ISSN: 2630-5720 | E-ISSN: 2687-346X
Volume: 63  Issue: 2 - 2023

Pages I - X

2.Cytotoxic Effects of Punicalagin on U87, PANC-1, A549, and 22RV1 Cancer Cell Lines
A Cansu Kilit, Esra Aydemir
doi: 10.14744/hnhj.2021.46034  Pages 115 - 119
INTRODUCTION: Cancer is an important public health problem worldwide and a disease that results in the highest number of deaths. Due to the existing drugs for cancer treatment, cumulative mutations, and drug interactions, treatment may fall insufficient. Hence, despite many new therapeutic approaches, there is still a need for more research to discover new molecules for treatment or for increasing drug efficacy. Regarding the development of new anticancer drugs, plant-derived agents stand out for their correlation with cancer. Flavonoids in our daily diet, together with other components like various vitamins, play a key role in the prevention of cancer.
METHODS: The pure punicalagin flavonoid obtained from the pomegranate peel was studied in vitro on cancer cell lines such as U87, PANC-1, A549, 22RV1 and its cytotoxic effect was tested.
RESULTS: It was observed that punicalagin showed cytotoxicity in all of the above-mentioned cancer cells, but was not cytotoxic in 293T human kidney epithelial cells.
DISCUSSION AND CONCLUSION: We hope that this study, which shows that Punicalagin has a selective cytotoxic effect, will shed light on other studies to investigate the detailed death mechanism of Punicalagin flavonoid and to be an alternative treatment to cancer treatments.

3.Long-Term Neurodevelopmental Outcomes of Newborns with High Bilirubin Levels
Derya Çolak, Münevver Kaynak Türkmen, Yelda Özsunar Dayanır, Hatice Aksu, Sema Başak, Ayşe Fahriye Tosun
doi: 10.14744/hnhj.2021.94759  Pages 120 - 125
INTRODUCTION: The aim of this study is to evaluate the long-term neurodevelopmental outcomes of newborns who had exchange transfusion due to hyperbilirubinemia and presented with bilirubin values at the border of exchange transfusion and did not need exchange transfusion during the preparation period.
METHODS: The study included 18 patients (n=18) who had exchange transfusion due to indirect hyperbilirubinemia (Group 1) and 10 patients (n=10) who applied with a bilirubin value at the border of exchange transfusion and decreased bilirubin during the preparation period (Group 2). Neurological examination, cranial magnetic resonance imaging (MRI), and auditory brainstem response test (BERA) results of the cases were evaluated through cross-sectional analysis. Ankara Developmental Inventory for children under the age of six and Wechsler intelligence scale-Revised for children over the age of six were performed.
RESULTS: Sixty-seven percentage (n=12) of the patients in Group 1 were male, mean gestational week was 38.4±1.8 (34–42) and mean age was 8.8±2.1 years. 40% (n=4) of the patients in Group 2 were male, mean gestational week was 37.9±1.7 (36–40) and mean age was 8.2±2.2 years.The mean venous serum total bilirubin level of group 1 was 29.5±8.2 mg/dL and Group 2 was 22.8±3.9 mg/dL, which was statistically significant (p=0.024). Neurological examination was abnormal in four patients in Group 1 and one patient in Group 2. Two of the cranial MRIs (n=8) in Group 2 were pathological. There was no significant difference between the groups in terms of neurological examination, cranial MRI, BERA, and developmental tests.
DISCUSSION AND CONCLUSION: In this study, the fact that there was no neurodevelopmental difference between the cases who underwent exchange transfusion or whose bilirubin levels were lowered by phototherapy without the need for exchange transfusion, and the cases with neurodevelopmental abnormalities were very few, once again demonstrated the importance of intervening before bilirubin encephalopathy occurs.

