University Medicine Faculty Research Articles

Our clinical experiences in ultra-sound guided peripheral nerve blocks: a retrospective evaluation

Peripheral nerve blocks are commonly used in extremity surgeries for anesthetic and/or postoperative analgesic purposes with general anesthesia. Ultra-sound (US) guided peripheral nerve blocks that have been used in recent years provide many superiorities in comparison with other conventional methods. The objective of this retrospective study was to carry out a retrospective evaluation of our experiences regarding 400 patients on whom US guided peripheral nerve was applied at the Inonu University Faculty of Medicine, Department of Anesthesiology and Reanimation during June 2012-March 2016. Demographic data of the patients, block type, purpose of block (for surgical or analgesic), type and volume of the local anesthetic, type of US probe, needle length, block success, toxicity finding and complications were all recorded. Blocks were performed for analgesia in 16% of the patients and for anesthesia in 84%. Lidocaine+bupivacaine combination, bupivacaine+prilocaine combination and bupivacaine were used on 82%, 13% and 5% of the patients as local anesthetic agent, respectively. Linear US probe (6-13 MHz) was used for all patients. In conclusion, US guided peripheral nerve blocks provide adequate depth of anesthesia and analgesia. It was found to be safe and useful and may be a good alternative to general anesthesia.

Evaluation of the respiratory system of non-alcohol drug addicted patients

<B>Introduction</b>: One of the diseases that has left a mark on our age is psychoactive substance addiction. The onset of narcotic substance abuse has dropped to very early ages of life in our country. The prevalence of abuse of such substances as heroin and cocaine through inhaling is increasing dramatically. Abusing these substances by inhalation has life-threatening risks such as bronchospasm, alveolar hemorrhage and acute respiratory syndrome. Our aim in this study was to describe possible respiratory system risks in individuals who had substance addiction.<br /> <B>Material and methods: </b> The study was conducted with 40 healthy and 40 drug addicted people who receive treatment at AMATEM department in Akdeniz University Medicine Faculty. The data were interpreted according to the results of the anamnesis, physical examination, chest X-ray, spirometry and respiratory questionnaire for both test groups, and the final evaluation was carried out using these data.<br /> <B>Results: </b> For the addicted group, the symptoms related to the respiratory system and the symptom scores of the respiratory questionnaire were found to be significantly high during our study (p < 0.05).<br /> <B>Conclusions</b>: Consequently, the results of our study revealed that substance addicts most frequently preferred the inhalation mode when abusing narcotic substances. Moreover, it was also determined that they were heavily smoking besides narcotic substance abuse. We believe that efforts to prevent smoking addiction in society can be developed so as to include narcotic substance abuse, especially among young individuals, which in turn can contribute to a decrease in future risks.

Effect of the Oxidant-Antioxidant System in Seminal Plasma on Varicocele and Idiopathic Infertility in Male Humans.

The aim of this study was to investigate seminal oxidant-antioxidant activity in idiopathic and varicocele infertility in men. Total anti-oxidant capacity (TAC), total oxidant status (TOS), paraoxonase (PON1), aryl esterase (ARE), and total thiol levels (TTL) were measured in seminal plasma with an autoanalyzer. The TOS/TAC ratio was determined as the oxidative stress index (OSI). A histopathological evaluation of the sperm was performed in the andrology laboratory of the hospital. Number, motility, morphology, volume, pH, and leukocytes were evaluated in all samples according to World Health Organization criteria. The three study groups were as follows: G1, males with idiopathic infertility; G2, males with varicocele infertility; and G3, normal healthy males (had fathered a child in the last 2 years). Each group was composed of 36 men (age, 25 - 40 years). The Rel Assay Diagnostics kit was used to determine the levels of the parameters. The study was conducted according to the principles of the declaration of Helsinki and was approved by Sakarya University Medicine Faculty Ethic Committee (e.n: 16214662/050.01.04/07). Statistical significance was assumed if p < 0.05. All statistical evaluations were performed using SPSS (version 20.0 for Windows; SPSS, Inc., Chicago, IL, USA). No differences were detected between the mean values of antioxidant parameters among the three groups (Kruskal-Wallis test). The p-values of the test parameters (TAC, TOS, PON1, ARE, TTL, OSI) are respectively: 0.494, 0.548, 0.068, 0.151, 0.202, 0.873. The antioxidant parameters of all subjects were compared using the MannWhitney U-test in both groups as fertile (G3) and infertile (G1 + G2). The PON1 levels in infertile subjects were significantly higher than those in fertile subjects. There was a statistically significant difference (p = 0.042). The other antioxidant parameters had no statistically significant difference (p > 0.05). The ARE was not performed in group 3 (control) due to a methodological problem. PON1 levels in infertile subjects were significantly higher than those of fertile subjects.

