Selçuk Tıp Dergisi Arşiv

The possible treatment alternatives for bacterial vaginosis are 500mg oral metronidazole twice a day for one week, vaginal cream with 2% clindamycin, vaginal gel with 0.75% metronidazole plus a single dose of 2gr oral metronidazole once a day or 300mg oral clindamycin twice a day for one week. The purpose of this study is to compare the treatment effectiveness and costs of oral ornidazole, local ordinazole with oral ornidazole, vit-C vaginal tablet and 2% clindamycin vaginal cream. 125 patients who were suitable for the study were divided in 5 groups randomly with closed letter method. Groups were formed respectively. Group 1: 500mg oral ornidazole tablet twice a day for 5 days, Group 2: 500 mg ornidazole vaginal ovules once a day for 3 days, Group 3: 500 mg ornidazole vaginal ovules once a day for 3 days plus 500mg oral ornidazole tablet twice a day for 5 days, Group 4: 250mg vitamin C (Vit-C) tablet once a day for 6 days, Group 5: one applicator (5gr) of clindamycin vaginal cream once a day for one week. The patients were recalled 1 week and 4 weeks later after their treatment. The effectiveness of the treatment were assesed by repeating their inital diagnosis and treatment methods. Clinical improvement was highest in the combined vaginal and oral ornidazole group and lowest in the vit-C tablet group. When we look at the costs of the medicines used in our study, they are going in an ascending order which is vaginal ornidazole treatment, vit-C vaginal tablet treatment, clindamycin vaginal cream treatment, oral ornidazole plus vaginal ornidazole treatment. The differences between the treatment groups regarding the costs were found statistically significant (p<0,01). When its relatively low cost and similar treatment rate of vaginal ornidazole treatment are considered, it can be chosen for patients who have low socioeconomic level.

The knowledge and attitudes of physicians are important in continuity of the correct applications in breastfeeding and “Baby Friendly Hospital” criteria in the society. Medical education process is a chance to educate future physicians about these issues and should be monitored. The aim of this study is to determine the knowledge level of the medical school students about “breastfeeding” and “Baby Friendly Hospital” criteria and applications in different academic years. In this cross sectional study a anonymous questionnaire was applied to medical students who are in first, third and sixth academic years of education in Necmettin Erbakan University Meram Medical School. After ethical approval 26 item questionnaire consisting socio demographic features and items about breasfeeding and baby freinedly hospital declared by WHO and UNICEF, voluntarily. The data was analyzed via statistics package program. Numbers, percentages, chi-square were used and p value <0.05 accepted as significant. Two hundred and ninety five students who were in 1st (34%), 3rd (35%) and 6th (31%) academic year participated to this study. The percentage of students who could count at least 3 benefits of breastfeeding other than feeding were 8%, 25% and 51% in respect to academic years (p<0.001). The knowledge about the existence of breastfeeding policy in their hospital and “infant friendly city” status of the city they are living in were higher in 6th year students (p<0.001). Knowledge level of correct breast feeding method (p<0.05), knowledge about at least 3 contraindications of breast feeding (p<0.001), and knowledge about the milking methods (by pump and machine) were also significantly higher in 6th year students (p<0.001). In this study it can be observed that the knowledge of students about breastfeeding and infant friendly hospital issues increase by advancing years. The target should be increasing innovations in the education program in order to raise awareness of doctors about this subject during their entire careers. In current situation supporting the theoretical education by practice may contribute to the reflection of breastfeedimg and infant friendly studies to the professional skill.

In patients with rheumatoid arthritis (RA), concomitant fibromyalgia syndrome (FMS) has been reported in 14-17% of cases. Several methods are used to evaluate the outcomes in RA. Among them, disease activity score (DAS 28) is the most frequently used. The previous studies demonstrated that the presence of FMS is associated with a significant increase in the DAS 28 scores in patients with RA. Therefore if, the presence of FMS is ignored if more aggressive treatment approach can be applied to these patients. The aim of this study was to assess the frequency of FMS and evaluate the effect of FMS to disease severity and treatment approach in RA patients. A total of 74 female RA patients were enrolled to the study and they were separated in two groups with regards to presence of concomitant FMS (Group 1 only RA, and group 2 RA with FMS). The number of tender (TJ) and swollen joints (SJ), erythrocyte sedimentation rate (ESR) and for pain visual analog scale (VAS) levels were noted and DAS 28 scores were calculated for RA disease severity. Additionally, the patients were examined for the presence of pain in 18 FMS tender points. Group 1 included 44 patients, while there were 30 patients in group 2. The mean DAS 28 score (3.41 & 4.77, p:0,000), the median number of TJ (4 & 11) (p:0,000) and mean VAS (21,81 & 45,00) (p:0,000) were significantly higher in group 2. However, the difference in SJ (0 & 0) and ESR (24.93 ± 18 & 30.33 ± 25 mm/h) values were not significant. The type of medication used for treatment (DMARD or Anti-TNF drug) did not differ according to FMS existence in RA patients or not whether having FMS or not in RA patients. This study revealed that, the number of TJ, mean VAS and mean DAS 28 score are higher in in RA patients having concomitant FMS in RA patients. RA severity evaluated with DAS28 score may be overestimated due to concomitant FMS which may lead to inappropriate treatment approaches. There was no difference in terms of medical treatments because the presence of FMS considered in our clinic.

