-1 potansiyel bir marker olarak kullanılabilir. Ayrıca, uterus ve over dokusu rejenerasyonunda VEGF ve IL-1 birbirleriyle etkileşim içerisinde olabilir.
Objective: Ischemia/Reperfusion injury causes parenchymal and endothelial cell damage as a result of inflammation. Vascular endothelial growth factor (VEGF) expressed in every kind of tissue in human body has important roles in migration, proliferation, endothelial cell permeability, angiogenesis and vasculogenesis. IL-1 is a one of the cytokine family member, play important role in hematopoiesis, inflammatory reactions and immune system regulation. Furthermore, auto-inflammatory diseases are treated by IL-1 as therapeutic agent. The aim of this study is to observe changes of VEGF and IL-1 immunreactivity in ischemia/reperfused rat uterus and ovary.
Methods: Rats were separated into two groups. Control group and ischemia/reperfusion group which rats were subjected to 45 min ischemia/45 min reperfusion. Uterus and ovary were fixed with 10% neutral formaldehyde and stained by H&E. VEGF and IL-1 immunohistochemistry was applied.
Results: Histopathological results show severe degeneration of endometrium in uterus and follicles in ovary in ischemia/reperfusion group. VEGF and IL-1 ir increased in ischemia/reperfusion group when compared to control group in uterus and ovary.
Conclusion: In consequence, the present results suggest that VEGF and IL-1 may be potential detection marker for ischemia/reperfusion injured uterus and ovary. Moreover, VEGF and IL-1 might be in relation with each other to regenerate uterus and ovary.

10.The Prevalence of Hearing Loss Among Babies in the Neonatal Intensive Care Unit in a Tertiary Hospital in Malaysia
Asma Binti Abdullah, Khairul Azlan Shahril Abu Dahari, Jaafar Rohana, Azmi Mohd Tamil, Ishak Shareena, Mohd Razif Mohamad Yunus
doi: 10.5222/MMJ.2020.68466  Pages 116 - 120
Objectives: To study the prevalence of hearing loss (HL) and to identify the possible risk factors causing hearing loss.
Methods: This retrospective study was conducted from January 2014- December 2016 at a tertiary hospital in Malaysia. All neonates admitted to the neonatal intensive care unit (NICU), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were screened with a two-step protocol using an automated auditory brain response (AABR) and/or Otoacoustic Emission and auditory brain response (ABR). Descriptive analysis was used for the prevalence of hearing loss, degree of hearing loss and number of risk factors per infant.
Results: A total of 2713 babies underwent hearing screening in NICU was enrolled in this study. Two thousand six hundred eight (96%) babies passed the screening test and 214 (4%) babies required a further diagnostic test. Only 105 (49%) babies completed the diagnostic test. Out of 105 babies, 40 (38.1%) babies had HL. Mild HL was the commonest HL with 22 (55%), moderate HL in seven babies (17.5%), severe HL in two babies (5%) and profound HL in nine babies (22.5%). Craniofacial anomalies was the only significant independent risk factor for HL with p<0.05. There was an increased risk of hearing loss in those with craniofacial anomalies up to 11 times higher compared to those without such anomalies.
Conclusion: The prevalence of hearing loss among NICU babies was 1.5% and mild HL was the commonest degree of HL (55%).

11.Comparing 5-year Outcomes of Aorta-Coronary Bypass Surgery and Percutaneous Coronary Intervention with New-Generation Drug-Eluting Stents in Non-Diabetic and Multivessel Acute Coronary Syndrome Patients with Intermediate Syntax Score
Firdovsi İbrahimov, Yusuf Yılmaz, Isfandiyar İsmayilov, Kamran Musayev, Ogtay (Oktay) Musayev, Shahana Alasgarli, Shafa Shahbazova, Mehriban İsgenderova, Tofig Jahangirov
doi: 10.5222/MMJ.2020.80270  Pages 121 - 127
Objectives: Our main objective was to determine the difference between patients undergoing CABG and PCI (with new-generation drug-eluting stents) who were non-diabetic during the course of a multi-vessel acute coronary syndrome (ACS) and intermediate SYNTAX score.
Methods: Between 2012 and 2014, we evaluated retrospectively 1011 non-diabetic patients with ACS in a single center. The follow-up of patients was done up to 5-years. Death associated with all causes, cardiac death, myocardial infarction, stroke, revascularization and stent thrombosis were recorded accordingly.
Results: 516 (%51) patients were included in the PCI group and 495 patients (%49) were in the CABG group. Stroke occurrence (0.8% in the PCI group and 2.6% in the CABG group, p = 0.022), repeated revascularization requirement (13.6% of the PCI group and 8.1% in the CABG group, p = 0.005) and the MACE percentage (20.3% in the PCI group, 14.5% in the CABG group, p = 0.015) were statistically significant between two groups. However, there was no statistical significance between two groups in terms of primary endpoints including death, MI, and stroke (10.9% in the PCI group and 8.3% in the CABG group, p = 0.165) and all-cause mortality (%6.2 in the PCI group, %4.7 in the CABG group, p=0.298).