Comparison of 3DCRT,VMAT and IMRT techniques in metastatic vertebra radiotherapy: A phantom Study

Vertebra metastases can be seen during the prognosis of cancer patients. Treatment ways of the metastasis are radiotherapy, chemotherapy and surgery. Three-dimensional conformal therapy (3D-CRT) is widely used in the treatment of vertebra metastases. Also, Intensity Modulated Radiotherapy (IMRT) and Volumetric Arc Therapy (VMAT) are used too. The aim of this study is to examine the advantages and disadvantages of the different radiotherapy techniques. In the aspect of this goal, it is studied with a randophantom in Uludag University Medicine Faculty, Radiation Oncology Department. By using a computerized tomography image of the phantom, one 3DCRT plan, two VMAT and three IMRT plans for servical vertebra and three different 3DCRT plans, two VMAT and two IMRT plans for lomber vertebra are calculated. To calculate 3DCRT plans, CMS XiO Treatment System is used and to calculate VMAT and IMRT plans Monaco Treatment Planning System is used in the department. The study concludes with the dosimetric comparison of the treatment plans in the spect of critical organ doses, homogeneity and conformity index. As a result of this study, all critical organ doses are suitable for QUANTEC Dose Limit Report and critical organ doses depend on the techniques which used in radiotherapy. According to homogeneity and conformity indices, VMAT and IMRT plans are better than one in 3DCRT plans in servical and lomber vertebra radiotherapy plans.

MedTalks: developing teaching abilities and experience in undergraduate medical students

ABSTRACTObjectives: According to the CanMEDS’ Scholar competency, physicians are expected to facilitate the learning of colleagues, patients and other health professionals. However, most medical students are not provided with formal opportunities to gain teaching experience with objective feedback.Methods: To address this, the University’s Medical Education Interest Group (MEIG) created a pilot teaching program in January 2015 entitled ‘MedTalks’. Four 3-hour sessions were held at the University Faculty of Medicine, where first and second year medical students taught clinically oriented topics to undergraduate university students. Each extracurricular session included three 30-minute content lectures, and a 90-minute small group session on physical examination skills. Each medical student-teacher received formal feedback from undergraduate students and from faculty educators regarding teaching style, communication abilities, and professionalism. In addition, medical student-teachers self-evaluated their own teaching experience.Results: Over 50 medical students from the University participated as medical student-teachers. Based on quantitative and qualitative evaluation surveys, 100% of medical students agreed that MedTalks was a useful way to develop teaching skills and 92% gained a greater confidence in individual teaching capabilities, based largely on the opportunity to gain experience (with feedback) in teaching roles.Conclusions: A program designed to give medical students multi-source teaching experience (lecture- and small group-based) and feedback on their teaching (from learners and Faculty observers, in addition to their own self-reflection) can improve medical student confidence and enthusiasm towards teaching. Future studies will clarify if medical student self-perceived enhancements in teaching ability can be corroborated by independent (Faculty, learner) observations of future teaching activity.

