Background:Structure most affected by the clinical deformities associated with lower extremity is the first metatarsal bone which may cause orthopedic problems and chronic pain on foot, because approximately 80% of the load from the talus and calcaneus is transmitted to the ground via medial arch. Materials and Methods:Our study was performed on lower extremities of 32 adult patients without any foot deformity, which were amputated due to circulation failure in the Department of Orthopaedics and Traumatology. Firstly, tibia length, foot length and foot width were measured. Subsequently, the dimensions and length of first metatarsus as well as proximal and distal articular surface dimensions of the first metatarsus were measured.Results: The average values were as follows: tibia length: 35.9 cm, foot length:22.7cm, foot width: 8 cm, length of first metatarsus: 5.8 cm. Statistical significance was found among the dimensions of proximal end, dimensions of distal head and the thinnest site of the bone (p=0.01). Conclusions:Various external deforming forces cause variations in the medial longitudinal arch and lead foot pain. The length, shape of the head as well as the dimensions of the proximal and distal joint surfaces of the first metatarsal bone are important factors in the development of foot deformities. Since peroneus longus and tibialis anterior muscles insert onto the first metatarsal bone, the forces exerted by their tendons affect morphology of the bone. Therefore, dimensions of these muscles and their tendons inrelation with the dimensions of first metatarsal bone are essential in the prevention and treatment of foot deformities.

Background:The prevalence of heart failure (HF) is increasing worldwide with new treatment methods (percutaneous, medical) that improvesurvival in heart diseases. Inflammation plays a central role in the development of HF, and many inflammatory markers have been studied to determine HF survival. In this study, we aimed to investigate the relationship between Systemic Immune-Inflammation Index and survival in patients with HF.Material Method:A total of 672 HF were included in this retrospective and observational study. The primary end-point of the study was all-cause mortality. The median follow-up duration of the study patients was 21 (8-42) months.Results :672 patients were analyzed,and all-cause mortality developed in 278 of these patient groups during the follow-up period. The number of all-cause mortality was 113 (34%) in the low SII group,and the number of all-cause mortality was 165 (49%) in the high SII group.Conclusion:This is the first and only study in the literature showing the relationship between the SII index and survival in patients with HF. In addition, the main finding of our study is that the SII index is an independent predictor of mortality in patients with HF.

Background: The blood type is known to be associated with the risk of cancer. This study aimed to evaluate the relationship between oncological diagnoses and blood groups of inpatients receiving palliative care. Material and methods: This retrospective study was conducted with patients receiving palliative care at our hospital between December 2019 and December 2020. The records of patients receiving comprehensive palliative care during this 1-year period were obtained from the hospital archive, and patients diagnosed with a malignant disease were included in the study. Results: Overall, 176 patients were included in the study. No association was found between the cancer type and ABO/Rh blood groups. The incidence of central nervous system (CNS) and breast cancers was lower in patients with blood group A than in those with other blood groups (p = 0.028). Moreover, the focus and site of metastasis and the ABO/Rh blood group were not related. In addition, the comparisons between blood groups in terms of the presence and site of metastasis revealed no significant relationship. Conclusions: Patients with blood group A had a lower incidence of CNS and breast cancers than patients with other blood groups, and there was no relation between metastases status and ABO/Rh blood groups.

Background: AlthoughCoronavirus Disease 2019 mainly affects the pulmonary system, the related studies on male reproductive health are limited. We aimed to investigate the effect of COVID-19 disease in spermiogram parameters of patients with male infertility.Material and Methods:39 outpatients with male infertility diagnosed with COVID-19 disease between 1st March 2020 and 31st March 2022 in our andrology policlinic were analysed, retropspectively. We evaluated the demographic data of the patients and the spermiogram analyzes before and after the COVID-19 disease.Results: The mean age of the patients were 33,44±7,52 years and body mass index (BMI) was 27,05±3,38 kg/m2. The mean time between PCR test and second semen analysis was 3,95±3,59 months. There were statistically significant reduction in semen volüme (p<0,03) and significant deterioration in sperm morphology (p<0,014), but no detect alteration on sperm motility. Conclusion: We observed adversly effects of SARS-CoV-2 virus on spermiogram parameters in patients with male infertility. Deterioration of spermiogram after COVID-19 disease may results with male infertility

