Ondokuz Mayis University Hospital Research Articles

The Effect of Fluid Challenge Test on Optic Nerve Sheath Diameter.

To investigate the effect of the fluid challenge test on the optic nerve sheath diameter (ONSD) change. Quasi-experimental study. Department of Anesthesiology and Reanimation, Ondokuz Mayis University Hospital, Samsun, Turkey, from January to November 2021. A fluid challenge was defined as a 500 mL crystalloid infusion administered over 10 minutes, and fluid responsiveness was defined as a subsequent increase in stroke volume of at least 15% administered to the ICU patients. The ONSD and hemodynamic variables were measured by ultrasonography before (T0), at the end (T1), and 30 min after the fluid challenge (T2). The primary outcome of the study was the change in ONSD measurements associated with the fluid challenge, and the secondary outcome was the relationship between fluid responsiveness and the change in ONSD. A total of 60 patients were included. The ONSD (mm) value was significantly higher at T1 compared to T0 (mean ± standard deviation: 5.12±0.30 mm vs. 5.10±0.32 mm; p=0.011). However, at T2, the ONSD was similar to that at T0 (5.10±0.31 mm vs. 5.10±0.32 mm; p=0.662). The stroke volume (mL) was also significantly higher at T1 and T2 compared to T0 [median IQR 60 (6) mL vs. 60 (4.7) mL vs. 52 (5) mL, respectively, p <0.01]. No significant relationship was found between the ONSD and the change in fluid responsiveness (p=0.621). The fluid challenge test increases ONSD and may cause an increase in intracranial pressure. Fluid therapy, Stroke volume, Intracranial pressure, Ultrasonography, Optic nerve sheath diameter.

Concurrent use of drugs and potential drug interactions in HIV-infected patients in a tertiary healthcare facility in Turkey

Purpose: To investigate the frequency of concurrent drug use and drug interactions in patients with human immunodeficiency virus (HIV) infection.&#x0D; Methods: The medical records of HIV-infected patients followed up at Ondokuz Mayis University Hospital in the last six months were retrospectively reviewed to assess the antiretroviral therapy (ART) regimens used, the prescribed concurrent drugs, and their interactions&#x0D; Results: The records of 268 patients were evaluated; of these, 43 (16 %) were women, and 225 (84 %) were men. The mean age of the patients was 43.8 ± 12.1 years. Concurrent drugs were prescribed to 210 (78.3 %) patients. Drug interactions were detected in 115 (42.9 %) patients. Of the 210 drug interactions detected, 168 (80 %) were potential interactions, 39 (18.6 %) were weak interactions, and 3 (1.4 %) were contraindicated. A statistically significant relationship was not observed in gender, age, and rate of concurrent drug prescription. Increased nephrotoxicity was the most common potential drug interaction. Non-steroidal anti-inflammatory drugs were the most commonly prescribed class of drugs along with ART.&#x0D; Conclusion: Physicians treating HIV-infected patients should be conscious of, and careful about the concurrent use of drugs and their potential drug interactions.

Fecal calprotectin levels used as a noninvasive method for screening for chronic gastritis in pediatric patients. A descriptive study.

Gastritis consists of inflammation of the gastric mucosa and is one of the main causes of dyspeptic symptoms in children. To investigate the presence of inflammation by evaluating fecal calprotectin (FC) in children diagnosed with chronic gastritis. Descriptive study in Pediatric Gastroenterology Department of Ondokuz Mayis University Hospital in Turkey. Between January 2016 and July 2018, FC levels were compared retrospectively in children with chronic gastritis (histopathology-based diagnosis), patients with inflammatory bowel disease (IBD) and healthy children. A total of 67 chronic gastritis patients (61.2% girls) with a mean age of 13.09 ± 3.5 years were evaluated. The mean FC levels were 153.4 μg/g in the chronic gastritis group, 589.7 μg/g in the IBD group and 43.8 μg/g in the healthy group. These levels were higher in chronic gastritis patients than in healthy individuals (P = 0.001) and higher in IBD patients than in the other two groups (P < 0.001). The FC level in the patients with chronic active gastritis (156.3 μg/g) was higher than in those with chronic inactive gastritis (150.95 μg/g) (P = 0.011). Among the patients with chronic active gastritis, the FC level was significantly higher in Helicobacter pylori-positive individuals than in negative individuals (P = 0.031). We confirmed the association between increased FC and chronic gastritis. Elevated FC levels may be seen in patients with chronic active gastritis. In order to be able to use FC as a screening tool for chronic gastritis, further studies in a larger study group are needed.

