E-ISSN 2980-2156
Formerly
Erciyes Medical Journal
Volume : 45 Issue : 6
JOURNAL OF CLINICAL PRACTICE AND RESEARCH - J Clin Pract Res: 45 (6)
Volume: 45  Issue: 6 - 2023
SYSTEMATIC REVIEW
1.After the 2023 Earthquake in Turkiye: An Assessment of Post-Earthquake Psychological Resilience in Children and Adolescents - A Systematic Review
Melike Kevser Gül, Sevgi Özmen, Esra Demirci
doi: 10.14744/cpr.2023.14633  Pages 539 - 548
Psychiatric disorders can be observed in children and adolescents following an earthquake, with both risk factors and protective factors influencing the development of these disorders. This review aims to compile studies examining the relationship between earthquakes and resilience in children and adolescents after the earthquake disaster in Türkiye. 113 articles were identified using the PubMed database and relevant keywords. After excluding irrelevant studies, 24 that were related to the topic were included in the review. 66.6% of the studies were conducted in China, with 41.6% of total studies having a longitudinal design. In our country, no study was found in this context. Resilience levels were lower in females than males. Resilience was found to be protective against depression, anxiety, and post-traumatic stress disorder, and was positively correlated with social support. High resilience was also associated with significant posttraumatic growth. However, it is not conclusive that all therapy and intervention programs related to resilience are effective. Protecting the mental health of children and adolescents, who are vulnerable and exposed to dangers following an earthquake, is crucial. Identifying protective factors for mental health, particularly resilience, and developing intervention methods for routine and field use to enhance resilience are vital to prevent the development of mental illnesses.

REVIEW
2.Earthquake in Türkiye: Impact on Health Services and Infection Threats
Yavuz Orak, Filiz Orak, Safiye Göçer, Mehmet Doğanay
doi: 10.14744/cpr.2023.59244  Pages 549 - 557
On February 6, 2023, Türkiye experienced two significant earthquakes with magnitudes 7.7 Mw and 7.6 Mw at 04: 17 Türkiye Standard Time (TRT) (01: 17 Coordinated Universal Time (UTC)) and 13: 24 TRT (10: 24 UTC), respectively, centered in Kahramanmaraş. The study aims to review the immediate aftermath of these earthquakes, their impact on health services, and the potential threats of infection due to these catastrophic events in Türkiye. Eleven provinces in the southeastern region of Türkiye, as well as areas in the northwestern region of Syria, suffered severe damage. Aftershocks continue, though with decreasing intensity. Thousands of structures, including crucial infrastructure, were destroyed. Approximately 15 million people in Türkiye and 10.87 million people in Syria were severely affected. About 200.000 people were injured, and more than 50.000 people died due to the earthquakes. Roughly 500.000 people fled from the earthquake-affected region to western cities. The rescue operations were completed within two weeks. The earthquake and its aftershocks, compounded by winter conditions, left thousands of people homeless in the region. Intensive efforts were initiated to address the health care, medicine, shelter, nutrition, sanitation, and other needs of the earthquake victims. In the upcoming days, earthquake survivors may face significant risks of infections, including airborne, food-borne, and water-borne infections, as well as nosocomial infections from resistant bacteria and parasitic infections. Identifying the risk factors that underlie the emergence and transmission of communicable diseases can enhance the development and implementation of more effective preventive measures. Currently, safety, security, mitigation, and infection control activities are essential to help restore daily life in the region.

