ISSN    : 2587-0998
E-ISSN : 2587-1404
SOUTHERN CLINICS OF ISTANBUL EURASIA - South Clin Ist Euras: 35 (1)
Volume: 35  Issue: 1 - 2024
1. Front Matter

Pages I - VIII

RESEARCH ARTICLE
2. Shock Index and Modified Shock Index Might be Reliable for Predicting Morbitidy in Pregnancy-Related Hypertensive Disorders
Kübra Çakar Yılmaz, Gül Çakmak, Ulgen Zengin, Sunullah Soysal, Ayten Saracoglu
doi: 10.14744/scie.2024.19052  Pages 1 - 7
INTRODUCTION: Maternal Early Warning Criteria including; systolic - diastolic blood pressure, peripheral oxygen saturation and urine output, is a useful marker for predicting postoperative complications. Shock index and the modified shock index were used to determine the need for fluid and transfusion in hypovolemia. The aim of this study is to evaluate the effectiveness of using shock index and modified shock index as a parameter of the early warning system to predict the need for postpartum blood transfusion, complications and mortality in pregnancy-related hypertensive diseases.
METHODS: Following the Ethics Committee approval, between 2012-2017, 192 patients between the ages of 13-47, undergoing caesarean section due to preeclampsia, eclampsia, chronic hypertension and gestational hypertension were enrolled in this study.
RESULTS: There was a positive correlation between SI and embolism and arrhythmia at admission and between the modified shock index and Intrauterine Growth Retardation at delivery (p<0.05). There is a significant positive correlation between the shock index and modified shock index at admission and fresh frozen plasma and Platelet suspension transfusion. There is a significant positive correlation between the shock index at delivery and packed red blood cells, fresh frozen plasma, and platelet suspension transfusion. There is a significant positive correlation between the modified shock index at delivery fresh frozen plasma and packed red blood cells transfusions (p<0.05).
DISCUSSION AND CONCLUSION: It was concluded that modified shock index and shock index could important markers in predicting maternal and fetal complications in hypertensive diseases due to pregnancy as well as postpartum blood transfusion.

3. A Rare Cause of Pulmonary Hypertension in Patients With Renal Transplant: High-Flow Arteriovenous Fistula
Serap Yadigar, Pınar Özdemir, Erman Özdemir
doi: 10.14744/scie.2024.75875  Pages 8 - 12
INTRODUCTION: Renal transplant is the most effective form of renal replacement therapy. Most of the patients with renal transplant have a history of hemodialysis before transplantation. Therefore, most have arterıovenous fistulas (AVF). Persistent, high flow AVF, which is a rare cause of pulmonary hypertension, should not be overlooked in patients who develop pulmonary hypertension after transplantation.
METHODS: In our study, we retrospectively presented our renal transplant patients who newly developed pulmonary hypertension and followed up in our center. We performed fistula closure in our patients with high-flow AVF, which is one of the rare causes of pulmonary hypertension. We recorded our renal (creatinine, glomerular filtration rate, albuminuria, proteinuria), cardiac (ejection fraction) and pulmonary function (pulmonary pressure) data in the 1st and 3rd month follow-ups after the AVF closure procedure.
RESULTS: We observed improvement in cardiac, renal and pulmonary functions of our patients. While creatinine, proteinuria, albuminuria, and pulmonary artery pressure values decreased after AVF closure; GFR and ejection fraction increased. Changes were statistically significant (p values <0.001)
DISCUSSION AND CONCLUSION: Pulmonary hypertension may develop in renal transplant patients. High-flow fistula is a rare cause of pulmonary hypertension. The presence of high-flow fistula should be kept in mind among the causes of pulmonary hypertension in patients with renal transplantation. Nephrologists should keep in mind the presence of high-flow AVF in patients with newly developing symptoms of pulmonary hypertension.