Lower serotonin level and higher rate of fibromyalgia syndrome with advancing pregnancy

Objective: The aim of the study is to investigate the relationship between changes in serotonin levels during pregnancy and fibromyalgia syndrome (FS) and the relationships between FS and the physical/psychological state, biochemical and hormonal parameters, which may be related to the musculoskeletal system.Study design: This study is a prospective case-control study conducted with 277 pregnant women at the obstetric unit of Ankara University Faculty of Medicine, in the period between January and June 2015. FS was determined based on the presence or absence of the 2010 ACR diagnostic criteria and all the volunteers were asked to answer the questionnaires as Fibromyalgia Impact Criteria (FIQ), Widespread Pain Index (WPI), Symptom Severity Scale (SS), Beck Depression Inventory and Visual Analog Scale (VAS). Biochemical and hormonal markers (glucose, TSH, T4, Ca (calcium), P (phosphate), PTH (parathyroid hormone) and serotonin levels) relating to muscle and bone metabolism were measured.Results: In the presence of fibromyalgia, the physical and psychological parameters are negatively affected (p < 0.001). There was no significant difference between the fibromyalgia and control groups in terms of glucose, Ca (calcium), P (phosphorus), PTH (parathyroid hormone), TSH (thyroid stimulant hormone), fT4 (free T4) levels (p = 0.060, 0.799, 0.074, 0.104, 0.797, 0.929, respectively). A reduction in serotonin levels may contribute to the development of fibromyalgia but this was not statistically significant. The Beck Depression Inventory scale statistically showed that increasing scores also increase the risk of fibromyalgia (p <0.001).Conclusion: Our study has shown that serotonin levels in women with FS are lower than the control group and that serotonin levels reduce as pregnancy progresses. Anxiety and depression in pregnant women with FS are higher than the control group. The presence of depression increases the likelihood of developing FS at a statistically significant level. Serotonin impairment also increases the chance of developing FS, but this correlation has not been shown to be statistically significant.

Left ventricle ejection fraction may predict mortality in renal transplant patients

Purpose: Mortality is a major problem in renal transplant patients, and appropriate preoperative evaluation is very important. We retrospectively reviewed the left ventricle ejection fraction (LVEF) of renal transplant patients.Material and methods: The clinical records of 1763 patients who had preoperative LVEF results and who underwent renal transplantation at Akdeniz University Faculty of Medicine during the years 2004–2014 were studied. The LVEF limit was set at 55%. LVEF, age, gender, diabetes mellitus, hypertension, type of dialysis were assessed by linear multiple regression analysis on survival.Results: There were a total of 1763 renal transplant patients. Those with LVEF of <55% were identified as having left ventricular dysfunction. The mean LVEF was 59.4 ± 9.1 in the 43 patients who died after renal transplantation, while it was 62.6 ± 7.4 in the survivors (p = 0.02). The mortality rate in the LVEF < 55% group was 6.8% (11/162 patients), while mortality in the LVEF ≥ 55% group was 2% (32/1601 patients, p < 0.001). LVEF was found to be the most powerful variable on survival by the linear multiple regression analysis, R2 = 0.05, p < 0.001.Conclusion: LVEF may predict mortality in renal transplant patients. LVEF is known to be lower in patients with high cardiac mortality, who may require greater modifications of the postoperative risks.

Hypereosinophilic Syndrome: Hacettepe Experience

The aim was to evaluate baseline demographic, clinical, and laboratory characteristics, treatment modalities, and outcome of children with idiopathic hypereosinophilic syndrome (HES) followed up in our center. Children who fulfilled the criteria of idiopathic HES followed up at Hacettepe University Faculty of Medicine, Pediatric Hematology Department between June 2004 and October 2013 were included in this study. Medical records of all children with idiopathic HES were reviewed to obtain regarding data. The mean age of 6 children with idiopathic HES was 52.8±44.3 months (13 to 132 mo) at diagnosis. Among 6 children with idiopathic HES; 2 had pulmonary involvement; 1 had cardiac and pulmonary involvement and splenomegaly; 1 had cardiac involvement and hepatosplenomegaly; 1 had cardiac and central nervous system involvement; and 1 had skin involvement. The mean follow-up duration was 36.5±31.4 months. Methyl prednisolone (MP) was used for the first-line therapy. Complete response was achieved with MP in 3 children. All steroid responsive children are alive; whereas 3 children who did not respond to MP had expired. In conclusion, cardiac and pulmonary involvement is the major causes of mortality in HES. Resistance to steroid therapy indicates poor prognosis.

