ISSN: 2630-5720 | E-ISSN: 2687-346X
Volume: 64  Issue: 1 - 2024
1.Front Matter

Pages I - X

2.Factors Affecting Pressure Sores in Palliative Care Patients
Buğu Usanma Koban, Emine Zeynep Tuzcular Vural, Hilal Özkaya, Işık Gönenç
doi: 10.14744/hnhj.2022.81567  Pages 1 - 7
INTRODUCTION: Determining the risks in terms of preventing the formation of pressure sores and the progression of existing wounds is very important in reducing mortality. In our study, we aimed to determine the factors affecting the formation of pressure ulcers and the stage of the wound in patients hospitalized in a palliative care center.
METHODS: The material of our cross-sectional and retrospective study consisted of patients hospitalized in a palliative care center between January 2017 and February 2018. The age, gender, primary diagnosis, comorbidities, hemoglobin, hematocrit, lymphocyte, neutrophil, C-reactive protein, albumin, and prealbumin values, and NRS 2002 scores of the patients were recorded; and the relationship of these variables with pressure ulcer information was analyzed.
RESULTS: Of the patients participating in our study, 277 (55.1%) were female, and 226 (44.9%) were male. According to the results of our study, the risk of pressure ulcers increases in patients over 65 years of age and in female patients. Having a cerebrovascular accident or dementia/Alzheimer's disease increases the risk of advanced wounds. The presence of hypertension or cardiovascular disease increases the risk of pressure ulcers. Diabetes and chronic kidney disease have not been found to be associated with wounds. Low albumin, hemoglobin, and hematocrit, and high lymphocyte levels are associated with advanced wounds. There was no statistically significant relationship between prealbumin, CRP, neutrophil levels, and the neutrophil/lymphocyte ratio and pressure ulcers.
DISCUSSION AND CONCLUSION: There is a strong relationship between the formation and progression of pressure ulcers and the diagnosis, nutritional status, presence of anemia, and hypertension. Taking precautions by being aware of the risks in elderly patients with chronic diseases and in need of care is of great importance in terms of preventing pressure ulcers, which increase morbidity and mortality.

3.Diagnostic Role of EEG in Parkinson’s Disease Patients with Cognitive Impairment
Gülbün Asuman Yüksel, Gizem Gürsoy, Yılmaz Çetinkaya, Figen Varlıbaş, Can Ulutaş
doi: 10.14744/hnhj.2022.60430  Pages 8 - 11
INTRODUCTION: The most common finding in comparative electroencephalography (EEG) exams in patients with Parkinson’s disease and healthy individuals in similar age groups is the increased generalized or localized slow-wave activity. The present study aims to investigate the EEG findings in patients with Parkinson’s disease and to determine their possible contribution to diagnosis.
METHODS: The study included patients followed up by the Movement Disorders Outpatient Clinic for diagnosed Parkinson’s disease. The Unified Parkinson’s Disease Rating Scale (UPDRS) was used to rate the clinical disability in patients with Parkinson’s disease with and without dementia based on DSM-V criteria. Patients were also evaluated using the Standardised Mini-Mental State Examination (SMME), the Geriatric Depression Scale (GDS), and the Neuropsychiatric Inventory (NPI). EEG recordings were performed according to the 10-20 system in both the patient group and healthy individuals in similar age groups with no metabolic/organic diseases.
RESULTS: 60 patients (16F, 44M, mean age: 69.23±11.56 years) diagnosed with Parkinson’s disease were compared with a control group of 25 individuals (17F, 8M, mean age: 70.12±8.18 years). In the patient group, 19 patients (31.7%) showed EEG pathology in the form of 4-8 Hz theta wave activity interpreted as mild disorganization, while 2 patients (3.33%) showed nonspecific slow-wave activity on both hemispheres. In the control group, only 1 patient (4%) had pathological EEG findings. 47.6% of the patients with Parkinson’s disease dementia showed EEG pathology. 2 patients with nonspecific slow-wave activity on both hemispheres were found to be from the Parkinson’s disease dementia group. Patients with EEG pathology had higher UPDRS scores (p=0.011), lower SMME scores (p=0.002), and higher NPI scores (p=0.004).
DISCUSSION AND CONCLUSION: The present study points out that there is a parallel between the development of dementia and EEG pathology in Parkinson’s disease and thus EEG may be important in the diagnosis and follow-up of cognitive decline.

