Elif Önder

Mean platelet volume in patients with non-alcoholic fatty liver disease

Mean platelet volume (MPV) is an indictor of platelet activation. Platelet activation and aggregation are central processes in the pathophysiology of coronary heart disease. Non-alcoholic fatty liver disease (NAFLD) is present up to one–third of the general population and the majority of patients with cardio-metabolic risk factors such as abdominal obesity, type 2 diabetes and other components of the metabolic syndrome (MS). The aim of the current study was to investigate the MPV in patients who had NAFLD. MPV values of the patients with NAFLD and of the patients without fatty liver disease were compared. NAFLD patients had significantly higher body mass index compared to the control cases. Among biochemical variables, fasting plasma glucose and triglyceride were significantly higher in the NAFLD group. NAFLD cases also had lower platelet count and higher MPV (10.43 ± 1.14 vs. 9.09 ± 1.25; p < 0.001, respectively). MPV was positively correlated with AST (r: 0.186, p < 0.042), ALT level (r: 0.279; p 0.002) and the presence of NAFLD (0.492; p < 0.001) but negatively correlated with platelet number (r: −0.26; p 0.004) and creatinine (r: −0.255; p 0.005). In logistic regression analysis (age, gender, NAFLD, body mass index, high-density lipid (HDL) cholesterol, systolic and diastolic blood pressure, triglyceride and fasting plasma glucose were used as covariates) only NAFLD was found to be the independent predictor of MPV (Odds Ratio (OR) 21.98) [95% confidence interval (CI): 2.404–201.048; p: 0.006]. We have shown for the first time in the literature that, patients with NAFLD have higher MPV. It may have prognostic value in NAFLD patients indicating a possible cardiovascular disease (CVD) risk increase.

The effect of breast-feeding duration on bone mineral density in postmenopausal Turkish women: a population-based study.

Introduction In the present study, we investigated the effects of breast-feeding time on bone mineral density (BMD) later in life. Material and methods The current study was based on a retrospective analysis of 586 postmenopausal women with a mean age of 60.8 years, who were screened for osteoporosis by dual energy X-ray absorptiometry (DXA).They were classified into 4 groups with respect to the duration of their breast-feeding as never (group 1), 1-24 months (group 2), 25-60 months (group 3), or > 60 months (group 4). Bone mineral density results for the femur neck and lumbar spine were classified into 3 groups according to WHO criteria as normal (T score > –1.0 SD), osteopenia (T score –1.0 to –2.5 SD), and osteoporosis (T score < –2.5 SD). Patients with osteopenia or osteoporosis (T score < –1.0 SD) were considered as having low bone mass (LBM). Results We found a correlation between duration of lactation and femur BMD or spine BMD in the study population (r = 0.116, p < 0.005; r = –0.151, p = 0.001, respectively). Significant differences were found between femur BMD and spine BMD of groups in one-way ANOVA analysis (p = 0.025, p = 0.005, respectively). Additionally, when compared with the other three groups, group 4 was older and had longer duration of menopause (p < 0.01). In logistic regression analysis, age and body mass index were found as independent risk factors of LBM [odds ratio: 1.084 (95% CI 1.031-1.141); odds ratio: 0.896 (95% CI 0.859-0.935)], while duration of lactation was not found as an independent predictor of LBM. Conclusions In this study, we have found that changes of bone metabolism during lactation had no effect on postmenopausal BMD measured by DXA. Consequently, it can be suggested that long breast-feeding duration is not a risk factor for low bone mass later in life.

Herbal self-medication use in Type 2 diabetes mellitus.