Sleep Quality and Cognitive Impairment in Patients with Parkinson’s Disease in Iran

Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Seyed Mehran Homam MD, Islamic Azad University Faculty of Medicine, Mashhad branch, Department of Neurology, Mashhad, Iran Phone: +989153137889 E-mail: mmazloomfarsibaf@yahoo.com Re cei ved/Ge lifl Ta ri hi: 04.02.2016 Ac cep ted/Ka bul Ta ri hi: 04.07.2016 ©Turkish Journal of Neurology, Published by Galenos Publishing House. This article is distributed under the terms of the “Creative Commons Attribution NonCommercial 4.0 International Licence (CC BY-NC 4.0)”. Objective: To evaluate the cognitive status and sleep quality and their association in patients with Parkinson’s disease (PD). Materials and Methods: In this analytical cross-sectional study, 120 patients with PD were selected from 22-Bahman and 17-Shahrivar hospitals. Demographic information was recorded on a form and Parkinson’s severity was determined using the Hoehn and Yahr scale (HY). Pittsburgh Sleep Quality Index (PSQI) and Epworth sleepiness scale (ESS) were used for the assessment of sleep quality and excessive daytime sleepiness, respectively. Cognitive status was assessed using the Montreal Cognitive Assessment questionnaire. Results: The mean age of patients with PD was 65.9±11.7 years, and 67.5% were men. Cognitive impairment was found in 113 (94.2%) patients, poor sleep quality in 87 (72.5%), and excessive daytime sleepiness in 27 (22.5%) patients. The mean PSQI and ESS scores were 9.03±4.70 and 7.38±3.73, respectively. There was a significant association between cognitive status and sleep quality, as well as daytime sleepiness (independent sample t-test, p<0.0001 for both). Conclusion: There is a significant association between cognitive impairment and poor sleep quality as well as excessive daytime sleepiness.

Thomas of Wroclaw (1297-1378) - Medieval bishop and scholar of English origin.

Peter of Tilleberi (Tilbury), later known as bishop Thomas of Wroclaw, after completing his studies (in Bologna or in Montpellier) worked as a physician in northern Italy and probably in Spain. Later through Germany and Bohemia, he came to Wroclaw in 1336 where he joined the Order of St. Dominic. In 1352, Thomas was made an auxiliary bishop of the diocese of Wroclaw. After the episcopal consecration, Thomas stopped living in the abbey, but all the time he was well known both as a priest and physician. He is known as an author of several treatises on medical sciences. His most important work entitled Michi competit (i.e. It suits me) is composed of four parts: Regimen sanitatis (i.e. Hygiene), Aggregatum (i.e. Aggregation), Antidotarium (i.e. Medicine directory) and Practica medicinalis (i.e. Medical practices). Moreover, he is the author of other treatises including, for example, De phlebotomia et de iudiciis cruoris (i.e. On phlebotomy and blood content) and De urinis (i.e. On urine). Some Polish scientists claim that bishop Thomas of Wroclaw with his knowledge and industriousness functioned as a university faculty of medicine even though the University of Cracow had not been established yet.

First trimester fetal aortic Doppler for hemoglobinopathies.

Objective:To evaluate fetal aortic Doppler for the prenatal diagnosis of hemoglobinopathies in the first trimester of pregnancy.Materials and Methods:Between January and November 2014, a total of 108 patients were enrolled in the study. The couples were carriers of either alpha/beta thalassemia, sickle cell disease or combined carriers of these and were admitted to Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology Prenatal Diagnosis Center. One hour before the chorionic villus sampling (CVS), patients were evaluated using fetal aortic Doppler. Pulsatility index, peak systolic velocity, and heart rate were noted.Results:There were no statistically significant differences in Doppler indices between different groups of CVS results when compared with the healthy controls.Conclusion:Fetal aortic Doppler investigation was found to be ineffective for the prenatal diagnosis of hemoglobinopathies.

