ISSN: 2630-5720 | E-ISSN: 2687-346X
HAYDARPAŞA NUMUNE MEDICAL JOURNAL - Haydarpasa Numune Med J: 62 (2)
Cilt: 62  Sayı: 2 - 2022
KAPAK
1.
Frontmatters

Sayfalar I - X

ÖZGÜN ARAŞTIRMA
2.
Effect of Chronic Disease Mortality on COVID-19 Fatality Rate
Akın Dayan, Elif Kul
doi: 10.14744/hnhj.2022.48753  Sayfalar 117 - 122
INTRODUCTION: COVID-19 is a highly contagious disease that was caused by the coronavirus family SARS-CoV-2 and which emerged in China in 2019. This study aimed to investigate the effect of chronic disease mortality on the COVID-19 fatality rate.
METHODS: In our study, a total of 44 countries including 37 OECD countries were evaluated. A model was created with variables including death percentages of cardiovascular disease (CVD), cancer, chronic respiratory system diseases, diabetes and also age, gross domestic product (GDP), and the number of beds and the effect on COVID-19 fatality rate were evaluated. Multiple regression analysis was used to evaluate the model created.
RESULTS: It was determined that the average age and diabetes deaths among the non-communicable disease deaths positively predicted the COVID-19 fatality rate. In the model created in the study, the effect of the number of patient beds, GDP, and deaths due to CVD, cancer, and chronic respiratory diseases on the COVID-19 fatality rate was not determined.
DISCUSSION AND CONCLUSION: In the study, older age and diabetes deaths positively predicted the COVID-19 fatality rate. In regions with high average age and diabetes mortality, additional policies may be required to reduce the COVID-19 fatality rate.

3.
Seven-Year Evaluation of Percutaneous and Mucosal Injury in Health-Care Professionals
Şenol Çomoğlu, Barış Ertunç
doi: 10.14744/hnhj.2022.69379  Sayfalar 123 - 127
INTRODUCTION: Hospital environments are places where patients are admitted due to sharp object injuries. Therefore, hospitals pose a risk for many diseases that can be transmitted by blood products. Although many diseases can be transmitted as a result of stab wounds, the most important ones are Hepatitis-B, Hepatitis-C, and Acquired Immunodeficiency Syndrome Virus. In our study, it was aimed to evaluate stab wounds in a 7-year period.
METHODS: A total of 452 injuries from two different centers were included in the study. Age, gender, time of the injury, serological results of the patient and the personnel exposed to the injury, type of injury, duration of duty of the health personnel, type of exposure, occupational group, and location of the injury were scanned from the Infection Control Committee records and recorded in the study forms.
RESULTS: The mean age of the cases was 29.7±8.2, and 272 (60.2%) were women. The most frequently injured health personnel were nurses and trainees. A majority of the (81.2%) injuries were caused by the needle tip. Source serology was determined in 67.3% of the cases and serologic positivity was found in 19.4% of them. With the onset of the COVID-19 pandemic, no stab wounds were reported in the units dealing with COVID-19 patients during this period.
DISCUSSION AND CONCLUSION: Despite the precautions taken, stab wounds still continue to be an important problem today. The fact that a significant portion of these injuries is preventable increases the importance of the problem. Especially, with the COVID-19 pandemic, the fact that sharp object injuries were not reported in the units where these patients were treated shows that the injuries can be seriously reduced if the personnel comply with the precautions and safety precautions at the maximum level. It should be kept in mind that safety is paramount, and maximum attention should be paid to every action taken.