4.Management of Immunosuppression Treatment in Autoimmune Liver Disease and Liver Transplantation Patients Infected with COVID-19
Şevki Konur, Ismet Kızılkaya, Ergin Turgut, Güner Kılıç, Ramazan Dertli, Yusuf Kayar
doi: 10.14744/hnhj.2022.46353  Pages 12 - 17
INTRODUCTION: It is known that viral infections progress more seriously in immunosuppressed patients than in the healthy population. In the literature, there is limited information on the course of COVID-19 infection in patients with autoimmune liver disease (AID) who receive immunosuppressive therapy, and in patients who have undergone liver transplantation. We present in detail the course of twelve patients, including six patients with AID and six patients with liver transplantation, who had COVID-19 infection and were followed up under immunosuppressive therapy.
METHODS: Six AID and six liver transplant patients with COVID-19 infection were examined in detail from 58 AID and 72 liver transplant patients followed in the hepatology outpatient clinic of our hospital. Demographic data such as age and gender, underlying liver diseases, medical treatments received, and how medical treatment was affected during COVID-19 infection were examined in detail.
RESULTS: The mean age of the twelve patients included in the study was 38.1±5.2 years, with 7 (58.3%) patients being male and 5 (46.7%) female. Two patients with cirrhosis-associated AID who are in remission under azathioprine monotherapy had their treatment dose reduced by half, while the others did not change. While the dose of immunosuppressant was reduced by half and methylprednisolone treatment was added in two of the transplant patients, no dose change was required in the other patient. All patients were discharged with full recovery.
DISCUSSION AND CONCLUSION: Interruption of immunosuppressive therapies is not appropriate because they prevent the activation of the underlying AID, prevent liver rejection in transplanted patients, as well as cytokine storm, which is the most important cause of mortality in COVID-19 disease. However, dose reduction can be made in selected cases.

5.Evaluation of Liver Damage in COVID-19 Patients Followed in The Intensive Care Unit
Fatih Sargın, Zeynep Gök Sargın, Hülya Sungurtekin
doi: 10.14744/hnhj.2022.98360  Pages 18 - 23
INTRODUCTION: In coronavirus disease 2019 (COVID-19), liver injury has been associated with the direct cytopathic effect on cholangiocytes, an uncontrolled immune response, sepsis, or drug-induced liver injury. This study aimed to evaluate liver damage in COVID-19 patients in the intensive care unit.
METHODS: Between January 1, 2021, and June 1, 2021, medications, mortality rates, length of stay in the intensive care unit, liver function tests, and acute phase reactants, during admission to the unit and on the 3rd, 7th, and 15th days of follow-up were analyzed retrospectively.
RESULTS: A total of 92 patients were included in the study. In a mean follow-up of 2 weeks, ALT levels increased by 62%, AST levels increased by 78.3%, GGT levels increased by 65.2%, ALP levels increased by 43.5%, and total bilirubin levels increased by 20.7% of the patients were observed. In repeated measurements of the patients, significant increases were observed in ALP (p=0.013), GGT (p=0.001), and bilirubin levels (p=0.012). Thirty-six patients resulted in mortality, and in patients who died, AST (p=0.02), day 15 AST (p=0.02), GGT (p=0.02), and ALP (p=0.009) values were observed to be significantly high. There was no relationship between CRP and IL-6 levels, transaminases, and cholestasis enzymes. When the patients who received and did not receive favipiravir treatment were compared, there was no difference other than the 3rd day AST (p=0.043) value.
DISCUSSION AND CONCLUSION: Increases in cholestasis enzymes were detected in the 15-day follow-up of patients admitted to the intensive care unit due to severe COVID-19. Furthermore, it was observed that the transaminase and cholestasis enzymes of the patients who ended in mortality were higher. In addition, liver enzymes were at similar levels between patients who received and did not receive favipiravir treatment.

6.Evaluation of Inflammatory Hematological Parameters in Cases of Glioblastoma, Primary Cerebral Lymphoma, and Metastasis Following Stereotactic Brain Biopsy
Selin Tural Emon, Ezgi Akar
doi: 10.14744/hnhj.2022.59320  Pages 24 - 28
INTRODUCTION: Inflammation and immune reaction are influential both in the etiology and prognosis of many tumors. Inflammatory parameters that can be measured in blood, such as neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lymphocyte-monocyte ratio, have been found to be associated with the prognosis and course of the disease in many intra and extracranial tumors.
METHODS: Between 2013-2021, lymphocyte, neutrophil, monocyte, and platelet values were measured in the preoperative blood tests of patients diagnosed histopathologically with glial tumors, metastasis, and primary cerebral lymphoma at our clinic through stereotactic biopsy. Ratios of neutrophil-lymphocyte, lymphocyte-monocyte, and platelet-lymphocyte were determined. The values identified in the three tumor groups were statistically compared.
RESULTS: In all three tumor groups, no significant difference was observed in the values of neutrophils, monocytes, and platelets. In the metastasis group, lymphocyte values were significantly higher compared to glial tumor and lymphoma cases. No significant statistical difference was observed in the neutrophil-lymphocyte, lymphocyte-monocyte, and platelet-lymphocyte ratios among the three groups.
DISCUSSION AND CONCLUSION: According to the results of our study, preoperative hematological inflammation parameters do not have a diagnostic or distinguishing effect in glial tumors, metastases, and primary cerebral lymphomas.

