ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of İstanbul - North Clin Istanb: 11 (4)
Volume: 11  Issue: 4 - 2024
EDITORIAL
1. Front Matter

Pages I - VIII

RESEARCH ARTICLE
2. Effect of latanoprost on choroidal thickness in patients with newly diagnosed primary open-angle glaucoma
Neslihan Buyukmurat, Erdi Karadag, Hanefi Ozbek
PMID: 39165701  PMCID: PMC11331209  doi: 10.14744/nci.2024.87405  Pages 271 - 276
OBJECTIVE: The purpose of this study was to assess the influence of latanoprost on choroidal thickness in patients with newly diagnosed primary open-angle glaucoma using Swept-Source Optical Coherence Tomography (SS-OCT).
METHODS: The retrospective, non-randomized study comprised 40 newly diagnosed primary open-angle glaucoma patients receiving latanoprost therapy (Group 1). Additionally, 40 age- and sex-matched healthy subjects served as the control group (Group 2). Using SS-OCT, measurements of subfoveal, horizontal temporal, and horizontal nasal quadrants choroidal thickness, as well as intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) thickness values, were collected at baseline and after 1 month for both groups.
RESULTS: The mean age was 39.8±4.15 years (range: 18–45 years) in group 1 and 41.67±7.95 years (range: 18–45 years) in group 2 (p>0.05). The mean choroidal thickness in the subfoveal area, horizontal temporal quadrant, and horizontal nasal quadrant prior to latanoprost therapy were 263.57±84.23 µm, 233.05±80.08 µm, and 219.52±83.28 µm in the group 1 whereas 278.9±93.88 µm, 243.8±73.37 µm and 209.85±92.92 µm in the group 2. After latanoprost therapy, the mean choroidal thickness in the subfoveal area, horizontal temporal quadrant, and horizontal nasal quadrant changed significantly to 299.77±41.29 µm, 269.9±43.80 µm, and 261.32±45.60 µm in the group 1 (p=0.02, p=0.016, and p=0.012, respectively) (Table 1). However, the mean choroidal thickness in the subfoveal area, horizontal temporal quadrant and horizontal nasal quadrant in group 2 changed not significant and was 279.25±103.37 μm, 246.42±87.07 μm and 203.62±106.74 μm, respectively (p=0.4, p=0.5 and p=0.9, respectively). The mean IOP decreased significantly in group 1 (p=0.000) but did not change significantly in group 2 (p=0.153). There was no difference in RNFL thickness values at baseline and 1 st month in group 1 and group 2 (p>0.05).
CONCLUSION: Topical latanoprost may increase choroidal thickness. Swept Source-OCT may contribute to our understanding of the actions of latanoprost on choroidal thickness.

3. Evaluation of the relationship between the presence of an accessory maxillary ostium and the presence and types of nasal septum deviation: A computed tomography study
Hanife Gulden Duzkalir, Ozge Adiguzel Karaoysal, Gunay Rona
PMID: 39165712  PMCID: PMC11331200  doi: 10.14744/nci.2023.02800  Pages 277 - 283
OBJECTIVE: The maxillary accessory ostium (AMO) has been associated with chronic rhinosinusitis and nasal septal deviation (NSD), but AMO may also be present in healthy individuals. AMO’s purpose, origin, and effects are uncertain. This study aimed to investigate the types and frequency of AMO and NSD, as well as their relationship.
METHODS: In our retrospective, single-center study, paranasal sinus tomographs performed in our clinic between 2022 and 2023 were scanned, and 200 patients who met the inclusion criteria were evaluated in terms of AMO direction (right/left), accessory ostium location (superior/middle/inferior 1/3), presence of NSD, and deviation type according to the Mladina index.
RESULTS: 60.5% of the patients were female and 39.5% were male. AMO distribution was similar between the groups (p>0.05). There was no significant correlation between the presence and localization of AMO and the presence of NSD (p>0.05). NSD was detected in 93 patients (89.4%) with AMO and 78 patients (81.3%) without AMO (p=0.16). The distribution of NSD presence and types was similar in right or left localization, AMO (+) and AMO (-) patients (p>0.05).
CONCLUSION: The evidence that AMOs cause chronic sinusitis and FESS failure is insufficient and cannot explain the presence of AMOs in healthy individuals or children. There are very few studies in the literature examining the NSD-AMO relationship. In our study, high rates of NSD and AMO were found in individuals without paranasal disease, but no statistically significant relationship was found between the presence, location, and type of NSD and AMO. Early-onset, long-term prospective studies on the relationship between NSD and AMO may help to explain the etiopathogenesis of paranasal diseases that reduce quality of life.

