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Öğe CHEST INJURIES ACCOMPANYING BLUNT SPINAL TRAUMA(Turkish Spine Society, 2021) Kapıcıbaşı, Hasan Oğuz; Malçok, Ümit AliObjective: Only a few studies in the literature have evaluated chest injuries accompanying blunt spinal trauma. We aimed to evaluate chest injuries observed concomitantly with spine injuries as well as reveal their clinical importance. Materials and Methods: Eighty-eight patients, who were treated and followed up by the authors after being admitted to the emergency department because of severe blunt spinal trauma, were evaluated retrospectively. Results: Data from a total of 55 patients [30 (54.5%) male and 25 (45.5%) female] who met the study criteria were included. The mean age of patients was 58±15.8. Falling from height was the most common cause of trauma in 32 patients (58.2%) and was significantly more frequent than other causes such as traffic accident, assault, non-vehicle traffic accident, and motorcycle accident (p<0.001). Spinal fracture was observed in 38 patients with severe blunt spinal trauma (69.1%), while ligament and other soft tissue damage was found in 17 patients (30.9%). Spinal fractures were significantly more frequent in the thoracic vertebra (n=28; 50.9%) compared to other regions such as the cervical and lumbar spine (p<0.001). It was observed that chest injury accompanied 33 (60%) patients who experienced blunt spinal trauma. When the thoracic region was classified as per injured tissues; rib fracture (n=10; 30.3%) and pulmonary contusion (n=6; 18.2%) were observed most frequently. Conclusion: Patients with thoracic spinal fractures should be considered at a high risk for chest injury, and this group of patients should be prioritized because of the possible life-threatening complications. In our study, we concluded that the rate of falling from height increased in the elderly group, as well as neurological losses. Moreover, the rate of neurological deficit following thoracic vertebral damage due to falling from height kept increasing especially in the elderly group.Öğe Correlation between the Tuffier's Line and the Spinopelvic Parameters(Cem TIRINK, 2023) Akar, Ali; Malçok, Ümit AliTuffier’s line (TL) is a horizontal line that connects the two superior iliac crests and is used to determine L4 and L5 vertebrae levels. Spinopelvic parameters have been gaining further importance in the diagnosis and treatment planning of spinal diseases. This study aims to reveal whether there is an interaction between TL and spinopelvic parameters. We examined the 113 patients who consulted our clinic for low back pains. TL levels were divided into five categories as L4 body, L4 inferior endplate, L4-5 disc space, L5 superior endplate, and L5 body. In the study group, 70 of the cases (61.9%) were female, 43 (38.1%) were male, and the average age was 50.8 (21–77). TL was determined to pass through L4 body in 38.9% of cases (n=44) regardless of gender. It was observed that sacral slope (SS) and lumbar lordosis (LL) were affected by the changes in TL level (P0.05). SS and LL being affected by changes in TL levels indicates that TL should be assessed together with the spinopelvic parameters. To conclude, TL is a potential spinal parameter that should be included in the spinopelvic parametersÖğe Distribution of Lumbar Microdiscectomy Cases by Tuffier’s Line Levels(2023) Akar, Ali; Malçok, Ümit AliObjective: The most used method in the surgical treatment of lumbar disc herniation (LDH) is lumbar microdiscectomy (LMD). In this study, we aimed to show the relationship between Tuffier's line (TL), which is widely used in determining the L4-5 distance in lumbar spinal interventions, and LMD levels. Materials and Methods: In this study, a total of 204 patients who had LMD or had low back pain were reviewed retrospectively. According to the projection