ISSN: 2630-5720 | E-ISSN: 2687-346X
Volume: 64  Issue: 2 - 2024
1.Front Matter

Pages I - X

2.Evaluation of the Nutritional Status of COVID-19 Patients Treated in the Intensive Care Unit
Arzu Yıldırım Ar, Öznur Demiroluk, Yıldız Yiğit, Halit Abbas Batırel
doi: 10.14744/hnhj.2023.00821  Pages 133 - 137
INTRODUCTION: Covid-19 presents with a wide variety of clinical manifestations, and these patients are also admitted to intensive care units (ICU). Long ICU stays, gastrointestinal involvement, and prolonged hospital stays can result in hypomotility and ischemia of the intestines, which may further result in increased mortality. In severe ARDS cases, the prone position is applied to the patients. In patients in the prone position, deep sedation with muscle relaxants and parenteral nutrition is generally preferred. We aimed to evaluate the Nutritional Risk Screening (NRS 2002) score at first hospitalization, the nutritional status of the patients, and their relationship with mortality in patients followed up for Covid-19.
METHODS: In this study, after the approval of the ethics committee (FSMEAH-KAEK2021/28), patients aged 18 years and over who had Covid-19 PCR test positivity and who were hospitalized in the ICU for more than 24 hours between 01.03.2020-28.02.2022 were included. Demographic data, APACHE II, SOFA, SAPS II, NRS 2002 scores, comorbidities, need for mechanical ventilation (MV), non-invasive MV or high-flow oxygen therapy, length of stay, enteral, parenteral, or oral nutrition and durations, need for prone positioning, time of first nutrition, inotrope requirement, discharge from the ICU, and mortality were recorded. SPSS v20.0 was used for statistical analysis.
RESULTS: Sixty-nine patients were studied in the study (35 male (50.7%), 34 female (49.3%)). The mean age of the patients was 72.2±12.3. The prone position was applied in 87% of patients on invasive mechanical ventilators, 30.4% of patients on non-invasive mechanical ventilators, and 7.2% of patients on high-flow oxygen therapy. Enteral nutrition rate was 89.9%, parenteral nutrition rate was 43.5%. Time to first nutrition was 1.4±0.6 days, and time to first enteral nutrition was 1.7±1.0 days. The number of patients who used vasopressor agents was 52 (75.4%), and the mortality rate was 69.6%. The mean NRS 2002 score was 4.2±0.9. SOFA score, IMV, NIMV, prone positioning, and vasopressor agent use were high in the mortality group.
DISCUSSION AND CONCLUSION: The presence of extrapulmonary involvement, associated dysmotility, deep sedation, the use of muscle relaxants, and the resulting intolerance affect the complications of ICU admissions and ICU discharge in Covid-19 disease. Therefore, ICU management and the nutritional state of Covid-19 patients can influence ICU discharge and mortality.

3.The Radiologic Diagnosis and Result of Endovascular Management of May-Thurner Syndrome
Demet Doğan, Seviye Bora Şişman, Hakan Barutca, Hasan Şahan, Sinan Şahin
doi: 10.14744/hnhj.2023.75010  Pages 138 - 142
INTRODUCTION: This study aims to present the clinical and radiologic findings of 20 cases diagnosed with May-Thurner Syndrome, along with an assessment of radiologic treatment modalities and their outcomes.
METHODS: We enrolled 20 patients diagnosed with May-Thurner Syndrome based on radiologic assessments conducted at our hospital's radiology department. Cases with more than 80% iliac vein compression on Multidetector Computed Tomography (MDCT) venography underwent conventional venography for diagnosis confirmation and subsequent endovascular intervention. We analyzed the degree of compression, clinical and radiologic presentations, follow-up imaging, and treatment outcomes.
RESULTS: Among the cases, two were asymptomatic and incidentally discovered. Venous insufficiency was present in various forms: superficial-deep insufficiency in five cases, acute deep vein thrombosis (DVT) in one, chronic DVT in nine, and a combination of superficial-deep insufficiency with chronic DVT in three cases. MDCT venography was performed for all patients. Four patients received endovascular treatment, resulting in patent stents on follow-up MDCT imaging.
DISCUSSION AND CONCLUSION: In patients exhibiting symptoms of venous insufficiency or recurrent DVT in the left lower extremity, considering May-Thurner Syndrome in the diagnostic process is crucial to ensure appropriate treatment and mitigate potential complications. Endovascular intervention represents a viable alternative to surgical approaches, particularly in cases demonstrating significant compression.