* Correspondence: elifonder61@yahoo.com To the Editor, We read the article entitled “Herbal self-medication use in patients with diabetes mellitus type 2” by Damnjanovic et al. in a recent issue of the Turkish Journal of Medical Science with great interest (1). We thank Dr Damnjanovic and colleagues for their interesting and also important investigation on herbal self-medication use in type 2 diabetics. They reported that type 2 diabetics have used different types of herbal product in daily life. Especially they found 5 important herbal products usage: ginseng, garlic, aloe, cinnamon, and St. John’s wort. We published a similar article about herbal therapy in type 2 diabetics in a Turkish diabetic population 2 years ago (2). Therefore, we wanted to make some comments on the article and this subject. Prevalence of herbal treatment use is very high in Turkish diabetic patients. Approximately 1/3 of diabetic patients have used different types of herbal products. Damnjanovic et al. reported 5 different types of herbal products. We detected approximately 20 different types of herbal products in our diabetic patients. They have most commonly used cinnamon, pepino, Prunus laurocerasus leaf, chamomile tea, cabbage juice, pomegranate flower, mulberry leaves, garlic etc. (2). We did not detect any favorable effect on control of diabetes because HbA1c levels were similar in both the herbal treatment and nonherbal group. We also investigated the factors influencing the use of herbal treatment. Patients were dissatisfied with the current medical treatment due to ineffectiveness, side effects, and hypoglycemia. Therefore, they tended to use herbal treatment. Dr Damnjanovic also reported that recommendations for herbal treatment arose from different sources. They reported that influencing decisions about herbal dietary supplements were media, friends, pharmacists, and physicians. We also detected similar findings. Advisers recommending herbal treatment in addition to medical therapy were as follows: neighbors or friends 45%, media 30%, health care workers (physicians and pharmacists) 13%, and herbalists 9%. In Turkey, one third of type 2 diabetic patients have used many different forms and types of herbal treatments regularly. The most important factors influencing herbal treatment use were dissatisfaction with current diabetic medicine and its side effects. In addition, other important factors leading to patients’ using herbal treatment were former users (friends, neighbors, and other patients) and the media. In conclusion, although various herbal treatments could be used as adjunctive therapy in addition to the current medical treatment, due to lack of evidence-based data in this field, potential severe adverse effects can result in death, depending on improper use. Moreover, to prevent misuse of herbal treatments for diabetic patients, we also recommend more educational programs on television or in the press about diabetes treatment. Received: 13.07.2015 Accepted/Published Online: 01.12.2015 Final Version: 23.06.2016 Letter to the Editor

An Atypical Femoral Fracture in a Patient on Long-term Alendronate Therapy

Abstract Background: Biphosphonates, especially alendronate, are used extensively and successfully for the treatment of osteoporosis. However, there are numerous recent studies that indicate low-energy subtrochanteric femoral fractures can be associated with long-term alendronate therapy. Findings: We present a 76-year-old female patient who has taken 70 mg alendronate per week for 7 years, and who presented with pain in the left thigh. Conclusions: The patient was diagnosed as atypical femoral fracture resulting from long-term alendronate use. The diagnosis and the treatment will be discussed with a review of the literature.

Recurrent and Massive Life Threatening Epistaxis due to Nasal Heroin Usage

Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.

Serebrovasküler infarktın nadir bir komplikasyonu: İki taraflı ses teli felci

Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not affect respiratory function. In recent years, regional anaesthesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patients with chronic disease who suffer from upper and lower extremity injuries. In this paper, we present two cases who underwent combined regional anaesthesia techniques for the lower and upper extremity surgery.Iki tarafli ses teli felci (ISTF) siklikla tiroid ve paratiroid cerrahisi gibi iyatrojenik bir hasar sonucu olusur. Fakat serebral infarkt sonrasi hava yolu tikanikligina neden olan BVKP nadir olarak bildirilmistir. Bu yazida tekrarlayan serebral infarktin, gec ortaya cikan ve hayati tehdit eden bir komplikasyonu olarak solunum durmasi ile sonuclanan bir ISTF olgusu sunduk. Atmis yedi yasinda erkek hasta, son 3-4 aydir giderek artan solunum yetmezligi sikayetiyle acil servisimize basvurdu. Ozgecmisinde kalp yetmezligi ve kronik obstruktif akciger hastaligi oykusu olmayan hasta, yaklasik bir yil once bir ayda iki kez serebral infarkt gecirmisti. Yapilan solunum sistemi muayenesinde bilateral wheezing ve stridor; norolojik muayenesinde ise sag tarafta kuvvet kaybi mevcuttu. Ust solunum yolu obstruksiyonunu degerlendirilmek uzere endoskopik laringoskopi yapildi. Laringoskopide iki tarafli ses tellerinin orta hatta sabit ve hareketsiz oldugu goruldu. Solunum yetmezliginde artma ve tekrarlayan solunum durmasi nedeniyle hastaya trakeostomi acildi. Operasyon sonrasi hastanin solunum yetmezligi geriledi. Solunum fonksiyonlari normale donen hasta taburcu edildi.Dysphagia aortica is a rare etiological factor of dysphagia resulting from extrinsic compression of the esophagus by thoracic aorta. There is no gold standard diagnostic proscedure for dysphagia aortica. Dysphagia aortica is usually escaped to attention in the differential diagnosis of dyssphagia. Here, we reported compression of the esophagus by thoracic aorta in a 54 years-old male patient who comsplained from dysphagia.