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Volume : 35 Issue : 4 Year : 2020



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Medeniyet Med J: 35 (4)
Volume: 35  Issue: 4 - 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.The Validity and Reliability of the Jefferson Scale of Physician Lifelong Learning for Medical Students into Turkish
İrem Dilara Kaptan, Hasan Huseyin Mutlu, Cem Malakcioglu, Hacer Hicran Mutlu, Mehmet Sargin
doi: 10.5222/MMJ.2020.33677  Pages 281 - 289
Amaç: Yaşam Boyu Öğrenme, kişisel ve mesleki nedenlerle doğumdan ölüme kadar süren gönüllü ve kendini motive eden bir öğrenme şeklidir. Tıp bilimi dinamik bir doğaya sahip olduğundan, tıp fakültesinde kazanılan bilgi, daha sonraki mesleki yaşamda çoğunlukla yeterli olmayacaktır. Bu çalışmanın amacı Jefferson Yaşam Boyu Öğrenme Ölçeği-Tıp Öğrencileri versiyonunun (JeffSPLL-MS©) Türkçe geçerlilik ve güvenilirliğini belirlemektir.
Yöntem: Önce dilsel eşdeğerlik analizi uygulanmış ve yapı geçerliliğini test etmek için doğrulayıcı faktör analizi (DFA) kullanılmıştır. Eş zamanlı geçerlilik Yaşam Boyu Öğrenme Eğilimleri Ölçeği (LLTS) ve JeffSPLL-MS©’nin eşzamanlı uygulanmasıyla test edilmiştir. Son olarak, çalışmadaki ölçeklerden alınan puanların iç tutarlılığı ve test-tekrar test güvenirliği hesaplanmıştır.
Bulgular: Dilsel eşdeğerlik çalışması ölçeğin Türkçe ve İngilizce formları arasında güçlü bir ilişki (r =.873, p =.001) olduğunu ortaya koymuştur. CFA için Kaiser Meyer Olkin (KMO) değeri.863 idi ve Bartlett Küresellik Testi sonuçları uygundur (X2 = 1173,6; p =.001, df = 91); JeffSPLL-MS için üç faktörlü 14 maddeli model-veri uyum indeksleri de tatmin edicidir ((X2 / df = 1,51); RMSEA = 0,046; NFI = 0,918; RFI = 0,902; CFI = 0,971) ve maddelerin faktör yüklemeleri.522 ile.764 arasında değişmektedir. LLTS ve JeffSPLL-MS© ölçeklerinin eşzamanlı geçerlilik göstergesi olarak Pearson korelasyon katsayısı.624 olarak hesaplanmıştır (p =.001). JeffSPLL-MS©’den elde edilen toplam puanların iç tutarlılığı (Cronbach alfa).843 ve tabakalı alfa katsayısı.892’dir. Alt ölçekler için Cronbach alfa değerleri aşağıdaki gibidir: .830 (F1 = Öğrenme inançları ve motivasyonu),.719 (F2 = Bilgi arama becerileri),.721 (F3 = Öğrenme fırsatlarına dikkat). Ölçeğin test-tekrar test güvenirlik değerleri ve alt ölçekleri dört haftalık bir süre içinde.709 ile.812 arasında değişmektedir.
Sonuç: JeffSPLL-MS©’nin Türkiye’de tıp eğitimi çalışmaları için geçerli ve güvenilir bir ölçüm aracı olarak kullanılabileceği sonucuna varılmıştır.
Objective: Lifelong Learning is a voluntary and self-motivated form of learning that lasts from birth to death for personal and professional reasons. As medical science has a dynamic nature, the knowledge gained in the faculty of medicine mostly will not be enough in the later professional life. The aim of this study is to determine the validity and reliability of the JeffSPLL-MS© in Turkish.
Method: Linguistic equivalence analysis was applied first, and confirmatory factor analysis (CFA) was utilized in order to test the construct validity. Concurrent validity was tested by simultaneous administration of Lifelong Learning Trends Scale (LLTS) and JeffSPLL-MS©. Finally, internal consistency and test-retest reliability of the scores gathered from the scales in the study were calculated.
Results: Linguistic equivalence study supplied that there is a strong relationship (r=.873, p=.001) between Turkish and English forms of the scale. For CFA, Kaiser Meyer Olkin (KMO) value was.863 and the results of Bartlett Sphericity Test were appropriate (X2 = 1173,6; p=.001, df=91); model-data fit indices for JeffSPLL-MS© with 14 items in three factors were also satisfactory ((X2/df =1,51); RMSEA=0,046; NFI=0,918; RFI=0,902; CFI=0,971) and factor loadings of items were ranging between.522 and.764. The Pearson correlation coefficient as the indicator of concurrent validity of the scales LLTS and JeffSPLL-MS© was calculated as.624 (p=.001). The internal consistency (Cronbach alpha) of the total scores gathered from JeffSPLL-MS© is.843 and stratified alpha coefficient is.892. Cronbach alpha values for the subscales are as follows: .830 (F1=Learning beliefs and motivation),.719 (F2=Skills in seeking information),.721 (F3=Attention to learning opportunities). The test-retest reliability values for the scale, and its subscales were ranged between.709 and.812 within a four-week period.
Conclusion: It is concluded that JeffSPLL-MS© can be used as a valid and reliable measurement instrument for medical education studies in Turkey.

