ISSN 2149-2042 | e-ISSN 2149-4606
Volume : 38 Suppl : 4 Year : 2025
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Medeniyet Medical Journal - Medeniyet Med J: 38 (4)
Volume: 38  Issue: 4 - 2023
1. Cover

Page I

ORIGINAL ARTICLE
2. Interatrial Block and Electrocardiographic Markers of Repolarization in Patients Hospitalized with COVID-19: Classical and Bayesian Analysis
Rengin CETIN GUVENC, Ali Kaan GUREN, Busra ENGUR, Selin CELİK, Refik DEMIRTUNC
doi: 10.4274/MMJ.galenos.2023.87400  Pages 236 - 242
Objective: Coronavirus disease-2019 (COVID-19) is associated with atrial fibrillation (AF) and ventricular arrhythmias. Several electrophysiological abnormalities on surface electrocardiography (ECG) are associated with AF and ventricular arrhythmias, either as markers of abnormal interatrial conduction or abnormal repolarization. The present study sought to understand whether such ECG markers are more common in patients hospitalized with COVID-19 infection during the pandemic.
Methods: A total of 87 COVID-19 patients formed the study group, whereas 64 patients who were hospitalized for any reason other than COVID-19 infection served as controls. The frequency of partial and advanced interatrial block (IAB), QT and corrected QT (QTc) durations, QT dispersion (QTd), and T peak-to-end duration (Tpe) were measured from ECGs at admission.
Results: Both partial and advanced IAB were more common in patients with COVID-19, although statistical significance was only observed for advanced IAB (11.5% in COVID-19 patients vs. 0.0% in controls, p=0.005). There were no differences between the groups for QTc, QTd or Tpe. On Bayesian analyses, there was strong evidence favoring an association between COVID-19 and advanced IAB (BF10: 16), whereas there was no evidence for an association for partial IAB, QTc, QTd, or Tpe (BF10<1 for all).
Conclusions: Patients hospitalized with COVID-19 were more likely to have advanced IAB, which may explain why AF is more frequent in these patients.

3. Vulnerabilities of Prostate Glandular Concretions Considered as Artefacts: A Cross-sectional Biopsy Slide Study
Surraj SUSAI, Rohini MOTWANI, Mrudula CHANDRUPATLA
doi: 10.4274/MMJ.galenos.2023.34683  Pages 243 - 251
Objective: There is no clear consensus regarding the contour of prostatic glandular intraluminal concretions. This study enlightens the rational approach toward deciphering the true nature of these concretions and evaluates their role in normal routine histology of the prostate gland.
Methods: Fifty hematoxylin and eosin slides that were prepared from procured transrectal biopsy specimens of normal prostate glands from asymptomatic patients suspected of having a prostatic disease but later found to be normal were retrospectively observed for the staining, contour, and positioning of the aggregated masses or concretions within their prostatic lumina and were then compared with the blood prostate specific antigen (PSA) levels.
Results: Although significant associations highlighting the utility of these masses in presumed pathological states of the gland were drawn by comparing their staining parameters and contours to those of their respective PSA levels, their interluminal contour variations and vivid staining appearances did not necessarily rule out the possibility of some of them being artefacts, provided they were assessed in totality with the surrounding acini. Intensely eosinophilic concretions were found in patients with a high mean age and those with high PSA levels.
Conclusions: Prostatic intraluminal masses that were rounded tended to indicate pathological shifts within the gland; however, the possibility of them changing to artefacts during slide preparations could not be ruled out.

4. Novel Predictor of the AF Development in Patients with OSAS: Importance of Visceral Adipose Index
Ugur OZKAN, Muhammet GURDOGAN
doi: 10.4274/MMJ.galenos.2023.07455  Pages 252 - 259
Objective: Obstructive sleep apnea syndrome (OSAS) is a sleep disorder whose frequency is increasing daily due to modern lifestyle. Patients with atrial fibrillation (AF), which has the same predisposing factors, frequently visit the outpatient clinic with complaints of palpitation. Existing symptoms are often associated with the course of OSAS, and the development of AF, a disease with high morbidity and mortality, cannot be detected. In our study, we investigated the relationship between the visceral adiposity index (VAI) and AF development in these patients.
Methods: We retrospectively analyzed 207 patients with OSAS who visited the cardiology outpatient clinic. The data of 44 patients with AF and 163 patients without AF were compared.
Results: Demographic characteristics and clinical risk factors were similar between the groups (p>0.05). VAI, apnea-hypopnea index, and inflammatory markers were higher in the AF group, and these risk factors were significant in the multivariate analysis (p<0.05).
Conclusions: Our study is important in terms of showing VAI as one of the most important predictors of AF, which has an impact on mortality and morbidity in patients with OSAS, whose frequency is increasing daily. Further prospective studies are required to confirm our observations and determine their clinical applicability.