Effects of preoperative calcium levels and parathyroidectomy on renal function in primary hyperparathyroidism: a retrospective study

MethodsThis retrospective study enrolled 71 patients who underwent parathyroidectomy for PHPT in the General Surgery Department at Ondokuz Mayis University Hospital from 2010 to 2018. All patients were histopathologically diagnosed with parathyroid adenoma. Total serum calcium, serum creatinine, serum intact parathyroid hormone (PTH), and serum 25-hydroxyvitamin D3 (25(OH)D3) were measured before and 3-6 months after surgery. Patients were assigned to the low eGFR group (60-90 mL/min/1.73 m2) or normal eGFR group (≥90 mL/min/1.73 m2) and to the low calcium group (≤11.2 mg/dL) or high calcium group (˃ 11.2 mg/dL).ResultsIn the low eGFR and high calcium group, there were significantly more patients with hypertension and older age. In the normal eGFR and high calcium group, eGFR was significantly reduced after surgery. Independent predictors of eGFR change after surgery were age, pre-parathyroidectomy calcium, and pre-parathyroidectomy eGFR.ConclusionsAfter surgery, patients with low eGFR had preserved renal function, whereas those with normal eGFR had decreased renal function. Mild renal dysfunction in PHPT was associated with older age, hypertension, and high calcium levels.

Factors Affecting Diagnosis of Brain Death and Process of Organ Donation in a University Hospital in Turkey

Introduction Diagnosis of brain death and organ donation are a complex process that requires a rapid organization among donor hospital, transplant center, regional coordination center and national coordination center. The aim of this study was to determine the factors affecting the timing of brain death diagnosis and cadaveric organ donation in a university hospital in Turkey. Methods Cases, who were diagnosed with brain death between the years 2015 and 2017 in the intensive care units at the Ondokuz Mayis University Hospital, were enrolled. The cases who were examined retrospectively were evaluated in terms of some factors such as demographics, blood group, being an organ donor, donation time, donation day, donation hour, receiver center and transport time. Results Of the 68 cases, 24 (35.3%) were in the 0-18 age group and 32 (47%) were in the 36-65 age group. Thirty-two (47.1%) cases were diagnosed with subarachnoid hemorrhage. Twenty-one (30.9%) cases were reported to be a forensic case. Fifty-two (76.5%) cases who were diagnosed with brain death were found eligible to donate organs. The process for brain death diagnosis was completed over 24 hours in 61 (89.7%) cases. The declaration was made within the first hour after the diagnosis in 66 (97.1%) cases. The family interview was conducted within the first hour after the declaration in 64 (94.1%) cases. Twenty-one (30.9%) cases became donors. Eleven (52.4%) of the forensic cases became donors and 10 (21.3%) of the non-forensic cases became donors. These ratios were found to be statistically significant (p = 0.01). The interval between organ donor brain death and organ harvesting was between 11 and 24 hours in 10 (14.7%) cases. The harvesting team was outside of the region in 15 (71.4%) of the donors. The waiting period for the harvesting teams outside the region was determined to be 5-8 hours in 8 (11.8%) cases. Conclusion The cadaveric organ donation rate in the Ondokuz Mayis University Hospital was 30.9%. This rate was above the general average of Turkey. Donation occurs up to 24 hours of harvesting, donor organs can be lost and prolonged processes may affect the viability of organs. Since Turkey is a large country with a wide variety of geographical features, it is not always possible that donors and recipients live in the same region. However, we think that this problem can be overcome as the Ministry of Health supports the use of resources for cadaveric organ donation.

Fear and Risk of Falling, Activities of Daily Living, and Quality of Life: Assessment When Older Adults Receive Emergency Department Care.

