Annals of Medical Research

Two-stage pancreaticoduodenectomy: A case report

2024-03-04T11:43:58+00:00

Pancreaticoduodenectomy is one of the major gastrointestinal surgeries and still has significant complication rates. Although most complications appear postoperatively, severe intraoperative difficulties and complications can occur in certain circumstances. Here, we presented the management of two cases who underwent two-stage pancreaticoduodenectomy due to intraoperative problems. Two patients have become hemodynamically unstable during an elective pancreatic resection combined with both arterial and venous reconstructions. All the gastrointestinal reconstructions were postponed to second sessions for damage control surgery. A two-stage pancreaticoduodenectomy is an option to be considered in a hemodynamically unstable patient during elective pancreaticoduodenectomy.

The impact of vaccination against SARS-CoV-2 infection on vestibular function and central compensation

2024-03-28T05:25:56+00:00

Aim: The aim of this study was to evaluate the effects of SARS-CoV-2 vaccines on vestibular system. In addition, in this study we aimed to investigate the possible protective effects of vaccination on the vestibular system in people who recovered Covid-19.

Materials and Methods: Totally, 77 subjects were divided into four groups, and evaluated using computerized dynamic posturography (CDP), vestibular evoked myogenic potentials (VEMPs) and video head impulse test (v-HIT). The groups were as follows; Group 1; who had SARS-CoV-2 infection at least one year ago and have not been vaccinated at all. Group 2; who had SARS-CoV-2 infection at least one year ago and were vaccinated 5 times (2 doses of Sinovac and 3 doses of Biontech). Group 3; who had no known SARS-CoV-2 infection, and were vaccinated 5 times (2 doses of Sinovac and 3 doses of Biontech). Group 4; who had no known SARS-CoV-2 infection, and have not been vaccinated at all.

Results: The SOT values of (Covid-Vaccine-) group were better than the (Covid+Vaccine-) group (p=0.001), and no other significant difference was found between the groups (p>0.05). The v-HIT gains of the groups were not significantly different (p>0.05). On o-VEMPs, there was elongation in the N1 and P1 latencies in (Covid+Vaccine-) group compared to (Covid-Vaccine+) group. The amplitudes decreased in (Covid+Vaccine-) compared to (Covid-Vaccine-) (p<0.05). According to c-VEMP results, vaccination led to elongation in the P1 latencies and increased the P1-N1 amplitudes (p<0.05).

Conclusion: Both SARS-CoV-2 viral infection and vaccination may impact on vestibular system. The impact of vaccination seems on the saccule level. However, vaccination may limit or diminish the impact of SARS-CoV-2 on equilibrium, possibly by facilitating the central compensation.

Imumunohistochemical analysis of CD133 and nucleostemin in squamous cell carcinoma and adenocarcinoma

2024-03-28T06:59:29+00:00

Aim: Cancer stands as a significant health issue in our era, with lung cancer being among the most widespread types in both Turkey and worldwide. The diagnosis may be delayed due to the late detection of symptoms and signs. Cancer stem cells cause the initiation and progression of cancer. There is a risk of cancer recurrence due to cancer stem cells that cannot be destroyed. Therefore, it is important to detect cancer stem cells and prevent the proliferation of these stem cells.

Materials and Methods: In the Pathology Department of Pamukkale University Faculty of Medicine, 72 squamous cell carcinoma and 51 adenocarcinoma cases diagnosed with non-small cell lung cancer were retrospectively examined. Nucleostemin and CD133 expression levels were evaluated immunohistochemically in sections taken from cancerous tissue samples of the cases.

Results: Disease-free survival and tumor stages of the cases and immunohistochemical expression level were compared. Nucleostemin and CD133 expression was commonly observed in tumor tissue from both adenocarcinoma and squamous cell carcinoma cases.

Conclusion: Therefore, in line with the data we obtained, we think that both nucleostemin and CD133 cannot be used as prognostic markers in non-small cell lung cancer.

The evaluation of the efficacy of C-reactive protein-to-albumin ratio as a marker for Hashimoto’s thyroiditis

2024-04-02T11:10:45+00:00

Aim: Hashimoto's thyroiditis (HT), the leading cause of hypothyroidism in developed nations, is an autoimmune condition characterized by the progressive destruction of the thyroid gland through various cell- and antibody-mediated immune mechanisms. C-reactive protein-to-albumin ratio (CAR) is a known inflammatory marker easily obtained from a routine blood test. In this context, this study aims to investigate the efficacy of CAR instead of conventionally used thyroid antibodies in predicting the diagnosis and prognosis of HT.