4.The Relationship Between the Patient's Abdominal Circumference, Symphysis Pubis-Fundal Distance, and Vertebral Column Length with the Incidence of Hypotension and the Level of Block in Cesarean Section Operations Performed Under Spinal Anesthesia
Nihan Yaman Mammadov, Duygu Karaköse Çalışkan, Halide Aydın
doi: 10.14744/hnhj.2023.62447  Pages 143 - 148
INTRODUCTION: The incidence of hypotension in cesarean section operations performed with spinal anesthesia varies between 55-90%. In this study, the relationship between the patient's abdominal circumference, symphyseal fundal height, and vertebral column length with the incidence of hypotension and the level of block in cesarean section operations performed under spinal anesthesia was investigated.
METHODS: The prospective, single-center study was conducted with patients who had undergone cesarean section with spinal anesthesia at the Training and Research Hospital. Pregnant and ASA II group patients older than 37 weeks who were to undergo cesarean section with spinal anesthesia were included in the study. Patients with multiple pregnancies, patients with premature rupture of membranes, preterm patients, and patients in active labor were excluded from the study. Those with diagnoses of abnormal presentation, polyhydramnios, oligohydramnios, macrosomic babies, and intrauterine growth retardation were also excluded from the study. Abdominal circumference was measured at the umbilicus level at the end of expiration in the supine position. Vertebral column length was measured and recorded from the C7 vertebra to the sacral hiatus. The distance of the patient from the symphysis pubis to the highest point of the uterine fundus in the supine position was measured and recorded. Spinal anesthesia was performed in the sitting position with a 26G Quincke spinal needle for the first time through the L4-5 interval and 2 mL of 0.5% hyperbaric bupivacaine was administered. When the block reached T6, the operation was started. Electrocardiogram (ECG), SpO2, and arterial blood pressure were monitored, and the first values were recorded.
RESULTS: A total of 98 parturient patients were included in this study. Overall, the incidence of hypotension was 87.78% (87 out of 98 parturients). Symphyseal fundal height correlated positively with spinal blockade levels at each different time point except for "Min. 4".
DISCUSSION AND CONCLUSION: Symphyseal fundal height is a sensitive marker to determine the risk of hypotension after spinal anesthesia. We found that the symphyseal fundal height is a more sensitive marker for hypotension that will develop after spinal anesthesia compared to the other two parameters.

5.Evaluation of Children Admitted to a Tertiary Hospital in Terms of Malnutrition
Eren Güzeloğlu, Büşra Özgünay
doi: 10.14744/hnhj.2022.81084  Pages 149 - 153
INTRODUCTION: Malnutrition refers to deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients. Many families around the world are unable to obtain or have access to nutritious foods such as fresh fruits and vegetables, legumes, meat, and milk. This study aims to evaluate malnutrition in cases admitted to and/or hospitalized in our outpatient clinic.
METHODS: The goal of our study was to evaluate patients aged 0-18 years for malnutrition who were followed up at the University of Health Sciences, Sancaktepe Training and Research Hospital Department of Pediatrics, between January 1, 2018, and December 1, 2020.
RESULTS: Among the cases who presented to the University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Pediatrics, between January 1, 2018, and December 1, 2020, 2495 cases were diagnosed with malnutrition. The mean age of the patients included in the study was 6.5±0.2 years. Of the cases, 1475 were male (59%), and 1020 were female (41%), and enteral product was started in 62% of the cases. Patients diagnosed with malnutrition during this period in our outpatient clinic constitute approximately 2% of all outpatients. Inpatient malnourished cases constitute approximately 1% of hospitalized patients during this period.
DISCUSSION AND CONCLUSION: It is known that the immigrant population (Syrian and other ethnic groups) is high in our region and early marriages are common. Birth intervals are usually 1 year and extended family size is common. The education level of mothers is generally at the primary school level and the socioeconomic status of the families is low. Mothers have insufficient knowledge and experience about breastfeeding and complementary feeding. Most families do not have health insurance. It is thought that malnutrition develops due to these reasons.

6.Factors Affecting Survival in Patients with Gastric Cancer Undergoing Surgery for Curative Purposes
Ferdi Cambaztepe, Ali Sürmelioğlu, Metin Tilki
doi: 10.14744/hnhj.2023.35762  Pages 154 - 164
INTRODUCTION: Gastric cancer is the fifth most common cancer today. It is the third most common cause of cancer-related death because it is usually at an advanced stage at the time of diagnosis. Several factors affect the prognosis of gastric cancer. In this study, we examined various factors affecting the prognosis in gastric cancer and evaluated their effects on the prognosis.
METHODS: Between 2011 and 2016, 146 patients who underwent resection with the diagnosis of curative gastric cancer in Haydarpaşa Numune Training and Research Hospital General Surgery Clinic were included in the study. A total of 146 gastric cancer patients who underwent curative surgery were retrospectively analyzed. Age, gender, type of operation, preoperative albumin and tumor markers, tumor stage, lymph node involvement, histological type, tumor localization, tumor differentiation, lymphovascular and perineural invasion, and Her-2 immunohistochemical features were examined, and survival analyses were performed.
RESULTS: Age, stage, lymph node involvement, and perineural-lymphovascular invasion were found to be statistically significant.
DISCUSSION AND CONCLUSION: It was concluded that the determination of these prognostic factors will have an important place in the planning of the treatment. However, the subject should be supported by randomized clinical studies involving more patients.

