ISSN: 2630-5720 | E-ISSN: 2687-346X
HAYDARPAŞA NUMUNE MEDICAL JOURNAL - Haydarpasa Numune Med J: 57 (2)
Volume: 57  Issue: 2 - 2017
RESEARCH ARTICLE
1. Effects of Isolated Viral Pathogens and Treatment Strategies on the Course of Acute Bronchiolitis
Fatih Akın, Abdullah Yazar, Şükrü Arslan
doi: 10.14744/hnhj.2017.76486  Pages 63 - 67
INTRODUCTION: Acute bronchiolitis, is a predominantly a viral disease, part of the spectrum of lower respiratory tract diseases, is a major cause of illness and hospitalization in infants and children younger than two years. The aim of the study was to determine the effects of treatment protocols, other laboratory results together with the isolated viral agents on the duration of hospitalization.
METHODS: Data of 95 children who were hospitalized with diagnosis of bronchiolitis in Konya Training and Research Hospital Pediatrics Clinic between October 2013 and May 2014 were reviewed retrospectively.
RESULTS: The most isolated agents were respiratory syncytial virus (RSV) and rhinovirus with an equal rate of 21.8%. When patients with no isolation were compared with patients only rhinovirus isolated no significant difference was found among hospitalization length. However hospitalization duration was significantly longer in patients with RSV-A infection and RSV-A + rhinovirus together, than patients with no virus isolation. While hospitalization length was not effected from receiving inhaled bronchodilator, ipratropium bromide or hypertonic saline, the duration was longer in patients receiving inhaled corticosteroid when compared with patients who didn’t receive inhaled corticosteroid. Mean hospitalization duration was significantly longer in patients with higher immunoglobuline E (IG E) levels. Smoke exposure and receiving breast milk in the first 6-months of life didn’t influence the length of stay in hospital.
DISCUSSION AND CONCLUSION: In conclusion, receiving inhaled corticosteroid, high Ig E levels and bronchiolitis due to RSV infection prolonges hospital stay.

2. What is the gold standard in the differential diagnosis of microangiopathic hemolytic anemia? Is it ADAMTS13 activity, platelet counts or serum creatinine levels?
Havva Üsküdar Teke, Gülsüm Akyol, Neslihan Andıç, İlter Bozacı, Döndü Üsküdar Cansu, Eren Gündüz, Büşra Emir, Olga Meltem Akay
doi: 10.14744/hnhj.2017.98608  Pages 68 - 72
INTRODUCTION: The aim of this study was to analyze the value of ADAMTS13 measurements and the other hemolysis tests in the diagnosis of thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS).
METHODS: At presentation, we analyzed patients retrospectively with microangiopathic hemolytic anemia (MAHA) treated in Eskisehir Osmangazi University Faculty of Medicine, Internal Medicine Department from 2014 to 2016. ADAMTS13 activity and other laboratory tests were measured with TTP (n=6), HUS (n=5) and other MAHA (n=8) patients.
RESULTS: ADAMTS13 activitiy and platelets count levels was significantly lower in TTP patients compared with HUS and other MAHA patients group (p=0.014, p=0.028). There was a significant correlation between ADAMTS13 activitiy levels and platelets count levels (p=0.001, r=0.693) and serum creatinine levels (p=0.008, r=0.589) in diagnosis. Severe decreased ADAMTS13 activity levels was significantly found in TTP group compared with HUS and other MAHA patients group (p=0.048).
DISCUSSION AND CONCLUSION: Severe thrombocytopenia and severe ADAMTS13 activity deficiency at the diagnosis of MAHA is not present in the HUS disease, is present in the TTP disease. Mild thrombocytopenia, normal or mild/moderate decrease ADAMTS13 activity levels and increased serum creatinine levels is present in the HUS disease.

