ISSN: 2630-5720 | E-ISSN: 2687-346X
Volume: 63  Issue: 3 - 2023

Pages I - IX

2.Prediction of the Development of Acute Liver Injury in Mushroom Poisoning by Hemogram Parameters
Ahmet Numan Demir, Refik Demirtunç
doi: 10.14744/hnhj.2021.43815  Pages 227 - 230
INTRODUCTION: Predicting acute liver damage caused by mushroom poisoning from hemogram parameters at first admission to hospital.
METHODS: This retrospective study involved adults ≥18 years old who presented to the emergency room with mushroom poisoning from January 2011 to January 2017. Diagnosis of mushroom poisoning was made by a recent history of eating mushrooms, the onset of gastrointestinal symptoms such as diarrhea, vomiting, or abdominal pain after eating mushrooms, and excluding other possible causes of acute liver damage. Acute liver injury was defined as a 5-fold or greater increase in liver enzymes or the development of moderate coagulopathy (international normalized ratio > 2.0). First admission hemogram parameters of those who had liver damage and those who did not develop liver damage in the emergency department were compared.
RESULTS: Acute liver injury developed in ten of 136 patients (68 women (50%), 68 men (50%), and mean age 39.5 years) included in the study. Three of them died (in-hospital mortality – 30% and mushroom poisoning overall mortality – 2.2%). Among the hemogram parameters, hemoglobin (13.9±1.7 g/dL vs. 15.4±1.7 g/dL, p=0.013), mean platelet volume (MPV) (7.6±1.02 fl versus 8.8±1.1 fl, p<0.05), and red cell distribution width (RDW) (16.5±4.8% vs 24.3±13.7%, p=0.034) in those who developed acute liver injury were significantly higher than those that did not develop.
DISCUSSION AND CONCLUSION: The high levels of MPV and RDW in the hemogram examination of the patients presented to the emergency department with mushroom poisoning may help to predict the progression of acute liver injury.

3.An Assessment of the Knowledge, Attitudes, and Practices of Pediatricians and Pediatric Residents in Spinal Muscular Atrophy
Filiz Mıhçı, Gökçen Öz Tuncer, Muhammet Gültekin Kutluk, Özlem Yayıcı Köken
doi: 10.14744/hnhj.2021.92260  Pages 231 - 236
INTRODUCTION: This study aims to investigate the knowledge levels and attitude of pediatricians and pediatric residents toward spinal muscular atrophy (SMA), which is one of the most frequent neuromuscular diseases and the second most common cause of mortality among autosomal recessive diseases.
METHODS: Pediatric residents and pediatricians were asked to answer a questionnaire consisting of 27 questions prepared by the authors. The questionnaire investigated knowledge levels and attitudes concerning genetic, pathophysiologic, and laboratory characteristics, in addition to follow-up and management features of SMA. The questionnaire was distributed using Google Forms (Google LLC, Mountain View, CA, USA).
RESULTS: Ninety-three physicians (48.4% (n=45) pediatricians, 15.1% (n=14) fellows, and 36.6% (n=34) pediatric residents) responded to the questionnaire. Of these, 56 (60.2%) had experience of working in a pediatric clinic for more than 5 years and 95.7% (n=89) had followed an SMA patient. Sixty-eight (73.1%) of the participants knew that a deletion in exon 7–8 was the cause of SMA in more than 95% of patients, 83 (89.2%) knew that it was characterized by progressive loss of motor neurons in the anterior horn, 86 (92.5%) knew that SMA classification was made based on the onset time of symptoms and genetic features, and 92 (98.9%) believed that SMA subtypes could define the prognosis. Ninety (96.8%) stated that the most important cause of mortality was the involvement of accessory respiratory muscles.
DISCUSSION AND CONCLUSION: This study revealed that physicians possess a satisfactory level of knowledge concerning the symptomatology, diagnostic algorithm, and follow-up features of SMA disease, which has become more popular following the development of treatments that could prolong survival and improve the quality of life. Modern treatment options are expected to change the natural course of the disease, and pediatricians are expected to stay up-to-date with the changing algorithms for diagnosis, follow-up, and treatment.

