E-ISSN 2980-2156
Erciyes Medical Journal
Volume: 45  Issue: 3 - 2023
1.Impact of Polyphenolic Compounds on the MAPK Signaling Pathway against Carcinogenesis
Adem Keskin
doi: 10.14744/etd.2023.94422  Pages 217 - 221
The mitogen-activated protein kinase (MAPK) signaling pathway is one of the signaling pathways involved in cellular life. Dysregulation of the MAPK signaling pathway is implicated in the emergence of diverse stages of carcinogenesis, including metastasis, angiogenesis, apoptosis, invasion, proliferation and cell differentiation. Therefore, it contributes significantly to the process of carcinogenesis. The mitogen-activated protein kinase signaling pathway presents numerous molecular com-ponents that can be regulated against carcinogenesis. Many studies have shown that polyphenols in various dietary sources have important contributions to the regulation of this pathway. This contribution occurs by inducing cell death, altering immunity, blocking angiogenesis and suppressing cancerous cell growth. Numerous studies have been conducted on this aspect of polyphenolic compounds, with encouraging outcomes. Its clinical efficacy against cancer is also being investigated. This study focuses on the importance of mitogen-activated protein kinase signaling pathway in carcinogenesis by emphasizing the properties of polyphenolic compounds. The study aims to research the clinical effectiveness of polyphenolic compounds in regulating the MAPK signaling pathway against cancer.

2.The Evaluation of the Role of (Pro)hepcidin in Anemia Encountered in Inflammatory Bowel Diseases
Şencan Acar, Murat Akyıldız, Zeynep Karaali, Şule Poturoğlu
doi: 10.14744/etd.2022.95881  Pages 222 - 226
Objective: Hepcidin is a peptide that acts as a hormone that provides iron homeostasis in the body and has antimicrobial activity. The synthesis of hepcidin is stimulated during inflammation and causes inflammation anemia. For this purpose, we aimed to determine the role of (pro)hepcidin in anemia in inflammatory bowel diseases (IBD) and its correlation with clinical and biochemical findings.
Materials and Methods: A total of 61 patients, 19 (31.1%) of whom were diagnosed with Crohn’s disease (CD), 42 (68.9%) with ulcerative colitis (UC), and a control group of 23 were included. Hepcidin and biochemical parameters which are related to anemia were measured.
Results: There was a significant difference between the CD group and vs control group in terms of hepcidin level. As the disease activity increases, the hepcidin level decreases with a probability of 83%. Hepcidin levels were found to be signifi-cantly lower in the CD group. Although hepcidin levels were lower in the UC group than in the control group, the result was not statistically significant.
Conclusion: We didn’t detect a statistically significant difference in the level of hepcidin between IBD and the control group.

3.The Effects of Tibialis Posterior Muscle Fatigue and Walking Speed on Dynamic Plantar Pressure Characteristics in Healthy Individuals: A Single Group Pre-Post
Azize Reda Tunç, Pınar Kısacık, Nilgün Bek
doi: 10.14744/etd.2023.77906  Pages 227 - 234
Objective: This study aims to investigate the effects of tibialis posterior muscle (TP) fatigue on dynamic plantar pressure (DPP) characteristics during different walking speeds.
Materials and Methods: Thirty healthy volunteers walked at normal and fast paces in three trials. The Footscan®3D system was used to obtain the distribution of dynamic plantar pressure before and after the TP fatigue protocol. The study measured the peak pressure (PP) of the hallux, toes 2–5, metatarsals (Meta 1-5), midfoot (MF), medial heel (MH) and lateral heel (LH), as well as the percentage of contact area (CA%) of the forefoot (FF), MF and hindfoot (HF), foot progression angle (FPA) and the minimum and maximum values of the subtalar angle.
Results: The results showed significant differences in the PP of Meta 4, MH and MF at a normal pace after the tibialis posterior muscle fatigue protocol. At a fast pace, significant differences were found in the PP of the MF and CA% of FF and MF. Before the fatigue protocol, there were significantly different values in the peak pressure of the hallux, toes 2–5 and MH between the two walking speeds. After the fatigue protocol, there were significantly different values in the peak pressure of toes 2–5, MH and LH between the two walking speeds. The study also found a significant difference in FPA between the two walking speeds (p<0.05).
Conclusion: The study provides evidence that TP fatigue may lead to injuries during long-term walking or sports activities. These results highlight the importance of endurance training and minimizing its negative effects on foot biomechanics by reducing fatigue.

