ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of İstanbul - North Clin Istanb: 6 (1)
Volume: 6  Issue: 1 - 2019
RESEARCH ARTICLE
1. Effect of exercise doses on functional recovery in neonatal brachial plexus palsy: A randomized controlled study
Nilay Sahin, Ali Yavuz Karahan
PMID: 31180384  PMCID: PMC6526989  doi: 10.14744/nci.2017.29200  Pages 1 - 6
INTRODUCTION: The aim of this study was to examine how much recovery upper obstetric brachial plexus palsy (OBPP) patients showed with exercises when they were 3, 6, and 12 months old and to evaluate whether the exercise treatment given at different frequencies contributes to this recovery or not.
METHODS: This study was designed as a randomized controlled trial. Sixty cases who were referred to Pediatric Rehabilitation and Pediatric Orthopedic Clinics with the diagnosis of having Groups I and II OBPP according to Narakas classification were included in the study. Subjects were randomly divided into two treatment groups. The first group had intense exercise program 3 times daily, and the second group had a standard exercise program once in a day. The subjects were assessed using a passive-active range of motion (ROM) and hospital for sick children muscle grading system at their first clinic visit and every month after until they became 12 months old.
RESULTS: In both groups, a significant recovery was observed in ROM and muscle strength of all movements of the shoulder, elbow flexion, and forearm supination at the 3rd, 6th, and 12th-month reassessments, whereas a significant difference was not achieved on both parameters between two groups.
DISCUSSION AND CONCLUSION: According to the results, exercise frequency did not affect the recovery rate and results in the cases with OBPP and exercises were influential against possible complications that may occur.

2. Why some pregnant women refuse glucose challenge test? Turkish pregnant women’s perspectives for gestational diabetes mellitus screening
Meryem Hocaoglu, Abdulkadir Turgut, Kadir Guzin, Oguz Devrim Yardimci, Taner Gunay, Ergul Demircivi Bor, Esra Akdeniz, Ates Karateke
PMID: 31180376  PMCID: PMC6526983  doi: 10.14744/nci.2018.37167  Pages 7 - 12
INTRODUCTION: Diabetes in pregnancy is associated with several adverse outcomes for both mother and baby. Awareness is the first step toward identifying pregnant women with diabetes. The purpose of this study was to assess Turkish pregnant women’s opinion and practice about 50-g glucose challenge test (GCT) and to assess the reasons why some of them refuse the test.
METHODS: This study was conducted on 312 patients at any age and gestational week in Istanbul, Turkey, by a personal interview using self-created questionnaire. Women were asked about their opinion and practice about 50-g GCT.
RESULTS: Among women who were ≤28 weeks of gestation, 42.5% (n=82/193) exhibited their desire to have a GCT in their ongoing pregnancy, 40.9% (n=79/193) pointed out their reluctance, and 16.6% (n=32/193) indicated that they had no opinion about the subject. Women who were ≤28 weeks of gestation and did not want to have GCT, were asked to explain the reasons of their reluctance. The most frequently indicated reason was the belief that GCT is harmful for their babies and themselves (n=62/79, 78.5%). Of the women who were >28 weeks of gestation, 37.8% (n=45/119) had GCT in the ongoing pregnancy, while 62.2% (n=74/119) did not have GCT. The most frequently indicated reason why women did not have a GCT was the belief that GCT is harmful for themselves and the baby (n=37/74, 50%).
DISCUSSION AND CONCLUSION: This study exposes an important problem - misinformation about 50-g GCT - that carries a dangerous potential for missing the diagnosis of gestational diabetes. Study findings put forth the need for raising awareness among pregnant women and training health-care professionals about the subject.