4. Factors Effecting Readmission of Acute Heart Failure Patients to Emergency Department
Ömer Faruk Gülsoy, Gorkem Alper Solakoglu, Ferhat Arslan, Çağatay Nuhoğlu, Şennaz Şahin
doi: 10.14744/scie.2023.67984  Pages 13 - 19
INTRODUCTION: The clear reasons for the re-presentation of acute heart failure patients to the emergency department have not been definitively established in the literature, yet it is anticipated that this patient group will utilize emergency services more frequently in the future. In our study, we aimed to determine the impact of demographic, biochemical, imaging, and outcome variables on the re-presentation to the emergency department within 90 days in patients revisiting due to acute heart failure.
METHODS: Patients revisiting the emergency department within 90 days due to acute decompensated heart failure between January 1, 2019, and January 1, 2021, were included in our study. A retrospective analysis of patients’ demographic and clinical characteristics was conducted, and factors influencing re-presentation were evaluated.
RESULTS: Our study included 250 patients who revisited the emergency department on average after 34±12.5 days. A significant relationship was observed between patients requiring intensive care unit or hospital admission and their re-presentation within 90 days (p<0.005). Furthermore, patients who received non-invasive mechanical ventilation in the emergency department re-presented earlier compared to those who did not (p<0.005). Patients’ ejection fraction values were also found to be associated with early re-presentation (p<0.005). Pearson’s R correlation analysis revealed a significant relationship between the use of furosemide within 90 days and re-admission (r=0.2015, p=0.0014).
DISCUSSION AND CONCLUSION: Our research demonstrated that re-presentation is influenced by the use of NIMV, furosemide, low ejection fraction, and hospitalization. Consequently, exercising caution while discharging patients receiving NIMV and high-dose furosemide in the emergency department, as well as formulating a follow-up strategy for patients with low ejection fraction in acute heart failure, holds paramount importance.

5. Correlations of Different Objective and Patient Related Outcome Measures for Patellar Instability Patients
Muhammed Enes Karatas, Mehmet Salih Söylemez, Mehmet Mete Oruç, Güray Altun
doi: 10.14744/scie.2023.87847  Pages 20 - 26
INTRODUCTION: We aimed to evaluate the effectiveness of modified Aberdeen Weight-Bearing Test (Knee) (AWT-K) and KSS (Knee Society Score) comparing their correlations with the Tegner Lysholm (TL) score in patellar instability patients.
METHODS: Patients treated for patellar dislocation were divided into two groups. The first group consisted of patients operated on for patellar instability and the second group patients followed by conservative means. Duration of follow-up, age, gender, Caton-Deschamps index, and type of surgical interventions were recorded. Since the TL scoring system was previously validated in the follow-up of patellar instability treatment, the compatibility of KSS and modified AWT-K scoring systems with the TL scoring system was evaluated and their effectiveness in the follow-up of patellar instability was examined.
RESULTS: A moderate correlation was found between TL and total KSS scores.However, when the relationship between KSS subgroups ES, SS, OKS, FAS and TL is examined; a weak and moderate correlation was found between the TL scoring system and OKS, SS, and FAS. When weak and non-correlated ES and SS were excluded, there was a strong correlation between TL score and mtKSS.There was a low correlation between TL scores and AWT-K 60-second average load difference and there was a low correlation between FA and AWT-K 60-second mean load difference and ratios.
DISCUSSION AND CONCLUSION: The weak correlation of the AWT-K test for weight-bearing on the knee with findings of KSS and the TL scoring system reveals that may not be an adequate follow-up instrument for patients with patellar instability in short-term follow ups.

