Use of Heparin and The Related Incidence of Heparin Induced Thrombocytopenia in an Education and Research Hospital in Turkey
Nibal Abunahlah, Aisha Abimbola, Yildiz Okuturlar, Meltem Breen, Hakan Kocoglu
J Clin Exp Invest 2017;8(3):71-75.
https://doi.org/10.5799/jcei.343189
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: We analyzed the incidence of heparin-induced thrombocytopenia in a group of
patients who received heparin (LMWH, UFH) in an education and research hospital using the 4T
test score as a diagnostic tool.
Patients and Methods: A retrospective descriptive study analyzing patients using heparin
preparations within the years 2015 and 2016. The risk for heparin-induced thrombocytopenia
was calculated using the 4T test score system and also the monitoring of platelet counts of each
patient.
Results: Of 19.257 patients who used either UFH or LMWH and were admitted to the hospital
within 2015 and 2016, 308 patients were suspected to have thrombocytopenia based on their
individual platelet counts by excluding only patients with thrombocytopenia. 100 patients were
determined to probably have heparin-induced thrombocytopenia and were further evaluated
using the 4t test score. Overall risk was calculated to be 0.5%. Incidence was calculated to be
0.15% (29 out of 19257). For patients with high-risk scores, the incidence was 0.01% (2 out of
19257). Patients who had a high 4T test score were using ranitidine. In 29 patients who had
intermediate and high-risk probability for HIT, mean starting day of HIT was 6.24±3.68 days;
mean withdrawal day of heparin was 9,55±5,86 days and mean delay of heparin withdrawal was
3.31±3.39 days.
Conclusion: Although the use of LMWH is being favored in the hospital when compared to
UFH, health care practitioners should still remain vigilant about the occurrence of HIT as a
complication of heparin therapy in hospitalized patients most especially within the first few
weeks following heparin administration.
Keywords: Heparin, thrombocytopenia, hospital setting, incidence
The physiological and genotoxic effects on model organisms of the water and ethanol extracts of Goji berry (Lycium barbarum L.)
Hulya Ozpinar, Necati Ozpinar, Savas Karakus
J Clin Exp Invest 2017;8(3):76-84.
https://doi.org/10.5799/jcei.343190
Research Article
[Abstract]
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ABSTRACT
Objectives: Herbal treatments in particular have a place which cannot be ignored in current alternative medicine. One of these plants, which has become very well-known recently and which is widely consumed in Turkey is the Goji berry (Lycium barbarum L.). To investigate the effects of Goji berry, on fertility when used by individuals in their 20s and on physical growth when used by those of a younger age. It was also aimed to test the genotoxic effects of the Goji berry on Allium cepa L. meristem stem cells.
Materials and Methods: Goji berry water and ethanol extracts were tested on a model organism of Caenorhabditis elegans (C. elegans) in respect of fertility and physical growth. Allium cepa L. meristem stem cells exposed to Goji berry extract were examined for genotoxic effects.
Results: A significant dose-related reduction was determined in fertility, physical growth and mitotic index in ethanol extract. In the water extract, a reduction in fertility was determined at high doses and an increase with the lowest dose used in the study. No significant effect was found on physical growth of water extract at any dose.
Conclusion: The results of this study showed negative effects on cell division, fertility and physical growth of Goji berry, which has been used since ancient times in Chinese medicine and for which several benefits have been claimed in literature. It must be emphasised that dose-related side-effects may develop with the use of plants for medicinal puposes.
Keywords: Goji Berry, Caenorhabditis elegans, Fertility, Physical growth, Genotoxic effects
Anesthetic Techniques in Octogenarians and Older Undergoing Orthopedic Surgery for Hip Fracture
Onur Palabiyik, Fikret Bayar, Tugba Caglar, Yasar Toptas, Ali Fuat Erdem, Ayca Tas Tuna
J Clin Exp Invest 2017;8(3):85-89.
https://doi.org/10.5799/jcei.343194
Research Article
[Abstract]
[PDF]
ABSTRACT
Objectives: Hip fracture is common orthopedic problems for patients aged 80 years and older. Because of their decreased cardiopulmonary capacity, an optimal anesthetic technique should be chosen by anesthesiologists. The purpose of the present study is to analyze anesthetic techniques and related postoperative mortality in octogenarians and older who underwent hip fractures surgery.
Patients and Methods: We analyzed hip fracture surgeries and identified patients aged 80 years and older between January 2012 and December 2013. Patient age, gender, coexisting diseases, American Society of Anesthesiologists (ASA) Physical Status classification, anesthetic technique, hematocrit, hemoglobin, total lymphocyte count (TLC), the length of surgery, intraoperative blood transfusion requirements, postoperative discharge ward, the length of postoperative hospital stay, and postoperative status were recorded.
