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Kocaeli Medical Journal - Kocaeli Med J: 8 (2)
Volume: 8  Issue: 2 - 2019
1. Cover

Pages I - XI

ORIGINAL ARTICLE
2. Our Recurrence Ratios in Pelvic Organ Prolapse Surgical Repair
Gökmen Sukgen, ünal Türkay
doi: 10.5505/ktd.2019.02170  Pages 1 - 7
INTRODUCTION: The objective of this study was to assess the recurrence ratios of pelvic organ prolapse surgical repair.
METHODS: BBetween June 2012 and May 2017, 126 non-randomly selected women underwent pelvic organ prolapse surgical repair. We used POP-Q System for staging. The patients were divided into four groups as follows; anterior repair group (n=64), posterior repair group (n=29), anterior-posterior repair group (n=13), and vaginal cuff prolapse group (n=20).
RESULTS: Mean age of the 126 patients was 58.5 ± 10.8 years (min. 42, max. 75), while mean weight was 70 ±12.7 kg (min. 48 kg, max. 92 kg) and mean parity was 3 (min. 0, max. 6). Our recurrence ratios were 8 patients (12.5%) in anterior repair group, 7 patients (24.1%) in posterior repair group, 1 patient (7.6%) in anterior-posterior repair group, and no patients in vaginal cuff prolapse group. In all cases, the overall recurrence ratio was 12.69%.
DISCUSSION AND CONCLUSION: A significant relationship between menopause and POP recurrence was determined. A significant relationship between surgical technique and recurrence free cases was also detected.

3. Effect of left coronary bifurcation angle and left main coronary artery length on coronary artherosclerotic plaque burden
Murat Ziyrek, Zafer Buyukterzi
doi: 10.5505/ktd.2019.23865  Pages 8 - 12
INTRODUCTION: Coronary artery disease (CAD) is an important public health problem. The Gensini score system (GS) is one of the most popular coronary scoring systems used in clinical practice to determine the atherosclerotic burden, extent and severity of CAD. Previous studies have showed the direct correlation between wide angulation and significant coronary stenosis. In this study we analysed the effect of coronary bifurcation angle and left main coronary artery (LMCA) length on the coronary atherosclerotic burden.
METHODS: Patients, who underwent coronary angiography were scanned. Patients having; acute coronary syndrome, normal coronary arteries, LMCA lesion, osteal left anterior descending (LAD) coronary artery lesion, osteal circumflex (CX) coronary artery lesion, inadequate visualisation for bifurcation angle measurement were excluded. LAD-CX coronary artery bifurcation angle and LMCA length of included patients were analysed by 2 experienced cardiologists by using "extreme pacs" software system. Atherosclerotic burden of included patients were determined by GS.
RESULTS: 63 patients (36 male, 27 female) were included. There was a strong positive correlation between LAD-CX bifurcation angle and gensini score (r= 0,854; p<0,001). There was a statistically nonsignificant positive correlation between LAD-CX bifurcation angle and LMCA length (r= 0,228; p=0,11). Regression analysis showed that LAD-CX bifurcation angle is an independent risk factor for atherosclerotic burden
DISCUSSION AND CONCLUSION: In this study, we concluded that as the LAD-CX bifurcation angle increases atherosclerotic burden significantly increases. It might also be said that LAD-CX bifurcation angle is an independent risk factor for atherosclerotic burden

4. Development of The Father's Attachment Scale in Intrauterine Period
sevgül donmez, Süreyya Gümüşsoy
doi: 10.5505/ktd.2019.22448  Pages 13 - 19
INTRODUCTION: The paternity role begins with the diagnosis of pregnancy and develops in the months following birth. Like mother, father also develops attachment behaviors during pregnancy. When the father feels the baby's movements in the womb, a direct relationship with the child begins. The aim of this study was to develop the Intrauterine Father Attachment Scale and to perform the validity and reliability of the scale.
METHODS: The study was performed methodologically with the spouses of the pregnant women between 24-38 weeks of age who applied for routine pregnancy control between November 2017 and April 2018. In the implementation of the scale, consisting of 23 items, 158 fathers were reached. Correlation analysis, Cronbach's alpha reliability coefficient, Kendall W test, Kaiser Meyer Olkin and Barlett's Test methods were used.
RESULTS: According to the scale's validity analysis, there was no statistically significant difference between the scores given by the experts to the scale items (Kendall göres W=0.256; p=0.705). The Cronbach's alpha value for all items of the scale is 0.73. The Cronbach Alpha coefficients were lower than the Cronbach Alpha coefficient of the scale. Kaiser Meyer Olkin (KMO) Test and Barlett's Test were used for the structure validity analysis of the scale and it was concluded that the data obtained from the scale were compatible for factor analysis (KMO = 0.861; p <0.05).
DISCUSSION AND CONCLUSION: It was concluded that the fathers who were at 24-38 weeks gestational age of the scale could be used as a valid-reliable scale in determining the attachment status of their babies

5. Histopathological analysis of the patients who applied with a cervical mass complaint: 1002 cases
Serkan Dedeoğlu, Serdar Ferit Toprak, Muhammed Ayral
doi: 10.5505/ktd.2019.68552  Pages 20 - 26
INTRODUCTION: The aim of this study is to investigate the diagnostic distribution of the neck masses which were surgically treated in Dicle University School of Medicine ENT clinic.

METHODS: Between 2006-2011, 1002 patients (406 females,596 males) with neck masses who were diagnosed and treated at the Dicle University Hospital, Diyarbakır, were reviewed noting their age, sex and histologic finding.
RESULTS: 425 (42%) of 1002 patients that has been examined, classified as inflammatory masses, 242 (24%) as malign neoplastic masses, 229 (23%) as benign neoplastic masses and 106 (11%) as congenital masses. The mean age was 37.6 ± 14.1 for patients with inflammatory neck masses, 14.7 ± 6.8 for patients with congenital neck masses. In the neoplastic neck masses group the mean age was 41.8 ± 10.3 in benign lesions, however, it was 54.5 ± 15.9 in malignant lesions
DISCUSSION AND CONCLUSION: In our study, inflammatory lesions were the most common pathologies in the etiology of the neck masses. This result is consistent with some studies in our country previously reported; however in this group the incidence of some diseases seems to be different.