ORIGINAL ARTICLE
3.Lymph Node Staging by CT Texture Analysis in Patients with Sigmoid Cancer
Mustafa Yıldırım, Murat Baykara
doi: 10.14744/cpr.2023.69775  Pages 558 - 564
Objective: Accurate radiological staging of colon cancer is essential for appropriately selecting patients who might benefit from neoadjuvant chemotherapy. Lymph node staging and the detection of metastatic lymph nodes form an integral part of the local staging. This study aimed to determine the efficacy of computed tomography texture analysis (CTTA) in characterizing lymph nodes in patients with sigmoid cancers.
Materials and Methods: Forty-five patients diagnosed with sigmoid adenocarcinoma, who underwent computed tomography (CT) scans, were included in this retrospective study. Based on post-surgery histopathological results, 25 patients were classified as stage N1-2, and 20 patients were classified as stage N0. CTTA was conducted on 51 metastatic lymph nodes from the 25 N1-2 patients and 30 benign lymph nodes from the 20 N0 patients. Histogram analysis was employed to calculate texture features, and the texture features of both groups were statistically compared. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive performance of the parameters.
Results: The maximum of the histogram, 99th percentile of the histogram, and entropy values were significantly higher in the metastatic lymph nodes. Conversely, skewness, uniformity, and kurtosis values were significantly higher in benign lymph nodes (p<0.05). ROC analysis for uniformity and skewness revealed area under the curve (AUC) values of 0.904 and 0.909, respectively.
Conclusion: In patients with sigmoid cancer, CTTA can serve as a useful tool for lymph node staging.

4.Does Arthroscopic Rotator Cuff Repair Improve Kinesiophobia, Depression, and Spatiotemporal Parameters in the Long Term?
Gülnihal Deniz, Furkan Bilek, Ömer Esmez, Arif Gülkesen, Murat Gürger
doi: 10.14744/cpr.2023.53825  Pages 565 - 574
Objective: This study aimed to investigate the long-term effects on pain, kinesiophobia, depression, functional capacity, balance, mobility, and spatiotemporal parameters in individuals who underwent rotator cuff (RC) surgery.
Materials and Methods: Measurements were conducted on 45 individuals recommended for RC arthroscopy. These included bilateral upper extremity range of motion (ROM), muscle strength, bilateral hand grip strength, spatiotemporal parameters, 9-hole peg test (9-HPT), Beck Depression Inventory (BDI), Tampa Scale of Kinesiophobia (Tampa), Shoulder Pain and Disability Index (SPADI), and Constant-Murley Score. All measurements were taken one week before and six months after the arthroscopic intervention.
Results: Post-RC arthroscopy results showed significant improvements in upper extremity ROM, muscle strength, hand grip strength, 9-HPT, Tampa, BDI, SPADI, and Constant-Murley Score compared to pre-arthroscopy measurements. Spatiotemporal parameters such as total weight transfer, step cycle duration, double stance duration, step length, gait cycle length, foot angle, and cadence values were highly significant in both operated and non-operated extremities after arthroscopic surgery (p<0.01). However, hindfoot pressure analysis and swing phase values were significant only on the operated side after arthroscopic surgery (p<0.05).
Conclusion: Prior to RC arthroscopy, individuals exhibited kinesiophobia, depression, reduced functional capacity, balance asymmetry, decreased mobility, and, consequently, spatiotemporal parameter asymmetry between the extremities. Gait disturbances (lengthened swing phase, decreased step length, increased foot angle), balance loss, and arm sway asymmetry were also evident before RC arthroscopy. Based on these findings, we suggest incor-porating balance and gait training into the early rehabilitation program after RC arthroscopy.

