Anatolian Clinic Journal of Medical Science / Anadolu Kliniği Tıp Bilimleri Dergisi

141-148

Authors: Filiz Fusun Bolukbas, Seyda Ignak, Ozlem Unay Demirel3, Yavuz Furuncuoglu, Ferhan Mantar, Sercen Cansu Sertel, Filiz Yarımcan Saglam, Cengiz Bolukbas

Aim: Non-alcoholic fatty liver disease (NAFLD) is the most frequent chronic liver disease. Because NAFLD is a complex disease, finding highly specific and sensitive biomarkers for diagnosis is very difficult. We investigated the possible relation between steatosis and fibrosis stages determined by FibroScan technique and serum vitamin B12 levels as a non-invasive biomarker in patients with NAFLD. Materials and Methods: A total of 129 patients (45.68±12.9 years of age, 29 females) with NAFLD and 50 healthy subjects (43.44±15.3 years of age, 21 females) were included in this study. FibroScan was performed in all patients for the staging of fatty liver fibrosis. Liver enzymes were also analyzed in addition to serum vitamin B12 and C-reactive protein (CRP) levels. Results: There was no difference with respect to age and gender between NAFLD and control groups. The serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and CRP levels were significantly higher in the patients with NAFLD than the controls (p<0.05). On the contrary, serum vitamin B12 vitamin levels were lower in the patients with NAFLD, compared to the controls (352.8±125.2pg/mL vs 435.2±134.4, p<0.01). There was a significant difference in mean serum B12 vitamin levels between the control group (435.2±134.4pg/mL) and the NAFLD subgroups with fibrozis staged F0 and F3 (366.17±129.7pg/mL, 285.22±101pg/mL, p<0.01). Discussion and Conclusion: Serum vitamin B12 levels were found to be significantly low in the patients with NAFLD in comparison to the control group. This decline in serum vitamin B12 levels was even more prominent as hepatic inflammation and fibrosis stage increased (F0–F3), but not in advanced fibrosis stage (F4).

157-162

Authors: Zafer Özmen, Eda Albayrak

Aim: In this study, we aimed to investigate the adult incidence of asymptomatic Bochdalek hernia detected incidentally by multislice computed tomography and the relation between Bochdalek hernia and obesity as well as diaphragmatic crus thickness. Materials and Methods: Eight hundred and seventy multislice computed tomography images of the thorax and abdomen were screened retrospectively to investigate Bochdalek hernia presence, prevalence, and localization. In the patients with Bochdalek hernia, diaphragmatic crus thickness at defect border and subcutaneous fat tissue thickness in the right paramedian area at umbilicus level were measured in the axial sections. Defect size and hernia sac volume were also calculated on the same images. Then, possible correlation of defect size and hernia sac volume with diaphragmatic crus thickness and subcutaneous fat tissue was investigated. Results: Thirty-four Bochdalek hernia (3.9%) sacs were detected in 30 patients. Bochdalek hernia was on the left side in 13 patients (43.3%), on the right side in 13 patients (43.3%), and bilateral in 4 patients (13.3%). The hernia sac consisted of omental fat tissue in 32 patients (94%), of liver in 1 patient (3%), and of colon in 1 patient (3%). The segmental volume of hernia was 153 [84–361] μl in female patients and 339 [202–432.5] μl in male patients, and the difference was statistically significant (p=0.032). Neither segmental volume of hernia nor defect size was found to be correlated with diaphragmatic crus thickness or subcutaneous fat tissue (p>0.05). Discussion and Conclusion: In our study, incidence of Bochdalek hernia detected by multislice computed tomography is 3.9% and segmental volume of hernia was found to be significantly lower in females compared to males. Although obesity plays an important role in pathogenesis of intraabdominal hernia, no significant correlation was detected between defect size of asymptomatic incidental Bochdalek hernia and obesity as well as diaphragmatic crus thickness.

