HEALTH SCIENCES QUARTERLY

Methotrexate intoxication as a diagnostic challenge: Do patients always tell the truth?

Ece Erbağcı — Sat, 25 Jan 2025 00:00:00 +0300

Dear editor,

Methotrexate is an effective and safe drug that has been used for many years in the treatment of psoriasis [1]. Clinical and laboratory monitoring is important for toxicity monitoring in patients. Herein, a case of methotrexate intoxication that developed after long-term uncontrolled and irregular use of methotrexate, but had diagnostic difficulties because the patient concealed this condition in her anamnesis, will be presented.

The evaluation of giant-cell arteritis (temporal arteritis) cases with optical coherence tomography angiography (OCT-A)

Murat Kaşıkcı, Adem Ertürk, Özgür Eroğul — Sat, 25 Jan 2025 00:00:00 +0300

To make measurements using optical coherence tomography angiography (OCT-A) in inactive giant cell arteritis (GCA) cases who have previously had GCA and have been treated and to compare the obtained data with healthy volunteers. In this observational case-control study, 18 eyes of 18 GCA cases previously diagnosed, treated with anterior arteritic ischemic optic neuropathy (AAION). 22 eyes of 22 ophthalmically healthy volunteers were included in the study. After external ophthalmic examinations of all participants were performed, their measurements were made with serial OCT-A. Superficial capillary plexus (SCP), deep capillary plexus (DCP), foveal avascular zone (FAZ), area covering 300 degrees around the fovea (FD-300), choriocapillaris (CC), retinal nerve fiber layer (RNFL), cup/disc (C/D) ratio and optic disc vessel densities (OD-VD) were evaluated. p<0.05 was considered significant. There was no difference between the two groups in terms of age, gender and shooting quality. Whole-SCP, SCP-foveal, SCP-parafoveal and SCP-perifoveal VD values were lower in the patient group. Whole-DCP, DCPparafoveal and DCP-perifoveal VD values were also low in the patient group. FAZ areas were similar between groups, but the FD-300 VD was different. Whole-OD VD and inside-OD VD were significantly lower in the patient group. Peripapillary-OD VD and RNFL values were similar. The C/D ratio was higher in the patient group. The effect on the microvascular process was significant in OCT-A. This suggested that even if the ischemic process still continues and there is no active inflammation, microvascular structures may continue to be affected.

The effectiveness of education provided to university students on COVID-19 phobia: A quasi-experimental study

Nur Özlem Kılınç, Fatoş Uncu, Dilek Güneş, Gamze Kırkıl — Sat, 25 Jan 2025 00:00:00 +0300

This study aimed to determine the effectiveness of education provided to university students on COVID-19 phobia. The study was structured as a pre-test, post-test single-group study, a quasi-experimental research design, conducted on 122 students at a university located in Eastern Anatolia. Pre-test forms (Information Form, COVID-19 Phobia Scale) were sent to the students via email, filled out, and returned to the researcher. Subsequently, online training was provided to the participating students, and post-test (COVID-19 Phobia Scale) data were collected. A statistically significant difference was found between the pre-test and post-test COVID-19 Phobia Scale values (p<.001). This difference was in favor of the pre-test, indicating a reduction in COVID-19 phobia levels after the intervention. The results of this study highlight the importance of pandemic phobia and education. It provides data support for pandemic and COVID-19 phobia for policymakers, healthcare administrators, and the literature.

Analysis of the implementation of activities of adolescent girls drinking iron supplement tablets to prevent anemia in West Sumatra Province

Rita Asriyanti, Azrimaidaliza, Frima Elda — Sat, 25 Jan 2025 00:00:00 +0300

The World Health Organization (WHO) has set six global nutrition targets, one of which is to reduce the prevalence of anemia among women of childbearing age by 50%, aiming for a global rate of 18%. According to Indonesia's 2018 Basic Health Research data, the prevalence of anemia in West Sumatra exceeded the national average, reaching 27.6%. This study aims to analyze the implementation of anemia prevention activities among adolescent girls in West Sumatra Province in 2023, focusing on both successful and unsuccessful districts/cities based on the coverage of iron supplement tablet consumption among adolescent girls. This research employed semi-structured interviews and purposive sampling, utilizing appropriate research instruments. Findings indicate that both successful and unsuccessful districts/cities lacked policies formally supporting anemia prevention activities in the form of local regulations. Additionally, differences in health workforce availability between these districts/cities were observed. The presence of Adolescent Health Cadres in schools fulfilled only 7.4% of the required demand. Furthermore, the availability of facilities and infrastructure for hemoglobin testing was hindered by challenges in procuring consumables needed for the tests.

