ISSN :2822-5872
ANKARA CITY HOSPITAL MEDICAL JOURNAL - ACH Medical Journal: 3 (1)
Volume: 3  Issue: 1 - Mart 2024
1.Full Issue

Pages I - II

RESEARCH ARTICLE
2.A disease to consider in the differential diagnosis of lower back pain: Celiac disease and related autoimmune disorders
Özlem Karakaş, Berkan Armagan, Diler Taş Kılıç, Bahar Özdemir Ulusoy, Ebru Atalar, Hasan Tankut Köseoğlu, Mahmut Yuksel, Cagdas Kalkan, Fatma Ebru Akın, Emin Altiparmak, Şükran Erten
doi: 10.5505/achmedj.2024.02997  Pages 1 - 6
INTRODUCTION: Celiac disease (CD) is an autoimmune disease caused by gluten ingestion in genetically susceptible individuals. Although gastrointestinal system symptoms are common, extraintestinal symptoms may be seen during the disease course. Due to similar genetic features and pathogenetic pathways for autoimmunity, increasing rheumatological diseases have been reported in CD in recent years. In this study, we aimed to evaluate patients with CD in terms of musculoskeletal symptomatology and presence of rheumatic disease and autoantibody positivity.
METHODS: The study was designed as a cross-sectional, retrospective cohort study. Between January 2020-2022, 65 patients with CD who were followed-up in the gastroenterology clinic of our hospital and consulted to the rheumatology outpatient clinic for any reason were included in the study. Medical records were reviewed, laboratory and imaging results were recorded.
RESULTS: Admission to the rheumatology clinic, the most common symptoms were inflammatory back pain(IBP) (43.1%) followed by xerophthalmia (15.4%). None of the patients with IBP had radiographically active sacroiliitis. In total, concomitant rheumatological diseases were 6 (9.2%): 2 patients (3.1%) had Sjögren’s syndrome and one undifferentiated connective tissue disease, systemic lupus erythematosus, psoriatic arthritis and familial Mediterranean fever. Except for the CD autoantibodies, the frequency of anti-nuclear antibodies (ANA) was 38%, and the most common extractable nuclear antigen (ENA) patterns were DFS-70 and SSA.
DISCUSSION AND CONCLUSION: Although the most common symptom is IBP, the absence of radiographic findings of spondyloarthritis in CD patients suggests these to be a non-rheumatological cause associated with CD. On the other hand, CD patients with xerophthalmia and/or ANA positivity may need to be evaluated for connective tissue diseases, especially SjS.

3.Correlation between Helicobacter pylori and serum levels of ghrelin, obestatin, leptin and motilin in hyperemesis gravidarum
Onur Osman Özkavak, Fatma Beyazıt
doi: 10.5505/achmedj.2024.80774  Pages 306 - 311
INTRODUCTION: Hyperemesis gravidarum (HEG) is the severe form of nausea and vomiting seen in pregnancy. Many factors are thought to affect the development of the disease however, the pathogenesis of HEG has not been clearly revealed yet. In this study, we aimed to evaluate serum ghrelin, obestatin, leptin, motilin levels and their relationship with Helicobacter pylori (H.pylori) in the patients diagnosed with HEG.
METHODS: A total of 160 patients including 48 HEG patients, 57 asymptomatic pregnant women, and 55 healthy non-pregnant women aged between 18-40 years, who were admitted to our tertiary research hospital were included in the study, Gastrointestinal hormone levels compared between three groups and the HEG group divided by the H.pylori seropositivity and hormone levels were compared between H.pylori positive and negative patients.
RESULTS: In the HEG group, the mean serum ghrelin level was significantly lower and the mean leptin level was significantly higher than the asymptomatic pregnant and non-pregnant control groups (p=0.0001 and p=0.0001). The mean obestatin level of the HEG group was significantly lower than the non-pregnant control group (p=0.012). The mean motilin level in the HEG group was significantly higher compared to the asymptomatic pregnant control group (p=0.020).
DISCUSSION AND CONCLUSION: This study suggests a possible role of ghrelin, obestatin, leptin and motilin in the pathology of HEG independent from H.pylori positivity.

