ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of İstanbul - North Clin Istanb: 1 (2)
Volume: 1  Issue: 2 - 2014
RESEARCH ARTICLE
1. P-wave dispersion and its relationship with the severity of the disease in patients with stable coronary artery disease
Fatih Akın, İnci Fıratlı, Fahrettin Katkat, Tevfik Gurmen, Burak Ayca, Muhsin Klayoncuoglu, Okay Abacı, Mustafa Sarı, Murat Ersanlı, Serdar Kucukoglu, Zerrin Yiğit
PMID: 28058305  PMCID: PMC5175065  doi: 10.14744/nci.2014.25733  Pages 65 - 70
OBJECTIVE: P- wave dispersion (PD) is an indicator of inhomogeneous and discontinuous propagation of sinus impulses. In the present study we aimed to investigate the PD and its association with the severity of the disease. İn patients with stable coronary artery disease.
METHODS: We prospectively analyzed 60 subjects with coronary artery disease (CAD) and 25 subjects with normal coronary angiograms (control group). The maximum and minimum P-wave duration and PD were measured from the 12-lead surface electrocardiograms. The CAD severity was assessed by the severity score (Gensini score) and the number of vessels involved (vessel score).
RESULTS: P max was longer in CAD group compared with the control group (p<0.001). PD was greater in the CAD group, compared with the control group (p<0.001). However, P min did not differ between the two groups. In bi-variate correlation, increased PD was correlated with presence of diabetes mellitus (r=0.316, p=0.014), smoking (r=0.348, p=0.006), left ventricular ejection fraction (r=-0.372, p=0.003), vessel score (r=0.848, p=0.001), and Gensini score (r=0.825, p=0.001). Multiple linear regression analysis showed that PD was independently associ¬ated with vessel score ((3=0.139, p=0.002) and Gensini score ((3=0.132, p=0.007).
CONCLUSION: PD was greater in patients with CAD than in controls and it was associated with CAD severity.

2. Patient satisfaction with outpatient health care services: evaluation of the components of this service using regression analysis
Fisun Vural, Seval Çiftçi, Yiğit Çakıroğlu, Birol Vural
PMID: 28058306  PMCID: PMC5175066  doi: 10.14744/nci.2014.30074  Pages 71 - 77
OBJECTIVE: In health care services, patient’s expectations, and satisfaction levels are important markers of the services provided. The aim of this study is to determine patient satisfaction level, and its influential factors in patients receiving treatment on an ambulatory basis who applied to a state hospital.
METHODS: In this cross-sectional study a total of 210 patients were face-to-face interviewed, and patient satisfaction questionnaire survey was performed. Socioeconomic characteristics, physical conditions of the hospital, pecularities of the health care providers, and satisfaction from health care services received were questioned independently. Regression analysis was performed to investigate factors effective on patient satisfaction.
RESULTS: A significant correlation was not found between sociodemographic factors, and patient satisfaction (p<0.05). Favourable patient acceptance of the health care services received is effected by the duration of the waiting period. Communication skills of the health care professionals have been found to be the fundamental factors effective on the preference or recommendation of a certain health care institute once more (p<0.005).
CONCLUSION: Empowering the communication skills of health care professionals, and decreasing the waiting
period were found to be necessary in order to increase the satisfaction levels of ambulatory patients.