4. The relationship between lung cancer and hepatosteatosis in patients with biopsy-confirmed lung cancer diagnosis
Murat Asik, Mehmet Ali Agirbasli, Kendal Erincik
PMID: 39165710  PMCID: PMC11331210  doi: 10.14744/nci.2024.88972  Pages 284 - 291
OBJECTIVE: The purpose of this study is to evaluate whether hepatosteatosis is associated with lung cancer in patients undergoing lung nodule biopsy.
METHODS: 359 patients (248 males, 69.1%) who underwent lung biopsy between the years 2016 and 2022 were included in this retrospective study. The average age of the patients was 64.59±14.05 (range=30–90) years. These patients were undergoing follow-up for a lung lesion and had undergone thoraco-abdominal CT scans. Attenuation measurements were performed on non-contrast CT scans from the liver and spleen parenchyma.
RESULTS: Pathology results showed that the majority of diagnoses were malignant (n=265, 73.8%). Statistical analysis revealed a significantly higher number of patients with malignancy among those with hepatosteatosis compared to those without hepatosteatosis (73% vs. 57%, p=0.006). Furthermore, patients with malignancy were more frequently male (73 vs. 27%, p=0.010), older (65.80±12.83 years vs. 61.20±16.63 years; p=0.06) and had a higher prevalence of diabetes mellitus (DM) (43.7 vs. 31.9%, p=0.046). Logistic regression analysis indicated that advanced age, DM, and hepatosteatosis were associated with an increased risk of malignancy (p=0.049, 95% CI (1.000–1.036), p=0.044, 95% CI (0.0347–0.98736), p=0.013, 95% CI (1.154–3.323), respectively).
CONCLUSION: The study findings suggest that hepatosteatosis might be associated with lung cancer. Therefore, due to its possible relationship with lung cancer, it should be taken very seriously, considering the chance of early diagnosis and treatment.

5. Incidence of and risk factors for venous thrombosis in hospitalized patients with hematologic malignancies: A single-center, prospective cohort study
Nevin Alayvaz Aslan, Ozde Elver, Cansu Korkmaz, Hande Senol, Alperen Halil Hayla, Nil Guler
PMID: 39165714  PMCID: PMC11331203  doi: 10.14744/nci.2023.92332  Pages 292 - 301
OBJECTIVE: Incidence of venous thromboembolism (VTE) is higher than the expected in patients with hematologic malignancies and duration of hospitalization period increases the risk of thrombosis. The objective of this study was to investigate the incidence of and risk factors for venous thrombosis in hospitalized patients with hematologic malignancies.
METHODS: We designed a prospective cohort study and enrolled patients with hematologic malignancies, who had been hospitalized between 2020 and 2021. Thromboprophylaxis was given to all patients, other than those under a high risk of hemorrhage.
RESULTS: 94 patients were enrolled. The incidence of superficial vein thrombosis was 11.7% and the incidence of deep vein thrombosis (including pulmonary embolism and catheter thrombosis) was 7.4%. Patients, who developed thrombosis, had statistically significantly longer hospital stays (21 vs. 11.5 days, p=0.023) and a higher number of hospitalizations (1 vs. 3, p=0.015) compared to those, who did not develop thrombosis. Patients, who had 3 or more risk factors for thrombosis, were found to be under the highest risk. (p=0.017, OR=4.32; 95% CI: 1.3–14.35). Furthermore, patients with recurrent hospitalizations (p=0.024, OR=1.49; 95% CI: 1.05–2.11) and higher fibrinogen levels (p=0.028, OR=1; 95% CI: 1–1.006) were under an increased risk of thrombosis.
CONCLUSION: Venous thrombosis is frequently seen in hospitalized patients with hematologic malignancies. A universally accepted risk scoring system is required for detection of patients, under a high risk for thrombosis.