7.The Effect of Vascular Endothelial Growth Factor on Liver Regeneration in a Rat Model
Mete Yazı, Hakan Özdemir, Zehra Ünal Özdemir, Gökçe Acun, Kaptan Gülben, Berna Savaş
doi: 10.14744/hnhj.2022.37530  Pages 29 - 34
INTRODUCTION: Stimulation of liver regeneration after hepatectomy may provide important advantages, especially in cases where liver tissue is at a critical level. Some studies have reported that vascular endothelial growth factor (VEGF) might ameliorate liver regeneration in animals. In this study, we aimed to examine the effects of exogenous VEGF164 on the regeneration of liver tissue after a 70% hepatectomy in rats.
METHODS: Twenty Wistar Albino male rats, weighing 300-350 g, were randomly divided into four groups, each having five animals. Group 1 and Group 3 were designated as control groups, and Group 2 and Group 4 as experimental groups. All rats underwent laparotomy and 70% partial hepatectomy. Postoperatively, control groups were administered saline through the tail vein at 0 and 6 hours, and VEGF164 was administered to the experimental groups in the same manner at 0 and 6 hours. Blood samples were collected by sacrificing the rats at 24 hours for Group 1 and Group 2, and at 72 hours for Group 3 and Group 4. Subsequently, relaparotomy was performed and the remaining liver tissues were completely removed in all groups. Then, the resected liver tissues were used to determine morphological regeneration rates. The histopathological proliferation of the liver was evaluated by calculating the Ki-67 proliferative index.
RESULTS: In the histopathological evaluation, it was revealed that the liver proliferation index was significantly higher in the VEGF164 group at 72 hours (p=0.028). Although liver weights were higher in the experimental groups, no statistically significant results were obtained in terms of morphological liver regeneration rates (p>0.05).
DISCUSSION AND CONCLUSION: Although the positive effects of exogenous VEGF on liver regeneration were not found in this rat model, statistically significant increases in the liver proliferation index are promising.

8.Importance of Percutaneous Cholecystostomy in the Treatment of High-Risk Acute Cholecystitis Patients
Doğan Erdoğan
doi: 10.14744/hnhj.2022.75975  Pages 35 - 39
INTRODUCTION: The prevalence of acute calculous cholecystitis (ACC) increases with age, and the majority of these patients have high comorbidities. In high-risk patients with increased comorbidities, conservative treatment or percutaneous cholecystostomy (PC) may be chosen instead of surgical treatment, depending on the center experience and the patient's risk status. Our aim is to investigate the efficacy and safety of PC, ACC recurrence rates, and the surgical need in Tokyo Grade of Severity - Grade 3 patients with high surgical risks.
METHODS: Twenty patients who applied to Haydarpaşa Numune Training and Research Hospital between December 2012 and February 2020, with Grade 3 severity acute cholecystitis (Tokyo guidelines), were included in the study. All were diagnosed with acute cholecystitis using the 2018 Tokyo criteria and treated with percutaneous cholecystostomy. Patient data were obtained through retrospective screening.
RESULTS: Eight (40.0%) of the total patients were female and 12 (60.0%) were male. The mean age of the patients was 78.6±9.9 years. The mean hospital stay was 17.8±11.8 days. The technical success of the PC procedure was 100%. The mean duration of the catheters was 29.0±14.7 days. No procedure-related mortality was observed. 100% of the patients had comorbidities, with all having more than one comorbidity. All patients were grade 3 according to the Tokyo severity rating. All were evaluated as ASA IV due to comorbidities and found to be at high risk for surgery. The follow-up period was 12 months. Mortality was calculated for 90 days, and mortality was observed in 3 (15%) patients.
DISCUSSION AND CONCLUSION: PC can be an effective and safe treatment method that can be applied before cholecystectomy or for permanent treatment to avoid mortality and morbidity in high-risk patients who are not suitable for surgery.