6. Mean platelet volume and renal involvement in patients with systemic lupus erythematosus
Gökhan Sargın, Taşkın Şentürk
doi: 10.5505/ktd.2019.76983  Pages 27 - 32
INTRODUCTION: Our aim is to determine the relationship between mean platelet volume (MPV) and renal involvement in patients with systemic lupus erythematosus (SLE). We also aimed to evaluate erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complement component 3 (C3), C4, and disease activity at the baseline and 6th months of treatment in SLE patients with renal involvement.
METHODS: A total of 85 SLE patients (4 male, 81 female, with the mean age of 39,5±10,5 years) who had been diagnosed with SLE were enrolled in the study. Age, gender, MPV, CRP, ESR, C3, C4, and SLE Disease Activity Index (SLEDAI) were evaluated. The data were assessed with Kolmogorov-Smirnov, Mann-Whitney, Wilcoxon test, and Spearman correlation.
RESULTS: The levels of MPV were higher in patients without nephritis compared to patients with nephritis. There was no significant difference in MPV between both groups. We found a correlation between MPV and disease activity for SLE patients with renal involvement and without renal involvement (r=-0,396, p=0.04, r=-0.278, p=0.03, respectively).
DISCUSSION AND CONCLUSION: MPV is negatively correlated with disease activity in lupus patients with renal involvement and without renal involvement. MPV may be helpful to assess disease activity and organ-involvement in patients with SLE. the knowledge about long-term results about this topic is limited.

7. Branchial Cleft Anomalies: Our clinical experience and literature review
hacer baran, Sedat Aydın
doi: 10.5505/ktd.2019.29052  Pages 33 - 37
INTRODUCTION: Branchial cleft anomalies are rare anomalies of embryological development. It develops due to incomplete development of branchial apparatus during fetal development and can be observed as a cyst, sinus tract, fistula or cartilage residue. The aim of this study is to evaluate the clinical features and surgical treatment results of branchial cleft anomalies operated in our clinic.
METHODS: A total of 62 patients diagnosed as the branchial cleft anomaly in our clinic and operated between 2007-2017 were evaluated retrospectively. The records of all patients were examined in terms of age, gender, clinical presentation, duration of symptoms, examinations, pathological results, and follow-up.
RESULTS: 40 (64.5%) of the 62 patients who were treated with the diagnosis of branchial cleft anomalies were female and 22 (35.5%) were male. The mean age was 26.5 ± 12.9 and the youngest patient was 7 and the oldest patient was 71 years old. The most common complaint in the patients was neck swelling in 53 (85.5%) patients. 20 (32.3%) of 62 patients have first and 42 (67.7%) second branchial cleft anomaly. The third and fourth branchial cleft anomalies were not observed.
DISCUSSION AND CONCLUSION: Branchial arches play an important role in the development of head and neck structures. Abnormal development of these structures leads to the formation of different anomalies such as cysts in the neck, sinus or fistula in the future. The treatment of branchial cleft anomalies is surgical excision.

8. Premenstrual Syndrome in Nursing Students and The Affecting Factors
Sevgül Dönmez, Süreyya Gümüşsoy
doi: 10.5505/ktd.2019.46873  Pages 38 - 45
INTRODUCTION: Menstruation is a physiological event involving 30-35 years of female life, and problems related to the menstrual cycle negatively affect many women in reproductive age. The most common menstrual problems are amenorrhea, dysmenorrhoea, dysfunctional uterine bleeding, and premenstrual syndrome. This study was designed to determine the prevalence of premenstrual syndrome in female nursing students and the affecting factors.
METHODS: This descriptive study was conducted with 319 female nursing students studying at a university in Gaziantep between October 2017 and November 2017. Students were surveyed by using the personal information form and Premenstrual Syndrome Scale.
RESULTS: The mean score for the overall scale was 122.20±39.54 and the prevalence of PMS was 63.0%. The analysis of the mean subscale scores in terms of the cutoff point revealed that in the premenstrual period, of the participants 63.3% experienced depressive mood, 39.8% had anxiety, 73.0% had fatigue, 67.1% had irritability, 48.9% had depressive thoughts, 67.7% had pain, 64.9% experienced a change of appetite, 56.1% experienced changes in sleep patterns, and 60.2% had bloating complaints.
DISCUSSION AND CONCLUSION: It was determined that more than half of the students experienced PMS and approximately one-third of them were affected by PMS–related life activities negatively.

9. What happens to ethanol levels during medium and long-term storage of blood specimens?
Nahide Ekici Günay
doi: 10.5505/ktd.2019.17363  Pages 46 - 53
INTRODUCTION: The standardization of processing methods and storage duration for ethanol analysis is important for the forensic sciences and toxicology. This retrospective study was conducted to investigate ethanol stability in serum specimens stored at 4°C for distinct periods
METHODS: The study was carried out by using blood specimens from 183 patients in whom ethanol measurement was ordered due to trauma and forensic causes. Seven study groups were created (ranging from 1 to 36 months). The same tubes were re-analyzed for blood ethanol concentration and the results were compared to the first measurements.
RESULTS: It was recorded that the stability was 3 years around for non-preservative blood ethanol specimens at +4oC. There was a 4.1% decrease in the first month. Then, an elevation trend for ethanol concentration was observed from month 5 to 26 and ethanol concentration was stabilized thereafter for month 26 and 36: 7.4% and 7.4% respectively. No ethanol increase was observed for negative specimens in medium-and long-term storage groups. Ethanol specimens with lower concentration exhibited relatively lower reduction. No significant association was shown between blood ethanol concentration and Glasgow Coma Scale Scores (GCSS) and/or Injury Severity Score (ISS) (P<0.862 and P<0.675).
DISCUSSION AND CONCLUSION: In the laboratory where the study was carried out, it was proposed that thestorage period could be up to 3 years for samples without additives. Additionally, although it is not an ideal sample type as a split sample, serum samples are usable for medium and long-term storage in obligatory situations.

10. A survey among invasive cardiologists to assess their awareness of atrial fibrillation
Cengiz Burak, Erkan Baysal, Bernas Altıntaş, İlyas Kaya, Serhat Günlü, Muhammed Süleymanoğlu, Serhat Hayme
doi: 10.5505/ktd.2019.80269  Pages 54 - 60
INTRODUCTION: Atrial fibrillation (AF) may occur in different clinical situations and has various treatment options. Therefore, clinical practice in real-life conditions may also be heterogeneous. The main aim of this survey was to evaluate the treatment approaches taken by invasive cardiologists in response to AF.

METHODS: At the 2017 interventional cardiology congress, a survey was conducted in which voluntary participants were randomly assigned, and 134 survey results were evaluated. The survey questionnaire covered topics of i) AF recognition and medical treatment approaches in certain situations, ii) approaches to AF ablation, and iii) the management of anticoagulation and antiplatelet therapy in patients with recent stent implantations.

RESULTS: Most participants preferred novel oral anticoagulation in patients with AF and mild mitral stenosis, but one-quarter of the participants preferred using VKA. For AF patients with hypertrophic cardiomyopathy whose CHA2DS2-VASc score was zero, 58.96% of participants preferred acetylsalicylic acid. Regarding their approach to ablation, 73.88% of physicians preferred ablation after third attack in symptomatic AF patients. When it came to the duration of prescribing oral anticoagulants in combination with dual antiplatelet therapy for patients with implanted drug-eluting stents due to acute myocardial infarctions, 64.18% of physicians preferred to prescribe triple therapy for three months, followed by 12 months of dual therapy.

