E-ISSN 2980-2156
Erciyes Medical Journal
Volume : 45 Issue : 5
Volume: 45  Issue: 5 - 2023
1.Current Advances in Breast Cancer: Implications for Developing New Treatment Strategies Through Epi-Drugs on the Road to Modifying the Epigenome
Sercan Kenanoglu, Emine Berrin Yüksel, Munis Dundar
doi: 10.14744/cpr.2023.08208  Pages 427 - 434
Breast cancer is one of the most commonly diagnosed neoplasms affecting women world-wide, and it remains a leading cause of both mortality and morbidity. While genetic pre-disposition plays a critical role in the development of this neoplasm, significant epigenetic dysregulations accompany existing variants. The emergence of acquired drug resistance to current chemotherapeutics poses a significant challenge in managing therapy. However, progress has been made in developing novel agents that directly target epigenetic modi-fications. These agents, called “epi-drugs,” can be used alone in the clinic or in combination with current treatment regimens, offering the potential to create diversified effects on the disease’s predictive process. Within the scope of this review, general information about the major epigenetic dysregulations in breast cancer will be provided, and their effects on the molecular mechanisms in the carcinogenesis process will be discussed. Furthermore, cur-rent treatment approaches for breast cancer will be explored, classifying these epi-drugs, such as DNA methyltransferase inhibitors (DNMTIs), histone deacetylase inhibitors (HDA-CIs), histone acetyltransferases (HATIs), and others that have been developed to target these mechanisms. Predictions regarding the future prospects of these epi-drugs are highlighted, and their contributions to the field of personalized medicine are emphasized based on the results obtained from clinical studies.

2.Metagenomic Profiling of Human Protozoan Parasites in Wastewater and Hospital Effluents
Aycan Gundogdu, Arzuv Charyyeva, Ozkan Ufuk Nalbantoglu
doi: 10.14744/cpr.2023.10820  Pages 435 - 446
Objective: Advancements in metagenomic techniques have provided new tools for profiling human parasites in environmental matrices such as wastewater. This study aimed to profile protozoan parasites in wastewater from a major city, rural area, and hospital in Kayseri, Türkiye, using metagenomic techniques.
Materials and Methods: Shotgun metagenome sequencing was conducted on ten water samples collected from five sampling sites over a two-week period. The sequences were aligned to 80 human parasite genomes to evaluate the presence and relative abundance of each parasite species. A comparative bioinformatic analysis was performed on the metagenomes from each sampling point.
Results: The diversity of parasites in the city wastewater exceeded that of the rural and hospital sampling points. Blastocystis spp. subtypes and Giardia intestinalis were dominant in rural wastewater, while Plasmodium falciparum, Plasmodium ovale, Toxoplasma gondii, and Acanthamoeba species showed significant abundance in hospital effluent (p<0.01). Moreover, protozoan parasites not previously reported in a clinical setting were identified in the water samples.
Conclusion: This is the first study in Türkiye investigating the presence of human parasites in wastewater using metagenomics. The study highlights the risk posed by human parasites in treated wastewater to population using natural resources. Implementing a specialized wastewater treatment targeting parasites could mitigate the potential spread of these pathogens in the environment. The study revealed certain sequences associated with species not previously identified in clinical instances. This finding may result from genomic resemblances with other eukaryotic organisms that were not systematically excluded, or alternatively, the displacement of protozoa linked to the increasing influx of refugees.