Anatomists’ views on cadaver and cadaver procurement in medical education

Ozan Turamanlar, Hüma Kaçar — Sat, 25 Jan 2025 00:00:00 +0300

Despite the importance of cadavers in anatomy education, there are a great difficulties in procuring cadavers in Türkiye due to the low quantity of donations. Anatomists have important roles in matters related to cadaver donation. Some of these roles are to explain to students and the public the value of cadavers in medical education and to inform them about cadaver donation. The aim of this study is to investigate anatomists' thoughts about cadavers and their supply. The study was conducted on anatomists who accepted the survey invitation sent from the digital platform. 100 volunteer anatomists participated in the survey. Ethics committee approval was received for the study. Anatomists argue that education with cadavers is a must (92%). Routine dissection is performed in 64% of the institutions to which the participants are affiliated. 78% of anatomists know the legal regulations regarding cadaver procurement, and 67% care about the method of procurement of the studied cadaver. While the participating anatomists found it appropriate to use unclaimed bodies for educational purposes, there was no common opinion among the anatomists in terms of ethics. Anatomists are more willing to recommend cadaver donation to someone they do not know than to donate a cadaver from their own family member. Only 13% of anatomists feel ready for body donation. The survey results show that anatomists have high knowledge and awareness about cadavers and their supply. High awareness has relatively less impact on anatomists' attitudes and behaviors regarding cadaver donation. It was determined that the majority of anatomists who participated in the research did not feel ready to donate cadavers. We think that bringing donation issues to the agenda more through trainings and events can contribute to the perspectives of anatomists.

Effect of Metformin usage on Vitamin B12 deficiency in patients with Type 2 Diabetes Mellitus

Sat, 25 Jan 2025 00:00:00 +0300

Metformin is the most commonly used drug in antihyperglycemic treatment in patients with type 2 diabetes mellitus (T2 DM). In recent years, there have been many studies reporting B12 deficiency in diabetic individuals using metformin drug. This study evaluates B12 deficiency in individuals with T2 DM diagnosis using metformin in our hospital. This study is a cross-sectional and descriptive research. In this study, the data of 786 patients who applied to the Mugla Education and Research Hospital Internal Medicine outpatient clinic with T2DM diagnosis and used metformin between January 01, 2018 and March 01, 2019 were evaluated. Demographic data, vitamin B12, HbA1c levels of the patients were obtained retrospectively from the hospital information system records. Patients with missing data were excluded from the study.347 (44.1%) male and 439 (55.9%) female patients were included in the study. Metformin dose of 248 (31.6%) of the patients was 1000 mg or less, 123 (15.6%) was 1700 mg, 414 (52.8%) was 2000 mg or more. According to the distribution of medication use, 161 (20.5%) patients were receiving metformin only, 322 (41%) patients were receiving metformin + other oral antidiabetic agents (OAD), and 303 (38.5%) patients were receiving metformin + insulin treatment. Vitamin B12 deficiency (57.8%) was higher in patients aged 60 years old and was over who used metformin (p<0.001). 347 (44.1%) of the patients included in the study received vitamin B12 replacement. We detected serious B12 deficiency in patients with T2DM who used metformin, especially in patients aged over 60 years old. Therefore, we emphasize the importance to monitor vitamin B12 levels in patients who are started on metformin and to perform B12 replacement in patients who are found to be deficient.