DISCUSSION AND CONCLUSION: The present survey showed differences in the approach to AF and, in some cases, incompatibility with the guidelines. This may be due to insufficient follow-up of the guidelines, or it may be due to a lack of clear recommendations supported by sufficient data on some subjects.


11. Right ventricular diastolic functions in pediatric patients with isolated pulmonary valve regurgitation
Mehtap Akbalık Kara, Pelin Ayyıldız, Metin Sungur, Nazlihan Gunal, Mehmet Kemal Baysal
doi: 10.5505/ktd.2019.34356  Pages 61 - 65
INTRODUCTION: Isolated pulmonary valve regurgitation (IPVR) is a rare clinical entity is usually well tolerated for many years. We wanted to evaluate right ventricular diastolic functions in IPVR.
METHODS: The study group was consisted of 3 girls and 10 boys who were referred to our instution. Patients were aged between 5-16 years. These patients compared with 27 age and sex matched healthy children. All patients detailed physical examination, electrocardiogram, echocardiography and chest X-ray were recorded.
RESULTS: In our study the group (group I) was consisted of 13 IPVR patients. In the control group ( group II ) there were 27 children (15 girls, 12 boys) aged between 6-19 years There was statistically significant difference in peak early diastolic flow velocity (E) between group I and II. There was no statistically significant difference in peak late diastolic flow velocity (A) between groups. The E: A ratio was significantly decreased in group I when compared with group II.Isovolemic relaxation time (IVRT) was prolonged in group I when compared with group II but it was not statistically significant different between groups. When compared between groups; in group I the E velocity time integral (VTI E) was decreased, A velocity time integral was (VTI A) was unchanged and VTI E/A was decreased.
DISCUSSION AND CONCLUSION: Although it is consent that IPVR is a benign lesion we found that right ventricular diastolic dysfunction in this patients. Worthwhile it is important to determine the arrythmias and right sided failure before the clinical symptoms appear.



12. Are we aware of Q fever enough? experience from a single centre.
Hasan Tahsin Gozdas, Fatma Sırmatel, Şeyda Karabörk, Hayrettin Akdeniz
doi: 10.5505/ktd.2019.60490  Pages 66 - 71
INTRODUCTION: Q fever is a zoonosis caused by Coxiella burnetii. The main clinical presentations are pneumonia and hepatitis. However, it can be difficult to recognise Q fever due to many different clinical presentations. In this study, we aimed to increase the awareness of Q fever by presenting clinical and laboratory features of Q fever cases from our institution.
METHODS: Patients with a diagnosis of Q fever in our hospital database were evaluated retrospectively. Patient characteristics as well as clinical and laboratory values at presentation were recorded.
RESULTS: A total of six patients were included in this study. Various clinical presentation was observed such as fever, anorexia and malaise as the most common symptoms. The most common laboratory abnormality was CRP elevation as being detected in all patients followed by LDH and transaminase elevations, both were found in four patients.
DISCUSSION AND CONCLUSION: Serological methods used to diagnose Q fever are not routinely performed, so Q fever cases can be missed easily. We believe that Q fever should be investigated further in patients from endemic regions who did not give adequate response to nonspesific antibiotic treatment.

13. Tertiary Center Results of Persistent Adnexal Masses in Pregnancy
Cagdas Sahin, Nuri Yıldırım, Ismet Hortu, Ceren Sancar, Gokay Ozceltik, Duygu Guzel, Aysegul Dikmen, Fırat Okmen
doi: 10.5505/ktd.2019.05657  Pages 72 - 77
INTRODUCTION: Aim of this study is evaluating of malignancy potential of persistent adnexal masses which is rare situation in pregnancy and scrutinizing of management of these masses.
METHODS: Cases who were diagnosed and treated in terms of pregnancy and concomitant adnexal mass between 2006-2018 in Ege University, School of Medicine, Department of Obstetrics and Gynecology were recruited for study.

RESULTS: Thirteen eligible cases were recruited for study. While, malign/premalign pathology was diagnosed in five of these cases, histopathologic results of eight cases were determined as benign. Comparing of two group, while no statistical significance was determined between two groups in terms of age of cases, cysts size, preoperative level of CA125, operation time and time of delivery (p>0.05), increased more suspicious malignant pathologic view was diagnosed in malign/premalign group in terms of ultrasonography findings (p=0.031).

DISCUSSION AND CONCLUSION: Adnexal masses is a rare situation in pregnancy. Except of urgent cases, operation decision should be given according to suspicious of malignancy. Ultrasonographic evaluation of mass come into prominence in this evaluation. Evaluating of operated suspicious adnexal masses with frozen section in intraoperatively is crucial for performing complete surgery.


14. Posterior Pericardial Window Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery
Mehmet EZELSOY, Kerem Oral, Kemal Tolga Saracoglu, Ayten Saracoglu, Belhhan Akpınar
doi: 10.5505/ktd.2019.95866  Pages 78 - 83
INTRODUCTION: The aim was to determine the effectiveness of the posterior pericardial window (PW) technique in preventing the development of pericardial effusion (PE) following coronary artery bypass grafting surgery (CABG).
METHODS: Patients undergoing coronary surgery were randomly divided into a control or a PW group. We divided 220 patients randomly into 2 groups, the posterior pericardial window group (n=110) and the control group (n=110). Preoperative, intraoperative and postoperative clinical data were collected retrospectively, including incidence of pericardial tamponade, drainage volume, ventilation time and moderate to large pericardial effusion. Evaluations were completed preoperatively, before discharge, and on postoperative 7 and 30 days including electrocardiography, chest radiography, echocardiography. Postoperative causes of morbidity, the duration of intensive care unit and hospital stay were recorded.
RESULTS: There was no significant difference in demographic data between two groups (P>.05). Echocardiography evaluations revealed no significant difference between groups preoperatively; however, before discharge the control group had a significantly higher number of patients with early and late cardiac tamponade compared with the PW group (P<.05). The incidence of postoperative pleural effusion in the PW group was significantly higher than control group. New onset atrial fibrillation was significantly more common in control subjects than in the PW group (P <.05).
DISCUSSION AND CONCLUSION: Posterior pericardial window technique is a safe and effective method which is easy to perform without any serious complication. This procedure may reduce late cardiac tamponade events and effusion-related atrial fibrillation which may be a fatal complication in CABG patients.

