Clinical Evaluation of Efficacy and Safety of Combined Topical Timolol and Oral Propranolol in Children with Infantile Hemangioma
Abdulameer Abdulbari Abdulhameed, Kalil Esmail Al-Hamdi, Muntaha Abdulhadi Mathkoor
J Clin Exp Invest 2018;9(1):1-8.
https://doi.org/10.5799/jcei.413049
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: To evaluate the efficacy and safety of combined topical timolol and oral propranolol in treatment of infantile hemangioma.
Patients and Methods: This prospective study was conducted in Basra teaching hospital in Basra, Iraq, where a total of 23 infants with 34 lesions of different types of hemangioma were included. All lesions were in proliferation phase. The infants’ ages were less than one year. They were treated with topical timolol solution 0.5% combined with oral propranolol in a period of 12 weeks (8-16 weeks). The response to treatment was evaluated clinically by using hemangioma score and Visual analogue scale. All infants followed 4-12 months after cessation of drugs.
Results: By using hemangioma score system; the combined therapy showed that, 28 (82.4%) lesions showed excellent response, two (5.9%) showed good response, four (11.8%) showed fair response and none of the lesions showed poor response at end of 16 weeks. At the end of 4 months superficial hemangioma showed 100% reduction in their score, while the ulcerative hemangioma showed 94.7% reduction in their score while mixed hemangioma showed only 76.7% reduction in their scores. Complete resolution occurred in 50% of lesions after 4 months of treatment. Neither included infants developed serious side effects nor, any of the regressed hemangioma recur during the follow up.
Conclusion: Combined topical Timolol 0.5% solution and oral propranolol seems to be a well-tolerated, safe treatment option with a good to excellent responses. The most responsive type of hemangioma to this combination are the superficial and ulcerative types.
Keywords:
Headache in Multiple Sclerosis From a Different Perspective: A Prospective Study
Gökhan Özer, Ufuk Ergün, Levent Ertuğrul İnan
J Clin Exp Invest 2018;9(1):9-13.
https://doi.org/10.5799/jcei.413052
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: It is known that patients with multiple sclerosis have a high incidence of headache. Although there is increasing evidence to suggest that periaqueductal gray matter (PAG) plays a role in the pathophysiology of migraine headache, it is not known whether the type of headache may be a predictor of a MS relapse.
Patients and Methods: The study enrolled 100 patients (68 females, 32 males) with clinically confirmed MS diagnosis established by McDonald diagnostic criteria. The type and duration of MS, MRI localization of lesions and cognitive status were recorded for all patients. Patients were questioned whether they experience headache during MS attacks.
Results: Sixty-eight percent of the patients had headache and 32% of the patients were free of headache. Of the patients with headache, 16% had tension –type headache (TTH), 14% had migraine, 11% had primary stabbing headache (PSH), 8% had TTH+ migraine, 6% had PSH+ migraine, 6% had medication overuse headache , 2% had medication overuse headache + migraine, 2% had paroxysmal hemicrania, 1% had cervicogenic headache, 1% had chronic TTH, and 1% had unclassified headache. There was a statistically significant relationship between the presence of headache and MS relapse (p<0.001). We found a statistically significant relationship between the type of headache and the localization of plaques in all MS patients in a statistical analysis using chi-square test, (p<0.001).
Conclusion: Headache may be the only symptom of a flare-up in MS patients. The relationship between stabbing headache and MS relapses merits further investigation.
Keywords:
Retrospective Investigation of Treatment Protocols for Drug Poisonings Admitted to Emergency Department
Selçuk Eren Çanakçı, Kenan Ahmet Turkdogan, Bekir Dağlı, Ayhan Aköz, Mücahit Avcil, Ali Duman
J Clin Exp Invest 2018;9(1):14-20.
https://doi.org/10.5799/jcei.413055
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: The purpose of this study was to investigate the demographic and etiologic features of acute poisoning cases, the toxic substances which cause the poisonings and their properties, laboratory findings and clinical features retrospectively and to show what could be the precautions to be taken.
Patients and Methods: Total of 483 patients, who were admitted to emergency department with drug poisoning within 3 years and whose information was available were taken into this retrospective study. The patients’ age, sex, date of admission to hospital, duration of hospitalization in emergency department and intensive care unit, clinical outcomes, agents and amounts of drugs taken, applied antidote and extracorporeal treatments, laboratory values of cases were examined.