Synthesis, characterization and cytotoxicity analyzes of novel AB-Type Amphiphilic Block Copolymers

Murat Mısır — Sat, 25 Jan 2025 00:00:00 +0300

AB-type novel amphiphilic poly(L-lactide)-block-(N-isopropylacrylamide) (PLLA-b-PNIPAM) and poly(L-lactide)-block-(N-vinyl-pyrrolidone) (PLLA-b-PNVP), diblock copolymers were synthesized through the combined use of ring-opening polymerization (ROP) and controlled/living radical polymerization (CRP) techniques. (PLLA-b-PNIPAM) block copolymer was prepared via combination of ROP and atom transfer radical polymerization (ATRP) using the novel PLLA-based ATRP macroinitiator. (PLLA-b-PNVP) block copolymer was synthesized via combination of ROP and reversible addition-fragmentation chain transfer (RAFT) polymerization using the PLLA-based RAFT macro chain transfer agent (CTA). For this purpose, at first 2,4-difluorobenzyl alcohol (1) was used to initiate the ROP of (L-LA) using tin(II) 2-ethylhexanoate Sn(Oct)₂ as a catalyst at 120 ℃ for synthesis of PLLA-OH (2). Secondly, bromoester end-functionalized PLLA-based ATRP macroinitiator (3) was synthesized by esterification of hydroxyl end group of (2). The first block copolymer, (PLLA-b-PNIPAM) (5), was synthesized by ATRP of NIPAM using (3) in presence of copper(I) chloride/tris[2-(dimethylamino)ethyl]amine (CuCl/Me₆TREN) as catalyst system in DMF/water at 25 °C. For the synthesis step of second block copolymer, at first PLLA macro chain transfer agent (CTA) (4) was then synthesized via substitution reaction of (3) with potassium ethyl xanthogenate (KEX) and finally PLLA-b-PNVP (6) diblock copolymer was prepared via RAFT polymerization of NVP using (4). The molecular structures of novel polymers (2-6) were elucidated by spectroscopic (FTIR and ¹H NMR) methods. In the application phase of this study, the effectiveness of copolymers was examined on cervical cancer cells. Cytotoxicity effects were evaluated in vitro on HeLa cell lines.

Evaluation of current survival and prognostic factors in multiple myeloma: Staging ISS or R-ISS?

Sat, 25 Jan 2025 00:00:00 +0300

Multiple myeloma (MM) is a complex hematological malignancy, and understanding the factors influencing prognosis and survival is crucial for improving patient outcomes. This study aims to evaluate the factors influencing the prognosis and survival of MM patients by comparing the International Staging System (ISS) with the Revised ISS (R-ISS). MM patients treated and followed up between 2015 and 2023 were retrospectively analyzed. According to ISS staging, 21.4% of patients were categorized as Stage 1, 30% as Stage 2, and 48.6% as Stage 3. Similarly, the R-ISS system revealed 14.3% as Stage 1, while 42.9% were Stage 2, and 42.9% were Stage 3. These findings indicate that the two systems provide differing stage distributions, which could impact prognosis evaluation. Mortality occurred in 58.6% of patients during the follow-up period, highlighting the severity of the disease in later stages. Further analysis revealed that higher levels of red cell distribution width (RDW), phosphorus content, lactate dehydrogenase (LDH), and beta-2 microglobulin levels were significantly associated with mortality, emphasizing their potential as markers of poor prognosis. In particular, ISS Stage II and III, R-ISS Stage III, along with elevated RDW, total protein, phosphorus, and LDH, were identified as independent prognostic factors. These results suggest that while both staging systems offer valuable insights, specific biomarkers play a crucial role in refining prognostic accuracy. In conclusion, while the ISS system appears to provide more meaningful staging information in this cohort compared to R-ISS, integrating additional biomarkers like RDW and LDH could enhance the prediction of patient outcomes.