Background:In this study, we aimed to investigate the demographic characteristics, comorbidities and reasons for applying to emergency dialysis in Syrian hemodialysis patients who applied to the emergency department.Material Method:This study was conducted at Azez Vatanand MareaHospitals in northwestern Syria. This study included end-stage renal failure (ESRD) patients and underwent emergency hemodialysis as a result of emergency department visits between January 1, 2022, and March 31, 2022. Demographic data, vital signs, laboratory results, concomitantdiseases, and indications for emergency dialysis were investigated retrospectively and analyzed statistically. Results :In this study has been detected that the mean age of the participants was 58 years and 34 (59.6%) of the patients were male and 23 (40.4%) were female. The patients who received two dialysis sessions per week older the patients who received three dialysis sessions per week (p=0.030). The presence of hypertension was found to be significantly higher in patients who received three sessionsper week (p=0.004). Emergency dialysis was performed in 26.3% of patients due to hypervolemia, in 14.1% due to hyperkalemia, in 29.8% due to uremic findings, and in 29.8% due to metabolic acidosis. When the laboratory parameters have been investigated only sodium values were found to be significantly higher in patients who received two sessions of hemodialysis (p=0.004). Conclusion:It may suggest that further increasing the hemodialysis service in northwest Syria may contribute to reaching the peak benefit to decrease the emergency dialysis patients.

Background:Although Extracorporeal Shock Wave Therapy (ESWT) is a widely used treatment option in patellar tendinopathy (PT), treatment protocols are not clearly defined. There is no consensus on the type of shock wave or the energy level, number of shocks, pressure,and frequency values. For this reason, this study will, on the one hand, aim to contribute to the confusion of whether ESWT is effective in the treatment of PT and, on the other hand, try to define the most effective ESWT protocol in the treatment of PT, rather than choosing one at random. Methods: Eighty-six patients with PT randomised to ‘Controlled Unfocused/Radial’ ESWT (r-ESWT), ‘Large-Focused’ ESWT (f-ESWT) and sham ESWT (s-ESWT) groups and the data of seventy-eight patients who could reach the last control were evaluated statistically. The patients received the ESWT application once a week for a total of three sessions. Patients were evaluated with Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment-Patella (VISA-P) scores just before the treatment (baseline), one day after the end of treatment (week 3), one month after the end of treatment (week 7) and three months after the end of treatment (week 15).Results: VAS and VISA-P scores have significantly improved at 3th, 7th, and 15thweeksin the r-ESWT group (p<0.05)and at 7th, and 15thweeksin the f-ESWT group (p<0.05). In terms of baseline-3thweek, baseline-7thweek and baseline-15thweek differences of VAS and VISA-P scores, r-ESWT was superior to f-ESWT (p<0.05). Conclusions: Although both r-ESWT andf-ESWT were effective in the treatment of PT according to the results of this study, the efficacy of r-ESWT was superior to f-ESWT.

Background: The World Health Organization (WHO) urges to integrate traditional medicine into health services particularly primary health care services. The aim of this study is to evaluate the knowledge and attitudes of residents on Traditional and Complementary Medicine (T&CM) and compare the ones in the department of Family Medicine with the others. Materials and Methods: A descriptive comperative study. Residents in a training and research hospital in Istanbul were divided into three groups as Family Medicine, Surgical specialities, and other Medical specialities. A questionnaire consisting of 23 questions was prepared and applied to the residents at the hospital, using a face-to-face interview technique. Results: In this study, 245 residents from different departments participated. Among them, 61.2% of the physicians (n=150) stated that T&CM applications will not be an alternative to modern medicine; 68.9% (n=169) stated that T&CM applications might contribute to modern medicine. It was determined that the most known applications were Acupuncture, Cupping therapy (Hijama), and Hirudotherapy. Among the participants, 11.0% (n=27) of the residents had a certificate of a T&CM applications. According to 69.2% of the residents in Family Medicine the main role of T&CM is in wellness and preventative healthcare. Among the residents in the Family Medicine, the number of participants using T&CM applications in the treatment of their own health problems was found to be higher than the ones in the other medical and surgical specialities; 38.5%, 9.6% and 10.1%, respectively (p<0.001). Conclusion: Compared to other medical and surgical specilities, residents in family medicine seem to have a more positive attitude towards T&CM practices.