7.Comparison of Computed Tomography and Ultrasonography as A Guide Method in 20-Gauge Transthoracic Fine Needle Biopsies
Ayla Türkar
doi: 10.14744/hnhj.2024.19327  Pages 165 - 171
INTRODUCTION: The goal of this study is to compare computed tomography (CT) and ultrasonography (USG) in transthoracic biopsies as a guide method.
METHODS: A total of 152 patients, consisting of 121 men and 31 women, underwent a 20-Gauge (20-G) fine needle aspiration biopsy. CT in 83 patients and USG in 69 patients were chosen as the guide method. The mean age of the patients was 66±10 (CT guidance group was 67±9, USG guidance group was 64±11), and the median lesion size was 65 mm (interquartile range [IQR] 45-80 mm). All lesions were chosen pleural-based and larger than 2 cm. Thus, the risks of major complications, especially pneumothorax and hemorrhage, and the difficulties in reaching the lesion were minimized, and it was aimed to investigate the contribution of the chosen guide method to the diagnosis. The advantages and disadvantages of both techniques were investigated.
RESULTS: While CT-guided biopsies had a diagnostic accuracy rate of 87.9%, a sensitivity of 87.3%, and a specificity of 100%, USG-guided biopsies had a diagnostic accuracy rate of 82.6%, a sensitivity of 82.1%, and a specificity of 100%.
DISCUSSION AND CONCLUSION: The necrosis content of the lesion is the primary factor reducing the success rate of both techniques. It causes more failures under ultrasonography guidance.

8.Evaluation of Pneumonia Risk Factors in Blunt Trauma Patients Followed in Intensive Care
Yelda Balık, Recep Balık, Işıl Köse, Çiler Zincircioğlu, Şükran Köse, Tuna Demirdal, Nimet Şenoğlu
doi: 10.14744/hnhj.2023.65707  Pages 172 - 178
INTRODUCTION: Injuries, leading to significant health and economic burdens globally, have become a prominent concern. Data from the World Health Organization (WHO) in 2012 ranks injuries as the ninth leading cause of death across all age groups, while the Centers for Disease Control and Prevention (CDC) highlights injuries as the primary cause of death among individuals under 45 years of age. Notably, traffic accidents, pedestrian incidents, and falls stand out as the leading causes of these injuries. In 2019, injuries resulted in staggering economic losses in the United States, with substantial portions allocated to hospital expenses, work loss, and the broader societal impact. This study addresses the increased susceptibility to pneumonia in trauma patients and the factors contributing to it, shedding light on its clinical implications.
METHODS: The study enrolled patients admitted to the Intensive Care Unit (ICU) following blunt trauma. Various statistical analyses were employed, including t-tests, Mann-Whitney U tests, chi-square tests, Fisher's exact tests, and Cox proportional hazards regression analysis, to identify potential risk factors for ventilator-associated pneumonia (VAP). The study examined variables associated with pneumonia in univariable and multivariate analyses, considering patient outcomes over time. Statistical significance was set at a p-value<0.05.
RESULTS: Over a five-year period, 32.3% of the patients (n: 42) developed pneumonia among the 130 included in the study. While pneumonia was more common in males and younger patients, no significant relationship was found with age or gender. The SAPS2 score was significantly higher in patients who developed pneumonia, but there was no significant relationship with the ISS score. Patients with pneumonia experienced significantly longer hospital stays, ICU stays, and mechanical ventilation durations. Notably, intubated patients, sedation, and nasogastric tube placement were significantly associated with pneumonia development.
DISCUSSION AND CONCLUSION: This study investigates risk factors for pneumonia development in trauma patients in the ICU and confirms the increased susceptibility of these patients to pneumonia. Although the study confirms factors like intubation, sedation, and nasogastric tube placement as risk factors, it provides nuanced insights into their impact on pneumonia development. Furthermore, the study highlights the importance of assessing pneumonia risk over time, emphasizing the critical role of early interventions to mitigate pneumonia rates. In conclusion, this study underscores the significance of identifying and understanding risk factors for pneumonia development in ICU patients after blunt trauma. Recognizing these factors and implementing preventive measures may ultimately reduce mortality and morbidity in this patient population.

9.Types of Anemias and Iron Deficiency Frequency in Hospitalized Patients with Decompensated Heart Failure: Internal Medicine Clinic Experience
Hatice Gizem Günhan, Refik Demirtunç
doi: 10.14744/hnhj.2023.03271  Pages 179 - 186
INTRODUCTION: One of the most common comorbid conditions in heart failure is iron deficiency and anemia. Because the patients are mostly elderly and have comorbidities, many examinations cannot be performed for the etiology of anemia, and it is accepted as chronic disease anemia caused by chronic diseases. However, iron deficiency can occur frequently in these patients with or without anemia. We conducted this study to investigate this frequency in heart failure patients hospitalized in the internal medicine service.
METHODS: This retrospective study comprised one hundred patients with decompensated heart failure (72.2±10.4 years; F/M: 41/59). Measurements of serum iron, ferritin, folic acid, vitamin B12, lactate dehydrogenase, bilirubin, reticulocyte, hemogram parameters, creatinine, ejection fraction, and cardiothoracic index of these patients were recorded from patients' files. The ESC 2016 guideline was used for the diagnosis of heart failure and diagnosis of iron deficiency in patients with heart failure.
RESULTS: A total of 26 patients were NYHA III (26%), 74 patients were NYHA IV (74%), 16 patients were stage C (16%), and 84 patients were stage D (84%). Anemia was detected in 62 patients (62%), iron deficiency anemia in 45 patients (45%), and anemia of chronic disease in 56 patients (56%). Iron deficiency was present in 70% of all patients. Iron deficiency was found to be statistically significant in patients with coronary artery bypass graft (p<0.05).
DISCUSSION AND CONCLUSION: Considering that the functional capacities and quality of life of patients with intravenous iron therapy increase in patients with chronic heart failure, we suggest that more attention should be paid to the investigation and treatment of the etiology of anemia in this patient group.