Materials and Methods: The participants in this prospective cross-sectional study were adults aged 18 years and above diagnosed with Hashimoto's thyroiditis (HT), seeking medical care at the Internal Medicine and Family Medicine Departments of Recep Tayyip Erdoğan University Training and Research Hospital in Rize, Turkey, during the period from April to July 2022. An age- and gender-matched control group was created from healthy individuals who applied to the outpatient clinics for routine check-ups. The patient and control groups were compared based on C-reactive protein (CRP), hemoglobin, and albumin serum levels of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH).

Results: The patient and control groups comprised 142 HT patients and 62 healthy individuals. CRP level and CAR value were significantly higher. However, albumin and hemoglobin levels were significantly lower in the patient group than in the control group. [1.5 (0.4-5.6) mg/dL vs. 0.98 (0.3-2.6) mg/dL, p<0.001; 58 (11.5-193.1) vs. 29.5 (8.1-72.2) p<0.001; 2.9 (2.1-4.1) g/dL vs. 3.3 (2.3-4.2) g/dL, p<0.001; and 12±1.1 g/L vs. 12.7±1.760 g/L, p=.005; respectively]. The multivariate analysis revealed CRP, CAR, albumin, FT3, and hemoglobin as significant predictors of HT, with CAR being the most promising one among them [Odds Ratio (OR): 1.11, 95% confidence interval (CI): 1.38-1.19, p=0.003].

Conclusions: This study’s findings indicated that CAR is an easily measurable, reliable, and cost-effective marker of HT that can be used as an alternative to conventional thyroid antibodies in primary care centers.

Clinical and sociodemographic characteristics of patients diagnosed with cutaneous leishmaniasis

2024-04-05T06:50:24+00:00

Aim: Leishmaniasis is a disease complex caused by Leishmania protozoan microorganisms, transmitted through the bite of the vector female sandfly. Cutaneous leishmaniasis (CL) is the most common clinical type. The formation, clinical features, and healing process of CL are determined by the characteristics of the host and the parasite. Our study aims to examine the clinical and sociodemographic characteristics of patients diagnosed with CL at our clinic of dermatology and venereal diseases.

Materials and Methods: In this prospective study, the clinical and demographic characteristics such as age, gender, number of lesions, size of lesions, duration of lesions, localization of lesions, and treatments received for CL diagnosis were examined in 74 patients diagnosed with CL by microscopic examination at Şanlıurfa Training and Research Hospital’s dermatology and venereal diseases clinic between October 2022 and March 2023.

Results: In our study, 40 (54%) patients were male, and 34 (46%) were female. The average age of the patients was 16.4±9.31 years. The number of lesions varied between 1 and 9, with a total of 158 lesions. Lesions were most frequently (64%) located on the face.

The average duration of lesions was 4.9±3.8 months, and the average size was 4.6±3.7 cm. 7 patients had a family history of CL. The diagnosis of CL in all patients was made by cutaneous smear. Post-diagnosis, 14 patients (19%) received systemic meglumine antimonate treatment, and 60 (81%) received intralesional meglumine antimonate treatment.

Conclusion: The data from our study demonstrate similar clinical and sociodemographic characteristics to those found in other studies conducted in our country.

The relationship between intimate partner violence, childhood traumas, alexithymia and coping styles with stress

2024-04-18T05:17:28+00:00

Aim: In this study, it was aimed to determine the sociodemographic characteristics, childhood traumas, alexithymia and coping methods with stress in women exposed to intimate partner violence and to examine the relationship between these characteristics and intimate partner violence in comparison with women who were not exposed to violence.

Materials and Methods: The study included 42 women who had been exposed to intimate partner violence in the last year and 42 women as the control group who applied to the Behavioral Sciences Center in our center. Sociodemographic data form, DSM-5 oriented diagnostic interview guide, Toronto Alexithymia Scale (TAS), Childhood Trauma Scale (CTS) and Stress Coping Styles Scale (SCS) were applied to all participants and the data obtained were compared.

Results: The rates of income level, education level of the partner and employment status of the partner were lower in the case group compared to the control group, while the rates of divorce, separation, elopement, forced marriage, witnessing domestic violence in childhood and inflicting violence on their children were higher in the case group. It was found that 97.6% of the women in the case group had experienced recurrent violence and 33.3% had been subjected to violence in their past relationships. Significant differences were found between the groups in the total scores of the TTS, the total scores of the CFTQ, and the scores of the SBTQ. There was a relationship between alexithymic characteristics and preferred stress coping methods. Alexithymia and childhood traumas were found to have a predictive effect on partner violence.