of TL at the spine level; it was divided into 5 categories as L4 corpus, L4 lower endplate, L4-5 disc space, L5 upper endplate, L5 corpus. The cases were analyzed according to age, gender, disc level and changes in TL. Results: 92.1% of the cases were operated at the L4-5 or L5-S1 level. TL was mostly at L5 upper endplate level in women, L4-5 disc space and above in men, and there was a significant relationship between TLs and gender in both groups (p<0.05). Conclusion: In our study, we found that although TLs were caudally in patients operated at L5-S1 level, they displaced cranially in patients operated at L4-5 level. However, it was observed that LDH development in the lower lumbar region and increased at the upper levels with ageing.Öğe Distribution of Traumatic Spinal Injuries in Turkey In Accordance with ICD-10 Codes between the Years 2015 and 2019(Eskişehir Şehir Hastanesi, 2021) Malçok, Ümit Ali; Akar, AliIntroduction: The incidence of traumatic spinal injuries (TSIs) is increasing around the world, our country included. In this study, the distribution of ICD-10 codes used after TSI examinations in Turkey and specifically in Çanakkale between the years 2015 and 2019, and their changes throughout the years were analyzed. Methods: Nationwide data of Turkey and data of Çanakkale province were obtained from relevant institutions and open access statistics reports. Anatomical regions, types of injury and annual changes in ICD-10 codes of TSI examinations were analyzed. Results: Across Turkey, the number of medical examinations increased by 18% in secondary and tertiary care facilities between the years 2015 and 2019. For TSI examinations, the increase was 61%. In Çanakkale province, the number of medical examinations increased by 13.4% and TSI examinations by 9% in this 5-year period. Across Turkey, S33 (919.868) was the most used code in TSI examinations in these 5 years. The least used code was S24 (3.951). In Çanakkale province, it was determined that the code S22 (6508) was used the most, and S24 (23) was used the least. Conclusion: It was determined that TSI examinations across Turkey increased by 61% in this 5-year period, and the lumbar region was the most effected. The neural injury rate was high in the cervical region, despite TSI being relatively less common. There was a significant difference between Çanakkale province and Turkey when the ICD code ratios in spinal region were compared. We can conclude from this difference that clinicians use different ICD-10 codes for the same disease. In conclusion, we believe that it should be confirmed that ICD-10 codes actually match the patient's diagnosis in epidemiological studies to be conductedÖğe Effect of miRs-17/20 on vasospasm in subarachnoid hemorrhage model of rats(2022) Büyük, Başak; Malçok, Ümit AliAim: To investigate the effects of melatonin and miRNA-17/20 administration on vasospasm and vascular damage on the bacillary artery in the Subarachnoid hemorrhage (SAH) model of rats.Methods: Rats were divided into 6 groups: Sham, SAH, SAH+NegmiRNA, SAH+MEL, SAH-miRs-17/20 group, SAH+MEL+miRs-17/20. For creating the SAH model the skin was cut with a vertical incision in the anterior region of the head.120 µL of fresh non-heparinized autologous arterial blood collected from the tail artery was injected into the prechiasmatic cistern under aseptic conditions. All steps in the Sham were the same as in the SAH group, except for blood injection. In the SAH+NegmiRs-17/20, miRs-17/20 miRNA Mimic-Negative Control#1 was administered 1 hour after SAH operation. In the SAH+MEL,10 mg/kg melatonin was administered intraperitoneally 1 hour after the SAH operation. In the SAH-miRs-17/20, mimic-miR-17 and mimic-miR-20 were given intranasally 1 hour after the SAH operation. In the SAH+MEL+miRs-17/20,intranasal mimic-miR-17 and intraperitoneal melatonin were administered 