Results: 179 (37,1%) of the cases were followed up for an average of 3,21 ± 4,5 days in the intensive care unit and 304 (62,9%) patients were followed up for an average of 2,1 ± 2 days in the observation unit of the emergency department. When the lipophilicity of poisoning drugs were examined, in 191 (39.5%) patients only lipophilic, in 100 (20.7%) patients lipophilic and additional substance, in 83 (17.2%) patients only hydrophilic and in 109 (22.6%) patients hydrophilic drug and additional substance was found. Extracorporeal treatment was applied to 14 patients. Our mortality rate was found 0.62%.
Conclusion: Early intervention in poisonings is life-saving. Supportive therapies, antidotes and extracorporal techniques may reduce mortality, but toxicological guidelines may be needed to guide clinicians in more extensive studies.
Keywords:
Detection of Acute Gastroenteritis Agents By Molecular Methods
Şafak Göktaş, Ayşegül Aksoy Gökmen, Pınar Şamlıoğlu
J Clin Exp Invest 2018;9(1):21-25.
https://doi.org/10.5799/jcei.413060
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: Gastroenteritis is the most important cause of morbidity and mortality in all age groups all over the world. Multiplex PCR tests give sensitive and specific results in the investigation of bacterial, viral, parasitic agents. In this study, it was aimed to determine the agents of the stool specimens of patients with acute diarrhea by multiplex PCR.
Materials and Methods: Stool sample taken from 471 patients sent to Istanbul Gelişim Laboratories between January 1, 2015 and September 30, 2016 was included in the study. All stool samples were processed according to manufacturer’s instructions with GastroFinder SMART 18 FAST multiplex PCR test (Pathofinder, Holland). 18 different gastrointestinal pathogens were diagnosed in one study.
Results: Of the 471 patients stool sample included in the study. The agent was negative in 241 (51.2%), while the agent was isolated in 230 (48.8%). 190 (82%) had a single pathogen, 40 had two or more pathogens. Of the 190 samples detected with single agent, 149 (31.6%) were bacterial, 26 (5.5%) were parasitic and 15 (3.1%) were viral agents.
Of the 149 bacterial agents, 108 (23%) was detected as Salmonella spp, 14 (6%) as EHEC, 8 (3.5%) as Clostridium difficile toxin A / B, 8 (3.5%) as Campylobacter spp., 7 (3%) Aeromonas spp., 2 (0.8%) Yersinia enterocolitica, 2 (0.8%) Enterotoxigenic E. coli (ETEC). Of 26 parasitic agents, 18 (7.8%) was detected as Giardia lamblia, 6 (2.6%) as Dientamoeba fragilis and 2 (0.8%) as Cryptosporidium spp.
Conclusion: Identification of enteric pathogens by multiplex PCR will avoids the use of unnecessary antibiotic treatments
Keywords: Gastroenteritis, Multiplex PCR, stool
Caesarean Scar Pregnancy: A Single Center Experience
Alev Özer, Abdullah Tok, Bülent Köstü, Murat Bakacak, Ferhat Aslan, Hilal Sakallı
J Clin Exp Invest 2018;9(1):26-29.
https://doi.org/10.5799/jcei.413062
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: To present the demographic and clinical characteristics and the treatment method of cases of caesarean scar pregnancy (CSP).
Patients and Methods: A retrospective examination was made of cases diagnosed with CSP at the tertiary reference hospital of Sütçu Imam University between January 2015 and December 2017. Data were retrieved related to the demographic characteristics of the patients, ultrasonography (USG) findings and treatment procedures.
Results: A total of 23 CSP cases were identified in the specified study period. The mean age of the patients was 31.2 ± 6.9 years, mean gravida was 4.4 ± 1.7, mean gestational age was 7.0 ± 1.1 weeks and the number of previous caesarean section (CS) deliveries was 2.0 ± 0.9. Intramuscular methotrexate (MTX) at a dose of 1mg/kg was applied to all the patients, then after 1 week, a dilatation and curettage (D&C) procedure. Before the MTX treatment, the initial serum beta-hCG value was determined as 15813.1 ± 12740.5 IU/mL. The hemoglobin (Hb) level was determined as 12.3 ± 1.4 before MTX treatment and 11.4 ± 0.6g/dL after the D&C procedure. Hysterectomy was not applied to any patient. CSP was determined at the rate of 8.0% of all ectopic pregnancies.