Falls tend to create fear and concern in older adults who also seek care in emergency departments (EDs) at high rates. The purposes of this study were to (a) describe risk and fear of falling in older adults seeking care in the ED and (b) explore relationships between risk and fear of falling with activities of daily living and quality of life. The study was conducted in the ED of Ondokuz Mayis University Hospital in Samsun, Turkey. Data were collected for 7 months in 2013-2014. Adults aged 65 years and above who scored at least 20 on the Standardized Mini-Mental Test and who presented for care in the ED were eligible to take part. Patients self-reported demographic information and completed the Tinetti Falls Efficacy Scale, the Morse Fall Scale, the Nottingham Health Profile (NHP), and the Modified Barthel Index (MBI). A total of 151 older adults took part. Prevalence of falls was high (48.3%), as well as fear of falling (63.6%). Risk of falling (Morse Fall Scale scores) was negatively correlated with the ability to carry out activities of daily living (MBI scores; r = -.50, p < .001) and positively related to scores on the NHP (r = .45, p < .001); likewise, fear of falling (Falls Efficacy Scale scores) was negatively correlated with the ability to carry out activities of daily living (MBI scores; r = -.79, p < .001) and positively correlated with NHP scores (r = .64, p < .001). Older adults seeking care in the ED who have a higher risk of falling are more dependent in daily living activities and experience lower quality of life. Care seeking in the ED offers an opportunity to assess fall risk and fear of falling and provide guidance on prevention and management of falls in older adults.

Dexamethasone Implant in Chronic Diabetic Macular Edema Resistant to Intravitreal Ranibizumab Treatment

Purpose: The aim of this study was to assess the efficacy of a single intravitreal dexamethasone implant (IDI) over 6 months in eyes with chronic diabetic macular edema (DME) that were resistant to intravitreal ranibizumab (IR) treatment. Methods: This retrospective study was conducted at the Ondokuz Mayis University Hospital, Samsun, Turkey. Efficacy outcomes were considered as the change from baseline in best corrected visual acuity (BCVA) and central macular thickness (CMT). Results: Thirty eyes of 20 patients with a mean age of 61.6 ± 8.8 (45-85) years were included in the study. The mean BCVA significantly increased from 0.68 ± 0.27 to 0.56 ± 0.30 logMAR (p = 0.001) and 0.57 ± 0.30 logMAR (p = 0.002) at months 1 and 2, respectively. The proportion of patients who gained 3 or more lines in BCVA was 20%. The mean CMT significantly decreased from 578.93 ± 17.95 µm at baseline to 282.10 ± 21.42, 292.26 ± 19.69, 371.70 ± 21.23, and 463.60 ± 23.16 µm at months 1, 2, 3, and 4, respectively (p = 0.001). Intraocular pressure (IOP) increase occurred in 5 (16.7%) eyes. Cataract surgery was required in 3 (13%) out of 23 phakic eyes. Conclusion: IDI provides significant benefits in visual acuity gains and anatomic improvements in eyes with chronic DME that are resistant to IR treatment. Increases in IOP and cataract progression can be observed in IDI-treated patients. However, its safety profile is acceptable.

Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism.

IntroductionNeutrophil-to-lymphocyte ratio (NLR), which is an essential marker of inflammation, has been shown to be associated with adverse outcomes in various cardiovascular diseases in the literature. In this study we sought to evaluate the association between NLR and prognosis of acute pulmonary embolism (APE).Material and methodsWe retrospectively evaluated blood counts and clinical data of 142 patients with the diagnosis of pulmonary embolism (PE) from Ondokuz Mayis University Hospital between January 2006 and December 2012. The patients were divided into two groups according to NLR: NLR < 4.4 (low NLR group, n = 71) and NLR ≥ 4.4 (high NLR group, n = 71).ResultsMassive embolism (66.2% vs. 36.6%, p < 0.001) and in-hospital mortality (21.1%, 1.4%, p < 0.001) were higher in the high NLR group. In multivariate regression analysis NLR ≥ 5.7, systolic blood pressure (BP) < 90 mm Hg, serum glucose > 126 mg/dl, heart rate > 110 beats/min, and PCO2 < 35 or > 50 mm Hg were predictors of in-hospital mortality. The optimal NLR cutoff value was 5.7 for mortality in receiver operating characteristic (ROC) analysis. Having an NLR value above 5.7 was found to be associated with a 10.8 times higher mortality rate than an NLR value below 5.7.ConclusionsIn patients presenting with APE, NLR value is an independent predictor of in-hospital mortality and may be used for clinical risk classification.