4.The Effect of C-erbB-2 Expression on Clinical-Pathological Prognostic Factors and Survival Ratios in Urothelial Tumors
Aylin Gönültaş, Güray Kılıç, Fügen Vardar Aker, Mehmet Aliustaoğlu
doi: 10.14744/hnhj.2021.59265  Pages 126 - 131
INTRODUCTION: Overexpression and the amplification of proto-oncogenic c-erythroblastic oncogene B (c-erbB-2) (HER-2/neu) encode transmembrane growth factor glycoprotein and are a part of the type I receptor tyrosine-protein kinase. It is known to play a role in the treatment of breast and stomach carcinomas. C-erbB-2 overexpression and amplification in urothelial carcinomas have also been demonstrated in many studies. However, possible treatment options and prognostic values are still not sufficiently defined. This study aims to determine the overexpression rate of c-erbB-2 in urothelial carcinomas. In addition, we sought to determine if there was a relationship between c-erbB-2 overexpression and clinical-pathological prognostic factors, such as histological grade, pathological stage, lymph node and distant organ metastasis, and survival time.
METHODS: C-erbB2 overexpression was examined using an immunohistochemical method performed on paraffin block samples of patients diagnosed with primary bladder urothelial carcinoma (n=41). The relationship of the data obtained after this examination with classical clinical-pathological prognostic factors, such as histological grade, pathological stage, regional lymph node metastasis, distant organ metastasis, and survival, was investigated. The obtained data were evaluated statistically. The alpha significance value was 0.05.
RESULTS: C-erbB-2 overexpression was positive in 9.75% (4/41) of the cases. c-erbB-2-positive tumors were all found to be at a high level. One patient was in stage T2, one stage T3, and two in stage T4. Three positive cases had lymph node metastasis; one patient did not have lymph node metastasis. Remote organ metastasis was not observed in any positive cases, and all positive cases were reported to survive. The fact that 75% (3/4) of the positive cases were lymph node metastasis may contribute to the literature.
DISCUSSION AND CONCLUSION: Standardized laboratory methods should be used and studied in large series, including more patients representing various races to evaluate c-erbB-2 overexpression and amplification status in urothelial tumors as a treatment option with prognostic value.

5.The effect of Vitamin D on Interferon-Gamma and Biochemical Parameters in Patients with Metabolic Syndrome
Berna Yücel Aybal, Süleyman Baş, Pınar Eker, Tahsin Aybal, Ali Ihsan Oluk, Gülbu Işıtmangil, Funda Müşerref Türkmen
doi: 10.14744/hnhj.2021.58751  Pages 132 - 136
INTRODUCTION: In this study, the effect of Vitamin D replacement on interferon-gamma (IFN-γ) cytokine and biochemical parameters has been investigated in metabolic syndrome (MetS) patients.
METHODS: The research was planned as a prospective study and included 44 outpatient cases that were selected as MetS according to the IDF-2005 diagnostic criteria without overt diabetes mellitus (DM) or any inflammatory disease. The patients’ Vitamin D level was <30 ng/mL, and their height, waist circumference, weight, and body mass index (BMI) measurements and biochemical parameters were recorded twice before and after 50000 IU Vitamin D replacement for 6 weeks. The IFN-γ levels were measured using the ELISA method and biochemical parameters by enzymatic colorimetric methods according to the manufacturer’s instructions. The data analysis and statistical analyses were performed using IBM SPSS Statistics 22 (IBM SPSS, Türkiye) software.
RESULTS: A statistically significant decrease was noted in the IFN-γ levels of the patients (p<0.001). Furthermore, statistically significant changes were noted in Vitamin D, glucose, calcium, and albumin levels, body weight, and BMI after Vitamin D replacement.
DISCUSSION AND CONCLUSION: The present study reveals that Vitamin D replacement leads to an anti-inflammatory effect on MetS patients as indicated by lower levels of IFN-γ and also a positive effect on hyperglycemia and BMI.