1 hour after the SAH operation. Brain samples, including the bacillary artery, were taken and subjected to routine tissue processing procedures. Vessel samples were evaluated and graded in histological sections stained with the H-E method in terms of vasospasm, edema in the tunica media, and folding of the lamina elastica interna.Results: The co-administration of melatonin and miRs-17/20 reduced the vasospasm and edema formation in the vessel wall. It has also been demonstrated that the application of miRs-17/20 after SAH alone reduces the development of edema in the vessel wall and folding of the internasal lamina elastica due to vasospasm.Conclusion: It has been shown that miRs-17/20 can reduce vasospasm in the vessel wall and prevent vessel damage by reducing edema.Öğe EFFECTS OF LUMBAR MICRODISCECTOMY ON SPINOPELVIC PARAMETERS(Turkish Spine Society, 2021) Malçok, Ümit Ali; Akar, AliObjective: One of the causes which accelerates spinal degeneration process is lumbar disc hernia (LDH). In this study, we observed the changes in spinopelvic parameters one month after single-level lumbar microdiscectomy (LM). Materials and Methods: Standardized bilateral standing scoliosis radiography images of 19 patients, which were performed before and 1 month after LM operation, were evaluated retrospectively. Sagittal vertical axis and coronal vertical axis distances, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt angles were measured with Surgimap software. Results: There was a positive correlation between pre-and post-LM values of all spinopelvic parameters included in the study. In comparative tests however, the difference was found to be not statistically significant. As a result, despite LM operation slightly improved spinopelvic parameters in the first month, there was not a significant change overall. Conclusion: LDH is known to worsen the degenerative process in spine. LM as a treatment option is seen to alleviate this degenerative process by slowing down the deterioration in spinopelvic parameters.Öğe Investigation of the frequency and relationship of fragmented QRS in patients with ischemic stroke Fragmented QRS in patients with ischemic stroke(Bayrakol Medical Publishing, 2021) Çam, Mustafa; Malçok, Ümit Ali; Akşit, Ercan; Ocak, ÖzgülAim: Acute ischemic stroke is an important cause of morbidity and mortality. Fragmented QRS (fQRS) is a depolarization disorder, which may be easily detected in 12-lead superficial electrocardiography (ECG), which displays a conduction delay caused by myocardial fibrotic tissue. Although the association of fQRS with ischemic heart disease is well known, there is no clear information about its relationship with ischemic stroke. In the present study, we aimed to investigate the relationship between fQRS and ischemic stroke.Material and Methods: Seventy consecutive patients with a diagnosis of ischemic stroke and 48 healthy individuals were included in this cross-sectional study. Baseline demographic and echocardiographic characteristics were recorded, and surface 12-lead standard ECGs were used.Results: The mean age of the patients was 65.19±13.91 years, and 46.6% were male. The number of patients with fQRS in the ischemic stroke group was greater than in the control group (p = 0.009). In multiple logistic regression analysis, left ventricular end-systolic diameter (LVESD) (p = 0.013, Odds ratio (OR) = 4.284, 95% Confidence interval (C.I.) = 1.366–13.432), and left atrium diameter (p = 0.020, OR = 3.985, 95% C.I. = 1.240–12.803) were found to be independent predictors of ischemic stroke.Discussion: The current study was the first to focus on evaluating the relationship between fQRS and ischemic stroke. In light of these results, we can say that patients with fQRS, who had lower LVEF, greater LVESD, and larger left atrium represent a high-risk group for ischemic stroke. fQRS may be