Certain psychiatric symptoms such as dissociative disorder, anxiety, and depression are more prevalent in migraine patients than in the rest of the society. Identification of these symptoms is important for the treatment success. We define the purpose of our study as the comparison of the levels of dissociative symptoms, anxiety, and depression between patients with chronic migraine and normal individuals, and the analysis of these levels for their relationship with the demographic properties such as severity of pain and frequency of attacks. The study included 77 female patients with chronic migraine who applied to the neurology polyclinic with the complaint of headache and were diagnosed by the criteria defined by International Headache Society, and 44 healthy volunteers with similar age and educational level with those patients. Both groups were applied Short Dissociative Experiences Scale (DES-Taxon), Somatoform Dissociation Questionnaire (SDQ), Beck Anxiety Scale (BAS), and Beck Depression Scale (BDS) by a psychologist. Demographic and clinical properties and Visual Analog Scale (VAS) results of patients with identified types of migraine were recorded. The scale results of patients with migraine and of the control group, and between the patients of migraine aura and without aura were compared. The results were compared by T-test and Pearson Correlation for the independent group. Dissociative symptoms was more common in the group with migraine (p=0,001). While this increase was correlated with depression and severity of pain, it was not correlated with anxiety. There was not any significant difference between migraine patients of migraine with aura and without aura, statistically. The results of this study reveals that the frequency of dissociative symptoms is higher in patients with migraine than in normal population. This difference was found to be in correlation with depression and VAS score. According to these data, it is important for the success of treatment and prevention of disability to question the symptoms of dissociative symptoms in patients with chronic migraine

Postpartum hemorrhage (PH) is responsible for 25-30 percent of maternal deaths worldwide. PH is the most important reason of maternal mortality and morbidity in developing countries. The most frequently reason of primary PH is uterine atony (UA). Approach for uterine atony starts with large intravenous and urinary catheterization. For the patients who don’t respond medical treatment, uterine tamponade, compression sutures, if necessary uterine artery ligation-embolization or hypogastric artery ligation is applied. The last and the most unwanted procedure is hysterectomy. Urgent peripartum hysterectomy rate is about %0.020-%0.509. We observed that Christopher B Lynch used sutures for uterus for not to perform hysterectomy and this technique is sited as B-Lynch technique in literature. After this procedure, by using different sutures for uterus to avoid hysterectomy, various suture techniques are tried to be defined. In this case series, we shared data of uterine atony hemorrhage control which was provided by use of fundal serosal plasental field suturation for 5 uterine atony cases ,who don’t respond classical modalities.

Acute rheumatic fever (ARF) is an acquired cardiac disease, that may develop as a non-supurative, late-onset complication of an infection with group A β-hemolytic Streptococcus, such as pharyngitis or tonsillitis, continues to maintain its importance in developing countries, despite it is relatively rare in developed countries. The aim of this study was to review patients, diagnosed with acute rheumatic fever at our center, and to discuss this disease, which is a major health problem in our country, in the light of recent literature data. Files of patients, who referred to Selçuk University Medical Faculty Hospital, and diagnosed with ARF between January 2010 and February 2014, were assessed, retrospectively, and patient demographic data, clinical and echocardiographic (ECHO) features, treatment responses were identified. A total of 65 patients, including 26 (40%) girls and 39 (60%) boys, diagnosed with ARF, with an average age of 11,6 years (5-17 years) at the time of diagnosis, 16 (24.6%), 11 (16.9%), 5 (7.7%) and 33 (50.8%) of 65 patients has also been diagnosed with carditis, arthritis, carditis and (+) arthritis, and silent carditis, respectively. The most frequently referred symptoms are arthritis and arthralgia, with a 59% rate. Although pathological murmurs and innocent murmurs were identified during physical examination in 25 (38.4%) and 21 (32.3%) patients, respectively; 19 (29.2%) patients had no evidence of heart murmur. The most common findings in echocardiographic assessment are mitral insufficiency (MI), aortic insufficiency (AI), and mitral and aortic valve involvement in 14 (21.5%), 10 (15.4%) and 22 (33.9%) patients, respectively. Acute rheumatic fever continues to be a health-threatining condition in our country. Even if there are no pathological murmur in patients referred with arthritis or arthralgia, with an increased level of acute phase reactants; echocardiographic assessment should be taken.