6.Investigation of Awareness Level of Spinal Muscular Atrophy Disease in Turkish Society
Ender Coşkunpınar, Yusuf Ordu, Burak İraz, Emine Yiğit, Buhari Yılmaz, Halime Yıldırım
doi: 10.14744/hnhj.2021.15945  Pages 137 - 141
INTRODUCTION: In this study, it was aimed to measure and investigate the level of awareness about SMA disease in individuals aged 18–65 in Turkish society. We believe that the obtained data will contribute to epidemiological studies and literature.
METHODS: A total of 2920 individuals between the ages of 18–65 who were compos mentis were included in our study. In the study, the data collected through online applications were analyzed by using a questionnaire consisting of 2 parts and a total of 24 questions. Data analysis was performed using the SPSS version 25 package program.
RESULTS: A decrease in the level of awareness about SMA disease is observed with increasing age (p=0.0001), individuals with higher education levels are more conscious about SMA disease (p=0.0001), individuals with knowledge about SMA types have received undergraduate and graduate education (p=0.0001), it was determined that 38% of the volunteers thought that SMA disease could be treated with this method. It was determined that 75% of the individuals participating in the study could not be diagnosed with SMA disease early, 20.12% thought that SMA disease could be treated with gene therapy, and that they were aware of the fact that Ministry of Health covered the treatment of certain types of SMA patients.
DISCUSSION AND CONCLUSION: Based on these results, it is understood that individuals who have consanguineous marriages do not know that consanguineous marriages have an effect on SMA disease. Awareness about SMA increases as you go east. We attribute this to the high number of patients in those regions. When the individuals with knowledge about gene therapy and SMA were compared, it was determined that 28,09% of the individuals had knowledge about both gene therapy and SMA disease. Today, the fact that news and social media posts about SMA disease and gene therapy are thought to have an impact on this result.

7.Why do Parents Choose to Attend the Emergency Department? A Cross-Sectional Study
Nevin Cambaz Kurt, Esin Yıldız Aldemir, Tuğçe Kurtaraner
doi: 10.14744/hnhj.2021.82642  Pages 142 - 147
INTRODUCTION: The aim of this study is to assess the parents’ reasons for choosing to attend the pediatric emergency department. Moreover, the levels of awareness of parents about the patient complaints to an emergency service as well as their level of socio-cultural level were investigated.
METHODS: Patients aged 0–18 years who admitted to the pediatric emergency department during working hours in 2020 were enrolled in the study. The mothers were asked about the 10-question questionnaire form. The results were statistically evaluated.
RESULTS: Two hundred and ninety patients were enrolled in the study. Most common symptoms on admissions were upper respiratory tract infection symptoms (%74) such as fever and runny nose/nasal congestion. Parents were asked about their reasons go to the pediatric emergency department; the reasons given by parents include that they think the situation is urgent (61%).
DISCUSSION AND CONCLUSION: We found that the main reasons the emergency departments are so busy is that families are particularly concerned about fever and want to get treatment quickly. Furthermore, we believe that increasing awareness on this subject among patients with low socio-cultural level will considerably reduce the rate of emergency admissions.

8.Retrolaminar Block for Post-Operative Analgesia in Patients Undergoing Lumbar Herniectomy Surgery
Nurcan Kutluer Karaca, Fethi Akyol
doi: 10.14744/hnhj.2021.48658  Pages 148 - 152
INTRODUCTION: Retrolaminar block (RLB) is a novel thoracic truncal block for analgesia for the thoracic and abdominal walls. However, the analgesic efficacy of RLB in patients undergoing selective lumbar herniectomy is not well known. The aim of this study is to determine the analgesic efficacy of RLB by measuring the pain intensity of patients with the Numeric Pain Rating Scale and evaluating the non-steroid anti-inflammatory drugs and opioid consumption after the surgery.
METHODS: Thirty patients with the American Society of Anesthesiologists physical status 1, 2, and 3 undergoing lumbar herniectomy of less than three levels between June 2019 and December 2019 were included in the study. The patients were evaluated in two groups: the RLB group (group R, n=15) and the intravenous (IV) analgesics group (group C, n=15). 10 mL 0.25% bupivacaine was applied bilaterally at the RLB. Tenoxicam, tramadol, and aldolan were administered as post-operative IV analgesic treatment. Numeric Rating Scale scores were evaluated at 2, 8, 12, 24, and 48 h after the surgery. Ketorolac and opioid consumption were evaluated at 24th and 48th h.
RESULTS: Compared with group C, group R exhibited lower pain scores at 2, 8, 12, and 24 h postoperatively (p<0.05 for each). Tenoxicam and tramadol doses at 24 and 48 h were lower in group R than the group C (p<0.05 for each).
DISCUSSION AND CONCLUSION: The retrolaminar block is an effective technique for post-operative analgesia in patients undergoing selective lumbar herniectomy within the first 24 h without significant complication.