Results: We retrospectively identified 106 patients aged 80 years and older underwent hip fracture surgeries. Six (5.6%), 36 (34.0%), 2 (1.9%), 53 (50.0%), and 9 (8.5%) of procedures were performed under general anesthesia (GA), spinal anesthesia (SA), epidural anesthesia, combined spinal-epidural anesthesia (CSEA), and peripheral nerve block (PNB), respectively. The postoperative 7 and 30-day mortality were 6.6% and 10.4%, respectively. Age, gender, ASA, hematocrit, hemoglobin, TLC, discharge to the ward, the length of postoperative hospital stay, and the postoperative mortality rates were similar between the GA, SA, CSEA, and PNB. There was no relationship between postoperative mortality and anesthetic technique.
Conclusion: In octogenarians and older, the postoperative mortality is higher after hip fracture and is not associated with the anesthetic technique.
Keywords: Octogenarians, general anesthesia, central neuraxial block, peripheral nerve block, mortality
Management of Ectopic Pregnancy In Unusual Location: Five-Year Experience In A Single Center
İsmet Hortu, Levent Akman, Ali Akdemir, Mete Ergenoğlu, Özgür Yeniel, Fatih Şendağ
J Clin Exp Invest 2017;8(3):90-95.
https://doi.org/10.5799/jcei.343197
Research Article
[Abstract]
[PDF]
ABSTRACT
Objectives: The aim of this study is to evaluate the diagnostic and therapeutic strategies in patients with unusual ectopic pregnancy and present a brief review of the literature.
Patients and methods: Twenty- seven cases with ectopic pregnancy in unusual locations were classified in five groups; two cesarean scars, six cervical, six cornual, two ovarian, and eleven heterotopic pregnancies. All of data were retrospectively analyzed according to the patient’s gestational week, gestational sac location, obstetric history, treatment modality and treatment success.
Results: Eleven patients with heterotopic pregnancy treated by surgery. Five of remaining sixteen patients were treated medically and two of them required major surgical procedure (hysterectomy and bilateral internal iliac artery ligation). Minimal invasive procedures and follow-up were done each remaining patient.
Conclusion: The suspicion of the ectopic pregnancy and evaluation the whole pelvic cavity through ultrasonography are crucial for diagnosis of ectopic pregnancy. Three-dimensional ultrasonography can be helpful tool for accurate diagnosis. Early diagnosis of ectopic pregnancy provides patients to utilize fertility preservation as well as choice several treatment modalities.
Keywords: Ectopic pregnancy, unusual location, 3D Ultrasonography, Laparoscopy
Retrospective Analysis of Multiple Sclerosis Patient Records in a Turkish reference Center
Rabia Kahveci, Esra Eruyar, Emine Özer Küçük, Yunus Nadi Yüksek, Tanju Tütüncü, Hilal Aksoy, Nurullah Zengin
J Clin Exp Invest 2017;8(3):96-100.
https://doi.org/10.5799/jcei.343199
Research Article
[Abstract]
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ABSTRACT
Objective: This study aims to identify sociodemographic and hospitalization characteristics of the multiple sclerosis (MS) patients admitted to a reference center in Turkey.
Patients and Methods: This is a single-center retrospective study which reviews MS patient records in 66 months. The study covered between April 1, 2010 and September 30, 2015. Data was collected on age, gender, number of admissions, number of hospitalizations (dates and durations), requests for laboratory tests and Magnetic Resonance Imaging (MRI), existence of disability reports and provision of home care. Total number of admissions for home care was 78.
Results: We determined 6996 MS admissions by 1578 patients in 66 months. 65.8% (n: 1038) of patients were females; mean age was 37.0. There were 4.4 admissions per patient. 584 (37.0%) patients had MRI requests. Blood tests were requested in 25% of all admissions. We identified 5213 (74.5%) admissions of 400 (25.3%) patients who have admitted at least five times to the center. For this group, mean admission per patient was 13.0, MRI request per patient was 2.1. 38.7% (n=152) of these patients was hospitalized at least once.
Conclusion: The use of resources for MS patients in a hospital setting is remarkable, which includes admissions, hospitalizations, blood tests and MRIs. However, when the number of patients with MS diagnosis taken into consideration, it is noteworthy that the number of demands for homecare is very small. Our study will be a guide for reducing cost of illness and improving care pathways.
Keywords: Multiple sclerosis, sociodemographic characteristics, hospitalization, Turkey
Coexistence of Chiari malformation type I and isolated hemihypertrophy in a 15-year old girl: a case report
Halil Kazanasmaz, Mustafa Calik
J Clin Exp Invest 2017;8(3):101-103.
https://doi.org/10.5799/jcei.343203
Case Report
[Abstract]
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ABSTRACT
Hemihypertrophy is the asymmetrical growth of one or more parts of the body, and might be either isolated or a component of various syndromes. Coexistence of isolated hemihypertrophy and Chiari malformation type I are very rarely. In this study, our objective was to present a 15 years old girl case with isolated hemihypertrophy and Chiari malformation type I in the light of literature data.
Keywords: Hemihypertrophy, Chiari malformation type I, child, syndrome