utilized in a follow-up of these patients and in any consideration of early anticoagulation treatmentÖğe Kifoplasti ve Vertebroplasti Operasyonlarının Klinik ve Radyolojik Olarak Değerlendirilmesi(2020) Malçok, Ümit Ali; Şafak, Özbey; Akman, Tarık; Aras, Adem BozkurtMaç:Omurga fraktürlerinin tedavisinde hedef anatomik redük-siyon sağlamak, spinal deformiteyi önlemek, ağrıyı azaltmak, ver-tebra yüksekliğini yeniden oluşturmak ve erken mobilizasyon ile hastanın günlük aktivitelerine erken geri dönmesini sağlamaktır. Bu çalışma ile osteoporoz veya tümöre bağlı olarak vertebra korpus fraktürü gelişmiş hastalara uygulanan perkütan vertebroplasti (PVP) veya perkütan balon kifoplasti (PBKP) sonrası ortaya çıkan klinik ve radyolojik sonuçları operasyon öncesi ve sonrası değerlendirmeyi amaçladık.Materyal ve Metot:Tek seviye vertebra korpus fraktürü olan 65 olguya, (44’u kadın %67,7, 21’i erkek %32,3), PVP ve PBKP işlemi uygulandı. Vakalar radyolojik olarak Magnetik Rezonans Görüntüleme, Bilgisayarlı Tomografi ve X-ray radyografi ile operasyon öncesi ve sonrası olarak değerlendirildi. Radyolojik değerlendirmede vertebra yükseklikleri ve Cobb açıları ölçüldü. Ağrıdaki değişimlerin izlenmesinde Visual Analog Skala (VAS) kullanıldı.Bulgular:Vakaların başlıca semptomu “ağrı” olup, PVP ve PBKP ile ortalama VAS skorları 7,9’dan 2’ye geriledi (p<0,05). Vertebra korpus açısındaki ortalama düzelme 2,2 derece olarak ölçüldü. Ön, orta ve arka vertebra korpus yüksekliklerinde anlamlı derecede artış olduğu görüldü (p=0,0001).Sonuç:Osteoporoz ve tümöre bağlı gelişen vertebra korpus frak-türlerinde uygulanan PVP veya PBKP operasyonu ağrının azaltıl-masında, vertebra korpus yüksekliğinin arttırılmasında ve Cobb açı düzeltilmesinde güvenilir ve etkili bir tedavi şeklidir. Verilen PMMA miktarının arttırılması; VAS değerinin azalmasına, Cobb açısının düzelmesine ve vertebra korpus yüksekliğinin artışına anlamlı katkı sağlamadı.Öğe Lomber Dejeneratif Skolyoza Yaklaşım(2018) Malçok, Ümit Ali; Yaman, OnurLomber dejeneratif skolyoz 50 yaş sonrası erişkin dönemde görülür. Asimetrik disk dejenerasyonu zemininde gelişmekte olduğu görülmektedir. Erişkin skolyotik deformitenin bir de novo deformite olduğu ve hastalığın ilerleyici olduğu hastalara anlatılmalıdır. Bu hastalarda tedavi yöntemine karar verebilmek için; şikayetleri, klinik bulguları, radyolojik ölçümleri ve sistemik hastalıkları birlikte yorumlanmalıdır. Cerrahi sonrası iyileşme seviyesini öngörebilmek için tüm bunlara ihtiyacımız var. SRS-Schwab Sınıflaması'nın kullanılması cerrahi sonrası beklentilerin daha iyi anlaşılmasını sağlayacaktır. Hangi eğriliklerin füzyona katılması gerektiği ya da füzyon seviyelerinin ne olması gerektiğini öngörebilmek için Berjano ve Lamartina sınıflamasından yararlanılabilinir. Literatürdeki serilere bakıldığında cerrahi tedavi yapılan hastaların yaşam kalitesi, konservatif takip edilen hastalara göre daha yüksek olduğu izlenmektedir.Öğe Neuroprotective Effects of Piceatannol on Olfactory Bulb Injury after Subarachnoid Hemorrhage(Springer, 2023) Akar, Ali; Öztopuz, Rahime Özlem; Büyük, Başak; Ovalı, Mehmet Akif; Aykora, Damla; Malçok, Ümit AliSubarachnoid hemorrhage (SAH) accounts for 5% of all stroke cases and is responsible for significant permanent brain and neurological damage within the first few days. Loss of smell is one of those neurological disorders following olfactory bulb injury after SAH. Olfaction plays a critical role in several aspects of life. The primary underlying mechanism of olfactory bulb (OB) injury and loss of smell after SAH remains unknown. Piceatannol (PIC), a natural stilbene, possesses anti-inflammatory and anti-apoptotic effects against various diseases. In this study, we aimed to investigate the potential therapeutic effects of PIC on OB injury following SAH at molecular mechanism based on SIRT1, inflammatory (TNF-α, IL1-β, NF-κB, IL–6, TLR4), and