169-176

Authors: Aynur Görmez

Aim: In the literature there has been growing interest in caregiving burden of adults with intellectual disability (ID), following the increase in life expectancy of adults with ID. There is no adequate data concerning the caregiving burden of this age group in Turkey. In this study we aimed to determine family caregiving burden of adults with ID and to investigate the relationship between caregiving burden and various clinical and sociodemographic parameters. Materials and Methods: One-hundred and two adults with ID and their families were included in this study, all of whom were reached through polyclinics, rehabilitation centers, and schools. The data were collected by using a specifically designed, structured form, the Zarit Caregiver Burden Scale, and the Psychiatric Assessment Scale for Adults with Developmental Disabilities. Results: The mean caregiving burden score was 54.68±13.83. The primary factor increasing the caregiving burden was found to be a comorbid diagnosis of an autism spectrum disorder (ASD) in the individual with ID (p=0.001). Presence of behavioral problems was another factor increasing the caregiving burden (p=0.031). The highest caregiving burden score was observed in universitygraduate caregivers. No significant relationship was found between caregiving burden and gender, age, physical and mental illnesses, incontinence status, physical disability status, community services attendance, and verbal ability level of people with ID as well as the duration of the care given. Discussion and Conclusion: Prevention and appropriate management of behavioral problems, in addition to determining the needs and expectations of families of people with ID on the autism spectrum will be a critical step in lessening the caregiving burden on the families. Another remarkable point is that the highest caregiving burden reported belonged to university-graduate caregivers, who are likely to have a greater awareness of problems.

183-192

Authors: Özlem Çınar Özdemir, Ramazan Kurul, Elif Duygu1, M. Fatih Uysal, Yeşim Bakar, Ömer Osman Pala, Kemalettin Erdem, Handan Ankaralı

Aim: In this study, we aimed to investigate effects of low frequency pulsed electromagnetic field therapy (PEFT) therapy on edema, life quality, depression, and range of joint motion in patients with chronic venous insufficiency. Materials and Methods: Fifty-five patients with chronic venous insufficiency who were at C3–C6 according to the clinical–etiological–anatomic–pathophysiological (CEAP) classification were included the study. The demographic data of the patients were obtained and analyzed before the study. Clinical evaluations tools included the Venous Insufficiency Epidemiological and Economic Study–Quality of Life Questionnaire (VEINES-QOL), the Beck Depression Inventory (BDI), and range of joint motion and circumferential measurements. The patients were divided into two groups using random number generator as treatment (n=21) and control (n=24) groups. All tests were performed at both the beginning and the end of the study. Following the initial assessment, LFAM therapy was administered to the treatment group for 5 days a week for 6 weeks. The individuals were asked to use compression stockings for 6 weeks at the same time. The control group used only compression stockings for 6 weeks. Results: When the first and last measurements of the both groups were compared, there was a significant difference in the ankle dorsiflexion and plantar flexion and depression measurements (p<0.001, p = 0.007, p <0.001). When the groups were compared in terms of circumferential measurements, depression, and life quality, a significant difference was found in depression evaluation and circumferential measurements of the ankle (CB) and the area above the ankle (CB1) (p <0.05) Discussion and Conclusion: This study showed that low-frequency low-dose electromagnetic field (PEFT) therapy increases joint motion range and decreases edema and depression in individuals with chronic venous insufficiency. This is the first study in our country where magnetic field therapy has been used in other stages of chronic venous insufficiency. We believe that the repetition of the study on a larger sample with longer follow-up periods might contribute to the literature.

200-203

Authors: Hüseyin Karaaslan, Mehmet Nuri Turan, Mehmet Ali Eren, Tevfik Sabuncu

Milk-alkali syndrome was first described in patients using high dose antacid drugs for peptic ulcer. The triad of the syndrome is hypercalcemia, metabolic alkalosis, and acute renal failure. The incidence of the syndrome that decreased after the development of modern ulcer treatments has currently been increasing again due to the use of calcium-containing medicine for osteoporosis and renal osteodystrophy. In this report, we present a patient who had been under calcium carbonate and active vitamin D treatment due to idiopathic hypoparathyroidism and presented with life-threatening hypercalcemia, metabolic alkalosis, and acute renal failure.

208-211

Authors: Ahmet Selim Özkan, Sedat Akbaş, Mehmet Rıdvan Yalın, Emine Özdemir

The Seckel syndrome is a rare autosomal disease that can cause difficult airway problems due to microcephaly, retrognathia, and the typical facial structure. In anesthesia management of patients with Seckel syndrome, it is important to take the necessary precautions against possible difficult venous access and difficult airway problems, and it should be noted that alternative tools can also be helpful in airway management.

220-223

Authors: Abdulhalim Şenyiğit, Mustafa Kanat

Despite modern treatment approaches, glycemic control is inadequate in more than %50 of diabetic patients. In addition to the factors associated with the patient, physician and health system, the progressive character of the disease also plays an important role in inadequate glycemic control. This paper reviews the main principles in type 2 diabetes treatment and the place of pioglitazone as an insulin sensitizer.