6. General analysis of breast cancer patients tested for BRCA mutations and evaluation of acute radiotherapy toxicity
Sule Karabulut Gul, Huseyin Tepetam, Berrin Benli Yavuz, Ozge Kandemir Gursel, Ayse Altinok, Irem Yuksel, Omar Alomari, Banu Atalar, Ilknur Bilkay Gorken
PMID: 39165702  PMCID: PMC11331201  doi: 10.14744/nci.2023.93196  Pages 302 - 308
OBJECTIVE: The objective of our study is to evaluate breast cancer patients with BRCA1 or BRCA2 gene mutations and compare them with patients without these mutations. Specifically, we aim to assess the acute side effects of radiotherapy in both groups.
METHODS: Data were collected from four participating centers, comprising information from 73 patients who underwent known mutation analysis and had complete data. Patients were monitored on a weekly basis throughout their treatment for acute toxicity, which was evaluated using the Radiation Therapy Oncology Group (RTOG) acute toxicity criteria.
RESULTS: The median age of the 73 patients included in our study was 43. Among them, 17 had BRCA1-positive mutations and 19 had BRCA2-positive mutations. Invasive ductal carcinoma was present in 67 patients, all of whom underwent surgery. Of the patients, 57 received conventional radiotherapy doses, while 16 received hypofractionated radiotherapy doses. During follow-up, metastasis occurred in three patients. In BRCA-positive patients, those under 40 years of age (p<0.001), with high nodal positivity (p=0.008), grade 2–3 (p=0.022), and lymphovascular invasion (p=0.002) were significantly more frequent compared to BRCA-negative patients (p<0.001). The median survival was 35.8 months. Grade 1 dysphagia developed in seven BRCA-negative patients and four BRCA-positive patients, with no significant difference observed between the two groups (p=0.351). There was also no statistical difference observed in the occurrence of grade 2–3 skin reactions, with 11 BRCA-negative patients and eight BRCA-positive patients experiencing these side effects.
CONCLUSION: Our study supports existing literature by identifying an association between the presence of BRCA mutations and young age, nodal status, grade, and lymphovascular invasion. Additionally, we found no significant difference in the occurrence of radiotherapy toxicity between BRCA-positive and BRCA-negative patients. These findings suggest that radiotherapy can be safely administered to BRCA-positive patients after breast-conserving surgery or mastectomy. Keywords for our study include breast cancer, BRCA mutation, radiotherapy, and side effects.

7. Relationship between inflammatory markers, hormonal profiles, and sperm parameters
Muserref Banu Yilmaz, Reyyan Gokcen Iscan, Zeynep Celik
PMID: 39165711  PMCID: PMC11331202  doi: 10.14744/nci.2023.41882  Pages 309 - 314
OBJECTIVE: The aim of this study is to evaluate the relationship between semen parameters, complete blood count, and hormone levels on the day of spermiogram.
METHODS: Semen parameters of 230 patients who were examined for full blood count test and hormone levels on the day of spermiogram were included in the study. Patients were grouped according to the total motile sperm count (TMSC), semen parameters, hemogram, and hormone levels were compared between groups.
RESULTS: No statistically significant difference was found between groups in neutrophil ratios, neutrophil, lymphocyte, platelet counts, neutrophile-to-lymphocyte ratio (N/L), and platelet-to-lymphocyte ratio (P/L). However, white blood cell (WBC) and lymphocyte counts were weakly positively correlated with sperm concentration (p=0.021, p=0.026), and a weakly significant positive correlation was found with WBC and neutrophil count for motility (p=0.038, p=0.004). FSH level was found to be lower in cases with TMSC >20 m than those with TMSC <5 m and 5-10 m (p=0.004, p=0.022). LH was found to be lower in cases with TMSC >20 m than those with TMSC <5 m (p=0.048). A negative correlation was found for both FSH and LH levels with sperm concentration, motility, and TMSC (p<0.001, p=0.014).
CONCLUSION: In this study, a significant negative correlation was demonstrated between FSH, LH levels and sperm concentration, motility, TMSC. N/L and P/L cannot be used as predictive markers of sperm quality. The results of a significant positive correlation between WBC, neutrophil counts, and sperm parameters encourage researchers to conduct prospective randomized controlled trials with larger sample sizes and different inflammatory and hormonal markers.