Conclusion: There was no difference in all-cause mortality and myocardial infarction between the PCI and the CABG groups during a 5-year follow-up. Repeated revascularization was lower in the CABG group than the PCI group. In contrast, the stroke rates were higher in the CABG group.

12.Examination of Blood and Tracheal Aspirate Culture Results in Intensive Care Patients: 5-Year Analysis
Hulya Caskurlu, Ismail Davarci, Mucahide Esra Kocoglu, Yasemin Cag
doi: 10.5222/MMJ.2020.89138  Pages 128 - 135
Giriş
Nozokomial enfeksiyonların büyük bir kısmı yoğun bakım ünitelerinde (YBÜ) görülmekte ve yüksek mortalite ve morbidite ile seyretmektedirÇalışmamızda hastanemiz yoğun bakım ünitesindeki hastaların kan ve trakealaspiratkütürlerinden izole edilen mikroorganizmaları ve antibiyotik direnç profillerini araştırmayı amaçladık.
Materyal ve Metod
Yoğun bakım ünitemizden 2014-2018 yılları arasında gönderilen kan ve trakealaspirat kültürleri retrospektif olarak değerlendirildi.Kültürleri yapıldıktan sorma üreyen mikroorganizmalar konvansiyonel metodlar ve otomatize sistemler ile tanımlandı ve antimikrobiyalduyarlılık testleri yapıldı.
Bulgular
Çalışma sırasında 23.275 örnekkabul edildi.Trakeal aspirat kültürlerinde Gram-negatif bakteri üreme oranı %89.7, Gram-pozitif bakteri üreme oranı %9.3 ve maya üreme oranı %1olarak bulundu.. A. baumannii (%25.7)en yaygın Gram-negatif mikroorganizma idi.Meropenem direnci;A.baumannii’ de 2014 yılında % 98.3,2018 yılında % 95.7,P.aeruginosa 2014 yılında % 69.2, 2018 yılında %36.5veE. coli de 2014 de %8, 2018 yılında % 2,K.pneumoniae. de 2014 de% 45.5,2018 de %45.8 olarak belirlendi.S.aureus’da metisilin direnci 2015 yılında%67.7iken2018 yılında%28 olarak saptandı. S. pneumonia da penisilin direnci 2015 de %13.4 iken 2018’ de % 76.8 olarak bulundu.

Kankültürlerinde üreyen mikroorganizmalrın %31.5’i Gram-negatif bakteri,%57.9!u Gram-pozitif bakteri ve %10.6 maya olarak belirlendi.Ensıkizoleedilen Gram-negatifbakterilerKlebsiella pneumoniae (%9.3)veAcinetobacterbaumannii (%8.8) idi. Meropenem direnci; Acinetobacterspp.’de 2014 yılında %97.32018 yılında %79.2,Klebsiella spp.’de 2014 de %76.9 2018 de %37.3,Pseudomonas spp’de2014 yılında % 79.2, 2018 yılında % 26.1 olarakbulundu. KNS bakterilerde Metisilin direnci 2015 ‘de %78.5 iken 2018 de %89.2, S.aureus’da 2015 ‘de %92.4 iken 2018’de % 42.6%,Enterokok cinsi bakterilerde ampisilin direnci 2014 yılında % 23,2018’de % 11.7 olarak bulundu.
Sonuç
ÇalışmamızdaGram-negatifmikroorganizmalardakarbapenemdirençoranlarındaveStaphylococcus aureus’dametisilindirençoranlarındayıllariçindedüşmeizlenmiştir. Ancak A. baumannii izolatlarında karbapenem direncinin hala yüksek olması enfeksiyon control önlemlerinin ısrarla devam etmesi gerektiğini göstermektedir.
Objective
In this study, we aimed to investigate the distribution of microorganisms isolated from the tracheal aspirate and blood culturesof ICU hospitalized patients, and their antibiotic resistance profiles.
Methods
Tracheal aspirate and blood cultures sent from ICU patients were evaluated retrospectively between 2014-2018.Antimicrobial susceptibility tests were performed on microorganism culturesthat that were identified by conventional methods and using an automated system.
Results
A total of 23.275 samples were accepted during the study period. The microorganisms isolated from tracheal aspirates culture were Gram-negative (89.7%), Gram-positive (9.3%) and yeasts (1%). The most common Gram (-) microorganisms were A.baumannii (%25.7). Meropenem resistance hasbeen documented98.3% forA.baumanniiin 2014,95.7% in 2018, 69.2% for P.aeruginosa.in 2014,35.6% in 2018,45.55 for K.pneumoniae 2014,45.8% in 2018 and 8%forE.coli in 2014,2% in 2018.Meticilin resistance in S. aureus has been documented at 28.0% in2018 while it was 67.7% in 2015. Penicillin resistance for S. pneumonia has been documented at 76.8% in 2018, 13.4% in 2015.