4.The Impact of Percutaneous Tracheotomy on Mortality and Length of Stay in the Critical Care Unit for COVID-19 ARDS
Gülçin Hilal Alay, Derya Tatlısuluoğlu, Kadir Bulut, Güldem Turan
doi: 10.14744/etd.2023.63832  Pages 235 - 239
Objective: The aim of this study was to investigate the effect of percutaneous tracheotomy on mortality and length of stay in the intensive care unit (ICU) for patients with COVID-19-associated acute respiratory distress syndrome (ARDS).
Materials and Methods: This study included patients with coronavirus disease-19 (COVID-19-associated) acute respiratory distress syndrome who were treated with invasive mechanical ventilation in a pandemic intensive care unit. Patients admitted to the pandemic intensive care unit between March and July 2021 were retrospectively reviewed. Patients who underwent percutaneous tracheotomy and did not have a tracheotomy during the follow-up were statistically compared in terms of lab-oratory and clinical characteristics such as mortality and length of stay in the intensive care unit.
Results: The study included 102 orotracheally intubated patients diagnosed with COVID-19 acute respiratory distress syndrome. The number of tracheotomized and not-tracheotomized patients was 34 and 68, respectively. The mean age of the patients was 60.39±14.10 years. The mean time to perform percutaneous tracheotomy was 7.94±6.11 days. There was no significant difference in mortality rate between the two groups (p=0.298). However, patients who underwent tracheotomy had a longer length of stay in the intensive care unit compared to those who did not (35.00±24.60 days vs 13.20±11.69 days, p<0.001).
Conclusion: Our study found no statistically significant difference in mortality rate between the two groups in our study. Additionally, the length of stay in the intensive care unit was not better in tracheotomized patients. While tracheotomy has some advantages in other severe lung diseases, its effect on mortality in patients with severe lung disease associated with COVID-19 should be evaluated further in randomized controlled trials.

5.Is There a Relationship Between Food Addiction, Dietary Quality and Metabolic Parameters in Obese Adults?: A Cross-Sectional Study Example
Emre Duman, Alev Keser, Serkan Asil
doi: 10.14744/etd.2023.80922  Pages 240 - 247
Objective: This cross-sectional study evaluated the association between food addiction, dietary quality, and metabolic pa-rameters and determined food addiction prevalence in overweight and obese adults.
Materials and Methods: This study was conducted with 134 obese and overweight adults. Food addiction was evaluated with the Yale Food Addiction Scale (YFAS), and dietary quality was assessed with the Healthy Eating Index-2010 (HEI-2010). The HEI-2010 scores range from 0 to 100 (>80: good dietary quality, 51–80: needs improvement, <51: poor dietary quality).
Results: 19.4% of the participants had a food addiction. The ratio of those with poor dietary quality (61.5%) in participants with food addiction was higher than those without food addiction (52.8%) (p>0.05). The ratio of participants with high AST levels to participants with food addiction (34.6%) is higher than those without food addiction (17.6%) (p<0.05). Participants without food addiction have lower cholesterol intake than participants with food addiction (p<0.05). YFAS symptom scores were positively correlated with AST, SBP, and DBP levels and negatively correlated with the age of the participants (p<0.05).
Conclusion: It was founded that a relationship may exist between food addiction, dietary quality, and metabolic parameters of obese and overweight adults. Especially in treating obesity, it is essential to make appropriate interventions to increase dietary quality.