Antithyroid peroxidase antibody positivity is associated with lower incidence of metastasis in breast cancer.

Thyroid extracts were first used to treat patients with metastatic breast cancer over a century ago. Since then, a number of studies have investigated the association between thyroid disorders and breast cancer. The presence of antibodies to thyroid peroxidase (TPOab) was recently reported to be associated with improved outcome in these patients. The aim of the present study was to evaluate the association between TPOab positivity and clinicopathological characteristics in breast cancer patients. The study included 318 newly diagnosed cases of breast cancer treated at Ondokuz Mayis University Hospital, Samsun, Turkey, between 2008 and 2012. Serum thyroid-stimulating hormone, free triiodothyronine and free thyroxine levels were measured at the time of diagnosis. Of the 318 patients, 253 were considered to be TPOab-negative (TPOab ≤34 IU/ml) and 65 TPOab-positive (TPOab >34 IU/ml). No cases with distant metastases were found in the TPOab-positive group. However, 20 (7.9%) of the 253 patients displayed distant metastases in the TPOab-negative group (P=0.01). Therefore, TPOab positivity was found to be associated with a lower incidence of metastasis in breast cancer patients.

OP-017 Neutrophil-to-Lymphocyte Ratio for The Assessment of Hospital Mortality in Patients with Acute Pulmonary Embolism

Introduction: Neutrophil-to-lymphocyte ratio (NLR), which is an essential marker of inflammation, has been shown to be associated with adverse outcomes in various cardiovascular diseases in the literature. In this study we sought to evaluate the association between NLR and prognosis of acute pulmonary embolism (APE). Material and methods: We retrospectively evaluated blood counts and clinical data of 142 patients with the diagnosis of pulmonary embolism (PE) from Ondokuz Mayis University Hospital between January 2006 and December 2012. The patients were divided into two groups according to NLR: NLR 126 mg/dl, heart rate > 110 beats/min, and PCO2 50 mm Hg were predictors of in-hospital mortality. The optimal NLR cutoff value was 5.7 for mortality in receiver operating characteristic (ROC) analysis. Having an NLR value above 5.7 was found to be associated with a 10.8 times higher mortality rate than an NLR value below 5.7. Conclusions: In patients presenting with APE, NLR value is an independent predictor of in-hospital mortality and may be used for clinical risk classification.

Visual field defects in 23 acromegalic patients

Pituitary tumors are the third most common primary intracranial neoplasm. Pathologic proliferation of the somatotrophs results as overproduction of growth hormone presenting as acromegaly. In pituitary adenomas typical visual field (VF) defect is bitemporal hemianopsia but tumor size and optic chiasmal position may cause variable VF defects and VF examination may remain normal. We retrospectively reviewed the medical records of 23 acromegalic patients with pituitary adenomas who received VF tests in the Department of Ophthalmology and Endocrinology, Ondokuz Mayis University Hospital, between 2000 and 2012. Pituitary tumor volume was calculated after performing measurements of tumor diameter in three orthogonal planes using Cavalieri's principle. VF test was performed with a Humphrey field analyzer 750 using a 4-mm² Goldmann size III stimulus. The mean age of the 23 patients (11 male/12 female) was 50.4 ± 11.9 years. 15 patients (65.2 %) had normal VF, two patients (9 %) had quadrantanopsia, three patients (13 %) had hemianopsia and three patients (13 %) had three quadrantanopsia. Among the patients with normal VF, four patients had a suprasellar mass that was elevating the chiasm and spreading along the optic tracts. We also observed VF defects typical of a chiasmal compression even though no suprasellar extension was detected in a few cases. Tumor volume of the patients with VF defects was significantly larger than tumor volume of patients with normal VF (p = 0.02). Tumor volume is an important parameter in VF defects. Advanced neuroimaging assesments should always be complemented in patients even with normal VF.