10.Risk Factors of Necrotizing Enterocolitis in Preterm Infants: A Single Center Experience
Hatice Mine Çakmak, Kenan Kocabay
doi: 10.14744/hnhj.2023.74555  Pages 187 - 192
INTRODUCTION: Necrotizing enterocolitis (NEC) is a fatal disease with up to 20% mortality rates. Identifying risk factors for NEC may reduce NEC incidences. This study aims to investigate NEC-related risk factors in preterm infants.
METHODS: We included 27 preterm infants with NEC and 35 infants without NEC among the preterm newborns (n=1669) hospitalized in the Duzce University School of Medicine neonatal intensive care unit between 2009 and 2021. Parametric numeric data were calculated using the independent sample's t-test. Two-sample comparisons of nonparametric data were performed using the Mann-Whitney test. Pearson chi-square, Yates correction, and Fisher's exact test were also used to evaluate the categorical data.
RESULTS: Our results agree with previous studies regarding some of these findings: birth weight is lower in the NEC group (1.37±0.49 kg) than in the non-NEC group (18.3±6.5 kg) (p=0.009), with statistically similar gestational age. We couldn't show the association between NEC and multiple gestations, chorioamnionitis, preeclampsia, Apgar scores, patent ductus arteriosus, mechanical ventilation, pre-NEC red blood cell, or fresh frozen plasma transfusions. In the NEC group, thrombocyte levels before NEC were significantly lower (98 [9-2253]) (/x10³ mm³) than in the control group (222 [17-345]) (/x10³ mm³) (p=0.012). In addition, mortality rates (22.2% vs. 2.9%, respectively) (p=0.037), use of vasopressors (29.6% vs. 2.9%, respectively) (p=0.008) were markedly higher in the NEC group than in the non-NEC group. Additionally, lower birth weight (NEC group: 1367.25±493.62 vs. non-NEC group: 1831.71±651.62) (p=0.009), prolonged use of antibiotics (NEC group: 24% vs. non-NEC group: 0%) (p=0.004), and poor circulation (NEC group: 84% vs. non-NEC group: 3%) (p<0.001) were statistically significant variables.
DISCUSSION AND CONCLUSION: NEC increases the mortality rates in preterm infants. The use of vasopressors, low birth weight, poor circulation, and antibiotics are significant risk factors for NEC, and low thrombocyte levels can lead to the prediction of NEC.

11.Predictors of Low-Level Viremia in People Living with HIV with Unsuppressed Viremia, A Retrospective Follow-up Study in Izmir
İlkay Akbulut, Sabri Atalay
doi: 10.14744/hnhj.2024.39145  Pages 193 - 198
INTRODUCTION: Globally, approximately 40 million people are living with HIV (PWH), with a new HIV infection occurring every 2 minutes. In Türkiye, the number of PWH is increasing, posing challenges to achieving national-level virological suppression goals. Current antiretroviral therapies (ART), tailored to individual people with HIV, have significantly improved viral suppression and maintenance. However, some individuals experience low-level viremia (LLV) despite adherence to consistent drug therapy. This study aims to identify the determinants and implications of LLV and ART management strategies.
METHODS: The study was conducted through a retrospective analysis of electronic medical records of 830 PWH followed at the Izmir Tepecik Training and Research Hospital of Health Sciences University over a 10-year period. Demographic characteristics, definitions of unsuppressed viremia, and ART regimens of the PWH included in this study were evaluated.
RESULTS: Low-level viremia was diagnosed in 17.1% of the 99 PWH with unsuppressed viremia enrolled in the study. The presence of comorbidities was found to have a significant impact on the development of low-level viremia. Additionally, it was observed that individuals with LLV had lower rates of virological suppression compared to other groups.
DISCUSSION AND CONCLUSION: This study evaluated the determinants of low-level viremia in people living with HIV and highlighted the presence of comorbidities and the importance of individualized treatment approaches. Further research is needed to effectively manage low-level viremia in PWH.