4.
Association between Oxidative Stress Markers and Hospital Admission due to Asthma
Sümeyye Alparslan Bekir, Beyza Nur Özkan
doi: 10.14744/hnhj.2022.57778  Sayfalar 128 - 133
INTRODUCTION: Asthma is a chronic respiratory disease marked by airway constriction, systemic and localized inflammation, and oxidative stress. The pathophysiological mechanism of asthma is influenced by oxidative stress, characterized by imbalance between increased reactive oxygen species and antioxidant defense. The role of oxidative stress in asthma development and control is crucial to the disease’s pathogenesis and treatment. Therefore, we aimed to evaluate oxidative stress biomarkers in asthmatic patients.
METHODS: Cross-sectional study, designed in tertiary care chest disease hospitals’ outpatient clinic. Asthma patients, who applied to the outpatient clinic within in February 2022, were included in the study. Asthma group and control group was compared.
RESULTS: 94 were enrolled in the study, 47 in each group. Mean age was 41±16.28 SD and body mass index (BMI) was 27.3±7.11 kg/m2 in group asthma. Mean age was 40±24.12 SD and BMI of the control group was 28.6±8.2 kg/m2. There was no statistically significant difference between the groups in terms of age, gender, weight, smoking status, and comorbidities (p>0.05). There was a statistically significant difference in total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), total thiol (TT), native Tiol (NT), and disulfide (DIS) between the control and asthma patient groups (p=0.001 for all variables). When compared to healthy controls, asthmatics had greater TOS, OSI, and DIS scores. Despite, healthy controls had considerably higher TAS, TT, and NT levels than the asthma group. There was no statistically significant relationship between oxidative stress markers and the comorbidities, hospital admissions in the last year and emergency admissions in the last year. Oxidative stress markers and the pulmonary function test results have no significant association (p>0.05) in the Asthma group.
DISCUSSION AND CONCLUSION: In the current study, TOS and DIS values of individuals with asthma are extremely high compared to healthy controls. Besides TAS, OSI, TT, and NT values of healthy controls were significantly higher than the asthma group. The oxidant/antioxidant balance was impaired and oxidative stress increased in asthma patients in the present study.

5.
Determination of Pro-BNP and Troponin I Levels for Short-Term Mortality Prediction in Ischemic Stroke Patients who did not Undergo Revascularization
Nilüfer Aydın, Çiğdem Özpolat, Özge Onur, Haldun Akoğlu, Arzu Denizbaşı Altınok
doi: 10.14744/hnhj.2020.86658  Sayfalar 134 - 139
INTRODUCTION: Emergency departments (EDs) are the first place to start treatment for most stroke patients. Prognozing patients for planning and proper management of the therapies have an important place in approaching stroke patients. Many studies have been carried out with serum biomarkers especially in terms of prognosis stroke. Our objective, in this study, is to research short-term (14th day) mortality prediction of serum Troponin I (TnI) and pro-brain natriuretic peptide (BNP) levels.
METHODS: This was a prospective and observational prognostic test study. All consecutive patients admitted to the ED with the onset of symptoms in the past 24 h and diagnosed with the first episode of acute ischemic stroke were included in the study. A total of 121 subjects were included in the study. On admission, pro-BNP and TnI were collected from all subjects. On the 14th day of admission, patients were checked for mortality.
RESULTS: Of 121 patients, 14 (11.5%) had a mortal outcome at the end of the 14th day. The overall median pro-BNP level of all patients was 799.00 pg/ml (IQR: 220.00–2818.25). The median pro-BNP level of the non-survivor group was significantly higher than that of the survivor group (p: 0.030). However, there was no significant difference between the TnI levels of the mortality groups. The optimal cutoff value of serum pro-BNP levels as an indicator of mortality on the 14th day was estimated to be 509 pg/ml (sensitivity: 85.7%, specificity: 49.5%, and AUC: 0.68 [95% CI, 0.59–0.769]).
DISCUSSION AND CONCLUSION: Various biomarkers are investigated for prediction of mortality in ischemic stroke patient. According to our study, elevated pro-BNP values are associated with mortality. Further study with larger patient cohorts can be studied regarding the relationship between these threshold, in terms of predicting the mortality, in a more comprehensive study, as well as using subgroup and underlying conditions.