The microorganisms isolated from blood culture were Gram (-) (31.5%), Gram (+) (57.9%) and yeasts (10.6%). Themostfrequentlyisolated Gram (-)bacteria were K.pneumonia (9.3%) and A.baumannii (8.8%). Meropenem resistance hasbeen documented 97.3% for A..baumannii. in 2014 and 79.2% in 2018, 76.9% forK.pneumoniae ein 2014 and 37.3% in 2018 and 79.2% for P.aeruginosa during 2014 and 26.1% 2018. Methicillin resistance has been documented at 89.2% in 2018 while it was 78.5% in 2015 for CNS, and at 42.6% in 2018 while it was 92.4% in 2015 forS. aureus

Conclusions
Our study showcased a drop throughout the year in carbapenem resistance across Gram (-)microorganisms and methicillin resistance in S.aureus. However, the persistent high carbapanem resistance in A.baumannii isolates demonstrates the crucial need to continue with infection control measures.

13.Incidence of Gliomas in Municipalities of Zenica - Doboj Canton in Bosnia and Herzegovina - A 10-Year Study
Nadija Ekinovic, Hakija Beculic, Rasim Skomorac, Aldin Jusic, Anes Masovic, Damir Kurtagic, Nedim Barucija
doi: 10.5222/MMJ.2020.97415  Pages 136 - 141
To determine the incidence of gliomas in Zenica – Doboj Canton and to analyze its potential connection to socio – demographic characteristics and its distribution throughout municipalities of Zenica – Doboj Canton in the period of 2009 – 2019. Retrospective, descriptive – analytical, 10 – year study included 146 patients from Zenica – Doboj Canton. Data was obtained and reviewed from patient’s medical records. It included patient’s socio – demographic characteristics and pathohistological diagnosis. Age, gender and place of birth were analysed and correlated with types and grades of glial tumors according to World Health Organisation’s latest classification. The study included 146 patients, 84 (58%) males and 62 (42%) females. The most common pathohistological diagnosis was Glioblastoma multiforme, a grade IV glioma in both females (26%) and males (35%), in total 91 (62%) patients, and the rarest was oligoastrocytoma, in 2 (1%) cases. Kakanj with 29 cases had the highest incidence of glioma in total (0,077%) and the highest incidence in females (0,069%) with 13 cases. Vareš with 5 male cases had the highest incidence (0,114%). The lowest incidence with none cases had Breza and Olovo. The results showed statistically significance in difference in incidence of gliomas in the relation to the region of residence. Analysis of data indicated that there is a significant connection between the occurrence of gliomas and socio – demographic characteristics of patients from Zenica – Doboj Canton.

