The patient perception of the lumbar puncture is perceived to be worse than it actually is. Therefore, it is very important to provide sufficient information to the patients about the LP and to inform them about the necessity of the procedure.

Aim: In present retrospective analysis, we aimed to evaluate the treatment results of subjects with inguinal hernia whom underwent surgical repair. Methods: Surgical treatment of inguinal hernia for last 7 years have been retrospectively analyzed. Surgical procedures include anterior mesh, posterior mesh, Mc Vay, non-mesh repair, plug mesh. Results: A total of 2320 patients underwent hernia surgery were included to the study. While, 2224 of the cases were elective procedures while 96 were operated in emergency conditions. Incarceration 78 of emergent cases were incarcerated and 18 were strangulated. Patients requiring emergency surgery were significantly older than the patients underwent elective hernia repair. Duration of hospital stay was significantly longer in emergent cases compared to elective cases. Need for intestinal resection was more common in emergent cases compared to elective surgery cases. Mc Vay and plug mesh procedures were more commonly used in emergent cases compared to elective surgery cases. Intestinal laceration and development of recurrences were more common in emergent surgery cases compared to elective surgery. Conclusion: Inguinal hernia patients should be scheduled for elective surgery without delay since need for emergent surgery may increase by time and emergent cases are associated with more complications and surgical morbidity.

Aim: Tadalafil is a potent, selective and reversible inhibitor of phosphodiesterase type 5 (PDE5) enzyme breakdowning cyclic guanosine monophosphate (cGMP). In this study, we aimed to investigate the effects of tadalafil on nociception, morphine analgesia and tolerance. Methods: In this study, 54 Wistar Albino (230-250 g) male rats were used. First of all, four different doses (2, 4, 8, 16 mg/kg) were used to determine the optimum effective dose of tadalafil on nociception. Optimum activity was found at 8 mg/kg and animals were divided into six groups: Saline (S), 8mg/kg tadalafil, 5mg/kg morphine (M), M+ tadalafil, morphine tolerance (MT) and MT+ tadalafil. Saline was given to the control group, tadalafil intraperitoneally and morphine subcutaneously administered at the indicated doses. To develop tolerance to morphine, 10mg/kg morphine was injected daily in the morning and evening for five days and tolerance was evaluated with single dose of morphine on sixth days. The resulting analgesic effect was measured with hot plate and tail flick analgesia tests and recorded at 30th, 60th, 90th and 120th minutes. Results: Tadalafil showed anti-nociceptive effect when given alone at different doses (p<0.05). However, tadalafil significantly decreased the analgesic effect of morphine (p<0.05). In addition, tadalafil significantly increased the tolerance to morphine (p<0.05). Conclusions: The phosphodiesterase type 5 inhibitor tadalafil have anti-nociceptive properties and it decreases analgesic effect of morphine, in addition improves tolerance development. These effects probably may occur via NO/cGMP pathway.

Aim: Hypocalcemia is a common clinical problem in critically-ill patients and it is associated with increased morbidity and mortality. The aim of this study was to investigate serum calcium, vitamin D and parathyroid hormone (PTH) levels in surviving and non-surviving septic shock patients. Method: Patients with septic shock criteria and who were older than 18 years of age were included, whereas patients with diseases influencing calcium homeostasis were excluded. Demographic and laboratory parameters were recorded prospectively. Results: 41 patients, 20 of which were male were included in the study. The median (min-max) age of study population was 67 (19-88) years. Frequency of hypocalcemia in the study population was 29.2% and 68.2% according to corrected calcium and ionized calcium, respectively. On the day septic shock was diagnosed (day 1), median vitamin D levels of survivors and non-survivors were 8.7 ng/ml (4.3-30.4) and 5.3 ng/ml (1.0-21.7), respectively (p=0.05). On the same day, median PTH levels of survivors and non-survivors were 94 ng/L (16.9-1746) and 49 ng/L (6.6-339), respectively (p=0.042). Although vitamin D levels were suppressed and PTH levels were elevated in non-survivors at day 5, this change was not statistically significant (p=0.19 and p=0.187). Conclusion: Hypocalcemia is frequent in septic shock patients, whereas vitamin D levels were low and PTH levels were high in the diagnosis day. These results suggest that vitamin D is suppressed by septic shock at non-surviving patients during course of septic shock. Parathyroid hormone may be a marker for worse outcome in critically ill patients.