3.Effect of Omeprazole on Fracture Healing in the Random-Patterned Rat Tibial Fracture Model: An Experimental Study
Mustafa Kinas, Ökkeş Bilal, Aybars Kıvrak
doi: 10.14744/cpr.2023.09797  Pages 447 - 455
Objective: Fractures represent one of the most common pathologies encountered in ortho-pedic practice. Various factors can impact fracture healing, both negatively and positively. This study aimed to investigate the influence of omeprazole, a proton pump inhibitor pre-scribed to mitigate the side effects of non-steroidal anti-ınflammatory drugs (NSAIDs) used for pain management post-fracture treatment and for deep vein thrombosis (DVT) prophy-laxis, on fracture union through an animal experiment.
Materials and Methods: The study utilized 40 male Wistar-Albino rats obtained from the Experimental Research Laboratory. Employing the simple randomization method, the ani-mals were divided into experimental and control groups, with tibia fractures induced and subsequently fixed intramedullarily. At the conclusion of the sixth week, comprehensive histological, radiological, and biomechanical assessments were conducted to compare frac-ture union and bone biomechanical strength with the control group.
Results: Histological and radiological evaluations were conducted on the tibias of 40 male Wistar-Albino rats. In terms of biomechanical analysis, 14 tibias from the control group and 16 tibias from the study group were examined. Remarkably, the study group exhibited supe-riors union compared to the control group both histologically (p=0.033), radiologically (AP1 view; p=0.040, AP2 view; p=0.036, LAT1 view; p=0.081, LAT2 view; p=0.03), and biomechan-ically (p=0.047), following omeprazole use.
Conclusion: The administration of omeprazole as a proton pump inhibitor following frac-ture treatment contributes positively to the process of fracture healing.

4.Temporomandibular Dysfunction Affects Neck Disability, Headache, Anxiety, and Sleep Quality in Women: A Cross-Sectional Study
Nezehat Özgül Ünlüer, Yasemin Ateş, Sevilay Seda Baş
doi: 10.14744/cpr.2023.76486  Pages 456 - 462
Objective: Temporomandibular dysfunction (TMD) is associated with the stomatognathic system, encompassing the masticatory muscles, temporomandibular joint, and the cranio-cervical system. This study aims to compare neck disability, headache, anxiety, and sleep quality between women with TMD and asymptomatic women. Additionally, the research seeks to explore the relationship between symptom severity and jaw pain, neck insufficiency, headache, sleep quality, and anxiety in women with TMD.
Materials and Methods: This cross-sectional study enrolled women aged 18 to 65 years, comprising 83 healthy women and 129 women with TMD. The study is registered as a clinical trial on the Clinical Trials platform with the identifier NCT0494820. TMD assessment utilized the Fonseca Anamnestic Index (FAI) while evaluating TMD severity, jaw pain, neck disability, anxiety, headache, and sleep quality.
Results: It was observed that women in the TMD group exhibited higher occurrences of bruxism and tinnitus. In comparison to the control group, the TMD group demonstrated elevated FAI scores, increased jaw pain, neck disability, headache, and anxiety, along with decreased sleep quality. Within the TMD group, the FAI score exhibited significant associations with jaw pain, neck disability, headache, anxiety, and sleep quality (p<0.05).
Conclusion: In summary, when evaluating individuals with TMD, it is imperative for therapists to meticulously examine adjacent structures and consider influential factors from a holistic perspective.

5.Evaluation of the Relationship Between Histopathological Findings in Appendectomy Specimens and Enterobius vermicularis Infection
Selahattin Aydemir, Meryem Gumus, Merve Inceman, Zeynep Tas Cengiz, Mehmet Hafit Bayir, Hasan Yilmaz
doi: 10.14744/cpr.2023.58070  Pages 463 - 470
Objective: This study aimed to assess the relationship between Enterobius vermicu-laris and appendicitis by determining the frequency of E. vermicularis in appendectomy specimens obtained after a preliminary diagnosis of appendicitis.
Materials and Methods: Retrospective evaluation was conducted on the results of appendectomy specimens examined histopathologically at Van Training and Research Hospital Pathology Laboratory from March 2016 to March 2022. Hematoxylin-eosin stained slides from 7,814 appendectomy specimens were scrutinized for the presence of E. vermicularis, acute inflammation, fecaloid material, lymphoid hyperplasia, oblit-eration, perforation, phlegmonous appendicitis, and peritonitis. Furthermore, slides stained with hematoxylin-eosin (H&E) from patients testing positive for E. vermicularis were re-evaluated by the author in pathology.
Results: E. vermicularis was identified in the appendectomy specimens of 50 (0.64%) out of 7,814 patients who underwent appendectomies. In histopathological examina-tions, the occurrence of lymphoid hyperplasia and fibrous obliteration was higher in E. vermicularis-positive patients compared to those who teste negative. Findings re-vealed that the mean white blood cell count (WBC) was lower in E. vermicularis-positive patients than in negative patients, while the mean eosinophil percentage (EO%) was higher.
Conclusion: These findings imply that although the parasite is not a direct causative factor for appendicitis, it may contribute to the development of factors that result in obstruction in certain cases.