12.Comparison of Long-Term Results of Dynamic and Rigid Systems at the Lumbar Level
Gürkan Berikol, Uzay Erdoğan, Ibrahim Taha Albas, Ali Ender Ofluoğlu
doi: 10.14744/hnhj.2023.90022  Pages 199 - 203
INTRODUCTION: This study aimed to compare the safety, efficacy, radiological changes, and long-term results of transpedicular stabilization systems using a rigid rod with lumbar dynamics (PEEK) in terms of reoperation requirements.
METHODS: Patients who underwent two-level lumbar stabilization with 92 rigid systems and 54 dynamic systems between January 2017 and January 2020 were included in the study. The VAS and ODI scores, segmental and total lumbar lordosis angles, and upper and lower segment vertebral heights of the patients were evaluated. Preop, postop 1st day, postoperative 12th month, and postoperative 24th month values were compared.
RESULTS: Of the patients included in our study, 59 were male and 87 were female. The mean age was 58 years. Revision surgery was performed in 12 patients with a rigid system and 6 patients with a dynamic rod system. Preoperative VAS values were 8 (2-10) in the rigid group and 9 (6-10) in the dynamic group (p<0.05). At the 12th postoperative month, it was 4 (2-7) in the rigid group and 4 (2-6) in the dynamic group (p<0.05). Preoperative lumbar lordosis was 48.8 (29.6-80.8) in the rigid system, while it was 47.9 (11.5-83.7) in the dynamic system (p>0.05). At the 24th postoperative month, it was 46.5 (25.9-73.7) in the rigid group and 43.3 (20.2-79.6) in the dynamic group (p>0.05).
DISCUSSION AND CONCLUSION: Although the development time of adjacent segment disease is longer with PEEK rod dynamic systems compared to rigid rod systems, adjacent segment disease can be seen in both systems.

13.ST Segment Elevated Myocardial Infarction Associated with High Mortality and Thrombus Burden in Patients with COVID-19 Infection
Gökhan Ergün, Emrah Çitil, Selami Demirelli, Bekir Çalapkorur, Erkan Demirci, Ziya Şimşek
doi: 10.14744/hnhj.2023.26918  Pages 204 - 208
INTRODUCTION: There is limited information regarding the clinical and angiographic characteristics and outcomes of patients with Coronavirus disease 2019 (COVID-19) presenting with ST segment elevation myocardial infarction (STEMI). The aim of this study was to describe the clinical and angiographic characteristics, as well as clinical outcomes, in COVID-19 positive patients with STEMI compared with COVID-19 negative STEMI patients.
METHODS: This was a single-center observational study conducted between May 2020 and May 2021. The study population consisted of 35 patients who were followed with active COVID-19 and diagnosed with STEMI, and 35 STEMI patients without COVID-19 infection.
RESULTS: Groups were similar in terms of gender, hypertension, obstructive airway disease, SYNTAX score, and localization of myocardial infarction (MI). Glucose levels, BUN, creatinine, and CRP levels were significantly higher in the COVID-19 group. LDL and hemoglobin levels were lower in the COVID-19 group (p<0.05). There was a positive correlation between in-hospital death and modified thrombus grade post-first device and a negative correlation between in-hospital death and post-procedural TIMI flow (p=0.001, r=0.480).
DISCUSSION AND CONCLUSION: Our results demonstrate that patients presenting with STEMI and concurrent COVID-19 infection have a higher post-procedural thrombus burden and worse Thrombolysis in Myocardial Infarction (TIMI) flow. STEMI patients with COVID-19 face procedural challenges and are associated with poorer clinical outcomes.

14.Efficacy of Surgery in Intradural Extramedullary Spinal Cord Tumors and Factors Affecting Prognosis
Ali Haluk Düzkalır, Luay Şerifoğlu, Hanife Gülden Düzkalır, Mehmet Zafer Berkman
doi: 10.14744/hnhj.2023.53533  Pages 209 - 217
INTRODUCTION: Intradural extramedullary spinal cord tumors (IDEMSTs), albeit rare, can severely impair quality of life, mobility, and survival. They represent 15% of central nervous system tumors. Early discovery, effective treatment, and better outcomes require understanding these tumors. Our study investigated IDEMSTs predictive variables and clinical features. We aimed to improve the management of IDEMSTs by examining age, gender, initial symptoms, clinical history, comorbidities, smoking habits, preoperative and postoperative neurological states, tumor location and size, pathological diagnosis, and surgical complications.
METHODS: Our analysis included 51 IDEMST patients who underwent surgery at our clinic. Demographics, presenting symptoms, time intervals between symptom onset, diagnosis, and surgery, comorbidities, smoking habits, preoperative and early postoperative neurological examinations, tumor location and size, surgical procedure, extent of tumor resection, pathological diagnosis, surgical complications, length of hospitalization, and preoperative and early postoperative assessment scales were evaluated. These factors were examined to determine surgical efficacy, patient outcomes, and prognosis.
RESULTS: Older patients had worse recovery rates and Karnofsky scores. Additionally, longer hospital stays were linked to worse neurological conditions. Neurological functions improved better in early surgery patients. Ependymoma patients had better pre- and post-op neurological functioning, while meningioma and thoracic tumor patients improved significantly. However, thoracic tumor patients had severe neurological impairments. Males showed better pre- and post-op neurological status. Lower severity and duration of symptoms before surgery also increased postoperative neurological improvement. Our data indicate that demographic, tumor-specific, morphological, and functional neurological variables can affect IDEMST surgical efficiency.
DISCUSSION AND CONCLUSION: Surgical excision is safe and effective for these IDEMSTs. Our study identifies the impact of age, tumor level, pathology, Karnofsky score, Nurick scale, and gender on surgical outcomes. Nevertheless, prospective studies on larger scales are required. These studies may allow for a more comprehensive evaluation of the prognostic factors affecting IDEMST surgery and produce more reliable results.