4.Alterations with PCR Positivity at Admission and Predictive Factors of Prolonged Hospital Stay in COVID-19
Sedat Altın, Seda Tural Onur, Gülşah Günlüoğlu, Fatma Tokgoz Akyıl, Erkut Bolat, Mehmet Toptaş
doi: 10.14744/hnhj.2021.72593  Pages 237 - 240
INTRODUCTION: The aim of the present study is to investigate the baseline predictive factors of prolonged hospital stay and to compare the patient characteristics according to polymerase chain reaction (PCR) positivity.
METHODS: Between March 11 and June 1, 2020, 234 patients hospitalized in a non-intensive care unit clinic with a diagnosis of COVID-19 were included retrospectively. The duration of hospitalization were classified as ≤7 days and >7 days. Furthermore, according to real-time PCR (RT-PCR) of nasopharyngeal swab positivity, patients were divided into two Groups.
RESULTS: Of all the 234 patients, the mean age was 54±13 and 167 (71%) was male. Thirty-six (36%) were PCR positive (+) at the first swab samples. Hospital stay was longer than 7 days in 122 (52%) of the patients. Ten patients (4.3%) died within 60-days. PCR-positive cases had lower baseline leukocytes (p=0.002), C-reactive protein (p=0.001) values, whereas hemoglobin (p=0.001) and albumin levels (p<0.0001) were detected in PCR-positive patients. While demographics and mortality were similar, hospital stay longer than 7 days were detected in a higher rate in PCR-positive patients (p=0.025). The analysis on hospital stay proved that, apart from PCR positivity rate, baseline aspartate aminotransferase (AST) level prolongs hospital stay in COVID-19 patients.
DISCUSSION AND CONCLUSION: This study demonstrates significant differences in patients with and without PCR positivity. Higher baseline AST levels and first PCR positivity prolongs hospital stay. Studies including larger patient groups would be better determine and enhance in this regard.

5.Is Lobectomy an Appropriate Surgical Strategy for Nodular Goiter in Endemic Areas?
Nurdan Altan, Bahar Canbay Torun, Adnan Hut, Hüda Ümit Gür, Yusuf Yunus Korkmaz, Gamze Çıtlak
doi: 10.14744/hnhj.2021.83584  Pages 241 - 246
INTRODUCTION: Thyroid nodules are evaluated by fine-needle aspiration biopsy (FNAB) according to their radiologic characteristics. International guidelines recommend lobectomy according to the size of the nodules and FNAB results. The aim of this study is to assess whether lobectomy is one of the treatment choices in endemic areas.
METHODS: Patients who underwent lobectomy between January 2013 and September 2017 were studied retrospectively. Patients’ demographic features, thyroid hormone levels, medications, FNAB results before the surgery, lobectomy indications, ultrasonographic features, final pathologies, and secondary surgical interventions were recorded.
RESULTS: Data of 388 patients who underwent lobectomy were examined. As patients were classified according to their FNAB results, all categories had higher malignancy rates than expected in the final pathology results. One hundred and eighteen (30.4%) patients had undergone completion thyroidectomy. The final pathology of the completion thyroidectomy samples showed 24.07% (n=26) malignancy.
DISCUSSION AND CONCLUSION: FNAB is the gold standard for the malignancy risks in thyroid nodules in all guidelines. In endemic areas, this classification system may be inadequate. Two-staged thyroid surgery is becoming more popular. In our series, 30.4% of patients had undergone completion thyroidectomy according to their final pathology results. We need to add newer sights to guidelines for endemic areas.

6.The Impact of COVID-19 Pandemic on Admission Times, Manual Detorsion Rates, and Outcomes in Testicular Torsion
Emre Tokuç, İlker Artuk, Rıdvan Kayar, Emrah Özsoy, Ramazan Topaktaş, Yavuz Baştuğ, Mehmet Akyüz
doi: 10.14744/hnhj.2021.02693  Pages 247 - 251
INTRODUCTION: This study aims to assess the admission times, manual detorsion rates, and outcomes of the testicular torsion cases during the COVID-19 pandemic.
METHODS: A retrospective analysis of the testicular torsion cases was done through our hospital’s electronic archive. Patients with were distributed into two groups as “COVID-19 era” (between March 11, 2020 and March 2021) and “pre-COVID-19 era” (between January 2018 and 10th of March 2020). Time between the onset of symptoms and the moment of detorsion was calculated as the duration of ischemia. Two groups were compared in terms of ischemia duration, manual detorsion rates, and operational outcomes.
RESULTS: No statistically significant differences was detected between groups in terms of ischemia duration, manual detorsion rates, and surgical procedure type (all p>0.05). During the COVID-19 pandemic, the number and percentage of manual detorsions have increased, resulting in a numerical decrease in orchiectomies.
DISCUSSION AND CONCLUSION: Conditions caused by COVID-19 may prompt urologists to manual detorsion more to set up safer surgical environment. Moreover, this approach may result in a decrease in orchiectomy rates by saving time and preserving the vascularity of the testis. Further studies with larger samples sizes and meta-analyses may support this concept significantly.

