Murat GÜNTEL,
Esra DOĞRU HÜZMELİ , İsmet MELEK, Senem URFALI, Boran URFALI, Evrim ASLAN, Nilufer ÇETİŞLİ KORKMAZ, İrem HUZMELİ
Abstract
Aim: Epidemiological data on the frequency, quantity, and consequences of symptomatic diabetic neuropathy remain poor. We conducted this study to examine the characteristic of neuropathic pain in patients with diabetes mellitus (DM).
Materials and Methods: Average daily pain intensity was measured using a 100 mm visual analog scale (VAS). Localization of the pain, position that aggravated pain, frequency of the pain, duration of the pain, pain’s influence on daily living activities were examined.
Results: The average patient age was 62.56 years and the number of males was 21 (42%). 29 Patients had only DM and 13 patients had hypertension (HT) plus DM, 4 patients had DM+HT+heart disease. The mean of pain according to VAS was 6.86±2.79. Thirtytwo patients defined that the pain affected their daily living activities negatively; 30 patients’ pain localization was lower extremity,12
patients’ was upper and lower extremity; mostly pain was aggravated by standing and 40 patients’ pain frequency was as every day; 24 patients’ pain duration was less than 1 year and 18 patients’ was between 1-5 years.
Conclusion: Studies on diabetic neuropathy are important drivers to improve the treatment of these patients. Neuropathic pain is considered to be more serious than other types of pain. So patients diagnosed with DM should be examined for neuropathic pain and the treatment plan should include pain decreasing medication and/or neurosurgical interventions.
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Aim: Neonatal abstinence syndrome (NAS) is a clinical condition characterized by findings that develop after intrauterine exposure to addictive substances, especially opioids, and is characterized by signs related to the absence of the addictive substance in the postpartum period. Typically, NAS manifests in the first few days of life in the form of hypertonia, autonomic instability, irritability, poor absorption reflex, weight loss and, rarely, seizures. The present study was performed the clinical features of mothers who used addictive substances during pregnancy.Materials and Methods: Neonates born between September 2016 and December 2019 to opioid-addicted mothers and admitted to the neonatal intensive care unit (NICU) after birth for findings consistent with NAS were included in this study. The patients' files were analyzed retrospectively. Maternal age, drug used/duration of use, smoking/alcohol use, the last time the substance was taken, gestational week of neonates, mode of delivery, birth weight, onset of NAS symptoms, highest Finnegan score, nutritional status, length of hospitalization, treatment duration and NICU follow-up data were recorded.Results: Nine babies were admitted to the NICU of follow-up for NAS symptoms. All mothers had heroin addiction. The median gestational week of the neonates was 37 (31-40) weeks and median birth weight was 2740(1530-3860) g. Median onset of symptoms was 2(1-4) days and the median Finnegan score of the patients was 10(3-17). Six (66.7%) neonates who did not recover with nonpharmacological treatment received phenobarbital therapy. Conclusions: For patients with NAS, phenobarbital therapy can be used as the first option when symptoms cannot be controlled by nonpharmacological methods in settings such as Turkey where oral morphine solution is not available. In our study, the symptoms were successfully controlled by phenobarbital therapy. However, more comprehensive studies are needed as there are insufficient data on long-term results.
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Aim: Coronary slow flow phenomenon (CSFP) is a microvascular circulation disorder. It is known that serum magnesium has positive effects on anti-inflammation, vasodilatation and endothelial functions. This observational study investigated the association of serum magnesium levels with CSFP.Materials and Methods: Patients who had undergone coronary angiography (CAG) after noninvasive testing were included in the study. CAG records were reassessed for CSFP and 100 patients were diagnosed as having CSFP. Control subjects (n = 80) had normal coronary flow. Serum Mg levels and other biochemical parameters such as glucose, creatinine, cholesterol levels and hemoglobin samples were collected before CAG. Serum Mg values were categorized into two groups: Mg levels equal/under and above 1.9 mg/dL.Results: The mean patient age was 56.1±9.7 years; 68.9% of patients were men. Patient’s hypertension, diabetes mellitus history and smoking habits rate were similar between groups. Biochemical tests revealed lower serum magnesium levels (1.87 vs 1.95mg/dL, p=0.02) for CSFP patients and controls, respectively. In multivariate regression analysis, a serum magnesium level under 1.9 mg/dL (OR:3.33, 95% CI:1.75-6.37, p<0.001) and male gender (OR:2.08, 95% CI: 1.016-4.34, p=0.04) were found to be independent predictors of CSFP.Conclusion: Low serum magnesium levels were associated with CSFP. However, these results are not sufficient to fully determine the role of Mg levels in the mechanism of CSFP-related chest pain.