15.Acute Kidney Injury After Hip Replacement Surgery Under Spinal Anesthesia in the Elderly: A Retrospective Analysis
Derya Özden Omaygenç, Ahmet Temizyürek, Ayça Sultan Şahin, Öznur Şen
doi: 10.14744/hnhj.2023.62333  Pages 218 - 225
INTRODUCTION: The elderly are particularly prone to perioperative organ dysfunction due to various procedure-related or anesthetic issues. We aimed to assess the retrospective data of the subjects who underwent total hip replacement surgery under spinal anesthesia within the scope of acute kidney injury (AKI) occurrence.
METHODS: Data from 130 patients were evaluated. Bupivacaine mixtures were preferred for providing adequate anesthesia. The sample population was split into two groups according to AKI development, considering the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Demographic features, intraoperative hemodynamical recordings, and other perioperative biochemical and clinical parameters of the groups were compared. Length of hospitalization (LOH), intensive care unit stay (ICUS), in-hospital mortality, and one-year mortality were established as outcome variables.
RESULTS: AKI was observed in 9.2% (n=12) of our sample population. In the entire set of data, baseline renal function was the only discriminating factor between the AKI (-) and AKI (+) groups. The initial glomerular filtration rate (GFR) was significantly lower in the latter (ml/min/m², 71 [30] vs. 37 [34.7], p<0.001). A GFR of 55 ml/min/m² was determined as a cutoff value for estimating AKI occurrence (AUC: 0.88, p<0.001) with 83.3% sensitivity and 76.3% specificity. AKI was associated with increased LOH (days, 3 [2] vs. 4 [9.5], p=0.038) and ICUS (days, 0.5 [3] vs. 3.5 [10.3], p=0.005).
DISCUSSION AND CONCLUSION: Baseline renal function was the only parameter closely related to AKI development in our sample population. AKI led to prolonged ICUS and hospitalization.

16.Demographic, Laboratory Features, and Vaccination Status of Hospitalized Children Under 5 Years Old with Rotavirus Gastroenteritis
Şeyma Şimşirgil Kara, Tamay Gürbüz, Zeynep Karakaya, Çağatay Nuhoğlu
doi: 10.14744/hnhj.2022.32549  Pages 226 - 233
INTRODUCTION: The aim of this study is to evaluate the demographic and clinical characteristics and vaccination status of patients under 5 years with rotavirus antigen-positive acute gastroenteritis (RVGE).
METHODS: Patients diagnosed with RVGE, who were admitted between December 1, 2017, and November 30, 2018, were included in the study. The demographic and laboratory characteristics and the vaccination status of the children were retrospectively evaluated.
RESULTS: Of the 194 patients included in the study, 115 (59.3%) were male and 79 (40.7%) were female. Children who breastfed for less than 6 months had a longer length of hospital stay (LOS) than those who breastfed for 6 months or more (p=0.001). LOS for unvaccinated children was longer than for vaccinated children (p=0.003). Children with blood group A had longer LOS than children with other blood groups. Children with significant stool leukocyte presence had longer LOS than those without stool leukocytes (p=0.013). The complication that significantly increased the LOS was hypokalemia (p=0.042).
DISCUSSION AND CONCLUSION: Vaccination has a protective effect that reduces morbidity in children under 5 years with RVGE. Our study found that both breastfeeding and the rotavirus vaccine significantly reduced the length of hospital stay.

17.Early Postoperative Effects of Uncomplicated Phacoemulsification on Corneal Parameters in Patients with Pseudoexfoliation Syndrome
Eren Ekici, Ali Keleş, Süleyman Korhan Karaman
doi: 10.14744/hnhj.2022.93284  Pages 234 - 240
INTRODUCTION: To compare early postoperative effects of uncomplicated phacoemulsification surgery on corneal endothelial cells and thickness in patients with pseudoexfoliation syndrome (PEX).
METHODS: One eye each of 32 patients with PEX and 32 age-matched non-PEX subjects was evaluated preoperatively and on the 1st, 7th, and 30th days after uncomplicated phacoemulsification surgery in this retrospective case-control study. Nuclear firmness, corneal edema (CE), anterior chamber reaction (ACR) intensity were graded by a slit-lamp microscope. Endothelial cell density (ECD), coefficient of variation in cell area (CV), hexagonal cell ratio (HEX), and central corneal thickness (CCT) were measured using a non-contact specular microscope.
RESULTS: There was no significant group-difference in age, sex, corneal edema (CE), anterior chamber reaction (ACR), coefficient of variation in cell area (CV), and hexagonal cell ratio (HEX). Mean effective phaco time (EPT) was significantly lower intraoperatively (p<0.001) and logarithm of the minimum angle of resolution (logMAR) values of best-corrected visual acuity (BCVA) were significantly higher on both 1st (p<0.001), 7th (p=0.011), and 30th (p=0.025) days postoperatively in the PEX group than in the non-PEX group. Mean ECD was significantly lower in the PEX group than in the non-PEX group on 7th (p=0.013), and 30th (p=0.037) days postoperatively. The mean CCT significantly differed only on the 1st (p<0.001) day postoperatively.
DISCUSSION AND CONCLUSION: Eyes with PEX presented lower corneal ECD and decreased BCVA after uncomplicated phacoemulsification surgery. Further, there was no association between CCT and PEX existence preoperatively and in the early postoperative period.