Conclusion: CSP, which has shown an increase in recent years in parallel with CS rates, may cause bleeding and serious complications even as far as maternal mortality. CSP cases in our clinic were successfully treated with a combination of systemic MTX followed by D&C.
Keywords: Ectopic pregnancy, caesarean scar pregnancy, methotrexate
Investigation of Parvovirus B19 IgG and IgM antibodies with ELISA, distribution with regard to age groups and comparison with literature
Ayşe İnci, Aytül Çorbacıoğlu Esmer
J Clin Exp Invest 2018;9(1):30-33.
https://doi.org/10.5799/jcei.413067
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: Human parvovirus is an un-enveloped, linear, single bundle DNA virus 18-26 nm in diameter which is common worldwide and causes an asymptomatic infection. The most common clinical manifestation is erythema infectiosum, it may also lead to aplastic crisis, arthropathy, neutropenia, thrombocytopenia and fetal infections. In this study, we aimed to determine parvovirus B19 sero-positivity rates, distribution according to age and contribute to epidemiologic data in our country.
Patients and Methods: Results of pregnant women who were admitted to Kanuni Suleiman Hospital between January 2015 and January 2017, examined for parvovirus B19 infection and whose parvovirus B19 IgG/IgM antibodies were examined with ELISA method were recorded from patient files. Parvovirus B19 IgM and parvovirus B19 IgG test results were retrospectively analyzed. parvovirus B19 IgM and parvovirus B19 IgG were examined with ELISA method in accordance with recommendations of the manufacturer.
Results: A total of 156 pregnant women whose parvovirus B19 IgG/IgM antibodies had been analyzed were included in the study. While parvovirus B19 IgG was positive in 64.7% of the patients, parvovirus B19 IgM alone positivity was not detected in any women. parvovirus B19 IgG and IgM were positive in 3 women. parvovirus B19 IgG positivity was greatest above 40 years and minimum in 18-25 age group.
Conclusion: In conclusion, parvovirus B19 IgG positivity was found similar with that in other countries. We consider that studies conducted with different groups and in different regions would contribute to epidemiologic data.
Keywords: Parvovirus B19, pregnancy, ELISA
Elderly Patients Treated in Selected Family Medicine Offices in Central Istria And Their Habits
Tina Zavidić, Đino Lovrinić
J Clin Exp Invest 2018;9(1):34-39.
https://doi.org/10.5799/jcei.413069
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: To describe the sociodemographic profile and investigate the habits of elderly patients attending family medicine offices in central Istria, Croatia.
Patients and Methods: This was a retrospective study, conducted in central Istria. Data were obtained by a physical examination, extraction from a recorded history of disease, and using an administered questionnaire. The patients were stratified into three groups: young (65-74 years), middle (75-84 years), and older old age (>85 years). Groups were compared about education, marital status, body mass index, frequency of visits to a family doctor, and habitual activities such as physical activity, smoking, coffee and alcohol consumption, and vitamins/dietary supplements intake, and hobbies.
Results: Overall, 191 patients were included, of which 93 young (49%), 82 middle (43%), and 16 older old (8%). The age groups differed statistically with regard to education and marital status. In the young old group, 53% of subjects had a high school/university diploma, in the middle old 19%, and in the oldest old 12% (p<0.001). The proportion of widowed subjects in the young, middle, and oldest old groups were 16%, 40%, and 50%, respectively (p=0.005). The most common diagnoses were cardiovascular diseases (76-83%), diabetes (41-56%), vision and hearing problems (13-31%), and musculoskeletal disorders (6-29%). The majority of responders were not physically active (59.2%) and had a body mass index ≥ 25 kg/m2 (50-77%).
Conclusion: Understanding the profile of elderly patients is paramount in order to preserve the dignity of living by meeting their health, social, and economic needs.
Keywords: Alcohol consumption, body mass index, comorbidity, elderly, physical activity, smoking
The impact of serum 25-hydroxyvitamin D level on migraine headache
Gökhan Özer
J Clin Exp Invest 2018;9(1):40-44.
https://doi.org/10.5799/jcei.413072
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: To investigate the impact of serum 25-hydroxyvitamin D levels on migraine headache in migraineurs
Patients and Methods: A total of 72 patients were included in the study. Serum vitamin D concentration and its impact on the migraine headache were assessed in migraineurs and migraine subgroups. To assess serum levels of vitamin D, 25(OH) D3 was measured by enzyme-linked immunosorbent assay (ELISA). Patients were categorized as follows based on the results of serum vitamin D measurements. Severity of migraine, average duration and frequency of attacks per month were recorded. The headache diary result (HDR) was determined as: Duration of headache × frequency of headache.