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Aim: Splint use is often recommended following wrist injection patients diagnosed with carpal tunnel syndrome (CTS), but there is not any data in the literature pertaining to the impact of splint treatment, used before injection, on the results of local injection treatment. The aim of this study to evaluate whether or not splint use starting before the injection would impact the local injection treatment outcomes.Materials and methods: Fifty seven patients (57 hands) with CTS and underwent ultrasound-guided injection were included in the study, and patients were divided into two groups in terms of splint use. Median nerve cross-sectional area (MNCSA), pain/numbness by visual analogue scale (VAS), symptoms and functionality by Boston Carpal Tunnel Questionnaire (BCTQ) were investigated before injection and 15 days after injection.Results: There was significant change over time in MNCSA, VAS, and BTCQ scores in groups. The patients not using splint group had significantly higher percentage change in VAS nighttime score.Conclusion: Our findings has shown that using neutral wrist splint, starting before and continuing after injection treatment, did not increase the injection treatment efficacy and may actually have negative effect on improvement in VAS nighttime scores.
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Aim: Inflammatory markers that may be associated with on the prognosis of acute ischemic stroke (IS) such as C-reactive protein/albumin ratio, neutrophil/lymphocyte ratio, albumin, red blood cell distribution width (RDW) have been investigated in the recent years. In this study, it was aimed to investigate the effects of all these inflammatory markers on in-hospital mortality and to determine the mortality rates due to cerebral artery occlusion in patients with acute IS. Materials and Methods: Patients hospitalized in our hospital with a diagnosis of acute IS between April 2014 and August 2018 were retrospectively analyzed. Logistic regression analysis was used to investigate the prognostic factors in IS. Receiver operating characteristic (ROC) curve analysis was performed to calculate the cut-off values and evaluate the predictive values of variables. Results: 344 patients, including 267 patients who were alive and 77 patients who died at the hospital, were included in the study. The infarcts that had the highest mortality rate were massive infarcts in the internal carotid artery area (75%), middle cerebral artery-M1 segment infarctions (62.5%) and total basilar artery infarcts (40%). According to the multivariate logistic regression model, only RDW-SD and albumin were found to be poor prognostic factors of IS (p=0.005 and p=0.021). Area under the ROC curve was as follows: RDW-SD 0.613 (95% CI, 0.53-0.69).Conclusions: High RDW-SD and low albumin levels at admission are independent poor prognostic factors of acute IS. er studies conducted with large patient populations are necessary to determine vascular mortality rates in patients with IS.
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Aim: Cardiac arrest in pregnancy is one of the most challenging clinical scenarios. Correct intervention plays a crucial role in increasing the chance of survival of both the baby and the mother. In this study we aimed to evaluate knowledge about resuscitation of parturients among anesthesiologists.Materials and Methods: A total of 356 anesthesiologists (162 anesthesiology residents, 146 anesthesiology specialists and 48 faculty member) were included in the study. The subjects of the study population were chosen among the anesthesiologists with various levels of experience who attended to national anesthesia meetings that were held from January 2015 to December 2015 in Turkey. The assessment was based on a questionnaire containing 10 questions and questions were designed to draw out knowledge deficiencies in critical areas of cardiopulmonary resuscitation in parturients. Results: There was a significant correlation between the age and the total score (r=0.198 / p=0.000). Concerning the effect of the occupational title, we found that the total score of the specialist group was significantly higher than that of the resident group (p=0.001). There was no correlation between the total score and having a CPR experience in parturients. Conclusion: The results of our study indicate that there is a lack of knowledge about the CPR in parturients in Turkey. Therefore education programs about the management of cardiac arrest and CPR in parturients should be planned and repeated on a regular basis.
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Aim: In this study, it has been aimed to investigate whether there is a relationship between pulmonary functions measured by spirometry and hepatic impairment tables. This may contribute to a better understanding of the mechanisms of liver pathophysiology which hasn’t been fully understood.
Materials and Methods: This study is a randomized controlled prospective trial. 39-63 years of age, 19 male and 9 female, a total of 28 patients diagnosed with liver failure, with 15 male and 17 female, a total of 32 healthy volunteers with similar social characteristics were studied. All of the participants’ pulmonary parameters (FEV1, FVC, FEV1/FVC, PEF, FEF25-75%, FEF25%, FEF50%, FEF75%, PIF, VC, MVV) were performed by pulmonary function tests (PFT). Groups’ data have been analyzed statistically. The significance level
was considered as p<0.05.
Results: In hepatic impairment patients, there was no significant difference in terms of the expected percentage values of PFT parameters that indicate obstruction. Weak restriction in 8 cases, moderate restriction in 9 cases and severe restriction in 4 cases were diagnosed. PFT parameters of patients with mid-level and refractory ascites were found to be significantly lower compared
with those without ascites (FEV1: p=0.009; FVC: p=0.010; VC: p=0.008). There was no remarkable correlation between AST, ALT, ALP, GGT levels and PFT parameters of patients as with ascites status.