18.Diagnostic Value of Contrast-Enhanced Vessel Wall Imaging in the Evaluation of Various Intracranial Non-Vascular Pathologies: A Single Center Experience
Deniz Aliş, Düzgün Yıldırım, Amalya Zeynalova, Filiz Tüzüner, Mustafa Emir Tavşanlı, Mustafa Seçkin, Elvan Cevizci Akkılıç, Murat Hamit Aytar, Deniz Esin Tekcan Şanlı
doi: 10.14744/hnhj.2022.71542  Pages 241 - 247
INTRODUCTION: Vessel Wall Imaging (VWI) is a relatively novel magnetic resonance imaging (MRI) technique primarily aimed at diagnosing vascular pathologies. In this study, we aimed to evaluate the diagnostic value of contrast-enhanced (CE) VWI in identifying various intracranial non-vascular pathologies.
METHODS: This retrospective study was approved by our institutional ethics committee with approval number 2022-05/17 on March 11, 2022. We retrospectively evaluated cranial CE-MRI, including the VWI sequence, of 189 patients (76 females and 113 males) who were referred to our radiology department for brain imaging for various reasons. MRI examinations were performed using a 3 Tesla unit. A single observer evaluated anonymized cranial MRI images without CE-VWI in addition to the relevant clinical information in a random order. The same observer interpreted the CE-VWI with relevant clinical information six weeks later. The findings, which could only be visualized on VWI in the second session, were noted.
RESULTS: In 10 patients of our study cohort (5.3%), VWI demonstrated pathological signal alterations or contrast enhancement (e.g., post-status frontal lobe pial enhancement in a patient with autoimmune epilepsy, contrast enhancement in the hippocampus in a diffusion-negative hyper-acute ischemic stroke patient, and optic disc enhancement in a patient with intracranial hypertension) that apparently reflected underlying clinical disorders, which otherwise could not be visualized on conventional MRI.
DISCUSSION AND CONCLUSION: CE-VWI might serve as a valuable adjunct for the diagnosis of various parenchymal or meningeal intracranial diseases, yet further, more comprehensive studies are needed to reveal the true potential of VWI.

19.Ultrasonographic Features Predictive of Malignancy in Intraductal Papillary Neoplasm of the Breast
İsmail Yurtsever, Şeyma Yıldız, Abdusselim Adil Peker, Hafize Otçu Temur, Bahar Atasoy, Serdar Balsak, Özlem Toluk
doi: 10.14744/hnhj.2024.93708  Pages 248 - 253
INTRODUCTION: To detect and evaluate features of gray scale B-mode ultrasonographic examination findings that may predict malignancy in intraductal lesions of the breast.
METHODS: In this retrospective study, 650 cases examined at Bezmialem Vakıf University Department of Radiology between January 2018 and December 2019 were scanned. Fifty-two female cases who were diagnosed with intraductal papillary lesions on gray scale B-mode US examination and underwent core biopsy were included.
RESULTS: Lesions were evaluated according to their largest size (4-50 mm, median 13 mm); the largest size of the lesion was found to be higher in the malignant group than in the benign group (p=0.008). As a result of our ROC analysis in terms of predicting benign and malignant outcomes with the largest size of the lesion, AUC=0.764, sensitivity 81.8%, specificity 70.7%, and cut-off>10.5 mm (p=0.001). According to this result, lesions over 10.5 mm are more likely to be malignant.
DISCUSSION AND CONCLUSION: There is a lot of benign/malignant overlap in the radiological features of papillary lesions. We found the lesion size to be the most important feature in this distinction. Therefore, in cases that warrant suspicion, performing a core needle biopsy may be indispensable.