9.Examination of Factors Affecting the Attitudes of Individuals Toward COVID-19 Vaccinations and Vaccination Preferences
Özge Öz Yıldırım, Mehmet Korkmaz, Dilek Çelik Eren, ilknur Aydın Avcı
doi: 10.14744/hnhj.2021.26023  Pages 153 - 160
INTRODUCTION: This research was conducted for the purpose of examining the attitudes of individuals toward COVID-19 vaccinations and the factors affecting the vaccination preferences of the individuals.
METHODS: This descriptive study was conducted with 592 people who were reached by Haphazard sampling method between February and March 2021. The data were collected using the web-based survey form. The form including questions an introductory and the Attitude Evaluation Form toward Covid-19 vaccine. Descriptive statistics, ANOVA, and Chi-square tests were used in the analysis of the data and statistical significance was accepted as p<0.05.
RESULTS: 35.6% of the participants were undecided that the vaccine will end the covid-19 pandemic and 53.4% think that the vaccine was useful and necessary to get rid of Covid-19 disease. 53.5% of the participants consider getting the Covid-19 vaccine. The rate of thinking of vaccination was higher in female, those who have a high level of fear and knowledge about Covid-19, with chronic diseases, and who have routine vaccinations (p<0.05).
DISCUSSION AND CONCLUSION: According to the results obtained in this study, more than half of the individuals consider to be vaccinated, this rate is higher in the individuals whose fear and knowledge levels about COVID-19 are higher, those with chronic disease, those who are vaccinated with routine vaccinations and in females.

10.Is HELLP Syndrome that Occurs After the 34th Week of Pregnancy More Risky for Mothers?
Osman Uzundere, Cem Kıvılcım Kaçar, Deniz Elmastaş, Canan Tiryaki, Sedat Kaya, Nedim Çekmen
doi: 10.14744/hnhj.2021.26097  Pages 161 - 167
INTRODUCTION: We compare patients with hemolysis, elevated liver enzyme levels, and low platelet (HELLP) levels syndrome developing before and after 34 weeks of pregnancy in terms of demographic data, laboratory values, treatments, and maternal and fetal complications.
METHODS: This retrospective descriptive study included 42 patients admitted to an intensive care unit (ICU) over 3 years. The patients were divided into two groups: Those who developed the syndrome at ≤34 weeks (Group I, n=23) and at ˃34 weeks (Group II, n=19) of pregnancy.
RESULTS: The HELLP syndrome rate was 7.08% (42/593). The mean ICU stay was 3.83±4.04 days and the mean hospital stay 7.49±5.71 days. The mean hemoglobin level and hematocrit of Group II patients were significantly lower than those of Group I patients (p=0.019; p=0.025); the aspartate aminotransferase (AST) level and prothrombin time (PT) of the former patients were significantly higher (p=0.047; p=0.001), as was the volume of erythrocyte suspension (ES) required (p=0.01). Most patients with hypertension and pre-eclampsia were in Group I; all patients lacking hypertension and pre-eclampsia were in Group II (p=0.03; p=0.03).
DISCUSSION AND CONCLUSION: Patients with HELLP syndrome developing after 34 weeks of pregnancy had a lower hemoglobin level and hematocrit; a higher AST level and PT; and required more ES. HELLP syndrome developing in the absence of hypertension and proteinuria was especially prevalent in women who were more than 34 weeks’ pregnant.