Painless Complex Regional Pain Syndrome in an Old Man

Address for Correspondence/ Yaz›flma Adresi: Fatih Bagcier MD, Ataturk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Erzurum, Turkey Phone: +90 442 344 70 87 E-mail: bagcier_42@hotmail.com Received/Gelis Tarihi: 21.07.2015 Accepted/Kabul Tarihi: 24.07.2015 To the Editor; A 62-year-old man presented to our outpatient clinic with the complaints of swelling and restriction of finger and wrist movements of his left hand. He provided history of distal radius fracture on his left hand two months prior to presentation to the our clinic. Following the trauma, the patient had been treated by immobilization in a cast for six weeks. He had no pain. On examination of the skin of the affected hand; wrist was swollen (non-pitting), hot, and was not tender to touch (Figure 1a). There was no hyperhidrosis, tremor, allodynia and hyperalgesia. Range of motion was restricted at the wrist and fingers. X-ray of the hand showed demineralization of the bones of the hand. A bone scan was performed and there was milder non-specific diffuse increased uptake in the remaining left wrist region (Figure 2a, 2b). Based on these findings, the patient was diagnosed as complex regional pain syndrome (CRPS) type 1 according to Zyluk scoring system (1). Physical therapy modalities and medical treatment was planned. In the physiotherapy program; range of motion exercises, contrast baths (four cycles over a 20 minute period), whirlpool bath (15 minutes), retrograde massage, pulse ultrasound (1 watt/cm2) was performed. The patient was administered intravenous methylprednisolone 30 mg/day pozology for a week. After the 20 sessions of physical therapy and medical treatment, the patient’s signs and symptoms markedly improved as compared to the initial examination (Figure 1b). Active and passive wrist flexion was full and he did not report any pain at the control visits. According to the International Association for the Study of Pain criteria of 1994, pain, evidence of change in blood flow or abnormal sudomotor activity and the absence of conditions that would otherwise account for symptoms are essential diagnostic entities of CRPS type 1 (2,3). Eisenberg and Melamed (4) reported a series of five patients with various foot pathologies who had presented with all of the criteria of CRPS except pain. Ayhan Kul, Fatih Bagcier, Mahir Ugur Yasli Bir Hastada Agrisiz Kompleks Bolgesel Agri Sendromu Painless Complex Regional Pain Syndrome in an Old Man DOI: 10.4274/tod.84856 Turk J Osteoporos 2016;22:67-8 Letter to Editor / Editore Mektup

Unusual Shoulder Pain Etiology in Old Man: Synovial Chondromatosis

Yaz›flma Adresi/Address for Correspondence: Fatih Bagcier MD, Ataturk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Erzurum, Turkey Tel.: +90 442 344 70 87 E-posta: bagcier_42@hotmail.com Gelis Tarihi/Received: 15.08.2015 Kabul Tarihi/Accepted: 01.09.2015 To the Editor; A 82-year-old male patient presented to our clinic with progressively worsening left shoulder pain. The pain started about 6 months ago, increased over time, spreading to the chest region. The characteristic of the pain was mechanical. He did not feel pain while sleeping. Previously, he had received analgesic medications but there was no significant improvement. There was no pain in any other joint, and there was no history of disease or trauma. Physical examination revealed the motion of the left shoulder joint was limited and painful in all directions. Neer’s impingement sign, Hawkins-Kennedy test, Yergasons tests were positive. There were no neurological deficits of the upper extremities. Serological and biochemical markers were normal. Impingement syndrome was diagnosed with physical examination. Magnetic resonance imaging (MRI) of the left shoulder revealed findings consistent with synovial chondromatosis (SC), which filled the subscapuler muscle region (Figure 1). Orthopedic surgical procedures including arthroscopic debridement were planned with symptomatic left shoulder. SC is a rare arthropathy of unknown etiology. The disease is generally monoarticular, usually occurs unilaterally in the large joints like the knee, hip, and elbow characterized by proliferation of the synovium with cartilaginous metaplasia (1). However any joint may be involved. Symptomatic presentation is quoted in the current literature mainly at the ages of 30 to 50 of a patient’s life. The diagnosis of SC is given after a thorough history, physical examination, and radiographic examination. Chronic, progressive pain, swelling, loss of motion and locking are more commonly seen symptoms, and soft-tissue swelling, crepitation, palpable loose bodies, and limited range of motion are the most common physical signs. It is beneficial to carry out computed tomography and MRI scans to identify and localize the lesions, and they also help to differentiate between other differential diagnoses. As radiotherapy and chemotherapy have no effect on SC, surgical removal of the affected synovium and the loose bodies is the preferred treatment (2). In the literature Kose et al. (3) presented a case with unilateral hip joint synovial osteochondromatosis, Giannetti et al. (4) presented a case with unilateral elbow joint synovial osteochondromatosis, Shearer et al. (5) presented a case with bilateral ankle joint synovial osteochondromatosis. Synovial osteochondromatosis was present in our case uncommon shoulder pain etiology in old man.

