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Volume : 36 Issue : 2 Year : 2020



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Medeniyet Med J: 36 (1)
Volume: 36  Issue: 1 - 2021
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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.Comparison of D-dimer Level Measured on Third Day of Hospitalization with Admission D-dimer Level in Predicting In-hospital Mortality in COVID-19 Patients
Murat Selçuk, Tufan Cinar, Nuran Gunay, Muhammed Keskin, Vedat Çiçek, Sahhan Kilic, Süha Asal, Ahmet L. Orhan
doi: 10.5222/MMJ.2021.07348  Pages 1 - 6
Amaç: Bu çalışma, koronavirüs hastalığı 2019 (COVID-19) hastalarında hastane içi mortaliteyi öngörmede 3. gün hastanede ölçülen D-dimer değeri ile başvuru D-dimer düzeyini karşılaştırmayı amaçlamaktadır.
Yöntem: Toplamda, COVID-19’lu 231 hasta çalışmaya dâhil edildi. D-dimer seviyeleri, 0-500 μq/mL normal aralığı ile immünoturbidimetrik test kullanılarak ölçüldü. Mevcut araştırmada, birincil sonlanım hastane içi tüm nedenlere bağlı mortaliteydi.
Bulgular: Mevcut araştırmada, 39 (%16,8) COVID-19 vakası hastanede yatarken öldü. Çok değişkenli analizde; yaş, D-dimer (3.üncü gün) (OR: 1.00, %95 CI: 1.00-1.00, p<0.001), beyaz küre sayısı ve kreatinin, COVID-19 vakaları için hastane içi ölümün bağımsız prediktörleri idi. Hastaneye yatışın 3’üncü gününde bakılan D-dimer seviyesi %83,2 duyarlılık ve %83,6 özgüllük ile ideal değeri 774 μq/mL’di (eğri altındaki alan (AUC): 0.903,%95 GA: 0,836-0.968; p<0.01). Hastaneye yatışın 3’üncü günündeki D-dimer düzeyinin, başvurdaki D-dimer düzeyinden daha yüksek duyarlılığa (sırasıyla %83,2’ye karşı %67,6) ve AUC değerine (sırasıyla 0,903’e karşı 0,799) sahip olduğu saptandı.
Sonuç: Bu araştırmadaki temel bulgu, COVID-19 hastalarında hastaneye yatışının 3’üncü günündeki D-dimer yükselmesinin, hastaneye başvuru sırasındaki D-dimer seviyesine göre hastane içi mortalitenin daha duyarlı bir prediktörü olmasıdır. COVID-19 hastalığı olan hastalarda D-dimer düzeyi açısından kesin prognozu tahmin etmek için daha fazla araştırmaya ihtiyaç duyulsa da, 3. gün yatıştaki D-dimer düzeyinin rutinde prognostik bir belirteç olarak kullanılma potansiyeline sahip olduğunu düşünmekteyiz.
Objective: The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases.
Method: In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0-500 μg/mL. In the current research, the primary outcome was the in-hospital mortality.
Results: In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00-1.00, p<0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 μq/mL (area under curve (AUC): 0.903, 95% CI: 0.836-0.968; p<0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively).
Conclusion: The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice.