7.Assessment of Thyroid Function in Patients with Parkinson’s Disease
Tamer Bayram, Derya Bayram, Gülbün Asuman Yüksel, Hülya Tireli
doi: 10.14744/hnhj.2022.68889  Pages 252 - 257
INTRODUCTION: The study aims to observe thyroid dysfunction, its prevalence, and the relationship between the Unified Parkinson’s Disease Rating Scale (UPDRS) and thyroid function in Parkinson’s patients.
METHODS: Seventy patients with Parkinson’s disease (PD) and 60 age-and sex-matched controls were enrolled in the study. PD patients were divided into tremor dominant-type (TDT) and akinetic-rigid-type (ART) subgroups. Serum fT4, TSH, and Anti TPO levels of patients were retrospectively reviewed. The results of the patients were compared with the controls, and the relationship between the UPDRS score and thyroid hormone levels was observed.
RESULTS: The mean levels of TSH and fT4 were higher in PD patients, but the difference was not statistically significant. TDT and ART subgroups did not show differences in age, UPDRS motor score, and TSH level. Only 1 (1.42%) female patient had hypothyroidism in the TDT subgroup. Three females and 2 males had subclinical hyperthyroidism in the PD group (2 females and 2 males in TDT and 1 female in the ART subgroup). The fT4 level and subclinical hyperthyroidism were significantly higher in the TDT subgroup than in ART. None of the patients in the PD group had hyperthyroidism or subclinical hypothyroidism. The prevalence of subclinical hyperthyroidism was higher in the PD group and the prevalence of hypothyroidism did not differ between the two groups. There was no significant relationship between the UPDRS score and thyroid hormone levels or anti-TPO.
DISCUSSION AND CONCLUSION: Thyroid dysfunction in Parkinson’s patients may cause difficulties in the treatment and follow-up process, as thyroid hormone levels may aggravate or camouflage Parkinson’s symptoms. In the study, the frequency of subclinical hyperthyroidism was higher in PD patients. The mean fT4 level and subclinical hyperthyroidism in TDT were significantly higher than those with ART. In addition, there was no correlation between the severity of the disease and the thyroid results. Thyroid tests should be carefully evaluated to facilitate treatment regulation in Parkinson’s disease.

8.The Effect of Serum Cortisol and Vitamin D Levels on Mortality in Covid-19 Patients Admitted to the Intensive Care Unit
Uğur Uzun, Murat Güneş, Fatma Demet Arslan, İsa Sahar, Taner Çalışkan, Çiler Zincircioğlu, Kazım Rollas, Nimet Şenoğlu, Aykut Sarıtaş, Işıl Köse
doi: 10.14744/hnhj.2022.99327  Pages 258 - 262
INTRODUCTION: One of the ways to reduce deaths due to Coronavirus-19 disease is to identify the factors that increase the mortality of the disease. Deficiency of vitamin D, which supports the immune system, and corticosteroids administered to suppress excessive inflammatory response may be risk factors that may affect mortality.
METHODS: In our study, we evaluated serum vitamin D and cortisol levels in Covid-19 patients during their admission to the intensive care unit, together with the demographic data and comorbidities of the patients, and examined their effect on mortality and their relationship with intensive care unit (ICU) scoring systems.
RESULTS: In the study, 101 Covid-19 patients were examined. Serum vitamin D and cortisol levels did not affect mortality statistically. Intensive care unit admission was more common in patients with low vitamin D levels. Cortisol levels were also higher in patients who died.
DISCUSSION AND CONCLUSION: Vitamin D deficiency increased the risk of admission to the intensive care unit, and serum vita-min D and cortisol levels during admission to the intensive care unit had no effect on the prediction of mortality.

9.Supraclavicular Brachiocephalic Vein Access for Tunneled Dialysis Catheter Placement in Patients with Bilateral Internal Jugular Vein Thrombosis
Umut Öğüşlü, Burçak Gümüş
doi: 10.14744/hnhj.2022.09825  Pages 263 - 269
INTRODUCTION: To evaluate the safety, effectiveness, and outcomes of tunneled dialysis catheters (TDC) placed through supraclavicular brachiocephalic vein (BCV) access in patients with bilateral internal jugular vein (IJV) thrombosis.
METHODS: Between January 2017 and October 2020, TDCs were placed through supraclavicular BCV access in 46 patients with bilateral IJV thrombosis. Patient demographics, number of attempts, technical and clinical success rates, complications, and patency rates were noted.
RESULTS: 21 (45.7%) patients were male. The mean age was 65.9 years (range 20–89). All catheters were placed at the first attempt. The right BCV was accessed in 16 (34%) patients. The technical and clinical success rate was 100%. No major complication was encountered. The mean follow-up period was 573.5 (range 50–1698) days. 44/46 (95.7%) of the catheters were functional at 30 days. The infection rate was 2.7/1000 catheter days. 38 catheter exchanges (mean: 1.9, range: 1–6) were required in 20 patients. The primary and secondary patency rates were 77.8% and 95.2% at 6 months, 77.8% and 95.2% at 12 months, and 74.8% and 84.8% at 24 months, respectively.
DISCUSSION AND CONCLUSION: TDC placement through supraclavicular BCV access is a viable option in patients with bilateral IJV thrombosis. High success rates and low complication rates with acceptable outcomes make this route an attractive alternative before proceeding to more complex access routes.

