Acta Medica Ruha

How Can Treatment for Alcohol and Drug Addiction Be More Effective?

2024-02-01T14:57:26+03:00

Dear Editor,

The aim of this letter is to highlight the low success rate in alcohol and substance addiction treatment in psychiatric clinics and to initiate a brief discussion about whether there are other treatment options. While hundreds of studies emphasize the importance of spiritual and religious support for the treatment of substance addiction, this situation is still ignored in psychiatric clinics in our country. İn order to increase the success rate in the treatment of alcohol and substance addiction and to reduce the frequency of relapse, it would be an appropriate approach for psychiatric clinics to work in coordination with associations by leaving all prejudices aside.

Evaluation Of Vaginal Culture Results in Patients Using Vaginal Pessary

2024-01-17T09:44:54+03:00

Abstract

Introduction: Although surgery is the main treatment in cases with uterine prolapse, the use of vaginal pessary is an important alternative in cases where surgery cannot be performed due to comorbid diseases and patient avoidance of surgery. With the use of pessaries, the pelvic organs are held in place and a significant improvement in the patient's quality of life is achieved.

Objective: Obviosly Usage of vaginal pessaries cause to vaginal infection. The aim of this study to determine solutions of the problems that patients may encounter and better evaluate this situation in the light of vaginal culture results taken from patients.

Method: 22 patients who applied to Gynecology and Obstetrics outpatient clinics and used vaginal pessaries due to pelvic organ prolapse for various reasons were included in the study. Previous vaginal culture results due to infection were evaluated retrospectively in the patients who are using pessaries. The cases were examined in terms of age, gravida, parity, height, weight, BMI, existing complaint, comorbidity, reason for not being able to undergo surgery, shape and degree of pelvic organ prolapse, whether it was accompanied by incontinence, and pathological findings using ultrasonography.

Results: During sterile speculum examination of the patients with vaginal discharge due to pessary use intense leukorrhea was detected in just 1 patient (4%) and 9 patient (40.9%) had minimal leukorrhea. Although the patient had a complaint, no evidence of infection was detected in 12 of the patients (54.5%) during the examination. The vaginal culture results shows that 7 of 22 patients (31%) were reported as "no growth". Normal flora elements grew in 12 of them (54%). Pathogenic microorganisms were observed in only 3 (13.6%) patients.The causative microorganism Echechia coli was observed in 2 of the patients with growth in vaginal culture, and Enterococcus faecealis was observed in 1.

Conclusion: As a result of this study, it is seen that local antibiotics used prophylactically and local estrogen given to prevent tissue damage provide adequate treatment in patients using vaginal pessaries, but it is more valuable to show the presence of infection by vaginal examination rather than culture to improve the quality of life of patients

Vitamin D Levels And Affecting Factors In Healthy Children Between 2 – 12 Years Of Age

2024-01-17T09:55:33+03:00

Objective: Although Turkey is sunny in the northern hemisphere's temperate climate zone, vitamin D deficiency is a common public health problem. Within the scope of this research, we aimed to elucidate vitamin D levels and the affecting factors in healthy children between the ages of two and twelve.

Method: This prospective survey was conducted with 600 children aged 2–12 who applied to the pediatrics outpatient clinic. The clinical examination was performed, and body mass indexes were calculated. In the prepared survey, the month of participation in the study, birth weight, gender, type of vitamin D use, and duration of vitamin D use in the first year after birth were questioned.

Results: The lowest vitamin D level was in the nine-twelve age group, and the highest was in the two-four age group. Vitamin D deficiency was more common in girls than in boys, with a statistical significance (X2 = 14.236; p=0.003). When the cut-off values and vitamin D levels of the cases are examined according to age, 73.5% of our cases in the two-four age group with a cut-off value of 23.40 ng/ml, 83% of cases in the five-eight age group with a cut-off value of 24.80 ng/ml and 88.5% of the cases in the nine-twelve age group with a cut-off value of 25.50 ng/ml had vitamin D insufficiency or deficiency. When the average cut-off value of all age groups was evaluated as 24.49ng/ml, it was determined that 82% had vitamin D deficiency or insufficiency.

Conclusion: It has been observed that vitamin D insufficiency and deficiency occur severely during childhood, and its prevalence increases with age. For this reason, adopting a lifestyle that prevents vitamin D deficiency in children and evaluating them in the interim periods may be beneficial in preventing possible complications.

Evaluation of Compliance of Patients Admitted to Emergency Department By 112 Ambulances According to International 32 Emergency Parameters

2024-02-13T22:55:45+03:00

Introduction: The inappropriate use of ambulances increases the workload of emergency services and adversely affects the economy.

Objective: We aimed to compare the compliance of the prediagnosis and the final diagnosis of cases brought to the emergency department by 112 ambulances with the World Health Organization (WHO) International 32 Emergency Parameter and investigate their possible inappropriate usage status.

Method: The compliance status of the prediagnosis and final diagnosis of the patients with the WHO International 32 Emergency Parameters were compared (n: 7521). Statistical analysis was conducted using MedCalc® Software and a value of 95% was used for confidence interval. This study is based on a specialization thesis.