6.Evaluation of Brainstem Subcortical Auditory Pathways with Diffusion Tensor Imaging After Gamma Knife Radiosurgery in Intracanalicular Vestibular Schwannoma
Dilek Hacer Çeşme, Alpay Alkan, Mehmet Ali Gültekin, Lutfullah Sari, Gökberk Alkan, Mehmet Hakan Seyithanoğlu, Mustafa Aziz Hatiboğlu
doi: 10.5222/MMJ.2021.15564  Pages 7 - 13
Amaç: İntrakanaliküler vestibüler schwannomlu (ICVS) olgularda Gamma Knife Radyocerrahisi (GKR) sonrası beyin sapı subkortikal işitsel yollarda DTG (Difüzyon Tensör Görüntüleme) parametrelerinde değişiklik olup olmadığını araştırmak ve tümör hacmi ile ADC (görünür difüzyon katsayısı) ve FA (görünür difüzyon katsayısı) değerleri arasındaki ilişkiyi analiz etmek
Yöntem: ICVS’li 17 hasta radyocerrahi öncesi ve sonrası değerlendirildi. Lateral lemniscus (LL) ve inferior kollikulus (IC) ADC ve FA değerleri ve tümör hacmi hesaplandı. Radyocerrahi tedavisine yanıt verenler Grup 1, yeterli yanıt vermeyenler ise Grup 2 olarak sınıflandırıldı. ADC ve FA değerleri ile tümor hacim değişiklikleri arasındaki ilişki analiz edildi.
Bulgular: Radyocerrahi sonrası tümör hacmi belirgin azalmıştı. GKR sonrası tümörden elde edilen ADC değerleri arttı (p: 0,002). GKR öncesi ve sonrası LL ve IC’de FA ve ADC değerleri (n: 17) açısından anlamlı farklılık saptanmadı. Tedaviye yanıt ile GKR sonrası kontralateral LL ADC değerleri arasında pozitif korelasyon mevcuttu (p=0,005, r: 0,652). GKR sonrası kontralateral IC FA değerleri ile tedaviye yanıt arasında negatif korelasyon saptandı (p=0,017, r: -0,568). Grup 1 ile Grup 2 arasında kontralateral LL ADC (p=0,03) ve IC FA değerleri (p=0,017) açısından anlamlı fark vardı.
Sonuç: Kohlear sinir ve subkortikal işitme yolakların düşük rejenerasyon potansiyeli sahip olması nedeniyle LL ve IC’deki ADC ve FA değişiklikleri mevcut olan intrakanaliküler tümör varlığı ile açıklanabilir. Radyocerrahi, beyin sapı düzeyinde subkortikal işitme yollarına ek hasar vermediğinden dolayı GKR’nin ICVS’li hastalarda güvenle kullanılabilecek noninvaziv bir tedavi yöntemi olduğunu düşünüyoruz.
Objective: To investigate changes in DTI (Diffusion Tensor Imaging) parameters in brainstem subcortical auditory pathways after Gamma Knife Radiosurgery (GKR) in patients with intracanalicular vestibular schwannoma (ICVS) and to analyze the relationship between tumor volume and ADC (apparent diffusion coefficient) and FA (fractional anisotropy) values.
Method: Seventeen patients with ICVS were evaluated before and after GKR. ADC and FA values of the lateral lemniscus (LL) and inferior colliculus (IC) and tumor volume were calculated. Patients who responded to GKR were classified as Group 1 and those who did not respond adequately as Group 2. The relationship between ADC and FA values and changes in tumor volume were analyzed.
Results: Tumor volume significantly decreased after GKR. ADC values obtained from the tumor increased after GKR (p: 0.002). There was no significant difference in LL and IC before and after GKR in terms of FA and ADC values (n: 17). There was a positive correlation between response to treatment and contralateral LL ADC values after GKR (p=0.005, r: 0.652). There was a negative correlation between contralateral IC FA values after GKR and response to treatment (p=0.017, r: -0.568). There was a significant difference between Groups 1 and 2 in regards to contralateral LL ADC (p=0.03) and IC FA values (p=0.017).
Conclusion: Since the cochlear nerve and subcortical auditory pathways have low regeneration potential after nerve damage, ADC and FA changes in LL and IC may be explained with the presence of intracanalicular tumors prior to GKR. Since GKR does not cause additional damage to the subcortical auditory pathways at the brainstem level, we think that GKR is a noninvasive treatment method that can be used safely in patients with ICVS.

