ISSN :2822-5872
Volume: 2  Issue: 2 - Mart 2023
1.The potential therapeutic and/or protective effects of steroid, PRP and melatonin on noise-induced hearing loss in rats
Deniz Baklacı, Nurcan Yurtsever Kum, Aysel Çolak, Hasan Şahin
doi: 10.5505/achmedj.2023.25744  Pages 36 - 44
INTRODUCTION: To investigate the potential therapeutic and protective effects of steroid, platelet-rich plasma (PRP), and melatonin treatment on noise-induced hearing loss (NIHL).
METHODS: A total of 42 rats were divided into five groups: Group 1 did not receive any drug, Group 2 received methylprednisolone via the intratympanic route at 24 hours after acoustic trauma (AT), Group 3 received PRP via the intratympanic route at 24 hours after AT, Group 4 received intraperitoneal melatonin at 24 hours before AT, and Group 5 received intraperitoneal melatonin at 24 hours after AT. Two of the 42 rats were sacrificed and used for blood source material to prepare PRP. Each group was exposed to noise at the 105 dB sound pressure level for 12 hours to induce AT. Auditory brainstem responses (ABRs) were determined before AT and on days 1 and 28 after AT, and then histomorphological assessment was performed to identify cellular changes.
RESULTS: In the ABR test performed on day 28 after AT, a statistically significant improvement was found in the hearing thresholds of all the four treatment groups compared to the control group (p < 0.05). The improvement in the melatonin groups (Groups 4 and 5) was statistically significantly better than in the steroid and PRP groups (p < 0.05). Although the hearing thresholds of the steroid group were better than those of the PRP group, this difference was not statistically significant (p > 0.05). As a result of the histopathological examination performed on day 28 after AT, cell loss after AT was statistically significantly reduced in all the experimental groups compared to the control group (p < 0.05).
DISCUSSION AND CONCLUSION: Based on ABR testing and histopathological findings in a rat model, we conclude that melatonin may be effective in reducing NIHL and noise-induced cochlear damage.

2.The role of 48-hour CRP/albumin ratio in the differential diagnosis of interstitial and necrotizing pancreatitis
Aziz Ahmet Surel, Osman İnan, Muhammet Kadri Colakoglu, Erdal Birol Bostanci
doi: 10.5505/achmedj.2023.65375  Pages 45 - 50
INTRODUCTION: In this study, we aimed to examine the prognostic importance of the c – reactive protein (CRP)/albumin ratio in predicting acute necrotizing pancreatitis.
METHODS: The study included 100 patients diagnosed with acute interstitial pancreatitis and 50 patients diagnosed with necrotizing pancreatitis between 2015 and 2020, all over the age of 18.
RESULTS: The CRP/albumin ratio was higher in the acute necrotizing pancreatitis group compared to the interstitial pancreatitis group (94.0 vs 34.0; p <0.001, respectively). Multivariable analysis revealed CRP/albumin ratio [OR: 1.075 (1.029-1.123), p = 0.001], source of infection [OR: 4.698 (2.078-10.620), p < 0.001], and lactate dehydrogenase [OR: 1.006 (1.002-1.010), p = 0.004] to be significantly predictive of developing necrotizing pancreatitis. A prediction value of CRP/albumin ratio >70.6 was found to be a significant marker in predicting necrotizing pancreatitis (Sensitivity: 76.0%; Specificity: 85.4%; AUC: 0.881; p < 0.001). In addition, to demonstrate the nonlinear relationship between CRP/albumin and the probability of necrotizing pancreatitis, cubic spline regression analysis was applied, showing that the probability of necrotizing pancreatitis increased in relation to the increase of the CRP/albumin ratio.
DISCUSSION AND CONCLUSION: We conclude that the CRP/albumin ratio is a predictor of acute necrotizing pancreatitis. We believe that the CRP/albumin ratio is an inexpensive, sensitive, and easy-to-use predictor of acute necrotizing pancreatitis that can be used for both diagnosis and treatment follow-up.

3.Determinants of Choosing Family Medicine as a Specialty for Young Doctors
Seyma Handan Akyon, Tarık Eren Yılmaz, Adem Ozkara
doi: 10.5505/achmedj.2023.55265  Pages 51 - 59
INTRODUCTION: The reasons why family medicine specialists tend to choose this branch show differences in social and academic aspects. In this study, it was aimed to determine the reasons for choosing family medicine as the specialty of family medicine resident doctors and their concerns and fears while choosing their specialty.
METHODS: Our study is a cross-sectional observational study. 275 assistant doctors who started family medicine specialization training in Ankara between 2018-2020and are actively working constitute our study population. The participants were asked to score 0: the most ineffective, 10: the most effective, for the reasons for preferring family medicine consisting of 20 propositions and their concerns while choosing family medicine consisting of 7 propositions.
RESULTS: A total of 130 volunteer participants, who filled out the questionnaire completely, were included in the study. According to the survey results, the most important reasons to select family medicine specialty were; the desire to "spend more time with the family, the environment, and themselves", "less night and weekend shifts" and the desire for a "more easy and comfortable life". On the other hand, the main concerns of family medicine residents when choosing this specialty were "unnecessary rest reports demands" and "unnecessary medication demands" by patients.
DISCUSSION AND CONCLUSION: While it was determined that the personal factors of the residents were at the center of the reasons for choosing the family medicine branch, the characteristics and factors related to the discipline were the secondary preference reasons. On the other hand, it is necessary to take measures against alarming situations and develop new policies.