5. The Impact of Effective Vaccination on Clinical and Radiological Involvement in COVID-19 Patients
Coskun DOGAN, Deniz BILICI, Burcu ARPINAR YIGITBAS, Omer ZENGIN, Orhan ZOR, Oguzhan AKMAN, Ilyas KOCABAG, Gonul Seven YALCIN, Esra ERTAN YAZAR
doi: 10.4274/MMJ.galenos.2023.88655  Pages 260 - 267
Objective: We aimed to analyze clinical, radiological, and laboratory differences between vaccinated and unvaccinated patients admitted to hospital due to coronavirus disease-2019 (COVID-19) pneumonia.
Methods: Patients hospitalized in the COVID-19 clinic between February 2022 and August 2022 were included in the study. Demographic, clinical features, and treatment results. Furthermore, the COVID-19 vaccination status of the cases was recorded. The cases were divided into two groups as those with and without COVID vaccination and compared.
Results: A total of 215 patients were included in our study, and the patients were divided into 2 groups according to their vaccination status: those who were unvaccinated against COVID-19 (n=100) and those who vaccinated COVID-19 (n=115). The presence of comorbid chronic diseases and cancer was lower in the unvaccinated group. The duration of hospitalization was longer in the unvaccinated group than in the vaccinated group (9.6 and 7.1 days, respectively) (p<0.001). While there was no difference between the two groups in terms of the radiological involvement pattern, the number of involved segments was significantly higher in the unvaccinated group (p<0.05). The number of patients who received high-dose glucocorticoid therapy in the unvaccinated group was higher (28 cases vs. 11 cases; p<0.001). There was no statistically significant difference between the two groups in terms of transfer of patients to the intensive care unit (p>0.05). 11.3% (13/115) of the patients in the vaccinated group died, whereas 14% (14/100) died in the unvaccinated group.
Conclusions: The vaccinated cases who were infected with COVID-19 had a shorter duration of hospitalization and lower severity of radiological involvement. The requirement for pulse steroids was also less compared with unvaccinated individuals. Despite having chronic diseases and cancer, which is considered to have a significant effect on mortality in COVID-19 patients. In addition, although the vaccinated group was older, they had mortality rates similar to those of unvaccinated subjects.

6. Early Echocardiographic Findings of Pulmonary Hypertension-specific Therapy in Children
Akif KAVGACI, Fatma Sedef TUNAOGLU, Serdar KULA, Ayse Deniz OGUZ, Semiha TERLEMEZ, Fatma INCEDERE
doi: 10.4274/MMJ.galenos.2023.06706  Pages 268 - 275
Objective: Echocardiography is a very useful tool for the diagnosis and evaluation of pulmonary hypertension (PH). This study was planned to investigate whether echocardiographic (ECHO) data of patients with PH are effective in the follow-up and course of treatment.
Methods: A retrospective analysis of the data from 26 PH patients was performed. Analyses were performed on the data of the patients, including their demographics and ECHO findings. The ECHO measurements of the patients were labeled as 0 (beginning of the PH specific therapy), 1 (on the 15th day of the therapy), 2 (one month after the previous echocardiogram).
Results: The left ventricle ejection fraction (EF) (p=0.05) and fractional shortening (FS) (p=0.038) values in ECHO2 were significantly higher than those in ECHO1. Aortic velocity-time integral1 (VTI1) was significantly higher than aortic VTI0 (p=0.001; p<0.01), and tricuspid annular plane systolic excursion2 (TAPSE2) was significantly higher than TAPSE0 (p=0.046). Moreover, right ventricular ejection time1 (RVET1) was significantly higher than RVET0 (p=0.034), and left ventricular ejection time1 (LVET1) was significantly higher than LVET0 (p=0.003).
Conclusions: This study provides information on ECHO parameters that improve during the initial stages of therapy. Based on the results of our study, even at the beginning of treatment, there were increases in right and left ventricular filling, EF, and FS. Clinical deterioration of PH can be detected early/before the clinical status of the patient worsens with detailed examinations using echocardiography.