10.Use of Hemogram Parameters in the Differentiation of Benign Thyroid Nodules and Thyroid Papillary Carcinoma Cases
Dursun Burak Özdemir, Ümit Özdemir, Ahmet Karayiğit, Hayrettin Dizen, Bülent Ünal
doi: 10.14744/hnhj.2022.97658  Pages 270 - 276
INTRODUCTION: We aimed to compare red cell distribution width (RDW), mean platelet volume (MPV), and some other laboratory parameters in patients with papillary thyroid carcinoma (PTC) or benign thyroid nodule (BTN).
METHODS: A total of 365 cases (186 with PTC and 179 with BTN) who underwent lobectomy or bilateral total thyroidectomy were included in the study. The patients were divided into two groups, PTC and BTN, according to histopathological diagnosis.
RESULTS: 76.4% of the patients were female and the mean age was 54.94±13.76 years. The median RDW value was 13.3% (12.7–13.9) in the PTC group and 13.2% (12.7–14.2%) in the BTN group. Mean MPV value was 10.28±1.20 fL in the PTC group and 10.26±1.07 fL in the BTN group. The groups were similar in terms of MPV and RDW values (p=0.477 and p=0.883, respectively). Thyroid gland size and detected nodule sizes were significantly greater in the BTN group compared to the PTC group (p<0.001 for all).
DISCUSSION AND CONCLUSION: Complete blood count results, including RDW and MPV, were found to have no clinical value in distinguishing between PTC and BTN.

11.Changes in Early Infection Parameters After Percutaneous Tracheotomy
Alev Öztaş, Arzu Yıldırım Ar, Güldem Turan
doi: 10.14744/hnhj.2022.93271  Pages 277 - 280
INTRODUCTION: Although tracheotomy (TO) is preferred in patients who require long hospital stays and mechanical ventila-tion (MV) support in the intensive care unit (ICU), it is a procedure that carries serious complications such as bleeding, tracheal damage, pneumothorax, emphysema, and infection. In our retrospective study, we evaluated early infection parameters after percutaneous TO. We also aimed to evaluate changes made in the first 48 h after TO without any other reason.
METHODS: We retrospectively evaluated the data of 125 patients who underwent TO between January 2018 and June 2019 by obtaining the permission of the scientific study committee of our hospital with the decision numbered 170173117–05006. In our clinic, percutaneous TO is performed at the bedside in accordance with sterile asepsis conditions. If the patient who underwent the procedure does not use antibiotics, prophylactic antibiotics are not administered. In our study, demographic data of the patients, APACHE-II, SAPS-2, primary diagnosis, TO opening time, C-reactive protein before and after tracheotomy, leukocytes, neutrophil–lymphocyte ratio, MV day time, ICU discharge, and presence of mortality were examined.
RESULTS: The mean age was 70±17.3, APACHE–II mean was 17.1±6.3, and mortality was 36.4%. No antibiotic changes were detected after TO. No differences were observed in the infection parameter changes after TO and the percentage change rates of infection parameters according to the presence of antibiotic use.
DISCUSSION AND CONCLUSION: Since the TO opening period is usually after the 10th day of intensive care hospitalization, patients may show signs of infection due to other causes. We are of the opinion that percutaneous TO applications in intensive care may also be a primary source of infection, and therefore, it is necessary to pay attention to the follow-up of infection parameters in this period.

12.Evaluation of Traumatic Brain Injury with Hematological Parameters: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio
Hale Aksu Erdost, Mine Arayıcı, Nevin Deniz Kırca, Orhan Kalemci, Ceren Kızmazoğlu, Kaan Köşker, Murat Örmen, Pınar Akan
doi: 10.14744/hnhj.2022.80948  Pages 281 - 286
INTRODUCTION: Traumatic brain injury (TBI) is one of the leading causes of death and disability, affecting millions of people worldwide[1]. Theoretically, neutrophil-to-lymphocyte ratio (NLR) and thrombocyte-to-lymphocyte ratio (TLR) have the potential to be used as a marker of the severity of the secondary brain injury process in TBI. The aim of this study was to investigate the changes in routine blood tests in patients with severe TBI and analyze the relationship between NLR, TLR, and TBI outcomes.
METHODS: In this study, we collected the data using the routinely analyzed hematological parameters of the patients admitted to our hospital for TBI and who underwent surgery in the past 10 years. GCS score and pupillary reaction of the patient at admission, demographical data, computed tomography (CT) scans, analysis of the blood sample is routinely performed at admission. White blood cell count, hemoglobin, mean corpuscular volume, red blood cell distribution width (RDW), platelet, and neutrophil count data were recorded from blood sample analysis.
RESULTS: There was a significant difference between the good outcome and bad outcome groups in terms of the mean age, pupillary activity, and GCS. While the groups were significantly different in terms of their hematological parameters, such as RDW, mean platelet volume (MPV), and neutrophil count (p=0.005, 0.017, and 0.043, respectively), no difference could be detected in terms of TLR and Glasgow Outcome Scale (p=0.14). However, NLR was observed to be higher in the patient group with bad outcome (p=0.0078).
DISCUSSION AND CONCLUSION: Secondary brain injury in patients with head trauma is associated with the inflammatory process, and although the results in our study were not significant in terms of TLR, blood count tests such as NLR and TLR, which affect prognosis, are indicators of inflammation. Therefore, the increase in NLR and TLR may be a guide for CT scan and surgical treatment. Moreover, we believe that neutrophil, RDW, and MPV values in routine blood count tests may also be prognostic indicators. Nevertheless, more advanced, comprehensive, and prospective studies are required to support the current results.