14.Turkish Adaptation of Khalfa Hyperacusis Questionnaire
Murat Erinç, Ufuk Derinsu
doi: 10.5222/MMJ.2020.97947  Pages 142 - 150
Amaç: Bu çalışmada hiperakuzili hastaların tanı ve tedavilerinde kullanılmak üzere Khalfa Hiperakuzi Ölçeği’nin Türkçeye uyarlanması amaçlandı.
Yöntemler: Genel popülasyondan rastgele seçilmiş 18-73 yaş arası (M= 29.76, SD= 10.59) toplam 529 kişiye (320 kadın, 209 erkek) Türkçeye çevrilen Khalfa Hiperakuzi Ölçeği ve Beck Anksiyete Ölçeği uygulandı. Verilerin değerlendirilmesinde açımlayıcı ve doğrulayıcı faktör analizi, korelasyon analizi, tanımlayıcı istatistiksel yöntemler, t-testi, varyans analizi ve Sidak testi kullanıldı.
Bulgular: Yapılan güvenirlik analizinde Cronbach alfa (αC) iç tutarlılık katsayısı 0,81 olarak tespit edildi. Faktör analizi sonucunda ise, üç adet alt boyut (dikkat, sosyal ve duygusal) tespit edilmiştir. Bu üç alt boyutun toplam varyansı %63 olarak bulundu ve alt boyutların iç tutarlılığı yüksek elde edildi (αC >0,70). Doğrulayıcı faktör analizi ile yapılan uyum istatistiklerinin Türk hastalardan toplanan gerçek verilerle kabul edilebilir düzeyde uyumlu olduğu görüldü. Hiperakuzi puanın ortalaması 15,69 (±6,63) olarak saptandı. Hiperakuzi ile anksiyete arasında pozitif yönde, düşük düzeyde güçlü ve anlamlı bir ilişki olduğu tespit edildi (r=0,357, p<0,05). Gürültüye maruz kalan hastaların hiperakuzi düzeylerinin, gürültüye maruz kalmayan hastalara kıyasla, daha yüksek olduğu görüldü (t=6,78, p<0,05). Zamanla gürültüye olan tahammüllerinde azalma olan hastaların hiperakuzi düzeyleri, olmayanlara kıyasla, daha yüksek bulundu (t=4,83, p<0,05).
Sonuç: Yapılan ölçümler sonucunda 14 soru ve üç faktörlü yapının geçerli ve güvenilir bir araç olduğu sonucuna varıldı.
Objective: The aim of this study is to adapt Khalfa Hyperacusis Questionnaire (HQ) into Turkish for the use in the diagnosis and treatment of patients with hyperacusis.
Methods: HQ and Beck Anxiety Inventory (BAI) were administered to a total of 529 participants (320 female, 209 male), aged 18 to 73 (M= 29.76, SD= 10.59) who were randomly selected from the general population. For the evaluation of the data, confirmatory and exploratory factor analysis, correlation analysis, descriptive statistics, t-test, analysis of variance, and Sidak correction test were used.
Results: In the reliability analysis, the Cronbach's Alpha (αC) internal consistency coefficient was found to be 0,81. Factor analysis revealed three subdimensions (attention, social, and emotional). The total variance of these three sub-dimensions were 63%, and the internal consistency of the subdimensions was also high (αC >0,70). Confirmatory factor Analysis and structural equation modeling results indicated that three-factor solutions with 14 items met the criteria for the adequacy of fit among the Turkish patients. There was a positive, weak, but significant association between hyperacusis and anxiety. (r=0,357, p = 0,01, p <0,05). The patients who were exposed to noise were found to have higher levels of hyperacusis, compared to those who were not (t=6,78, p = 0,01, p <0,05). The patients who had decreased noise tolerance over time were found to be higher hyperacusis levels than those without (t=4,83, p = 0,01, p <0,05).
Conclusion: Based on these measurements, 14 questions and three-factor solutions were found to be a valid and reliable tool.

15.SARS-CoV-2: A Piece of Bad News
Shatha F. Abdullah, Inas K. Sharquie
doi: 10.5222/MMJ.2020.82584  Pages 151 - 160
A shocking third face appeared from coronaviruses (CoV) in late 2019 follows SARS (Severe acute respiratory syndrome-CoV) in 2003 and MERS (Middle East respiratory syndrome –CoV) in 2012; it’s a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV). First emerging in China, it has spread rapidly across the globe, giving rise to significant social and economic costs and imposing severe strain on healthcare systems. Despite many attempts to control viral spread has been futile, the only old practice of containment including city lockdown and social distancing are working to some extent. Unfortunately, specific antiviral drugs and vaccines remain unavailable. Many factors are encountered to play an essential role in viral pathogenesis. These include a broad viral-host range with high receptor binding affinity to various human tissues, viral adaptation to humans, a high percentage of asymptomatic infected carriers, prolonged incubation, and viral shedding periods. A wide variety of pulmonary and extrapulmonary tissue damage mechanisms including direct cell injury or immune-mediated damages involving the immune cells, up-regulation of pro-inflammatory cytokines, and antibody dependent enhancement that can result in multi-organ failure. In this article, we summarise the evidence on the various steps in SARS-CoV-2 pathogenesis and immune evasion strategies to assess their contribution to our understanding of unresolved problems related to SARS-CoV-2 prevention, control, and treatment protocols.

16.Ex Utero Intrapartum Treatment (EXIT) Of Gigantic Intrapartum Lymphangioma
Ren Hui Lo, Nik Khairani Nik Mohd, Khairudin Abdullah, Azliana Aziz, Irfan Mohamad
doi: 10.5222/MMJ.2020.06992  Pages 161 - 165
With the advancement of radiological investigation, intrapartum detection of fetal abnormalities is now precisely done. Lymphangiomas are now diagnosed even before patient is born. The swelling can be gigantic and potentially life threatening during the delivery. Up to date, it is still a great challenge to doctors as how to deliver the baby together with the big neck mass. We present a case of huge intrapartum neck lymphangioma, for which we performed ex-utero intrapartum treatment (EXIT) procedure, followed by excision of the lesion later. The challenges on managing both mother and infant will be discussed.