Conclusion: The fact that the level of alexithymia and the use of ineffective methods to cope with stress are higher in women who are victims of violence is important in therapeutic studies to be conducted with these women. Variables affecting intimate partner violence should be evaluated in a larger population with longitudinal follow-up.

Complaints, diagnosis, follow-up, and treatment of patients applying to 0-6 years old child psychiatry and developmental pediatrics outpatient clinic

2024-04-02T12:03:22+00:00

Aim: By studying children aged 0-6 with outpatient and health board admissions, we aimed to contribute valuable insights to the literature on early childhood support, focusing on admission complaints, diagnosis distribution, treatments, and patient follow-ups.

Materials and Methods: Between 01.08.2022 and 01.02.2023 patients aged 0-6 from Diyarbakır Gazi Yaşargil Hospital's Pediatric and Adolescent Mental Health and Developmental Pediatrics clinic, including those seeking health board evaluations, were studied. This prospective analysis examined patient demographics, complaints, diagnoses, health board interactions, treatments, and additional medical conditions. Patient follow-up numbers were scanned from the system for analysis before concluding the retrospective study.

Results: Of the 600 patients included in the study, 337 patients came to the health board outpatient clinic, 160 to the child psychiatry outpatient clinic, and 103 to the developmental pediatrics outpatient clinic. 220 (36.7%) were female and 380 (63.3%) were male. The most common presenting complaints of the patients were speech delay, hyperactivity, report renewal, and irritability. In our study, the presenting diagnoses were global developmental delay, isolated speech delay, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), articulation disorder, behavioral problems, stuttering, and specific learning disorder (SLD) with decreasing frequency. It was observed that 77.5% of the patients had no follow-up and the highest rates of follow-up were ADHD (67.4%) and ASD (56.9%). It was observed that 87.5% of the patients with a health board application had no follow-up.

Conclusion: Determining the diagnosis, follow-up, and treatments of the patients may guide the areas in which child psychiatrists and developmental pediatricians should work more intensively in the future. Early diagnosis, screening initiatives, awareness campaigns, and training for parents, teachers, and health professionals, along with telehealth, multidisciplinary strategies, and school collaborations, enhance health board applications and patient follow-up.

Efficacy of intra-articular concentrated growth factor, platelet-rich plasma, and hyaluronic acid in knee osteoarthritis: A comparative analysis

2024-03-20T10:47:38+00:00

Aim: Knee osteoarthritis (KOA) is a prevalent chronic joint condition causing substantial pain and disability. In recent years, intra-articular injections of platelet-rich plasma (PRP), concentrated growth factor (CGF), and hyaluronic acid (HA) have emerged as promising KOA therapies. We aimed to compare the effects of intra-articular CGF, PRP, and HA in KOA patients.

Materials and Methods: Patients diagnosed with KOA and who were grade 2-3 according to the Kellgreen-Lawrence classification in radiological imaging were included in the study. Patients were randomized into three groups receiving a single injection of either HA, PRP, or CGF. Patients were evaluated for pain scores using the visual analog scale (VAS) and for pain, stiffness, and physical function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 1 and 6 months after the procedure.

Results: Of 60 patients, 41 were female and 19 were male. According to the Kellgren-Lawrence classification, 27 patients had grade II and 33 patients had grade III KOA, with a similar distribution among the three groups. The VAS scores showed a statistically significant decrease in all groups at 1-month and 6-month follow-up compared to pre-procedural scores. However, there was no significant difference among the groups in terms of VAS scores. The WOMAC-pain, -stiffness, -physical function scores also showed a significant decrease in all groups at 1-month and 6-month follow-up compared to pre-procedural scores. The CGF group had the lowest WOMAC scores at both time points, with a statistically significant difference compared to the PRP group (p<0.05). Patient satisfaction rates were high in all groups, while the satisfaction rate was highest in the CGF group.

Conclusion: CGF demonstrated superior pain alleviation and functional improvement compared to PRP and HA. Although the results of this study demonstrate the potential of regenerative treatments for KOA, more research with larger samples and longer follow-up is needed for robust validation. Additionally, the standardization of treatment protocols is important.

Clinical demonstration of the relationship between cervical subcutaneous fat tissue thickness and obesity

2024-03-27T10:34:20+00:00

Aim: Neck pain is an important complaint in neurosurgery practice and is observed with a frequency of 30-50% throughout life. The most common complaint of working women who apply to the doctor is neck pain. Obesity is known as a common disease in recent years and traditional measurements are used in its evaluation in practice. In this research, we aimed to show the relationship between obesity in patients with neck pain that may accompany cervical disc herniation. We examined the usability of neck circumference measurement in indicating obesity.