7.Factors Affecting Neonatal Hearing Screening Follow-up in Developing Countries: One Insitution Prospective Pilot Study
Nermin Hrncic, Amna Goga, Selma Hrncic, Haris Hatibovic, Djenad Hodzic
doi: 10.5222/MMJ.2021.19577  Pages 14 - 22
Objective: To detect factors related with loss to follow-up (LTF) in neonatal hearing screening (NHS) program of one institution in a developing country.
Methods: A prospective study was planned based on the data collected in a pilot study conducted a year before in the same institution. In this pilot study, hearing screening was performed before hospital discharge for every infant (1217 newborns) in six months period. Total referral rate was 19.1% (223/1217). Loss to follow-up (LTF) was 38.1% (85/223). Telephonic interviews were done with 50 parents who had not come with their child to the second hearing test. For these telephonic interviews the questionnaire with four sections (socio-demographic information; information about pregnancy, birth, and present health condition of the child; caregiver knowledge of neonatal hearing screening, and reasons for default on follow-up) was created.
Results: The mothers participated in this study were 29.1 years (±5.2 SD) of age in average. Place of residence was mostly rural (64%; n=32) with 39.4 Km (±24.8 SD) away from from the rescreen referral center. Their knowledge on neonatal hearing screening, hearing impairment incidence or treatment opportunities was at a very low level. Caregivers’ perceptions that follow-up was unnecessary (50%; n=25), was most frequently given reason for follow-up default, followed by newborns bad health condition (12%; n=6) and forgetting about the follow-up visits (8%; n=6).
Conclusion: The main reason for default in follow-up in our study was caregiver’s poor knowledge about this topic.

8.Malignant Otitis Externa: How to Monitor the Disease in Outcome Estimation?
Ayşe Pelin Yiğider, Okan Övünç, Esra Arslan, Ahmet Volkan Sünter, Tevfik Fikret Cermik, Özgür Yiğit
doi: 10.5222/MMJ.2021.36528  Pages 23 - 29
Amaç: Malign otitis eksterna esas olarak yaşlı diyabetik hastaları etkileyen ve ölümle sonuçlanabilen ciddi bir hastalıktır. Hastalığın ilerleyişi arasında tedavi yanıtları ile klinik ve radyolojik parametreler arasındaki ilişkinin değerlendirilmesi amaçlandı. İkincil amaç, malign otitis eksterna tedavisinde klinik sonuçlarımızı sunmaktı.
Yöntem: Retrospektif olarak tek merkezde yapıldı. İncelenen veriler arasında şikayet öyküsü, semptomların süresi, hiperbarik oksijen tedavisi eklenmesi, cerrahi girişim varlığı, patolojik bulgular, kültür pozitifliği ve mikroorganizma, laboratuvar bulguları, sintigrafi, görüntüleme yöntemleri ve hastalığın sonucu yer aldı.
Bulgular: Çalışmamıza 17 kadın (%65,4) ve 9 erkek (%34,6) olmak üzere toplam 26 malign eksternal otitisli hasta dahil edildi. Tedaviye başlamadan önce semptom süresi, Hiperbarik oksijen tedavisi sonucu olumlu etkilemedi. Enflamatuar belirteçler ve Peleg evreleme, tedavi yanıtını önemli ölçüde yansıtıyordu.
Sonuç: Enflamatuar parametrelerin yakından izlenmesi prognoz tahmininde anahtar noktadır. Yönetimin planlanması ve sonuçların tahmin edilmesi, hastalığın derecesinin uygun radyolojik ve klinik değerlendirmesine dayanır. MOE değerlendirmesinde, verilerin karşılaştırılabilir bir şekilde havuzlanması için evrensel puanlama sistemleri tercih edilmelidir.
Objective: Malignant otitis externa (MOE) is a serious disease affecting mainly the elderly diabetic patients that may result in mortality. It was aimed to evaluate the relationship between treatment responses and clinical and radiologic parameters among progress of the disease. Secondary aim was to present our clinical outcomes in the treatment of malignant otitis externa.
Method: This study was retrospectively conducted in a single center. Reviewed data included history of complaints, duration of symptoms, addition of hyperbaric oxygen treatment, presence of surgical intervention, pathological findings, culture positivity and microorganism, laboratory findings, scintigraphy, imaging modalities and outcome of disease.
Result: A total of 26 cases with malignant external otitis including 17 females (65.4%) and nine males (34.6%) patients were included in our study. Duration of symptoms before the initiation of treatment, and hyperbaric oxygen treatment did not positively influence the outcome. Inflammatory markers and Peleg staging significantly reflected the treatment response.
Conclusion: Close monitoring of inflammatory parameters is the key point in the prediction of prognosis. Planning the management and predicting the outcomes rely on proper radiological and clinical assessment of the extent of disease. In the assessment of MOE, universal scoring systems should be preferred for pooling the data in comparable manner.