9.Static and Dynamic Cyclotorsion Compensation with the Schwind Amaris Laser System: Twelve-Month Refractive and Visual Outcomes
Mehmet Kay, Ece Turan Vural, Hatice Elvin Yıldız, Burak Erdem
doi: 10.14744/hnhj.2022.82085  Pages 40 - 47
INTRODUCTION: Static (SCC) and dynamic cyclotorsion compensation (DCC) were evaluated in myopic/myopic astigmatism patients undergoing transepithelial photorefractive keratectomy (T-PRK) or femtosecond laser in situ keratomileusis (F-LASIK).
METHODS: This retrospective, nonrandomized case series research comprised 236 eyes from 118 patients who had T-PRK (137 eyes) and F-LASIK (99 eyes). The refractive results at the preoperative and 12th months were compared. The association between SCC and DCC values and pre- and postoperative refractive results was investigated.
RESULTS: SCC in the T-PRK group was 3.34±2.69° and 3.54±2.73° in the F-LASIK group. SCC was 3.38±2.68° in all patients. DCC in the T-PRK group was 1.51±1.07° and 1.74±0.93° in the F-LASIK group. In all patients, DCC was 1.57±0.90°. There was no significant difference between the T-PRK and F-LASIK groups in SCC and DCC (p>0.05). The preoperative trefoil showed a significant association with SCC (p<0.05). DCC was shown to have a significant relationship with postoperative total HOA and trefoil (p<0.001, p<0.05, respectively).
DISCUSSION AND CONCLUSION: Even with aberration-free refractive surgery, successful corneal aberrations and refractive results were achieved 12 months after surgery with minimal SCC and DCC. SCC and preoperative trefoil, as well as DCC and postoperative total HOA and coma, had proportionate relationships.

10.Antimicrobial Effects of Nanocrystalline Silver-Loaded Wound Dressings in Full-Skin Thickness Rat Burn Wounds
Ayşe İrem İskenderoğlu, Zarife Barbak, Simin Cevan Amirhizi, Nesibe Sinem Çiloğlu, Sebahat Aksaray
doi: 10.14744/hnhj.2022.68916  Pages 48 - 54
INTRODUCTION: Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care to minimize mortality and morbidity. Despite major advances in the management of burn patients, infectious complications remain a major contributor to morbidity and mortality. In this experimental study, the effect of two different nanocrystalline silver dressings on Candida albicans-contaminated full-thickness burn wounds in rats was analyzed.
METHODS: A full-thickness skin burn was formed in a total of 24 female 200-230 gr Sprague-Dawley rats. After the burn wound was seeded with 108 CFU/ml standard strain of Candida albicans ATCC90028, the animals were separated into three groups, and the antifungal activity of nanocrystalline silver-containing nanofiber dressing and Acticoat dressing was compared. All rats were sacrificed on the seventh day. Biopsies were obtained from the center of the burn eschar and the paravertebral muscles beneath the burn eschar. Blood was drawn from the left ventricle, and lung biopsies were examined by performing thoracotomies.
RESULTS: There was no significant difference in Candida and bacteria growth on the burn eschar, muscle, lung tissue, and blood cultures among the groups (p>0.5).
DISCUSSION AND CONCLUSION: Nanocrystalline silver dressings facilitate wound healing and have wide antimicrobial effects. Although these effects are well known, the antifungal and antibacterial activity of the nanocrystalline silver dressings used in our study could not be revealed.

11.Breast-Conserving Surgery for Breast Cancer
Murat Tan, Ali Deneçli
doi: 10.14744/hnhj.2022.31644  Pages 55 - 60
INTRODUCTION: Breast cancer is notably significant as it is the most common cancer in women. Recent findings indicate that breast-conserving surgery (lumpectomy and axillary dissection) in early-stage breast cancer offers a long disease-free period and comparable overall survival to those undergoing mastectomy. This highlights the potential preference for breast-conserving surgery in early-stage breast cancers.
METHODS: This study included 26 patients diagnosed with breast cancer at the SSK Izmir Training and Research Hospital General Surgery Service between 20/02/2001 and 11/11/2004. Factors such as medical considerations, cosmetic results, patient age, patient preference, mammographic findings, tumor size and number, condition of axillary lymph nodes, and histopathological findings were considered. Breast-conserving surgery was performed, followed by a retrospective analysis of these patients.
RESULTS: This study analyzed local control and survival outcomes in 26 patients diagnosed with early-stage (Stage 1-11) breast cancer, with a median follow-up of 3.9 years between 20/02/2001 and 11/11/2004. The median follow-up period for the patients was 45 months. Quadrantectomy+axillary dissection was performed in 20 patients, and Lumpectomy+axillary dissection in 6 patients. All 26 patients received radiotherapy with a dose of 46-50 Gy (2 Gy/day).
DISCUSSION AND CONCLUSION: Reviewing the article with current publications, Lancet in December 2019 supports whole breast irradiation after breast-conserving surgery for early-stage breast cancer. A 2011 randomized controlled trial reported excellent long-term outcomes for invasive ipsilateral breast tumor recurrences following lumpectomy, particularly after radiation therapy and tamoxifen-sparing surgery. These findings strongly suggest that breast-conserving surgery combined with radiotherapy is equivalent to mastectomy.