3. Assessment of health-promoting lifestyle behaviors of adults living in the semi-rural area
Hatice Aygar, Sevil Akbulut Zencirci, Gulsum Ozturk Emiral, Melike Alaiye, Aziz Soysal, Muhammed Fatih Onsuz, Burhanettin Isikli, Selma Metintas
PMID: 31180385  PMCID: PMC6526993  doi: 10.14744/nci.2017.19327  Pages 13 - 20
INTRODUCTION: The aim of the present study was to determine the level of healthy lifestyle behaviors and related factors in the individuals who applied to the primary health-care center.
METHODS: The study is a cross-sectional study of adults aged 18 years and over who applied to the primary health-care center. The sample size of the study was calculated as 992 people and 995 participants were accessible. The health-promoting behaviors of the individuals were assessed by the Health-Promoting Lifestyle Profile II (HPLP-II). In the analysis of the data, Mann–Whitney U-test, Kruskal–Wallis tests, and multiple linear regression analysis were used to determine effective variables on scale score.
RESULTS: The mean age of the participants was 43.8±17.1. Of the total participants, 45.7% (n=455) of them were female. The median score obtained from the HPLP-II was 132. Health responsibility, nutrition, and interpersonal relations subscale scores of male were lower than female patients, while physical activity subscale scores were higher in male patients. In participants under the age of 48 years in the study, health responsibility, nutrition, interpersonal relations, and stress management subscale scores were higher. The scores of the married participants were higher than the areas out of the stress management subdimension. Stress management subscale scores were higher in individuals with primary and lower education levels in terms of health care, nutrition, and interpersonal relations. Those who had good family income status and health perception scores also received higher scores in terms of all subscale scores.
DISCUSSION AND CONCLUSION: Gender, age group, marital status, education level, income level, physician-diagnosed chronic disease history, and perceived health status were found to be related to health-promoting behaviors. Educational programs should be prepared in these issues by determining the issues that individuals are lacking in protecting and developing their health and social needs should be taken into consideration when these programs are being prepared.

4. Is high level of hemoglobin A1C an indicator for extended period of antibiotherapy in diabetic foot ulcers?
Mustafa Dogan, Lutfi Cagatay Onar, Bilgehan Aydin, Seyit Ali Gumustas
PMID: 31180382  PMCID: PMC6526988  doi: 10.14744/nci.2018.25582  Pages 21 - 27
INTRODUCTION: Diabetic foot ulcers are the most common cause of hospitalization among the diabetic complications. Hemoglobin A1C (HbA1C) has a critical role in medical follow-up of diabetic patients. In fact, the role of HbA1C and related clinical parameters has been investigated in literature there are only a few studies investigating the relationship between HbA1C and the prolonged antibiotherapy. We aim to reveal the reciprocal relationship between this two parameters.
METHODS: The clinical data of 139 patients who admitted with diabetic foot ulcers are analyzed retrospectively. Besides the demographic information, the levels of HbA1C wound localizations, the degree of the wounds regarding the Wagner classification, culture antibiogram, and the duration of the antibiotic agents. The data have been analyzed with IBM SPSS Statistics (IBM Statistical Package for the Social Sciences) for Windows 22.0.
RESULTS: The clinical data of the 139 diabetic foot patients are retrospectively assessed. The mean age was 56.50 (±4.12). There were 81 male (58.27%) and 58 (41.73%) female patients. The distal type diabetic foot ulcers were found to be the most frequent type (n=83, 59.71% [±3.12]). The mean HbA1C level was 9.60 (±1.10). The “7–15%” subgroups of HbA1C level patients showed statistically significant prolongation of the antibiotherapy time (p<0.01).
DISCUSSION AND CONCLUSION: The results showed that the higher levels of HbA1C have a significant effect on treatment duration and formation of deeper and larger wounds with advanced stages of Wagner classification. This result may reveal the importance of the exact starting time of the treatment besides the proper glycemic control. Lager scaled studies may clarify the credited parameters related to diabetic foot ulcers for a reinterpretation of the issue.