9.The Comparison Between Non-High Risk Patients with and Without Cancer Diagnosed with Pulmonary Embolism
Tayfun Caliskan, Ozlem Turkoglu, Kadir Canoglu, Omer Ayten, Bengu Saylan, Oguzhan Okutan, Zafer Kartaloglu
doi: 10.5222/MMJ.2021.43066  Pages 30 - 35
Amaç: Bu çalışma, kanseri olan ve olmayan yüksek riskli olmayan pulmoner emboli (PE) hastalarında pulmoner bilgisayarlı tomografik anjiyografide (PBTA) PE lokalizasyonu, trombüs yükü, sağ ventrikül disfonksiyonu (SVD), serum D-dimer, serum kardiyak troponin I (kTnI) ve alt ekstremite derin ven trombozu (DVT) varlığının karşılaştırılmasını amaçlamıştır.
Yöntem: Her hasta için trombüs yükü Miller Skoru ile hesaplandı. PE yeri PTBA’da değerlendirildi. Serum D-dimer, kTnI düzeyleri ölçüldü. Hastalara SVD için ekokardiyografi ve DVT için alt ekstremite renkli mod doppler ultrasonografi yapıldı.
Bulgular: PE tanılı yetmiş bir hasta çalışmaya alındı. Hastalar kanser varlığına göre iki gruba ayrıldı. İki grup arasında D-dimer düzeyleri (p=0,15), PE yeri (p=0,67), trombüs yükü (p=0,34), SVD (p=0,28) ve DVT (p=0,33) yönünden istatistiki anlamlı bir fark saptanmadı. Kanseri olan ve PE tanısı konulan hastalar, kanser tanısı olmayanlara göre istatistiksel olarak anlamlı derecede daha yüksek kTnI düzeylerine sahipti (p=0,03).
Sonuç: Kanseri olan ve olmayan PE tanısı konulan hastalar arasında D-dimer, trombüs yükü, emboli yerleşimi, SVD ve DVT varlığı açısından fark saptanmadı. Kanseri olan yüksek riskli olmayan PE hastalarında kTnI düzeyleri, kanseri olmayan yüksek riskli olmayan PE hastalarından daha yüksekti.
Objective: This study aimed to compare the pulmonary embolism (PE) location and clot burden on computed tomography pulmonary angiography (CTPA), the degree of right ventricular dysfunction (RVD), D-dimer, and cardiac troponin I (cTnI) levels, and the presence of a lower extremity deep venous thrombosis (DVT) in patients with and without cancer diagnosed with a non high risk pulmonary embolism (PE).
Method: We calculated Miller score for each patient for clot burden. The location of PE was also evaluated at CTPA. D-dimer and cardiac cTnI levels were measured. Patients had echocardiography for RVD and lower extremity color flow Doppler ultrasonography for DVT.
Results: The study included 71 patients with PE. The patients were divided into two groups according to the presence of cancer. There was no statistically significant difference for D-dimer levels (P=0.15), PE location (p=0.67), clot burden (P=0.34), RVD (P=0.28) and DVT (P=0.33) between groups (P=0.15). Cancer patients diagnosed as PE had statistically significantly higher levels of cTnI than those who were diagnosed as PE without cancer (P=0.03).
Conclusion: There was no significant difference between patients diagnosed as PE with and without cancer in terms of D-dimer levels, clot burden and emboli location, RVD and DVT. cTnI levels were higher in non-high risk PE patients with cancer than these patients without cancer.cancer.