5.Estimation of Genetic Correlation Between Rheumatoid Arthritis and Multiple Sclerosis Using Summary Statistics from Genome-Wide Association Studies
Ragıp Onur Öztornacı
doi: 10.14744/cpr.2023.18209  Pages 575 - 580
Objective: Genome-wide association studies (GWAS) have revolutionized our understanding of the genetic basis of diseases by examining millions of genetic variants across the genome. Rheumatoid arthritis (RA) and multiple sclerosis (MS) are chronic autoimmune diseases characterized by immune system dysregulation and inflammation. Investigating the genetic correlation between RA and MS can provide insights into shared genetic factors, potential mechanisms, and pathways underlying these complex disorders. The objective of this study was to compare different statistical methods to estimate the genetic correlation between RA and MS using GWAS summary statistics.
Materials and Methods: To estimate single nucleotide polymorphism (SNP) heritability and genetic correlation, we utilized two popular methods: Linkage Disequilibrium Score Regression (LDSC) and Linkage Disequilibrium Adjusted Kinship (LDAK) models.
Results: Our analysis revealed a significant, moderate, positive correlation between RA and MS using both LDSC and LDAK (LSDCMS-RA=0.448, LDAKMS-RA=0.387, SpearmanMS-RA=0.0262, p<0.001). Additionally, there were notable differences in heritability estimates between the two methods and the traits. The LDAK model demonstrated higher heritability estimates for the RA-MS relationship ( =0.314) compared to the LDSC ( =0.138).
Conclusion: There is a significant positive genetic correlation between RA and MS, indicating a shared genetic component. Differential heritability estimates from LDAK and LDSC highlight the importance of the method. Genetic overlap informs common pathways and potential therapeutic targets. These findings contribute to the evidence of a moderately positive genetic correlation, emphasizing the need for further research and personalized approaches to managing autoimmune diseases.

6.Do the Proximal Ulnar Angulations Have Correlations with Each Other? Anatomical Study and Review of the Literature
Latif Sağlam, Gkionoul Nteli Chatzioglou, Buse Naz Çandır, Osman Coşkun, Özcan Gayretli
doi: 10.14744/cpr.2023.65365  Pages 581 - 588
Objective: The proximal ulna has a complex and unique architectural anatomy, therefore, its fractures are difficult to manage. This paper aimed to evaluate proximal ulnar angu-lations that contribute to the fixation and restoration of proximal ulna fractures in the Turkish population.
Materials and Methods: This study was performed on 107 Turkish adult ulnae (55 right, 52 left) whose age and sex were unknown. The ulnar length (UL), proximal distance of varus angulation (PDVA), and widths at the point of varus angulation were measured with a digital caliper. The proximal ulna torsion angle (PUTA), varus angulation (VA), proximal ulna dorsal angulation (PUDA), articular angle (AA), and olecranon–diaphysis angle (ODA) were measured with a goniometer. The statistical analysis was carried out at the SPSS 21.0 program (IBM Corporation, Armonk, NY, USA).
Results: The median UL was 251.97 mm (minimum: 196.84 – maximum: 497.76 mm), me-dian PDVA was 82.7 mm (minimum: 16.21 – maximum: 108.62 mm), mean total width was 15.04±1.84 mm, mean posterior-interosseous width was 13.72±2.37 mm and mean posterior-anterior width was 15.15±1.93 mm. The mean PUTA was 27.10°±9.04°, the me-dian VA was 14° (minimum: 5° – maximum: 23°), the median PUDA was 8° (minimum: -3° – maximum: 20°), the median AA was 25° (minimum: 19° – maximum: 39°), and the mean ODA was 17.39°±5.33°. A moderate negative correlation was detected between the PUDA and ODA (rs= -0.50, p<0.001).
Conclusion: The mean proximal ulnar angulations in this study can be beneficial during surgery for the fixation of proximal ulna fractures. This study revealed the correlation be-tween proximal ulnar angulations in the Turkish population.

7.The Effects of an Online Symptom-Based Learning Method Designed to Enhance Clinical Reasoning: A Qualitative Study
Selçuk Akturan, Ayşenur Duman Dilbaz, Bilge Delibalta
doi: 10.14744/cpr.2023.44154  Pages 589 - 598
Objective: The ‘Online Symptom-Based Learning (SBL)’ method was developed to support the clinical decision-making processes of students in clinical years, using the Education Man-agement System (EMS) integrated with Zoom. This research aimed to gather the opinions of students and faculty members about the ‘Online SBL’ method applied during the pandemic.
Materials and Methods: This qualitative study involved 34 faculty members using Online SBL and 267 clinical year students from Karadeniz Technical University Faculty of Medicine. The researchers employed a convenience sampling method and selected volunteers for fo-cus group interviews, including 28 clinical year students and 23 faculty members from dif-ferent departments and clinical courses.
Results: Analysis revealed five main themes upon which the researchers agreed: educators’ previous experiences in clinical reasoning, their experiences with SBL, students’ experiences with SBL, the contributions of SBL to education, and suggestions for improving SBL.
Conclusion: The primary findings indicated that SBL improved clinical reasoning skills, pos-itively affected the educational climate during the pandemic, promoted student-centered thinking among educators, and facilitated interdisciplinary collaboration towards common learning objectives. However, challenges included anxiety associated with conducting SBL online, some educators’ persistence in educator-oriented thinking, and difficulties in group assessments. The Online SBL method could be beneficial not only online but also in face-to-face undergraduate education across all health professions.