17.Carcinosarcoma of the Mediastinum: A Rare Cause of Vocal Cord Palsy and Progressive Dysphagia
Irfan Mohamad, Nithya Kanesan, Norsyamira Aida Mohamad Umbaik, Norzaliana Zawawi
doi: 10.5222/MMJ.2020.82956  Pages 166 - 169
Carcinosarcoma is a rare type of malignant tumour that possess both the elements of carcinoma and sarcoma. They may occur in various locations such as the uterus, breast, thyroid, lung and gastrointestinal system. However, there are very few primary mediastinal carcinosarcoma reported. We are reporting a case of 75-year-old male who presented with progressive dysphagia and hoarseness for 3 weeks duration. Contrast-enhanced computed tomography (CECT) neck showed features of enlarged mediastinal necrotic nodes and the biopsy of this mass showed morphology and immunohistochemical profile that are consistent with carcinosarcoma. However, patient succumb to his illness soon after diagnosis.

18.Kimura Disease with Parotid Swelling and Cervical Lymphadenopathy: A Case Report and Literature Review
V Sha Kri Eh Dam, Sakinah Mohamad, Irfan Mohamad
doi: 10.5222/MMJ.2020.84594  Pages 170 - 174
Kimura disease (KD) is a rare chronic benign inflammatory disorder of unknown aetiology that is prevalent in Asian males. The head and neck region, especially the parotid glands and cervical lymph nodes, are most commonly affected. Diagnosis is based on clinicopathological features, while radiology findings are non-specific. Although various treatment strategies have been proposed, there is a high recurrence rate. Combination therapy has been found to produce better results than monotherapy. We present a case of KD with huge parotid and cervical lymph node involvement that was treated with a combination of surgery and corticosteroids administered perioperatively.

CASE REPORTS
19.A Rare Case of Metformin Intoxication with Mortal Course
Merve Osoydan Satıcı, Abdullah Algın, Gökhan Aksel, Serkan Emre Eroğlu
doi: 10.5222/MMJ.2020.96641  Pages 175 - 178
Metformin ile ilişkili laktik asidoz, metformin zehirlenmesinde nadir görülen bir yan etkidir. Mortalite oranı hakkında % 3'ten % 83'e değişen çelişkili veriler mevcuttur. Bu çalışmada metformin zehirlenmesine bağlı laktik asidoz ve akut böbrek yetmezliği gelişen ve mortalite ile sonuçlanan bir olguyu tartışmayı amaçladık. 33 yaşında kadın hasta, 3000 mg metformin içtikten sonra acil servise bulantı ve kusma ile başvurdu. Takibinin 2.saatinde laktik asidoz geliştiği gözlendi, infüzyon replasman tedavilerine ve hemodiyalize rağmen metabolic asidozun derinleştiği görüldü. Solunum yetmezliği gelişen ve mekanik ventilasyon desteği verilen hastada, başvurusunun 48.saatinde kardiyak arrest gelişti. Sonuç olarak metformin zehirlenmesine bağlı gelişen asidozun çok hızlı derinleştiği ve optimal destekleyici tedaviye rağmen mortalite ile ilerleyebileceği unutulmamalıdır. Akut metformin ilişkili laktik asidozun yönetimi ve tedavisi için daha spesifik öneriler ve daha ileri çalışmalara ihtiyaç vardır.
Metformin-associated lactic acidosis is a rare side effect in metformin poisoning.There is conflicting data about mortality rate changing from 3% to 83%.We aimed to discuss a case with lactic acidosis and acute renal failure with progressing mortality due to metformin intoxication. A 33 year-old female patient admitted to emergency department with nausea and vomiting after taking 30 tablets of metformin 1000mg.2th hour of follow-up, patient was observed to develop lactic acidosis which did not recover despite the infusion replacement treatments and hemodialysis,After respiratory failure developed, under mechanical ventilation, cardiac arrest developed at the 48th hour of his admission. It should be remembered that acidosis deepens very quickly and can progress with mortality despite optimal supportive therapy. More specific recommendations and further studies are required for the management and treatment of acute metformin associated lactic acidosis.

LETTERS TO THE EDITOR
20.The Insights of Head and Neck Non-Hodgkin Lymphoma
Wan Faiziah Wan Abdul Rahman, Irfan Mohamad
doi: 10.5222/MMJ.2020.23682  Pages 179 - 180
Abstract | Full Text PDF




 

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