In elderly with cardiovascular disease over 65 years of age the relationship between frequency of frailty and quality of life

Taner Akarsu, Ayşen Mert, Ebru Bulut, Zeynep Güneş — Sat, 25 Jan 2025 00:00:00 +0300

This study aim was designed as an analytical cross-sectional study to assess the prevalence of frailty in patients aged 65 years and older with cardiovascular disease and to investigate its relationship with quality of life. The population consisted of a State Hospital Cardiology patients, and the sample consisted of 255 patients, who were calculated according to the incidence of the event (frequency of frailty) (25%) at the 95% confidence interval. Data were collected face to face by interview method between 25.07.2019-01.04.2020. In this study, frailty was observed in 30.9% of cardiovascular patients aged 65 and older. Frailty is mostly seen in illiterate people, women, single people, those who state that their income does not meet their expenses, and those who live alone, and there is a statistically significant difference between them (p≤ 0.05). A statistically significant relationship was found between frailty and factors such as the number of comorbidities, fall history in the past year, frequency of hospitalizations, and the number of medications taken within the last year in patients with cardiovascular disease. This study identified a negative correlation between the total score of the quality of life scale, its sub-dimension scores, and frailty (r=-0.414:p=0.000). Additionally, it was observed that patients with cardiovascular frailty experience a lower quality of life. In our study the frequency of frailty due to sociocultural factors is high in elderly individuals living alone with cardiovascular disease.

An evaluation of the wastes and obstacles within the context of lean management in emergency services

Erman Gedikli — Sat, 25 Jan 2025 00:00:00 +0300

The objective of this study is to evaluate the types of waste within the context of lean management practices in emergency departments and to provide recommendations for addressing the challenges associated with their implementation. The aim is to enhance the effectiveness of performance improvement processes and to improve patient satisfaction. The opinions of 8 experts in the field were collected and analyzed using fuzzy AHP. The analysis revealed that defects (29%) are the most common type of waste in emergency departments, with a significant impact on efficiency and patient safety. This is followed by extra handling (15%) and waiting time (13%). Addressing these issues, along with other types of waste such as wasted talent, movement, transportation, inventory, and overproduction, is critical to improving overall operational performance. The overcoming of integration challenges necessitates the implementation of a multifaceted strategy, which should encompass the commitment of leadership, the engagement of staff, and the establishment of a culture of continuous improvement. The success of lean management is contingent upon several factors, including leadership support, multidisciplinary collaboration, process streamlining, and the ability to navigate resistance to change.

The effect of blood parameters measured in the emergency department on 30-day mortality in patients with proximal femur fractures: A retrospective analysis

Yasin Bülbüloğlu, Oya Akpınar Oruç — Sat, 25 Jan 2025 00:00:00 +0300

Proximal femur fractures (PFF) are a common and significant health problem in the elderly population, often leading to morbidity and mortality. This study aims to investigate the association between hematological and biochemical parameters measured at admission and 30-day mortality by retrospectively evaluating patients diagnosed with PFF in the emergency department. This retrospective study includes 344 patients over the age of 65 who admitted to the Emergency Medicine Department of Afyonkarahisar Health Science University Faculty of Medicine Hospital and were diagnosed with PFF between January 1st, 2018, and July 1st, 2023. The patients' demographic characteristics, PFF-related features, and their hematological and biochemical parameters at presentation, were recorded. Specific parameters were proportionally analyzed in accordance with relevant literature. The relationship between these findings and 30-day mortality was evaluated. Of the included patients, 59.6% were female, with a mean age of 81.88 ± 7.76 years. The 30-day mortality rate was 7%. A significant difference was observed in the mortality group regarding ICU admission history, length of hospital stays, glucose/potassium ratio, WBC, neutrophil, hemoglobin, and RDW levels. According to ROC analysis, the AUC for hemoglobin was 0.641 (95% CI: 0.589–0.690), with a cutoff value of <12.8, yielding a sensitivity of 87.5% and specificity of 36.0% (p=0.01). For RDW, the AUC was 0.721 (95% CI: 0.672–0.767), with a cutoff value of >16.2, resulting in a sensitivity of 54.2% and specificity of 86.7% (p=0.001). Hemoglobin, red cell distribution width, and glucose/potassium ratio levels in the emergency department are associated with 30-day mortality in patients diagnosed with PFF. Evaluating these parameters in clinical practice may aid in the early identification of high-risk patients and facilitate the planning of appropriate treatment strategies. Future research should validate these findings through larger-scale studies.