8.Fifteen Years of Experience in Ambulatory Blood Pressure Monitoring in Children at a Single Center
Mustafa Şapçıoğlu, Şenay Zırhlı Selçuk, Ahmet Taner Elmas, Yılmaz Tabel
doi: 10.14744/cpr.2023.47965  Pages 599 - 604
Objective: This study was conducted at a tertiary medical center in a region where similar studies had not been previously conducted. It aimed to analyze 15 years of data obtained from the ambulatory blood pressure monitoring (ABPM) program and to address the challenges associated with diagnosing hypertension (HT).
Materials and Methods: This study included 1,859 children aged 5-18 years who were admitted between 2005 and 2020 and diagnosed with HT according to clinical measurements. All necessary demographic and clinical data were collected retrospectively. Measurements were performed using the Mobil-O-Graph device.
Results: A total of 1,859 cases, comprising 1,098 (59.1%) boys and 761 (40.9%) girls, were included in the study. Of these cases, 327 (17.6%) were obese, and 1,532 (82.4%) were of normal weight. According to ABPM data, 30.7% of all cases were normotensive. Additionally, the rate of HT in obese subjects (79.2%) was significantly higher than in non-obese subjects (67.2%). Logistic regression analysis of the study showed that older age, obesity, and being in the diastolic non-dipper group were associated with a higher risk of invalid measurement.
Conclusion: This study emphasizes the high prevalence of white coat HT in children in our region, despite the difficulties related to measurement adequacy, and thus highlights the importance of using ABPM in the diagnosis and follow-up of hypertension.Objective: This study was conducted at a tertiary medical center in a region where similar studies had not been previously conducted. It aimed to analyze 15 years of data obtained from the ambulatory blood pressure monitoring (ABPM) program and to address the challenges associated with diagnosing hypertension (HT).
Materials and Methods: This study included 1,859 children aged 5-18 years who were admitted between 2005 and 2020 and diagnosed with HT according to clinical measurements. All necessary demographic and clinical data were collected retrospectively. Measurements were performed using the Mobil-O-Graph device.
Results: A total of 1,859 cases, comprising 1,098 (59.1%) boys and 761 (40.9%) girls, were included in the study. Of these cases, 327 (17.6%) were obese, and 1,532 (82.4%) were of normal weight. According to ABPM data, 30.7% of all cases were normotensive. Additionally, the rate of HT in obese subjects (79.2%) was significantly higher than in non-obese subjects (67.2%). Logistic regression analysis of the study showed that older age, obesity, and being in the diastolic non-dipper group were associated with a higher risk of invalid measurement.
Conclusion: This study emphasizes the high prevalence of white coat HT in children in our region, despite the difficulties related to measurement adequacy, and thus highlights the importance of using ABPM in the diagnosis and follow-up of hypertension.