Background:Pregnancies of advanced maternal age have been increasing worldwide in recent years. Advanced maternal age pregnancies have adverse obstetric, perinatal, and neonatal outcomes. This study aims to investigate the frequency of placenta previa in pregnant women of very advanced maternal age and to examine the relationship between advanced maternal age and placenta previa using statistical methodologies.Methods:This retrospective study includes 140 pregnant women aged 46-48 years who applied to the hospital between September 2018 and December 2019 in our clinic. Patients were divided into two groups according to the mode of delivery: (i) normal vaginal delivery (NVD) (n=99) and (ii) cesarean section (C-section) (n=41). Demographic characteristics, pregnancy outcomes, C-Section rates, preterm delivery rates, fetal growth restriction rate, neonatal outcomes, and C-Section indications were recorded.Results:A significant difference was found in infant birth weight and the gestational week at delivery between theNVD and C-section groups (p<0.05 for both). According to the independent samples t-test, infant birth weight was significantly higher in the NVD group compared to the C-section group (p<0.05). Placenta previa was detected in 8 (19.5%) patients in the C-Section group.Conclusion:The results indicate that placenta previa, which is one of the location anomalies of the placenta, is more common in pregnancies of very advanced maternal age than in pregnancies of normal reproductive age and that having a less fertile uterus at an older age can cause to adverse pregnancy outcomes.

Background:New generation antiepileptic drugs, adopted in treating epilepsy in recent years, yield better results. Yet, patients may perceive themselves as helpless due to the burden of epilepsy and, thus, seek any treatment approach to relieve their problems. Complementary/alternative medicine (CAM) has recently become preferred among patients worldwide. In this study, we attempted to investigate CAM use among Turkish patients with epilepsy and their knowledge, attitude, and behavior profiles regarding CAM.Materialsand Methods: We carried out this prospective cross-sectional study with epilepticpatients aged 18 years and older. After noting down their demographic and clinical characteristics, we inquired the patients about CAM methods. In addition, we collected the data using the Perception of Health Scale (PHS), the Dispositional Hope Scale (DHS), and the Problem-Solving Inventory (PSI).Results: There were 135 patients with epilepsy, 45.92% males and 54.1% females, with a median age of 29 years (IQR=22-42). While 81.5% of the patients had focal-onset, 18.5% had generalized-onset seizures. The mean disease duration was 9 years (IQR=4-19). About one-third (29%) used at least one CAM method. The most common CAM methods reported by the patients were massage therapy (30.2%), herbal therapy (25.2%), and hijamat-cupping (18.6%). In addition, 78.95% stated the CAM method they used was helpful. Finally, we found disease duration to be significantly higher among CAM users (p=0.02).Conclusion: CAM use was prevalent among patients with epilepsy, and those with prolonged disease duration used CAM more; therefore, patients should be inquired about CAM use. Further research may consider scientifically evaluating all aspects of CAM use and methods.

CIN has become a common morbidity and mortality due to increasing radiocontrast-mediated imaging (2). Therefore, it has become essential to predict the development of CIN and to take more intensive medical measures before contrast application. Although it is recommended today to predict the development of CIN, such as the Mehran Risk Score, increasing studies have shown that many important parameters other than the parameters of the Mehran score may be important in predicting CIN (3,4). We think that integrating simple, reproducible and quickly accessible parameters such as AST and ALT into the Mehran Risk Score will further increase the predictive value of contrast-induced nephropathy of the Mehran risk score. Although hydration is currently the only proven treatment to prevent contrast nephropathy, CIN is still frequently encountered, especially after percutaneous coronary procedures, despite preprocedural and post-procedural hydration (5). It is seen more frequently in subjects prone to nephropathy such as diabetes, and kidney functions are affected more deeply than normal individuals after contrast application (6). Therefore, increasing the predictive value of the Mehran risk score would be particularly beneficial for such patients. In addition to all these, it has been shown that C-peptide may be protective against contrast nephropathy in diabetic patients in a recent article by Toprak (7). If these results are supported by large-scale randomized clinical trials, administration of C-peptide in high-risk patients may hold great promise in preventing the development of CIN.

Conclusion:This study has shown that Metamizole Sodium, a collectively inhibitingCOX1 and COX2significantly improves flap vascularity, and when postoperative analgesia is required following a flap surgery, it is a suitable drug of choice