6.Comparison of T2W FLAIR Images of Patients with Multiple Sclerosis and Ischemic Gliosis via Histogram Analysis
Murat Baykara, Mustafa Yıldırım, İsmail Taşkent, Hanefi Yıldırım, Duran Tavut
doi: 10.14744/etd.2023.35306  Pages 248 - 252
Objective: In some cases, it may be challenging to differentiate radiologically between ischemic gliotic foci and multiple sclerosis (MS) plaques. This study aims to evaluate the effectiveness of histogram analysis in the differentiation of MS plaque and ischemic gliosis lesions on the T2-weighted (T2WI) FLAIR sequence.
Materials and Methods: This study was conducted on the Magnetic Resonance Imaging (MRI) examinations of patients diagnosed with ischemic gliosis and multiple sclerosis. Inactive lesions of 43 patients with ischemic gliosis and 46 with mul-tiple sclerosis imaged by the same device were included in the study. Histogram analysis parameters of both groups were calculated. The entire image analysis algorithm was obtained through in-house software coded in MATLAB. Both groups were compared using a student’s t-test. The diagnostic value of the parameters was detected with the receiver operating characteristic (ROC) curve.
Results: Mean gray level intensity, the standard deviation of the histogram, and entropy values calculated via minimum, maximum and median values were significantly higher in patients with ischemic gliosis. ROC curve analysis indicated that a threshold value of 545.19 for mean gray level intensity has 69.8% specificity and 69.6% sensitivity.
Conclusion: Histogram analysis may help differentiate MS and ischemic gliosis.

7.Neglected Treatment for Hand Injuries: Pain
Sedat Özbay, Elif Değirmenci
doi: 10.14744/etd.2023.68639  Pages 253 - 257
Objective: Hand injuries are a common reason for emergency room visits, and it is critical to managing the pain process effectively. This study aims to look at the demographics, pain assessment, and management of patients who visited the emergency department with hand injuries.
Materials and Methods: Healthy patients over 18 who presented to the emergency room within the first 24 hours of an acute hand injury between December 2020 and February 2021 were included. The Numerical Pain Rating Scale was employed to assess pain severity. The etiology of the trauma, pain scale, analgesic treatment, imaging requests, consultation, and tetanus vaccine situation were all documented.
Results: The patient’s pain severity was classified at admission. It was found that 38.8% had mild pain, 39.2% moderate, and 21.9% had severe pain. The average pain scores of the patients were determined as 4.89±2.14. Analgesic was executed in 13.5% of the patients who applied, and 86.5% did not receive painkillers. Analgesia was applied to 2% of the patients with mild pain, 14.7% with moderate pain, and 31.6% with severe pain. We found that as pain severity increased, analgesia was more, and it was found to be statistically significant (p=0.0001).
Conclusion: Analgesia is a neglected step in trauma care. Emergency physicians should prioritize pain relief. All patients with hand trauma should be pain-scored and given appropriate analgesia.

8.Prevalence of Post-COVID-19 Syndrome and Related Factors among University Employees: A Prospective Cohort Study
Feyza Nehir Öznur Muz, Selma Metintas, Muhammed Fatih Onsuz, Alaettin Ünsal, Didem Arslantas, Ali Kılınç, Selva Dilan Gölbaşı Koç, Sevda Sungur
doi: 10.14744/etd.2023.56313  Pages 258 - 264
Objective: The term post-COVID (coronavirus disease) is used to refer to the presence of prolonged symptoms 12 weeks or more after the disease treatment. This study aimed to evaluate the presence of symptoms and anxiety in patients with COVID-19 who did not require inpatient care at the third and sixth months following symptom onset.
Materials and Methods: The study is a prospective cohort study involving 471 university employees who contracted COVID-19 between October 2020 and October 2021. Data were obtained through the disease contact follow-up program implemented at the university and phone interviews conducted at the third and sixth months from symptom onset.
Results: The study group comprised 361 individuals at three months and 109 at six months from symptom onset. The study found that symptoms persisted in 116 (32.1%) people in the third month and in 47 (13.0%) people in the sixth month. The most common symptoms at three months were shortness of breath, fatigue, and fatigue, while fatigue, fatigue, and shortness of breath were the most common symptoms at six months.
Conclusion: Understanding the long-term effects of coronavirus will enhance the management of the disease. As a result, the follow-up of symptomatic COVID-19 and post-COVID-19 patients will become more systematic and effective.