6. The Impact of the COVID-19 Pandemic in Schizophrenia Patients Registered with the Community Mental Health Center
İsmail Koç, Ebru Akbuğa Koç
doi: 10.14744/scie.2024.85579  Pages 27 - 33
INTRODUCTION: The aim was to examine the effect of the COVID-19 pandemic on schizophrenia patients registered at the Community Mental Health Center (CMHC) in terms of depression, suicide risk, and tendency to violence.
METHODS: The study was conducted on patients registered at the CMHC who were regularly followed up. It was carried out on one hundred and eight individuals who met the diagnosis of schizophrenia according to the DSM-V and the inclusion criteria. Individuals were respectively classified as hospitalized patient group during the Covid-19 pandemic period (n=39), non-admitted patients with an emergency plan without hospitalization (n=37), and stable patient group (n=32). In the study, the Socio-Demographic Questionnaire, the Calgary Depression Scale for Schizophrenia (CDSS), the Buss-Perry Aggression Questionnaire (BPAQ), and the Suicide Probability Scale (SPS) were used.
RESULTS: While there was a significant difference between the groups in CDSS and BPAQ scores (p<0.05), there was no significant difference between the groups in the total score of SPS (p>0.05). There was no significant difference between the groups in terms of physical, verbal aggression, and anger in the BPAQ sub-dimensions (p>0.05), but a significant difference was found in the hostility subgroup (p<0.05). While there was no significant difference between the groups in the sub-dimensions of negative self and exhaustion, hostility in the SPS (p>0.05), a difference was found between the groups in the sub-dimension of disconnection from life (p<0.05). Also, a significant negative correlation was found between education level and CDSS values (r: 0.451; p: 0.025).
DISCUSSION AND CONCLUSION: In our study, the significant difference found in CDSS and BPAQ total scores of the three groups showed that schizophrenia patients with CMHC follow-up who tend to depression or violence were significantly affected by the pandemic period, and their treatment follow-up was more severe.

7. Impact of Lowering the Screening Age for Colorectal Cancer on Early Diagnosis and Treatment: A Retrospective Study in a Turkish Cohort
Cem Batuhan Ofluoğlu, Fırat Mülküt, Mehmet Mustafa Altıntaş, Ayhan Çevik
doi: 10.14744/scie.2024.45762  Pages 34 - 38
INTRODUCTION: This study was planned in line with the American Cancer Society’s recommendation to lower the colorectal cancer (CRC) screening age from 50 to 45. The study aims to evaluate the results of colonoscopic polypectomy in patients aged 45-49 in Türkiye, examining the prevalence and characteristics of colorectal polyps and malignancies, with the goal of establishing a database for Türkiye.
METHODS: Colonoscopies in the endoscopy unit of our hospital between September 2020 and September 2023 were retrospectively examined. Patients aged 45-49 diagnosed with polyps or malignancies were included. Exclusions were made for patients who were unreachable, unable to complete a full colonoscopy, underwent the procedure for screening purposes, had a history of malignancy, suffered from polyp syndromes, or were under surveillance following a prior colonoscopy. We analyzed demographic information, indications for colonoscopy, and pathological findings. Statistical analyses were carried out using SPSS version 25.0, with a p-value of <0.05 considered statistically significant.
RESULTS: From 748 patients, 106 with detected polyps or malignancy were included. Most patients were male (56.6%), with an average age of 47.07±1.52. Key colonoscopy indications were benign perianal diseases (34%), changes in bowel habits (27.4%), and anemia (12.3%). The majority of polyps were located in the left colon and rectum, predominantly low-grade dysplasia adenomas (68.9%) and high-grade dysplasia adenomas (9.4%). The polyp detection rate was 14.2%, and the malignancy rate was 2.8%.
DISCUSSION AND CONCLUSION: According to the literature, the rate of polyp and malignancy detection in colonoscopies performed as part of the screening program for people aged 50 and over is similar to the rates found in our study. Based on this similarity, it may be appropriate to consider including patients in the 45-50 age group in the screening scope.