11.Evaluation of Patients with Electrophysiologically More Advanced Carpal Tunnel Syndrome in Their Nondominant Hands
Nuray Can Usta
doi: 10.14744/hnhj.2022.69376  Pages 168 - 173
INTRODUCTION: Carpal tunnel syndrome (CTS) usually occurs bilaterally and in the dominant hand. This study aims to compare the patients with electrophysiologically more advanced CTS in their nondominant hand with patients with more advanced CTS in their dominant hand.
METHODS: The files of patients with a diagnosis of CTS, verified with electromyography (EMG), registered to EMG laboratory which is a third-level health institute, were scanned retrospectively between October 2021 and December 2021. Missing data were completed by contacting the patients on the phone. The patients included in the study were separated into two groups according to their electrophysiological findings the ones with more advanced CTS in the nondominant hand forming Group 1 and the ones with more advanced CTS in the dominant hand forming Group 2.
RESULTS: 124 CTS patients (105 female patients, Group 1 n=58 and Group 2 n=66 patients) were included in the study. The average ages of the patients were 50.7±12 (27–78) in Group 1 and 50.4±10.3 (22–69) in Group 2 (p=0.86). No differences were detected between Group 1 and Group 2 in terms of sex, occupation, smoking, body mass index, and CTS provocation test results. The disease duration was longer in Group 1 CTS patients than in Group 2 (p=0.037). CTS complaints were observed more in the dominant hand in Group 1 patients and were detected more bilaterally in Group 2 patients (p=0.001). Drug use frequency was detected as being higher in Group 1 CTS patients due to hyperlipidemia (p=0.039).
DISCUSSION AND CONCLUSION: The reason of visiting a doctor to take longer despite the electrophysiologically more advanced CTS of the nondominant hand might be due to the fact that the complaints with the nondominant hand have a lesser effect in daily lives. Investigation of local reasons with more advanced electrophysiological CTS in the nondominant hand is extremely crucial and therefore, physicians should be vigilant to seek for local reasons. As a result of there is a need for more detailed studies of the local, regional, and systemic causes, with a larger number of patients.

12.Quality of Life Among Health Professionals in Intensive Care Units Who Provided or Didn't Provide Care to COVID-19 Patients
Uğur Uzun, Bilge Togay, Işıl Köse, Nimet Şenoğlu, Aykut Sarıtaş, İsa Sahar, Çiler Zincircioğlu, Kazım Rollas, Taner Çalışkan, Pelin Uzun Sarıtaş
doi: 10.14744/hnhj.2021.22755  Pages 174 - 181
INTRODUCTION: Coronavirus disease (Covid-19) not only has affected people all over the world as a disease but has also led to overwhelming unfavorable results both socially and psychologically. Since staff working in intensive care units are exposed to high levels of virus and have increased work load, they receive the ultimate share from this condition.
METHODS: We aimed to compare whether there was a difference on the life qualities of health-care personnel working in intensive care units in which covid-positive patients (ICU +) and covid-negative patients (ICU-) had been treated. A total of 62 women and 27 men were involved. Of 89 health-care staff included in the study, 49 worked in ICU (+) while 40 worked in ICU (-). Statistical analyses were carried out by IBM SPSS V22 programme.
RESULTS: No significant difference was determined with respect to life qualities of ICU (+) and ICU (-) workers. Burnout was observed higher in personnel in ICU (+) doctor and working for 24 h. Burnout elevated in ICU (-) nurses graduated from university. It was observed that there was a decrease in physical activity of 71,4% of ICU (+) personnel feeling symptoms related to covid in themselves; 42.9% changed their eating habits and 71.4% used drug supplements.
DISCUSSION AND CONCLUSION: There was a high burnout level particularly in doctors and nurses in ICU no matter what kind of patients they had looked after. It is of utmost importance that essential support is to be provided to protect health-care personnel in the so-called pandemic period.

13.Concordance with Histopathology and with Various Parameters in the Grade Groups of Prostate Cancer on Needle Biopsy Versus on Radical Prostatectomy
Kenan Arslan, Levent Verim, Ömer Yüksel, Çağatay Tosun, Emre Karabay, Osman Bilen
doi: 10.14744/hnhj.2021.15045  Pages 182 - 189
INTRODUCTION: We aimed to define the compatibility between biopsy and surgical pathology results in connection with age, prostate-specific antigen (PSA), prostate volume (PV), and body mass ındex (BMI) in prostate cancer (PCa) patients. PCa is the second most common male cancer in the world. PCa is also the most common urological cancer and is the second most common cancer after lung cancer among all cancers in Türkiye.
METHODS: We evaluated 165 PCa patients who were diagnosed with ultrasound-guided transrectal-targeted prostate biopsy and then operated with open radical prostatectomy. We compared the Gleason Scores (GSs) of biopsy specimens and the GSs of the prostatectomy specimens with the relationship of some parameters as age, PSA, PV, and BMI.
RESULTS: Pathology data were at similar compatibility ratio (67%) in both groups < 65 and ≥ 65-year-old Pathology results were consistent in patients with a PSA value <10 ng/mL and ≥10 ng/mL as 66% and 73%, respectively. The histopathological compliance in patients with a PV <80 cc and ≥80 cc was 66% and 93%, respectively. The compatibility of BMI with the pathology results was found at the group with BMI ≥25 kg/cm² (64%) and the patients with BMI <25 kg/cm² (74%).
DISCUSSION AND CONCLUSION: The harmony between the fine needle biopsies’ and the radical prostatectomy specimens’ GS varies between 24% and 78% in the literature. When all patients were taken into consideration, a moderate agreement was found between the pathology results of biopsy and the pathology results of surgery (110/165, 67%).