10.Do Benign Mass Lesions in the Superficial Lobe of Parotid Gland Influence Landmark-Based Search for Facial Nerve Trunk at Surgery?
Subhadip Sardar, Mainak Dutta, Sirshak Dutta, Saumik Das, Ramanuj Sinha
doi: 10.5222/MMJ.2021.43067  Pages 36 - 43
Objective: To assess the influence of benign mass lesions in the superficial lobe of parotid on the known anatomic landmarks for identifying the facial nerve trunk.
Method: Patients with unilateral biopsy-proven benign mass lesions in the superficial parotid were selected for this observational study. During superficial/partial superficial parotidectomy, distance of the facial nerve trunk from each landmark was assessed using spring calliper and correlated with the lesion’s volume (measured from the pre-operative imaging). At least two identifiers among tragal pointer (TP), posterior belly of digastric muscle (PBDM) and tympanomastoid suture (TMS) were considered.
Results: The study involved 32 patients. The lesions mostly involved the parotid tail (50%) and pretragal region (34.3%), and constituted of pleomorphic adenoma (~66%) and Warthin’s tumor (~9%), the rest being various cysts and hamartomas. TP was universally uncovered, while PBDM and TMS were exposed in 26 and 25 patients, respectively. Average distances between the facial nerve trunk and TP, PBDM and TMS were 12.79 mm (SD=2.33), 9.78 mm (SD=1.21) and 7.58 mm (SD=1.33), respectively. Correlation coefficients between the lesion’s volume and the distance of facial nerve from a given landmark were -0.11, 0.04 and -0.16 for TP, PBDM and TMS, respectively.
Conclusions: TP was the most easily available landmark on surgical dissection, while PBDM was the most consistent and the least variable when volumetric data of the benign mass lesions in the superficial lobe of parotid were considered as a factor influencing the distance from the facial nerve trunk.

11.Usage of Students’ Potential in Biomedical and Health Care Research in Bosnia and Herzegovina
Emir Begagic, Nermin Duzic, Zlatan Memic, Nemanja Arandelovic, Anida Celebic, Hakija Beculic
doi: 10.5222/MMJ.2021.47715  Pages 44 - 51
Objective: To provide relevant insight into the current degree of usage of the research potential of students of biomedical sciences in Bosnia and Herzegovina.
Method: The chosen data collection method was online surveying via Google search engine. The target group were students of biomedical sciences in Bosnia and Herzegovina. The surveying was conducted in July 2019, and responses were subjected to descriptive statistics.
Results: Although the majority of participants claimed that they were familiar with the seminar and scientific papers writing methodology and that the related course is available in their faculty’s curriculum, the quality of such courses may be questioned as the majority of study participants self-reported that they do not possess or did not posses necessary knowledge for writing and publishing a scientific paper. Also, the majority of respondents reported that they have never participated in any scientific research, which questions the involvement of students in scientific research in our country as well. More than half of respondents were actively reading scientific papers, but a third of them did not have that habit. Two-thirds of students reported that they have never attended any scientific event where they could learn more about the scientific research methods. Inadequate awareness of the importance of research, lack of students’ interest in making a research, and lack of knowledge were characterized as main obstacles in conducting scientific research according to survey responses.
Conclusion: Information obtained through research indicate that the student potential in scientific research in Bosnia and Herzegovina has not been used in its maximal capacity, requiring several steps to be taken towards its improvement.