6.MODY Probability Ratios in Patients Diagnosed with Type 2 Diabetes Mellitus at a Young Age
Mirac Vural Keskinler, Ayse Naciye Erbakan, Aytekin Oguz
doi: 10.5222/MMJ.2020.56805  Pages 290 - 294
Amaç: Yaşam Boyu Öğrenme, kişisel ve mesleki nedenlerle doğumdan ölüme kadar süren gönüllü ve kendini motive eden bir öğrenme şeklidir. Tıp bilimi dinamik bir doğaya sahip olduğundan, tıp fakültesinde kazanılan bilgi, daha sonraki mesleki yaşamda çoğunlukla yeterli olmayacaktır. Bu çalışmanın amacı Jefferson Yaşam Boyu Öğrenme Ölçeği-Tıp Öğrencileri versiyonunun (JeffSPLL-MS©) Türkçe geçerlilik ve güvenilirliğini belirlemektir.
Yöntem: Önce dilsel eşdeğerlik analizi uygulanmış ve yapı geçerliliğini test etmek için doğrulayıcı faktör analizi (DFA) kullanılmıştır. Eş zamanlı geçerlilik Yaşam Boyu Öğrenme Eğilimleri Ölçeği (LLTS) ve JeffSPLL-MS©’nin eşzamanlı uygulanmasıyla test edilmiştir. Son olarak, çalışmadaki ölçeklerden alınan puanların iç tutarlılığı ve test-tekrar test güvenirliği hesaplanmıştır.
Bulgular: Dilsel eşdeğerlik çalışması ölçeğin Türkçe ve İngilizce formları arasında güçlü bir ilişki (r =.873, p =.001) olduğunu ortaya koymuştur. CFA için Kaiser Meyer Olkin (KMO) değeri.863 idi ve Bartlett Küresellik Testi sonuçları uygundur (X2 = 1173,6; p =.001, df = 91); JeffSPLL-MS için üç faktörlü 14 maddeli model-veri uyum indeksleri de tatmin edicidir ((X2 / df = 1,51); RMSEA = 0,046; NFI = 0,918; RFI = 0,902; CFI = 0,971) ve maddelerin faktör yüklemeleri.522 ile.764 arasında değişmektedir. LLTS ve JeffSPLL-MS© ölçeklerinin eşzamanlı geçerlilik göstergesi olarak Pearson korelasyon katsayısı.624 olarak hesaplanmıştır (p =.001). JeffSPLL-MS©’den elde edilen toplam puanların iç tutarlılığı (Cronbach alfa).843 ve tabakalı alfa katsayısı.892’dir. Alt ölçekler için Cronbach alfa değerleri aşağıdaki gibidir: .830 (F1 = Öğrenme inançları ve motivasyonu),.719 (F2 = Bilgi arama becerileri),.721 (F3 = Öğrenme fırsatlarına dikkat). Ölçeğin test-tekrar test güvenirlik değerleri ve alt ölçekleri dört haftalık bir süre içinde.709 ile.812 arasında değişmektedir.
Sonuç: JeffSPLL-MS©’nin Türkiye’de tıp eğitimi çalışmaları için geçerli ve güvenilir bir ölçüm aracı olarak kullanılabileceği sonucuna varılmıştır.
Objective: Lifelong Learning is a voluntary and self-motivated form of learning that lasts from birth to death for personal and professional reasons. As medical science has a dynamic nature, the knowledge gained in the faculty of medicine mostly will not be enough in the later professional life. The aim of this study is to determine the validity and reliability of the JeffSPLL-MS© in Turkish.
Method: Linguistic equivalence analysis was applied first, and confirmatory factor analysis (CFA) was utilized in order to test the construct validity. Concurrent validity was tested by simultaneous administration of Lifelong Learning Trends Scale (LLTS) and JeffSPLL-MS©. Finally, internal consistency and test-retest reliability of the scores gathered from the scales in the study were calculated.
Results: Linguistic equivalence study supplied that there is a strong relationship (r=.873, p=.001) between Turkish and English forms of the scale. For CFA, Kaiser Meyer Olkin (KMO) value was.863 and the results of Bartlett Sphericity Test were appropriate (X2 = 1173,6; p=.001, df=91); model-data fit indices for JeffSPLL-MS© with 14 items in three factors were also satisfactory ((X2/df =1,51); RMSEA=0,046; NFI=0,918; RFI=0,902; CFI=0,971) and factor loadings of items were ranging between.522 and.764. The Pearson correlation coefficient as the indicator of concurrent validity of the scales LLTS and JeffSPLL-MS© was calculated as.624 (p=.001). The internal consistency (Cronbach alpha) of the total scores gathered from JeffSPLL-MS© is.843 and stratified alpha coefficient is.892. Cronbach alpha values for the subscales are as follows: .830 (F1=Learning beliefs and motivation),.719 (F2=Skills in seeking information),.721 (F3=Attention to learning opportunities). The test-retest reliability values for the scale, and its subscales were ranged between.709 and.812 within a four-week period.
Conclusion: It is concluded that JeffSPLL-MS© can be used as a valid and reliable measurement instrument for medical education studies in Turkey.