14.Rectus Sheath Hematoma in COVID-19 Patients
Büşra Burcu, Didem Ertorul
doi: 10.14744/hnhj.2021.14890  Pages 190 - 193
INTRODUCTION: The COVID-19 pneumonia epidemic that started in 2020 and the management of its cases are not completely clear. Moreover, the process becomes more complicated in patients with comorbidities. In this study, we presented COVID-19 pneumonia patients diagnosed with rectus sheath hematoma (RSH).
METHODS: We retrospectively analyzed 12 patients that we followed up in the pandemic clinic between March 2020 and September 2021. The examinations performed at admission, the blood values and imaging findings in the detection of RSH, and the procedures performed were recorded.
RESULTS: Six of our cases were male and six were female, and the mean age was 77 (range: 68–89) years. In treatment protocols, low-molecular-weight heparin 0.6 milliliter and prednol 40 milligrams (IV) were administered twice a day. The diagnosis of RSH was made on the 8th (6–12) day on average of hospitalization and the start of treatment. A possible intra-abdominal connection of the hematoma or other intra-abdominal bleeding foci were excluded by computed tomography (CT) in all cases. After LMWH was discontinued, all patients were followed conservatively by recording their daily examinations and hematoma diameters, and the hematoma stopped and regressed spontaneously. All patients were followed conservatively and bleeding was successfully stopped. No morbidity or mortality associated with RSH was observed.
DISCUSSION AND CONCLUSION: CT is the main tool used to determine the origin, amount, and type of bleeding in the diagnosis of RSH. Although it is a self-limiting entity, it may rarely require intervention. Hypercoagulation appears to play a key role in the pathogenesis of COVID-19. Side effects seen while intervening in the coagulation cascade require rapid diagnosis and treatment.

15.Management of Testicular Microlithiasis in Children: A Single-Center Experience
Sefa Sağ, Dilek Başar
doi: 10.14744/hnhj.2022.91297  Pages 194 - 197
INTRODUCTION: Testicular microlithiasis (TM) is a rare condition characterized by asymptomatic calcification of seminiferous tubules. There is limited data on the natural history and risk of developing testicular malignancy in patients with pediatric TM. The aim of study was to review our experience in children with TM and to compare and evaluate the management of TM in light of literature.
METHODS: The retrospective study included pediatric patients (aged below 18 years) that were diagnosed with TM by scrotal ultrasonography (US) in our center between May 2015 and May 2020. Demographic characteristics, physical and US examination findings, and follow-up records were reviewed for each patient.
RESULTS: A total of 12 children diagnosed with TM were analyzed. The mean age at presentation was 6.6±3.5 years and the mean follow-up period (time between the first and last US examinations) was 31.2±16.2 (range, 8–56) months. The most common US indication was scrotal pain (n=4), followed by trauma (n=3), unilateral undescended testis (n=3), bilateral undescended testis (n=1), and Down syndrome with bilateral orchiopexy (n=1). Calcific density showed no significant change in US throughout the follow-up period. Serum α-fetoprotein and β-human chorionic gonadotropin levels were within normal limits in all patients and no testicular germ cell tumors or new abnormal symptoms were detected in any patient throughout the follow-up period.
DISCUSSION AND CONCLUSION: No testicular cancer or new abnormal findings were detected in patients with TM throughout the follow-up period. Further studies with larger patient series and longer follow-up periods are needed to develop a standard management algorithm.