4.The Relationship of Cases with Isolated Proteinuria in Pregnancy with Maternal and Perinatal Outcomes
Candan Yılmaz, Mete Bertizlioğlu, Setenay Arzu Yılmaz, Ersin Çintesun, Çetin Çelik, Özlem Seçilmiş Kerimoğlu, Huriye Ezveci
doi: 10.5505/achmedj.2024.83702  Pages 312 - 319
INTRODUCTION: There are a limited number of studies in the literature on the obstetric consequences of isolated gestational proteinuria (IGP) disease and the progression of preeclampsia (PE). It has been stated that gestational proteinuria may be a risk factor for PE. With this study, we aimed to determine the risk factors for the development of PE in cases with isolated proteinuria during pregnancy and to compare the maternal and perinatal outcomes of the cases.
METHODS: The study was designed as a retrospective cross-sectional study. Pregnant women over the 20th gestational week and diagnosed with proteinuria by 24 hour urine analysis were included in the study. Patients who were diagnosed with gestational proteinuria and did not develop PE during their follow up were classified as IGP and patients who developed PE.
RESULTS: The average time between the detection of proteinuria and the development of PE was calculated as 16 days. Week of gestation at delivery(p<.001)and the time between proteinurine detection and delivery(p=.002) were significantly lower in the PE group. In 52 of 185 patients with gestational proteinuria in total, proteinuria was detected an average of 32w 5d, and increased blood pressure and development of PE occured at an average of 35 weeks of gestation. NB intensive care requirement, preterm delivery and IUGR rates were found to be significantly higher in the group with PE. Ceserean delivery rate in IGP was calculated as 54.14%,ceserean delivery rate in PE was 78.85%. A significant correlation was found between the history of preeclampsia in the development of preeclampsia in IGP patients(OR: 11,000 (1,199-100,883), p=0.034) and increased urine proteinuria(OR: 1,0001 (1,000-1,001),p=0.007).
DISCUSSION AND CONCLUSION: Patients who have had preeclampsia before and who have a high 24 hour urine value are more likely to return to PE. IGP has a more benign prognosis in terms of maternal and fetal compared to PE.

5.What are the factors affecting the mound displacement detected in endoscopic treatment failure of vesicoureteral reflux
Gökhan Demirtaş, Tugrul Tiryaki
doi: 10.5505/achmedj.2024.86570  Pages 320 - 324
INTRODUCTION: Success rates of endoscopic treatment for vesicoureteral reflux range from 50-100%. Various factors predict outcomes after endoscopic injection. Mound displacement is one of the most critical factors for failure.We observed mound displacement in most of the patients with endoscopic injection failure. We aimed to evaluate predisposing factors for mound displacement in patients with endoscopic injection for vesicoureteral reflux.
METHODS: In 2020, operative images were taken and archived in cases where the endoscopic injection was applied due to vesicoureteral reflux. The localization of the bulking agent was evaluated during the redo procedure in 11 patients who were re-admitted due to the failure of the injection procedure. In addition, age, gender, side and degree of reflux, bladder thickness in US, and bladder trabeculation were evaluated.
RESULTS: Local migration of bulking agent was seen in 11 patients at cystoscopy after initial treatment failure. Our repeat endoscopic injection rate was 11/80 (13.75%). Bladder wall thickness and/or trabeculation, constipation, and post-voiding residue (over 20 ml) were significantly higher in patients with mound displacement.
DISCUSSION AND CONCLUSION: Patients with thick bladder walls with increased PVR and accompanying constipation have the risk of mound displacement. Therefore, we recommend performing a cystoscopy in all cases with recurrence to evaluate the location of the bulking agent. If the mound displacement is noted, we recommend reinjection. Patients with a thick bladder wall, postvoiding residue, and concomitant constipation are at increased risk of bulking agent displacement. If migration of bulking agent is detected, we recommend reinjection with Double HIT or multi-site injection techniques.

6.Ultrasonographic Assessment of Median Nerve Cross-Sectional Area in Obstetricians
Dilek Menekse Beser, Deniz Oluklu, Derya Uyan Hendem, Sule Goncu Ayhan, Atakan Tanacan, Dilek Sahin
doi: 10.5505/achmedj.2024.02486  Pages 325 - 330
INTRODUCTION: We aimed to investigate whether the median nerve cross-sectional area (MNCSA) is affected in obstetricians due to occupational reasons
METHODS: In this cross-sectional study, 93 participants were included. The median nerve cross-sectional area was measured by high-resolution ultrasonography, and clinical symptoms of carpal tunnel syndrome were questioned.
RESULTS: The measurements of MNCSA for the right hand were higher in ≥ 8 years of working experience than in < 8 years of working experience (11mm2 vs. 8 mm2, p<0.001). A significant positive moderate correlation was also between right MNCSA and working experience and daily ultrasonography practice (r=0.557; p<0.001, r=0.561; p<0.001, respectively).
DISCUSSION AND CONCLUSION: This study showed that increased MNCSA was associated with obstetricians’ working experience and daily ultrasonography practice. Considering the prevalence of carpal tunnel syndrome in specific occupational groups, MNCSA measurement by ultrasound may contribute to early diagnosis and convenient selection for further diagnostic tests.