6.Surgeon-Specific Infection Rates and Risk Factors for Prosthetic Joint Infections
Necati Mumcu, Zeynep Türe Yüce, Gamze Kalin Unuvar, Ahmet Güney, Ayşegül Ulu Kılıç
doi: 10.14744/cpr.2023.81300  Pages 471 - 479
Objective: Prosthetic joint infections (PJIs) can lead to extended hospital stays, necessi-tate additional surgeries, and require antimicrobial treatment, thereby increasing costs and causing significant morbidity. This study aims to ascertain surgeon-specific infection rates and identify risk factors associated with PJIs.
Materials and Methods: This research was conducted with two study arms between Janu-ary 1, 2017, and February 28, 2019. In the first arm, all cases undergoing primary total knee and hip arthroplasty by the same surgeon were prospectively included and monitored for the development of PJIs. In the second arm, all patients admitted to the same surgeon due to PJI were included.
Results: The first arm comprised 152 patients, of whom five developed PJIs (3.2%). Risk fac-tors for PJI development included diabetes mellitus (p=0.030), rheumatoid arthritis (p=0.014), superficial surgical wound infections in the same joint (p=0.001), and postoperative hemato-mas (p=0.008). In the second arm, 23 patients with PJIs were included. Gram-positive microor-ganisms (84.6%) were the most frequently isolated pathogens. The overall treatment success rate stood at 76%, with a treatment success rate of 72.2% for patients receiving daptomycin.
Conclusion: Effective measures such as perioperative glycemic control, regulation of immunosuppressive drugs, management of anticoagulant therapy, postoperative wound care by trained personnel, adherence to infection control protocols, and tailoring of PJI treatments based on local surveillance data are crucial for preventing PJIs and achieving treatment success.

7.Neuroprotective Potential of 20(S)-Ginsenoside Rg3 Against the Progression of Diabetic Neuropathy: Experiments on Rat Sciatic Nerve
Serap Oktay, Mehmet Bilgen, Özlem Bozkurt Girit, Mehmet Dincer Bilgin
doi: 10.14744/cpr.2023.35229  Pages 480 - 486
Objective: This study aims to experimentally evaluate the impact of 20(S)-ginsenoside Rg3 on the progression of neuropathy induced by streptozotocin (STZ)-induced diabetes.
Materials and Methods: Adult male Wistar rats were randomly divided into three groups: con-trol, untreated diabetic, and 20(S)-ginsenoside Rg3-treated diabetic groups (n=6 each). The rats were intraperitoneally injected with a single dose of STZ (50 mg/kg) to induce diabetes, which was verified by the presence of hyperglycemia (>300 mg/dl). Treatment involved administering a daily dose of 20(S)-ginsenoside Rg3 at 5 mg/kg/day through oral gavage for five weeks. Control rats received an equivalent volume of saline phosphate buffer (pH 7.4). Nociceptive alterations were assessed using tail flick and hot plate tests in the fourth week. Distal latency and nerve con-duction velocity were measured in vivo from the exposed sciatic nerve in the fifth week.
Results: While STZ-induced diabetes led to a significant decline in body weight, an increase in blood glucose levels, and delays in both sensory and motor responses, 20(S)-ginsenoside Rg3 treatment favorably corrected these adverse effects. This treatment effectively alleviated weight loss, lowered blood glucose levels, protected the sciatic nerve, and thus clearly demonstrated a protective role against the progression of neuropathy.
Conclusion: Treatment with 20(S)-ginsenoside Rg3 holds the potential to be used as a neuro-protective agent for diabetic neuropathy. It may also exert preventive actions against post-dia-betic events at the molecular level, and the mechanisms underlying these actions need further exploration.

