Acta Medica

Assessment of the relationship between serum uric acid levels and oxidative stress markers in patients with uncomplicated type 2 diabetes mellitus

Esat Kıvanç Kaya, Tuba Çandar, İhsan Ergün — Sun, 29 Dec 2024 00:00:00 +0300

Objective: Type 2 Diabetes Mellitus is a worldwide health issue characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both, and is associated with significant negative health outcomes. Oxidative stress plays a crucial role in the onset, progression, and complications of this disorder. Elevated serum uric acid level is an independent predictor of vascular complications in diabetic patients, and hyperuricemia may contribute to oxidative stress. The objective of this study is to examine the correlation between increased serum uric acid levels and the markers of oxidative stress, including ischemia-modified albumin (IMA), total oxidant status (TOC), and total antioxidant capacity (TAC), in type 2 diabetic patients who don’t have vascular complications.

Materials and Methods: A total of 73 individuals were enrolled in the study including 20 type 2 diabetic patients with high serum uric acid levels (> 6.5 mg/dl), 21 type 2 diabetic patients with normal serum uric acid levels (< 6.5 mg/dl), and 32 healthy individuals. Ischemia-modified albumin, total oxidant status, and total antioxidant status levels were compared between patient groups and the control group

Results: As a result of this study, there was no significant association between serum uric acid levels and ischemia-modified albumin, total oxidant status, and total antioxidant status levels in type 2 diabetic patients.

Conclusions: This study concluded that high serum uric acid levels do not directly affect oxidative stress in type 2 diabetic patients without vascular complications.

The relationship between hypertension and COVID-19 vaccine in the long term and occupational evaluation

Seval Müzeyyen Ecin, Tülin Okur — Sun, 29 Dec 2024 00:00:00 +0300

Introduction: Many cardiovascular complications, especially myocarditis and pericarditis, have been observed with vaccination. One of these cardiovascular complications is hypertension with a rate of 1-5%. Hypertension emerged in the acute period after vaccination and tended to be persistent in patients with advanced age and comorbid diseases. In this study, we aimed to examine the relationship between hematological, biochemical markers and demographic characteristics between healthy individuals who have never been vaccinated or vaccinated and patients with new- onset hypertension.

Material and Method: Patients diagnosed with new-onset hypertension and healthy COVID-19 vaccinated, and non-COVID-19 vaccinated control patients of similar age and number were included in the study. The relationship between hematological, biochemical and demographic data between newly diagnosed hypertension patients and healthy COVID-19 vaccinated, and healthy non-vaccinated patients was examined.

Result: 56.3% of newly diagnosed hypertension patients were female, 46.9% were primary school graduates, 37.5% were housewives, 81.3% had stress in their lives. Hypertension patients were older (p<0.01), had lower hemoglobin levels (p=0.05) and higher LDL-C levels (p<0.01) than healthy unvaccinated patients.

Conclusion: Although it is seen that the cause of hypertension cannot be attributed solely to the vaccine, since the hypertensive group was older, had a higher body mass index, hyperglycemia and hyperlipidemia compared to the healthy group, and the number of patients in the study was small, but being a housewife is the most important occupational group and stress is an important trigger. The majority of vaccinees were primary school graduates. Anemia and LDL elevation were found in hypertensive and vaccinated patients. To the best of our knowledge, it is one of the first studies to examine LDL elevation in vaccinated patients and the relationship between long- term newly diagnosed hypertension and vaccination, although confounding factors cannot be excluded.

A tale of two uropathologists: concordance of Gleason Grade Groups in prostatic adenocarcinoma over needle biopsies and radical prostatectomies

Güneş Güner, Kemal Kösemehmetoğlu — Sun, 29 Dec 2024 00:00:00 +0300

Objective: The standard 12-core transrectal prostate needle biopsies don’t reflect the tumor entirely. Approximately 35-36% of needle biopsy diagnoses of Gleason grade group (GG) 1 are upgraded upon radical prostatectomy (RP). Pathologists are not in perfect concordance in Gleason scoring. Two uropathologists in a university hospital aimed to determine how concordant needle biopsy GGs were with RP GGs. Moreover, they also assessed how frequently they up-/down-graded the needle biopsy GGs each other gave when they graded RPs.

Material and Methods: In-house prostate needle biopsies and RPs from 31/01/2020 to 10/09/2022 were retrieved from the hospital database. Patients who had both a needle biopsy and an RP were included. Whether each case was down-/up-graded upon RP, GGs and the pathologist that reported the cases were tabulated.