8. Motorcycle Accident Cases Presented to the Emergency Department Before and During the COVID-19 Pandemic
Emre Çetin, Halil Doğan
doi: 10.14744/scie.2024.70048  Pages 39 - 46
INTRODUCTION: To examine patients who presented to the emergency department following motorcycle accidents before and during the COVID-19 pandemic period in order to comparatively assess the incidence of these accidents, associated trauma severity, and patient outcomes.
METHODS: In this retrospective observational study, we evaluated 1,137 patients who presented to the Adult Emergency Department of Bakırköy Dr. Sadi Konuk Training and Re-search Hospital with injuries caused by motorcycle accidents. The electronic files of the patients who were determined to have presented to the emergency department after a motorcycle accident were screened, and their age, gender, blood pressure, pulse, oxygen saturation, respiratory rate, body temperature (at presentation), time of the accident, motorcycle speed at the time of the accident as reported by the driver, protective equipment used, time of arrival at the emergency department, length of stay in the emergency department and hospital, the types of treatment applied throughout the patients’ stay, and the outcomes of the patients were recorded in the case forms.
RESULTS: Of the 1135 patients included in the study, 129 (11.4%) presented to the emergency department before the pandemic and 1,006 (88.6%) during the pandemic period. There were 1,055 (93%) male patients and 80 (7%) female patients. Of all the patients, 145 (12.9%) were hospitalized, and 990 (87.2%) left the hospital. Of those who left the emergency room, 42 (3.7%) refused treatment, and 35 (3.1%) left without the physician’s approval. Of the hospitalized patients, 20 (1.8%) were admitted to the intensive care unit, and four (0.4%) were referred to other hospitals. Upon examination of in-hospital mortality, it was determined that 1,132 (99.7%) patients survived, and three (0.3%) died. When assessing the association between injury locations according to the use of full-body protective equipment, a correlation was found in terms of head and neck, lung, extremity, pelvis, and multi-trauma injuries.
DISCUSSION AND CONCLUSION: Regardless of traffic density, the use of protective equipment by motorcycle drivers prevents serious injuries in accidents. The EMTRAS and ESI scores are clinical pre-diction tools that can be used to predict mortality and morbidity in motorcycle accidents.

9. The Relationship Between Hemoglobin A1c and Hemogram-derived Novel Inflammatory Indices
Soner Yesilyurt, Ekmel Burak Ozsenel, Almila Senat, Osman Erinc
doi: 10.14744/scie.2024.07992  Pages 47 - 53
INTRODUCTION: An increasing number of studies are investigating the importance of new inflammatory markers derived from hemogram in the clinical management of diabetes, which is a chronic inflammatory condition. In this study, we aimed to assess the relation between HbA1c, Systemic Inflammatory Index (SII), Systemic Inflammation Response Index (SIRI), and Systemic Inflammation Aggregate Index (SIAI).
METHODS: A total of 22,183 participants, including the control group (n=9100), prediabetes group (n=7087), and diabetes group (n=5996), were divided into 3 groups according to their HbA1c levels. In these 3 groups, hemogram-derived new inflammatory markers SII, SIRI, and SIAI values, as well as C-reactive protein, sedimentation, and leukocyte values, were evaluated.
RESULTS: The median values of all 3 indices were found to be higher in the diabetes group compared to the other groups [SII=515(380-716), SIRI=0.93(0.66-1.35), SIAI=248(164-374), p<0.001]. In the control group, HbA1c and glucose values were not significantly correlated with inflammation indices (p>0.05). However, in the prediabetes group, significant correlations were detected between SII and SIRI values and glucose (r=0.033, p=0.006; r=0.040, p=0.001) and HbA1c levels (r=0.038, p=0.001; r=0.069, p<0.001).
DISCUSSION AND CONCLUSION: Hemogram-derived inflammatory indices showed a gradual increase in patient groups based on HbA1c levels, but weak correlations were found between HbA1c levels and inflammatory markers as indicators of glucotoxicity. Hemogram is an easily accessible and widely used test in clinical practice. Therefore, hemogram-derived indices may be an alternative to traditional inflammatory markers in assessing glycotoxicity-induced inflammation. The detection of inflammation, which positively correlated with HbA1c levels through new indices, may help in predicting diabetic complications.

