International Journal of Current Medical and Biological Sciences

Where do we stand in predicting contrast-induced nephropathy?

Ertan Aydın — 2022-12-27

We read with great interest Toprak's research article on contrast-induced nephropathy, titled "Relationship between basal liver function test levels and contrast-induced nephropathy (CIN) in patients undergoing coronary angiography", published in your journal (1). A well-designed and presented article explores the possible relationship between preprocedural basal liver enzymes and contrast-induced nephropathy. It has been shown that high levels of basal liver enzymes Aspartate Alanine Aminotransferase (ALT) and especially Aminotransferase (AST) may predict the development of CIN. Multivariate logistic regression analysis revealed that AST level was an independent predictor of CIN (OR 1.006, 95% CI 1.003–1.009, p<0.001). AST level was found to be predictive for estimating CIN in ROC curve analysis, with optimal threshold value, AST ≥43 U/L, 77% sensitivity and 71% specificity (area under the curve: 0.764, 95% confidence interval [CI]: 0.712-0.817, p<0.001).

CIN has become a common morbidity and mortality due to increasing radiocontrast-mediated imaging (2). Therefore, it has become essential to predict the development of CIN and to take more intensive medical measures before contrast application. Although it is recommended today to predict the development of CIN, such as the Mehran Risk Score, increasing studies have shown that many important parameters other than the parameters of the Mehran score may be important in predicting CIN (3,4). We think that integrating simple, reproducible and quickly accessible parameters such as AST and ALT into the Mehran Risk Score will further increase the predictive value of contrast-induced nephropathy of the Mehran risk score.

Although hydration is currently the only proven treatment to prevent contrast nephropathy, CIN is still frequently encountered, especially after percutaneous coronary procedures, despite preprocedural and post-procedural hydration (5). It is seen more frequently in subjects prone to nephropathy such as diabetes, and kidney functions are affected more deeply than normal individuals after contrast application (6). Therefore, increasing the predictive value of the Mehran risk score would be particularly beneficial for such patients. In addition to all these, it has been shown that C-peptide may be protective against contrast nephropathy in diabetic patients in a recent article by Toprak (7). If these results are supported by large-scale randomized clinical trials, administration of C-peptide in high-risk patients may hold great promise in preventing the development of CIN.

The Investigation of Anatomic and Orthopedic Properties of First Metatarsal Bone

Berin TUGTAG DEMİR — 2022-12-01

Amaç: Alt ekstremite ile ilişkili klinik deformitelerden en çok etkilenen yapı, ortopedik problemlere ve ayakta kronik ağrıya neden olabilen ilk metatarsal kemiktir, çünkü talus ve kalkaneustan gelen yükün yaklaşık %80'i medial ark yoluyla yere iletilir.

Materyal ve Metod: Çalışmamız Ortopedi ve Travmatoloji Anabilim Dalı'nda dolaşım yetmezliği nedeniyle ampute edilen ayak deformitesi olmayan 32 erişkin hastanın alt ekstremiteleri üzerinde yapıldı. İlk olarak tibia uzunluğu, ayak uzunluğu ve ayak genişliği ölçüldü. Daha sonra birinci metatarsın boyutları ve uzunluğu ile birinci metatarsın proksimal ve distal eklem yüzey boyutları ölçüldü.

Bulgular: Ortalama değerler tibia uzunluğu:35,9 cm, ayak uzunluğu:22,7cm, ayak genişliği:8 cm, birinci metatars uzunluğu:5,8 cm olarak hesaplandı. Proksimal uç boyutları, distal baş boyutları ve kemiğin en ince yeri boyutları arasında istatistiksel anlamlılık bulundu (p≤0,01).

Çeşitli dış deforme edici kuvvetler, medial longitudinal arkta değişikliklere neden olur ve ayak ağrısına yol açar. Başın uzunluğu, şekli ve birinci metatarsın proksimal ve distal eklem yüzeylerinin boyutları ayak deformitelerinin gelişiminde önemli faktörlerdir.

Sonuç: Peroneus longus ve tibialis anterior kasları birinci metatars üzerine eklendiğinden, tendonlarının uyguladığı kuvvetler kemiğin morfolojisini etkiler. Bu nedenle, ayak deformitelerinin önlenmesi ve tedavisinde bu kasların ve tendonlarının birinci metatars boyutlarına göre boyutları önemlidir.