Conclusion: Ascites that can frequently coexist with chronic liver disease cases, may cause restrictive type pulmonary dysfunctions in PFT by creating mechanical pressure. But also, there is no correlation between the ascites status or PFT diagnoses and liver function tests.
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Materials and Methods: The study had a relational descriptive design. It was conducted in the surgery clinics of a university hospital in the southeast of Turkey from November 2019 to February 2020. The study sample consisted of 200 patients in preoperative period.
Results: The average score of patients in preoperative period from the attitudes toward uncertainty scale was 49.04±14.81. The average age of patients included in the study sample was 49.17±16.96. 59.5% of patients were female, 43.5% of them had an education below graduate level and 84.5% of them had someone to help with home care. A statistically significant difference was
detected between the average uncertainty score and age, having someone to help with home care, total number of hospitalizations, American society of anesthesiologists preoperative risk status prior to surgical intervention and presence of any chronic diseases (p<.05).
Conclusion: Study findings indicate that patients in preoperative period had moderate levels of uncertainty. It was found that the patient’s age, having someone to help with home care, total number of hospitalizations, American society of anesthesiologists preoperative risk status and chronic disease variables affected the uncertainty levels. In the light of these results, it is thought that patients should be approached individually by taking these variables into consideration and the quality of patient support and their coping levels should be assessed.
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Aim: The purpose of this study was to investigate the fracture strength (FS) and fracture types of endodontically treated teeth that restored with CAD/CAM made novel ceramic posts.Materials and Methods: Seventy human maxillary central incisors were selected, endodontically treated and expanded to 1.8 mm diameter with leaving of 2-3 mm canal filling. The teeth were randomly divided into 7 post restoration groups (n=10); a glass fiber post system as control (GFbr), monolithic zirconia (GMzr), lithium disilicate (GLds), zirconia-reinforced lithium silicate (GZr_Lds) ceramics, nanoparticle-filled (GRmc_Cer), resin nano-ceramic (GRmc_Lu), and polymer-infiltrated (GRmc_En) resin matrix ceramic groups. Then composite cores were build-up, crown restorations fabricated, and incubated in a water bath (37 ± 10C, 24 hours). A dynamic load was applied at 135° to the long axis of each specimen with a crosshead speed of 1 mm/min. FS and fracture types (favorable-catastrophic) were recorded. The FS values were statistically analyzed with one-way ANOVA and Tukey HSD tests (α=.05). Results: While the FS values of GMzr (365.62 ± 28.52 N) was significantly higher than GFbr (261.07 ± 24.51 N), all other groups (167.09-191.64 N) significantly lower, according to the Tukey HSD (P<.05). Catastrophic fractures were observed only for GMzr. Conclusion: The results of this study suggest that the novel CAD/CAM ceramic materials substantially be suitable for the rehabilitation of severely damaged teeth with composite resin core build-up in the anterior region. However, only the monolithic zirconia post restorations may be more durable than the glass fiber post systems.
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Aim: Rhabdomyolysis (RML) is a clinical and biochemical syndrome caused by acute necrosis of striated muscle fibers and the subsequent transportation of potentially toxic cellular contents into the systemic circulation. In this study, we present data from rhabdomyolysis patients that developed acute renal failure who were hospitalized and treated in our clinic in 2019. Materials and Methods: We reviewed all cases of RML treated in the tertiary hospital within a 12-month period, which was defined as serum creatinine kinase (CK) levels > five times the upper normal limit. The inclusion criteria were as follow: (a) being aged ≥ 18 years, (b) being treated for RML within the designated time period, (c) AKI development. The exclusion criteria are as follows: (a) being aged <18 years, (b) patients without AKI, (c) patients with End Stage Renal Disease(ESRD), (d) patients with neuromuscular diseases. Among a total of 583 patients with CK > 5 time upper normal limit (UNL), 14 conformed to the inclusion criteria and were selected as subjects Results: A total of 14 patients were included in the study, 12 of which were male. The mean age of the patients was 48.1 (18–80). The etiologies were as follows: hypothyroidism, 3; prolonged exposure to sun, 2; electrolyte imbalance due to severe diarrhea, 1; viral upper respiratory tract infection (URTI), 3; intramuscular injection, 1; heavy exercise or falls.Conclusion: Rhabdomyolysis is an interdisciplinary clinical condition that can lead to life-threatening outcomes including AKI. Rapid diagnosis and treatment can be life-saving. AKI is a significant potential complication of RML and renal function should be evaluated irrespective of CK levels or the presence of myoglobinuria.
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