10. Term Pregnancy Following Uterine Prolapse Surgery, Literature Review and Case Presentation
Gizem Boz İzceyhan, Eralp Bulutlar, Çetin kılıççı
doi: 10.14744/scie.2024.75508  Pages 54 - 58
INTRODUCTION: Herniation of the pelvic organs into or outside the vagina is what is known as pelvic organ prolapse (POP). This paper was prepared in order to offer a case report of our pregnant patient who reached term after undergoing this operation, as well as to conduct a literature review on the vaginally assisted laparoscopic sacrohysteropexy (VALSH) procedure, which is a new method in the surgical treatment of POP. Both of these goals were accomplished through the writing of this article.
METHODS: A patient who 32 years old was admitted to our hospital with a palpable mass in the vagina. Because our patient was planned to get pregnant in the future, we suggested that she undergo a procedure known as VALSH, which is a uterus-preserving operation. The patient, who became pregnant spontaneously one year after the operation, had a healthy baby by cesarean section on at 38 weeks of gestation.
RESULTS: We conducted a literature review on the vaginally assisted laparoscopic sacrohysteropexy procedure, which is a new method in the surgical treatment of POP. It is unknown what kind of surgical procedure should be used to treat POP in young women who are still of childbearing age. Studies have shown that young women have an increased chance of POP recurrence following surgical treatment; however, no studies have been conducted to investigate the effect of surgical POP repair on subsequent pregnancies and the kind of delivery that occurs during those pregnancies.
DISCUSSION AND CONCLUSION: No signs of prolapse returning were detected during the tests conducted at the 6th week, 6th month of pregnancy, and the 12th month postpartum. We believe that the surgical procedure we utilized is an appropriate treatment for women of childbearing age who plan to become pregnant. The lack of prolapse recurrence indicates that the pregnancy can progress to full term without complications.

11. The Relationship between Serum ACE Level and Disease Severity in Patients Hospitalized Due To COVID-19 pneumonia
Berrin Zinnet Eraslan, Zeynep Yıldız, Sevda Şener Cömert, Nesrin Kıral, Ersin Demirer, Elif Torun Parmaksız, Ayşe Batırel
doi: 10.14744/scie.2024.48039  Pages 59 - 64
INTRODUCTION: The renin-angiotensin-aldosterone system (RAS) plays an important role in the pathophysiology of COVID-19. The role of the angiotensin-converting enzyme (ACE), which is part of RAS, in COVID-19 is unclear. The study aimed to investigate whether there was a relationship between serum ACE level at admission and disease severity in COVID-19.
METHODS: A total of 158 patients hospitalized in our clinic between January 2021 and April 2021 due to COVID-19 pneumonia were included in this study. Patients were divided into two groups: mild-moderate and severe pneumonia, according to the severity of the disease. The two groups were compared in terms of age, gender, symptoms and signs, comorbidities, laboratory parameters, serum ACE level, and mortality. Serum ACE level was measured by a spectrophotometric method.
RESULTS: The mean age of the patients was 61 years (min: 18, max: 89), and 85 (53.5%) were male. The most common symptoms were dyspnea (61%), cough (57.2%), and malaise (49.7%). The number of leukocytes, C-reactive protein, ferritin, D-Dimer, and days of hospitalization were higher in the severe pneumonia group compared to the mild-moderate pneumonia group, and the difference was statistically significant (p=0.004, p<0.001, p=0.005, p=0.01, p<0.001, respectively). The rates of intensive care unit admission, intubation, and mortality were higher in the severe pneumonia group (p=0.035, p=0.035, p=0.035, respectively). The mean serum ACE level of the patients was 25.14 (min: 3.39, max: 75.28) U/L; no significant difference was found between the groups (p=0.61).
DISCUSSION AND CONCLUSION: No correlation was found between serum ACE levels at the time of hospitalization and COVID-19 severity. Serum ACE levels at admission did not reflect disease severity.