8.Healing Factors in Perforated and Unperforated Pediatric Appendectomies: A Descriptive Study
Aysegul Simsek, Işıl Ar, Suzan Yıldız, Bihter Ozturk Yildirim
doi: 10.14744/cpr.2023.39974  Pages 487 - 493
Objective: Appendicitis is the most common surgical emergency in childhood and requires urgent intervention. The goal of this research was to identify the factors influencing healing in perforated and non-perforated appendectomy procedures.
Materials and Methods: This descriptive research involved 75 children who underwent appendectomy. Information was collected during the preoperative and postoperative stages using a data collection form and a pain assessment scale. Both parents and children hospi-talized with appendicitis contributed to this information.
Results: The primary complaints leading children to the hospital were nausea and vomiting, which started, on average, 2.7 days prior to admission. While 96% of the children underwent open surgery, 77.3% presented with non-perforated appendicitis. Feeding was ceased 9 hours pre-operation and recommenced in the 15th postoperative hour. A significant difference was noted between perforation status and discharge time. Factors influencing healing included the length of hospital stay, perforation status, preoperative information, time of postoperative oral feeding initiation, and intravenous fluid therapy.
Conclusion: The study suggests that early feeding, mobilization, and patient counseling can reduce pain and expedite recovery and discharge.

9.A Comparison of Dual-Energy CT with MRI in the Detection of Traumatic Bone Marrow Edema in Distal Extremity Bones
Ahmet Turan Kaya, Zeynep Maras Ozdemir, Mehmet Fatih Erbay, Aysegul Sagir Kahraman, Leyla Karaca, Mustafa Karakaplan, Şükrü Gürbüz
doi: 10.14744/cpr.2023.52714  Pages 494 - 504
Objective: Our objective was to evaluate the performance of dual-energy computed tomography (DECT) in detecting post-traumatic bone marrow edema (BME) in distal extremities.
Materials and Methods: We prospectively studied 31 consecutive patients (25 males) who presented within the first four weeks following distal extremity traumas (wrist, n=19; ankle, n=14) (protocol number: 2017/74). All patients underwent DECT and magnetic resonance imaging (MRI) within three days of presentation. Two independent radiologists analyzed DECT images for fractures and BME qualitatively. Computed tomography (CT) numbers on Virtual non-calcium (VNCa) images were obtained in both edematous and non-edematous areas for quantitative consensus assessment. We used MRI as a reference standard.
Results: MRI identified BME in 56/71 bones (78.9%). The rates of BME detection on CT compared to MRI at the patient level were found to be statistically significantly lower, ex-cept for individuals over 40 years of age, women, those with 7–30 days between trauma and admission, and those with CT-detected fractures (p<0.05). The rates of BME detection on CT at the bone level, compared to MRI, were found to be statistically significantly lower (p<0.01), except for women and those with fractures detected on CT. The interobserver agreement for the qualitative analysis of BME was fair (κ=0.407 and p<0.001). DECT’s diag-nostic accuracy rates in predicting BME were significantly higher in patients with fractures (p=0.028). CT numbers in edematous areas were significantly higher than in non-edema-tous areas (p<0.001).
Conclusion: DECT may serve as an alternative for detecting post-traumatic BME in distal extremity bones. However, in our heterogeneous bone sample group, it exhibited low sen-sitivity and a low negative predictive value