apoptosis (p53, Bax, Bcl-2, caspase-3)-related gene expression markers and histopathology level; 27 male Wistar Albino rats were used in a pre-chiasmatic subarachnoid hemorrhage model. Animals were divided into groups (n = 9): SHAM, SAH, and PIC. Garcia’s neurological examination, brain water content, RT-PCR, histopathology, and TUNEL analyses were performed in all experimental groups with OB samples. Our results indicated that PIC administration significantly suppressed inflammatory molecules (TNF-α, IL–6, IL1-β, TLR4, NF-κB, SIRT1) and apoptotic molecules (caspase-3, p53, Bax). We also evaluated edema levels and cell damage in OB injury after SAH. Ameliorative effects of PIC are also observed at the histopathology level. Garcia’s neurological score test performed a neurological assessment. This study is the first to demonstrate the neuroprotective effects of PIC on OB injury after SAH. It suggests that PIC would be a potential therapeutic agent for alleviating OB injury after SAH.Öğe Protective effect of metformin against lithium-induced cerebral neurotoxicity in rats(2021) Malçok, Ümit Ali; Şehitoğlu, Müşerref Hilal; Buyuk, Basak; Taş, Halil İbrahimNeurotoxic effects are seen in patients using lithium regardless of dose. The neuroprotective activity of metformin used in the treatment of patients with type 2 diabetes mellitus is known. In this study, the protective efficacy of metformin against the neurotoxic effects of lithium was investigated. Neurotoxicity was induced by administering high dose oral lithium (40 mmol/kg) to rats for two weeks. Four groups were formed, with 6 rats in each group. OSI indices were calculated by measuring serum TAS and TOS levels. TAS, TOS, OSI, Gpx ADAM10, and ADAM17 levels were measured in the brain tissue. The neuroprotective activity of metformin was examined histopathologically by calculating the pyknosis scores, vacuolization, and interstitial edema in the hippocampus and cortex tissues. When lithium and metformin were given together, serum levels of TAS, TOS, and OSI were lower than that of the Lithium group (p<0.001), whereas the TAS level in the brain tissue was higher than that of the lithium group (p<0.05). With the concomitant administration of lithium and metformin, ADAM10 levels decreased (p<0.05), whereas ADAM17 and Gpx levels increased (p>0.05). In histopathological evaluation, pyknosis, interstitial edema, and vacuolization scores of the hippocampus and cortex regions increased with lithium alone but were low when lithium was given together with metformin. Levels of the antioxidant molecules Gpx and TAS decreased with lithium, and ADAM10 and ADAM17 proteins, which indicate the strength of intercellular bonding, increased by administering metformin. In conclusion, the toxic effect of lithium on brain tissue was reduced by metformin.Öğe Radiological evaluation of anatomical changes in implant and adjacent segments after rigid fusion(2020) Malçok, Ümit Ali; Aylanç, NilüferAim: We aimed to determine the anatomical remodeling seen after lumbar spine stabilization in detail. Using magnetic resonanceimages, it is also aimed to reveal this remodeling is not only limited to the adjacent segment and also happens in the upperinstrumented vertebra region. At the end of this study, it is suggested to develop new radiological parameters to predict the changesin the adjacent segment and upper instrumented vertebra regions.Materials and Methods: Twenty cases operated for degenerative lumbar stenosis were included in our study. Quantitative datawere obtained by radiological measurements by a radiologist and neurosurgeon. On magnetic resonance images, the anatomicalstructures changed by remodeling were compared before and after the operation during (6-26 months) postoperative period. Unlikeprevious studies, anterior, middle and posterior disc heights; Cobb angle in the