13.Role of Apparent Diffusion Coefficient Value to Predict Locoregional Invasion and Systemic Metastasis in Cervical Cancer
Ezel Yaltırık Bilgin, Nazan Çiledağ, Koray Aslan
doi: 10.14744/hnhj.2022.32858  Pages 287 - 291
INTRODUCTION: We questioned the relationship between apparent diffusion coefficient (ADC) values and the presence of locoregional invasion and systemic metastases in patients with cervical cancer. We aimed to evaluate the role of ADC values in predicting tumor cellularity and aggressiveness.
METHODS: Forty patients with histopathologically proven cervical cancer diagnosis who applied to our center between January 2018 and January 2022 were evaluated retrospectively and included in the study. ADC values were measured from the ADC maps created from the diffusion-weighted images of the patients. In addition, invasion of adjacent organs (bladderrectum) was evaluated with pelvic magnetic resonance examination (MRI) and distant organ metastases were evaluated, primarily by PET-CT and, if any, other scanning methods (brain MRI, bone scintigraphy) at the time of diagnosis.
RESULTS: The mean ADC value of patients with locoregional invasion was found to be 0.89×10–3 mm2/s, and the mean ADC value of patients without locoregional invasion was 0.96×10–3 mm2/s. Although the mean ADC value of the patients with locoregional invasion was lower than the patients who were not detected, this difference between the two groups was not statistically significant (p=0.466). The mean ADC value of patients with systemic metastasis was 0.73×10–3 mm2/s, and the mean ADC value of patients without systemic metastasis was 0.96×10–3 mm2/s. The mean ADC value of patients with sys-temic metastasis was found to be low, close to the statistical significance level (t=1.954, p=0.058). As a result of ROC analysis, the most appropriate cutoff limit for ADC value for systemic organ metastasis was found to be 0.93 (sensitivity=59% and specificity=83%).
DISCUSSION AND CONCLUSION: Systemic metastasis risk and poor prognosis can be predicted by diffusion-weighted imaging and ADC values.

14.Impact of Comorbidities on Prognosis in Asymptomatic, Mild, and Moderate COVID-19 Patients: A Retrospective Türkiye Study
Hakan Aydın, Halil Doğan, Davut Tekyol, Ömer Faruk Çetin, Ferhat Yüce, Mehmet Kemal Emem
doi: 10.14744/hnhj.2022.01212  Pages 292 - 298
INTRODUCTION: Predicting the mortality risk of 2019 coronavirus disease (COVID-19) patients in the early period is important in terms of using the limited health system’s resources efficiently. The aim of this study was to determine the effects of comorbidities on the occurrence of pneumonia and prognosis in asymptomatic, mild, and moderate COVID-19 patients.
METHODS: This retrospective, single-center, and cross-sectional study was conducted between April 1 and May 15, 2020, in the emergency department of a tertiary hospital in Istanbul, Türkiye. In our study, patients with laboratory-confirmed COVID-19 were examined for the occurrence of pneumonia and 28-day mortality.
RESULTS: The study was included 3047 adult patients. In our study, pneumonia detection rate was 55.3%, hospitalization rate was 18.0%, and 28-day mortality rate was 0.7%. NCIP (85.3% vs. 47.7%; p<0.001) and mortality (2.8% vs. 0.1%; p<0.001) rates were higher in patients with at least one comorbidity disease than those without. Advanced age, smoking, hypertension, diabetes, asthma, chronic kidney disease (CKD), and malignancy were important risk factors for the occurrence of pneumonia. In addition, in our study, COVID-19 patients with hypertension, diabetes, CKD, chronic liver disease, or malignancy had a higher probability of 28-day mortality.
DISCUSSION AND CONCLUSION: In our study, the most important risk factors for both pneumonia and 28-day mortality were advanced age, diabetes, CKD, and malignancy. The effects of comorbidities should be considered when determining the risk stratification and need for hospitalization of asymptomatic, mild, and moderate COVID-19 patients.