Results: One hundred and thirty cases were assessed. Needle biopsy and RP GGs were identical in 63,1% (n=82). Pathologist1 (P1) assessed both the needle biopsy and RPs of 41 patients, 8 of which they downgraded and 8 upgraded (19,5%). Pathologist2 (P2) assessed both the needle biopsy and RP samples of 23 patients; downgrading 13% (n=3) and upgrading 17,4% (n=4) of cases. Where the needle biopsy was reported by P2 and RP was reported by P1 (n=48), 10 (20,8%) were downgraded and 8 (16,7%) were upgraded. The reverse scenario was noted in 18 patients; 2 (11,1%) of which were downgraded, 5 (27,8%) were upgraded. While P2 showed a tendency to upgrade more frequently, this was not statistically significant (p=0,2774, Pearson chi-square).

Discussion: The two uropathologists’ up- and down-grading rates seemed concordant. Routine practice doesn’t allow time for one pathologist to re-score the other’s cases, nor is every case consulted. Looking back at pathologist-specific tendencies to up/downgrade one’s own or a colleague’s scores may help direct ourselves and others to curb tendencies to over/undergrade.

The assesment of dermatology life quality index in nurses with occupational skin diseases in Türkiye

Ecem Bostan, Hafize Nur Boztaş — Sun, 29 Dec 2024 00:00:00 +0300

Objective: The skin acts as one of the body’s first defense components against many external factors by creating a physical barrier. Therefore, it is significantly vulnerable to the irritating effects of protective personal equipment use. A wide range of occupational skin diseases (OSD) can be observed in the nurses who are in close contact with patients and frequently use personal equipment. We aim to identify different types OSD observed in the nurses and explore the impact of these skin diseases upon Dermatology Life Quality Index (DLQI).

Materials and Methods: A web-based questionnaire consisting of 24 questions related to the physician-confirmed cutaneous diseases observed in the participants who were actively working as nurses in Türkiye. DLQI was calculated by using DLQI score.

Results: Two hundred twenty nine participants were included in the study with a mean age of 33.74 years. The mean duration working as a nurse was 9.86 years. One hundred (43.7%) participants reported to have at least one skin disease; the most commonly observed occupational cutaneous skin diseases were xerosis, contact dermatitis, pruritus, brittle nail syndrome and callus formation. The median DLQI score was 4 (interquartile range=7.5). The time during which the participants worked as a nurse was significantly associated with the development of at least one OSD (p=0.02).

Conclusions: Our study show that OSD, most common ones being xerosis, contact dermatitis and pruritus seem to affect dermatologic life quality of the nurses in Türkiye.

8 years with laparoscopic liver surgery: a referral center experience

Hilmi Anıl Dinçer, Doğukan Doğu, Ömer Cennet, Ahmet Bülent Doğrul — Sun, 29 Dec 2024 00:00:00 +0300

Objective: Laparoscopic liver surgery (LLR) was first performed in 1992 and LLR began to be performed for many benign and malignant etiologies, especially hepatocellular carcinoma (HCC) and colorectal cancer metastases (CRC). Recent studies have shown that LLR has less bleeding, shorter hospital stay (LOS), faster recovery, and similar long-term oncologic outcomes compared to open surgery. This study aims to examine the results of LLR, which has been performed for 8 years in our institution, which is one of the referal centers in the field of hepatopancreaticobiliary surgery.

Methods: Twenty-nine patients who underwent LLR for malignant and benign reasons in our hospital between January 2016 and March 2024 were included in the study, and 416 patients who underwent open surgery, and laparoscopic ablation. Data were obtained retrospectively from the hospital registry system.

Results: 18 (62.1%) of the patients were male and the median age was 57 (41-62.5). 23 (79.31%) of the patients underwent surgery for malignant reasons. The most common indications for surgery were HCC (24.14%) and CRC (20.69%). Median blood loss was 200 (100-375) ml. Median LOS was three (3-5) days, and 30-day readmission rate was 3.45%. Clavian-Dindo ≥3 complication grade was seen in 13.79% of patients and no mortality was observed in any patient. R0 resection was achieved in 73.91% of patients. Disease recurrence developed in 56.52% of patients at a median follow-up of 22.1 (9.9-48.5) months. Of the patients who developed recurrence in the liver, recurrence developed at the surgical margin in 13.04%, and in other liver segments in 30.43%. Median overall survival was 48.5 months, and median recurrence-free survival was 21 months. 1-, 3-, and 5-year overall survival were 85%, 76%, and 48%, respectively, while 1- and 3-year recurrence-free survival were 71% and 34%, respectively.

Conclusion: In this study, it was shown that LLR is a safe alternative to traditional open surgery in terms of length of hospital stay, blood loss, recurrence rates, and survival rates in parallel with the literature, and that although the surgical margin was positive, recurrence developed mostly in other liver segments, and in some patients, no recurrence was observed despite positive margins.

