P-ISSN 2587-2400 | E-ISSN 2587-196X
EJMO: 2 (2)

Volume: 2  Issue: 2 - 2018

RESEARCH ARTICLE
1.Efficacy of Calendula Officinalis as an Antibacterial Agent for In Vitro Pseudomonas Aeruginosa
Mbuso Mabuza
doi: 10.14744/ejmo.2017.18189  Pages 55 - 60 (508 accesses)
Objectives: The aim of this in vitro microbial study was to evaluate the efficacy of Calendula officinalis tincture 60% (v/v) ethanol as an antibacterial agent for in vitro Pseudomonas aeruginosa.
Methods: The standardized disk diffusion method was employed. Seven pairs of Mueller–Hinton agar plates were used; one plate was the experiment and one a control. P. aeruginosa broth cultures were grown for 24 hours. A sterile cotton swab was soaked in P. aeruginosa broth culture and then streaked evenly in 3 directions over the entire surface of the agar plates to obtain a uniform inoculum. Sterile filter paper disks (0.45-µm pore size; 5-mm diameter) were impregnated with standardized amounts of C. officinalis tincture 60% (v/v) ethanol. The first set of disks was impregnated with undiluted C. officinalis tincture 60% (v/v) ethanol, and the subsequent sets of disks were impregnated with a series of 2-fold dilutions of C. officinalis tincture 60% (v/v) ethanol. One disk from each set was aseptically placed on the inoculated agar surface of each plate. The plates were inverted and incubated at 37°C in ambient air for 24 hours, after which any presence of clear zones of inhibition were observed against a light background and the diameter of these zones was measured. The whole procedure was performed in triplicate. The mean activity of the 2 treatment groups was 6.88 and 6.69 mm, respectively.
Results: The antibacterial activity of C. officinalis tincture 60% (v/v) ethanol and the 60% ethanol control groups showed a similar pattern on in vitro P. aeruginosa. There was no statistically significant difference between the experimental and control groups (p>0.05; t-test).
Conclusion: There was no evidence to prove the efficacy of C. officinalis tincture 60% (v/v) ethanol as an antibacterial agent for in vitro P. aeruginosa.

2.The Association of Globulin Level with Treatment Response and Overall Survival in Patients with Multiple Myeloma
Rafet Eren, Ozlem Ozdemir, Ceyda Aslan, Mehmet Hilmi Dogu, Sermin Altindal, Osman Yokus, Elif Suyani
doi: 10.14744/ejmo.2017.63835  Pages 61 - 64 (514 accesses)
Objectives: An increased globulin level, along with a decreased albumin level, is one of the hallmarks of multiple myeloma (MM). Albumin level has been included in the risk assessment of patients with MM; however, there are insufficient data on the prognostic value of globulin level. The aim of this study was to determine the association of globulin level at diagnosis with the treatment response and overall survival (OS) in patients with MM.
Methods: This study was a retrospective analysis of 30 patients who were diagnosed with MM, followed up, and had their globulin level recorded at the time of diagnosis at the University of Health Sciences Istanbul Training and Research Hospital Department of Hematology between June 2013 and August 2016.
Results: The median age of the patients was 61 years (range: 34-71 years). Eleven patients were female (36.6%) and 19 were male (63.4%). The median globulin level was 4.98 g/dL (range: 2.3-11.6 g/dL), and the cut-off value was 4.9 g/dL, according to the median. The patients were divided into 2 groups: >4.9 g/dL and <4.9 g/dL. Fifteen patients (50%) had a globulin value <4.9 g/dL, whereas 15 (50%) had a globulin value of >4.9 g/dL. The groups were comparable in terms of gender, age, Durie-Salmon stages, kappa/lambda ratios, creatinine value, beta-2 microglobulin level, lactate dehydrogenase level, OS, and treatment response rates (p>0.05). The globulin level was not significantly associated with treatment response or OS (p>0.05).
Conclusion: This study is the first to investigate the role of globulin in patients with MM. An increased globulin level during the course of MM is not a concern for clinicians, as it does not appear to negatively affect treatment response or OS.