9.Evaluation of Potential Drug-Drug Interactions Caused by Antibacterial and Antifungal Drugs in the Intensive Care Unit: A Retrospective Cross-Sectional Study
Şeyda Benligil, Eren Demirpolat, Ayşegül Ulu Kılıç, Kürşat Gündoğan
doi: 10.14744/cpr.2023.02996  Pages 605 - 613
Objective: Antimicrobial drugs are frequently used in the intensive care unit (ICU) and may cause drug-drug interactions (DDIs) which change treatment outcomes. This study aims to determine the frequency of potential DDIs (pDDIs) caused by antimicrobial drugs in the ICU, according to two databases, address the differences between these two databases, discuss the clinical significance of pDDIs and investigate their relationship with clinical outcomes.
Materials and Methods: This study was designed as a 1-year retrospective cross-sectional study. Patients over the age of 18 who used antimicrobials for at least 72 hours were included. pDDIs between other drugs and antimicrobials were checked using the “drug interactions” modules of the Lexicomp and Micromedex databases. Data were collected from the hospital’s records by a clinical pharmacist.
Results: A total of 393 drug profiles were evaluated for 100 patients, of which 84.2% were antibacterial drugs. According to at least one database, 88% of patients had pDDIs. Of these, 62.4% were classified as major according to at least one database. Only 27.3% of pDDIs had the same level of interaction in both databases. Common pDDIs posed risks such as additive nephrotoxicity, excessive sedation, respiratory depression and QT interval prolongation.
Conclusion: pDDIs should be checked not only by one database but by multiple databases, coupled with the input of an experienced clinical pharmacist.

10.Propranolol Treatment Reduces A549-Derived Lung Cancer Spheroids via Intrinsic Apoptosis
Menderes Yusuf Terzi
doi: 10.14744/cpr.2023.37929  Pages 614 - 623
Objective: Propranolol (PRO), a non-selective beta-adrenergic receptor inhibitor, has been recently discovered to possess anti-tumorigenic effects in cancer patients. There-fore, we aimed to investigate the in vitro effects of PRO in A549-derived lung cancer spheroids in terms of cell viability, spheroid formation, cell cycle regulation, cell differen-tiation, and apoptosis.
Materials and Methods: The effect of 24-hour PRO treatment on A549 cell viability was assessed using the 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. A sub-cytotoxic PRO concentration (125 µM) was employed to evaluate its impact on the clonogenicity of A549-derived cancer spheroids after seven days of incubation. Messenger Ribonucleic Acid (mRNA) levels of cell cycle regulators including cyclin-dependent kinase inhibitor 1A (p21) and G2 checkpoint kinase (WEE1), apoptotic markers such as caspases 3, 8, 9 (CASP3, CASP8, CASP9), and stem cell differentiation markers, namely POU class 5 ho-meobox 1 (octamer-binding transcription factor 4 (OCT4)), prominin 1 (CD133), and adenos-ine triphosphate (ATP) binding cassette subfamily G member 2 (ABCG2) were measured us-ing reverse transcription quantitative polymerase chain reaction (RT-qPCR) after a 24-hour treatment of cancer spheroids with PRO.
Results: PRO treatment reduced cell viability and inhibited the clonogenicity of cancer spheroids by activating intrinsic apoptotic markers CASP3 and CASP9, leading to cell cy-cle arrest via increased p21 expression. PRO did not significantly alter stem cell differen-tiation markers.
Conclusion: The proliferation and clonogenic activity of lung cancer spheroids can be ef-fectively suppressed with PRO, primarily through inducing intrinsic apoptosis following p21-mediated cell cycle arrest. While short-term PRO exposure did not affect the gene ex-pression levels of stem cell differentiation markers, the notable decrease in both cell viability and spheroid formation efficiency suggests the potential of PRO as a therapeutic drug in lung cancer treatment.