3. Evaluation and prevalence of major central nervous system malformations: a retrospective study
Şadan Tutuş, Sezin Özyurt, Ebru Yılmaz, Gökhan Açmaz, Mustafa Ali Akın
PMID: 28058307  PMCID: PMC5175067  doi: 10.14744/nci.2014.84803  Pages 78 - 83
OBJECTIVE: Central nervous system (CNS) anomalies are the most common abnormalities of all malformations and can be diagnosed on routine prenatal ultrasonography (US). We aimed to find out fetal CNS anomaly rate in our clinic which is the referral center in the region.
METHODS: This is a retrospective study of 15000 pregnant women who were scanned for routine obstetric follow-up from January 2012 to July 2013 in our referral center. We diagnosed CNS anomalies in 41 fetuses by using high resolution ultrasound unit with 3.5 MHz transabdominal and 6 MHz transvaginal transducers.
RESULTS: CNS anomalies included 12 Chiari malformations, 2 Dandy-Walker malformations (DWM), 1 variant of Dandy-Walker syndrome (DWS), 3 iniencephalies, 15 anencephalies, 1 alobar holoprosencephaly, 2 isolated hydrocephalies, 3 hydrocephalies with cerebellar hypoplasia, 1 occipital encephalocele, 1 lumbosacral myelomeningocele accompanied with microcephaly. There were some associated anomalies in the groups that included club-foot deformities in 6 cases, ventricular septal defect (VSD) in 2 cases, polycystic kidney in 2 cases, scoliosis in 1 case, hypoplasic left ventricle in 1 case; alone atrium, single umbilical artery, echogenic focus, hydronephrosis and cleft lip and palate in the same case, and omphalocele in one.
CONCLUSION: Prognosis and early detection of CNS abnormalities have become an important issue because
the most serious complications of major CNS anomalies are disability and getting bedridden and this situation is inevitably related to health economy. On the other hand prognosis of the fetus and family counseling is another important issue. Parents should decide whether to continue their pregnancies or not.

4. Assesment of the patients presenting with severe anemia to the emergency internal medicine clinic
Seydahmet Akın, Ercan Ergin, Sinan Kazan, Nurgül Keskin Tukel, Didem Kılıç Aydın, Mustafa Tekçe, Mehmet Aliustaoğlu
PMID: 28058308  PMCID: PMC5175068  doi: 10.14744/nci.2014.10820  Pages 84 - 88
OBJECTIVE: Etiological evaluation of the patients who were hospitalized with the diagnosis of severe anemia (Hb<7 gr/dl) in the emergency internal medicine clinic between January and July, 2013.
METHODS: In this study, 112 patients who were hospitalized in Dr. Lutfi Kirdar Kartal Education and Research Hospital emergency internal medicine clinic with severe anemia between January and July 2013 were retrospectively analyzed. Patients’ initial complaints, underlying causes of their anemia and prognosis of the patients were evaluated.
RESULTS: The etiology of anemia was iron deficiency in 60 (53.6%), chronic kidney failure in 16 (14.2%), hematologic malignancies in 12 (10.7%), liver cirrhosis in 12 (10.7%) and other non-malignant hematologic disorders in 4 (3.6%) patients.
CONCLUSION: The most common cause of anemia in patients who apply to emergency internal medicine clinic with severe anemia is iron deficiency. The most common complaints on admission are subjective ones such as weakness, fatigue and lassitude. Chronic disease anemia does not cause severe anemia as much as iron deficiency.


5. Clinical and demographic characteristics and functional status of the patients with fibromyalgia syndrome
Nilay Şahin, Aziz Atik, Erdal Doğan
PMID: 28058309  PMCID: PMC5175069  doi: 10.14744/nci.2014.07108  Pages 89 - 94
OBJECTIVE: To investigate the clinical and demographic characteristics and functional status of the patients with fibromyalgia syndrome (FMS).
METHODS: Ninety-four patients with the diagnosis of FMS were included in the study. All patients were evaluated with short form 36 for quality of life (SF-36), pain, depression, benign joint hypermobility syndrome (BJHS), myofacial pain syndrome (MPS), and demogrophic characteristics. End-point measurements were SF-36 for quality of life, visual analogue scale, Beck Depression Index, anamnesis, and physical examination.
RESULTS: The majority of the patients were women who were suffering from generalised pain with a median age of 40.4. Mostly depression and sleep disorders were accompanying the syndrome. Physical examination revealed MPS and BJHS in most of the patients.
CONCLUSION: BJHS and MPS must also be investigated in patients with the diagnosis of FMS.