9.An Evaluation of the Efficacy of Predictive Tests and Anthropometric Measurements in Determining Difficult Intubation in Children
Lütfiye Pirbudak, Didem Yilmaz Doğan, Ergun Mendes, Yusuf Emeli, Elzem Sen, Hüseyin Gocergil
doi: 10.14744/etd.2023.05046  Pages 265 - 271
Objective: Determining risk factors prior to intubation is crucial for patient safety. This study aimed to assess the usability of the predictive tests and anthropometric measurements in identifying potential difficult intubation in children.
Materials and Methods: This prospective study involved 200 pediatric patients aged 7 to 15 years who were scheduled to receive general anesthesia and were classified as American Society of Anesthesiologists (ASA) I-II with no pre-existing airway issues. Patients were categorized based on age into three groups: Group 1 (7–9 years, n=69), Group 2 (10–12 years, n=65), and Group 3 (13–15 years, n=66). Modified Mallampati Classification (MMC), mandibular protrusion (MP), tooth anomalies (missing tooth, decayed tooth, protruding upper incisor, and long upper incisor), thyromental distance (TMD), sternomental distance (SMD), and atlanto-occipital joint mobility (AOJM1 and AOJM2) were determined for each patient. These prediction tests were then compared with the Cormack–Lehane (CL) classification.
Results: Statistically significant differences were observed between the groups in terms of TMD, SMD, and missing tooth. The MMC exhibited the highest sensitivity and positive predictive value (PPV) (100% and 47%, respectively), while the MP had the highest specificity (94.5%). It was predicted that reference values of ≤6 cm for TMD and ≤12 cm for SMD would yield very low sensitivity and PPV for Group 1.
Conclusion: Reference values of ≤5 cm for TMD and ≤10 cm for SMD were found to provide useful predictive information for children aged 7–9 years.

10.A Home Education Technique for Inhaler Devices Used by Patients with Obstructive Lung Disease
Fadime Tulucu
doi: 10.14744/etd.2023.07888  Pages 272 - 277
Objective: The feedback from multiple international centers continue over the course of several years, due to inhaler device handling errors in obstructive lung disease patients. In this study, the effectiveness of an easy-to-apply and continuous inhaler device education method that maybe implemented within a hospital setting and continued at home was evaluated.
Methods: A total of 60 patients with COPD who used an inhaler device with >2/10 critical errors were included in the study. They were then trained on how to use their inhaler devices and these 60 patients were then divided into two equal groups. Group 1 consisted of control patients who did not receive additional education. Group 2 patients had the inhaler administration steps recorded as voice commands on their mobile phones. In addition a reminder of medication administration time was added. All patients were followed for six months to evaluate the outcome of training.
Results: Among patients, 86.7% were unaware of misuse of their device. The success of Group 1 patients were 56.7% after the first education in the clinic. After six months, no patient was successful. However within Group 2 success rate was 46.7% at the end of first education and at the sixth month control.
Conclusion: The patients do not realize that they are mishandling their inhaler devices. They also forget the steps of inhaler treatment after a period. The continuity of education supplied by phone application is supported in this study. Such applications may be adapted to clinical settings to increase the treatment success.

11.Changes in Colorectal Cancer Practices during the Early COVID-19 Period
Hakan Yırgın, Yunusemre Tatlıdil, Osman Sibic, Inci Kızıldağ Yırgın, Mehmet Aziret, Mehmet Abdussamet Bozkurt
doi: 10.14744/etd.2023.04977  Pages 278 - 284
Objective: The aim of our study is to investigate the management of colorectal cancer patients during the Coronavirus Disease 2019 (COVID-19) pandemic, which has affected our daily routine. We aimed to compare our results between the pre-pandemic and pandemic periods, and evaluate any seasonal differences within the COVID-19 pandemic.
Materials and Methods: Our retrospective study was conducted in a single center. We included all participants who had elective and emergency gastrointestinal operations due to colorectal cancer between March 2019 and March 2021. Partic-ipant data were separated and compared between the pre-pandemic and pandemic periods, with the latter divided into two groups (Group 1: Phase 1–2, Group 2: Phase 3).
Results: There were no statistically significant differences between the cases treated before and during the COVID-19 pandemic period in terms of mean age, gender distribution, diagnosis, tumor location, American Society of Anesthetists (ASA) score, recurrence, or mortality (p>0.05). We found no differences between the pre-pandemic and pandemic periods in admission to the hospital, surgical approach, need for stoma, complications, length of stay in the intensive care unit (ICU), total hospitalization, or tumor stage (p>0.05). However, we observed that the percentage of open surgical operations was statistically significantly higher, and the percentage of laparoscopic surgical operations was statistically significantly lower in Group 2 compared to Group 1 (p=0.020).
Conclusion: The pandemic periods should not be assessed with the same perspective. Treatment approaches can change according to hospital capacity during peak periods of COVID-19 disease.