8. Evaluation of the relationship between mast cell activation and postural orthostatic tachycardia syndrome in children and adolescents
Yunus Emre Bayrak, Ozlem Kayabey, Evic Zeynep Basar, Isil Eser Simsek, Metin Aydogan, Abdulkadir Babaoglu
PMID: 39165715  PMCID: PMC11331198  doi: 10.14744/nci.2023.64920  Pages 315 - 321
OBJECTIVE: Postural orthostatic tachycardia syndrome (POTS) is one of the orthostatic intolerance syndromes that are common in young adolescents and impair quality of life. POTS is a multi-systemic disease. Many mechanisms have been defined in POTS etiology, such as autonomic denervation, hypovolemia, hyperadrenergic stimulation, low condition, and hypervigilance. Recently, mast cell activation (MCA) has also been on the agenda in etiology. There are few studies in the literature on the relationship between MCA and POTS in adulthood. However, data on children and adolescents is limited. In light of this information, we aimed to evaluate the relationship between POTS and MCA by measuring serum tryptase levels, a specific marker for MCA.
METHODS: This prospective study included patients who were admitted to Kocaeli University Faculty of Medicine Hospital Pediatric Cardiology outpatient clinic for syncope-presyncope between November 2018 and August 2019. Patients who underwent the TILT-table test were enrolled in the study. Patients with structural heart disease or chronic heart disease were not included in this study. Serum tryptase levels were obtained from all patients before the TILT-table test, and serum tryptase levels were re-studied after the test was terminated in patients with positive TILT-table tests for POTS. Patients diagnosed with POTS were classified as Group 1, and other patients were classified as Group 2.
RESULTS: Twenty-eight of the 58 patients included in the study (mean: 14.4±2.0 years; 38 girls, 20 boys) were diagnosed with POTS. The remaining 30 patients were diagnosed with vasovagal syncope and included in Group 2. The increase in mean heart rate during the test was 38±6 beats/min and 47.05%±15.65% in patients with POTS. Basal serum tryptase levels were not different between groups (3.2±1.3 ng/ml and 3.84±1.78 ng/ml, respectively; p=0.129), while serum tryptase levels (both baseline and after 45–60 min of the TILT-table test) were higher in patients presenting with symptoms related to MCA compared to others.
CONCLUSION: In the literature, MCA was considered to be one of the mechanisms leading to POTS. Although other mechanisms, such as neuropathic and hypovolemic POTS, may be active in the patients, the symptoms of MCA in these patients should be routinely questioned.