12.Evaluation of Radiological Findings of Pregnant Women with COVID-19
Hilal Gülsüm Turan Özsoy, Gültekin Adanaş Aydın, Serhat Ünal
doi: 10.14744/hnhj.2022.80947  Pages 61 - 69
INTRODUCTION: This study aims to evaluate the radiological findings of pregnant women with COVID-19 pneumonia.
METHODS: A total of 192 pregnant women diagnosed with COVID-19 by performing real-time reverse transcriptase-polymerase chain reaction test (RT-PCR) were studied retrospectively. Chest X-rays and thoracic CT findings were defined by dividing patients into three groups according to the time of diagnosis: <12 weeks of gestation (first trimester, n=15), 12-24 weeks of gestation (second trimester, n=33), and >24 weeks of gestation (third trimester, n=144). Only 98 patients who underwent chest X-ray and computed tomography (CT) were included in the study. Data including affected lung side, number of involved lobes, number of lesions, lesion density/opacity, and parenchymal infection pattern were evaluated.
RESULTS: Twenty-five patients were asymptomatic at the time of admission, and the most common symptom was dry cough in 103 patients. The median D-dimer level was the lowest in the first trimester group (<12 weeks) and the highest in the third trimester group (>24 weeks). The mean white blood cell count was significantly higher in the third trimester group (>24 weeks) than in the first trimester group (<12 weeks) (p=0.036). Ninety-eight patients underwent radiological imaging studies. Findings suggestive of COVID-19 pneumonia were found in 59 (65%) out of 90 patients by means of chest radiography and in 21 (87.5%) out of 24 patients by performing thorax tomography. The most common findings were bilateral and multilobar lung involvement, patchy involvement, and ground-glass opacities (GGOs).
DISCUSSION AND CONCLUSION: This study's results show that pregnant women with COVID-19 have similar radiological findings to non-pregnant COVID-19 patients, and the most common findings are bilateral and multilobar involvement. Furthermore, pregnant patients can be admitted with lower GGO (lesion in ground glass density) rates and higher consolidation rates compared to the general population.

13.IL-23 Receptor Gene RS1004819, RS7517847, RS11209026 Single Nucleotide Polymorphisms in Turkish Patients with Ulcerative Colitis
Irfan Küçük, Ismail Yılmaz, Ersin Tural, Egemen Küçük, Mustafa Kaplan
doi: 10.14744/hnhj.2022.01336  Pages 70 - 77
INTRODUCTION: It was aimed to determine whether IL-23R gene rs1004819, rs751784, and rs11209026 single nucleotide polymorphisms (SNPs) cause susceptibility to ulcerative colitis (UC) or not and to evaluate the relationship between these SNPs and the phenotypic subtypes in Turkish population.
METHODS: This case-control study included ninety-eight UC patients (85 males and 13 females) and 41 healthy controls (37 males and 4 females). Clinical and endoscopic features were recorded. Genotyping of the SNPs was analyzed by polymerase chain reaction (PCR) based on direct sequencing.
RESULTS: There was no significant difference between patients with UC and healthy controls regarding the analyzed genotype and allele frequencies (p>0.05). The TG genotype of the IL-23R gene rs7517847 SNP was associated with extensive disease (OR: 3.55; 95% CI: 1.01–12.45). The AA genotype of IL23-R-rs1004819 was more prevalent in patients who never smoked (OR: 4.16; 95% CI: 1.12–15.36), and the GA genotype was related to smoking (OR: 4.46; 95% CI: 1.60–12.48) and left-sided colitis (OR: 2.61; 95% CI: 1.18–5.77). The GG genotype of the IL23-R-rs1004819 SNP was more frequent in patients with UC who had higher scores of clinical activities.
DISCUSSION AND CONCLUSION: Although IL-23R gene rs1004819, rs7517847 and rs11209026 SNPs were not associated with the disease susceptibility, significant associations were reported between the clinical features of UC. Further studies are needed to investigate disease susceptibility to UC in different populations.