4.New prognostic markers in acute cholangitis patients with COVID-19
Fadime Güllü Haydar, Yavuz Otal, Gamze Avcıoğlu
doi: 10.5505/achmedj.2023.88597  Pages 60 - 68
INTRODUCTION: COVID-19 is the cause of a pandemic with high mortality rates that affect the entire world. In the present study, the importance of blood parameters was investigated in predicting the severity of the disease in patients diagnosed with both covid19 and acute cholangitis simultaneously
METHODS: A total of 37 patient groups (n=37) who were diagnosed with both COVID-19 and acute cholangitis, a total of 38 patients in the control group (n=38) infected with Covid 19 and with no comorbidity, and 68 completely healthy control group (n) =68) were included in the study retrospectively and simultaneously. Those who had positive RT-PCR (Real-Time Polymerized Chain Reaction) test results were included in the study. The results of routine biochemistry, serology, hormone, and blood gas tests of the patients were compared with those of the control group. The Tokyo 2018 Criteria (TG18) were used in the diagnosis of acute cholangitis and disease severity grading.
RESULTS: The WBC(white blood cell), CRP(c-reactive protein), N/L Ratio(neutrophile/lynfosite ratio), AST(Aspartat Aminotransferaz), ALT(Alanin Aminotransferaz), LDH(Laktate dehidrogenaz), GGT(Gama glutamil transferaz), ALP(alkalen fosfataz) total bilirubin, and direct bilirubin levels were higher in the patient group at statistically significant levels than in the control group (p<0.001). The albumin levels were lower than in the control group (p<0.001). Total bilirubin/lymphocyte, GGT/lymphocyte, ALP/lymphocyte ratios, and D-dimer parameters had the highest AUC (Area Under the Curve) values in ROC analysis (0.984, 0.924, 0.923, and 0.897, respectively).
DISCUSSION AND CONCLUSION: Total bilirubin/lymphocyte, GGT/lymphocyte, and ALP/lymphocyte ratios may be useful in predicting the severity of the disease in acute cholangitis cases developing with COVID-19 simultaneously.

5.Effect of sodium-glucose cotransporter-2 inhibitors on circadian blood pressure rhythm in patients with type 2 diabetes mellitus
Ayeşenur Karahan, İhsan Ateş, Emra Asfuroğlu Kalkan, OSMAN İNAN, Enes seyda Şahiner
doi: 10.5505/achmedj.2023.72792  Pages 69 - 75
INTRODUCTION: The aim of this study was to investigate the effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on circadian blood pressure rhythm in normotensive patients diagnosed with type 2 diabetes mellitus (DM) who were not on antihypertensives.
METHODS: The study included normotensive patients with type 2 DM who were initiated on SGLT2 inhibitors (empagliflozin, n=31; dapagliflozin, n=36) in addition to an antihyperglycemic agent.
RESULTS: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) changed from a nondipper to a dipper pattern after treatment in 22.4% (n=15) and 25.4% (n=17) of the patients, respectively. Both SBP and DBP changed from a nondipper to a dipper pattern after treatment in 17.9% (n=12) of all patients. This change in circadian blood pressure was not significantly different for the dapagliflozin and empagliflozin groups (p>0.05). Fasting blood sugar and HbA1c levels significantly decreased in both groups after SGLT2 inhibitor treatment (p<0.001). Serum creatinine and spot urine microalbumin levels and the microalbumin/creatinine ratio decreased significantly in both groups (p<0.05). The posttreatment decrease in spot urine protein and creatinine levels was significantly higher in the dapagliflozin group compared to the empagliflozin group (p<0.05).
DISCUSSION AND CONCLUSION: The circadian blood pressure pattern changed from a dipper to a nondipper pattern in normotensive type 2 DM patients after they used SGLT2 inhibitors.

6.Relationship between plasma atherogenic index and coronary slow flow phenomenon
Birsen Doganay, Ozlem Ozcan Celebi
doi: 10.5505/achmedj.2023.92400  Pages 76 - 83
INTRODUCTION: Epidemiological studies indicated that patients suffering from coronary slow flow phenomenon (CSFP) are predisposed to dyslipidemia. However, there are limited studies evaluating the relationship between atherogenic index of plasma (AIP), which is a novel indicator of atherogenic dyslipidemia, and CSFP. This study aimed to investigate the prognostic role of the AIP in predicting CSFP among patients with undergoing coronary angiography.
METHODS: This retrospective study included 110 patients with CSFP diagnosed by methods of Thrombolysis in Myocardial Infarction (TIMI)-frame count (TFC) and 110 controls with normal coronary flow (NCF). AIP obtained as the base 10 logarithm of the ratio of triglycerides to HDL.
RESULTS: Mean AIP level was higher in the CSFP group than NCF group (0.6 ± 0.2 vs. 0.4 ± 0.2, p < 0.001). Multivariable regression analysis showed that AIP level (OR = 15.33, 95% CI = 4.11-57.18, p < 0.001), as well as neutrophil and platelets levels, were independent predictor of CSFP. The threshold value of the AIP in predicting CSFP was >0.7 with 64.5% sensitivity and 69.8% specificity (Area under the curve [AUC] = 0.714, p < 0.001).
DISCUSSION AND CONCLUSION: API was higher in CSFP patients and was determined as an independent predictor of CSFP. Prior to planned diagnostic coronary angiography, API exhibits significant diagnostic performance in predicting CSFP.