7. Speech Perception as a Function of the Number of Channels and Channel Interaction in Cochlear Implant Simulation
Mustafa YUKSEL, Sultan Nur KAYA
doi: 10.4274/MMJ.galenos.2023.73454  Pages 276 - 283
Objective: Speech perception relies on precise spectral and temporal cues. However, cochlear implant (CI) processing is confined to a limited frequency range, affecting the information transmitted to the auditory system. This study analyzes the influence of channel interaction and the number of channels on word recognition scores (WRS) within the CI simulation framework.
Methods: Two distinct experiments were conducted. The first experiment (n=29, average age =23 years, 14 females) evaluated the number of channels using eight, twelve, sixteen, and 22 channel vocoded and nonvocoded word lists for WRS assessment. The second experiment (n=29, average age =25 years, 16 females) explored channel interaction across low, middle, and high-interaction conditions.
Results: In the first experiment, participants scored 57.93%, 80.97%, 83.59%, 91.03%, and 95.45% under 8, 12, 16, and 22-channel vocoder and non-vocoder conditions, respectively. The number of vocoder channels significantly affected WRS, with significant differences observed in all conditions except between the 12-channel and 16-channels (p<0.01). In the second experiment, the participants scored 2.2%, 20.6%, and 50.6% under high, mid, and low interaction conditions, respectively. Statistically significant differences were observed across all channel interaction conditions (p<0.01).
Conclusions: While the number of channels had a notable impact on WRS, it is essential to note that certain conditions (12 vs. 16) did not yield statistically significant differences. The observed differences in WRS were eclipsed by the pronounced effects of channel interaction. Notably, all conditions in the channel interaction experiment exhibited statistically significant differences. These findings underscore the paramount importance of prioritizing channel interaction in signal processing and CI fitting.

8. Effects of Potentially Inappropriate Medications in Older Patients with Gastrointestinal System Cancer
Melike OZKAN, Irfan KARAHAN, Selim YALCIN, Gozde SENGUL AYCICEK
doi: 10.4274/MMJ.galenos.2023.03063  Pages 284 - 290
Objective: Potentially inappropriate medications (PIM) is a crucial problem in the geriatric population. The amount of prescription and unadherence increase because of the different problems encountered in cancer patients. Our aim was to evaluate the effects of PIM in patients with gastrointestinal system cancer and to investigate its relationship with chemotherapy side effects, mortality, and progression.
Methods: This retrospective cohort study assessed 154 patients with gastrointestinal system cancer. Demographics and disease features, the presence of PIM according to the “TIME-to-STOP” criteria and baseline laboratory parameters were recorded. The effects of PIM on survival and adverse treatment events were evaluated.
Results: 66.9% of the cases were male and 33.1% were female. The mean age was 71.9±6.4 years. The most common side effects of chemotherapy are nausea, vomiting, kidney injury, and pain. The most frequently used prescriptions among the 98 PIMs were gliclazide, hyoscine N-butylbromide, simethicone, diphenoxylate atropine, and thiocolchicoside. PIM was detected in 68.1% of the participants. Chemotherapy side effects were more common in PIM group (p<0.001, odds ratio =5.6). PIM had no effect on mortality. Factors associated with mortality were age, stage, albumin, creatinine, operation history, and progression. A significant relationship was found between age, cancer stage, albumin, creatinine, operation history, and PIM in the regression model. There was no relationship between PIM and progression-free survival.
Conclusion: Chemotherapy toxicity may increase with PIM detected on diagnosis. We suggest that PIM is an important factor in predicting the side effects of chemotherapy and minimizing the adverse effects.

CASE REPORTS
9. Unusual Pattern of Coeliac Trunk and Its Branches: A Cadaveric Study of Two Cases with its Embryological and Clinical Correlation
Ariyanachi KALIAPPAN, Rohini MOTWANI, Mrudula CHANDRUPATLA
doi: 10.4274/MMJ.galenos.2023.63993  Pages 291 - 295
The coeliac trunk, the first anterior branch, often originates at the level of the T12 vertebral body, right below the aortic hiatus, as the first ventral branch of the abdominal aorta. It commonly divides into the left gastric, common hepatic, and splenic arteries. We report a rare variation in the branching pattern and course of branches of the coeliac trunk in two donated female cadavers during routine abdominal dissection. It is essential to understand the coeliac trunk and the distinctions in its origin and branching pattern to perform efficient upper abdominal surgical and radiological procedures and to adopt novel interventional and treatment options for hepatic cancers. As anatomists, we are also attempting to link our study’s variations to their embryological genesis.

LETTERS TO THE EDITOR
10. Comment on “The Effects of Thyroid Hormone Levels on Patent Ductus Arteriosus Closure in Newborns”
Mahmood Dhahir AL-MENDALAWI
doi: 10.4274/MMJ.galenos.2023.36724  Page 296
Abstract |Full Text PDF

ERRATUM
11. Erratum

doi: 10.4274/MMJ.galenos.2023.e002  Page 297
Abstract |Full Text PDF

INDEX
12. 2023 Referee Index

Page E1
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13. 2023 Author Index

Pages E2 - E3
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14. 2023 Subject Index

Pages E4 - E5
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