5. The relationship between vitamin D level and hepatosteatosis in obese children
Fatma Dursun, Nelgin Gerenli, Seyma Meliha Su Dur, Heves Kirmizibekmez
PMID: 31180389  PMCID: PMC6526990  doi: 10.14744/nci.2018.26097  Pages 28 - 32
INTRODUCTION: The increasing incidence of obesity in children is a significant risk factor for nonalcoholic fatty liver disease and obesity-associated morbidity. In the present study, we aimed to explore the correlation between Vitamin D level and hepatosteatosis in obese children.
METHODS: A total of 110 children aged 10–16 years who presented to pediatric endocrinology outpatient clinic for obesity were enrolled. The study was completed in a single season between September and November. Hepatosteatosis was diagnosed by ultrasonography. The patients were grouped into two groups: Group 1 comprised patients with hepatosteatosis and Group 2 consisted of patients without hepatosteatosis. 25 hydroxy (25-OH) Vitamin D levels were compared between patients with and without hepatosteatosis.
RESULTS: No statistically significant difference was observed between 25-OH Vitamin D levels of patients with and without hepatosteatosis. When the effects of age and sex were kept constant, there was no significant correlation between Vitamin D level and aspartate aminotransferase, alanine aminotransferase, and body mass index values.
DISCUSSION AND CONCLUSION: Unlike the results of the previous studies, we were unable to detect any significant difference between Vitamin D levels of obese patients with and without hepatosteatosis. We think that obesity, rather than Vitamin D status, that is, in fact, independently associated with nonalcoholic fatty liver disease. Larger studies are needed to investigate the impact of Vitamin D in children with obesity with hepatosteatosis.

6. Hair whitening and obesity are independently related to ascending aorta dilatation in young-middle aged men
Mustafa Cetin, Emrah Bozbeyoglu, Turan Erdogan, Sinan Altan Kocaman, Omer Satiroglu, Murtaza Emre Durakoglugil
PMID: 31180373  PMCID: PMC6526979  doi: 10.14744/nci.2017.43433  Pages 33 - 39
INTRODUCTION: Hair whitening (HW) is strongly linked with aging. Ascending aortic dilation (AAD) and HW share common etiologic factors. We investigated the association of HW with ascending aortic diameters.
METHODS: Our study included 93 male subjects aged below 50 years. All patients underwent echocardiography to measure ascending aortic diameter, in addition to routine biochemistry tests, physical examination, and thorough medical history. HW score (HWS) was defined according to the percentage of white hair (HWS 1: <25%; HWS 2: 25–50%; HWS 3: 50–75%; and HWS 4: 75–100).
RESULTS: Patients with highest HWS were older and had a higher percentage of hypertension (HT) and family history of HW. Moreover, this subgroup had increased ascending aortic diameter, higher serum uric acid, and lower total bilirubin concentrations. Multivariate analyses including age, HT, height, waist circumference, c-reactive protein, and family history of HW identified body weight and HWS as the independent predictors of ascending aortic diameter.
DISCUSSION AND CONCLUSION: An independent association between the degree of HW and AAD exists in middle-aged men, which may depend on coexisting factors that enhance both pathologies rather than causality. We think that oxidative stress may be one of these stressors.