11.Comparing Pediatric and Adult Primary Chest Wall Tumors
Ömer Faruk Demir, Ömer Önal, Alper Özcan, Ayşe Ülgey, Burcu Baran Ketencioğlu, Mehmet Köse
doi: 10.14744/cpr.2023.07279  Pages 624 - 631
Objective: This study aims to evaluate the differences in surgical interventions and out-comes for primary chest wall tumors in pediatric and adult patient groups.
Materials and Methods: We reviewed records of patients operated on for primary chest wall tumors from January 2005 to June 2019. Patients aged 18 and younger were classified as pediatric (group I), while those above 18 were considered adults (group II). We analyzed demographic characteristics, histopathologic diagnosis, number of resected ribs, prosthet-ics requirements, complications, chemotherapy and radiotherapy applications, and related complications. The Kaplan-Meier method was used to analyze patient survival times, and the log-rank test was employed for comparing survival times between groups.
Results: Of the 71 patients who underwent operations for primary chest wall tumors in our clinic between January 2005 and June 2019, 20 were pediatric (28.2%) and 51 were adults (71.8%). The 5-year overall survival rates for pediatric and adult patients were 72.9% and 68.8%, respectively (p=0.683), while the 5-year disease-free survival rates were 76.0% and 69.0%, respectively, showing no significant differences (p=0.709).
Conclusion: Our findings indicate no significant differences between pediatric and adult primary chest wall tumors regarding disease-free survival times, overall survival rates, and surgical complications.

12.To Determine the LDL Phenotype with Lipids, Lipoproteins, and Apoproteins as well as sdLDL by Association Rule Mining
Mehtap Atak, Mehmet Kıvrak, Hatice Sevim Nalkıran, Hüseyin Avni Uydu, Ömer Şatıroğlu
doi: 10.14744/cpr.2023.09719  Pages 632 - 639
BACKGROUND: The atherogenic lipoprotein phenotype is closely related to determining the risk of Coronary Artery Disease (CAD) and monitoring the treatment process. In particular, it is acknowledged that it is critical not only to have high sdLDL but also to have low lbLDL in determining Pattern B.
OBJECTIVES: The aim of this study was to determine the lipid phenotype using Association Rules Mining (ARM) method based on the concentrations of lipids, lipoproteins, and apoproteins as well as sdLDL.
METHODS: The research type was retrospective; the case-control analytical research method was used. Numerical variables were expressed as mean, standard deviation, median, and min-max values. There is a statistically significant difference between the LDL size categories in terms of TG, LDL, HDL, ApoB, ApoE, sdLDL, and lbLDL distributions. ARM was used to detect lipoprotein phenotype.
RESULTS: There is a statistically significant difference between the LDL size categories in TG, LDL, HDL, ApoB, ApoE, sdLDL, and lbLDL distributions (p_TG<0.001, p_LDL=0.03, p_HDL<0.001, p_ApoB=0.016, p_ApoE=0.004, p_sdLDL< 0.001, and p_lbLDL<0.001). ARM method revealed that the probability of phenotype B was found to be 100% for values in the range of 15.5-109 and 0-31.5 for sdLDL and lbLDL, respectively.
CONCLUSIONS: This study presents a current approach to the detection of lipoprotein phenotypes using ARM, and further supports the close relationship between atherogenic phenotype and sdLDL.

CASE REPORT
13.A Case of Intravascular Myopericytoma Located in the Neck
Deniz Bayçelebi, Levent Yıldız
doi: 10.14744/cpr.2023.54264  Pages 640 - 643
Background: Myopericytomas are rare tumors originating from perivascular myoid cells, with overlapping features of glomus tumors and myofibromas.
Case Report: We present a case of intravascular myopericytoma, a rare variant of myopericytomas, with a mass located in the neck. This case is accompanied by a review of the rel-evant literature discussing its histomorphological and immunohistochemical features. In histopathology, this tumor is characterized by spindle or epithelioid cells that surround the vessels in a concentric pattern.
Conclusion: While these tumors most commonly occur in extremities, they are rarely seen in the head, neck, and trunk. Even though they are generally considered benign, it’s import-ant to note that cases showing increased mitotic activity, recurrence, and metastasis have been reported.