3.Schematization of the Katilmis Technique for Vocal Cord Lateralization: How Is It Done?
Riza Dundar, Yilmaz Ozkul, Murat Songu, Erkan Kulduk, Huseyin Katilmis
doi: 10.14744/ejmo.2018.98598  Pages 65 - 69 (447 accesses)
Objectives: The aim of this study was to demonstrate a technique for vocal and ventricular fold lateralization in patients with bilateral vocal fold immobility (BVFI) using crossing sutures with the thyroplasty window technique.
Methods: A total of 76 patients diagnosed with BVFI were operated on using this previously described technique involving vocal and ventricular fold lateralization using crossing sutures with a thyroplasty window between February 2006 and April 2016.
Results: All of the patients displayed marked symptomatic Improvement in dyspnea. No patient experienced aspiration postoperatively or during follow-up.
Conclusion: Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique is an effective procedure in the rehabilitation of BVFI.

4.Impact of L-Arginine on Language Skills in Children with Hypoxic–ischemic Encephalopathy
Gokhan Ozer
doi: 10.14744/ejmo.2017.53824  Pages 70 - 72 (414 accesses)
Objectives: The aim of this study was to investigate the impact of L-Arginine on speech and language development in pediatric patients with hypoxic–ischemic encephalopathy (HIE).
Methods: The oral language skills of 24 pediatric patients with HIE using L-Arginine were classified and the impact of L-Arginine on language skills was evaluated retrospectively. While there is no standard dose of L-Arginine, the usual dosage is 2.5 g orally for children younger than 5 years of age and 5 g orally for children older than 5 years of age.
Results: The study enrolled 24 pediatric patients with a mean age of 3.9 years (range: 1.25–12 years). A pre-treatment median rating of 1 for oral language development increased to 3 post treatment, according to the results of a Wilcoxon signed-rank test used to examine the statistical significance of the difference between 2 variables. The difference was statistically significant.
Conclusion: Although the exact pathophysiology of HIE has not been fully elucidated, it is associated with diffuse cerebral damage that leads to impaired motor and language development; moreover, HIE has no cure. In this study, L-Arginine therapy had a positive and significant impact on language development in children affected by HIE. Additional, larger series are needed to confirm these preliminary findings.

5.Accuracy of a Novel Head and Neck Phantom for Heterogeneous Media Verification Using an Irregular Field Algorithm
Michael Onoriode Akpochafor, Akintayo Daniel Omojola, Muhammad Yaqub Habeebu, Samuel Olaolu Adeneye, Moses Adebayo Aweda, Chieloka Chinazom Iloputaife, Temitope Aminat Orotoye, Abayomi Emmanuel Opadele
doi: 10.14744/ejmo.2017.92400  Pages 73 - 78 (579 accesses)
Objectives: The treatment outcome in patients can be improved with a fast and accurate treatment planning system (TPS) algorithm. The aim of this study was to design a novel head and neck phantom and to use it to test whether the accuracy of the irregular field algorithm of the Precise Plan 2.16 (Elekta Instrument AB, Stockholm, Sweden) TPS was within ±5% of the International Commission on Radiation Units and Measurements (ICRU) limit for homogenous and inhomogeneous media by rotating the Elekta Precise linear accelerator gantry angle using 2 fields.
Methods: A locally designed acrylic phantom was constructed in the shape of a block with 5 inserts. Acquisition of images was performed using a HiSpeed NX/i computed tomography scanner (GE Healthcare, Inc. Chicago, IL, USA); the Precise Plan 2.16 TPS was used to determine the beam application setup parameters and an Elekta Precise linear accelerator was used for radiation dose delivery. A pre-calibrated NE 2570/1 Farmer-type ion chamber with an electrometer was used to measure the dose. The mimicked organs were the brain, temporal bone, trachea, and skull.
Results: The maximum percentage deviation for 10×10 cm and 5×5 cm inhomogeneous inserts was 1.62 and 4.6, respectively, at a gantry angle of 180°, and that of the 10×10 cm homogeneous insert was 3.41 at a gantry angle of 270°. The percentage deviation for only the bone insert (homogeneous) and for all inserts (inhomogeneous) using parallel opposed beams was 2.89 and 2.07, respectively. Also, the percentage deviation between the locally designed head and neck phantom and the solid water phantom of the linear accelerator was 0.3%.
Conclusion: The validation result of our novel phantom in comparison with the solid water phantom was good. The maximum percentage deviations were below the ICRU limit of ±5%, irrespective of gantry angles and field sizes.