Results: While the most frequent diagnosis group among the prediagnostically compliant ones was trauma (26.3%), the most frequent diagnosis group among the final diagnostically compliant ones was cardiovascular system diseases (20.1%). A significant difference was observed when comparing the compliance status with the indicators (McNemar Test, p<0.05).

Conclusion: In our study, in cases brought to the emergency department by 112 ambulances, the rate discrepancy of their final diagnoses was found to be higher compared to the prediagnosis group. This fact shows that even the cases that showed no compliance with the international parameters were referred to emergency departments via ambulance.

Effect of Sodium Nitroprussıde in Patients With Detrussor Overactivity

2024-01-21T17:18:58+03:00

Introduction: Detrusor instability is a common cause of urgency and urge incontinence in neurologically normal patients. Nitric oxide, relaxes the smooth muscles of the detrusor, prostate, and urethra.

Aim: We aimed to explain the therapeutic effects of sodium nitroprusside on detrusor overactivity in patients with detrusor overactivity.

Methods: A total of 21 patients with detrussor overactivity have been enrolled in this research. The patients were divided into 3 groups according to their sodium nitroprusside dosage, as low-dose, medium-dose, and high-dose. Hydrostatic pressure in the bladder was measured and at the same time, intra-abdominal pressure was measured with a catheter inserted into the rectum. Cystometry results have been evaluated in terms of sensation (first sensation, first desire, strong desire), detrusor compliance, maximal detrusor pressure, maximal cystometric bladder capacity and instability index parameters.

Results: No statistical significance has been achieved between nitroprusside groups in terms of first sensation, first desire, and strong desire values (p>0.05). When the patients' maximal detrusor pressure, maximal cystometric bladder capacity and compliance values were interpreted, no significant difference was found between the isotonic and SNP groups and their doses. There was no significant difference between the groups in the duration of contractions. Additionally, no difference has been observed between the groups in the blood pressure values of the patients at the end of the study compared to the baseline.

Conclusion: This study indicated that SNP did not exhibit any positive or negative effects in individuals with detrussor overactivity. The reason for this could be stated as: first, the urothelium acts as a barrier to the passage of sodium nitroprusside and prevents it from reaching the detrusor and the latter may be due to the lack of effect of sodium nitroprusside on detrusor function.

Evaluation of Preeclampsia Patients – 3 Years of Data

2024-02-13T22:40:23+03:00

Introduction: Preeclampsia is the most important cause of maternal, fetal, and neonatal morbidity and mortality worldwide, affecting approximately 4% of all pregnancies.

Objective: Patients admitted to our clinic and diagnosed with non-severe preeclampsia, severe preeclampsia, HELLP syndrome, and eclampsia were retrospectively examined, and the demographic, clinical, and laboratory data obtained from these patients were compared with the diagnostic groups.

Method: A total of 156 patients, including 63 with non-severe preeclampsia, 84 with severe preeclampsia, 6 with HELLP syndrome, and 3 with eclampsia, who were followed up and treated in our center, were evaluated. Patient characteristics were classified by comparing the groups regarding delivery methods, demographic characteristics, and clinical and laboratory parameters.

Results: In terms of maternal complications, peripartum hemorrhage and placental abruption were more common in the eclampsia and severe preeclampsia groups. At the same time, DIC was more common in the patient group diagnosed with HELLP syndrome, and these results were found to be statistically significant (p<0.05). When demographic, clinical, and laboratory data were compared with whether maternal complications developed, the rate of maternal complications was found to be significantly higher in patients with elevated AST and ALT. No maternal mortality occurred in any of the patient groups.

Conclusion: The higher rate of maternal complications in patients with elevated AST and ALT suggested that follow-up of this patient group in the intensive care unit will be beneficial in reducing maternal morbidity and mortality.

The Prognostic Role of Biomarkers in Pulmonary Contusion

2024-02-04T20:19:39+03:00

Objective: Within the scope of this research, we aimed to elucidate the treatment and follow-up of pulmonary contusion patients by revealing the prognostic role of biomarkers. All parameters in total blood samples taken from the cases at the first admission were analyzed as biochemical biomarkers.

Method: A total of 482 patients aged 18 and over admitted to our institution due to thoracic traumas were examined. Among the cases admitted to the emergency department with injuries accompanied by blunt thoracic trauma, cases with radiologically proven pulmonary contusion were included in the study.

Results: WBCs, neutrophil, and lymphocyte count, neutrophil-lymphocyte ratio (NLR), ALT, AST, and LDH values were significantly higher in the group with pulmonary contusion (p<0.05). The lymphocyte levels were significantly lower in pulmonary contusion patients (p<0.05). The rate of complications, intensive care unit stay, requirement for mechanical ventilation, and mortality rate were significantly higher in the group with pulmonary contusion (p>0.05). The univariate analysis found that WBC, neutrophil and lymphocyte count, NLR, ALT, AST, and LDH parameters denoted a statistically significant difference between the two groups (p>0.05). WBC, neutrophil count, NLR, ALT, AST, and LDH values were significantly elevated in the group with lung contusion>50% (p<0.05).

Conclusion: In this study, WBC, neutrophil and lymphocyte count, NLR, ALT, AST, and LDH were predictive biomarkers. Additionally, age, motor vehicle accidents, falls, impact trauma mechanism, pneumothorax, injury site, and number of rib fractures were other contributing predictors that allow a wider range of clinical application and decision-making.