15.The Association of Lower Perioperative Mean Arterial Pressure and Primary Failure in Distal Radiocephalic Arteriovenous Fistula Operations
Abdulkerim Özhan, Mehmet Şenel Bademci, Cemal Kocaaslan, Fatih Avni Bayraktar, Ahmet Öztekin, Defne Cansu Karamanlı, Ömer Arda Uslu, Murat Baştopçu, Ebuzer Aydın
doi: 10.14744/hnhj.2022.01328  Pages 299 - 304
INTRODUCTION: Arteriovenous fistula (AVF) is the recommended vascular access type for hemodialysis-dependent patients. Although the patency rates are respectable, primary failure is still a challenge. We aimed to investigate the association between lower perioperative mean arterial pressure and primary failure in distal radiocephalic AVF operations.
METHODS: A total of 141 patients who underwent distal radiocephalic AVF operation were retrospectively investigated (70 females, mean age: 48.0±5.5). The patients were divided into two groups according to the average value of the perioperative mean arterial pressure measurements. Risk factors were compared between groups.
RESULTS: No difference was found between groups in terms of baseline characteristics and risk factors. The primary failure was found to be higher in the lower perioperative mean arterial pressure group (17% vs. 34%, p=0.030). Risk factors for primary failure were taken into univariate logistic regression analysis, and none were found significant.
DISCUSSION AND CONCLUSION: Our study revealed that lower mean arterial pressure in the perioperative period is associated with a higher primary failure rate for distal radiocephalic AVFs.

16.Analysis of Difference Between Survivals in Seventh and Eighth Editions of TNM Staging in Resectable Multiple Primary Lung Cancers (MPLC)
Elçin Ersöz Köse, Cansel Atınkaya Baytemir, Mustafa Akyıl, Rıza Serdar Evman, Abidin Levent Alpay, Irfan Yalçınkaya
doi: 10.14744/hnhj.2022.45477  Pages 305 - 311
INTRODUCTION: Staging of multiple primary lung cancer (MPLC) cases and planning the treatment are of great importance in terms of the prognosis of the disease. Size of lung lesion (T) and lymph node status (N) are of the most reliable indicators of prognosis in patients with lung cancer. In this study, we evaluated whether there was a survival difference in T and N status in the survival analysis of the seventh and eighth edition of staging in MPLC who underwent curative radical surgery.
METHODS: A total of 55 patients diagnosed with MPLC in our clinic between January 2000 and April 2016 were retrospec-tively screened. These patients were divided into 2 main groups: 20 synchronous and 35 metachronous lung cancers. Survivals for both groups were calculated according to both the seventh and eighth edition of TNM staging systems (TNM7 and TNM8), taking into account the tumor sizes at first operation, stages, lymph node presence, histopathological type, and tumor localization.
RESULTS: In our study, a statistically significant difference was found in terms of survival between tumor sizes and stages in TNM7 staging system, according to the results of the pairwise comparison test applied in synchronous lung cancers (p<0.05). However, no statistically significant difference was found in terms of survival in TNM8 staging system (p>0.05). In metachronous lung cancers, no statistically significant difference was found in terms of tumor size and survival between stages in both TNM7 and TNM8 staging systems according to the results of the pairwise comparison test (p>0.05). A statistically significant difference was found between lymph node groups in terms of survival in TNM8 staging system in synchronous and metachronous lung cancers (p<0.05). Staging according to the TNM8 staging system in synchronous lung cancers changed in 11 of our patients and in 22 patients in metachronous lung cancers.
DISCUSSION AND CONCLUSION: TNM7 staging was found to be more sensitive in terms of survival difference according to tumor size and stages in synchronous tumors, while TNM8 staging was found to be more sensitive in terms of survival difference due to lymph node involvement in both synchronous and metachronous tumors. In cases with MPLC, the proposed eighth edition of staging system is superior to the seventh edition as descriptors of tumor sizes are elaborated.