7.Association of Hereditary Prothrombotic Risk Factors with ST Elevation Myocardial Infarction
İbrahim Halil Damar, Recep Eroz
doi: 10.5222/MMJ.2020.67366  Pages 295 - 303
Amaç: Ciddi bir sağlık sorunu olan ST yükselmeli miyokart enfarktüsü (STEMI), genellikle koroner arter hastalığının trombotik bir komplikasyonudur. STEMI hastalarını ve kontrol grubunu, FactorV Cambridge G1091C, FactorV Leiden G1691A, MTHFRC677T, MTHFR A1298C, FactorII G20210A, FaktörXIII (V34L), PAI-1, FGB, ITGB3, APOB, FVHR2 dahil olmak üzere kalıtsal trombofilinin olası nedenleri açısından karşılaştırdık.
Yöntem: Çalışmaya STEMI’li 53 hasta ve akut koroner sendrom tanısı olmayan 47 kişi dahil edildi. STEMI’li hastalara perkütan koroner girişim uygulandı. Tüm olgulara ekokardiyografi yapıldı ve tüm olgular kalıtsal trombofili genleri açısından değerlendirildi.
Bulgular: Kalıtsal trombofilinin MTHFR A1298C, FaktörXIII (V34L), ITGB, ACE ve homozigot veya bileşik heterozigot gen varyasyonu STEMI ile anlamlı olarak ilişkilidir (p<0.05). Ayrıca sigara içen MI hastalarında MTHFR A1298C, FactorV Leiden G1691A, PAI ve ACE gen varyasyonu, HT’li MI hastalarında Faktör XIII (V34L), PAI ve ACE gen varyasyonu, aile öyküsü olan MI hastalarında PAI ve ACE gen varyasyonu ve HL’li MI hastalarında PAI gen varyasyonu anlamlı derecede kontrol grubundan daha yüksek bulundu.
Sonuç: Kalıtsal trombofili faktörleri, daha büyük seri çalışmalarla desteklendiğinde STEMI’nin önlenmesi ve tedavisinde umut vaat edebilir.
Objective: The ST- elevation myocardial infarction (STEMI), a serious health care problem, is commonly a thrombotic complication of coronary artery disease. We compare the STEMI patients and control group in terms of the possible causes of inherited thrombophilia including FactorV Cambridge G1091C, FactorV Leiden G1691A, MTHFRC677T, MTHFR A1298C, FactorII G20210A, Factor XIII (V34L), PAI-1, FGB, ITGB3, APOB, FVHR2, ACE gene variants.
Methods: Fifty-three patients with STEMI and 47 individuals without diagnosis of acute coronary syndrome were included in the study. Percutaneous coronary intervention was performed for patients with STEMI. Echocardiography was performed and inherited thrombophilia genes were evaluated in all subjects.
Results: The MTHFR A1298C, Factor XIII (V34L), ITGB, ACE and homozygous or compound heterozygous gene varations of inherited thrombophilia are significantly related with STEMI (p<0.05). Also significantly higher MTHFR A1298C, FactorV Leiden G1691A, PAI and ACE gene variations in MI patients who were smokers; Factor XIII (V34L), PAI and ACE gene variations in MI patients with HT; PAI and ACE gene variation in MI patients with FH and PAI gene variations in MI patients with HL were detected when compared with the control groups with all of the same risk factors (p<0.05).
Conclusion: Hereditary thrombophilia factors may show promise in the prevention and management of STEMI when supported studies with larger case series.