6.Prevalence and Progression of Refractive Errors Among El-Mustansiriyah Medical Students
Alaa Ali Salih
doi: 10.14744/ejmo.2017.99609  Pages 79 - 83 (355 accesses)
Objectives: Refractive errors (RE) are defined as an error in focusing light on the retina and are a frequent reason for reduced visual acuity. The 3 most common types of RE are: myopia, which is difficulty seeing distant objects clearly; hypermetropia, which is difficulty seeing close objects clearly; and astigmatism, which is distorted vision resulting from an irregularly curved cornea. The aim of this study was to investigate the prevalence of RE among medical students at Al-Mustansiriya Medical College and to evaluate associated factors.
Methods: A cross-sectional study was conducted at Al-Mustansiriya Medical College to assess RE among medical students. The data collectors were divided into 6 groups to gather data provided by the students of each annual cohort. Some incomplete forms were excluded.
Results: In this study, it was determined that about 33% of all students at Al-Mustansiriya Medical College had RE, with myopia being the most prevalent type (57.58%), especially in the fourth year students (25%), while the least common was hypermetropia (2.73%). There was quite a difference in the ratio of males and females with RE (38.48% and 61.52%, respectively).
Conclusion: Myopia was the most common eye problem observed among medical students. The incidence of myopia was greater in females than in males in all cohorts.

7.Effects of Nutritional Status and Habits During Pregnancy on Term and Preterm Births
Halime Pulat Demir, Cemile Idiz, Hatice Merve Bayram, Seda Yıldırım
doi: 10.14744/ejmo.2018.61687  Pages 84 - 90 (392 accesses)
Objectives: This study was designed to explore nutritional status and behaviors in pregnancy and investigate the effects on preterm and term births.
Methods: The study was conducted with 120 mothers who gave birth (60 preterm and 60 term deliveries) in a private hospital between November 2015 and December 2015 in Istanbul. A questionnaire to record the demographic characteristics of patients, smoking and alcohol use, nutritional habits, and food consumption frequency was administered in a face-to-face interview.
Results: In all, 65% of the births were by cesarean section and 35% were vaginal delivery; 41.7% of the preterm deliveries were in women aged ≥35 years, whereas only 5% of term deliveries were in women aged ≥35 years. Statistically significant differences were found in terms of education, work status, income level, smoking, pregnancy nutrition, and psychological status between preterm and term delivery mothers (p<0.05). Gestational weight gain was ≤8 kg in 36.7% of mothers with preterm deliveries and ≥12 kg in 36.7% of mothers and 8-12 kg in 68.3% of the mothers with term deliveries. Compared with preterm delivery mothers, term delivery mothers had fewer nutritional problems during pregnancy and more regular meal consumption (p<0.05).
Conclusion: Weight gain and nutrition in pregnancy are variables that affect preterm birth. Hence, nutritional training should be provided regularly to pregnant women, and their weight should be monitored.