Materials and Methods: This study was made on 100 patients aged between 20 and 70, after determining the Sample Size with Power Analysis. The presence of cervical disc herniation and the thickness of the cervical subcutaneous adipose tissue were measured and recorded on Magnetic Resonance Imaging. Neck circumference measurements of the patients were compared with waist circumference measurements. The data collected for the study were recorded using the SPSS 22 program and analysed in the same program.

Results: 55% of the patients had disc herniation and 38% had an additional chronic disease. Individuals with a cervical herniated disc had higher waist circumference and subcutaneous asymptote tissue values than those without (p<0.01). BMI values of individuals with a cervical herniated disc were found to be higher than those without (respectively, 30.47±4.93, 27.77±4.60, p=0.023). A positive linear correlation was found between the BMI values of the patients, neck circumference, waist circumference and subcutaneous adipose tissue (p<0.05 core coefficient 0.676&0.750&0.463, respectively).

Conclusion: Neck circumference measurement, which is a simple and fast method, we can diagnose obesity. We saw that in our study, as in many cases, obesity was observed more frequently with cervical disc herniation, especially in women.

Evaluation of the difference between sexual functions and depression, anxiety and stress before and after bariatric surgery in men diagnosed with and without diabetes mellitus

2024-04-05T07:42:24+00:00

Aim: It was aimed to investigate the difference between erectile function, orgasmic function, sexual desire, sexual satisfaction and general satisfaction, and depression, anxiety and stress before and after bariatric surgery in men with and without diabetes mellitus (DM).

Material and Methods: A total of 80 male patients, 40 individuals who underwent bariatric surgery and were diagnosed with type 2 diabetes and 40 individuals who did not, were included in the study. Patients were evaluated with the International Erectile Function Form and Depression Anxiety Stress Scale before and 6 months after the operation. The difference between stress, anxiety, depression and sexual function values of diabetic and non-diabetic groups undergoing bariatric surgery was analyzed before and after the operation.

Results: In the non-diabetic group, there was a difference between pre- and post-bariatric surgery in depression and erectile function, orgasmic function, sexual desire, sexual satisfaction and general satisfaction scores (p = 0.000), apart from stress (p = 0.720) and anxiety (p = 0.675). In the diabetic group, a difference was found in all subscale scores except sexual desire (p = 0.160). When the groups are compared after surgery; while stress and anxiety scores decreased more in the diabetic group; erectile function, orgasmic function, sexual desire, sexual satisfaction and general satisfaction scores increased more in the nondiabetic group.

Conclusion: The presence of DM in men undergoing bariatric surgery may limit the improvement in sexual functions after surgery; however, diabetic individuals may benefit more from surgery in terms of depression, stress and anxiety.

Clinical and immunological features of 55 adult patients with selective IgG4 subclass deficiencies

2024-04-15T11:18:48+00:00

Aim: Despite intensive research on elevated IgG4 concentrations in serum, little is known about the importance of selective IgG4 subclass deficiency. We investigated the clinical and immunological characteristics of 55 patients with selective IgG4 subclass deficiency.

Materials and Methods: IgG subclass analyses performed in our hospital over 3 years were examined. The clinical features of patients with selective IgG4 subclass deficiency were reviewed, and the definitive diagnoses and the reasons for IgG subclass analysis were recorded.

Results: Of 1,675 IgG subclass analyses performed, 55 were indicative of selective IgG4 subclass deficiency. The final diagnoses associated with selective IgG4 subclass deficiency were variable. The most common clinical finding was recurrent infections (33 patients, 60%), and most had upper respiratory tract infections (18 patients, 54.5%). Allergic diseases were noted in 25 patients (45.4%) and were the second most common conditions. Allergic rhinitis was the most frequent allergic disease. Autoimmune diseases were noted in 18 patients (32.7%), Hashimoto thyroiditis being the most frequent.

Conclusion: This is the first study of adult selective IgG4 subclass deficiency at a single tertiary medical center in Turkey. In patients with IgG4 deficiency, while the primary concern is the presence of recurrent infections, consideration should also be given to allergic and autoimmune diseases.

The results of patients with histopathological diagnosed xanthogranulomatous cholecystitis: A single-center experience

2024-03-29T12:11:07+00:00

Aim: Xanthogranulomatous cholecystitis (XGC) is a rare and benign gallbladder disorder. Unnecessary or additional surgical interventions were reported secondary to extended inflammation or suspicion of malignancy. This study aimed to examine patients diagnosed with XGC in our clinic.