8.Factors of Respiratory Symptoms Among Domestic Waste Collectors
Loganathan Salvaraji, Mohammad Saffree Jeffree, Richard Avoi, Hazelina Mohd Akhir, Syed Sharizman Syed Abdul Rahim, Khamisah Awang Lukman
doi: 10.5222/MMJ.2020.82246  Pages 304 - 309
Objective: Increasing amount of waste concurrently increases the risk of exposure to hazardous materials among waste collectors. Vigorous exertion in the field intensifies the abundance of contaminated inspirable droplets. If left undetected and untreated, it may provoke significant pernicious health effects and redundant burdens to employees and employers. The purpose of this study is to determine the prevalence of respiratory symptoms and their associated factors among domestic waste collectors.
Method: A cross-sectional study was conducted in Kota Kinabalu, Sabah between January and April 2020. Data were collected using a validated questionnaire which encompasses details about sociodemographic, health status, environment, and employment characteristics.
Results: A total of 290 waste collectors with a mean age of 40 (±9) years old were participated in the study. Most of them were from Kadazan-Dusun-Murut ethnic origin with educational background till secondary school. The average monthly income of the workers was USD 298.45 (±171.9) per month, and they had been in service for 11 (±9.04) years. Respiratory symptoms were seen in 21% of the workers. The identified significant risk factors were determined as underlying chronic diseases (OR=2.34; 95% CI=1.054, 5.219) and contact with pets (OR=1.87; 95% CI=1.004, 3.288).
Conclusion: Respiratory symptoms are prevalent amidst domestic waste collectors and related to their health and field activities.

9.A Study of Depressive Symptoms in Doctors Working at COVID-19 Hospitals: An Online Survey.
Musharaf Bashir, Himani Ahluwalia, Sheikh Imran Sayeed, Imran Nazir Salroo
doi: 10.5222/MMJ.2020.88614  Pages 310 - 314
Objective: COVID19 outbreak has put a tremendous physical and mental burden on frontline doctors. A limited amount of literature is available in this area. The present study was done to assess the depressive symptoms and depression levels in doctors working at COVID-19 Hospitals.
Method: This study was based on an online survey that was started on May 2020 and ended on 30th June, 2020. An online questionnaire which included details such as age, gender, and 21 items to assess depressive symptoms was sent through social media to doctors from various countries. Depressive symptoms were measured by Beck’s Depression Inventory-II (BDI-II). Items of a total of 220 questionnaires were responded. Out of these, only 200 responses were analyzed using SPSS software.
Results: Out of 200 subjects, 110 (55%) had depressive symptoms and 90 (45%) had no symptoms. Males had more depressive symptoms (42.5%) than females (12.5%). Those who worked at COVID-19 centers 75 (37.5%) had higher depressive symptoms. The number of males working at COVID-19 centers was much higher (36%) than females (12%). Depressive symptoms were significantly higher in males than females (35.35±10.25 vs 16.90±7.76; p<0.0001).
Conclusion: Doctors, especially males working at COVID-19 centers have higher depressive symptoms than their female colleagues.
Multicentric studies with larger sample sizes are needed to study the impact of COVID-19 on frontline doctors.