8.Prostate Biopsy to Diagnose Acute Bacterial Prostatitis: Current Microbiological Spectrum, Sensitivity to Antibiotics, and Clinical Findings in Turkey
Hakan Türk, Sıtkı Un, Gamze Aslı Şener, Mehmet Yoldas, Fırat Akdeniz, Erkan Arslan
doi: 10.14744/ejmo.2018.41636  Pages 91 - 96 (420 accesses)
Objectives: Ultrasound-guided transrectal prostate biopsy is considered the standard procedure for diagnosing prostate cancer. However, minor complications, such as hematuria, hematospermia, and rectal bleeding, as well as clinically significant complications, such as urinary tract infections and acute bacterial prostatitis (ABP) can occur. ABP is an acute disease requiring immediate treatment. The aim of this study was to evaluate the clinical presentation, microbiological profile, antibiotic susceptibility, and treatment of patients with ABP that developed after a transrectal prostate biopsy.
Methods: The records of a total of 3550 patients who underwent an ultrasound-guided transrectal prostate biopsy in the clinic between September 2012 and December 2017 were retrospectively examined. The age, prostate volume, prostate-specific antigen level, number of cores per prostate biopsy, biopsy indications, and urine and blood culture results of those with ABP were recorded.
Results: Among 3550 patients who had undergone prostate biopsy, ABP developed in 195 (5.4%) following biopsy. Of these, 37 (39.3%) had initiated antibiotherapy treatment elsewhere before admission to this clinic. A positive urine culture was detected in 101 (51.7%) and a positive blood culture in 43 (22%) of the 195 patients diagnosed with ABP. The microorganisms were identified as Escherichia coli (141 patients), Klebsiella spp. (1 patient) and Enterococcus faecalis (2 patients). E. coli was the most common bacteria and was isolated in 98 (97%) of all urine cultures.
Conclusion: In complicated urinary tract infections, clinicians should consider antibiotic resistance patterns, particularly in terms of extended-spectrum beta-lactamase-producing strains, and should make the required changes for the treatment to be successful according to the culture results. To reduce the rate of this complication, frequent use of antibiotics should be avoided in primary healthcare centers.

9.Modulation of Vascular Endothelial Growth Factor and Tissue Necrosis Factor Alpha Using Ethanol Stem Bark Extract of Boswellia Dalzielii H. Attenuates Ethanol-induced Gastric Ulcer in Albino Rats
Anas Husainy Yusuf, Hamza A Salami, Maryam Babakura, Umar Kyari Sandabe, Nuhu Sambo, Abdulwasiu Abubakar
doi: 10.14744/ejmo.2018.74745  Pages 97 - 104 (440 accesses)
Objectives: The modulation of vascular endothelial growth factor, antioxidants, and tissue necrosis factor alpha (TNF-α) using ethanol stem bark extract of Boswellia dalzielii H. was evaluated in an ethanol-induced gastric ulcer albino rat model.
Methods: Thirty albino rats of either sex (200–250 g) were starved for 48 h but were allowed drinking water with 8% sucrose to avoid dehydration. The rats were placed on wire gauze above the base of the cage to prevent coprophagy. At the end of the fasting period, the rats were equally divided and assigned to six treatment groups. Group A served as control and 5 ml/kg distilled water was orally administered to the rats without further treatment. Rats in group B were given 5 ml/kg distilled water and served as negative control. Rats in groups C, D, and E were pretreated with 100, 200, and 400 mg/kg of the ethanol stem bark extract of B. dalzielii H, respectively. Group F received 50 mg/kg ranitidine. After 1 h, all the rats in groups B–F were each given absolute ethanol 1 ml/200 g body weight of rat. All treatments were by intragastric lavage. One hour after the treatment with ethanol, all the rats in the experiment (groups A–F) were euthanized with an overdose of anesthetic ether and their stomachs were excised. The stomachs were cut along the greater curvature and washed in warm normal saline. Each stomach was stretched out and pinned on board.
Results: The results of the study revealed that pretreatment with ethanol stem bark extract of B. dalzielii H. decreased gross and histological gastric mucosal damage caused by intragastric administration of absolute ethanol in a dose-dependent manner when compared with controls. The gastric ulcer index and gastric tissue level of malondialdehyde (MDA) and TNF-α were significantly reduced (p<0.001), whereas the gastric tissue level of superoxide dismutase, catalase, total antioxidant capacity, and vascular endothelial growth factor (VEGF) was significantly increased (p<0.001) when compared with the controls.
Conclusion: The plant extract attenuated gastric mucosal damage induced by ethanol via upregulation in the expression of gastric tissue VEGF, reinforcement of the antioxidant system, and reduction in the gastric tissue level of MDA and the pro-inflammatory cytokine TNF-α.