12.Occult Adrenal Insufficiency in Renal Amyloidosis Patients
Didem Turgut, Serhan Vahit Piskinpasa, Havva Keskin, Kemal Agbaht, Ezgi Coskun Yenigun, Fatih Dede
doi: 10.5222/MMJ.2021.93902  Pages 52 - 57
Amaç: Sistemik amiloidoz birçok organı etkileyebilir ve adrenal yetmezlikle sonuçlanabilecek endokrinolojik problemlere sebep olabilir. Renal tutulumlu amiloidoz hastalarında ise adrenokortikal rezervi değerlendirmek zordur. Biz bu çalışmada farklı kortizol ölçüm yöntemleri ile renal tutulumlu amiloidoz hastalarında gizli adrenal problemlerini tespit etmeyi planladık.
Yöntem: Bu kesitsel çalışmada renal tutulumu olan amilodoz hastalarını ve sağlıklı kontrol grubunu adrenal yetmezlik testleri açısından değerlendirdik. Bazal kortizol ve kortizol bağlayıcı globulin (KBG) ölçüldü. Serum serbest kortizol düzeyi hesaplandı. 250 mcg ACTH stimulasyon testi sonrası kortizol yanıt testleri değerlendirildi ve serbest kortizol indeksi (SKI) hesaplandı.
Bulgular: Çalışmaya 20 amilodoz hastası ve 25 sağlıklı kontrol grubu dahil edildi. Bazal serum kortizol düzeyleri hasta ve kontrol grubunda benzerdi [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)]. Ancak amiloidoz grubunda ACTH stimulasyon testi sonrası 60. dk. kortizol yanıtı daha düşüktü [624 (497-685) vs 743 (674-781) nmol/L, p=0.011)]. 20 hastanın 8’inde (40%) bu değer <500 nmol/L olarak bulundu. Ancak sadece bu sekiz hastanın üçünde (15%) SKI <12 nmol/mg olarak bulundu. Bu üç hasta klinik olarak da adrenal yetmezlikle uyumlu olabilecek bulgular taşıyordu.
Sonuç: Ağır proteinürisi olan renal tutulumlu amiloidoz hastalarında, adrenal yetmezlik araştırılırken sadece ACTH stimulasyon testinin kullanılması yanlış pozitifliklere sebep olabilir. Bu grup hastaları SKI gibi hesaplanmış ölçümlerle birlikte değerlendirmek daha uygun olacaktır.
Objective: Systemic amyloidosis may affect many organs, and may cause endocrinologic problems which may result in adrenal insufficiency. However, assessment of adrenocortical reserve is challenging in amyloidosis patients with renal involvement. We aimed to evaluate adrenocortical reserve with various methods of cortisol measurement to determine any occult clinical condition.
Methods: Patients with renal amyloidosis and healthy subjects were evaluated in this cross-sectional study. Basal cortisol, corticosteroid-binding globulin (CBG), and albumin levels were measured. Serum free cortisol (cFC) level was calculated. Cortisol response tests performed after ACTH stimulation test (250 μg, intravenously) were evaluated, and free cortisol index (FCI) was calculated.
Results: Twenty renal amyloidosis patients, and 25 healthy control subjects were included in the study. Patients and control subjects had similar median serum baseline cortisol levels [258 (126-423) vs 350 (314-391) nmol/L, p=0.169)] whereas patients’ stimulated cortisol levels at the 60th minute were lower [624 (497-685) vs 743 (674-781) nmol/L, p=0.011)]. The 60th-minute total cortisol levels of 8 of the 20 (40%) amyloidosis patients were <500 nmol/L, but only three of these 8 patients had stimulated FCI <12 nmol/mg suggesting an adrenal insufficiency (15%).
Conclusion: ACTH stimulation test and cortisol measurements should be considered in renal amyloidosis patients with severe proteinuria to avoid false positive results if only ACTH stimulation test is used. It will be appropriate to evaluate this group of patients together with estimated measurements as FCI.