3. Effects of density gradient sperm preparation on semen parameters and acrosomal status
İlknur Keskin, Seda Karabulut
doi: 10.14744/hnhj.2017.08208  Pages 73 - 77
INTRODUCTION: The aim of this study is to observe the changes in the sperm parameters after density gradient sperm preparation. The data will help the specialist to decide the preparation technique and to predict the outcome of semen parameters after using this technique.
METHODS: One thousand four hundred two men screening for infertility were analyzed attending Florence Nightingale Hospital, IVF clinic for infertility investigation between 04.2011- 10.2016. Semen analysis were performed according to WHO 2010 before and after semen preparation. Samples having <1 mil/ ml sperm concentration were prepared by density gradient centrifugation technique and the semen parameters (sperm concentration, total motility, progressive motility, normal morphology rates and normal acrosomal status rates) were analyzed after the preparation.
RESULTS: Although the sperm concentrations were decreased, total motility, progressive motility and normal morphology rates were increased after density gradient semen preparation. The sperm concentrations were decreased by 37.49% after semen preparation (P= 0,01). Total motility rates were increased significantly by 21.47% (66.1% before and 87.57% after semen preparation), progressive motility rates were increased by 28.12% (11.45% before and 39.57% after semen preparation), normal morphology rates were increased by 5% (3% before and 8% after semen preparation), normal acrosomal status rates were increased by 14% (62% before and 76%)) after semen preparation (p<0,01).
DISCUSSION AND CONCLUSION: According to the results of this study, the sperm parameters including the total motility, progressive sperm motility, normal morphology and normal acrosomal status rates increased but the sperm concentration decreased after density gradient sperm preparation. The data will help the specialist to decide the sperm preparation technique for using in assisted reproductive techniques and to predict the outcome of semen parameters after using this technique.

4. Relationship Between Serum 25 Hydroxy Vitamin D Levels and Disease Activity in Patients with Rheumatoid Arthritis
Nilgün Mesci, Duygu Geler Külcü
doi: 10.14744/hnhj.2017.76376  Pages 78 - 82
INTRODUCTION: To investigate the relationship between serum vitamin D levels and disease activity in patients with rheumatoid arthritis (RA).
METHODS: Patients who were followed up and treated with RA diagnosis in the Rheumatology branch of our clinic were included. Serum 25 hydroxy (OH) D levels were measured regularly in these patients, and files of those who did not receive vitamin D replacement therapy were retrospectively screened. Demographic characteristics such as age, gender, height, weight, duration of illness, medications used and 1 hour serum erythrocyte sedimentation rate (ESR) which was measured at the same date with serum25 hydroxy (OH) D, C-reactive protein (CRP) levels, serum calcium, laboratory parameters such as phosphorus, alkaline phosphatase, parathormone were recorded. Disease activity was determined by calculating the Disease Activity Score (DAS) scores.
RESULTS: The mean age of 34 RA patients included in the study was 54.09 ± 11.8 years. 30 of the patients were female, 4 were male. The mean duration of illness was 8.38 ± 6.87 years. The mean DAS 28 score was 4.59 ± 2.07, CRP was 0.92 ± 1.12 mg/dL, ESH was 27.79 ± 18.57 mm/h and 25 (OH) D vitamine levels were 19.87 ± 13.22 ng/mL. When the correlation of serum 25 (OH) D vitamin levels with other parameters is examined; positive correlation was found with age, duration of disease and ESR, and negative correlation was found with disease activity and CRP level. However, only positive correlation of 25 (OH) D vitamin with disease duration and negative correlation with CRP was statistically significant (p <0.05 ).
DISCUSSION AND CONCLUSION: Vitamin D deficiency is associated with autoimmune diseases and vitamin D has an immunomodulatory role. In this study, serum vitamin D levels were correlated with disease activity and CRP in patients with RA, and it is considered that an approach considering the levels of vitamin D in the treatment plan is necessary.