7.An early prognostic marker for determining disease severity in acute cholangitis: CRP/albumin ratio
Sema Nur Arasan, Osman Inan, Enes Seyda Sahiner, Aziz Ahmet Surel, Emin Altiparmak, Oguzhan Zengin, Ihsan Ates
doi: 10.5505/achmedj.2024.78942  Pages 331 - 337
INTRODUCTION: This study was undertaken to investigate the importance of the CRP/albumin ratio (CAR) as an early prognostic marker for determining disease severity in acute cholangitis.
METHODS: A total of 366 patients aged >18 years diagnosed with acute cholangitis were included in the study. Acute cholangitis severity was determined according to the 2018 Tokyo criteria.
RESULTS: The study population consisted of 49.2% patients with mild, 24.6% moderate, and 26.2% severe acute cholangitis. The cut-off CAR value for predicting moderate risk compared to the mild risk group was found to be >1 with 73.3% sensitivity and 76.7% specificity (AUC±SE: 0.785±0.03; +PV: 61.1%, -PV: 85.2%; p<0.001). The CAR cut-off value for predicting severe risk compared to the moderate risk group was found to be >2.9 with 71.9% sensitivity and 71.1% specificity (AUC±SE: 0.788±0.03; +PV: 72.6%, -PV: 70.3%; p<0.001). The CAR cut-off value for predicting admission to the intensive care unit (ICU) was >2.5 with 77.4% sensitivity and 74.6% specificity (AUC±SE: 0.803±0.03; +PV: 43.1%, -PV: 90.1%; p<0.001). The CAR cut-off value for predicting mortality was >2.8 with 100% sensitivity and 74.9% specificity (AUC±SE: 0.890±0.03; +PV: 19.5%, -PV: 100%; p<0.001). Compared to its components, the CAR was found to exhibit superior diagnostic performance in predicting moderate or severe risk, ICU admission, and mortality.

DISCUSSION AND CONCLUSION: We found that the CAR is a good prognostic marker in determining the severity of acute cholangitis in the early period.

CASE REPORT
8.Neuromyelitis Optica associated with Myastenia Gravis: A Case Report
Selin Betas Akin, Tutku Atay, Abdullah Guzel, Gokce Zeytin Demiral, Ulku Turk Boru
doi: 10.5505/achmedj.2024.40085  Pages 338 - 341
Neuromyelitis optica (NMO, Devic syndrome) is an inflammatory, demyelinating central nervous system disorder typically associated with optic neuritis and transverse myelitis involving three or more segments in the spinal cord. Myasthenia Gravis (MG) is an autoimmune disease characterized by weakness in fatiguing muscles due to impaired neuromuscular transmission. NMO can coexist with autoimmune diseases, and its association with myasthenia gravis is common. Studies in existing patients with both NMO and MG support that MG symptoms often appear earlier and tend to be milder. Here, we present a case of a 45-year-old woman with concurrent NMO and MG, aligning with findings from previous studies.

9.Urothelial cell carcinoma of bladder in the second trimester of pregnancy: A clinical case presentation
Turgay Kacan
doi: 10.5505/achmedj.2024.58661  Pages 342 - 345
Bladder cancer in pregnant women is a rare and challenging condition to manage due to its potential impact on both the mother and the fetus. Bladder cancer may be incidentally detected or manifest with macroscopic hematuria and irritative symptoms. However, the physiological processes occurring during pregnancy, influenced by hormonal changes, can complicate the diagnosis by masking these symptoms. Due to the limited number of cases reported in the literature, there is a lack of guideline recommendations for the follow-up and treatment of bladder tumors in pregnant individuals.
In this case report, we aim to present a patient with transitional cell urothelial cancer who presented with macroscopic hematuria in the second trimester, a detected mass in bladder on ultrasound, and underwent complete resection by bipolar transurethral resection.

LETTER TO THE EDITOR
10.Assessing Healthcare Challenges in Somalia: A 2024 Perspective
Sakarie Mustafe Hidig
doi: 10.5505/achmedj.2024.96168  Pages 346 - 347
Abstract |Full Text PDF