CASE REPORTS
13.Abdominal variant of Lemierre’s Syndrome in a Patient with Pancreatic Adenocarcinoma
Yavuz Furuncuoğlu, Bala Basak Oven, Başak Mert, Enis Cagatay Yilmaz, Mustafa Kemal Demir
doi: 10.5222/MMJ.2021.17992  Pages 58 - 62
Lemierre Sendromu, özellikle Fusobacterium necrophorum gibi enfeksiyöz ajanlarla ilişkili internal juguler ven tromboflebiti ile karakterize bir hastalıktır. Hem orofarenks, hem de gastrointestinal sistemde bulunan Fusobacterium necrophorum hepatik abselerle sonuçlanabilen ve ciddi bir durum olan pilefilebite neden olabilmektedir. Bu tabloya Lemierre sendromunun abdominal varyantı da denmektedir. Gastrointestinal malignitesi bulunan hastalar, özellikle cerrahi geçirenler, Lemierre sendromu abdominal varyantına daha duyarlı olmaktadır. Bu hastalığın hayatı tehdit eden komplikasyonlarının önüne geçmek için zamanında tanı gerekmektedir. Malignite hastalarında karaciğer metastazlarıyla ayrımında, difüzyon ağırlıklı manyetik rezonans görüntüleme (MRG) fayda sağlamaktadır. Erken tedavi hayat kurtarıcı olduğu için radyologlar ve klinisyenler yanlış tanının önüne geçmek adına bu zorlayıcı tanıyı da akıllarında bulundurmalılar.
Lemierre’s syndrome is an illness characterized by internal jugular vein thrombophlebitis related to infectious agents, primarily Fusobacterium necrophorum. These bacteria, residing in both the oropharynx and the gastrointestinal tract, may lead to pylephlebitis, a serious condition that could result in the development of hepatic abscesses. This manifestation of the disease is regarded as the abdominal variant of Lemierre’s syndrome. Patients with gastrointestinal malignancies, especially those who undergo surgeries, are susceptible to the abdominal variant of Lemierre’s syndrome. Timely diagnosis is required to avoid the life-threatening complications of the abdominal variant of Lemierre’s syndrome. Diffusion-weighted magnetic resonance imaging (MRI) might be very useful in differentiating this disease from liver metastasis in patients with malignancies. Radiologists and clinicians need to be aware of this challenging condition to prevent misdiagnosis, since prompt treatment is often lifesaving.

14.A Rare Cause of ST-Segment Elevation Myocardial Infarction in COVID-19: MINOCA Syndrome
Serkan Emre Eroğlu, Enis Ademoğlu, Samet Bayram, Gökhan Aksel
doi: 10.5222/MMJ.2021.25478  Pages 63 - 68
Non-obstrüktif Koroner Arterlerle birlikte Miyokart İnfarktüsü (MINOCA), miyokard infarktüsü teşhisi konulan bir hastada koroner anjiyografide darlığın %50’den az olması veya dar olmaması olarak tanımlanır.
COVID-19’daki büyük trombojenik yatkınlığı nedeniyle, elektrokardiyogram’da ST-elevasyonlu miyokard infarktüsü görülen hastalarda MINOCA sendromu tanısı nadiren düşünülür. Bu vaka sunumunda, yoğun bakım ünitesi’nde, COVID-19 viral pnömonisine bağlı solunum yetmezliği ile takip eden MINOCA tanısı almış 47 yaşında bir erkek hastayı tartışıyoruz. Hastanın 12-derivasyonlu elektrokardiyografisinde “inferiyor STEMI” vardı. Acil koroner anjiyografide de sol ön inen arter orta kısmında %30-40 darlık gösterildi. Bilgisayarlı tomografik pulmoner anjiyografisi normal olan hasta iyileşerek evine taburcu edildi.
MINOCA, COVID-19’a bağlı olarak hiperinflamasyon veya çeşitli süreçlerle tetiklenebilir. MINOCA sendromuyla ilişkili bu süreçleri açıklamak için daha fazla klinik denemeye ihtiyaç vardır.
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as having a stenosis of less than 50% or no stenosis in coronary angiography in a patient diagnosed with myocardial infarction.
Because of its thrombogenic predisposition in COVID-19, the diagnosis of MINOCA syndrome is rarely thought in the patients with ST-segment elevation myocardial Infarction on electrocardiogram. In this case report, we discuss a 47-year-old male patient diagnosed with MINOCA who was followed up with respiratory failure due to COVID-19 viral pneumonia in intensive care unit. His 12-lead electrocardiogram showed “inferior STEMI”. A 30-40% stenosis was also shown in the midportion of left anterior descending artery in emergency coronary angiography. The patient had a normal computed tomographic pulmonary angiography and was discharged with a full recovery.
MINOCA may be triggered by hyperinflammation or various processes due to COVID-19. To explain these processes associated with MINOCA syndrome, further clinical trials are needed.