5. Evaluation of our Measles cases in the aspect of demographic features, disease morbidity and mortality
Özde Nisa Türkkan, Zehra Esra Önal, Çiğdem Sağ, Narin Akıcı, Tamay Gürbüz, Çağatay Nuhoğlu
doi: 10.14744/hnhj.2017.66376  Pages 83 - 88
INTRODUCTION: The aim was to evaluate patient demographic features and morbidity and mortality, and to control and prevent epidemics of measles with the help of our evaluation.
METHODS: This is a retrospective study that included 20 measles patients in the pediatric age group who were diagnosed at the Istanbul Haydarpaşa Numune Training and Research Hospital Clinic of Pediatrics between 2013 and 2014.
RESULTS: Only definitive measles cases were included in the study, as defined by the Permanent Guideline for the Surveillance of Measles, Rubella, and Congenital Rubella Syndrome of the Turkish Ministry of Health. All of the data were obtained from the patients’ medical records, patient files, and Turkish Ministry of Health Measles/Rubella Case Review forms. The majority of our cases accumulated during the summer, which differs from the normal course of measles. Based on a comparison of the number of cases in previous years using the Turkish Ministry of Health data and the data of our clinic, it is obvious that there was a measles epidemic in 2013 in Turkey. In the present study, we found a very high complication rate of 70% (14 patients).
DISCUSSION AND CONCLUSION: The most frequent complication was bronchopneumonia. As a result of the political instability in neighboring countries, new vaccination campaigns must be organized. An online national data network must be assembled to make notification of infectious disease easier and faster. Given the high complication rate, nutritional inadequacy and nutritional status overall in Turkish children may make the course of measles worse and must be evaluated carefully.

6. Evaluation of Serum Zinc Levels in Children with Iron Deficiency Anemia
Pelin Ataman, Zehra Esra Önal, Çiğdem Sağ, Narin Akıcı, Tamay Gürbüz, Çağatay Nuhoğlu
doi: 10.14744/hnhj.2017.10820  Pages 89 - 94
INTRODUCTION: Iron deficiency anemia is a leading problem among children in developing countries. In this study we aimed to evaluate the correlation between demographic features and serum zinc levels in children with iron deficiency anemia.
METHODS: This study was performed in Haydarpaşa Training and Research Hospital between 01.11.2013 and 01.12.2013, among children with iron deficiency aged 6 months to 12 years. Height and weight percentages, nutrition behaviors and family social and economic features were investigated. Blood samples for zinc deficiency were performed and the correlation between iron and zinc deficiency in the samples was evaluated.
RESULTS: There was no statistically significant difference between serum zinc levels and gender, nutrition, monthly incoming and parental education level among children with iron deficiency (p>0.05). There was positive correlation between serum zinc levels and age and weight (p<0.05). There was no significant correlation between serum zinc levels and height and serum transferrin saturation (p>0.05).
DISCUSSION AND CONCLUSION: In this study we did not demonstrate zinc deficiency in children with iron deficiency. This result is related with different ages of children and specially related with consumption of large amounts of nuts and proteins among the older children. We decide that studies including larger samples are needed.

7. Surgical, Oncological and Long-Term Functional Outcomes of First 103 Laparoscopic Partial Nephrectomy: A Single-Centre Experience
Serdar Aykan, İsmail Ulus, Mehmet Yılmaz, Serkan Gönültaş, Serhat Süzan, Ahmet Yaser Müslümanoğu
doi: 10.14744/hnhj.2017.87597  Pages 95 - 100
INTRODUCTION: We aim to evaluate surgical, oncological and functional outcomes of our first 103 laparoscopic partial nephrectomy experience.
METHODS: A total of 103 patients underwent laparoscopic partial nephrectomy between 2008 – 2016 were identified retrospectively. Demographic data, perioperative renal functions, radiological and pathological features of tumors were recorded.
RESULTS: Mean patient age was 54,72 (range: 19-71) and mean tumor diameter was 32,42 mm (12-82 mm). Preoperative mean creatinine value was 0.78 mg/dl (0.4-1.7), postoperative first day creatinine value was 1,04 mg/dl (0.5-2.48) and creatinine value at postoperative 1. month was 0.89 mg/dl (0.4-1.8). There was no statistical significance between preoperative and postoperative functional parameters.
Pathological study revealed 6 (%5,82) oncocytomas, 12 (%11,65) angiomyolipomas and 85 (%82,52) renal cell carcinomas. Of 85 renal cell carcinomas, 62 (%60,19) clear cell, 14 (%13,59) papillary and 9 (%8,73) chromophobe subtypes reported. Mean follow-up was 46 (range: 6-92) months. There was no local recurrence or metastasis ocurred during follow-up including patients with positive surgical margins. Cancer specific survival was %100 and overall survival was %96.2 with 4 non-cancer related death.
DISCUSSION AND CONCLUSION: Although it has a challenging learning curve, laparoscopic partial nephrectomy has impressive results regarding patient comfort and similar oncological outcomes with radical neprectomy.