17.Bloody Nipple Discharge in Children: Single-Center Experience
Sefa Sağ, Hatice Küçük
doi: 10.14744/hnhj.2022.25986  Pages 312 - 315
INTRODUCTION: Bloody nipple discharge (BND) in children is an exceptionally rare entity. The aim of the study was to evaluate the underlying etiologies, treatment strategies, and clinical outcomes in children with BND.
METHODS: The retrospective study included pediatric patients (aged below 18 years) who presented with BND in our clinic between May 2015 and May 2020. Demographic and clinical characteristics including age, gender, laboratory, ultrasound (US), and histopathological findings, treatment modalities, and follow-up records were evaluated for each patient.
RESULTS: Patients comprised six (75%) girls and two (25%) boys. Median age at diagnosis was 15 years (minimum-maximum: 3–192 months) and all the girls were adolescents. BND was located in the left breast in five and in the right in three patients, and bilateral BND was not detected in any patient. All patients had normal serum hormone levels and a negative discharge culture. In US examination, mammary ductal ectasia (MDE) was diagnosed in two patients, one patient had hypoechoic tissue in the subareolar region, whereas the others had normal US findings. Cytology showed ductal epithelial cells without malignancy, which confirmed MDE in all patients. BND resolved with antibiotic treatment in one patient and resolved with no treatment in other patients.
DISCUSSION AND CONCLUSION: BND can occur in adolescent girls as well. MDE is a leading cause of BND. Given that MDE is usually a self-limiting condition, unnecessary invasive interventions should be avoided. Cytological and US examinations seem to be highly useful in the diagnosis and follow-up of patients with BND.

18.Clinical Spectrum of Acute Poisoning Cases Admitted to the Pediatric Emergency Department
Muhammed Selçuk Sinanoğlu, Erhan Berk
doi: 10.14744/hnhj.2022.01069  Pages 316 - 321
INTRODUCTION: Pediatric poisoning is a common emergency worldwide. Routine surveillance is necessary for public health officials and physicians to update strategies for pediatric poisoning prevention and management. In this study, we aimed to investigate the epidemiology of poisoning among children admitted to the emergency department.
METHODS: In this study, the epidemiological features of 110 cases of poisoning brought to Malatya Training and Research Hospital Pediatric Emergency Service between March 2020 and December 2021 were retrospectively reviewed and examined.
RESULTS: Hospital admissions are most frequently seen in the age groups of 1–3 (52.7%) and 12–18 (23.6%) years. Of 110 poisoning cases, 56.4% were drug poisoning and 54.5% of them were girls. While there are no symptoms in 74.5% of the cases, the most common symptom is abdominal pain with 40.7%. 92.7% of the patients needed intensive care. Only 45.5% of the cases were followed up and gastric lavage was performed with activated charcoal in 23.6% of them.
DISCUSSION AND CONCLUSION: Childhood poisoning has an important place among the reasons for admission to the hospital. Early detection of poisonings and appropriate approach are lifesaving. Parenting advice and protective safety measures are important.

19.Surgical Outcomes of Intracranial Meningiomas: A Retrospective Study
Eylem Burcu Kahraman Özlü, Anas Abdallah
doi: 10.14744/hnhj.2022.11129  Pages 322 - 328
INTRODUCTION: In this study, it was aimed to evaluate the clinical outcomes of patients who underwent surgical resection for meningioma.
METHODS: Medical records were retrospectively reviewed for all cranial and spinal cases diagnosed and underwent surgery at BRSHH Hospital between 2012 and 2016. All intracranial meningioma patients constituted the core sample for this study.
RESULTS: This series included 136 (88 females, 48 males) patients, with a mean age of 55.1±14.1 years. The mean preoperative course was 23.0±40.5 months. The most common symptom was headache (71.3%). The most common location was the frontal region which was seen in 29 patients (21.3%). The mean follow-up period was 36.0±18.95 months. 84.4% of grade I, and 68.2% of grade II demonstrated isointense lesions on T1-weighted magnetic resonance imaging (MRIs) (p=0.027). 15.5% of grade I and 47.7% of grade II showed irregularity (p=0.04). Giant tumors were more commonly associated with non-grade I meningiomas than grade I (p=0.006). 58.9% of grade I and 79.5% of grade II meningiomas demonstrated peritumoral edema on MRIs. The presence of preoperative neurological deficit (p<0.0001), irregularity on MRI (p=0.002), and recurrence (p=0.002) were associated with poor prognosis of surgical outcomes. Gross-total resection (GTR) (p=0.0003) was associated with a good prognosis.
DISCUSSION AND CONCLUSION: The presence of preoperative neurological deficit, irregularity on MRI, and recurrence were factors associated with poor prognosis of surgical outcomes. GTR was associated with good surgical outcomes. The presence of preoperative deficits and irregularity on MRIs were associated with a high recurrence rate.