12. Subcoracoid Effusion in Subscapularis Tears Is it a Radiological Marker?
Ersin Şensöz, Engin Eceviz
doi: 10.14744/scie.2024.69320  Pages 65 - 69
INTRODUCTION: Diagnosing subscapularis tendon rupture in preoperative MRI slices can be challenging. This study investigated whether subcoracoid effusion (SE) is more common in subscapularis tendon injuries and whether it can serve as a marker.
METHODS: Patients with subscapularis tendon rupture were categorized as Group 1, consisting of 26 patients, while patients with intact subscapularis tendon but other cuff pathologies were classified as Group 2, consisting of 116 patients. We evaluated the presence of effusion in the subcoracoid bursa, effusion in the subscapular bursa, acromiohumeral distance, and coracohumeral distance. We examined retrospectively 208 patients who underwent shoulder arthroscopy in the same clinic between January 2021 and August 2023. We included 142 patients in the study who underwent surgery due to rotator cuff rupture. cuff rupture. We reviewed preoperative MRI images and surgical notes of the patients. Patients with subscapularis rupture were categorized as Group 1, consisting of 26 patients, while patients with intact subscapularis but other cuff pathologies were classified as Group 2, consisting of 116 patients.
RESULTS: No statistically significant differences were observed between the groups regarding sex, age, and gender. Of 142 patients, 26 (18%) had arthroscopically confirmed Ssc tears. Among these, 22 were repaired, and 4 underwent debridement. There was no significant difference between the groups regarding acromiohumeral distance (p=0.253) and coracohumeral distance (p=0.12). No significant difference was found in subscapular bursa effusion between the groups (p=0.81). The difference in SE between the groups was statistically significant (p=0.0003).
DISCUSSION AND CONCLUSION: In our study, we showed the relationship between the sub finding and Ssc tears. We found no relationship between coracohumeral and acromiohumeral distance and subscapularis tears.

13. Efficacy of Cyclocryotherapy on Pain in Patients with Absolute Glaucoma
Burcu Yelmi, Anıl Ağaçkesen, Burak Tanyildiz, Şaban Şimşek
doi: 10.14744/scie.2023.24582  Pages 70 - 73
INTRODUCTION: The aim of this study was to evaluate the short-term efficacy of cyclocryotherapy in pain control in 63 patients with absolute glaucoma who had pain and no vision despite maximum medical treatment.
METHODS: 63 eyes of 63 glaucoma patients defined as absolute glaucoma were included in the study. The intraocular pressures, number of drops used, pain status and need for recurrent therapy were compared before and after the procedure at 1 and 3 months.
RESULTS: 13 of the patients were female and 40 were male. The mean age was 59.4±17.5 years. 50 of the patients were diagnosed with neovascular glaucoma, 3 with congenital glaucoma, 1 with primary open-angle glaucoma and 9 with angle-closure glaucoma. Preoperative mean intraocular pressure was 50.7±12 mmHg, while it was found to be 37.9±15.4 mmHg in the 1st month and 28.5±15.8 mmHg in the 3rd month postoperatively. The decrease in intraocular pressure before and after the procedure was statistically significant at 1 and 3 months. (p<0.0001) Pain control was received 85% at the first month and 96% at the third month after the procedure. Number of medications that were used was found 3.00 and 2.3±0.9 respectively before and after the procedure and this was statistically significant. (p<0.0001) While no phthisis was observed in any patient, evisceration was applied to 2 patients because of uncontrolled pain.
DISCUSSION AND CONCLUSION: Cyclocryotherapy may be a preferred treatment option before evisceration, as it is a non-invasive, inexpensive and easily applicable method in patients whose pain control cannot be achieved, although it has lost its former popularity with the discovery of new options in the surgical and medical treatment of glaucoma.