6.
Falls in Geriatric Cases
Gönül Koyuncu, Nazmiye Koyuncu
doi: 10.14744/hnhj.2020.69926  Sayfalar 140 - 144
INTRODUCTION: The aim of this study is to examine the causes of falls and the clinical consequences of falling in elderly pa-tients in fallrelated emergency department admission.
METHODS: This study was conducted retrospectively on patients aged 65 and over, presenting with a fall to Health Sciences University Haydarpaşa Numune Training and Research Hospital Emergency Medicine Clinic between 01.01.2019 and 01.08.2019. Data such as demographic characteristics of the patients, systemic diseases, drug use, reason for falling, place of fall, diagnosis in the hospital were determined and these data were analyzed comparatively with each other.
RESULTS: Of the 443 patients aged 65 and over who applied to the emergency department due to falls, 246 patients who met the criteria were included in the study. One hundred forty-four (58.5%) of these patients were female. The mean age was 71.4+4.7 years. Of the patients, 104 (42.3%) fell indoors, 129 (52.4%) fell outside, and 13 (5.4%) fell on the stairs. One hundred and eighty-eight patients (77.7%) fell due to dizziness and loss of balance. Falls were more common in people with systemic disease (p=0.043). The most common diagnoses were soft tissue trauma (STT) (20.1%), fracture (14.7%) and head trauma (4.9%), respectively. There was a statistically significant correlation between the number of falls and age (p<0.001).
DISCUSSION AND CONCLUSION: It has been reported that the annual fall rate per capita in healthy people aged 65 and over is around 30-40%; this rate increases with age, and the biggest risk factor for falls is a previous fall history. Similarly, in this study, the annual fall rate was calculated as 31.7% and the rate of multiple falls as 11.4%. Evans et al. reported head trauma as the most common diagnosis of falling in this age group (26.8%). However, in our study, the diagnosis of soft tissue trauma was in the first place with a rate of 20.5%. The second most common diagnosis was fracture (14.7%). The reason for this difference may be that we consider soft tissue traumas as a separate category.

7.
Quality of Work Life in Nurses
Nazmiye Koyuncu, Gönül Koyuncu
doi: 10.14744/hnhj.2020.59144  Sayfalar 145 - 149
INTRODUCTION: The aim of this study is to make a general evaluation of the quality of work life (QWL) of the nurses working in our hospital.
METHODS: This study was conducted as a prospective and descriptive study on nurses, who works at Health Sciences University Haydarpaşa Numune Training and Research Hospital between August 10, 2019 and August 20, 2019 and and who met the inclusion criteria. The nurses were asked to fill in the data collection form in which data such as demographic information is collected, and work-related quality of life scale for healthcare workers.
RESULTS: A total of 244 nurses (88.9% female) working in Haydarpaşa Numune Training and Research Hospital were included in this study. No significant relationship was found between the two sexes, between married and singles, between income level, duration of work in the profession and QWL. On the other hand, there was a statistically significant and weak correlation between age and QWL.
Significant results were obtained when the differences between departments were examined (ANOVA p=0.007). The QWL of nurses working in surgical branches was higher than those working in the emergency department (p: 0.04) and those working in medical branches (p=0.013).
DISCUSSION AND CONCLUSION: Consistent with the literature, nurses stated that the items with the lowest satisfaction were the wages they received and the time they spared for themselves outside of work. Güçlü et al. reported that nurses working in surgical intensive care units and Liu et al. reported that nurses working in surgical clinics stated higher QWL and job satisfaction scores. In this study, the QWL of nurses working in surgical branches was found to be higher than nurses working in both medical branches and emergency services.

8.
How Effective and Safe is Limberg Flap in the Treatment of Pilonidal Sinus
İsmail Aydın, Tuğrul Kesicioğlu
doi: 10.14744/hnhj.2020.04695  Sayfalar 150 - 156
INTRODUCTION: A pilonidal sinus (PS) is a disease that arises from chronic irritation and secondary inflammation of hair follicles located in the sacrococcygeal and natal region. The purpose of this study was to determine the results of patients who underwent Limberg flap with the diagnosis of PS and the effectiveness of Limberg flap.
METHODS: The files of patients who were operated in our clinic between January 2015 and October 2019 with the diagnosis of PS were examined retrospectively. In addition to the demographical features of patients who have applied Limberg flap, type of the disease, the duration of the surgery, the hospitalization duration, the existence of complications after the surgery, and recurrence of the disease were analyzed.
RESULTS: Of 212 patients included in the study, 158 (74.5%) were male and 54 (25.4%) were female. The average age of the patients was 26.3 (18–44). 8 (3.73%) of the patients had Type-1, 48 (22.6%) had Type-3, 101 (47.6%) had Type-4, and 29 (13.6%) had Type-5 diseases. Patients who had Type-5 disease were found to recur after different surgical techniques. Due to the Type-2 disease, 26 (12.2%) patients underwent abscess drainage and Limberg flap approximately 3 weeks later. The average surgery period was 42.5 (32–78) min. Wound infection has been seen in 12 (5.6%) patients and wound dehiscence has been seen in 7 (3.3%) patients. Wet dressing and primary repair were performed at the lower edge of the flap because of the local recurrence to 5 (2.3%) patients.
DISCUSSION AND CONCLUSION: Nowadays, though it is stated that minimal invasive methods are effective for the treatment of the disease, we believe that surgical methods are more appropriate for the treatment. Furthermore, the surgical method to be chosen should be Limberg flap that is a reliable and effective procedure with its low recurrence rates, short hospitalization period, and low rate of complications.