10.An Alternative Approach to Wound Healing Field with Polypodium Vulgare
Sebnem Batur, Sule Ayla, Ayse Arzu Sakul, Mehmet Evren Okur, Ayşe Esra Karadağ, Benay Daylan, Ekrem Musa Özdemir, Nuray Kepil, Mehmet Yalcin Gunal
doi: 10.5222/MMJ.2020.89983  Pages 315 - 323
Amaç: Bu çalışmada Polypodium vulgare L. (Polypodiaceae), yara iyileşme adayı olma potansiyeli açısından değerlendirildi. Farelerde eksizyonel bir yara modeli kullanılarak hem in vivo hem de in vitro yara iyileşmesinde P.vulgare’nin antimikrobiyal ve antioksidan aktivitesini araştırdık.
Yöntem: Eşit olarak dört gruba ayrılmış toplam 32 Balb-c faresi kullandık; Grup 1 kontrol, grup 2 taşıyıcı grup 3 Polipodyum vulgare, grup 4 Centella asiatica özütü (CAE). Tüm tedaviler topikal olarak günde bir kez uygulandı. Yara izi alanı, yara kapanma yüzdesi ve epitelizasyon süresi ölçüldü. İmmünhistokimyasal değerlendirmede PDGF, VEGF ve kollajen boyaları kullanıldı.
Bulgular: CAE ve P. vulgare ekstrakt gruplarının yeni vasküler organizasyon, epidermis ve granülasyon doku organizasyonu açısından kontrol ve taşıyıcı gruplarından daha etkili olduğu gözlenmiştir. PDGF, VEGF ve kollajen immünohistokimyasal boyama, P.vulgare ekstraktı ve CAE gruplarında kontrol ve taşıyıcı gruplarına göre daha kuvvetliydi. P. vulgare ve CAE grubunda PDGF boyama yoğunluğu, kontrol ve taşıyıcı gruplarından daha kuvvetliydi, ancak P. vulgare grubundaki VEGF ve kollajen boyama, kontrol grubundan farklı değildi.
Sonuç:
P. vulgare yara iyileşmesini ve granülasyon dokusunu, epidermal rejenerasyonu ve anjiyogenezi arttırdı. Antioksidan ve antimikrobiyal aktiviteleri ile bilinen P. vulgare ekstraktı, yara iyileşmesini desteklemek için yararlı olabilir.
Objective: In this study, we examined the effects of Polypodium vulgare L. (Polypodiaceae) as a candidate to be used for wound healing scarred area. We investigated the antibacterial, and antioxidant activity of P. Vulgare on both in vivo, and in vitro wound healing using an excisional wound model in mice
Method: We used 32 Balb-c mice equally divided into four groups: Group 1 control, Group 2 vehicle, Group 3 Polypodium vulgare, and Group 4 Centella asiatica extract (CAE). All treatments were applied topically once in a day. The scar area, percentage wound closure and epithelization time were measured. PDGF, VEGF, and collagen immunohistochemical staining were used for evaluation.
Results: CAE and P. vulgare extract groups were observed to be more effective than the control and vehicle groups in terms of new vascular, epidermal and granulation tissue organization. PDGF, VEGF, and collagen immunohistochemical staining was stronger in the P.vulgare extract and CAE groups compared to the control and vehicle groups. In the P. vulgare and CAE groups, PDGF staining intensity was stronger than the control and vehicle groups, but VEGF and collagen staining in P. vulgare group was not different from the control group.
Conclusion: P. vulgare had an effect on the injured area by regenerating the epidermis and increasing vascularization. P. vulgare extract with known antioxidant, and antimicrobial activities may be helpful as a supportive treatment in wound healing.