15. Visceral adiposity index and overactive bladder in postmenopausal woman: A novel predictive risk factor
Hüseyin Eren, Mustafa Ozan HORSANALI, Eyüp Dil, Emin Özbek
doi: 10.5505/ktd.2019.24382  Pages 84 - 89
INTRODUCTION: To investigate the association between visceral adiposity index (VAI) and overactive bladder (OAB) symptoms in postmenopausal female patients aged over 45 years.
METHODS: Between March 2017 and December 2017, 76 postmenopausal female patient with OAB symptoms were evaluated. Anthropometric indices serum cholesterol levels, fasting glucose levels, urodynamic findings and OAB-8 scores were recorded. VAI was calculated according to gender-specific formula. Participants were divided into three groups according to VAI levels. The relationship between VAI and OAB symptoms were statistically compared in terms of urodynamic outcomes and OAB-8 scores.
RESULTS: Mean age of the patients were 57.2+/-8.3 years and mean BMI was 32.3+/-2.8 kg/m2. Statistical significance was observed in terms of abdominal pressure (Pabd), post voiding residual urine mounts (PVR), maximum bladder capasity (MBC) and OAB-8 scores between groups. VAI correlated positively with PVR, detrusor overactivity (DOA), urinary frequency, urge incontinence, nocturia and OAB-8 scores whereas a negative correlation existed MBC and first desire to void.
DISCUSSION AND CONCLUSION: We observed that patients with higher levels of VAI had more OAB symptoms and worse urodynamic findings.VAI may also be used as a marker for predicting overactive bladder symptoms.

16. DRESS Syndrome in Patient with Diagnosis of Meningitis; Case Report
Gülten ünlü, Semsi Nur Karabela, Emine DÜNDAR, Kadriye Kart Yaşar
doi: 10.5505/ktd.2019.76093  Pages 90 - 95
DRESS (Drug Rash with Eosinophilia and Systemic Sypmtoms) Syndrome, solid organ involvement, skin immunity, hematological involvement is the drug reaction. If not treated, it may be mortal. The most common drugs are aromatic anticonvulsants. In this study, we present a rare case of DRESS syndrome with diagnosis of meningitis. Early diagnosis and treatment are important because of the systemic involvement and mortality.

17. Diagnosis of acute knee injury-comparison of the results of clinical examination, MRI and arthroscopy-Save clinical tests from extinction!
maki grle, Ivana Grle, Goran Vrgoc, Goran Sporis
doi: 10.5505/ktd.2019.24186  Pages 99 - 102
INTRODUCTION: The aim of this study was to compare the physical exam and magnetic resonance imaging (MRI) results, with results of arthroscopy, in patients with acute knee injury. The second aim was to compare the clinical results of patients who underwent arthroscopic meniscetomy after 3 weeks, 3 and 6 months from injury.

METHODS: From January 2003 to November 2008, there were 159 patients which underwent arthroscopic surgery on the knee. 121 patients with acute injury, 99 men and 22 women, age 13 to 62 years, 67 right knee/54 left knee. The orthopaedic surgeon performed test to examine the meniscus for tear, test to examine for stability of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). Also were collected information of range of movement (ROM), and patients had to fulfil the Lysholm knee questionnaire. Postoperatively were done the same measurements.

RESULTS: The results showed no statistical difference for the accuracy of the initial diagnosis between clinical examination and MRI (p = 0.640). The results were similar for the rupture of the meniscus (p = 0.948) and meniscus and ACL (p=1.000).

DISCUSSION AND CONCLUSION: Comparing the results of precision, sensibility, specificity, predictive positive and negative value of clinical and MRI tests and comparing them to the results of arthroscopy, there was no statistically significant difference. The results of Lysholm and ROM showed no statistical difference between three groups and statistically significant improvement of postoperative results when comparing them with preoperative results in all groups.


18. Chronic Obstructive Lung Disease Frequency in Colorectal Polyp and Relationship with Systemic Inflammation
Şule Taş Gülen, Onur Yazıcı, Altay Kandemir
doi: 10.5505/ktd.2019.15013  Pages 103 - 109
INTRODUCTION: The prevalence of chronic obstructive pulmonary disease (COPD) in patients with colorectal polyps and its relationship with systemic inflammation was investigated in our study.
METHODS: A total of 35 cases with COPD diagnosis (COPD group) and 163 control groups without chronic disease in medical history among patients who were diagnosed colorectal polyposis by colonoscopy between December 2016-December 2017 were included to the study. Demographic data such as age, smoking history, pathology results, anatomic location of the lesion, hemogram data such as leukocyte, neutrophil lymphocyte ratio (NLR) and mean platelet volüme (MPV) were recorded.
RESULTS: 137 (69.2%) of the cases were male and the mean age was 63.56 ± 11.68 (20-89) years. Smoking history was available in 129 cases, of which 62 (48.1%) had a smoking history. The prevalence of COPD was 8% among patients with colorectal polyposis in the previous year. Leukocyte, NLR and MPV values were statistical significantly higher in patients with COPD compared to healthy group (p = 0.001, <0.001, <0.001, respectively). When the polyps were histopathologically categorized as neoplastic and non-neoplastic polyps, no significant difference was found in the comparisons of inflammation parameters between the groups.
DISCUSSION AND CONCLUSION: COPD and adenomatous polyps are associated with systemic inflammation and its prevalance among adenomatous polyps was found to be 8%. Prospective studies are needed to examine the inflammation values of neoplastic and non-neoplastic polyp subgroups in patients with polyps with COPD.

CASE REPORT
19. Inflammatory Fibroid Polyp Which is Presented with Invagination: Case Report
Kübra Bozkurt, Gülşah Şafak Örkan, Adem Yüksel, Esma Türkmen Bekmez, Dinçer Aydın, Gokmen Umut Erdem
doi: 10.5505/ktd.2019.21043  Pages 110 - 113
Inflammatory fibroid polyp is a rare polypoid lesion of the gastrointestinal tract that generally originates from the submucosa. It is 1-3 cm in size. Immunohistochemical staining is also thought to be of dendritic cell origin. Pathogenesis of inflammatory fibroid polyp is unknown. In differential diagnosis may be confused with other mesenchymal tumors and gastrointestinal stromal tumors. Although it originates mostly from the stomach antrum, it can also be found elsewhere throughout the gastrointestinal tract. Diagnosis is complaints related with obstructions or usually detected coincidentally by complaints. Especially, it is difficult to detect in small intestine located polyps without developing a complication. We aimed to present a case of inflammatory fibroid polyp causing invagination.

20. Re-emergence of a splenic artery pseudoaneurysm following rupture presenting as syncope: management with transarterial embolization
Fatih Uzunkaya, Aysegül İdil Soylu, Kağan Karabulut, Mehmet Selim Nural
doi: 10.5505/ktd.2019.48264  Pages 114 - 118
Splenic artery pseudoaneurysms are rare but potentially lethal disorder. Transarterial embolization has become the preferred mode of therapy for the disorder, however, accompanying walled-off pancreatic fluid collections including pseudocysts can make the management more challenging. Herein, we present the case of a 40-year-old woman presenting with syncope due to the rupture of a splenic artery pseudoaneurysm into a walled-off pancreatic necrotic collection. The pseudoaneurysm that re-emerged at a larger size following the rupture was endovascularly excluded from circulation after a failed attempt.