Relationship Between Primary Tumor, Metastasis and Blood Type in Patients with Malignancy Receiving Palliative Care

Onur Öztürk — 2022-12-27

Background: The blood type is known to be associated with the risk of cancer. This study aimed to evaluate the relationship between oncological diagnoses and blood groups of inpatients receiving palliative care. Material and methods: This retrospective study was conducted with patients receiving palliative care at our hospital between December 2019 and December 2020. The records of patients receiving comprehensive palliative care during this 1-year period were obtained from the hospital archive, and patients diagnosed with a malignant disease were included in the study. Results: Overall, 176 patients were included in the study. No association was found between the cancer type and ABO/Rh blood groups. The incidence of central nervous system (CNS) and breast cancers was lower in patients with blood group A than in those with other blood groups (p = 0.028). Moreover, the focus and site of metastasis and the ABO/Rh blood group were not related. In addition, the comparisons between blood groups in terms of the presence and site of metastasis revealed no significant relationship. Conclusions: Patients with blood group A had a lower incidence of CNS and breast cancers than patients with other blood groups, and there was no relation between metastases status and ABO/Rh blood groups.

An example from non-traumatic emergency patient group in a post-conflict low-income region: Dialysis patients applying to the emergency department in northwest Syria

BURAK ÇELİK — 2023-01-22

Background

In this study, we aimed to investigate the demographic characteristics, comorbidities and reasons for applying to emergency dialysis in Syrian hemodialysis patients who applied to the emergency department.

Material Method

This study was conducted at AAA Hospital and BBB Hospitals in northwestern Syria. This study included end-stage renal failure (ESRD) patients and underwent emergency hemodialysis as a result of emergency department visits between January 1, 2022, and March 31, 2022. Demographic data, vital signs, laboratory results, concomitant diseases, and indications for emergency dialysis were investigated retrospectively and analyzed statistically.

Results

In this study has been detected that the mean age of the participants was 58 years and 34 (59.6%) of the patients were male and 23 (40.4%) were female. The patients who received two dialysis sessions per week older the patients who received three dialysis sessions per week (p=0.030). The presence of hypertension was found to be significantly higher in patients who received three sessions per week (p=0.004). Emergency dialysis was performed in 26.3% of patients due to hypervolemia, in 14.1% due to hyperkalemia, in 29.8% due to uremic findings, and in 29.8% due to metabolic acidosis. When the laboratory parameters have been investigated only sodium values were found to be significantly higher in patients who received two sessions of hemodialysis (p=0.004).

Conclusion

It may suggest that further increasing the hemodialysis service in northwest Syria may contribute to reaching the peak benefit to decrease the emergency dialysis patients.

Investigation of the Effects of Cyclooxygenase I and Cyclooxygenase II Inhibitors on Angiogenesis in a Random-Pattern Rat Abdominal Skin Flap

ayhan sönmez — 2023-01-29

Background:

Cyclooxygenase (COX) inhibiting agents are already in use before, during and after flap surgery due to their analgesic and anti-inflammatory properties and they are known to improve flap viability. We have investigated the influence of selective COX2 inhibitors in the neoangiogenesis of random pattern flaps.

Methods:

Forty-eight rats were divided into 4 groups and their lateral based inguinal flaps measuring 3x3 cm were used as the experimental flap models. Group 1 was the control group so no agents were administered. In groups 2, 3 and 4; Celecoxib (selective COX2 inhibitor), Metamizole Sodium (nonselective COX1 and COX2 inhibitor) and Paracetamol (selective to COX2 in the periphery) were administered, respectively. Clinical observations, radiological studies and histopathological analyses were undertaken in order to demonstrate and compare the individual agents' influence in flap viability and neoangiogenesis.

Results:

Groups 2 and 4 displayed lesser neoangiogenesis when compared with the control group by the end of the first week. The vessel intensities of groups 3 and 1 were not significantly different at the end of the first week; however, by the end of the third week, group 3 yielded a significantly better neoangiogenesis rate (p<0,05). Metamizole sodium is proven to significantly enhance vascularization by the end of 3 weeks.

Conclusion:

This study has shown that Metamizole Sodium, a collectively inhibiting COX1 and COX2 significantly improves flap vascularity, and when postoperative analgesia is required following a flap surgery, it is a suitable drug of choice.

The Effect of the SARS-CoV-19 (COVID-19) Virus on Sperm Parameters of Patients with Male İnfertility

Eyup Dil — 2023-02-02

Background: Altough Coronavirus Disease 2019 (COVID-19) disease mainly affects the pulmonary system, studies on male reproductive health are limited. We aimed to investigate effect of spermiogram parameters of COVID-19 disease in patients who applied our clinic with male infertility.