11.Morphological Variations of Peroneus Tertius: A Cadaveric Study with Anatomical and Clinical Consideration
Khizer Hussain Afroze M, Sangeeta Muralidharan, J. Leonoline Ebenezer, Sasirekha Muthusamy
doi: 10.5222/MMJ.2020.98512  Pages 324 - 329
Objective: The objective of this study was to highlight variations in the morphology of peroneus tertius muscle owing to its evolutional, academic, and clinical importance.
Methods: Sixty-six disarticulated lower limbs were used to study the morphological variations of peroneus tertius (PT) muscle like absence, duplication, accessory PT muscle, and abnormal site of origin and insertion. Detailed dissection was performed to study the proximal and distal attachments of PT muscle, and observed variations were recorded.
Results: Twelve out of 66 specimens showed the following variations, accessory and duplicate peroneus tertius was observed in one specimen (1.52%) each. We categorized variations in insertions into six types. The most common variation in the present study was type II (84.8%) followed by type VI (10.6%). Type IIa and IV were observed in one specimen (1.52%) each.
Conclusion: The present study highlights variations in both origin and insertion of PT muscle. We have also postulated a new modified classification which is the first of its kind to highlight two new additional variations in insertions existing in the current literature. Awareness of the above variations would be useful to surgeons performing tendon transfers, tendoplasty, and resection surgeries of the foot.

12.Optic Nerve Head Changes in Patients with Optic Neuritis Secondary to Multiple Sclerosis: A Comparison of The Affected and Fellow Healthy Eyes
Sevcan Balcı, Merve Beyza Yıldız, Alev Özçelik Köse, Devran Süer, Ece Turan Vural, Canan Emir, Nursal Melda Yenerel
doi: 10.5222/MMJ.2020.99075  Pages 330 - 337
Amaç: Multipl skleroz (MS) hastalarında optik koherens tomografi (OKT) ile yapılan lamina kribroza (LK) kalınlık ölçümlerinin ve optik nörit (ON) atağının bu ölçümlere olan etkisinin remisyon döneminde değerlendirilmesi.
Yöntem: Relapsing-remitting MS tanısı alan ve tek gözden ON atağı geçirme hikayesi olan, en az üç aydır MS ve ON atağı remisyonda olan 20 olgu ile yaş, cinsiyet uyumlu 28 sağlıklı olgunun rasgele seçilen gözü dahil edildi. MS’li grupta; ON atağından etkilenen gözleri Grup 1 (MS+ON), ON atağından etkilenmeyen diğer sağlıklı gözleri Grup 2 (MS-ON), sağlıklı bireylerin gözleri ise Grup 3 olarak değerlendirildi. Olgulara çekilen OKT görüntülerinden ortalama LK, peripapiller retina sinir lifi tabakası (ppRSLT) ve subfoveal koroid (SFK) kalınlık ölçümleri gruplar arasında karşılaştırıldı.
Bulgular: Ortalama LK kalınlığı MS+ON ve MS-ON gruplarında kontrol grubu ile karşılaştırıldığında anlamlı (p<0,001) olarak ince olduğu saptandı. MS+ON ve MS-ON grupları arasında ortalama LK kalınlık değeri karşılaştırıldığında ise anlamlı fark olmadığı görüldü (p=0,073). MS+ON ve MS-ON gruplarında ortalama ppRSLT kalınlığı kontrol grubu ile karşılaştırıldığında anlamlı düzeyde ince olduğu saptandı (sırasıyla, p=0,003, p=0,035).
Sonuç: Çalışmamızda ON atağı geçirmemiş olan MS’li gözlerde LK’nin anlamlı düzeyde etkilenmiş olması dikkat çekicidir. MS’te bu ölçümlerin değerlendirilmesi, hastalarda oluşan optik sinir hasarının erken tespiti için önemli olabilir.
Objective: To evaluate the thickness of lamina cribrosa (LC) in patients with multiple sclerosis (MS) using optical coherence tomography (OCT) and the effect of optic neuritis (ON) attack on these measurements during the remission period.
Methods: The study included 20 cases diagnosed with relapsing-remitting MS with a history of ON attacks affecting one eye and in remission of MS and ON attacks for at least three months, and 28 randomly selected eyes of age- and sex-matched healthy controls. In the MS group, the eyes affected by ON attack were assigned as Group 1 (MS+ON), their fellow unaffected eyes as Group 2 (MS-ON), and healthy control eyes as Group 3. The LC, peripapillary retinal nerve fiber layer (ppRNFL), and subfoveal choroidal thickness measurements were made by using OCT in all cases, and results were compared between the groups.
Results: The mean LC thickness in MS+ON and MS-ON groups was significantly lower than the control group (p<0.001). There was no significant difference between MS+ON and MS-ON groups in terms of mean LC thickness (p=0.073). The mean ppRNFL in the MS+ON and MS-ON groups was statistically significantly lower than the control group (p=0.003, p=0.035, respectively).
Conclusions: It is noteworthy that LC is significantly affected in eyes with MS who have not had a history of ON attack. Evaluation of the LC measurements can be important for early detection of optic nerve damage in patients with MS.