Results: Average vitamin D level was 7.4 ng/ml among patients with migraine with aura group and 8.5 ng/ml in patients with migraine without aura. Severe vitamin D deficiency was detected in 14 (66.7%) patients with migraine with aura and 9 (64.3%) patients with migraine without aura, with no statistically significant difference between the two groups. No significant correlation was found between vitamin D levels and HDR among migraineurs (r=-0.042, p=0.812) as well as in patients with migraine with aura (r=0.044, p=0.842) and in patients with migraine without aura (r=0.059, p=0.842) versus control group with respect to HDR and vitamin D levels. The severity of migraine pain was not associated with vitamin D levels. Serum vitamin D concentration was lower in male patients versus control group.
Conclusion: The impact of vitamin D on the severity and number of migraine attacks is not clear. Further studies are needed to demonstrate the association between vitamin D status and neurological diseases.
Keywords: Migraine, 25-hydroxyvitamin D, headache
Partial unilateral lentiginous and colon polyp in a young male patient
Gulhan Gurel, Sevinç Şahin, Emine Çölgeçen
J Clin Exp Invest 2018;9(1):45-47.
https://doi.org/10.5799/jcei.413079
Case Report
[Abstract]
[PDF]
ABSTRACT
Partial unilateral lentiginosis is an unusual pigmentary disorder characterized by numerous lentigines grouped within an area of normal skin. Pigmented macules are usually localized in one half of the body. Associations with café-au-lait spots, cutis marmorata, acanthosis nigricans, nevus depigmentosus, vitiligo, blue nevus, segmental neurofibromatosis, central nervous system diseases, celiac disease, and sickle cell anemia have been reported. We describe a 17-year-old male patient with a partial unilateral lentiginous lesion on the left side of the body and left upper back and incidental polyp in the descending colon.
Keywords: Partial unilateral lentiginosis, polyp, colon
An incarcerated Amyand's hernia: Shall we apply appendectomy routinely?
Gökhan Demiral, Muhammed Kadri Çolakoğlu, Süleyman Kalcan, Ahmet Pergel
J Clin Exp Invest 2018;9(1):48-49.
https://doi.org/10.5799/jcei.413076
Case Report
[Abstract]
[PDF]
ABSTRACT
Amyand’s hernia is a very rare clinical condition characterized by the presence of a normal or inflammed appendix within the inguinal hernia sac. It may be present as an acute apendicitis inside the sac or incarcerated hernia. Sometimes it may be asymptomatic. We report a case of 70-year-old male patient that was presented to our emergency service with a huge right inguinal mass that was diagnosed as an incarcerated inguinal hernia and underwent operation. The intraoperative findings included small intestinal segment, large omental tissue and mobile cecum with healthy appendix inside the sac. There was no sign of strangulation. Lichtenstein herniorhaphy was done without appendectomy.
Keywords: Amyand’s hernia, incarceration, appendix vermiformis
Comparison of Quality and Content of Violence Guidelines for Health Care Sector
Rabia Kahveci, İlknur Yasar, Duygu Ayhan Başer, Hilal Aksoy, Esra Meltem Koç, Adem Özkara
J Clin Exp Invest 2018;9(1):50-56.
https://doi.org/10.5799/jcei.413085
Research Article
[Abstract]
[PDF]
ABSTRACT
More than 50% of the employees in health sector are exposed to violence at any time. This study investigated international workplace violence guidelines for the health care sector to compare their quality and content and explore whether these guidelines could be used in different settings. We ran a broad review to identify international guidelines for violence in health care. After identification of the guidelines, the quality of the guidelines was assessed by personal experience and views of the authors, also taking AGREE domains into consideration as a guidance. The identified guidelines were later qualitatively analyzed for the content by two researchers and compared to each other.
Canada, New Zealand, USA, UK and Turkey’s guidelines were involved in the study. Definitions of workplace violence, risk factors, objectives of the guideline, legal requirements, responsible stakeholders, target population, strategies recommended, physical environment, training and staffing were assessed in the content of the violence guidelines. It was found that current guidelines need improvement in both quality and content, but it is possible to have an international guidance that could be applicable in different settings.
The development of violence guidelines should be the first and most strategic step for better protection of the health care workers. We expect our results to be useful in preparation of new guidelines for different settings.
Keywords: Health care sector, violence, guidelines, quality