Material and Methods: We retropspectively analysed 39 outpatients with male infertility diagnosed with COVID-19 disease between 1st March 2020 and 31st March 2022 in our andrology policlinic. The demographic data of the patients and the spermiogram analyzes before and after the COVID-19 disease, which were evaluated in the andrology laboratory of our clinic, were recorded and compared statistically.

Results: The mean age of the patients was 33.44±7.52 years and body mass index (BMI) was 27.05±3.38 kg/m². The mean time between PCR test and second semen analysis was 3.95±3.59 months. While we observed a statistically significant reduction in semen volume and significant deterioration in sperm morphology, we could not detect alteration on sperm motility.

Conclusion: We observed adversly effects of SARS-CoV-2 virus on spermiogram parameters in patients wtih male infertility. Deterioration of spermiogram after COVID-19 disease may results with male infertility.

Keywords: Semen, COVID-19, Male infertiliy, SARS-CoV-2, Spermatogenesis

The Efficacy of Large-Focused and Controlled-Unfocused (Radial) Extracorporeal Shock Wave Therapies in the treatment of Patellar Tendinopathy: A randomized sham-controlled single-blind trial

Volkan Şah — 2023-02-01

Objectives: Although Extracorporeal Shock Wave Therapy (ESWT) is a widely used treatment option in patellar tendinopathy (PT), treatment protocols are not clearly defined. There is no consensus on the type of shock wave or the energy level, number of shocks, pressure, and frequency values. For this reason, this study will, on the one hand, aim to contribute to the confusion of whether ESWT is effective in the treatment of PT and, on the other hand, try to define the most effective ESWT protocol in the treatment of PT, rather than choosing one at random.

Methods: Seventy eight patients with PT randomised to ‘Controlled Unfocused/Radial’ ESWT (r-ESWT), ‘Large-Focused’ ESWT (f-ESWT) and sham ESWT (s-ESWT) groups. The patients received the ESWT application once a week for a total of three sessions. Patients were evaluated with Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment-Patella (VISA-P) scores just before the treatment (baseline), one day after the end of treatment (week 3), one month after the end of treatment (week 7) and three months after the end of treatment (week 15).

Results: VAS and VISA-P scores have significantly improved at 3^th, 7^th, and 15^th weeks in the r-ESWT group (p<0.05) and at 7^th, and 15^th weeks in the f-ESWT group (p<0.05). In terms of baseline-3^th week, baseline-7^th week and baseline-15^th week differences of VAS and VISA-P scores, r-ESWT was superior to f-ESWT (p<0.05).

Conclusions: Although both r-ESWT and f-ESWT were effective in the treatment of PT according to the results of this study, the efficacy of r-ESWT was superior to f-ESWT.

Key Words: patellar tendinopathy, extracorporeal shock wave therapy, radial, focused

The Prognostic Role of the Systemic Inflammatory Index (SII) in Heart Failure Patients

Yasin Özen — 2023-02-20

Aim: The prevalence of heart failure (HF) is increasing worldwide with new treatment methods (percutaneous, medical) that increase survival in heart diseases. Inflammation plays a central role in the development of HF, and many inflammatory markers have been studied to determine HF survival. In this study, we aimed to investigate the relationship between Systemic Immune-Inflammation Index and survival in patients with HF.

Material and Methods: A total of 672 HF were included in this retrospective and observational study. The primary end-point of the study was all-cause mortality. The median follow-up duration of the study patients was 21 (8-42) months.

Results: 672 patients were analyzed and all-cause mortality developed in 278 of these patient groups during the follow-up period. The number of all-cause mortality was 113 (34%) in the low SII group and the number of all-cause mortality was 165 (49%) in the high SII group.

Discussion: This is the first and only study in the literature showing the relationship between the SII index and survival in patients with HF. In addition, the main finding of our study is that the SII index is an independent predictor of mortality in patients with HF.

Conclusion: SII may have prognostic significance in the follow-up of HF patients

Evaluation of Knowledge and Attitudes of Family Medicine Residents on Traditional and Complementary Medicine: A descriptive comperative study

Mahmut Isik — 2023-03-03

Abstract

Background: The World Health Organization (WHO) urges to integrate traditional medicine into health services particularly primary health care services. The aim of this study is to evaluate the knowledge and attitudes of residents on Traditional and Complementary Medicine (T&CM) and compare the ones in the department of Family Medicine with the others.

Materials and Methods: A descriptive comperative study. Residents in a training and research hospital in Istanbul were divided into three groups as Family Medicine, Surgical specialities, and other Medical specialities. A questionnaire consisting of 23 questions was prepared and applied to the residents at the hospital, using a face-to-face interview technique.