ORIGINAL ARTICLE
21. Comparison of paracervical lidocaine, İntrauterine lidocaine and rectal indomethacine for pain control during endometrial sampling with suction curretage
Bahar Sarıibrahim Astepe, Burçin Öğretmenler Yılmaz, Arzu Yavuz, Ünal Türkay, Hasan Terzi
doi: 10.5505/ktd.2019.63626  Pages 119 - 125
INTRODUCTION: Different analgesia/local anesthesia regimens are used during endometrial sampling procedures in the outpatient settings. The aim of this study was to evaluate the effectiveness of paracervical/ intrauterine anesthesia with lidocaine and rectal indomethacine for pain control in patients having endometrial sampling with suction curretage.
METHODS: 166 women were included to the study. Intrauterine lidocaine(IUL) group consisted of 43 women, paracervical lidocaine(PCL) group consisted of 40 women, rectal indomethacine(RI) group consisted of 41 women and control(C) group consisted of 42 women. After completing the suction curretage procedure, all of the patients were evaluated for their pain scores during the intervention with VAS (visual analog scale) immediately(VAS 0) and 30 minutes later(VAS 30).
RESULTS: Pain felt during the suction curretage (VAS 0) was different but it was not different for VAS 30 between the groups. When intergroup differences were evaluated, there was not any significant difference betweeen IUL&PCL&RI groups according to VAS 0 scores while there was significant difference between IUL&PCL&RI groups and control group. The control group had higher VAS 0 scores than the IUL&PCL&RI groups. When the groups were compared according to the intervention time, there was significant difference between RI&IUL, RI&PCL, C&PCL, C&IUL groups as well. The patients in the rectal indomethacine and control group had shorter intervention times than the intrauterine lidocaine and paracervical lidocaine groups.
DISCUSSION AND CONCLUSION: Paracervical block with lidocaine, intrauterine lidocaine installation and rectal indomethacine administration were equally effective in pain control during endometrial biopsy with suction curretage.

22. Simple and New Echocardiographic Parameter Related to Aging: Descending Aortic Continuous Wave Doppler Systolic Peak Gradient
ONUR ARGAN, SERDAR BOZYEL
doi: 10.5505/ktd.2019.50251  Pages 126 - 133
INTRODUCTION: The world inhabitants increasing to grow older fastly, due to rising longevity.A new parameters related to cardiovascular aging may help to understand cardiac pathophysiology and prevention of cardiac disorders.The aim of the study was to find out a possible relationship between descending aortic continuous wave doppler systolic peak gradient and aging,age related illnesses.
METHODS: The study group was composed of 372 people.Aortic coarctation patients and under 18 years old participants exluded to the study.Continuous wave doppler measurements from suprasternal window at supine position were recorded with the cursor parallel to main flow of direction in descending aorta.Descending aortic continuous wave doppler systolic peak gradient was obtained from all participants and correlations were evaluated between participants caracteristics,echocardiographic,biochemical parameters and age.
RESULTS: When descending aortic continuous wave doppler systolic peak gradient was analyzed,there was negative correlations with age (r= -0.499,p<0.001);creatinine (r=-0.217,p<0.001);urea (r=-0.289,p<0.001);Hba1c (r=-0.252,p<0.001);LVEDD (r=-0.188,p<0.001);LVESD (r=-0.200,p<0.001);IVS (r=-0.259,p<0.001);PW (r=-0.248,p<0.001);LA (r=-0.272,p<0.001);PAP (r=-0.217,p<0.001); E/E’(r=-0.185,p<0.001); ascending aortic diameter (r=-0.269,p<0.001) and positive correlations with eGFR (r=0.395,p<0.001),EF (r= 0.266,p<0.001).
In Mann Whitney U test, descending aortic continuous wave doppler systolic peak gradient was significantly lower in hypertension (p<0.001); coronary artery disease (p<0.001); atrial fibrillation (p<0.001); systolic heart failure patients (p<0.001) when compared to those without this disease.In stepwise linear regression analysis, significant independent correlates of descending aortic continuous wave doppler systolic peak gradient was only age (p<0.001).

DISCUSSION AND CONCLUSION: Measurement of descending aortic continuous wave doppler systolic peak gradient is noninvasive,practical,repeatable and simple method and independently related to the aging.This parameter can be easily feasible in clinical practice as an indicator of aging.

23. Prognostic Efficacy of C-reactive protein to Albumin Ratio in Patients with ST Elevation Myocardial Infarction Complicated by Cardiogenic Shock
TUFAN CINAR, VEYSEL OZAN TANIK, Cengiz Burak, Mahmut Yesin, Metin Çağdaş, yavuz karabağ, Ibrahim Rencüzoğulları
doi: 10.5505/ktd.2019.14238  Pages 134 - 141
INTRODUCTION: In this study, we aimed to investigate whether C-reactive protein (CRP) to albumin ratio (CAR), recently developed inflammation based risk index, has a prognostic value in patients with ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock due to a pump failure.

METHODS: We retrospectively enrolled 79 consecutive STEMI patients who underwent a primary percutaneous coronary intervention and complicated by cardiogenic shock.
RESULTS: During the in-hospital course, 40 of the 79 patients (50.6%) died. The mean value of CAR was significantly higher in patients with non-survivors than those who survived (8.58 [4.68–12.25] vs. 4.67 [4.21–6.03]; p<0.001). A Cox multivariate regression analyses revealed that the CAR was an independent predictor of the in-hospital mortality (HR: 1.053, 95%CI: 1.006-1.101; p=0.027). Kaplan-Meier analysis showed that the patients with CAR≥8.4 had a significantly higher the incidence of death compared to those with CAR<8.4 (p<0.001).

DISCUSSION AND CONCLUSION: The present study is the first to demonstrate that the CAR may have a prognostic value for the in-hospital mortality in patients with STEMI complicated by cardiogenic shock.


24. Clinical and Demographic Profile of Patients with Active Epilepsy: Experience From a Tertiary Care Hospital in Turkey
Sehnaz Basaran, muhammed nur ögün
doi: 10.5505/ktd.2019.59489  Pages 142 - 149
INTRODUCTION: To investigate the clinical and demographic findings of patients at epilepsy outpatient clinic of a tertiary care hospital.
METHODS: We retrospectively analysed one hundred and eighty-seven patients with active epilepsy who admitted to our epilepsy clinic between January 2016 and February 2018. In addition to demographic characteristics, we evaluated clinical variables such as; seizure frequency, duration of illness, type of seizures, antiepileptics, electroencephalographic (EEG) and magnetic resonance imaging (MRI) findings.
RESULTS: The mean age of the patients were 36,9 ± 13,1 years; and 54.5% were male. Family history of epilepsy was found in 48 patients (25.7%), and 35 patients (18.7%) had a kinship between parents. The most frequent risk factors were head trauma, febrile convulsions and perinatal problems. Partial seizures was seen in 67.9 %, generalised seizures in 29.3% and unclassified seizures in 2.7%. Brain MRI of 107 patients (57.2%) and interictal EEG of 57 patients (30.5%) was normal. A total of 116 (62%) received monotherapy, while 71 (38%) continued on polytherapy.
DISCUSSION AND CONCLUSION: In this study, clinical and demographic data of the patients were consistent with the literature. We believe that detailed examination with regular follow- up in comprehensive epilepsy clinics would provide a potential benefit in preventing seizures and better outcome.