14.The Evaluation of Sleep Hygiene in Subacromial Impingement Syndrome: A Case Control Study
Sibel Süzen Özbayrak, Hamza Sucuoğlu
doi: 10.14744/hnhj.2022.49091  Pages 78 - 85
INTRODUCTION: The aim of our study is to evaluate the pain, function, and sleep quality of patients with Subacromial Impingement Syndrome (SIS) and to reveal the relationship of this situation with the presence of depression in patients with sleep disorders.
METHODS: Patients aged between 30-60 years with nocturnal shoulder pain who were diagnosed with SIS (SIS group) and healthy individuals (control group) whose age and gender were matched were included. The presence of SIS was confirmed with clinical evaluation and Subacromial Injection Test (SIT). Visual Analogue Scale (VAS) at rest, during activity, and at night were recorded. Pain and disability of the shoulder were assessed by the Shoulder Disability Questionnaire and American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form. Pittsburgh Sleep Quality Index (PSQI) and Sleep Hygiene Index (SHI) were used to evaluate sleep quality. The diagnosis of depression was made according to the Beck Depression Inventory (BDI).
RESULTS: Sleep quality assessed by PSQI total score and SHI were significantly decreased in the SIS group (p=0.010, p=0.017, respectively). The SIS group had significantly higher PSQI sleep latency and sleep disturbances scores (p=0.045, p=0.019, respectively). The SIS group had mild depression according to BDI (p=0.001). In the SIS group, PSQI subscores (sleep latency, sleep disturbances) and SHI score were moderately significantly correlated with BDI score (p<0.05).
DISCUSSION AND CONCLUSION: Sleep quality may deteriorate in SIS patients compared to the healthy control group. In these patients, there may be a relationship between some of the subscores showing the deterioration in sleep quality and depression.

15.Levels of hs-CRP as a Cardiovascular Risk Factor in Different Groups of Patients with Hypothyroidism
Bahar Arıcan Tarım, Mehmet Ali Tarım, Funda Müşerref Türkmen
doi: 10.14744/hnhj.2023.15689  Pages 86 - 92
INTRODUCTION: It is known that thyroid function disorders negatively affect all systems, especially the cardiovascular system. In our study, we investigated hs-CRP levels and their relation with metabolic syndrome components between hypothyroid patients who are taking thyroid hormone replacement therapy (THR) and those who are newly diagnosed and haven’t started treatment yet.
METHODS: 124 subclinical and overt hypothyroid patients, 53 healthy controls without known disease, admitted to the Internal Medicine outpatient clinic were enrolled in this cross-sectional, controlled study. Patients were divided into 3 groups. Group 1: taking THR and having normal thyroid test results, Group 2: taking THR but not having targeted thyroid tests, Group 3: Newly diagnosed with hypothyroidism. Blood pressure, body mass index (BMI), waist circumference, glucose, sT4, sT3, TSH, lipid profile, and hs-CRP (nephelometric method, Beckman Coulter Image800 device) were measured.
RESULTS: There was a negative correlation between HDL cholesterol and hs-CRP levels in patients with hypothyroidism (p<0.05). When patients and controls were divided into groups according to their BMI (<25 kg/m² and ≥25 kg/m²) and waist circumference (a border of 88 cm for women, 102 cm for men), there was a statistical difference in hs-CRP levels (p<0.05).
DISCUSSION AND CONCLUSION: In both subclinical and overt hypothyroidism (with/without THR), hs-CRP levels are higher compared to controls, and cardiovascular risk increases. The difference detected in mean hs-CRP levels between the control and patient groups is not correlated with the increase in LDL-cholesterol levels, whereas it is negatively correlated with HDL-cholesterol levels. Both in control and patient groups, hs-CRP levels are affected by obesity. It is important to detect and follow hs-CRP levels in hypothyroidism for cardiac risk, but it is not independent of BMI and waist circumference.

16.Chronic Low Back Pain Management: Comparison of Facet Denervation with Radiofrequency Thermoablation and Facet Joint Injection
Luay Şerifoğlu, Mustafa Umut Etli, Mustafa Efendioğlu
doi: 10.14744/hnhj.2023.13914  Pages 93 - 96
INTRODUCTION: Chronic low back pain (CLBP) remains a prevalent and challenging condition to manage. This study aims to reassess and compare the effectiveness of two minimally invasive treatments, which are facet joint denervation via radiofrequency thermoablation (RFT) and facet joint injection (FI).
METHODS: A retrospective analysis was conducted on 84 patients suffering from CLBP. The cohort was divided into two groups: 42 patients underwent RFT, and 42 underwent FI. Pain was assessed using a Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst pain), with evaluations conducted at the first and sixth months post-treatment.
RESULTS: Initial findings indicated a significant reduction in pain scores in the RFT group, with a 60.9% reduction after the first month and 74.3% after six months. In contrast, the FI group showed a 51.8% reduction in pain scores after the first month, which decreased to 35.4% after six months. These results suggest more pronounced and sustained pain relief in patients undergoing RFT than those receiving FI.
DISCUSSION AND CONCLUSION: The comparative analysis reaffirms the efficacy of RFT in managing CLBP, outperforming FI in both short-term and especially long-term pain reduction. This study underscores the importance of selecting appropriate treatment modalities based on individual patient profiles and specific anatomical targets for optimal outcomes in CLBP management.