6. Comparing the effectiveness of neutrophillymphocyte ratio as a mortality predictor on middle and advanced age coronary artery bypass graft patients
Derih Ay, Burak Erdolu, Gündüz Yümün, Ufuk Aydın, Ahmet Demir, Osman Tiryakioğlu, Ahmet Hakan Vural
PMID: 28058310  PMCID: PMC5175070  doi: 10.14744/nci.2014.75047  Pages 95 - 100
OBJECTIVE: In this study, the effect of neutrophil-lymphocyte ratio (NLR), which is a recently developed inflammatory parameter, as an early stage mortality predictive marker on coronary artery bypass (CABG) patients of various age groups was examined.
METHODS: Seventy eight patients under the age of 45 (Group 1) and 80 patients who were older than 45 (Group 2) randomly chosen from the patients who underwent isolated CABG surgery, were examined. The preoperative characteristics and NLRs were noted. The primary end point of the study was determined as all-cause in- hospital mortality.
RESULTS: Mortality was observed in 2 patients in Group 1 and 11 patients in Group 2. The threshold value of NLR was 2,47 in the Receiver Operating Characteristic (ROC) curve in Group 1 and there wasn’t any significant correlation between preoperative NLR and mortality rates in the patients whose NLRs were above this curve. The threshold value was determined as 4.07 in Group 2 and there was a significant relation between preoperative NLR and mortality (p<0,01). No relation was found between NLR and mortality when all the examined patients were considered (p>0.05).
CONCLUSION: NLR that can be easily calculated, can be used as a mortality predictor in the patients of advanced age who will undergo isolated CABG procedure.

7. Impact of stroke etiology on clinical symptoms and functional status
Özge Gülsüm Memetoğlu, Aslıhan Taraktaş, Naciye Bilgin Badur, Feyza Ünlü Özkan
PMID: 28058311  PMCID: PMC5175059  doi: 10.14744/nci.2014.40327  Pages 101 - 105
OBJECTIVE: The aim of this study is to investigate the differences between hemorrhagic and ischemic stroke
patients in terms of clinical and functional features.
METHODS: Medical records of the patients with stroke were analyzed retrospectively. The patients’ demographic characteristics, stroke etiology, time interval after the event, comorbid illness and functional status were recorded.
RESULTS: The stroke etiology was ischemia for 60 (36 male/24 female) (75%) patients, and haemorrhage for 20 (10 male/10 female) (25%) patients. Patients with ischemic stroke were classified as Group 1, and patients with hemorrhagic stroke were classified as Group 2. The mean age for Group 1 was 62.2±13.2, and 55.8±17.1 years for Group 2 (p=0.592). In Group 1, 33 (55%) patients, and in Group 2, 11 (55%) patients were primary school graduates (p=0.984). Localization of the lesion was in the right side for 33 (55%) patients in Group 1, and for 15 (75%) patients in Group 2 (p=0.372). The mean time interval after event for Group 1 was 7 months (0-211 days), and for Group 2 it was 14.5 (1-420 days) months (p=0.592). FIM score for Group 1 was 71.9±28.0, and 68.1±21.0 for Group 2 (p=0.575). The mean Brunnstrom score for upper extremity was 3.5 for Group 1, 3 for Group 2, (p=0.866), and for lower extremity, it was 3.5 for Group 1, and 3 for Group 2 (p=0.143). Spasticity was present in 45 (75%) patients in Group 1, and in 12 (60%) patients in Group 2 (p=0.311). In Group 1 51 (85%) of the patients and 18 (95%) patients had a history of comorbid disease (p=0.554).
CONCLUSION: Etiology of stroke is thought to be not effective on the patient’s clinical and functional status.