20.Effects of Blood Hemoglobin Levels on Vertebral Discal Degeneration
Eyüp Çetin, Volkan Şah, Mustafa Arslan, Özkan Arabacı, Mehmet Edip Akyol, İlker Ünlü
doi: 10.14744/hnhj.2023.35219  Pages 329 - 333
INTRODUCTION: Vertebral discopathies are one of the most important causes of low back pain, which is very common in the community. Although there are many biochemical and mechanical causes of discogenic low back pain, the most important is discal degeneration. Many studies have been conducted suggesting that disc degeneration could be associated with various factors. In our study, we aimed to reveal a possible relationship between disc degeneration and levels of hemoglobin (HGB).
METHODS: We investigated the connection between discal degeneration and certain parameters, especially HGB levels, in a total of 174 patients in two separate groups; those with and without disc degeneration. Age, weight, height, body mass index, chronic diseases, mean HGB, hematocrit (HTC) level, white blood cell (WBC), high-density lipoprotein, low-density lipoprotein (LDL), and triglyceride (TG) values of the patients were recorded.
RESULTS: No significant difference was detected (p>0.05) between the groups with and without degeneration in terms of HGB, HTC, WBC, and LDL values. The TG level in the group with disc degeneration was significantly (p<0.05) higher than the group without disc degeneration.
DISCUSSION AND CONCLUSION: Lumbar disc degeneration is a public health problem that continues to be discussed in the lit-erature. There was no significant difference in terms of HGB levels between the groups, with and without degenerated disc.

21.Critical Insights Based on the Ministry of Health’s 6-Year Data Analysis: An Epidemiological Study of Patient Visits Trends of Emergency Departments in Türkiye
Suayip Birinci, Mustafa Mahir Ülgü, Melih Gaffar Gözükara
doi: 10.14744/hnhj.2023.17048  Pages 334 - 339
INTRODUCTION: Although emergency services are at a vital point in health systems, they occupy a large place in terms of service capacity and finance. An emergency service visit complaint may be within the scope of the primary health-care service, or it may be a health problem that must be completed with the minutes. Overcrowding of emergency departments (EDs) and delayed visits may be critical for priority patients to receive treatment. In our study, it was aimed to examine all 6-year patient visits to all emergency services in Turkiye in detail and to determine the epidemiological trends of visits.
METHODS: The study includes a total of 925,161,028 ED visits, including both children and adults. Data were collected from the EDs of all healthcare institutions in Türkiye, through the Sağlıkta İstatistik ve Nedensel Analizler (Statistics and Causal Analysis in Health) program web inter-face.
RESULTS: Average time from registration to triage was 16.9 min. 787,617,762 triages have been made. About 28.30% were classified as green triage, 68.51% were classified as yellow triage, 3.18% as red triage, <0.01% as black triage, and 137,543,266 visits (14.87% of among total visits) were as other (non-triaged). The highest number of visits, 66.2 million (7.2%), occurred be-tween 20: 00 and 21: 00 weekly, while the lowest number of visits occurred between 5: 00 and 6: 00, with about 6 million visits (0.65%).
DISCUSSION AND CONCLUSION: The high volume of ED visits, particularly during non-office hours and among certain demo-graphic groups, highlights the need for targeted strategies to optimize healthcare delivery. This could include enhancing primary and secondary care services, improving health literacy among the population, and implementing effective triage systems and which, will be key to ensuring the sustainability of Türkiye’s health-care system and improving health outcomes for the population.

22.If you Want to Find, you Must Think: Case Report and Literature Review of the Periprosthetic Knee Infection from Brucella Melitensis
Murat Köken, Alperen Kaan Yaman, Burak Akan
doi: 10.14744/hnhj.2022.26928  Pages 340 - 345
In addition to the difficulty of diagnosis in periprosthetic joint infections (PJI) following total knee arthroplasty, the infectious agent is also often difficult to identify. Correct identification of the pathogen increases the chance of a successful treatment. Although rare, clinicians should keep Brucella infections in mind when a pathogen cannot be found in PJI cases. A 58-year-old female patient was diagnosed with a periprosthetic Brucella infection following bilateral total knee arthroplasty. All symptoms disappeared in the postoperative 1st year after a two-step revision arthroplasty. We aimed to draw attention to periprosthetic infections caused by Brucella and to perform a review of literature in this case report.

23.Spinal Myxopapillary Ependymoma: A 12-Year-Old Pediatric Case with Hydrocephalus Presenting with Gait Abnormality
Ayşe Özlem Balık, Adem Karabulak, Zehra Esra Önal, Çağatay Nuhoğlu, Okan Akıncı
doi: 10.14744/hnhj.2022.37108  Pages 346 - 349
Primary malignant central nervous system tumors are the second most common group of childhood tumors. These tumors can increase the intracranial pressure with compression on the adjacent structures, as well as cause hydrocephalus by obstructing the cerebrospinal fluid (CSF) flow. Ependymomas, which constitute 10% of intracranial tumors, are responsible for 40-60% of spinal tumors in children and young adults. Its incidence has been reported as 0.3/100,000. Myxopapillary ependymomas are usually slow growing and benign lesions. Patients may present with spinal deformities such as scoliosis, torticollis or gait abnormalities.

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