“C-shaped” anterolateral thigh flap for stomal repair due to recurrence in patients with total laryngectomy

Ahmet Hamdi Sakarya, Ömer Saraç, Zeynep Akdeniz Doğan, Bülent Saçak — Sun, 29 Dec 2024 00:00:00 +0300

Background: Stomal recurrence after total laryngectomy is one of the most challenging problems in head and neck surgery due to the complexity of its management. The tracheal opening remains deep and caudal after resection, creating a neo stoma that presenting a significant challenge for reconstructive surgery. With this study, we aimed to describe the design of the C-shaped ALT flap to show that it is the ideal design in such a difficult reconstruction.

Methods: Five patients who underwent a free ALT flap for defects in the anterior neck wall and airway after resection due to tumor recurrence adjacent to a permanent stoma between 2018-2020 were included in the study. Tumor resection was performed by the Otolaryngology team in all cases. Age, gender, cause of defect, ALT flap size, donor site closure method, number of perforators, ischemia time, flap survival, early complications, and postoperative tracheostomy use and postoperative quality of life assessment were reviewed.

Results: 5 male patients were included in the study and the mean age was 63.8. The mean duration between admission and recurrence after laryngectomy was 11.2 months. Flap survival was noted in all patients. The patients did not encounter complications such as tracheostomy-related dehiscence, discharge, fistula, cannulation difficulties due to flap collapse, and mediastinitis during their lifetime. In the follow-ups, one still alive, the mean survival time of the other three patients was four months. We found an average high score in our patients regarding functional scales in QLQ-H&N35 module.

Conclusions: The C-shaped ALT flap design provides ease of insertion into a tension-free tracheal-skin suture line and helps to reduce the rates of stoma-related complications and increase the quality of life of the patients.

Daratumumab-associated varicella-zoster virus meningoencephalitis in relapsed refractory multiple myeloma

Atakan Turgutkaya, Ali Zahit Bolaman, İrfan Yavaşoğlu — Sun, 29 Dec 2024 00:00:00 +0300

Daratumumab is a widely-used monoclonal anti-CD38 antibody both in newly-diagnosed and relapsed refractory multiple myeloma. CD38 is expressed on the surface of NK, regulatory B, and T cells. Therefore, patients receiving the drug are prone to decreased immunity, especially against herpes virus infections. Varicella-zoster virus is one of the herpesviruses, and reinfection typically occurs in immunocompromised individuals, including multiple myeloma patients, by reactivation of endogenous latent infection within the sensory ganglia. This type of infection (herpes zoster) usually presents in a dermatomal skin area. Here, we report a patient who developed varicella-zoster virus meningoencephalitis under daratumumab treatment.

Femoral tunneled hemodialysis catheter insertion through subacutely occluded lower extremity central veins in patients with exhausted vascular access

Ferdi Çay, Onur Ege Tarı, Güldehan Haberal, Fatma Gonca Eldem — Sun, 29 Dec 2024 00:00:00 +0300

Maintaining venous access and catheter patency in patients undergoing hemodialysis through the central catheter is a dire necessity. When conventional venous accesses have been exhausted, unconventional venous access techniques have become rational options to create vascular access for hemodialysis. Herein, a case with exhausted venous access, that underwent tunneled dialysis catheter insertion through subacutely occluded lower extremity central veins was described.

Genetic heterogeneity and metabolic reprogramming in breast cancer

Yarkın Dolaş, Ayşe Buruş, Başak Çeltikçi — Sun, 29 Dec 2024 00:00:00 +0300

Breast cancer is the most prevalent cancer and the leading cause of cancer-related mortality among women. Recent breakthroughs in breast cancer therapeutics have significantly enhanced outcomes for hormone receptor-positive and HER2-negative subtypes. However, the emergence of drug resistance, particularly in triple-negative breast cancer, presents a formidable challenge. The intricate interplay of genetic and metabolic diversity within breast cancer cells is pivotal to its development. By reprogramming metabolic pathways, cancer cells can adapt and thrive, meeting the demands of survival, growth, and invasion. These metabolic shifts also play a key role in the development of resistance to conventional therapies. This review explores the genetic and metabolic complexities of breast cancer, emphasizing the diverse subtypes and their unique profiles. We examine how genetic variations and metabolic alterations contribute to breast cancer development and progression, influencing both treatment efficacy and resistance. By integrating insights into the genetic background and metabolic reprogramming of breast cancer subtypes, this review aims to highlight the genetic variations and metabolic alterations that contribute to the pathogenesis of breast cancer, with a vision of advancing more precise and effective targeted therapies as well as discovering of novel diagnostic and prognostic markers.