Effect of Neoadjuvant Chemotherapy on Axillary Lymph Node Positivity and Numbers in Breast Cancer Cases.

The aim of this study is to compare the numbers of axillary lymph nodes (ALN) taken out by dissection between patients with breast cancer operated on after having neoadjuvant chemotherapy (NAC) treatment and otherswithout having neoadjuvant chemotherapy, and to investigate factors affecting lymph node positivity. A total of 49 patients operated due to advanced breast cancer after neoadjuvant chemotherapy and 144 patients with a similar stage of the cancer having primary surgical treatment without chemotherapy at the general surgery clinic of Ondokuz Mayis University Medicine Faculty between the dates 01.01.2006 and 31.10.2012 were included in the study. The total number of lymph nodes taken out by axillary dissection (ALND) was categorized as the number of positive lymph nodes and divided into <10 and ≥10. The variables to be compared were analysed using the program SPSS 15.0 with P<0.05 accepted as significant. Median number of dissected lymph nodes from the patient group having neoadjuvant chemotherapy was 16 (16-33) while it was 20 (5-55) without chemotherapy. The respective median numbers of positive lymph nodes were 5 ( 0-19) and 10 (0-51). In 8 out of 49 neoadjuvant chemotherapy patients (16.3%), the number of dissected lymph nodes was below 10, and it was below 10 in 17 out of 144 primary surgery patients. Differences in numbers of dissected total and positive lymph nodes between two groups were significant, but this was not the case for numbers of <10 lymph nodes. The number of dissected lymph nodes from the patients with breast cancer having neoadjuvant chemotherapy may be less than without chemotherapy. This may not always be attributed to an inadequate axillary dissection. More research to evaluate the numbers of positive lymph nodes are required in order to increase the reliability of staging in the patients with breast cancer undergoing neoadjuvant chemotherapy.

Demographic and Clinical Findings of Epilepsy Patients who Underwent Follow-up at the Newly Established Clinic of the Muğla Sıtkı Koçman University Faculty of Medicine

Demographic and Clinical Findings of Epilepsy Patients who Underwent Follow-up at the Newly Established Clinic of the Muğla Sıtkı Koçman University Faculty of Medicine

Evaluation of anatomical and functional outcomes in patients undergoing repair of traumatic canalicular laceration.

The present study was designed to evaluate functional and anatomical success of traumatic canalicular laceration repair. Consecutive patients who presented at Atatürk Training and Research Hospital Eye Clinic, İzmir Katip Çelebi University Faculty of Medicine and had canalicular laceration repair performed by the same surgeon between January 2009 and December 2014 were included in the study. Demographic data, length of time between injury and surgery, and cause of the trauma, surgical method employed, and duration of follow-up were recorded. Postoperative epiphora was evaluated using Munk score. Patency of lacrimal system was assessed with canalicular irrigation. Thirty-five male and 6 female patients were included in the study. Mean age of 41 participants was 31.85±18.9 years (range: 1-79 years). Avulsive injury was observed in 66% (n=27), and direct (penetrating) injury in 34% (n=14). Distribution of injured canaliculi was as follows: left inferior canaliculus 63.4% (n=26), right inferior canaliculus 19.5% (n=8), right superior canaliculus 9.8% (n=4), and left superior canaliculus 7.3% (n=3). Thirty-four patients had monocanalicular tube implantation (mini-Monoka) and 10 patients had bicanalicular annular intubation using pigtail probe. Average follow-up time was 6±5.7 months. Munk score was Grade 0 in all patients. Canalicular irrigation indicated all canaliculi were patent. Recent microsurgical techniques result in successful repair of canalicular laceration.