Results: In this study, 245 residents from different departments participated. Among them, 61.2% of the physicians (n=150) stated that T&CM applications will not be an alternative to modern medicine; 68.9% (n=169) stated that T&CM applications might contribute to modern medicine. It was determined that the most known applications were Acupuncture, Cupping therapy (Hijama), and Hirudotherapy. Among the participants, 11.0% (n=27) of the residents had a certificate of a T&CM applications. According to 69.2% of the residents in Family Medicine the main role of T&CM is in wellness and preventative healthcare. Among the residents in the Family Medicine, the number of participants using T&CM applications in the treatment of their own health problems was found to be higher than the ones in the other medical and surgical specialities; 38.5%, 9.6% and 10.1%, respectively (p<0.001).

Conclusion: Compared to other medical and surgical specilities, residents in family medicine seem to have a more positive attitude towards T&CM practices.

Is very advanced maternal age associated with increased prevalence of placenta previa?

Muhammet serhat Yildiz — 2023-03-03

Background: Pregnancies of advanced maternal age have been increasing worldwide in recent years. Advanced maternal age pregnancies have adverse obstetric, perinatal, and neonatal outcomes. This study aims to investigate the frequency of placenta previa in pregnant women of very advanced maternal age and to examine the relationship between advanced maternal age and placenta previa using statistical methodologies.

Methods: This prospective study was conducted at the Sanliurfa Gynecology and Obstetrics Hospital in Sanliurfa, Turkey and included 140 pregnant women aged 46 to 48 years who applied to the hospital between September 2018 and December 2019. Patients were divided into two groups according to the mode of delivery: (i) normal vaginal delivery (NVD) (n=99) and (ii) cesarean section (C-section) (n=41). Demographic characteristics, pregnancy outcomes, C-Section rates, preterm delivery rates, fetal growth restriction rate, neonatal outcomes, and C-Section indications were recorded.

Results: A significant difference was found in infant birth weight and the gestational week at delivery between the NVD and C-section groups (p<0.05 for both). According to the independent samples t-test, infant birth weight was significantly higher in the NVD group compared to the C-section group (p<0.05). Placenta previa was detected in 8 (19.5%) patients in the C-Section group.

Conclusion: The results indicate that placenta previa, which is one of the location anomalies of the placenta, is more common in pregnancies of very advanced maternal age than in pregnancies of normal reproductive age and that having a less fertile uterus at an older age can cause to adverse pregnancy outcomes.

Keywords: Advanced maternal age, Placenta previa, Normal vaginal delivery, Cesarean section

Investigation of Complementary and Alternative Medicine Use in Turkish Patients with Epilepsy

Ülkühan DÜZGÜN — 2023-03-03

Background: New generation antiepileptic drugs, adopted in treating epilepsy in recent
years, yield better results. Yet, patients may perceive themselves as helpless due to the
burden of epilepsy and, thus, seek any treatment approach to relieve their problems.
Complementary/alternative medicine (CAM) has recently become preferred among
patients worldwide. In this study, we attempted to investigate CAM use among Turkish
patients with epilepsy and their knowledge, attitude, and behavior profiles regarding
CAM. Materials and Methods: We carried out this prospective cross-sectional study
with epileptic patients aged 18 years and older. After noting down their demographic
and clinical characteristics, we inquired the patients about CAM methods. In addition,
we collected the data using the Perception of Health Scale (PHS), the Dispositional Hope
Scale (DHS), and the Problem-Solving Inventory (PSI).Results: There were 135 patients
with epilepsy, 45.92% males and 54.1% females, with a median age of 29 years
(IQR=22-42). While 81.5% of the patients had focal-onset, 18.5% had generalized-onset
seizures. The mean disease duration was 9 years (IQR=4-19). About one-third (29%)
used at least one CAM method. The most common CAM methods reported by the
patients were massage therapy (30.2%), herbal therapy (25.2%), and hijamat-cupping
(18.6%). In addition, 78.95% stated the CAM method they used was helpful. Finally, we
found disease duration to be significantly higher among CAM users (p=0.02).
Conclusion: CAM use was prevalent among patients with epilepsy, and those with
prolonged disease duration used CAM more; therefore, patients should be inquired about
CAM use. Further research may consider scientifically evaluating all aspects of CAM
use and methods. Keywords: Complementary and alternative medicine; CAM;
Traditional medicine; Epilepsy; Turkish patients; Perception of health scale;
Dispositional hope scale; Problem-solving inventory