9.
A Cheap and Effective Handmade Balloon Trocar for Laparoscopic Total Extraperitoneal Hernia Repair
Halim Özçevik, Oğuzhan Sunamak, Turgut Dönmez
doi: 10.14744/hnhj.2020.50024  Sayfalar 157 - 161
INTRODUCTION: In the laparoscopic totally extraperitoneal (TEP) technique for the treatment of inguinal hernia, balloon dissector equipment is widely used all over the world to open the preperitoneal area and create sufficient working area. Since this equipment is expensive, it requires a less costly device. This study aims to evaluate the efficiency and reliability of the low-cost handmade balloon trocar (HMBT) device.
METHODS: Fifty-two patients (47 male and 5 female) who underwent TEP with HMBT between May 2018 and September 2019 were analyzed retrospectively for patient demographics, duration of operation, open techniques or transabdominal preperitoneal necessity, drain use, complications, and hospital stay periods.
RESULTS: The mean age was 32.45±12.63 years; the mean body mass index was 26.01±3.01 kg/m2. ASA scores were 1, 2, and 3. The mean operation time was 41.21±7.51 min. There were no intraoperative complications in any patients. Six patients required a drain; Five patients were discharged after drain removal. One patient needed re-hospitalization due to scrotal hematoma. Fifty-one patients were discharged on the 1st post-operative day. The mean hospital stay period was 26.13±6.56 h.
DISCUSSION AND CONCLUSION: HMBT may be a safe, cheap, and feasible alternative method of achieving the preperitoneal space in TEP.

10.
Treatment of Craniotomy-Related Bone Flap Osteomyelitis
Semih Kıvanç Olguner, Mehmet Can, Vedat Açık, Mustafa Emre Saraç, İsmail İştemen, Ali İhsan Ökten
doi: 10.14744/hnhj.2020.07830  Sayfalar 162 - 167
INTRODUCTION: Cranial bone flap osteomyelitis (BFO) is rare. A few publications relating to postoperative osteomyelitis are available in the literature. In this study, we aim to share our experiences with the clinical management of BFO cases that developed secondary to surgery in the name of contributing to the literature.
METHODS: Forty-four BFO cases that developed secondary to 4582 neurosurgical operations carried out in our clinic between 2011 and 2018 were evaluated. Patients were investigated in terms of demographic attributes, pathogen microorganisms, time that lapsed between the first surgery and development of osteomyelitis, and the cause of the primary surgery. Clinical procedures of patients who developed BFO and were treated by preserving or discarding the bone flap (BF) were studied retrospectively.
RESULTS: A total of 44 patients were followed up due to BFO in our clinic between the years 2011 and 2018. Diagnoses before the first operation were tumor in 18 patients (40.9%), anterior circulation aneurysm in 11 patients (25%), epidural hematoma in 10 patients (22.7%), and chronic subdural haematoma in 5 patients. Regarding to the growth of the culture, microorganisms were grown in 31 cases (31/44) (70.4%) and it could not be grown in culture in 13 patients (13/44) (29.6%). Twenty patients (20/44) (45%) in the study group were treated by debridement+wound irrigation and preserving the BF with antibiotherapy. BF of the remaining 24 patients, on the other hand, were discarded.
DISCUSSION AND CONCLUSION: Surgery-associated osteomyelitis is one of the most undesired complications. BFs are discarded in nearly half of the patients, although the pathogen microorganism is isolated in a great majority of the cases and the appropriate antibiotherapy is applied. BFO treatment becomes more complicated especially due to the close anatomical relation between the frontal and pterional craniotomies and the sinuses.