14. The Relationship Between Lactate Level and Fluid Management After Hepatectomy
Mustafa Çolak, İlhan Ocak
doi: 10.14744/scie.2024.82698  Pages 74 - 78
INTRODUCTION: After surgeries such as hepatectomy, careful monitoring of various physiological measurements is crucial for successful outcomes. Among these measurements are lactate levels, which are significant indicators of tissue perfusion and oxygenation. Particularly in the postoperative period, arterial blood lactate (ABL) levels are important for monitoring tissue perfusion. Maintaining an optimal fluid balance is critical for sustaining tissue perfusion and preventing potential complications. The aim of this study is to examine the relationship between patients’ ABL levels and fluid therapy in the postoperative period.
METHODS: This study was designed as a retrospective analysis to examine the outcomes of patients treated in the intensive care unit following hepatectomy. To assess the impact of fluid therapy on patients’ clinical outcomes, the amounts of fluids administered were calculated. Initial arterial blood lactate levels, peak lactate levels, the rate of lactate clearance, acidosis status, and base deficit values in arterial blood gas analyses were recorded. The Pearson Correlation Test was used to determine the relationship between arterial blood gas parameters, ABL trend parameters, and fluid therapy, considering p<0.05 as statistically significant.
RESULTS: In this study, 108 patients who underwent hepatectomy were examined. Patients were administered 42.3 cc/kg of fluid until their ABL levels returned to the normal range. Additionally, a significant correlation was found between the highest ABL levels and the total amount of fluid administered (r=0.385, p<0.01).
DISCUSSION AND CONCLUSION: The study identified a relationship between ABL levels and fluid intake. We believe that high lactate levels indicate a sepsis-like condition requiring intensive fluid therapy. These results suggest that monitoring ABL levels in patients who have undergone hepatectomy can be an important tool for predicting the need for fluid therapy and the duration of close monitoring. Arterial blood lactate monitoring can play a critical role in the postoperative management and monitoring of patients.

15. Relationship Between Serum Adiponectin and Kisspeptin Levels and Insulin Resistance in Patients With Pcos
Muserref Banu Yılmaz, Sadik Sahin, Belgin Devranoğlu, Miray Nilufer Cimsit Kemahli, Zeynep Çelik, Beyza Nur Özkan, Eray Metin Guler, Ebru Kale
doi: 10.14744/scie.2024.38268  Pages 79 - 84
INTRODUCTION: In this study, it is aimed to investigate the relationship between serum adiponectin and kisspeptin levels and insulin resistance in patients with Polycyctic Ovary Syndrome.
METHODS: 144 patients diagnosed with Polycyctic Ovary Syndrome in a tertiary center, were included in the study. At the first visit, the height and weight measurements were recorded and menstrual functions were questioned. After ultrasonographic evaluation and hormonal assessment, patients were divided into groups according to insulin resistance(IR), then were compared in terms of hormonal parameters.
RESULTS: Weight and BMI were significantly higher in the insulin-resistant group(p=0.018,p=0.012). Mean fasting glucose, fasting insulin levels and HOMA indexes of the insulin-resistant group were significantly higher than the non-resistant group, respectively(p<0.001).LH/FSH ratios were significantly lower in the IR+ group(1.33 vs 1.58,p<0.05). No significant difference was observed between the groups in terms of adiponectin and kisspeptin levels, but the mean kisspeptin level in the IR- group was higher than the IR+ group(32.72 vs 19.36,p=0.067). Adiponectin and kisspeptin were both found to have a very weak positive relationship with FSH(r=0.169 and 0.171 ).
DISCUSSION AND CONCLUSION: Adiponectin is known to decrease in obesity and type 2 diabetes, but does not show the difference in insulin-resistant patients with Polycyctic Ovary Syndrome. Kisspeptin, which is a hypothalamic peptide and associated with increased LH levels in patients with Polycyctic Ovary Syndrome, was found to be lower in the IR+ group. In order to clarify the role of kisspeptin and adiponectin in the mechanisms of Polycyctic Ovary Syndrome and insulin resistance, it is needed to be examined in a larger sample with BMI-matched healthy controls.