The identification of the airway anatomy and associated pathological structures are the basic clinical skills for the especially specialists of anesthesiology, intensive care, emergency medicine, chest diseases and ENT. There are a lot of anatomical structures, which affect the airway management and external anatomical landmarks are insufficient for the complete evaluation of these structures, even in the best conditions. Bedside ultrasonography, which is used especially in the vascular interventions and regional anesthesia applications extensively, can also be useful in the visualization of the airway structures. In this paper, these two issues of how the airway structures can be visualized by USG and of how this information can be used in clinics are defined together with the literature.

Sydenham’s Chorea (SC) is a neurological movement disorder that results from antistreptocpccal antibodies cross-reacting with brain tissues, especially basal ganglia and causing to an inflamatory reaction. According to the 1992 modified Jones criteria, acute rheumatic fever is a major criterion and is sufficient evidence on which to base a diagnosis. SC is frequently seen in the 5-15 years of age. It appears approximately 6 months later from the attack of ARF. SC usually continues 4-6 weeks, it may be permanent. Carditis accompanies SC much more frequently than the other signs of ARF. SC is a neuropsychiatric disorder that may present with anxiety, emotional lability, obsessive compulsive symptoms, attention deficit and hyperactivity symptoms or tics. Most of the cases improve spontanously and many treatment are available. Recurence is common. Penisilin prophylaxis should continued to avoid carditis and recurrence. SC is considered to be the most common cause of acquired chorea in devoloping countries. Even though it has been recognized for centuries, it has kept up its importance by periodic exacerbations. SC and ARF are still declining in recent years in our country, together with which is a significant cause of morbidity as a public health problem.

Thyroid ectopy is caused by failure of the descent of thyroid tissue through thyroglossal duct during embryological development. Base of the tongue is the most common ectopic localisation of thyroid gland. It is usually asympthomatic. Adenoma, hyperplasia, inflammation, malignancy similarly can be seen in ectopic thyroid tissue, as may occur in normal thyroid tissue. In this report, we present the case who has no thyroid tissue on normal localisation, searched for ectopic localisation with scintigraphycally; treated for hypothyroidism and followed.

Noonan syndrome is an autosomal dominant disorder that is typically dysmorphic anamolies at birth. In many affected individuals, this syndrome is associated with cardiac defects and a distinctive facial appearance. We aimed to discuss a different variant of Noonan Syndrome progressing especially with gingival overgrowth and dental anomaly in our cases. A 15-year-old female patient presented to our family medicine outpatient clinic with the complaint of growth retardation. The patient was diagnosed with Noonan Syndrome with phenotypic symptoms. Noonan Syndrome is one of the syndromes without any chromosomal anomalies developing with Turner-like phenotypic features. Gingival overgrowth and dental anomaly coexistence in addition to the oral symptoms that are likely to be related to the Noonan Syndrome was present in our case.Specifically, if there are accompanying symptoms and findings in cases with gingival overgrowth and dental anomalies as seen in patients’ mouth and teeth examinations, Noonan Syndrome may be taken into consideration.

Amyloidoma is a tumoral deposition characterized by localized deposition of amyloid in the tissues. It is very rare in the head and neck region, especially in the maxillary sinus. A 64 years old female patient applied to our clinic with complaints of left-sided nasal obstruction and epistaxis. Endoscopic examination revealed a yellowish polypoid mass obstructing the left nasal passage. Paranasal sinus tomography revealed a tumoral mass filling the left maxillary sinus and repressing the medial wall. Biopsy was positive for amyloidosis. A complete resection of the mass was suggested for a definite diagnosis. The tumor was removed by endoscopic medial maxillectomy, which permitted total excision of the lesion. Pathology results showed amyloidosis. No other organ involvement was detected. Rectal biopsy and proteinuria were negative. Here, we present the extremely rare case having localized amyloidosis of the maxillary sinus.

Scimitar syndrome is a rare congenital partial pulmonary venous return anomaly that is characterized with anomalous pulmonary venous drainage of the right sided pulmonary veins to the inferior vena cava or the right atrium. It may be accompanied with hypoplasia of the right lung with bronchial abnormalities, dextra position of the heart and systemic arterial supply to the lung. Radiologically, this anomalous vein appears as a scimitar-like shadow (Turkish Swords) on chest x-ray, and runs from the middle of the right lung to the cardiophrenic angle. In our report, we have presented a child with scimitar syndrome who was evaluated for recurrent lower respiratory tract infection.