25. Pelvic Floor Disorder with Advancing Age
Gökmen Sukgen, Ünal Türkay
doi: 10.5505/ktd.2019.00921  Pages 150 - 154
INTRODUCTION: The increasing life span in the population leads to a rapid increase in the proportion of older women, which in turn requires the prevention and treatment of pelvic floor dysfunctions caused by changes in the pelvic floor with the advancing age. Pelvic floor dysfunction due to pelvic floor changes is an important health problem for women who make up half of the adult population. The objective of this study was to investigate the age range, frequencies and the phases of pelvic floor disorders in women of different ages.
METHODS: In this study, a questionnaire was applied to 30 women in ages ranging from 20 years to 70 years. In line with the results obtained, the age range, the intervals and stages of this disorder were explored.
RESULTS: The highest rate (30%) of complaints was observed to be feeling of urgency which was followed by urinary incontinence (26.7%), mass complaint (20%) and urination disorder (16.7%), while the lowest rate (6.7%) of the complaints was recorded for fecal incontinence. T-test analysis revealed that complaints of women before and after menopause were statistically meaningful.
DISCUSSION AND CONCLUSION: The results suggest that feeling urgency is one of the most common complaints caused by pelvic floor disorders and menopausal status needs to be watched carefully for early detection and proper attention of this disorder.

26. Totally extraperitoneal repair under general anesthesia versus Lichtenstein repair under spinal anesthesia for unilateral inguinal hernia
Yahya Çelik, Cagri Tiryaki
doi: 10.5505/ktd.2019.55798  Pages 155 - 159
INTRODUCTION: Inguinal hernia is the most common surgical operation done by general surgeons. There are two main surgical therapeutic options: open surgery and laparoscopic surgery. The aim of this study is to compare the outcome of unilateral inguinal hernia operations either by open surgery or by laparoscopic surgery.
METHODS: We have retrospectively reviewed patient charts of patients with inguinal hernia who were operated in our hospital between January 2012 - January 2018 by open surgery or laparoscopic surgery. Age and sex of the patients, type of operation, duration of operation, post-op hospital stay, follow up time, time to return to normal daily activities, and recurrence and other complications were reviewed.
RESULTS: Total 1008 patients have been operated: 539 patients (53.5%) by open surgery, 469 patients (46.5%) by laparoscopic surgery. Mean follow up time was 28,4±20,2 months. Duration of operation is shorter in patients who have undergone open surgery compared to laparoscopic surgery patients. Seroma rate (5.8%) was higher in laparoscopic surgery patients compared to open surgery patients (3.7%) (p: 0,896). Recurrence rate was higher in laparoscopic surgery patients(3,84%) compared to open surgery patients (2,23%)(p: 0,038). In laparoscopy patients post-op hospital stay and time to return to work was shorter compared to open surgery patients.
DISCUSSION AND CONCLUSION: Laparoscopic inguinal hernia repair is more favorable in terms of shorter hospital stay, shorter time to return to work, less postoperative pain and numbness compared to open inguinal hernia repair and it’s as safe as open inguinal hernia repair in terms of recurrence or other complications. However, duration of operation in laparoscopic surgery is still longer, although it became shorter in recent years.



27. Investigation of The Effect of Oculo-Motor Exercises in Children with Intermittent Exotropia
Işıl Kutlutürk Karagöz, Gülay Aras Bayram, Betül İlkay Sezgin Akçay, Z.Candan Algun
doi: 10.5505/ktd.2019.59140  Pages 160 - 167
INTRODUCTION: In the treatment of intermittent exotropia, which is frequently seen in childhood, non-surgical techniques are often preferred. The present study aims to evaluate the effect of oculo-motor exercises on intermittent exotropia treatment and patient-parent satisfaction levels and quality of life.
METHODS: 51 patients diagnosed with intermittent exotropia were performed demographic characteristics, age, months of birth, outdoor time, cycloplegic refraction measurements, corrected and uncorrected visual acuity with snellen chart, and close and distant alternan prism covering tests (PÖT), Titmus tests and convergence measurements. Oculo-motor exercises with gaze stability as home exercise protocols were given to all participitans for two sessions per day for six weeks by the physiotherapist. Satisfaction and quality of life tests were performed before and after exercise.
RESULTS: In the analysis, left eye visual acuity [p=0.076], right eye sciascopy [p<0.001], left eye sciascopy [p=0.009], and Prism Covering Test with distant measurements [p=0.003], showed increas after exercises trainning, proxy questionnaire scores [p=0.004] is decreased. While the left eye was associated with visual acuity, age [p<0.001], outdoor activities duration [p=0.024] and exercise exercise diary [p=0.038], the Prism Covering Test [p=0.039] was found to be significantly associated with age only.
DISCUSSION AND CONCLUSION: In our study, regardless of the application amount of exercise, it was concluded that there was no effect on other measurement values except left eye visual acuity. For more reliable results, large scale and control group studies are needed to eliminate the existing limitations.

28. Relationship between Ankylosing Spondylitis and Obstructive Sleep Apnea Syndrome with Epworth Sleepiness Scale and Müller Maneuver
Tuğba Atan, Doğan Atan
doi: 10.5505/ktd.2019.76598  Pages 168 - 172
INTRODUCTION: OSAS can be seen more frequently in individuals with ankylosing spondylitis than in normal. Aim of the study is to investigate the presence of OSAS with Müller maneuver and Epworth Sleepiness Scale in patients with AS.
METHODS: Patients with AS (n= 22) and healthy control subjects (n= 18) with similar sex and age distribution were evaluated. Head-neck examination was performed in both groups and the degree of palatine tonsil size, the degree of mallampati were recorded. In addition, Müller maneuver and the degree of obstruction of the hypopharynx and tongue root levels were recorded in the flexible fiberoptic examination. Epworth Sleepiness Scale was applied to all participants to determine the presence of OSAS. The values of palatine tonsil size, mallampati degree, Müller maneuver and Epworth Sleepiness Scale were compared between patient and control groups. In addition, the relation between Epworth Sleepiness Scale and disease duration and disease activity measured by BASDAI scores were evaluated in AS patient group.
RESULTS: The results show that AS and healthy controls do not differ statistically in physical examination findings and the Müller maneuver values. Epworth Sleepiness Scale was found 8.45 ± 3.73 in the patient group, 3.72 ± 2.34 in the control group and a statistically significant difference was found (p <0.001). There was no statistically significant difference between Epworth Sleepiness Scale and disease duration and BASDAI scores.
DISCUSSION AND CONCLUSION: It can be considered that there may be high risk for OSAS in patients with AS. For more reliable results, large patient series studies with polysomnography are required.