Aim: The effects of gestational exercise on potential pathological conditions is not known yet. Therefore, in the present study, it was aimed to evaluate the effects of forced running exercise on lipopolysaccharide (LPS)-induced brain damage in pregnant rats. Method: Pregnant females in the experimental group were forced to exercise 30 minutes daily for five days a week. Lipopolysaccharide (LPS)-induced brain injury model was created by administering 500 µg/kg body weight of LPS on gestational days 18 and 19. To evaluate injury histopathologically, brain tissues were fixed at the seventh postnatal day through transcardial perfusion (n=4 pups/group). When the remaining pups reached 30-day of age, Morris water maze test (MWM) was performed to assess memory and learning, open filed (OP) and elevated plus maze (EPM) for testing anxiety, and Porsolt test (PT) for evaluating depression. The groups were defined as brain injury group (BI, n=13) and exercise+brain injury group (E+BI, n=7). Results: The results obtained from MWM test indicated that animals found the platform in a shorter duration and distance at the day five compared to the day three. However, there was no significant difference between the groups. No significant difference was found in OP test regarding the distance traveled, time spent at the margins, movement at the center and the time spent as immobile. However, in the EPM test, the offspring at the BI group displayed higher mobility and increased number of entry to the open arms compared to the E+BI groups (p=0.01). There was no significant difference regarding mobility duration and total distance traveled in the PT test. Conclusion: The results of the EPM test suggests that the gestational exercise can suppress the stress factors in the pregnant females with brain injury leading to the prevention of hyperactivity-induced negative learning behavior.

Aim: In this study we aimed to compare the 25(OH) vitamin D level of obese patients and the serum 25(OH) vitamin D level of healthy individuals who have normal weight; and also to evaluate the relation between 25(OH) vitamin D level and body mass index (BMI), waist circumference, hip circumference, body fat ratio. Methods: Among the patients who went into Okmeydani Training and Research Hospital Internal Medicine polyclinic and the patients hospitalized at the Internal Medicine clinic between the dates December 2012 - May 2013 and whose ages range between 18 and 70; total 105 individuals took part in the study. 62 individuals whose BMI is =30 formed the patient group, while 43 individuals whose BMI is between 18, 5 and 25 formed control group. Vitamin D level of the patient group and control group was measured. The data obtained was statistically analyzed. Results: The weight, BMI, waist circumference, hip circumference, body fat ratios of the patients in the case group were significantly higher than the ones in the control group (p<0.05). The 25 (OH) vitamin D level of the patients in the case group was significantly less than the ones in control group (p=0.03). There was statistically significant negative correlation between 25 (OH) vitamin D value and weight (r=-0.26 p=0.01), waist circumference (r=-0.23 p=0.02), and BMI (r=-0.26 p=0.01). Conclusion: Physicians should consider in treatment of vitamin D deficiency that, serum vitamin D levels are higher in obese compared to lean subjects and correlated negatively with BMI, weight and waist circumference.

Aim: We aimed to compare the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness of B12 vitamin deficiency patients with healthy controls using optical coherence tomography (OCT). Methods: Forty-six patients (27 females / 19 males) diagnosed with B12 vitamin deficiency and 46 healthy controls (26 females / 20 males) with similar age and sex were included in the study. RNFL thickness of global, superotemporal, temporal, inferotemporal, superonasal, nasal and inferonasal sectors and GCL thickness and volume measurements of central, superior, inferior, temporal, and nasal sectors were performed using Spectralis-OCT device in all cases. Results: The mean age of the patient group was 42.17±15.34 years, while that of the control group was 44.21±12.34 years (p=0.528). Mean serum vitamin B12 levels were measured as 163,47±19,80 pg/ml in the patient group and 311,80±76,30 pg/ml in the control group (p <0,01). There was no statistically significant difference between the global RNFL thicknesses of the two groups (p> 0,05). However, statistically non-significant thinning was observed in the superotemporal and global RNFL thickness of the group with B12 vitamin deficiency (p values are 0,140 and 0,171, respectively). There was also no statistically significant difference between GCL thicknesses and volumes of the two groups (p> 0.05). Conclusions: No significant reduction was observed in RNFL and GCL thicknesses of adult subjects with B12 vitamin deficiency compared with healthy controls.