15.A Misleading Presentation of Pheochromocytoma in Pregnancy: A Case Report
Jasmina Begum, Supriya Kumari, Manwar Ali, Saubhagya Kumar Jena, Kishore behera, Pritinanda Mishra
doi: 10.5222/MMJ.2021.29660  Pages 69 - 74
Pheochromocytoma is a catecholamine-secreting adrenal tumor and also a rare cause of secondary hypertension in pregnancy. Its low prevalence, nonspecific clinical presentation, and symptoms similar to preeclampsia generate a diagnostic challenge during pregnancy. A 23-year-old hypertensive pregnant woman at 36th gestational week of her first pregnancy was admitted with severe hypertension (210/150 mmHg), headache and proteinuria that made us presume the case as severe preeclampsia. In spite of starting with maximum doses of antihypertensive medications like IV labetolol,and oral nifedipine, loading dose of an anticonvulsant drug, and IV magnesium sulphate, her symptoms persisted. Keeping in view the risks involved to mother and fetus, we delivered the baby by emergency cesarean section. In the postoperative period, along with severe uncontrolled hypertension, she developed tremors, palpitation, and sweating that all led us to further diagnostic workup for secondary causes of hypertension. Eventually, a diagnosis of pheochromocytoma was confirmed by abdominopelvic contrast- enhanced computed tomography and by increased 24-hour urine metanephrine, normetanephrine, and vanillylmandelic acid levels. Subsequently, adrenal suppression was achieved by a multidisciplinary approach, and then she underwent laparoscopic adrenalectomy. This case highlights the importance of maintaining a high index of suspicion and multidisciplinary approach while investigating secondary causes of hypertension in young women, thereby differentiating it from preeclampsia.

16.Acute Retropharyngeal Calcific Tendonitis as a Rare Cause of Odynophagia and Neck Pain
Prempreet Kaur Manjit Singh, Muhammad Irsyad Mohamed Noor, Rohaizam Jaafar, Amali Ahmad, Irfan Mohamad
doi: 10.5222/MMJ.2021.37539  Pages 75 - 79
Retropharyngeal calcific tendonitis (RCT) is an aseptic inflammatory process of the superior oblique tendons of the longus colli muscle caused by the deposition of calcium hydroxyapatite crystals. We reported a 23-year-old woman who presented with a sudden onset of neck pain with odynophagia after waking up from sleep. Physical examination showed paracervical point tenderness with limited neck movement in all directions. Prior to surgery, further imaging was requested to aid in diagnosis, which in turn revealed RCT. It is important to be aware that RCT presentation may mimic other severe conditions such as retropharyngeal space abscess or meningitis.

LETTERS TO THE EDITOR
17.BCG Protection Against COVID-19: Is it Reality or Illusion?
Inas K. Sharquie, Khalifa E. Sharquie
doi: 10.5222/MMJ.2021.12499  Pages 80 - 82
Abstract | Full Text PDF




 

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