16.Evaluation of Ovarian Reserves of Patients who Have Received Methotrexate Treatment Due to Ectopic Pregnancy
Bedri Sakcak, Kübra Kaytaz Tekyol, Cevdet Adıgüzel, Oğuz Yücel
doi: 10.14744/hnhj.2021.43926  Pages 198 - 202
INTRODUCTION: The study aimed to investigate the effects of treatment on ovarian reserve in patients who received a single dose of methotrexate (MTX) due to ectopic pregnancy.
METHODS: This prospective study included patients who were diagnosed with ectopic pregnancy in the gynecology and obstetrics clinic of our hospital and met the criteria. The sociodemographic and clinical data of the patients were recorded. Then, MTX was intramuscularly administered at a dose of 50 mg/m2 to eligible patients. Single-dose MTX treatment was considered sufficient in patients with a 15% decrease in serum beta-human chorionic gonadotropin (ß-HCG) concentration between the 4th and 7th days. Weekly ß-HCG follow-ups were undertaken until the ß-HCG levels were negative (5 U/mL). Before starting treatment, serum ß-HCG, complete blood count, and kidney and liver function tests were conducted in all patients. Follicle-stimulating hormone (FSH) and anti-Mullerian hormone (AMH) levels were investigated to evaluate ovarian reserves. 6 months after treatment, the ovarian reserve tests were repeated. The values recorded before and 6 months after treatment were statistically compared.
RESULTS: Thirty-four patients who were diagnosed with an ectopic pregnancy over the study period and met the specified criteria were evaluated. The mean values of investigated parameters were years for age, gravida, parity, body mass index, cm for ectopic focus size, and the baseline β-HCG. Before MTX treatment, the AMH and FSH values were reported. At the end of 6 months after MTX, the AMH and FSH values were determined, respectively. There was no significant difference in the statistical comparison of the serum AMH values before and after 6 months of treatment (p>0.488).
DISCUSSION AND CONCLUSION: Single-dose MTX administration for ectopic pregnancy treatment had no significant effect on ovarian reserves measured according to the parameters mentioned above.

17.Importance of Inflammatory Markers in Ovarian Torsion
Emin Erhan Dönmez, Gulizar Özbilen, Fisun Vural
doi: 10.14744/hnhj.2021.67625  Pages 203 - 209
INTRODUCTION: Early diagnosis is important for the preservation of ovarian function and fertility after ovarian torsion. In this study, we aimed to investigate the usability of inflammatory markers in the diagnosis of ovarian torsion.
METHODS: Data of 120 patients who had been operated for ovarian torsion (60) and benign adnexal mass (60) between 2013 and 2019 were analyzed retrospectively. The final C-reactive protein (CRP) value and hemogram parameters of the patients in the preoperative period were recorded. Laboratory and clinical comparisons were made between both groups.
RESULTS: When the torsion group and the control group were compared, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), white blood cell (WBC), and CRP values were found to be statistically higher in the torsion group (p=0.000, p=0.003, p=0.000, p=0.028). When the cutoff value for NLR was >2.95, sensitivity was 79.2%, specificity was 90.3%, when the cutoff value was >169.7 for PLR, the sensitivity was 49.0%, and specificity was 84.6%. For WBC >8.58, sensitivity and specificity were 73.58% and 78.85%, respectively, and for CRP >0.47, sensitivity and specificity were 90.6% and 88.5%, respectively.
DISCUSSION AND CONCLUSION: According to the results of this study, these markers can be used as inflammatory markers in the diagnosis of ovarian torsion.

18.Occupational Hand Injuries and Third-Line University Hospital Emergency Department Admissions in Istanbul
Mehmet Koşargelir, Ayşegül Ürün, Ahmet Kürşat Yiğit, Abdullah Ibrahim
doi: 10.14744/hnhj.2021.21704  Pages 210 - 214
Introduction: The severity of occupational hand injuries ranges from mild to serious (such as loss of a limb). Here, we retrospectively studied patients presenting to an emergency department with hand injuries and the causes of such injuries. We recommend measures that will reduce occupational injuries and the associated effects on the workforce.
Methods: Injuries diagnosed as occupational accidents from January 2017 to June 2019 were retrospectively analyzed. A total of 221 cases met this inclusion criterion. The following variables were analyzed: Age, sex, occupational injury type, time from trauma to emergency department admission, insurance status, whether or not consultation was requested, injury details, and operations performed. All data were statistically analyzed.
Results: Patient age ranged from 18 to 65 years (average 31.4 years). Of all patients, 85% were male and 15% female. Most hand injuries were caused by sharp objects (81 cases), followed by angle grinders or saws (33), compression (66), and falls (24). Fifty-one cases were treated in the emergency department and subsequently discharged without any further consultation. However, 172 cases were referred onward, 151 to the plastic surgery department and 21 to the orthopedic department. The vast majority (143) of referred patients required further surgical interventions.
Discussion and Conclusion: The incidence of limb loss can be reduced by increasing the number of finger re-attachment centers and improving existing centers. We believe that better education would decrease the incidence of workplace injuries in Türkiye. An increase in the number of qualified workers and more rigorous certification would ensure that workers are adequately informed of the difficulties and dangers of any particular job. If more precautions were taken, time lost from work would decrease.