12.The Relationship between Plantar Sensation and Functional Parameters in Individuals with Hallux Valgus: A Pilot Study
Elif Kirdi, Pinar Kisacik, Gül Şener
doi: 10.14744/etd.2023.56649  Pages 285 - 289
Objective: Hallux valgus (HV), one of the most common forefoot deformities, may increase mechanical loading on the lateral side of the foot, leading to hyperkeratosis in these areas and deterioration of plantar sensation. Thus, the objective of this study was to investigate the relationship between plantar sensation and clinical and functional parameters, such as HV severity, foot posture, gait, and balance in individuals with HV.
Materials and Methods: A total of 29 participants were recruited for the study. The following measurements were taken: the HV angle with a universal goniometer, hallux pain with the Visual Analog Scale, plantar cutaneous sensation with Sem-mes-Weinstein monofilaments, clinical status of the forefoot with the American Orthopaedic Foot and Ankle Society (AO-FAS) Hallux-Metatarsophalangeal (MTP)-Interphalangeal (IP) Scale, foot posture with the Foot Posture Index (FPI), postural sway with a force platform, and temporospatial gait parameters with an electronic walkway. Spearman correlation analysis was applied to investigate the relationship between the parameters.
Results: Although age and plantar forefoot sensation were moderately correlated (p=001; r=0.63), the HV angle and pain intensity were not associated with any of the sensory parameters (p>0.05).
Conclusion: The present study showed that plantar forefoot sensation worsened as the patients’ age increased. It is believed that pressure neuropathy may be the reason why HV patients’ forefoot sensitivity deteriorates with age in particular.

13.Dialysis Requirements of Kidney Transplant Recipients During COVID-19
Cihan Uysal, Tuğba Yılmaz, Sumeyra Koyuncu, Ismail Koçyiğit
doi: 10.14744/etd.2023.41861  Pages 290 - 295
Objective: The complications of Coronavirus Disease 2019 (COVID-19) have increased among kidney transplant recipients (KTR) due to chronic immunosuppression and comorbidities. Additionally, acute kidney injury (AKI) is frequently observed during COVID-19. This study aimed to investigate the impact of COVID-19 on kidney allograft survival.
Materials and Methods: The retrospective, single-center investigation study included 88 patients who had a functioning kidney allograft prior to COVID-19 diagnosis. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection was confirmed with a polymerase chain reaction (PCR) test and thoracic computerized tomography. AKI and dialysis require-ments were analyzed using laboratory, demographic, and clinical parameters.
Results: The median age of the patients was 44.5 (34.3-53.8) years, and the median allograft survival was 59.0 (20.8-116.5) months. The mean baseline estimated glomerular filtration rate (eGFR) was 58.2 (21.2-92.8) ml/min/1.73 m2 before the COVID-19 diagnosis. The frequency of AKI was 70.4% (62 patients), and dialysis therapy was required in nine patients (10.2%). The clinical features of COVID-19 and inflammatory markers had no statistical significance in predicting dialysis requirements. However, logistic regression analysis indicated that serum protein level (p=0.034), serum albumin level (p=0.048), hemoglobin (p=0.028), baseline eGFR (p=0.033), and age (p=0.041) were significantly predictive for dialysis requirements.
Conclusion: Age, anemia, and decreased baseline eGFR are related to severe AKI and dialysis therapy in KTR during COVID-19.