Developmental studies on community-based education in Pamukkale university faculty of medicine (Turkey): Interprofessional educational approach

Objective: Pamukkale University Faculty of Medicine uses a problem-based learning and student-centered education with aiming to give strengths to the students regarding the skills in public health and preventive medicine. In the context of improving community-based education and integrating the interprofessional education into community-based education, the “Home visits for health services” has been integrated into the medical curriculum in the 6th year medical students. The resident physicians and Home Health Services teams were divided into groups for home visits. Interprofessional education aims to enable the 6th year medical students to recognize the bedbound and disabled patients in the province of Denizli in terms of biological, psychological and social perspectives as well as to appreciate the importance of these with acting in concert with the professional health team. Methods: An interns-oriented questionnaire has been prepared to assess the actualization rate of these goals. The questionnaire includes 4 questions about recognition of community health problems, 3 questions about health organization and direction, 2 questions about team work, 2 questions about professional and ethical values, and 1 question about interprofessional education. Results: In the analysis of results, the highest score was obtained for the question of “This training has helped to develop my ability to facilitate showing empathy towards the patients and to improve my humanistic and ethical values”. Again, the question of “This training helped me to recognize the problems of bedbound and disabled patients” received a high score. There was not a statistically significant difference between the 6th year student groups (p>0.05). Conclusions: It was found that this training helped the students to better recognize the community health problems, to show empathy, to develop humanistic and ethical values and to recognize the problems of disabled and bedridden patients.

A Case of Tumour Induced Osteomalacia Linked to a Hemangiopericytoma of the Palatine Fossa

2Department of Oral Pathology, Faculty of Dentistry, St. Jospeh University, Beirut, Lebanon 3Department of Nephrology, The Lebanese Hospital, Geitawi The Lebanese University Faculty of Medicine. Beirut, Lebanon 4Department of Neurology, The Lebanese Hospital, Geitawi – The Lebanese University Faculty of Medicine. Beirut, Lebanon 5Department of Radiology – The Lebanese Hospital, Geitawi – Beirut, Lebanon 6Department of Internal Medicine The Lebanese Hospital, Geitawi, Beirut, Lebanon 7Department of Surgery The Lebanese Hospital, Geitawi – Beirut, Lebanon

Trends in maternal health in Lithuania 1995-2014.

Background.The Lithuanian Perinatology Program, orders issued by the Ministry of Health, regulating the care and treatment of mothers and their infants, and the well-running perinatal care system helped to improve the diagnostics and treatment of pregnancy pathology. Over the last 20 years, Lithuania has experienced significant improvements in the maternal and perinatal health.Materials and methods.Data was collected from the official statistics database, Medical Data of Births, provided by the Institute of Hygiene Health Information Centre, Vilnius University Faculty of Medicine, and the Vilnius University Centre of Neonatology in 1995–2014.Results.The average maternal age at delivery ranged from 25.8 years in 1995 to 28.8 years in 2014. The comparison of 2001 and 2014 data shows that the incidence of gestational diabetes increased by 6.7 times due to the improved diagnosis. The percentage of hypertensive disorders decreased from 6.1% in 1997 to 3.2% in 2014. Between 1995 and 2014, the prevalence of anemia among pregnant women declined by half. The marked decrease in respiratory, urinary, genital and other diseases was observed among pregnant women. From 1995 to 2014, in Lithuania there were 67 maternal deaths related to pregnancy and childbirth. Hemorrhage and infections during pregnancy, delivery and the postpartum period are considered the most common causes of maternal death.

Spinal cord stimulation in 62 patients: Retrospective evaluation

Spinal cord stimulation (SCS) is used for various indications such as Failed Back Surgey Syndrome, peripheral causalgia, neuropathic pain, complex regional pain syndrome, reflex sympathetic dystrophy, peripheral vascular disease, ischemic heart disease and cancer pain. This is a retrospective study. 62 patients applied SCS were included in retrospective study from february 2011-january 2015 in Akdeniz University medicine faculty algology department. We asked about patients' VAS values before and after procedure, analgesic medicine usings, sleep disorders, pleasure after procedure, daily activity improvement and time of going back to work. We found that decrease on the patients' pain severity and improvement on quality of sleep and daily activities. As a result; our study and the other studies show that SCS is reliable and effective procedure on chronic pain management.