10.Lateral Tibial Slope Should Be Considered When Planning Medial Unicompartmental Knee Arthroplasty
Fahri Emre, Murat Bozkurt
doi: 10.14744/cpr.2023.58077  Pages 505 - 510
Objective: The purpose of this study was to evaluate the effects of medial tibial slope (MPTS) and lateral tibial slope (LPTS) on clinical scores and range of motion (ROM) after unicompart-mental knee arthroplasty (UKA).
Materials and Methods: A total of one hundred eighty-two patients with medial compartment osteoarthritis, treated by UKA between January 2011 and May 2017, were retrospectively evaluated. Postoperative MPTS and LPTS were measured using computed tomography (CT). Patients were categorized into four groups based on MPTS and LPTS values: Group 1 had MPTS and LPTS>5°; Group 2 had MPTS>5°, LPTS<5°; Group 3 had MPTS<5°, LPTS>5°; and Group 4 had MPTS and LPTS<5°. Preoperative and postoperative Knee Society Score (KSS) and ROM were compared.
Results: The mean age of the patients was 64.3±5.2 years (range: 52–78) and the mean body mass index (BMI) was 26±1.6 kg/m² (range: 22–29.6). There were no significant differences between the groups regarding age, BMI, follow-up period, and gender (p=0.402, p=0.076, p=0.712 and p=0.787, respectively). The postoperative KSS scores and postoperative maxi-mum flexion in patients with both MPTS and LPTS>5° were significantly higher compared to the other groups (p<0.001 for both).
Conclusion: Sagittal alignment should not be overlooked in UKA. Unlike previous studies that evaluated only MPTS using a lateral radiograph and ignored LPTS, this study demon-strated that LPTS affects postoperative ROM and clinical scores. Therefore, defining MPTS along with LPTS is recommended.

11.Rat Model: Intrathecal Lipid for Total Spinal Block-Induced Hemodynamic Instability
Kamil Darçın, Muhammet Ahmet Karakaya, Yılmaz Yenigün, Ibrahim Kulac, Seçil Çetin, Aytekin Ünlükaplan, Ömür Erçelen
doi: 10.14744/cpr.2023.29392  Pages 511 - 516
Objective: This study aimed to assess the potential of intrathecal administration of lipid emulsions as a targeted therapeutic strategy to mitigate the hemodynamic consequences of high or total spinal anesthesia induced by bupivacaine in a rat model.
Materials and Methods: After receiving approval from Koç University’s Local Ethics Board of Animal Experiments, 14 adult female Wistar Albino rats were randomized into two groups: Lipid and Saline. After inducing a high spinal block, each group was treated with either intrathecal lipid emulsions or isotonic saline solutions, respectively. Hemodynamic parameters such as systolic, diastolic, and mean arterial blood pressures, as well as heart rate, were continuously monitored. A histological analysis was conducted upon comple-tion of the study.
Results: The Lipid group exhibited a significant increase in mean systolic (p=0.002), diastolic (p=0.002), and arterial pressures (p=0.002) compared to the Saline group. The mean pulse rate also differed significantly between the groups (p=0.009). Notably, while all rats in the Saline group succumbed, only two fatalities occurred in the Lipid group, with the other five rats surviving (p=0.021).
Conclusion: This study suggests that intrathecal administration of lipid emulsions can serve as a rapid and effective intervention to counteract the hypotension and bradycardia in-duced by high or total spinal anesthesia with bupivacaine in rats. While these findings are promising, further experimentation and clinical trials are required to confirm this method’s potential, focusing on its long-term safety, efficacy, and the establishment of an optimal administration protoco.

12.A MEN-2A Case Developing Transient Adrenal Insufficiency after Unilateral Pheochromocytoma Surgery
Mahsum Ozan, İhsan Solmaz, Jehat Kılıç, Nurettin Ay, Salim ilksen Basçeken, Süleyman Özçaylak, Firdevs Acer, Başak Bolayır, Hikmet Soylu, Sedat Çetin, Halit Diri
doi: 10.14744/cpr.2023.55264  Pages 517 - 520
Background: This case report provides detailed experiences of a patient with Multiple Endocrine Neoplasia type 2A (MEN-2A) who underwent surgery for pheochromocytoma and medullary thyroid cancer (MTC).
Case Report: A 58-year-old male patient with resistant hypertension, despite triple anti-hypertensive drug therapy, was diagnosed with pheochromocytoma after investigation into the underlying etiology. Although the adrenalectomy performed was unilateral rather than bilateral, and there were no signs of Cushing’s syndrome or adrenal insufficiency before the operation, temporary adrenal insufficiency developed after the excision of the large adrenal mass. Additionally, the biochemical diagnosis of MTC was primarily established using a calcium stimulation test (CST) rather than basal cal-citonin levels.
Conclusion: In cases where unilateral adrenalectomy is performed for a large adrenal mass, postoperative hypotension resistant to conservative therapy should raise suspi-cion of adrenal insufficiency. Furthermore, when basal calcitonin levels fall within the gray zone, a CST may be necessary for the diagnosis of MTC.