11.
Comparison of Endoscopic Surgery and Transcallosal Microsurgery in Colloid Cysts of the Third Ventricle
Ali Arslan, Müjdat Büke, İsmail İştemen, Yurdal Gezercan, Mustafa Emre Saraç
doi: 10.14744/hnhj.2020.91489  Sayfalar 168 - 172
INTRODUCTION: Treatment of colloid cysts in symptomatic patients is surgery. Two most frequently used methods are transcallosal microsurgery and endoscopic surgery. However, the question as to which method is more effective remains to be controversial. Better results as compared to the past have been reported especially on recent advancements in endoscopic techniques and the technology. In the light of these recent advancements, we aimed to compare both methods employed in our clinic.
METHODS: Twenty-six patients operated in our clinic due to the colloid cyst of the third vernicle between the years 2012 and 2017 were included in the study. Fourteen patients that underwent transcallosal microsurgery and 12 that underwent endoscopic surgery were compared as two groups. The two groups were compared in terms of surgical duration, hospitalization duration, bleeding, total resection, reoperation, and shunt necessity.
RESULTS: Complaints of patients at the time of arrival at the clinic and the neurological findings and demographic data relating thereto were identified to be the same in both groups. While total resection and complication rates were observed to be higher in the transcallosal microsurgery group; hospitalization duration, surgical duration, shunt necessity, and bleeding were determined to be lower.
DISCUSSION AND CONCLUSION: Endoscopic surgery is as effective in the excision of the colloid cysts of the third ventricule as microsurgery. Furthermore, it reduces surgical duration, bleeding, hospitalization duration, and shunt necessity.

12.
Long-Term Radiological Outcomes of Short-Segment Stabilization in Thoracic Burst Fracture
Salim Katar, Mehmet Onur Yuksel, Serdar Çevik, Pınar Aydın Öztürk, Oğuz Baran, Sevket Evran
doi: 10.14744/hnhj.2020.34711  Sayfalar 173 - 177
INTRODUCTION: Short-segment (SS) transpedicular instrumentation and distraction have been used as a popular method recently due to the kyphotic angulation and adequate spinal canal decompression provided by the fusion of fewer mobile vertebra segments. This study aims to demonstrate that adequate decompression of spinal canal and kyphosis angulation can be improved by SS instrumentation and distraction in thoracic vertebrae burst fracture.
METHODS: Patients who were admitted to our clinic for thoracic vertebra burst fractures between 2014 and 2017 and who underwent fusion with transpedicular screws were retrospectively analyzed.
RESULTS: Both the sagittal index (SI) and canal occupation rates (COR) showed statistically significant changes between the pre-operative and early post-operative periods (pSI=0.001, pCOR=0.001). Evaluation results of the patients at 2-year follow-up; mean SI was 16.2°±1.25° and the mean COR was 6.25±2.4%. There was no statistically significant difference between both SI and CORs postoperatively and after 2 years of follow-up (pSI=0.916, pCOR=0.565).
DISCUSSION AND CONCLUSION: We believe that SS stabilization is sufficient especially in patients with COR <40%, SI <25°, American Spinal Injury Association score E, and preserved posterior elements of the vertebra.

13.
Epilepsy and Pregnancy: Retrospective Analysis of 58 Cases
Koray Gök, Erdal Yılmaz, Asude Özgül, Nazife Reyyan Gök, Mehmet Suhha Bostancı, Selçuk Özden
doi: 10.14744/hnhj.2022.37431  Sayfalar 178 - 182
INTRODUCTION: This study aimed to retrospectively evaluate the perinatal outcomes of pregnant women diagnosed with epilepsy followed in our clinic.
METHODS: In this retrospective cohort study, a total of 58 pregnant women diagnosed with epilepsy who were delivered after pregnancy follow-up at Sakarya University Training and Research Hospital Gynecology and Obstetrics Clinic between January 2015 and March 2021 were evaluated.
RESULTS: The mean age of the patients was 28.4±5.7 years. It was determined that 25 cases (43.1%) had seizures during pregnancy. It was determined that the rate of seizures during pregnancy in those who had a seizure in the past 1 year before pregnancy was statistically significantly higher than those who had their last seizure longer than 1 year (p=0.000). It was found that 72.7% of the patients in the polytherapy group had epileptic seizures during pregnancy, and this rate was significantly higher than the monotherapy group (p=0.042).
DISCUSSION AND CONCLUSION: The frequency of seizures during pregnancy is strongly associated with epileptic seizure status in the last year before pregnancy and multiple antiepileptic therapies.