8. Peripheral Blood Cell Immunophenotypes in Multiple Sclerosis Patients in Remission
Vuslat Yılmaz, Canan Ulusoy, Özlem Mercan, Suzan Adın Çınar, Recai Türkoğlu
doi: 10.14744/hnhj.2017.21931  Pages 101 - 103
INTRODUCTION: In this study, lymphocyte subpopulation alterations of multiple sclerosis (MS) patients were aimed to be identified by flow cytometry.
METHODS: Twenty-five relapsing remitting MS patients and age-gender matched 11 healthy controls were included. CD3+ T cell, CD4+ helper T cell, CD8+ cytotoxic T cell, CD3+CD4+CD25high regulatory T (Treg) cell, CD19+ B cell, CD16+CD56+ natural killer (NK) cell, CD3+CD56+ NKT cell percentages were quantified by four color flow cytometry.
RESULTS: Assessment of cell populations yielded no significant differences among T cell, T reg cell, B cell, NK cell and NKT cell groups of MS patients and healthy controls. While T and B cell percentages were comparable between patients and healthy controls, NK and NKT cells were found to be decreased in MS patients albeit at an insignificant level. Helper, cytotoxic and regulatory T cells were determined to be at similar percentages in patients and healthy individuals.
DISCUSSION AND CONCLUSION: Our results suggest that lymphocyte activation and inflammatory alterations of the central nervous system involved in MS pathogenesis can not be determined in peripheral blood cell samples.

CASE REPORT
9. Lemmel’s syndrome: A rare cause of abdominal pain and hyperbilirubinemia due to duodenal diverticulum
Anıl Ergin, Mehmet Mahir Fersahoğlu, Bülent Kaya, Ender Onur
doi: 10.14744/hnhj.2017.58077  Pages 104 - 106
Biliary obstruction is most commonly caused by choledocholithiasis and periampullary tumors.Duodenal diverticula is a rare pathology and usually asymptomatic.Obstruction of bile duct due to duodenal diverticula is known as Lemmel’s syndrome.There are difficulties in both diagnosis and traetment.A 84 years old patient was succesfully treated with ERCP in our clinic.The patiet was discussed in this case report

10. Synchronous Pancreatic Ductal Adenocarcinoma and Thyroid Medullary Carcinoma
Ceren Canbay Göret, Ömer Faruk Özkan, Mehmet Yılmaz Akgün
doi: 10.14744/hnhj.2017.69188  Pages 107 - 111
Due to advancements in modern medicine the survival rate for cancer patients has increased. Occurrence of two or more primary tumors in the same patient has thus also increased. Synchronous ductal pancreas adenocarcinoma and thyroid medullary carcinoma was found in a 52 years old male patient presenting at our hospital. Occurrence at this tumors simultaneously has never been reported. We aim to share our experience.

11. A Rare Disease: Encephalitis After Exanthem Subitum
Fatih Akın, Abdullah Yazar, Esra Türe, Dursun Odabaş
doi: 10.14744/hnhj.2017.83997  Pages 112 - 114
Human herpes virüs 6 causes exanthem subitum (ES), which is a benign disease presenting with fever in the first two years of life. ES is characterized by the abrupt onset of high fever and rash which occurs immediately after resolving of fever. The most common complications are central nervous system (CNS) complications such as febrile seizures and encephalitis. In this article, we report a case of encephalitis after ES who admitted with the complaints of eruption, poor feeding and drowsiness to our pediatric emergency clinic.

12. Laparoscopic Treatment of an Atypic Vezicosygmoid Fistula
Serkan Akan, Özgür Haki Yüksel, Çağlar Yıldırım, Ahmet Ürkmez
doi: 10.14744/hnhj.2017.32042  Pages 115 - 118
Spontaneous fistula formation between the bladder and the sigmoid colon is a very rare entity. In general, the underlying cause is that the sigmoid colon diverticula is inflated and perforated in the bladder wall. Sometimes, it can also develop due to infiltration of the sigmoid tumors to the bladder wall. Apart from these, inflammatory bowel diseases, tuberculosis, lymphoma, trauma and previous surgical interventions are other underlying causes. Herein, we presented a case of a vesicosigmoid fistula that was spontaneously developed without any underlying specific etiology.

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