adjacent segment, spinal canal area, bilateral neuralforamen, facet joint areas and flavum thicknesses were evaluated.Results: From the sixth month after lumbar fusion, it was observed that angles and anatomical structures were changed in adjacentsegment. Also, it was observed that the areas with neural structures expanded in the upper instrumented vertebra region. Thedegeneration in adjacent segment and relaxation in the upper instrumented vertebra region were found to be statistically significant.A statistically strong positive correlation was found between the number of vertebrae included in the lumbar fusion and the meanheight of the adjacent segment disc (r: 0.526, p: 0.017).Conclusion: After comparing the measurements in adjacent segment and upper instrumented vertebra regions before and after theoperation, it was concluded that the remodeling was statistically significant. We suggest that the parameters in our study can beused as a scoring method for early detection of adjacent segment degeneration and/or disease. Thus, it will be possible to createfollow-up indicators findings after fusion.Öğe Rarely Seen Intradiploic Skull Hematoma in Infants(Lippincott, Williams & Wilkins, 2021) Malçok, Ümit Ali; Akar, AliAlthough the first intradiploic hematoma (IH) case was reported in 1934, only 7 infant cases were reported in the literature. The authors present 2 IH cases, without birth trauma or bleeding disorder, which were treated surgically. IH is also included in the differential diagnosis of babies with a skull deformity. Computed tomography and magnetic resonance imaging modalities should be used together in diagnosis and treatment. The authors believe that the surgery to treat skull deformity because of IH in babies should be planned in the early period.Öğe RELATION BETWEEN SPONTANEOUS INTRACEREBRAL HEMORRHAGE AND fQRS COMPLEX(Merthan TUNAY, 2021) Malçok, Ümit Ali; Çam, Mustafa; Akşit, Ercan; Ocak, ÖzgülIntroduction: There has not been a change in spontaneous intracerebral hemorrhage (SICH) incidence over the last three decades. Mean age of cases keep rising. Despite the rising success rate of treatments, there has not been a significant improvement in prediction of hemorrhages beforehand. In this study, we aimed to find whether there was a relation between fragmented QRS (fQRS) complex and SICH in follow-up of risky patients.Materials and Methods: This study was planned as a case-control study. The data of 30 SISH and 30 healthy control individuals who meet the criteria were used in the study. Those who scored between 1-5 points according to the hemorrhage severity scale were discarded and the cases who scored zero points were included in the study. Interpretation of electrocardiogram (ECG) records and echocardiogram (ECHO) procedures were performed blindly by a cardiologist. The existence of fQRS complex in ECG records and standard parameters in ECHO procedure were evaluated.Results: Mean age of hemorrhage cases was 69 and 19 of them (%63) were male. There were not any significant differences in age, diabetes prevalance and smoking habits between groups, however, hypertension (HT) was seen more frequently in hemorrhage cases (p<0.05). fQRS complexes were seen more frequently in SICH group compared to the control group (p<0.01). In addition to the decrease in left ventricular ejection fraction (LVEF) (p<0.05), there was also an increase in left atrium (LA) (p<0.05). However, it was observed that SISH cases with fQRS complex in ECG recordings were 5 times more than the control group (OR 5.2, p<0.01).Conclusion: In this study, the relation between the existence of fQRS and SICH risk was evaluated. The fQRS complex in his ECG; It was concluded that in patients with a decrease in LVEF, an increase in LA and accompanying HT, SISH is seen moreÖğe SİSPLATİN'İN NÖROTOKSİK ETKİSİNE BAĞLI GELİŞEN HİPOKAMPAL NÖRON HASARINA KARŞI MELATONİN NÖROPROTEKTİF ETKİNLİĞİNİN ARAŞTIRILMASI(İzmir Demokrasi Üniversitesi, 2021) Malçok, Ümit Ali; Büyük, BaşakSisplatin yaygın kullanılan ancak yaşam kalitesini düşüren etkileri olan bir antineoplastiktir. Özellikle nörotoksik etkileri, hastaların %70’inde tedavi esnasında veya sonrasında bilişsel bozulmalara yol açmaktadır. Bu çalışmada melatoninin siplatin toksistesini azaltıcı etkinliği araştırıldı. Denek olarak 24 yetişkin erkek Wistar Albino ırkı sıçan kullanılarak 4 grup oluşturuldu. Sıçanlara 1. 