14.
Executive Functioning in Children with Attention Deficit and Hyperactivity Disorder and Social Anxiety Disorder
Melek Gözde Luş
doi: 10.14744/hnhj.2021.82957  Sayfalar 183 - 189
INTRODUCTION: The aim of the present study was to evaluate the association of executive functioning with social phobia and anxiety in children with ADHD.
METHODS: Fifty children (aged 6–17 years) with ADHD diagnosis based on the DSM-5 diagnostic criteria were included in the study. Clinicians administered the Child Anxiety Sensitivity Index (CASI) and the Social Anxiety Scale for Children-Revised (SASC-R). Teachers and parents of the children completed the Conners’ Rating Scale and the Behavioral Rating Inventory of Executive Function (BRIEF).
RESULTS: The CASI and SASC-R scores were not correlated with the parents’ and teachers’ scores of the Conners’ scale. However, the SASC-R scores had significantly moderate positive correlations with shift (r=0.387 and p=0.005), initiate (r=0.341 and p=0.015), plan/organize (r=0.340 and p=0.016) scores, and with metacognition index (p=0.359 and r=0.010) of the parent forms of the BRIEF scale. For the teacher form of the BRIEF scale, the SASC-R scores were moderately and negatively correlated with plan/organize score (r=−0.425 and p=0.002) and behavioral regulation index (p=−0.295 and r=0.038); however, the CASI scores were moderately and positively correlated with shift (r=0.317 and p=0.025) and initiate (r=0.314 and p=0.026) scores.
DISCUSSION AND CONCLUSION: Social anxiety might significantly affect executive functions; however, these effects can vary according to the environmental factors.

15.
Effects of Topical Coenzyme Q10 on Retinal Nerve Fiber Layer and Ganglion Cell Complex in Patients with Open-Angle Glaucoma
Okşan Alpoğan, Ece Turan Vural, Meltem Toklu, Serhat İmamoğlu, Aysegül Ersanlı, Muhammed Nurullah Bulut
doi: 10.14744/hnhj.2022.21548  Sayfalar 190 - 194
INTRODUCTION: Recent studies have shown that retinal ganglion cell apoptosis is of great importance in the pathophysiology of glaucoma. Coenzyme Q10 (CQ10) is a molecule used for its neuroprotective effect in the treatment of glaucoma. Our aim was to evaluate the effect of CQ10 and Vitamin E (Vit E) combination on retinal nerve fiber layer (RNFL) and ganglion cell complex in open-angle glaucoma (OAG) patients by optical coherence tomography (OCT).
METHODS: In this retrospective study, thirty-one OAG patients with glaucoma in both eyes (intraocular pressure [IOP] <21 mmHg with medical treatment) were enrolled. Data of 28 patients were included in the study. At baseline and after 6 months, OCT parameters were obtained from patients treated with a combination of CQ10 and Vit E (CoQun ophthalmic drop twice daily) in addition to antiglaucomatous therapy in one eye (GC group); fellow eyes received antiglaucomatous therapy only (GT group).
RESULTS: IOP and OCT parameters were similar in both groups (p>0.05) at baseline. There was a significant increase in the average RNFL value at baseline and after 6 months of treatment in the GC group (p=0.045). In the GC group, the differences in the superior RNFL and the average RNFL values after 6 months were significantly greater than those recorded in the GT group (p=0.019, p=0.034, respectively).
DISCUSSION AND CONCLUSION: In our study, we found a statistically significant effect of CQ10 on the RNFL. The combination of CQ10 and Vit E treatment can have beneficial effects on the RNFL in primary OAG patients.

16.
Evaluation of Clinical Outcomes of a Cohesive Ophthalmic Viscosurgical Device
Nimet Burcu Çelik, Hacı Uğur Çelik, Mehmet Şahin Sevim
doi: 10.14744/hnhj.2020.40326  Sayfalar 195 - 199
INTRODUCTION: To evaluate, the clinical outcomes in patients undergoing cataract surgery with use of sodium hyaluronate 1.4% for its ability to maintain anterior chamber space and protection of corneal endothelial cells.
METHODS: This was a single center, retrospective observational study. A total 52 patients (eyes) having age older than 45 years with Grade I to III cataract were enrolled in the study and BIO-HYALUR Plus was used as ophthalmic viscosurgical device (OVD) during the standard cataract surgery procedure. Pre-operative and post-operative day 1, 1 week, 1 month, and 3 months visits, data assessments included: Adverse events observed during the study were also noted for the evaluation of safety.
RESULTS: Intraoperative anterior chamber space maintenance has been well formed for all 52 (100%) patients (eyes). Corneal clarity was observed for all patients. At 3-month follow-up visit, the mean best-corrected visual acuity was improved to 0.9±0.17 (Snellen Decimal). There was decreased in mean ECC, cell density, intraocular pressure, corneal thickness, coefficient of variance in cell size, and cell area compare to pre-operative visits on follow-up period. No adverse events were reported during entire study
DISCUSSION AND CONCLUSION: BIO-HYALUR Plus OVD cohesive properties and was safe and effective for every stage of cataract surgery without additional toxicity nor result in increased endothelial cell loss.