The Synergy Between Endoscopic Assistance and Extraoral Approach In Subcondylar Fracture Repair. A Report of 13 Cases

We aimed to present the primary experience of one surgeon with a new surgical technique performed on the first 13 cases and to evaluate outcomes following an extraoral endoscopic approach to subcondylar fractures. Fifteen subcondylar fractures in 13 patients, who were treated at Ondokuz Mayis University Hospital between January 2010 and June 2011, were included in this study. Patients were operated on using either endoscopic or open approach. Rigid plate fixation was completed endoscopically using extraoral approach in nine fractures, while six fractures were plated by conversion to a full-open approach. In all six fractures that could not be fixed endoscopically, the proximal fragments were medially displaced, whereas seven of nine fractures that were successfully fixed endoscopically were laterally displaced. An extraoral endoscopic approach for subcondylar fractures is feasible and can be carried out with decreased morbidity. This approach is recommended for those with limited experience in endoscopy to treat low laterally displaced subcondylar fractures as their initial cases.

Comparison of nosocomial candidemia of pediatric and adult cases in 2-years period at a Turkish university hospital.

Although there are limited numerous reports of candidemia in adults, data on paediatrics are stil limeted. The aim of the present study was to compare the aetiology and risk factors of nosocomial candidemia among the paediatric and adults in our hospital. This study includes the patients hospitalised and diagnosed as fungemia at Ondokuz Mayis University Hospital between June 30, 2007 and June 30, 2009 whose blood cultures sent to our microbiology laboratory. After fungal growth was observed in blood cultures, the yeast cells were inoculated onto Saboraud glucose agar. The colonies were identified by conventional yeast identification methods and ID 32C yeast identification system according to the manifacturer's instructions. During this period 51 paediatric and 69 adults were studied. The most common yeast form was Candida albicans (43.3%) followed by C. parapsilosis (25.0%) and C. tropicalis (17.5%). Although the non-albicans Candida species represent more than half (56.7%) of all candidemic cases C. albicans was the most common frequent etiologic agent. There was no statistically significant difference between patient age (paediatric and adult) and distribution of Candida species (p>0.05) Neoplasia (in adults) and prematurity (in paediatrics) were the main underlying diseases. Predisposing factors and mortality rates were not different among paediatrics and adults. We reinforce the necessity of continous epidomiologic surveillance to follow the dynamics of candidemia.

The effect of medical treatment on the level of C-Reactive protein and leukocyte count in patients with congestiveheart failure

The purpose of this study is to investigate the effect of standard heart failure treatment on the C-reactive protein (CRP) level. During this study, 60 patients with heart failure were admitted to the Department of Cardiology at Ondokuz Mayis University Hospital for a period of over six months (November 2001–April 2002). Each patient was classified according to the New York Heart Association functional class at admission and at discharge. We determined the CRP levels in patients with heart failure at admission and compared them to the CRP levels at discharge. As a result, we observed a decrease in the levels of CRP after treatment compared to the levels before treatment (before treatment, 40.37 ± 48.75 ng/mL; after treatment, 27.60 ± 39.50 ng/mL). This decrease was found to be statistically significant (p < 0.03). In parallel to the significant improvement in the left ventricular ejection fraction (LVEF) capacity and systolic function (LVEF before treatment, 28.7 ± 7.9%; after treatment, 32.2 ± 8.6%, p < 0.001), we also observed a decrease in the white blood cell count (WBCc) after treatment (before treatment, 9450 ± 5412/mm3, after treatment, 7976 ± 2455/mm3, p < 0.006). We can conclude that the CRP levels in patients with heart failure measured several times during hospitalization may predict, in an independent way, a response to standard medical treatment of heart failure, and we may use the CRP level as a criterion for follow-up and decision to discharge patients.

The Utility Frequence of The Devices with Electromagnetic Field By Nurses.

AIM: The electromagnetic waves (EMW) emitted by both natural and man made sources have increased in our daily surroundings and the threat presented by these waves is crucial for human health. The aim of this study was determine the utility frequence of the devices with electromagnetic field by the nurses deployed in Ondokuz Mayis University Hospital (OMUH). METHOD: This cross-sectional study was conducted between 1and 31May 2009 at OMUH. Of the 456 nurses who worked at the hospital in this period, 368 (80.7%) nurses accepted to participate in our study. The data are presented as medians (minimum-maximum) and percentages. The data were evaluated using Mann-Whitney U test and the level of statistical significance was determined as p