CASE REPORT
8. Relapsing polychondritis and otologic findings
Serhan Derin, Abdulkadir Oran, Fatma Demirkuru, Selçuk Uçar
PMID: 28058312  PMCID: PMC5175060  doi: 10.14744/nci.2014.36035  Pages 106 - 108
Relapsing polychondritis is a cartilage tissue disease characterized by inflammatory and destructive episodes. Elastic cartilage of the ear and nose, hyaline cartilage of the joints, hyaline cartilage of vertebra and trachea are the main involvement areas. Also organs having proteoglycan structure such as eyes, heart, blood vessels, and the inner ear can be affected. In this article otologic findings of a 54-year-old male patient with a diagnosis of relapsing polychondritis were presented and discussed in the light of the literature.

9. Sudden sensorineural hearing loss in a multiple sclerosis case
Muhammet Tekin, Gül Özbilen Acar, Osman Halit Çam, Fatih Mehmet Hanege
PMID: 28058313  PMCID: PMC5175061  doi: 10.14744/nci.2014.35744  Pages 109 - 113
Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. MS involves different regions of the central nervous system in different periods, and causes demyelination. MS is a neuromotor disorder which progresses with remissions and relapses. Symptoms of MS may regress completely or heal after the relapses leaving sequelae. Sudden sensorinerural hearing loss (SSHL) is hearing loss of 30 dB or more over
at least three contiguous audiometric frequencies that develops over a period of a few hours to 3 days. In 4-10 % of the MS patients, sensorineural hearing loss occurs between relapses or remissions. In this case, audiotory brainstem response (ABR) test is the most appropriate test for the diagnosis of sensorineural hearing loss in MS patients. In this article, we will discuss a patient diagnosed as MS who presented with sudden sensorineural hearing loss during the remission of the disease.

10. Annular sarcoidosis mimicking granuloma annulare: a case report
Zafer Türkoğlu, Burçe Can, Ebru Zemheri, İlkin Zindancı, Filiz Topaloğlu Demir, Mukaddes Kavala
PMID: 28058314  PMCID: PMC5175062  doi: 10.14744/nci.2014.32042  Pages 114 - 116
Cutaneous sarcoidosis is a great imitator and we have to remember this mimicker also in the differential diagnosis of erythematous annular lesions. We report the case of a 50-year- old man with a 7-year history of erythematous, annular or serpiginous, scaly plaques on his scalp, forehead, preauricular region and around his mouth who was misdiagnosed as granuloma annulare.

11. Use of ESWT in avascular necrosis of bilateral femoral heads: case report
Levent Özgönenel, Hilal Yeşil, Murat Yeşil
PMID: 28058315  PMCID: PMC5175063  doi: 10.14744/nci.2014.98698  Pages 117 - 120
A 57-year-old female patient was admitted to the department of physical medicine and rehabilitation with lumbar and left hip pain lasting for 1.5 months. Physical examination and magnetic resonance imaging revealed stage 1 avascular necrosis of bilateral femoral heads. Extracorporeal Shock Wave Therapy (ESWT) was utilized for early stage disease and a significant reduction in pain and functional recovery was noted.

INVITED REVIEW
12. Synthetic cannabinoids
Rabia Bilici
PMID: 28058316  PMCID: PMC5175064  doi: 10.14744/nci.2014.44153  Pages 121 - 126
Use of cannabinoids is increasing at an alarming rate. Their easy availability, cheapness, perceptive legality and difficulty in detecting its presence with standard urine toxicologic tests, and similar factors probably contribute to the increased use, and popularity of synthetic cannabinoids. Although laws, and regulations concerning auditing of these substances have been implemented in many countries, production of new types of synthetic cannabinoids rapidly takes place. Primary psychoactive ingredient of cannabis is Δ 9-tetrahydrocannabinoid which is partial agonist of cannabinoid receptors, while synthetic cannabinoids are potent, and complete agonists of these receptors. Therefore it is not surprising that synthetic cannabinoids exert more powerful effects than cannabinoids. Clinical effects of synthetic cannabinoids can cause referrals to emergency services, and hospitalizations. Despite lack of any specific therapy benzodiazepines, antipsychotics, and fluid replacement may be required. Clinical follow-up studies are needed for better comprehension of its clinical effects, and treatment outcomes.

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