7. Relation of multicenter automatic defibrillator implantation trial implantable cardioverter-defibrillator score with long-term cardiovascular events in patients with implantable cardioverter-defibrillator
Abdulkadir Uslu, Cem Dogan, Hakan Duman, İbrahim Halil Tanboga, Lutfu Askin, Serdar Sevimli
PMID: 31180377  PMCID: PMC6526984  doi: 10.14744/nci.2018.69335  Pages 40 - 47
INTRODUCTION: To test the hypothesis that multicenter automatic defibrillator implantation trial (MADIT) - implantable cardioverter-defibrillator (ICD) scores predict replacement requirement and appropriate shock in a mixed population including both primary and secondary prevention and long-term adverse cardiovascular events.
METHODS: The study has a retrospective design. Patients who were implanted with ICD in the cardiology clinic of Atatürk University Faculty of Medicine between 2000 and 2013 were included in the study. For this purpose, 1394 patients who were implanted with a device in our clinic were reviewed. Then, those who were implanted with permanent pacemaker (n=1005), cardiac resynchronization treatment (CRT) (n=45) and CRT-ICD (n=198) were excluded.
RESULTS: A total of 146 patients (98 males, 67.1%) with a mean age of 61.1 (±14.8) years were recruited. The median follow-up time was 21.5 months (mean 30.6±25.9 months; minimum 4 months, and maximum 120 months). The median MADIT-ICD scores in the patients were 2. MADIT-ICD scores were categorized as low in 15.1%, intermediate in 57.5%, and high score in 27.4% of patients. Accordingly, MADIT-ICD scores (1.29 [1.00–1.68], p=0.050), hemoglobin (0.86 [0.75–0.99], p=0.047), and left ventricular ejection fraction (EF) (0.97 [0.94–0.99], p=0.023) were determined as independent predictors of major adverse cardiovascular events in the long-term follow-up of ICD-implanted population.
DISCUSSION AND CONCLUSION: In this study, we showed that there was an independent association of long-term adverse cardiovascular events with MADIT-ICD score, hemoglobin, and EF in patients implanted with ICD.

8. Validation of a smartphone-based electrocardiography in the screening of QT intervals in children
Mehmet Karacan, Nida Celik, Enes Elvin Gul, Celal Akdeniz, Volkan Tuzcu
PMID: 31180383  PMCID: PMC6526985  doi: 10.14744/nci.2018.44452  Pages 48 - 52
INTRODUCTION: A 12-lead electrocardiography is a critical component for the screening of long QT syndrome; however, besides, an electrocardiograph, trained personnel are also necessary which limits the screening capability of conventional electrocardiographs. The development of smartphone electrocardiography technologies provides a potential alternative platform for electrocardiography screening for selective purposes such as arrhythmias and QT interval abnormalities. The aim of this pilot study was to assess the reliability of a smartphone-based electrocardiography device in the measurement of QT and corrected QT intervals in children.
METHODS: In all participants, 10-s smartphone electrocardiography tracing from AliveCor device and a standard 12-lead electrocardiograph were obtained simultaneously. Two pediatric electrophysiologists performed the measurements of QT and corrected QT intervals in a blinded manner with Bazett’s formula. The results were compared statistically.
RESULTS: A total of 285 children (mean age 9.8±4.9 years) who presented to our clinic were included in the study. The mean QT intervals obtained from 12-lead electrocardiographs and AliveCor devices were 343±40 ms and 340±41 ms, respectively. The mean corrected QT intervals obtained from 12-lead electrocardiographs and AliveCor devices were 419±28 ms and 415±33 ms, respectively. There was high correlation between the QT intervals of 12-lead electrocardiographs and AliveCor recordings (Pearson’s correlation coefficient: 0.83 [p<0.001]) and significant correlation between the corrected QT intervals of 12-lead electrocardiographs and AliveCor recordings (Pearson’s correlation coefficient: 0.57 [p<0.001]).
DISCUSSION AND CONCLUSION: AliveCor recordings can accurately detect QT intervals and can potentially be used for the screening of congenital long QT syndrome in children.