CASE REPORT
10.Transcervical Removal of a Rare Giant Proximal Wharton’s Duct Sialolith and Submandibular Gland
Muhammad Izzuddin Hamzan, Normala Basiron
doi: 10.14744/ejmo.2017.42104  Pages 105 - 109 (425 accesses)
Sialolithiasis, the most common salivary gland disease, is a condition in which a calculus forms in the gland, most often the Wharton’s duct. Rarely, these calculi can reach several centimeters in size, and have been described as giant sialoliths in the literature. Patients diagnosed with small sialoliths can undergo conventional treatment, but those with larger sialoliths require a sialolithotomy or resection of the entire gland. The management of a salivary gland sialolith depends on its location, size, and the surgeon’s experience. Presently described is a case of a giant sialolith located at the proximal part of the Wharton’s duct near the hilum of the left submandibular gland, its surgical management, and a review of the current literature. To the best of our knowledge, no similar case has been reported before in the literature and this is the first case of a giant calculus in the proximal submandibular duct to be reported in the author’s country of origin.

11.Collecting Duct Carcinoma with Sarcomatoid Differentiation in S-Shaped, Crossed-Fused Renal Ectopic Kidney: A First Case Report and Review of the Literature
Huseyin Eren, Mustafa Ozan Horsanali, Yavuz Metin, Oguzhan Okcu
doi: 10.14744/ejmo.2018.88597  Pages 110 - 113 (397 accesses)
A 63-year-old male patient with hematuria and flank pain was admitted. Radiological evaluation revealed S-shaped, left-to-right cross-renal ectopia with a renal mass localized in the upper pole of the right kidney. Three-dimensional computed tomography (3D-CT) showed that the orthotopic moiety had 1 artery and 2 veins, and the ectopic moiety had 1 artery and 1 vein. A nephron-sparing partial nephrectomy was performed. The pathological diagnosis was collecting duct carcinoma with sarcomatoid differentiation. Using 3D-CT, we were able to achieve the appropriate preoperative surgical planning for this challenging case. To our knowledge, this is the first case report of collecting duct carcinoma with sarcomatoid differentiation in a cross-fused renal ectopic kidney.

12.Acute Stroke in a Patient with Mucopolysaccharidosis Type I with Increased Carotid Intima-Media Thickness
Asburçe Olgaç, Leyla Tümer, Çağrı Damar, Alev Hasanoğlu, Fatih Ezgü
doi: 10.14744/ejmo.2018.51523  Pages 114 - 116 (383 accesses)
Mucopolysaccharidosis type I (MPS I) is a rare autosomal recessive disease caused by a deficiency of the lysosomal enzyme alpha-L-iduronidase. Cardiovascular involvement in MPS I includes deposition of glycosaminoglycans (GAGs) in the myocardium, cardiac valves, great vessels, and coronary arteries. Although the vascular effects of GAG accumulation are well known, the clinical effects of the histopathological changes are poorly understood. Because most studies on the vascular effects of GAG accumulation are performed postmortem or with invasive techniques such as angiography, recent studies have focused on endothelial function in patients with MPS I and noninvasive techniques that may help detect vascular dysfunction. Presently described is the case of a patient with MPS type I with acute stroke and proven endothelial dysfunction.

13.Oral Amiodarone-induced Liver Injury with Gamma Glutamyl Transferase Elevation: A Case Report
Mehmet Zahid Kocak, Nurullah Ilhan, Süleyman Özsarı, Kemal Fidan
doi: 10.14744/ejmo.2017.82474  Pages 117 - 119 (453 accesses)
Amiodarone-induced hepatotoxicity varies from asymptomatic serum aminotransferase elevation to severe liver disease. Aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase are known to be elevated in amiodarone-induced liver damage. However, no study in the literature has reported that gamma glutamyl transferase (GGT) is elevated in this condition. Described is the case of an 82-year-old female patient with elevated GGT while using oral amiodarone for rapid response atrial fibrillation. The GGT level decreased after amiodarone was discontinued. GGT elevation was considered to be a potentially prominent drug side effect according to the Council for International Organizations of Medical Sciences/ Roussel Uclaf Causality Assessment Method scale. GGT is found in biliary epithelial cells and hepatocytes. GGT elevation may be due to drug or alcohol use. Histological changes in alcoholic liver disease and those in liver injury due to amiodarone toxicity are similar. It is thought that amiodarone-induced liver injury and GGT elevation are related to this histological similarity.


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