14.A Rare Complication of Diabetes Mellitus: Bruns-Garland Syndrome (Diabetic Amyotrophy)
Fidel Demir, Esref Akıl
doi: 10.14744/cpr.2023.88598  Pages 644 - 647
Background: Diabetic amyotrophy, also known as diabetic proximal neuropathy, is a rare neuropathic complication of diabetes mellitus. It is most commonly characterized by severe pain in the hip and thigh, followed by asymmetric weakness and wasting of the proximal muscles of the lower limbs.
Case Report: This paper presents the case of a 68-year-old man with an 8-month history of poorly controlled Type-2 diabetes mellitus who developed progressive asymmetrical weak-ness and atrophy in his left thigh. After a physical examination, magnetic resonance imag-ing, and electrophysiological studies, diabetic amyotrophy was diagnosed.
Conclusion: Physicians should consider the possibility of diabetic amyotrophy in patients with diabetes mellitus who exhibit primary involvement of proximal muscles of the lower limbs, marked by pain, weakness, and atrophy.

15.The Nightmare of the Gastroenterologist: Bleeding Duodenal Varices
Idris Kurt
doi: 10.14744/cpr.2023.54154  Pages 648 - 650
Background: The management of hemorrhage from duodenal varices remains controversial. Available treatment methods include endoscopic, radiological, and surgical techniques, with endoscopic therapy being the most commonly used modality.
Case Report: We describe a case of a patient who underwent band ligation for large duo-denal varices. Hemostasis was achieved for forty-eight hours, but the patient later suffered from severe rebleeding. Tragically, the patient passed away after surgical salvage treatment due to decompensation and infection.
Conclusion: In light of a review of pertinent literature, we advise against the sole use of endoscopic band ligation for large varices. It should be complemented with other treatment modalities, ideally radiological interventions such as transjugular intrahepatic porto-systemic shunt or transvenous obliteration.

16.Skull Base Osteomyelitis Complicating COVID-19: A Novel Secondary Infection?
Emel Tahir, Heval Can Bilek, Emre Demirel, Sinan Atmaca
doi: 10.14744/cpr.2023.77486  Pages 651 - 654
Background: Data from the onset of the Coronavirus Disease 2019 (COVID-19) pandemic has revealed a broad spectrum of clinical conditions and comorbidities. Secondary infec-tions, such as sinonasal mucormycosis, have become more frequent due to COVID-19-related immunosuppression and its subsequent treatments. Skull base osteomyelitis is another potentially fatal infection that is prevalent among immunocompromised individuals. An-giotensin-Converting Enzyme 2 (ACE2) receptors in the external auditory canal may also be implicated in cases of external otitis linked to COVID-19.
Case Report: This report discusses two cases of treatment-resistant external otitis and skull base osteomyelitis in two elderly, immunosuppressed patients (with diabetes mellitus and chronic renal failure) who had previously been treated for COVID-19. In both cases, neither topical nor intravenous antibiotic treatments were effective, leading to referrals for hyper-baric oxygen therapy.
Conclusion: For patients exhibiting persistent ear discharge and a history of COVID-19, it is imperative to avoid underestimating a potential diagnosis of skull base osteomyelitis and to pursue early imaging.

HISTORY OF MEDICINE
17.Whipple of Whipple’s Triad
Tomás González-Vidal, Elias Delgado, Edelmiro Menéndez Torre
doi: 10.14744/cpr.2023.03511  Pages 655 - 657
Allen Oldfather (A. O.) Whipple (1881–1963) is renowned for giving rise to two medical ep-onyms: Whipple’s Triad, for the diagnostic criteria in hypoglycemia, and Whipple’s proce-dure, for the cephalic duodenopancreatectomy. Notably, A. O. Whipple’s life coincided with that of the unrelated George Hoyt Whipple, who is credited with the third eponymous Whip-ple in medicine – Whipple’s disease, or intestinal lipodystrophy. Nearly a century after its first description, Whipple’s Triad continues to be a valuable tool, comprising a set of symptoms and laboratory data that raise the clinical suspicion of hypoglycemia resulting from endog-enous hyperinsulinism.

OTHER
18.Reviewer Index

Pages 658 - 661
Abstract |Full Text PDF

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