5. 9. ve 13. günlerde ve 4 mg/kg dozunda intraperitoneal (ip) sisplatin verilerek nörotoksisite oluşturuldu. Tedavi grubuna ise 13 gün 10 mg/kg/gün dozunda ip melatonin uygulanarak gruplar karşılaştırıldı. 14. günde yapılan sakrifikasyon sonrası hipokampus dokuları alındı. Piknozis ve ödem skorları hesaplanarak sisplatin toksisitesi ve melatoninin etkinliği analiz edildi. Sham grubu ile Mel ve Cisp+Mel grupları arasında piknosis açısından anlamlı fark olmadığı ancak sisplatin verilen grupta belirgin düzeyde piknotik nöron artışı olduğu görüldü (p<0.01). Sisplatin verilen ratlarda hipokampus dokusundaki ödemin belirgin düzeyde arttığı buna karşın melatonin verildiğinde ödem skorlarının istatistiksel olarak anlamlı seviyede düştüğü izlendi (p<0.01). Sisplatin ve melatonin benzer oksidatif ve apoptotik süreçleri zıt yönlerde etkilemektedir. Biz de çalışmamızda melatoninin sisplatin toksisitesi üzerine olan etkilerini inceledik ve melatoninin sisplatinin nörotoksik etkilerine karşı koruyucu etki gösterdiği sonucuna ulaştık. Ulaştığımız bu sonuç yaygın kullanılan bir kemoteropatik olan sisplatin, melatonin ile kombine edilerek kullanıldığında kanser hastalarının daha az nörotoksik yan etkilere maruz kalmasını sağlayacaktırÖğe SPONTAN İNTRASEREBRAL HEMORAJİ İLE fQRS KOMPLEKSİ ARASINDAKİ İLİŞKİ(2021) Malçok, Ümit Ali; Çam, Mustafa; Aksit, Ercan; Ocak, ÖzgülAmaç: Spontan intraserebral hemoraji (SİSH) insidansında, son üç dekat boyunca değişim olmadığı ve olguların yaş ortalamalarının arttığı görülmektedir. Günümüzde, hastaların tedavilerindeki başarı oranı artmakta ancak kanamaların tahmin edilmesinde umut verici bir ilerleme sağlanamamıştır. Bu çalışmada, fragmente QRS (fQRS) kompleks varlığı ile SİSH arasında bir ilişki olup olmadığını göstermeyi amaçladık. Materyal ve Metot: Bu çalışma vaka-kontrol çalışması olarak planlanmıştır. Çalışma kriterlere uygun 30 SİSH’li ve 30 sağlıklı kontrol bireye ait veriler kullanıldı. Hemoraji derecelendirme ölçeğine göre 1-5 puan alanlar çalışma dışı bırakıldı ve sıfır puan alan olgular çalışmaya alındı. Tüm olgulara ait elektrokardiyogram (EKG) kayıtlarının yorumlanması ve ekokardiyografi (EKO) işlemleri, kardiyoloji uzmanı tarafından kör olarak gerçekleştirildi ve EKG kayıtlarında fQRS kompleksi varlığı arandı. Bulgular: Hemoraji geçiren hastaların yaş ortalaması 69 ve 19’u (%63) erkekti. Grupların yaşları, diyabet prevalansı ve sigara alışkanlıkları arasında belirgin bir fark yoktu, ancak hipertansiyonun (HT) kanama geçiren olgularda daha fazla bulunduğu görüldü (p<0,05). Ayrıca SİSH hastalarında, kontrol grubuna kıyasla fQRS kompleksi daha sık görüldü (p<0,01). SİSH olgularına ait EKO parametrelerinde ise sol ventrikül ejeksiyon farksiyonunda (SVEF) azalmanın (p<0,05) yanı sıra sol atriyumda (SA) artış olduğu görüldü (p<0,05). Bununla birlikte, EKG kayıtlarında fQRS kompleksi bulunan SİSH olgularının, kontrol grubuna göre 5 kat daha fazla olduğu görüldü (OR 5,2, p<0,01). Sonuç: Bu çalışmada fQRS varlığı ile SİSH arasındaki ilişki değerlendirildi. EKG’sinde fQRS kompleksi bulunan; SVEF’de azalma, SA’da artma olan ve eşlik eden HT’si olan hastalarda, SİSH’nin daha fazla görüldüğü sonucuna ulaşıldı.