29. Investigation of atherogenic dyslipidemia in patients with isolated coronary artery ectasia
Mustafa Doğduş, Tümer Erdem Güler
doi: 10.5505/ktd.2019.10337  Pages 173 - 181
INTRODUCTION: The pathophysiology of coronary artery ectasia (CAE) has not been clearly identified. Dyslipidemia is considered an independent risk factor for cardiovascular disease (CVD). Although the relationship between atherogenic dyslipidemia and CVD is well known, there is no information about atherogenic dyslipidemia with isolated CAE. The aim of the present study was to evaluate the atherogenic dyslipidemia in patients with isolated CAE.
METHODS: The patient group included 91 patients with isolated CAE and the control group consisted of 90 consecutive subjects who proved to have normal coronary angiograms. Serum levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and atherogenic indices (atherogenic dyslipidemia index, non HDL-C, atherogenic coefficient, cardiac risk ratios 1 and 2) were analyzed.
RESULTS: The atherogenic dyslipidemia index, non HDL-C, atherogenic coefficient, and cardiac risk ratios 1 and 2 were significantly greater in the isolated CAE patients than in the controls (p < 0.001; p = 0.001; p = 0.001; p = 0.001; p < 0.001, respectively). The multivariate logistic regression models revealed that atherogenic dyslipidemia index was found to be independent factor predicting isolated CAE (p < 0.001, Odds ratio (OR) = 1.329, 95% Confidence interval (C.I.) = 1.110–1.591).
DISCUSSION AND CONCLUSION: This is the first study that evaluates the relationship between the atherogenic dyslipidemia and isolated CAE. Our findings suggest that increased atherogenic indices (atherogenic dyslipidemia index, non HDL-C, atherogenic coefficient, cardiac risk ratios 1 and 2) may be involved in the early pathogenesis of the isolated CAE.

30. Role Of MPV And Platelet/MPV Ratio İn The Diagnosis Of Cardiac Dilemma; Cardiac Or Non-Cardiac Chest Pain, And Severity Of Acute Coronary Syndrome
Onur Karakayali, Serkan Yilmaz, Anıl Karakayalı, SERDAR BOZYEL
doi: 10.5505/ktd.2019.47135  Pages 182 - 190
INTRODUCTION: We aimed to investigate effectiveness of mean platelets volume (MPV) and platelet/MPV ratio as an independent marker on mortality for prediction of critical vascular stenosis in the differential diagnosis of acute coronary syndrome and cardiac/non-cardiac chest pain in patients presenting to the emergency department.
METHODS: Retrospective observational study included patients of 45 years of age and above presented to the ED with chest pain. Patients were divided into groups with cardiac/non-cardiac chest pain. MPV, platelets/MPV ratio, coronary anjıography results, in-hospital and 1-month hospital mortality were recorded
RESULTS: A total of 753 patients; Cardiac pathology was determined in 282 (37.46%). The mean age was determined as 60.1 years and 59% were male. A statistically significant difference was detected between cardiac and non-cardiac patients with regard to platelet, MPV and plt/MPV values (p=0.005, p<0.001 p<0.001, respectively).
ROC curve, which plots Major cardiac advers event (MACE) estimation of MPV, Platelets/MPV values; AUC was found as 0.677 for MPV and 0.366 for Plt/MPV. Mean MPV value was statistically significantly low in patients with Non-STEMI-ACS (p=0.003) compared to the patients with STEMI in MACE+ group. MPV value was statistically significantly higher and the mean Platelets/MPV value was statistically significantly lower in patients with critical stenosis compared to none critical stenosis (p≤0.001)
DISCUSSION AND CONCLUSION: Although MPV values and platelet/MPV ratio are not sufficient to use alone in routine daily practice, we consider that MPV and the platelets/MPV ratio are significant as dependent markers for the diagnosis of ACS when used together with the other described risk factors in the literature.

31. Clinical Predictors of Coronary Slow Flow in Female Patients
Alper Sercelik, Fikret Besnili, zarema karben
doi: 10.5505/ktd.2019.96530  Pages 191 - 196
INTRODUCTION: Previously, the coronary slow flow (CSF) has been reported to be related to male sex, high BMI, and smoking. However, CSF is a clinical condition seen in women and no studies have been conducted on this subject. We aimed to investigate predictors of coronary slow flow in female patients.
METHODS: A total of 80 female patients, 40 of whom were normal (mean age: 51.9±5.2 years) and 40 with coronary slow flow(mean age: 54.6 ±7.7 years) were selected. TIMI frame counts were calculated, and data on demographics, comorbidities, and medication use were collected. CSF was defined as frame count >27. 
RESULTS: Percentage of diabetes mellitus (DM) was significantly higher in the CSF group ( 52.5 % vs. 22.5 %; p: 0.005). DM was found to be significant predictor of female patients with CSF in the multivariate logistic regression analysis (O.R: 3.44, 95%CI: 1.14–10.36; p: 0.028).
DISCUSSION AND CONCLUSION: We found that DM was significantly increased and only independent predictor of CSF in female patients with CSF.

32. Patient attitudes and level of compliance to soft contact lens care in Turkey
Can Kocasaraç, Hüseyin Dündar, Hasan Altınkaynak, Abdulvahit Demir
doi: 10.5505/ktd.2019.79836  Pages 197 - 203
INTRODUCTION: To identify the demographics profile of lens wearers, to evaluate compliance to contact lens use, and to determine major noncompliant behaviours.
METHODS: 257 contact lens wearers were sequentially interviewed by a single ophthalmologist by using a questionnaire. The questions addressed the demographics of contact lens wearers, contact lens hygiene behaviors and attitudes towards lens care.
RESULTS: The mean age of lens wearers was 29 years with the majority of females (78%). Major reported forms of noncompliance were sleeping with lenses (70.5%), participating in water activities with lenses (52.5%), not cleaning lens cases properly (44%), and not replacing the lenses according to the recommended lens replacement frequency (47.5%). There was not statistically significant difference in compliance levels between participants in regard to age, gender, contact lens wearing hours per day, duration of contact lens use, frequency of eye examinations, education level, source of knowledge about contact lens care, and different types of contact lens purchase.
DISCUSSION AND CONCLUSION: Sleeping with lenses, participating in water activities with lenses, not cleaning lens cases properly, and not replacing the lenses according to the recommended lens replacement frequency are the common noncompliant behaviors in lens wearers.