19.Alzheimer's Disease and Insulin Relationship: Type 3 Diabetes
Ezgi Akar, Mehtap Kaçar
doi: 10.14744/hnhj.2020.94840  Pages 215 - 219
Alzheimer’s disease is a disease that occurs with advancing age and is characterized by progressive dementia and neural degeneration. In recent years, it has been stated that insulin deficiency and insulin resistance are associated with neurodegenerative processes in Alzheimer’s disease. It has been supported by many recent studies that a decrease in the amount of brain insulin and insulin resistance has a role in the accumulation of amyloid beta and hyperphosphorylated tau protein, which are held responsible for the pathogenesis of Alzheimer’s disease and reduces synaptic pilasticity. For this reason, the definition of Type III diabetes has been used for Alzheimer’s disease in recent years and has brought a new perspective to the pathogenesis and treatment of Alzheimer’s disease. In this study, we aimed to discuss the role of insulin deficiency and insulin resistance in Alzheimer’s etiopathogenesis. For this purpose, current articles related to Alzheimer’s and Type III diabetes have been reviewed.

20.Two Cases Presenting with Unilateral Ptosis at an Advanced Age: Primary Lymphoma of the Lacrimal Gland
Mehmet Serhat Mangan, Zühal Ozcan, Ece Turan Vural
doi: 10.14744/hnhj.2021.68094  Pages 220 - 222
Lesions of the lacrimal gland constitute one of the subgroups of orbital masses and can have benign or malignant characteristics. They are evaluated in two main histopathological groups as epithelial and non-epithelial, with lymphomas belonging to the non-epithelial group. Lacrimal gland lymphomas have been analyzed under the orbital lymphomas header in most of the literature studies and there are only a few articles evaluating these lesions separately. The aim of this study was to present the clinical, radiological, and histopathological evaluation and related findings of two cases with a confirmed biopsy diagnosis of primary lacrimal gland lymphoma that presented with unilateral ptosis at an advanced age. In conclusion, primary lacrimal gland lymphomas are limited to the orbit and can appear without any systemic findings. The possibility of lacrimal gland lymphoma should be considered especially in patients at an advanced age presenting with unilateral ptosis. Organic pathologies that could cause ptosis must be ruled out before planning ptosis surgery.

21.Conflicting Behavior of Glioependymal Cyst: A Report of Three Cases and Review of Literature
Ersin Hacıyakupoğlu, Ali Erhan Kayalar, Mustafa Efendioğlu, Sebahattin Hacıyakupoğlu
doi: 10.14744/hnhj.2022.14892  Pages 223 - 226
Three cases evaluated as glial tumor were operated and diagnosed incidentally as conus medullaris cystic lesion. In the first case, following a traffic accident, paraparesis and urinary incontinence developed. A collapsed fracture at L2 was determined on lumbar Magnetic Resonance Imaging (MRI), so posterior fusion was applied with a transpedicular screw. The urinary incontinence did not improve, and on the follow-up MRI, a cystic mass was determined in the conus medullaris, so gross total surgery was performed. The other two cases had complaints of low back pain. The neurological and systematic examinations were normal. A cystic mass was determined in the conus medullaris on the lumbar MRI taken in each case and as these were thought to be glial tumors, partial excision, and marsupialization was applied. The pathological diagnosis in these three cases was glia ependymal cyst. The cases are presented with a review of the relevant literature.

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