17.
Analysis of Isocitrate Dehydrogenase 1 Mutation and 10q23/PTEN Alterations in Turkish Glioblastoma Patients
Ceren Sümer, Havvanur Turgutalp, Figen Celep Eyüpoğlu
doi: 10.14744/hnhj.2020.35582  Sayfalar 200 - 205
INTRODUCTION: The object of this study is to identify the frequency isocitrate dehydrogenase 1 gene (IDH1) mutations and 10q23/PTEN locus alterations in Turkish patients with glioblastoma multiforme (GBM).
METHODS: For this purpose, DNAs obtained from paraffin-embedded archival materials belong to 54 cases diagnosed as GBM were applied direct sequencing. In addition, overall 25 cases and 10 non-neoplastic brain tissues which were used as controls were analyzed by fluorescent in situ hybridization (FISH).
RESULTS: We detected 5 heterozygous IDH1 c.395G>A mutations (9.3%) with wild-type arginine 132 replaced by histidine (R132H). Although there is no statistical significance between the age of the cases and IDH1 p.R132H mutation, the patients harboring the p.R132H mutation were younger (median age; 38) than patients without this mutation (median age; 52). The median survival time of the patients with this mutation was calculated at 7 months, while it was 5 months for the patients with no mutation; however, this finding was not statistically significant. According to our FISH results, we found a total of 16 10q23/PTEN alterations, of which 8 were hemizygous deletion (32%) and 8 were monosomy (32%).
DISCUSSION AND CONCLUSION: Understanding the prevalence of IDH1 mutations and 10q23/PTEN alterations may have importance in terms of the diagnosis, prognosis, and treatment of GBM patients.

18.
The Effects of Demographic, Clinical, and Radiological Parameters of Multiple Sclerosis on Quality of Life and Fatigue
Erdil Arsoy, İsmail Delipoyraz, Nesrin Bulut, Erdem Tuzun, Recai Türkoğlu
doi: 10.14744/hnhj.2020.01346  Sayfalar 206 - 212
INTRODUCTION: Multiple sclerosis is a progressive disease involving the central nervous system, usually starting between 20 and 40 years of age and causing recurrent dysfunction. There may be differences in physical, social and psychological effects depending on the degree of the disease. Fatigue is a common symptom of MS, which can be seen in different disease degrees and affects quality of life. The relationship between clinical and radiological findings and fatigue and quality of life remains unclear. Therefore, the purpose of the research is to evaluate the relationship between disease markers such as age, mood, physical disability, laboratory findings, and fatigue and quality of life.
METHODS: The study included 100 patients who met the 2010 McDonald’s criteria, had an Expanded Disability Status Scale (EDSS) score of <6.5 and had no episodes in the last month. Oligoclonal band (OCB), autoimmune thyroid antibody values and cranial and spinal magnetic resonance images of the patients were examined to evaluate the laboratory and radiological findings. Beck depression inventory and Fatigue Impact Scale were engaged for mood and fatigue assessment. The MS Functional Composite and 36-item short-form survey (SF-36) included to evaluate cognitive and physical impairment related to MS.
RESULTS: There was a low but significant correlation between fatigue and EDSS (p=0.041), 9 hole test (dominant hand) (p=0.005) and timed 25 walk (p=0.020) tests. There was no significant relationship between fatigue and SF-36 scores and thyroid auto-antibodies and OCB scores. In addition, there was a significant relationship between fatigue and cranial (p=0.049) and spinal (p=0.025) MR results.
DISCUSSION AND CONCLUSION: This study showed that an increase in lesion burden in MS patients also increased their fatigue. In addition, this positive correlation between lesion burden and fatigue was not observed between laboratory results such as OCB and autoimmune thyroid antibodies.