9. Effect of bone grafting on bone union in exchange nailing for the treatment of femoral shaft nonunions
Cumhur Deniz Davulcu, Sertac Saruhan, Emre Bilgin, Eyup Cagatay Zengin
PMID: 39165704  PMCID: PMC11331199  doi: 10.14744/nci.2023.43410  Pages 322 - 327
OBJECTIVE: This study aims to investigate the effect of bone grafting on the bone union in exchange nailing (EN) for the treatment of femoral shaft nonunions.
METHODS: A total of 26 patients (16 male) were included in this study. The mean age of the patients was 36.1±9.3. Bone grafts were used in 8 patients (bone graft group), and EN was performed without bone grafting (no bone graft group) in 18 patients. Etiology, fracture type, location, and classification of the fractures at the time of initial injury were evaluated. The reduction type (open or closed) and locking status of the nails were also noted. Nonunion types were recorded. In the bone grafting group, iliac bone autografts were used in seven patients and a synthetic bone graft was used in one patient. Following EN, the presence and duration of bone union, and the increase in the nails’ diameter were analyzed for each group and compared.
RESULTS: Union rates were 100% and 94.4% in bone grafting and no bone grafting groups, respectively. The mean union period was not significant between the groups (22.5 and 16.5 months, respectively). The mean increase in the nail diameter was 1.88 mm in the bone graft group and 2.00 mm in the no bone graft group (p>0.05).
CONCLUSION: This study demonstrated that high union rates can be achieved with EN by means of using larger diameter nails with or without bone grafting in the management of femoral shaft nonunions, and bone grafting had no significant effect on union rates and periods.

10. Diagnosis and treatment of solid pseudopapillary tumor of the pancreas: A single center’s experience
Ahmet Gokhan Saritas, Mehmet Onur Gul, Abdullah Ulku, Serdar Gumus, Ishak Aydin, Atilgan Tolga Akcam
PMID: 39165713  PMCID: PMC11331207  doi: 10.14744/nci.2023.36776  Pages 328 - 335
OBJECTIVE: The present study reviews the records of patients with solid pseudopapillary pancreas neoplasm (SPT).
METHODS: A total of 13 patients diagnosed with SPT were included in the study. The criteria for SPT in the pathology specimens were the presence of cells with an oval round orthochromatic nucleus, with a thin chromatin structure and no nucleolus distinction, lined around a fibrovascular papilla in cystic areas.
RESULTS: The study included 11 female and two male patients, with a mean age of 33.07 (range: 16–73) years. All operated patients underwent open surgery, with five undergoing a subtotal pancreatectomy and splenectomy; one a distal pancreatectomy and splenectomy; four a spleen-preserving distal pancreatectomy; and one a pancreaticoduodenectomy. None of the operated patients developed recurrence during the long-term follow-up. The mean follow-up time of operable patients was 69.18 (range: 22–97) months, and none had metastasis at follow-up. The mean follow-up time for the malignant SPT patients was 2.75 (1.5–4) months.
CONCLUSION: SPTs are rare pancreatic tumors encountered more frequently today due to advances in imaging methods and have a low potential of recurrence and a good prognosis.

11. Impact of pelvic floor muscle training on sphincter function and quality of life in patients who underwent low anterior resection: A comparative evaluation
Cem Batuhan Ofluoglu, Isa Caner Aydin, Yunus Emre Altuntas, Kenan Cetin, Rahsan Inan, Noyan Ilhan, Firat Mulkut, Hasan Fehmi Kucuk
PMID: 39165708  PMCID: PMC11331206  doi: 10.14744/nci.2024.37786  Pages 336 - 342
OBJECTIVE: Our study aimed to determine the impact of pelvic floor muscle training (PFMT) on sphincter function and overall well-being in patients who underwent low anterior resection (LAR) and diverting ileostomy due to rectal cancer. For this purpose, anal electromyography (aEMG), low anterior resection syndrome (LARS) score, and the European Organization for Research and Treatment of Cancer quality-of-life questionnaires (EORTC-QLQ)-C30 (generic for cancer) and CR29 (specific to colorectal cancer) were used. The primary endpoint of our study is to determine the effect of PFMT on sphincter function by aEMG, the secondary endpoint is to evaluate the effect on quality-of-life using the LARS score, EORTC-QLQ-C30 and CR-29 questionnaires.
METHODS: Conducted between January 2017 and April 2018 at a tertiary hospital’s general surgery clinic, the study included 32 patients between the ages of 18 and 75 who underwent low anterior resection and diverting ileostomy surgery. The patients were divided into two: the Study Group (SG), which started PFMT after surgery, and the Control Group (CG), which was not subjected to additional exercises. Six months after closure of the diverting ileostomy, both groups were evaluated with aEMG, LARS scores, and EORTC-QLQ-C30 and CR-29.
RESULTS: aEMG duration values were significantly lower in the SG (17.6 m/sec vs. 19.9 m/sec; p=0.001). Additionally, a significant decrease in SG, major LARS rates (12.5% vs. 62.5%; p=0.004) and LARS scores (23.1 vs. 30.0; p=0.003) was observed. While there was no significant difference between the groups in EORTC-QLQ C30, increased sexual interest and decreased fecal incontinence were observed in SG in EORTC-QLQ-CR29.
CONCLUSION: PFMT significantly improves LARS scores, quality-of-life questionnaires and aEMG parameters, positioning PFMT as an accessible, non-invasive, easy-to-use first-line treatment option in the treatment of LARS.