33. Efficiency and Midterm Results of Glue Ablation with Cyanoacrylate and Endovenous Thermal Ablation with Radiofrequency of Great Saphenous Vein Under Warfarin Therapy
Emir Cantürk
doi: 10.5505/ktd.2019.72335  Pages 204 - 209
INTRODUCTION: The number of articles examining the percutaneous treatment of chronic venous insufficiency in patients receiving warfarin therapy is insufficient especially for glue ablation. The aim of our study was to evaluate the early and midterm postprocedural outcomes of glue ablation with cyanoacrylate closure and endovenous thermal ablation with radiofrequency and to compare these techniques in a group of patients with uninterrupted warfarin therapy.
METHODS: From January 2013 to January 2018, a total of 306 patients who underwent glue ablation or endovenous thermal ablation with radiofrequency of the great saphenous vein under either tumescent or local anesthesia due to chronic venous insufficiency were included in this study. Of 306 patients, 30 patients (12 males, 18 females; mean age 63,28±3,46 years; range 51 to 72 years) underwent either glue ablation (11 patients) or endovenous thermal ablation (19 patients) under warfarin therapy.
RESULTS: Recanalization was observed in 5 patients (16.6%) during the follow-up period. Of these 5 patients, 4 patients (21%) underwent endovenous thermal ablation with radiofrequency and 1 patient (9%) underwent glue ablation. One-year success rate of glue ablation with cyanoacrylate closure and endovenous thermal ablation with radiofrequency were 90,9% and 78,9%, respectively (P=0.047). Five patients with recanalization have treated with glue ablation with 100% success.
DISCUSSION AND CONCLUSION: Glue ablation could be safely and effectively performed in patients with uninterrupted warfarin therapy without postprocedural bleeding or deep vein thrombosis and, it was associated with superior mid and long-term results compared to the endovenous thermal ablation with radiofrequency.

34. The relationship between coronary artery ectasia and coronary collateral circulation in patients with chronic total occlusıon
Bernas Altıntaş, Halil Akın
doi: 10.5505/ktd.2019.74436  Pages 210 - 218
INTRODUCTION: In this study, we investigated the relationship between coronary ectasia (CAE) and coronary colleteral (CCC) development in patients with chronic total occlusion (CTO).
METHODS: Between February 2015 and June 2018, 403 consecutive CTO patients who underwent coronary angiography for stable angina pectoris or positive effort testing were included in the study. CCC was graded on baseline angiograms with the use of qualitative classification by Rentrop. The study patients were divided into 2 groups with respect to good CCC (Rentrop 2-3) and poor CCC ( Rentrop 0-1). Angiographically, segmental or diffuse expansion 1.5-2 fold in coronary arteries is defined as CAE
RESULTS: The study included consecutive 403 Patients with CTO, median age 68 (61-75) years were included in the study. There were 168 patients in the good CCC group and 235 patients in the poor CCC group. CAE was identified 60 patients (25.5%) in the poor CCC group and 24 patients (14.3%) in the good CCC group at angiographic examination (p=0.006). In addition, diabetes mellitus (DM) (p = 0.032) and the incidence of stable angina pectoris (p = 0.011) were significantly increased in the group with poor CCC. SYNTAX score was significantly higher in the group with good CCC (p = 0.002). In multivariable logistic regression, Stable angina pectoris [OR: 0.37(0.22-0.62), p=0.002], CAE [OR: 0.51(0.26-0.98), p=0.046] and SYNTAX score [OR: 1.31(1.11-1.56), p=0.001], were found to be associated with presence of good CCC
DISCUSSION AND CONCLUSION: In our study, we found a significant relationship between the presence of CAE and poor CCC in patients with CTO.

35. The Effects of Anxiety Levels on Burnout Syndrome in Nurses
Halil Şengül, Fadime Çınar, Arzu Bulut
doi: 10.5505/ktd.2019.75875  Pages 219 - 229
INTRODUCTION: Anxiety and burnout syndrome, which affects physical and mental causes and negatively affects the working environment, are the concepts that negatively affect both the individual and the organization. These concepts, which have been experienced intensively in recent times, refer to the changes in the life of the individual through the depletion in the inner world of the individual as a result of failure, failure, desire to work and diminished desire or desire. The aim of this study was to reveal the anxiety levels of nurses in intensive work environment and the relationship between these levels and burnout syndrome.
METHODS: The population of the study consisted of 387 nurses and sample of 194 nurses.This research was conducted between July 2018 and September 2018. “Personal Information Form” and “Beck Anxiety Inventory” and “Maslach Burnout Syndrome Scale” was collected using. In study, reliability analysis, independent samples t-test, one-way ANOVA, Tukey multiple comparison test, pearson correlation and regression analysis were performed.
RESULTS: In the study, it was determined that nurses experienced moderate exhaustion and depersonalization sub-dimensions, high level of burnout and high level of disability in terms of personal achievement sub-dimension.
DISCUSSION AND CONCLUSION: As a result, anxiety and nursing problems of nurses increase burnout levels. Improvements to reduce burnout levels in health care workers should not ignore anxiety and related disorders, and the improvement factors required in both cases should be mobilized together.

36. Evaluation of Spontaneous Statements of Adverse Drug Reactions: Our Clinical Pharmacology Experience
Duygun Altıntaş Aykan, Hülya Nazik, Yusuf Ergün
doi: 10.5505/ktd.2019.46693  Pages 230 - 239
INTRODUCTION: Although drugs are tested in animals and volunteers before they are licensed, safety profiles may not be fully defined. Therefore, reporting of adverse drug reactions (ADR) is important in previously unrecognized ADR and taking necessary precautions. In this study, spontaneous ADR to Pharmacovigilance Contact Point were evaluated.
METHODS: The data of 45 patients between 2015-2017 were included. First part included patients’ demographic data, second part included information about ADR, the related laboratory tests, outcome of ADR, severity of the effect and special issues of the patient. In the third part, drugs’ generic and commercial names, route of administration, daily dose, interval, drug exposure date and indications were recorded. In the fourth part, information of the reporting individual was recorded.
RESULTS: We found that two patients in 2015, 18 patients in 2016 and 25 patients in 2017 were reported as ADR. Reactions were 48.9% maculopapular eruption, 22.2% urticaria and/or anaphylaxis, 15.6% red neck syndrome, 4.4% cardiac palpitations, 2.2% DRESS (drug reaction with eosinophilia and systemic symptoms), 2.2% itching, 2.2% speech impairment and 2.2% tremor. 95.6% of reactions resulted in improvement, 2.2% continued adverse effect and 2.2% resulted in death. 75.6% of all cases were reported as non-serious, while 24.4% were reported as severe.
DISCUSSION AND CONCLUSION: Each parameter in ADR form is important in strengthening the causality. Spontaneous reports in our country tend to increase indicates that awareness of pharmacovigilance is increasing, but it is noteworthy that reporting process is not as common as the developed countries.