Öğe The effects of lower back pain due to herniated disc on sleep, quality of life and depression symptoms(2022) Malçok, Ümit AliIntroduction: This study aims to evaluate the relationship between herniated disc-related low back pain and depression, sleep, and quality of life.Methods: A control group consisting of 28 patients with herniated disc-related pain and 28 healthy volunteers were included in the study. Beck Depression Inventory (BDI) and Quality of Life Index (SF-36) are applied to all groups. Pain severity was evaluated with the Visual Analogue Scale (VAS). Sleep parameters were analyzed with an actigraphy device.Results: Depression and quality of life scores differed between the two groups, and they were observed as significantly higher in the group with herniated disc. Moreover, there was a positive correlation between pain severity and depression. On the other hand, there was a negative correlation between pain intensity and sleep efficiency. Subjects with low back pain had worse sleep quality and lower sleep efficiency (mean 71.7%) than the control group. The logistic regression analysis found a significant relationship between depression and VAS pain variables (p=0.030; 95% CI: 0.021-0.823).Conclusions: Our study's results reveal a relationship between pain and depression in herniated disc patients. Moreover, it was concluded that the deteriorated sleep quality due to low back pain also increased the severity of depression. This relationship related to the unpleasant consequences of chronic pain should be taken into account when planning the medical treatment and follow-up of patients with herniated disc, and also when explaining their expectations from surgical treatment.Öğe Unpredicted respiratory arrest following hypoglossal nerve palsy during subarachnoid hemorrhage: Experimental study(2021) Aydın, Muhammed Enes; Malçok, Ümit Ali; Erdoğan, Aysel; Çağlar, Özgür; Aydın, Mehmet; Atalay, Canan; Gündoğdu, BetülAim: Although acute respiratory arrest is the most dangerous complication of subarachnoid hemorrhage; if there is any association between hypoglossal nerve-tongue palsy induced acute mechanical upper airway obstruction has not been extensively described so far. Our aim is to evaluate if there is a relationship between hypoglossal ischemia-tongue paralysis and upper airway obstruction during subarachnoid hemorrhage.Materials and Methods: Formerly studied 23 rabbits’s documents chosen from our SAH experiments. A control group (Group A) include 5 normal animals, Sham group (Group B) include 5 animals which saline was administered, and a study group (Group C) include 13 animals (7 survive-C1 / 6 dead-C2) which were injected with homologous blood into the cisterna magna. Blood pressure values and and electrocardiograhic changes were recorded per days of all animals before, during and after surgery during two weeks and all animals decapitated under general anesthesia. Hypoglossal nerves, tongue muscles and upper arways were evaluated. Numbers of degenerated axons/neurons density of hypoglossal nerves-atrophic tongue muscles and airway obstruction scores (AOS) of all animals were determined and analysed statistically with ANOVA. AOS was classified according to tongual sliding down distances to larynx numbered between 1-7 mm to scored with 1-7.Results: Important neurodegeneration was noticed in axons of the hypoglosssal nerves and tongue muscle denervation injury was in more severe in AOS observed animals. The hypoglossal nerves, degenerated axon density (n/mm2), numbers of atrophic muscles (n/mm3) and AOS was: 4±2, 1±1, 1±1 in A; 7±3, 2±1, 2±1 in B and 98±11, 23±5, 5±2 in C1 groups. P values between the axonal degeneration of hypoglossal nerves/muscles and AOS was p<0.005 for C2/C1; p<0.0005 for C2/A and p<0.0001 C2/B. Conclusion: Hypoglossal ischemia induced tongual muscle palsy related respiratory arrest should be remembered in neurocritical cases. Maintaining normal respiratory functions is only possible with airway tone, which is possible with an intact hypoglossal nerve.