9. Efficiency of inferior petrosal sinus sampling in the diagnosis of Cushing’s disease and comparison with magnetic resonance imaging
Tumay Bekci, Umit Belet, Aysegul İdil Soylu, Fatih Uzunkaya, Mesut Ozturk, Aysegul Atmaca
PMID: 31180374  PMCID: PMC6526980  doi: 10.14744/nci.2018.83584  Pages 53 - 58
INTRODUCTION: The purpose of this study is to assess the efficiency of inferior petrosal sinus sampling (IPSS) in the diagnosis of adrenocorticotropic hormone-dependent Cushing’s disease and to compare it with magnetic resonance imaging (MRI).
METHODS: The diagnostic efficiency of IPSS in the differentiation of pituitary Cushing’s disease from ectopic Cushing’s disease was retrospectively evaluated in 37 patients who had IPSS in our clinic. Six patients were excluded from the study due to missing data. Hypophysis MRI examinations of 31 patients before IPSS were also evaluated. The contributions of MRI and IPSS to the detection of pituitary adenoma and the determination of lateralization were researched.
RESULTS: Bilateral IPSS was successfully performed in 30 patients of the 31 patients in the study group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of IPSS in differentiating between central and ectopic Cushing’s syndrome before corticotrophin-releasing hormone (CRH) stimulation were 93.3%, 100%, 100%, 33.3%, and 93%, respectively, whereas after CRH stimulation were 100%, 100%, 100%, 100%, and 100%, respectively. The accuracy of both the rates was significantly higher compared with MRI.
DISCUSSION AND CONCLUSION: IPSS has the highest diagnostic efficiency in differentiating central Cushing’s disease from ectopic Cushing’s disease.

10. An evaluation of magnetic resonance imaging with histogram analysis in patients with idiopathic subjective tinnitus
Murat Baykara, Saime Sagiroglu
PMID: 31180375  PMCID: PMC6526986  doi: 10.14744/nci.2018.72593  Pages 59 - 63
INTRODUCTION: Tinnitus is defined as the perception of sound in the ears without any acoustic stimulus. It has still not been determined whether tinnitus originates peripherally, centrally, or from several locations. The aim of the study was to determine any possible cochlear pathology in patients with normal hearing and tinnitus of unspecified etiology.
METHODS: The study included 22 patients who presented at the clinic with the complaint of idiopathic subjective tinnitus that had been ongoing for at least 1 year. A total of 44 ears were included; 28 with tinnitus and 16 healthy ears. Unilateral tinnitus was determined in 16 patients and bilateral in six patients. The temporal magnetic resonance imaging (MRI) and audiogram results of the patients were retrieved from the hospital records. The MRI histogram measurement was made automatically and calculated for each ear separately.
RESULTS: Entropy was found to be significantly higher in the control group and distribution was lower (p>0.01). In the tinnitus group, distribution was found to be broader, and kurtosis was statistically significantly greater (p<0.001).
DISCUSSION AND CONCLUSION: MRI histogram analysis can be considered as a method to be used in the clinical evaluation of the determination of possible cochlear pathology in ears with tinnitus.

11. Effects of weapon types, interventions, and transport times on complications in combat injuries to musculoskeletal system
Rahman Senocak, Huseyin Tas, Orhan Ureyen, Sahin Kaymak, Oguz Hancerliogullari
PMID: 31180379  PMCID: PMC6526995  doi: 10.14744/nci.2018.09225  Pages 64 - 68
INTRODUCTION: To analyze the effects of weapon type, medical interventions, and transportation time on complications due to combat-related injuries of the musculoskeletal and soft tissue (ST).
METHODS: A total of 108 patients treated at the emergency department (ED) over a period of 3.5 years were included in this study. The effects of weapon type, type of first intervention team, interventions at the ED, and transport time on complications were compared by retrospectively assessing patients’ recorded data.
RESULTS: The average age of 108 patients with ST injuries was 24 years. 25 patients developed complications. The ratio of complications in patients with injuries from explosive weapons was 25.42% and was significantly greater (p<0.05) than the rate observed from non-explosive weapons. Regarding the transport time of patients reaching the hospital, the greatest complication rate was 30.77% in patients transported to the hospital in 2–4 h; this rate was significantly (p<0.05) greater than for those transported in other time ranges. Regarding the ED procedures, the complication rate was 37.50% and significantly higher (p<0.05) in the group that received debridement + irrigation + late primary repair.
DISCUSSION AND CONCLUSION: Transporting the injured to the ED within the first 2 h, treatment including irrigation and debridement, and secondary healing following explosive injuries containing contamination and dead tissue appear to be good options for reducing complications.