16. The Relationship Between Microalbuminuria and Serum Uric Acid Levels in Patients With Type 2 Diabetes Mellitus
Nazire Aladağ, Funda Müşerref Türkmen
doi: 10.14744/scie.2024.99975  Pages 85 - 90
INTRODUCTION: Increasing evidence suggests that oxidants from uric acid synthesis may cause renal dysfunction and cardiovascular diseases by inducing inflammation and endothelial dysfunction. Variations in the correlations between inflammation and albuminuria due to race and ethnicity have been noted in diabetic patients. However, studies on this topic among Turkish patients with type 2 diabetes remain limited. This study aimed to investigate the relationship between serum uric acid levels and microalbuminuria in patients with type 2 DM.
METHODS: This prospective cross-sectional study included 80 patients with T2DM, divided into two groups: 40 with microalbuminuria (30–300 mg in 24-hour urine proteinuria) and 40 without (<30 mg in 24-hour urine proteinuria). Biochemical parameters were assessed through the analysis of venous blood samples, which were collected following a 12-hour fasting period during outpatient evaluations.
RESULTS: The study population had a mean age of 57.8±11.6 years. The mean uric acid levels (4.7±1.5 vs. 4.0±1.1, P=0.036) and the mean creatinine clearance (114.6±5.8 vs. 98.1±3.4, P=0.050) were higher in the group with microalbuminuria compared to the group without. The 24-hour urinary protein levels were positively correlated with HbA1C (r=0.305, P=0.036), uric acid (r=0.308, P=0.032), and creatinine clearance (r=0.294, P=0.050).
DISCUSSION AND CONCLUSION: Individuals with T2DM and microalbuminuria tend to display elevated levels of uric acid. Considering the potential effects of increased uric acid levels on diabetic nephropathy, end-stage renal disease, and the development of cardiovascular disease, routine monitoring of uric acid levels in T2DM patients may be important from a prognostic perspective.

17. Lower Gastrointestinal Endoscopy in Elderly: A Single-center Experience
Muhammer Ergenç, Tevfik Kıvılcım Uprak
doi: 10.14744/scie.2022.15013  Pages 91 - 97
INTRODUCTION: Endoscopic procedures are frequently applied to the elderly population over 65, with the increased population of this age group. The comorbidities of this population are thought to be increased risk factors for endoscopic interventions. We need more literature on applying lower gastrointestinal (GI) endoscopy to the elderly population. This study aims to analyze the efficiency and safety of lower GI endoscopy in the aged population.
METHODS: We performed a retrospective observational study of patients over 65 who underwent lower GI endoscopy from January 2016 to January 2021 at the Istanbul Sultanbeyli State Hospital Endoscopy Unit. This study was approved by the local Ethics Committee and registered with ClinicalTrials.gov (NCT05012527). A total of 564 patients’ following parameters were analyzed: indications, endoscopic findings, histopathological findings, and complications of lower GI endoscopy.
RESULTS: The cecal intubation rate was 90% in colonoscopies. The inadequate bowel cleansing rate was 12.4% in colonoscopies and 13% in all lower endoscopy procedures. There was a six percent malignancy detected. The polyp detection rate is approximately 45% in colonoscopies, and polyps are seen mainly left side of the colon. The overall diagnostic yield rate is 48.7%, and colorectal cancer yield is 5.9% on colonoscopies. The complication rate was 1.2%.
DISCUSSION AND CONCLUSION: This study showed that colonoscopy in the elderly has a high diagnostic yield and can be applied safely.

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