REVIEW
13.Tuberculosis and Coronavirus disease 2019 (COVID-19) From Clinical Perspective: A Systematic Review
Tri Hari Irfani, Reynold Siburian, Riska Nabila, Tungki Pratama Umar
doi: 10.5222/MMJ.2020.36775  Pages 338 - 343
The aim of this review is to examine the effects of COVID-19 on Tuberculosis (TB) management and to highlight evidence of the extent of TB and COVID-19 co-infection. Current findings on TB and COVID-19 have been identified using six databases: Pubmed, Science Direct, Pubmed Central, MedXRiv, Wiley, and Google Scholar. This search in literature was conducted up to 8 May 2020. We included five studies that met the selection criteria. These selected studies have been performed in regions having various demographic characteristics including developed and developing countries, mainly China. The total number of participants in each study ranged from 24 to 203. The case fatality rate of patients with TB and COVID-19 co-infection was found to be high (6/49; 12.3 percent) while a combined diagnosis of TB and COVID-19 was found in 9/49 patients. This condition is linked to several complications, manifested as the need for ex novo oxygen supply, pneumothorax, and extreme hypoxia. Researches on BCG vaccination have shown that countries without vaccination policy are more likely to be seriously affected than those with BCG vaccination programs. COVID-19 infection in patients with TB or the lack of sufficient BCG vaccination may be associated with higher detrimental consequences, including mortality.

CASE REPORTS
14.A Rare Intra-Orbital Mass: An Isolated Mucocele
Che Mohdhilmi Che Mat, Fakri Mustapha, Rosli Mohd Noor, Rosdi Ramli, Irfan Mohamad
doi: 10.5222/MMJ.2020.01057  Pages 344 - 348
Mucocele is a mucous filled benign cystic lesion. It develops due to obstruction of any natural ostium of the paranasal sinus. Even though being benign, it has capability to erode and cause thinning the adjacent bony structures. Isolated intraorbital mucocele without paranasal sinus disease is a rare condition. We present a 39-year-old female patient with right medial canthal swelling without any nasal symptoms, and normal nasoendoscopic finding. Imaging revealed the lesion as a right ethmoidal mucocele with normal paranasal sinuses. However intraoperatively, it was an isolated intraorbital lesion, lateral to lamina papyracea with thick-yellowish mucin discharge.

15.Concurrent Double Primary Tumours: Papillary Thyroid Carcinoma and Cervical Epithelioid Angiosarcoma
Sai Guan Lum, Nurhamizah Mahmud, Nurismah Isa, Marina Mat Baki
doi: 10.5222/MMJ.2020.83479  Pages 349 - 355
Angiosarcoma is one of the rarest types of malignant vascular tumours that involved the head and neck region. It predominantly affects the scalp and superficial soft tissues. Angiosarcoma arising from the deep cervical soft tissue is extremely rare. There is a limited literature on neck angiosarcoma that occurred simultaneously with papillary thyroid carcinoma. We report a rare case of concurrent papillary thyroid carcinoma and cervical epithelioid angiosarcoma, and postoperative rapid progression of residual angiosarcoma that mimicked a neck haematoma. The diagnostic challenge and possible etiologies have been discussed here.




 

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