17.Enhanced Topical Delivery of Rosehip Oil (RO) through Nanostructured Lipid Carriers (NLC)
Ali Asram Sağıroğlu, Beyza Sümeyye Aydın, Firdevs Demirel
doi: 10.14744/hnhj.2023.64614  Pages 97 - 103
INTRODUCTION: Rosehip oil (RO) is rich in bioactive constituents with potential for various formulations. This investigation aims to design and analyze Nanostructured Lipid Carriers (NLC) containing RO to protect its delicate components, prolong RO's shelf life, and enhance its permeability.
METHODS: The NLC formulation was created using high shear homogenization, with RO as the liquid lipid and Compritol 888 ATO (C888) as the solid lipid. A series of assessments was conducted to evaluate encapsulation effectiveness, particle size distribution, polydispersity index, zeta potential, ex vivo skin penetration, and stability.
RESULTS: The NLCs showed uniform spherical morphology, average particle sizes of 180 nm, PDI below 0.3, and zeta potential around -30 mV. High encapsulation efficiency was also observed. Ex vivo experiments indicated improved Quercetin reten-tion in both Stratum Corneum (SC) and viable epidermis/dermis layers with NLC-encapsulated RO compared to RO alone. Stability assessments showed that the NLC formulation remained stable at 4°C for at least 90 days.
DISCUSSION AND CONCLUSION: The findings support NLC's efficacy in delivering active compounds to the skin, presenting an encouraging alternative for treating skin conditions.

18.Ethics Committee Application Procedures in Clinical Trials
Hilal İlbars, Berna Terzioğlu Bebitoğlu
doi: 10.14744/hnhj.2022.56667  Pages 104 - 110
In Türkiye, legal regulations regarding clinical trials have been prepared in accordance with international standards and are updated when necessary. It is sometimes delayed for investigators to follow current regulations in addition to their routine work. With this purpose, this article aims to provide a brief overview of the current legislation and ethical committee procedures, especially as a guide for researchers and parties involved in clinical research.

19.Importance of Enterobacterales that Develop Resistance Due to Expanded-Spectrum Beta-Lactamase and Carbapenemase Production
Neval Yurttutan Uyar, Meltem Ayaş
doi: 10.14744/hnhj.2022.56588  Pages 111 - 117
The development of antibiotic resistance is increasing worldwide. Third-generation cephalosporins-resistant Enterobacterales (ESBL-E) and carbapenems-resistant Enterobacterales (CRE) have been placed in the critical category by the World Health Organization on its list of global priority pathogens.
ESBL-E is a group of Enterobacterales bacteria that exhibit resistance to beta-lactams, broad-spectrum beta-lactams, and third-generation cephalosporins. The CTX-M-15 enzyme, responsible for resistance, is the most identified identified in the ESBL-E group bacteria.
In parallel with the increase in infectious diseases caused by the ESBL-E group bacteria, the use of carbapenems increased, resulting in an increase in carbapenem resistance. Carbapenemases are classified into three groups: A, B, and D. OXA (Oxacillin-hydrolyzing carbapenemase) enzymes that form Class D carbapenemases are endemic in Türkiye.
The first CRE strain was detected in the 1980s and soon spread worldwide. Carbapenemase groups A, B, and D are observed in various countries and are even considered endemic in some, such as Türkiye.
At EUCAST (European Committee on Antimicrobial Susceptibility Testing) and CLSI (Clinical and Laboratory Standards Institute) guidelines, the carbapenem group of antibiotics are suggested as preferred agents for the treatment of ESBL-producing Enterobacterales serious infections.
There are three approaches for treating infections caused by carbapenem-resistant Enterobacterales: 1) re-evaluation of treatment options with existing antibiotics (fosfomycin, colistin, tigecycline, such as the use of older antibiotics), 2) treatment with two carbapenems (combination of two different carbapenems), 3) treatment with new β-lactam and beta-lactamase inhibitor combinations or with new antibiotics (Ceftazidime/avibactam, Meropenem/vaborbactam, Plazomicin, Eravacyclin; the use of new antibiotics).
An increase in the prevalence of multidrug-resistant bacterial infections such as CRE and ESBL-E is causing antibiotic resistance to pose a global threat today. An international, multidisciplinary approach is needed to combat this global threat.