13.Rare Xanthogranulomatous Inflammation of the Nose
Satesh Kumaran Ganeson, Dakshaini Ananada Narayanan, Norhaslinda Abdul Gani, Farah Dayana Zahedi
doi: 10.14744/cpr.2023.03522  Pages 521 - 523
Background: Juvenile xanthogranuloma is an uncommon benign mass that frequently arises among children. Regardless of its juvenile onset, the occurrence among the adult popu-lation is usually between the second and third decades of life.
Case Report: We would like to present a case of adult xanthogranuloma in a 30-year-old male and a brief literature review of its etiology, histopathology, and management.
Conclusion: Juvenile xanthogranuloma is a benign disease that is common in childhood but rare in adults. The diagnosis is confirmed by histological studies. The lesion is generally self-limiting and regresses spontaneously; however, surgical excision can be performed for cosmetic or diagnostic purposes.

14.T-Cell Acute Lymphoblastic Leukemia Camouflaged as Acute Tonsillitis: A Rare Case Report
Kuganathan Ramasamy, Davina Teo, Sai Guan Lum, Farid Razali
doi: 10.14744/cpr.2023.43153  Pages 524 - 527
Background: Sore throat is a common complaint encountered in daily clinical practice. It is a defining characteristic of acute tonsillitis which is typically treated with symptomatic care and antibiotics in cases of bacterial infection. Despite being generally uncomplicated, acute tonsillitis can mask sinister pathologies such as diphtheria, infectious mononucleosis, and even malignancy.
Case Report: In this report, we present a case of a young adult with nonresolving acute exudative tonsillitis. Upon recognition of unusual alarming features, further investigations have led to the diagnosis of T-cell acute lymphoblastic leukemia (T-ALL).
Conclusion: Although unusual, hematological malignancies such as acute leukemia may manifest as acute tonsillitis. The significance of recognizing red flags that may occur in com-mon symptoms such as sore throat is emphasized. It is necessary to be aware of this entity to prevent delayed diagnosis.

15.An Unusual Diagnostic Journey Through MLPA: From Spinal Muscular Atrophy to a Severe Case of Prader-Willi Syndrome
Emine Göktaş, Betül Okur Altındaş, Hülya Tarım, Gulsum Kayhan, Ayse Gul Zamani, Mahmut Selman Yıldırım
doi: 10.14744/cpr.2023.92486  Pages 528 - 533
Background: Prader-Willi Syndrome (PWS) is a multisystemic disorder characterized by dysmorphic facies, hypotonia, developmental delay, cognitive impairment, hypogonadism, and obesity. It is caused by the absence of expression of paternally derived genes on chromosome 15. Here, we report the diagnostic journey of a case with severe neonatal hypotonia.
Case Report: A neonatal patient was referred for the prediagnosis of spinal muscular atrophy (SMA). During the SMA Multiplex Ligation-dependent Probe Amplification (MLPA) analysis, a diminished signal of a reference probe on the 15q11.2 was revealed. Later, it was confirmed that she had a deletion confined to 15q11.2-q13.1, with a methylation pattern compatible with PWS.
Conclusion: Since hypotonia might be the only finding in newborns with PWS, this case was presented to emphasize the importance of a comprehensive approach to such patients.

16.Rodent Ulcer
Satvinder Bakshi
doi: 10.14744/cpr.2023.77487  Pages 534 - 535
Abstract |Full Text PDF

17.Onion Skin in the Ear Canal: Keratosis Obturans
Geng Ju Tuang, Norazila Abdul Rahim, Masaany Mansor
doi: 10.14744/cpr.2023.87587  Pages 536 - 537
Abstract |Full Text PDF

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