12. Abnormal Pap smear frequency and comparison of repeat cytological follow-up with colposcopy during patient management: the importance of pathologist’s guidance in the management
Erol Arslan, Fulya Gokdagli, Halenur Bozdag, Dogan Vatansever, Michael Karsy
PMID: 31180371  PMCID: PMC6526981  doi: 10.14744/nci.2018.93270  Pages 69 - 74
INTRODUCTION: Cervical cancer contributes to a significant global health burden with room for improvement of primary prevention methods. This study aimed to determine the prevalence of Turkish women with abnormal cytology and their management by comparing results from repeat cytological analysis with close follow-up and colposcopy.
METHODS: A retrospective evaluation of 8738 women who underwent Pap smears at a single institution during 2011 was performed. Either repeat cytological analysis or colposcopic biopsy was used for follow-up evaluation of women who had abnormal index cytology.
RESULTS: From the 8670 women, 8259 of had normal cytology results (95.3%) and 411 women had abnormal cytology (4.7%) in the index Pap smear. The frequency of initial abnormal cytology was 65% (n=267), 27% (n=111), 3.4% (n=14), 2.4% (n=10), 1.9% (n=8), and 0.3% (n=1) for atypical squamous cell of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), ASC cannot exclude high-grade intraepithelial lesion (ASC-H), high-grade SIL (HSIL), atypical glandular cells (AGC), and invasive cancer, respectively. Of the 267 women with initial ASCUS, 108 (40.4%) underwent repeat cytology analysis, 84 (31.5%) underwent colposcopic biopsy, and 75 (28.1%) were lost to follow-up. On histopathology, 8.3% (n=7) of patients had cervical intraepithelial neoplasm 2 (CIN2) on colposcopy. Of 60 women with LSIL that underwent colposcopic biopsy, 13.3% (n=8) had CIN2/3.
DISCUSSION AND CONCLUSION: The results of the study suggest that routine cytological follow-up may be an appropriate method in the management of ASCUS instead of immediate colposcopy while immediate colposcopy cannot place repeat cytology for LSIL in developing countries.

CASE REPORT
13. Sacroiliitis during isotretinoin treatment: Causal association or coincidence?
Ece Aydog, Gulcan Ozturk, Asuman Comert, Neslihan Tasdelen, Ozlem Akin, Duygu Geler Kulcu
PMID: 31180372  PMCID: PMC6526982  doi: 10.14744/nci.2018.93798  Pages 75 - 80
Isotretinoin, a retinoid derivate used in acne treatment, has a variety of side effects involving the musculoskeletal system; however, sacroiliitis is rarely observed. Our aim was to present nine cases of sacroiliitis in patients being treated with isotretinoin. Sacroiliitis was identified and monitored using magnetic resonance imaging (MRI). Clinical symptoms were resolved with nonsteroidal anti-inflammatory drug therapy after isotretinoin treatment was ceased. Different from the other cases, follow-up MRI was done. Follow-up MRI revealed improvement in some patients. Although the association between isotretinoin therapy and sacroiliitis has been covered in literature, this association is not yet completely understood. We aimed to discuss the relationship between two.

14. Phytocontact dermatitis due to Ranunculus arvensis: Report of three cases
İsa An, Derya Ucmak, Mustafa Esen, Ozlem Devran Gevher
PMID: 31180380  PMCID: PMC6526994  doi: 10.14744/nci.2018.93695  Pages 81 - 84
Ranunculus arvensis (R. arvensis) is a member of the Ranunculaceae family and is often used by advanced age women living in rural areas for the topical treatment of arthralgia, myalgia, hemorrhoid, and warts. Protoanemonin is a substance found in the fresh leaves of the plants from the Ranunculaceae family and leads to contact dermatitis. In this report, we present three cases that developed phytocontact dermatitis caused by the topical use of R. arvensis as an alternative treatment method for arthralgia and palmoplantar psoriasis.