12. Management of urological injuries following gynecologic and obstetric surgery: A retrospective multicenter study
Ahmet Keles, Ilkin Hamid-zada, Ozgur Arikan, Gurkan Dalgic, Ali Selim Durmaz, Esra Keles, Ahmet Karakeci, Fatih Bicaklioglu, Hasan Samet Gungor, Kursad Nuri Baydili, Bilal Eryildirim, Eyup Veli Kucuk, Asif Yildirim
PMID: 39165709  PMCID: PMC11331205  doi: 10.14744/nci.2024.46403  Pages 343 - 348
OBJECTIVE: Urinary system injuries may occur iatrogenically during some surgical procedures especially gynecological and obstetrical surgeries. Unfortunately, these injuries can lead to serious complications in patients. In this multicentric study, we aimed to review and report our experiences and results of urinary tract injuries identified during gynecological and obstetrical surgery.
METHODS: We included women with urinary tract injuries during gynecological and obstetrical surgeries between January 2018 and October 2023 at four centers. Detailed data collected include patient demographics, surgical details, injury characteristics, diagnostic and treatment methods, timing of injury diagnosis and management reports of the patients. The incidence of bladder and ureter injuries was evaluated and the rate of intraoperative urological consultations was recorded.
RESULTS: In a total of 328 patients with a median age of 47 years (24-90), urinary tract injuries were diagnosed, including 227 (69.2%) iatrogenic bladder injuries (IBI) and 101 (30.8%) iatrogenic ureteral injuries (IUI). These injuries were diagnosed in 299 patients (91.2%) during surgery and in 29 patients (8.8%) after the surgical procedure. We observed intraoperative detection rates of 71.9% for IBI and 28.1% for IUI. IBI (71.9%) was diagnosed significantly more frequently than IUI (28.1%) (p=0.001). Cesarean section resulted in significantly more frequent IBI, whereas tumor debulking surgeries resulted in more IUI (n=52, 56.5%) than the other types of procedures (p<0.001).
CONCLUSION: Our study provides a comprehensive overview of iatrogenic urological injuries during gynecological and obstetrical surgeries. Although the bladder is the most frequently injured organ during gynecological and obstetric surgeries, early diagnosis and urological intervention are mandatory to prevent delayed complications. Surgeons must have a thorough understanding of the pelvic anatomy and appropriate surgical techniques to prevent iatrogenic injuries during surgery and ensure timely diagnosis and treatment of urinary tract injuries.

13. Evaluation of the results of tongue reconstruction using local flaps following partial glossectomy
Merdan Serin, Seyda Guray, Gulsum Cebi
PMID: 39165703  PMCID: PMC11331197  doi: 10.14744/nci.2024.47529  Pages 349 - 352
OBJECTIVE: Tongue reconstruction results following partial glossectomy using primary closure and local tissue rearrangement were evaluated in this study.
METHODS: 7 patients diagnosed with tongue carcinoma were included. Tongue defects were reconstructed using local transposition, advancement and rotation of the remaining tongue tissue and closure of the defect. The patients were evaluated 6 months and 1 year following the surgery.
RESULTS: None of the patients had permanent speech impairments or major swallowing problems following the surgery despite 33% to 50% reduction in tongue length.
CONCLUSION: Unnecessary utilization of microvascular flaps for partial tongue reconstruction should be avoided in partial glossectomy patients in which reduction in tongue length is below 50%.