14.Public Perception and Behavior Toward Personal Listening Device Usage: Outcome of World Hearing Day Screening in a Tertiary Centre
Najihah Hawari, Jeyasakthy Saniasiaya, Jeyanthi Kulasegarah, Tengku AhmadShahrizal Tengku Omar
doi: 10.14744/etd.2023.43568  Pages 296 - 299
Abstract |Full Text PDF

15.Interscapular-thoracic Amputation: A Giant Dermatofibrosarcoma Protuberans Tumor
Alberto De Anda Coronado, Nohemi Lopez, Eduardo Navarro Bahena, Gerardo E. Munoz-Maldonado
doi: 10.14744/etd.2022.48457  Pages 300 - 302
Background: Dermatofibrosarcoma protuberans (DFSP), an uncommon sarcoma of the dermis, is a low-grade, spindle-cell tumor that usually grows slowly and has a high local recurrence rate, but rarely metastasizes to distant sites. The diagnosis is based on histopathology and the standard treatment is wide surgical excision with tumor-free margins.
Case Report: Described is the case of a 75-year-old female who presented with a giant tumor on her upper right arm that had been increasing in size for a year. A biopsy provided the diagnosis of DFSP. Radical surgery was performed and the arm was disarticulated from the scapula.
Conclusion: Treatment for DFSP typically involves surgical excision; however, the size of the tumor in the present case was exceptionally large. Disarticulation offered the best prognosis.

16.Glioblastoma with Unusual Features: Presentation with Intracerebral Hematoma, Diagnosis with CT Perfusion and Subsequent Cerebral Venous Sinus Thrombosis with Resultant New Hemorrhage
Hande Melike Bülbül, Süleyman Men, Nuri Karabay, Ayca Ersen, Ercan Özer
doi: 10.14744/etd.2022.11736  Pages 303 - 306
Background: During the course of primary malignant brain tumors, there is an increased tendency for both intracerebral hemorrhage and venous sinus thrombosis.
Case Report: A 63-year-old man presented with a headache, and a brain computed tomography (CT) scan showed a hematoma in the right occipital lobe. Magnetic resonance imaging (MRI) revealed almost complete rim enhancement, and CT perfusion showed increased cerebral blood volume values. A new bleeding focus and a thrombus extending from the superior sagittal sinus to the cortical vein were seen on CT and MRI scans performed due to the headache that developed the day before surgery. After surgical evacuation of the hematoma, a giant cell glioblastoma diagnosis was made as a result of pathological examination of the lesion.
Conclusion: In challenging cases like this, perfusion techniques are useful. Cerebral venous sinus thrombosis should also be kept in mind during the perioperative and postoperative periods to avoid complications.

17.Anti-GQ1b Negative Miller Fisher Syndrome Mimicking Acute Sphenoid Sinusitis
Kuganathan Ramasamy, Jeyasakthy Saniasiaya, Norhaslinda Abdul Gani
doi: 10.14744/etd.2022.80932  Pages 307 - 309
Background: Miller Fisher Syndrome is a variant of Guillain-Barre Syndrome, classically characterized by the triad of ataxia, areflexia and ophthalmoplegia. However, many conditions can mask the presentation of Miller Fisher Syndrome, potentially leading to grave consequences due to delayed diagnosis or even misdiagnosis.
Case Report: We describe a case of Miller Fisher Syndrome mimicking acute sphenoid sinusitis with intracranial com-plications in an otherwise healthy 19-year-old man. Accurate diagnosis with prompt treatment led to full clinical recovery of our patient.
Conclusion: Sphenoid sinusitis warrants great vigilance and thorough neurological examination due to its proximity to struc-tures such as the cavernous sinus and its associated cranial nerves. This case highlights its potential to mask more devastating conditions like Miller Fisher Syndrome and the successful role of medical management without the need for sphenoidotomy.

18.Intracranial Germinoma Metastasizing to the Liver
Ahmet Yasin Yitik, Ergin Sağtaş, Furkan Ufuk
doi: 10.14744/etd.2022.78380  Page 310
Abstract |Full Text PDF

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