15. Ectopic Cushing’s syndrome due to adrenocorticotropic hormone secreting atypical thymic carcinoid tumor
Cevdet Duran, Meryem Ilkay Eren Karanis, Suleyman Bakdik, Uysaler Aslan, Mustafa Calik, Saniye Goknil Calik
PMID: 31180388  PMCID: PMC6526992  doi: 10.14744/nci.2018.53244  Pages 85 - 88
Cushing’s syndromes (CS) due to thymic carcinoids are rarely seen. In this text, a case with CS due to ectopic adrenocorticotropic hormone (ACTH) secreting atypical thymic carcinoid tumor is presented. A 50-year-old Turkish male patient was admitted to our emergency department with typical CS features. Basal hormone profile, low- and high-dose dexamethasone suppression tests, and inferior petrosal sinus sampling results were consistent with ectopic ACTH secretion. Thorax computerized tomography showed an upper mediastinal mass, and trans-thoracic biopsy showed atypical thymic carcinoid with positive ACTH staining. Since the vascular invasion was detected, tumor was accepted inoperable; somatostatine receptor analogs, chemotherapy, and radiotherapy were planned. Ectopic CS can be derived from atypical thymic carcinoid. In this case, ACTH staining was used to confirm ACTH secretion from thymic tissue, and positive staining was detected. ACTH staining routinely was not performed for extra hypophyseal tissue tumors. In suspicious and difficult cases, ACTH staining can be helpful to confirm the presence of ACTH in tumor tissues.

16. Transurethral excision and re-erosion of mesh material after transobturator tape surgery: A case report
Sener Gezer, Harun Levent Gulculer
PMID: 31180378  PMCID: PMC6526978  doi: 10.14744/nci.2018.46704  Pages 89 - 92
Bladder injury is a rare complication of transobturator tape surgery. Herein, we present a female case in whom intravesical mesh was excised using transurethral endoscopic scissors, and another floating mesh material with calculi formation was seen in bladder and excised with endoscopic forceps 2 months later.

REVIEW
17. Diagnosis and treatment of urticaria in primary care
Melek Aslan Kayiran, Necmettin Akdeniz
PMID: 31180381  PMCID: PMC6526977  doi: 10.14744/nci.2018.75010  Pages 93 - 99
Urticaria, also known as hives among people, is a very common disease characterized by erythematous, edematous, itchy, and transient plaques that involve skin and mucous membranes. It is classified as acute spontaneous urticaria, chronic spontaneous urticaria, chronic inducible urticaria, and episodic chronic urticaria. Many factors such as infections, medicines, food, psychogenic factors, and respiratory allergens are accused of etiology, but sometimes, it is idiopathic. Clinical presentation involves red, swelling, and itchy plaques. The lesions usually resolve spontaneously within 2–3 h without a trace. The patients are sometimes confronted with an angioedema that can also involve the respiratory tract. In this case mucous membranes, such as eyelids, lips, swell with some pain and burning sensation. If respiratory tracts are involved, it may be life threatening and should be treated urgently. The diagnosis is usually straightforward, urticarial vasculitis, drug eruptions, viral eruptions, and urticaria pigmentosa must also be considered. H1 antihistamines and, sometimes, short-term systemic corticosteroids are preferred for the treatment; H2 antagonists may be added during resistant cases, although other treatment options, such as omalizumab, cyclosporine, and leukotriene receptor antagonists, may be considered during missed events.

LETTER TO THE EDITOR
18. The therapeutic dilemma of peripartum cardiomyopathy
Murat Biteker, Cem Cil, Oguzhan Celik, Aysel Gokcek, Kadir Kayatas
PMID: 31180387  PMCID: PMC6526987  doi: 10.14744/nci.2018.54938  Pages 100 - 101
Abstract |Full Text PDF

19. Peripartum cardiomyopathy and thrombotic complications
Ugur Aksu, Selim Topcu, Oktay Gulcu, Ibrahim Halil Tanboga
PMID: 31180386  PMCID: PMC6526991  doi: 10.14744/nci.2018.54815  Page 102
Abstract |Full Text PDF

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