Hysterectomy-Related Morbidity and Mortality Rates in Turkey from 1999 to 2008

Objective The aim of this study was to report the morbidity and mortality rates associated with hysterectomies performed at our unit and to recommend a plan to reduce complications. Methods: In this retrospective review of morbidity and mortality rates, we reviewed the charts of 1188 patients who underwent hysterectomy between 1999 and 2008 at the Ondokuz Mayis University Hospital in Samsun, Turkey. Results The overall hysterectomy-related morbidity rate was 4.3%. There were no operative or postoperative deaths. The incidence of intraoperative bowel injury was 0.4%, bladder injury was 0.5%, while the incidence of vesicovaginal fistula was 0.2% in this study. Conclusions In order to reduce the hysterectomy-related morbidity rate, proper selection, pre-operative preparation and less invasive alternative treatments can be employed, such as various methods of endometrial ablation or resections. (Journal of Endometriosis 2010; 2: 41–4)

Ventricular tachycardia and coronary anatomy changes due to a large cardiac cyst

A 76-year-old woman was admitted to the emergency department of the Ondokuz Mayis University Hospital due to palpitation. She had ventricular tachycardia, and normal sinus rhythm was restored by electrical cardioversion. Teleradiography showed a large, bilobular, cystic and calcific structure on the cardiac silhouette. Three-dimensional cardiac computed tomography revealed that the cyst was 4 cm × 4 cm × 3 cm, and was located between the epicardium and the myocardium at the anterior interventricular sulcus, just beneath the proximal left anterior descending (LAD) coronary artery (Figure 1). Coronary angiography determined no severe coronary artery stenosis, but interestingly, the cyst caused a change in the normal route of the LAD coronary artery (ie, the LAD coronary artery had been ‘jumping over’ the cyst) (Figure 2). The cyst was thought to be responsible for the arrhythmia, and the patient underwent surgical resection. Cardiac cysts are often discovered incidentally. They may lead to complications such as rupture, allergic reaction, embolization, cardiac tamponade, pericarditis, myocardial ischemia, rhythm disturbances and valve dysfunction (1). In most cases, surgery is the preferred method of treatment (2). Figure 1) Three-dimensional cardiac computed tomography (arrow shows left anterior descending coronary artery; asterisk shows cyst) Figure 2) Coronary angiography at right anterior oblique caudal view (arrow shows ‘jumping’ left anterior descending coronary artery; asterisk shows cyst)

Crimean‐Congo hemorrhagic fever: Five patients with hemophagocytic syndrome

Three pediatric and two adult Turkish patients with Crimean Congo Hemorrhagic Fever (CCHF) induced hemophagocytic syndrome (HPS) were admitted to Ondokuz Mayis University Hospital, which is in the Middle Black Sea Region of Turkey. All of them had remarkable hemophagocytosis in the bone marrow with severe bleeding symptoms along with the other known clinical and laboratory findings of CCHF. We would like to present these patients and to discuss the pathophysiology and the effect of acquired HPS on the severity of the disease.

Visceral childhood leishmaniasis in Turkey

Between 1981 and 2001, we retrospectively analysed 40 cases of visceral leishmaniasis (VL) admitted to the Paediatric Infection Unit of Ondokuz Mayis University Hospital, in the middle Black Sea region of Turkey. Median age at presentation was 3 y. Fever and splenomegaly were found in all patients. Bone marrow smear examination resulted in the diagnosis of VL in 95% of cases. All patients were treated initially with meglumine antimonate and 95% of them were cured with this therapy. The remaining patients were cured with liposomal amphotericin B. Conclusions: VL should be considered in patients with fever and splenomegaly, particularly those residing in the Mediterranean region. Meglumine antimonate seems to be the first choice of treatment in childhood.

Visceral childhood leishmaniasis in Turkey.

Between 1981 and 2001, we retrospectively analysed 40 cases of visceral leishmaniasis (VL) admitted to the Paediatric Infection Unit of Ondokuz Mayis University Hospital, in the middle Black Sea region of Turkey. Median age at presentation was 3 y. Fever and splenomegaly were found in all patients. Bone marrow smear examination resulted in the diagnosis of VL in 95% of cases. All patients were treated initially with meglumine antimonate and 95% of them were cured with this therapy. The remaining patients were cured with liposomal amphotericin B. VL should be considered in patients with fever and splenomegaly, particularly those residing in the Mediterranean region. Meglumine antimonate seems to be the first choice of treatment in childhood.