19.
Palliative Care Cost Analysis
Ayşenur Modanlıoğlu, Güven Bektemur, Aytekin Kaymakcı, Osman Ekinci
doi: 10.14744/hnhj.2022.82574  Sayfalar 213 - 220
INTRODUCTION: This study aims to determine the costs that emerged in the palliative care unit.
METHODS: The universe of this cross-sectional retrospective study is the palliative care unit of a training and research hospital in Istanbul. In the study, all necessary medical, administrative and financial records for 2018 were taken as a sample. The full cost model according to the cost scope, the actual cost model according to the time the costs are assessed, the transaction cost model according to the determination method, and the traditional cost model according to the basis of distribution were used in the calculation general production expenses. The expenses were analyzed in Microsoft Excel 2016 program and evaluated in detail.
RESULTS: In the research, the highest expense item among the total expense groups was found to be personnel expenses (41%), followed by general production expenses (34%) and raw material and consumable expenses (25%). Inner group evaluations revealed that the highest expense in the personnel expenses group is the additional payments to the doctor and nurse (63.41%), the drug and pharmacological product expenses (62.85%) in the raw material and consumable expenses group, and the legal obligations (26.19%) in the general production expenses group.
DISCUSSION AND CONCLUSION: The price set for palliative care treatment in the Tariff on Health Services was found to cover the expenses of the Ministry of Health Education and Research Hospitals functioning with the university for 2018 and to provide a profit of 94.59 TL per inpatient daily.

DERLEME
20.
Configuration of the Anesthesia Clinic in the COVID-19 Pandemic: Dokuz Eylül Faculty of Medicine Anesthesiology and Reanimation Department
Leyla İyilikçi, Hale Aksu Erdost, Necati Gökmen, Bahar Kuvaki, Hasan Hepaguslar, Uğur Koca, Çimen Gülben Olguner, Ayşe Karcı, Fikret Maltepe, Sevda Özkardeşler, Volkan Hancı, Serhan Yurtlu, Ferim Günenç, Yüksel Erkin, Aydın Taşdöğen, Elvan Öçmen, Şule Özbilgin, Semih Küçükgüçlü, Erol Gökel
doi: 10.14744/hnhj.2020.93824  Sayfalar 221 - 231
As in the whole world, when the first case detection in the pandemic emerged in our country on March 11, 2020, as anesthesiologists and Dokuz Eylul University Faculty of Medicine Anesthesiology and Reanimation Department Faculty Members, we took the necessary precautions in the operation of the operating theatre and intensive care units. Subsequently, it was aimed to prepare a guideline on how to behave in patients whose operation is mandatory in the light of the available data, which can be applied during the pandemic, aiming to protect both patient safety and working healthcare professionals.

OLGU SUNUMU
21.
Hyperlactatemia Due to Linezolid Use: A Case Report
Merve Keleş Doğan, Şeyma Betül Yığcı, Duygu Yeşilyurt, Kadir Kayataş
doi: 10.14744/hnhj.2020.13285  Sayfalar 232 - 234
Lactate is a by-product of anaerobic respiration, and is cleared from blood by the liver and kidneys. Lactate levels greater than 2 mmol/L is defined as hyperlactatemia, and higher than 4 mmol/l with acidosis is defined as lactic acidosis. It is the most common cause of metabolic acidosis in hospitalized patients. Linezolid is an antibiotic in the oxazolidinone class that directly inhibits protein synthesis in the mitochondria of bacteria and may cause lactic acidosis, which may have a high mortality. In our article, we aimed to present a case who used linezolid for pneumonia and developed hyperlactatemia on the 12th day of treatment.

22.
Multiple Congenital Esophageal Stenosis: In a 14-Month-Old Girl
Zeliha Akış Yıldız, Nelgin Gerenli, Zekeriya Ilce
doi: 10.14744/hnhj.2022.93357  Sayfalar 235 - 238
We aimed to share our very rare case with multiple congenital esophageal stenosis and its treatment. A 14-month-old girl presented with dysphagia, vomiting, and growth retardation, two esophageal strictures were detected in the esophagogram and esophagoscopic examination. While the proximal stenosis responded to balloon dilatation, the distal stenosis did not respond to dilatation and was perforated. Distal stenosis was treated with resection and anastomosis. Cases presenting with dysphagia and chronic vomiting should always be evaluated with esophagogram and endoscopy. Balloon dilatation should be the first choice in cases with stenosis. In cases that do not respond to dilatation, resection and anastomosis should be performed without insisting on dilatation.

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