20.Pituitary Apoplexy Presenting as Unilateral Oculomotor Palsy in a Patient with Diabetes Mellitus
Özlem Kesim Şahin, Can Ulutaş, Ayşe Özlem Balık, Onur Erdoğan, Fatih Bayraklı, Mehmet Gencer
doi: 10.14744/hnhj.2022.74507  Pages 118 - 121
Pituitary apoplexy is a clinical syndrome caused by hemorrhage and/or infarction of the pituitary gland. This study presents a case of a 53-year-old man with a seven-day history of severe headache and left-sided oculomotor palsy, who had pupil-sparing oculomotor palsy with a previous history of diabetes mellitus. Diabetes-related microvascular ischemia was initially considered due to the pupil sparing, before imaging studies. However, pituitary hemorrhage was detected adjacent to the ICA cavernous segment in cranial and pituitary MRI, identified as the cause of the oculomotor nerve palsy. This case is significant for highlighting pituitary apoplexy as a rare cause of oculomotor palsy without pupil involvement in patients with diabetes mellitus.

21.Intrathoracic Kidney with Diaphragmatic Eventration: A Case Report
Şahin Paşalı, Mehmet Dinek, Rıdvan Özbek, İbrahim Erol
doi: 10.14744/hnhj.2022.93653  Pages 122 - 124
Intrathoracic ectopic kidney is the rarest form of ectopic kidneys. Intrathoracic kidneys do not seem to be associated with an increased risk of complications, such as renal stone formation, infection, or reduced renal function, and most cases are asymptomatic. It should be kept in mind when renal tissue cannot be observed in the renal fossa or pelvic area in ultrasonography. Asymptomatic cases with eventration usually do not require any surgical intervention and follow-up is appropriate. We aimed to present a case of an intrathoracic kidney with diaphragmatic eventration, diagnosed by imaging performed in a patient presenting with bilateral flank pain.

22.Maturity-Onset Diabetes of the Young-2 (MODY2) in Youth
Ayşe Gümüş Özçelik, Akın Dayan, Memet Taşkın Egici
doi: 10.14744/hnhj.2022.88886  Pages 125 - 127
Maturity-Onset Diabetes of the Young (MODY) is an autosomal dominant inherited monogenic disease that emerges in youth. The primary defect is a loss of beta-cell function, impairing insulin secretion. Its prevalence among all diabetes cases varies between 2% and 5%. The most common forms, MODY2 and MODY3, are caused by mutations in the glucokinase and hepatocyte nuclear factor 1-alpha genes, respectively. MODY2, resulting from heterozygous inactivating mutations of the glucokinase gene, is characterized by mild fasting hyperglycemia. It can be controlled by diet and is considered in cases of familial diabetes, impaired glucose tolerance, or gestational diabetes. This case presents a patient diagnosed with diabetes during pregnancy, who was later found to have the heterozygous p.MET394Thr(c.1181T>C) variation in the GCK gene mutation analysis, a finding also present in her child. Clinically recognizing MODY cases and differentiating them from Type 1 and Type 2 diabetes is crucial in treatment selection. Primary care physicians should consider MODY in the differential diagnosis for diabetes patients, as it can guide early diagnosis and treatment choices.

23.A Case of Emerging Epidermoid Cyst After Excision of Benign Cystic Teratoma Located in the Conus Medullaris
Özden Erhan Sofuoğlu, Neşe Keser, Hasan Burak Gündüz, Bülent Timur Demirgil, Seda Yagmur Karataş Okumuş, Dilek Karadağ, Erhan Emel
doi: 10.14744/hnhj.2023.46667  Pages 128 - 131
Teratomas constitute 0.1% of all spinal cord tumors and contain tissues originating from the three germ layers. The aim of surgery in spinal teratomas is total excision. However, total excision of tumors in the conus medullaris may lead to potentially significant morbidities. We aimed to present an epidermoid cyst (EC) after subtotal resection of teratomas. A 19-year-old woman complained of low back pain and numbness in the posterior aspect of the left leg. Magnetic resonance imaging (MRI) showed a tethered cord and an intradural lesion at the L4 level. During surgery, part of the capsule was left. Histopathological examination was reported as a benign cystic teratoma. Thirty-three months later, a control follow-up MRI showed a cystic lesion at the L4 level. After the total excision of the lesion, a neuro deficit developed. Histopathological examination was reported as EC. Spinal ECs account for less than 1% of spinal tumors. These tumors are lined with stratified squamous epithelium, similar to the skin's epidermis, and arise from the pathological displacement of epidermal cells into the spinal canal. It should be remembered that EC may develop after incomplete resection of conus medullaris-localized teratomas, and complete resection of these masses may result in neurological deficits.

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