20.Comparison of Clot Activator Gel Biochemistry Tubes
Eray Metin Güler, Beyza Nur Özkan, Hakan Beyaztaş, Ali İmran Daştan, Mehmet Murat Yekrek
doi: 10.14744/hnhj.2023.97355  Pages 254 - 260
INTRODUCTION: The clinical laboratory testing process has three phases, and one of the most common errors that adversely affect the accuracy of laboratory test results occurs in the pre-analytical phase. Different brands of blood collection tubes used in laboratories can adversely affect the accuracy of the parameters. This study aims to compare the clot activator gel biochemistry tubes for selected clinical parameters.
METHODS: Fifty healthy volunteers aged between 18-70 years were included who didn't have any chronic or inflammatory disease, any clinical or pathological disease, and didn't use any medication. The biochemical parameters such as serum albumin, creatinine (crea), urea, triglyceride (TG), calcium (Ca), sodium (Na), potassium (K), and chloride (Cl) levels; aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) activity were measured by an autoanalyzer. Student's t-test and Bland-Altman plot methods were used for statistical data analysis by SPSS software.
RESULTS: There was no statistical difference between the two different tube brands in terms of all evaluated clinical parameters that could affect the accuracy of the test results.
DISCUSSION AND CONCLUSION: When the BD® brand tube is taken as a reference, it is thought that AYSET® tubes give the same or close values, and the clinical use of AYSET® brand tubes will not cause an error in laboratory tests.

21.Factors Affecting Vitamin D Level in Antiretroviral Treatment Naive Persons Living with HIV
İmran İçel Yıldırım, Serpil Erol, Derya Öztürk Engin, Gözde Akkiraz Baç, Handan Ankaralı, Sebahat Aksaray
doi: 10.14744/hnhj.2023.66674  Pages 261 - 267
INTRODUCTION: In this study, it was aimed to investigate the factors affecting vitamin D levels in antiretroviral treatment naive persons living with HIV.
METHODS: This retrospective study, which included 100 patients, was performed in the Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital. The relationship between patients’ 25(OH)D vitamin levels and demographic characteristics, underlying diseases, coinfection or malignancy, possible transmission time of HIV infection, substance use, smoking and alcohol use, CD4+ T lymphocyte counts, HIV RNA levels, and laboratory values were investigated.
RESULTS: Of the 100 patients included in the study, 90 (90%) were male, and the mean age was 36.7±11.5. At the time of admission, 84 patients (84%) had either vitamin D deficiency or insufficiency. For between-group differences, the patients were divided into two groups based on a 25(OH)D level of <30 ng/ml and ≥30 ng/ml. The two groups were similar with respect to age, body mass index, comorbidities, sex, smoking status, alcohol use, and possible transmission time of HIV infection (p>0.05). Except for the ALT level (p<0.05), the two groups were similar with respect to all laboratory variables.
DISCUSSION AND CONCLUSION: This study found that antiretroviral treatment naive persons living with HIV, with and without vitamin D deficiency, showed similar characteristics with respect to some traditional risk factors such as age, gender, and obesity. However, only significant correlations were found between ALT and vitamin D levels. More studies are needed to show the relationship between ALT and vitamin D levels.

22.Trifocal Nummular Headache: A Case Report of Dramatic Response to Local Anesthetic Injection
Cansu Köseoğlu Toksoy, Ülkü Türk Börü
doi: 10.14744/hnhj.2023.15975  Pages 268 - 270
The nummular headache is characterized by focal pain in an oval or elliptic region of the head, typically 1-6 cm in diameter. Pain localization is commonly monofocal, but occasionally it is bifocal or multifocal, with each symptomatic region exhibiting all characteristics of nummular pain. It was first described by Pareja and included in the 3rd edition of the International Classification of Headache Disorders (ICHD-3) under primary headache. We report a case of a 51-year-old male patient with nummular headache presenting in three areas on the scalp, which is rarely observed. Local anesthetic was injected onto the sphenopalatine ganglion, resulting in immediate recovery. Nummular headache is a rare but sometimes very severe pain, and lidocaine is an effective treatment option.

23.A Complication of Epidural Catheter Administration: Pneumocephalus and Related Diplopia
Ahmet Şen, Esra Kongur, Ali Alkan Yılmaz, Özlem Şen, Ahmet Akyol
doi: 10.14744/hnhj.2023.87528  Pages 271 - 274
Intracranial hypotension may occur after lumbar puncture, spinal anesthesia, and craniospinal trauma. Complications such as orthostatic headache, neck pain, photophobia, tinnitus, nausea, and diplopia are frequently seen in these patients. Complications such as air embolism and pneumocephalus can also be seen in the methods used to determine the epidural space. We aimed to present the postoperative complications and the process in our patient in whom we attempted to insert an epidural catheter to provide intraoperative anesthesia and postoperative analgesia in radical prostatectomy surgery.

24.Case Report: Ischemic Stroke As a Result of Aortic Dissection
Burcu Bayramoğlu, İsmail Tayfur, Ferah Kader, Dijan Tav, Gültekin Akyol
doi: 10.14744/hnhj.2023.69370  Pages 275 - 277
Stroke is one of the leading causes of mortality and morbidity. Aortic dissection is a highly mortal medical condition without treatment as well. Aortic dissection can present with different clinical signs and symptoms, one of which is stroke. Treatments of ischemic stroke and aortic dissection are different from each other. Because of that, early diagnosis and treatment of ischemic stroke due to aortic dissection is important. In this case, we aimed to explain a young male patient with a large ischemic stroke as a result of painless dissection and thrombus of the carotid arteries and painless dissection of the ascending and descending aorta, arcus aorta, and iliac artery.

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