Materials and Methods: The data of patients were recruited who underwent cholecystectomy and diagnosed with XGC. We excluded patients with no radiologic examination, accompanying pancreas, biliary tree, and hepatic cancer. We recruited the data of patients' demographics, clinical symptoms, imaging studies, characteristics of surgery, and postoperative outcomes.

Results: The mean age was 57 ±19.1 years, and there were 12 (31%) females. Abdominal pain was found in 38 (97%) patients as a significant complaint. Elective and emergent cholecystectomy were performed in 18 (46%) and 21 (54%) patients, respectively. Open surgery was performed on 17 (44%) patients, and laparoscopic surgery on 22 (56%). The surgery was completed as laparoscopic in 17 (77%) patients. According to radiologic examinations, suspicious gallbladder malignancy was reported in 4 (10%), 8 (20%), and 4 (10%) patients with USG, CT, and MRI, respectively. There was 1 (3%) patient diagnosed with XGC by USG, 4 (10%) by CT, and 1 (3%) by MRI. Common bile duct (CBD) stone was observed in 10 (26%) of 39 patients. Conversion to open surgery was found in 5 (13%) patients. Intraoperative frozen section analysis was performed in 8 (20%) patients. Extended surgery was performed to 7 (17%) patients.

Conclusion: Preoperative diagnosis and surgical management of XGC can be challenging. If a surgeon has suspicion of XGC in preoperative period, expert radiologist opinion should be asked, and they should always keep in mind to perform frozen-section examination.

Dilation of benign esophageal strictures with balloon/bougie; a single center experience

2024-04-25T05:30:24+00:00

Aim: Narrowing in the esophagus caused by benign conditions such as peptic injury, surgical anastomosis, radiation therapy, Schatzki rings, esophageal webs, erosive injury and eosinophilic esophagitis are called benign esophageal strictures. In the treatment of benign esophageal stricture, endoscopic dilation with balloon or bougie is the first priority.

Materials and Methods: The study included a total of 96 patients who were diagnosed with a benign stricture at the gastroenterology clinic of our university from May 2009 to October 2023. All patients were symptomatic, and their main complaint was dysphagia. The benign stricture was diagnosed through clinical examination, radiological imaging and endoscopy. Patient data were scanned retrospectively. The dilation method (bougie, balloon), the number of times the procedure was permormed and any potential complications were recorded. Stents were applied to patients who did not provide adequate dilatation.

Results: A total of 96 patients were included in the study. Forty-seven (49%) of them were women and 49 (51%) were men. The average age was 48±17 years (the youngest was 18, the oldest was 81). A total of 198 dilation procedures were performed on 96 patients. The average follow-up period was 79±54 (1-179) months. Srictures were divided into 4 groups according to etiology as anastomotic stricture, peptic stricture, caustic stricture and post-radiotherapy stricture. Of the cases with stricture, 76 (79.2%) underwent bougie dilation, 26 (27.1%) underwent balloon dilation, 5 (5.2%) underwent bougie and then balloon dilation, and in 5 (5.2%) cases, metallic stent was placed due to failed dilations.

Conclusion: This study shows the effectiveness of bougie and/or balloon dilation in treating most of the patients with benign esophageal strictures, with a low complication rate. It is less invasive, comfortable and cost-effective than the alternative surgical approach.

Factors affecting yo-yo syndrome in university students with obesity

2024-04-24T12:31:18+00:00

Aim: Millions of people of all ages around the world are overweight or obese. Although many try dieting to lose their excess weight, the success rate is 20%, and only 2% are able to control their weight. This process becomes a vicious cycle of constantly gaining and losing weight, which is called yo-yo syndrome. Previous studies have found that obesity awareness was low in samples of university students. The present study aimed to determine the reasons that obese university students develop yo-yo syndrome by analyzing their dietary histories.

Materials and Methods: This qualitative study applied a phenomenological research method. The study population consisted of nine students in various faculties at Ordu University. Semi-structured interviews were conducted, and demographic information, such as age and gender, was collected to determine the number of diets that were started and stopped. Data were collected from the Faculty of Education.

Results: The following themes emerged from the data analysis: defense mechanisms in the categories of rationalization, denial, and projection; boredom in the category of boredom; health in the categories of fear of disease and death anxiety; social–physical anxiety in the categories of bodily discontent and mockery; and social anxiety in the categories of cultural pressure, peer relationships, and close relationships.

Conclusion: The reasons that the university students in the study sample developed yo-yo syndrome were identified according to the categories and themes that emerged from the data analysis. Based on these findings, it has been suggested that psycho-education, psychiatric treatment, and follow-ups would be beneficial in treating yo-yo syndrome.