14. Assessing the efficacy of the shock index in predicting mortality in patients with intracerebral hemorrhage
Aysenur Onalan, Bengu Mutlu Saricicek
PMID: 39165707  PMCID: PMC11331208  doi: 10.14744/nci.2024.67434  Pages 353 - 358
OBJECTIVE: It has been reported that the shock index assists in the prediction of poor prognosis in stroke patients. However, the role of this index in predicting mortality and prognosis in patients with intracerebral hemorrhage has not been sufficiently investigated. The objective is to examine the correlation between the shock index and mortality and unfavorable clinical outcomes in individuals with intracerebral hemorrhage.
METHODS: 110 consecutive cases of intracerebral hemorrhage were evaluated in the emergency department. The shock index values of the patients were calculated using their initial blood pressures and HR. For descriptive purposes, the shock index values were categorized into three groups: <0.50, 0.50–0.70, and >0.70. The relationships of these three values and the mean shock index with hematoma volume, hematoma rupturing into the ventricle, length of hospital stay, complications during this period, and in-hospital and three-month mortality were examined.
RESULTS: There were 58 male patients in this study, with a mean age of 62.66±13.64 years. The mean baseline Glasgow Coma Scale score was 13.78±2.37, and the mean baseline shock index value was 0.51±0.13. The mean time of hospitalization was estimated to be 17.01±14.02 days. The mean in-hospital mortality rate was 19%, and the mean three-month mortality rate was 23%. No statistically significant differences were found in hematoma volume, hematoma rupturing into the ventricle, length of hospital stay, complications during this period, or in-hospital and three-month mortality according to the mean shock index value or shock index categories (<0.50, 0.50–0.70, and >0.70).
CONCLUSION: The shock index evaluated in the emergency department in patients with intracerebral hemorrhage is not related to mortality or morbidity.

ORIGINAL IMAGES
15. Pachymeningitis in a pediatric case of IgG4-related disease successfully treated with mycophenolate mofetil
Betul Sozeri, Sevinc Kalin, Mustafa Cakan
PMID: 39165705  PMCID: PMC11331204  doi: 10.14744/nci.2022.15246  Pages 359 - 360

REVIEW
16. Cannabis therapy in rheumatological diseases: A systematic review
Jozélio Freire de Carvalho, Maria Fernanda Leal Dos Santos Ribeiro, Thelma Skare
PMID: 39165706  PMCID: PMC11331211  doi: 10.14744/nci.2023.43669  Pages 361 - 366
Cannabis has been used in rheumatic diseases as therapy for chronic pain or inflammatory conditions. Herein, the authors systematically review the rheumatological diseases in which cannabis has been studied: systemic sclerosis, fibromyalgia, osteoarthritis, rheumatoid arthritis, osteoporosis, polymyalgia rheumatica, gout, dermatomyositis, and psoriatic arthritis. We systematically searched PubMed for articles on cannabis and rheumatic diseases between 1966 and March 2023. Twenty-eight articles have been selected for review. Most of them (n=13) were on fibromyalgia and all of them but one showed important reduction in pain; sleep and mood also improved. On rheumatoid arthritis, two papers displayed decrease in pain and in one of them a reduction in inflammatory parameters was found. In scleroderma there was a case description with good results, one study on local use for digital ulcers also with good outcomes and a third one, that disclosed good results for skin fibrosis. In dermatomyositis a single study showed improvement of skin manifestations and in osteoarthritis (3 studies) this drug has demonstrated a good analgesic effect. Several surveys (n=5) on the general use of cannabis showed that rheumatological patients (mixed diseases) do use this drug even without medical supervision. The reported side effects were mild. In conclusion, cannabis treatment is an interesting option for the treatment of rheumatological diseases that should be further explored with more studies.

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