ISSN - | E-ISSN -2822-2288
Volume: 2  Issue: 3 - 2022
1.Prostate Intraepithelial Neoplasia in Prostate Core Biopsies done for Suspected Prostate Cancer
Muhammed Mubarak, Rahma Rashid, Shaheera Shakeel
doi: 10.14744/ejma.2022.47955  Pages 95 - 99
Objectives: Prostate intraepithelial neoplasia (PIN) is a premalignant lesion of the prostate with little and varied information on its prevalence in prostate biopsies. This study aimed to determine the prevalence of PIN in tansrectal ultrasound (TRUS)-guided prostate core biopsies in suspected prostate cancer.

Methods: Between July 2012-June 2017, 919 adult males of age ≥ 40 years underwent TRUS-guided biopsies. These were processed for histopathological evaluation. Data was entered into SPSS version 20.0.

Results: The mean age of all patients was 66.14±8.91 years with a median serum total PSA (tPSA) of 16.6 ng/ml (IQR: 9.4-55.0). Of the 919, 80 (8.7%) were diagnosed with PIN. Among these, 66 (82.5%) had concurrent cancer and 14 (17.5%) had isolated PIN. Mean age of patients with PIN and cancer was 66.06±9.8 years and only PIN was 65.43±5.4 years (p=0.817). The median serum tPSA was higher in patients with PIN and cancer, 66.7 ng/ml (IQR: 24.77-183.50) than in isolated PIN, 9.15 ng/ml (IQR: 7.22-19.00) (p=0.124). There was a positive correlation between increasing PSA levels and findings of PIN with adenocarcinoma (p=0.001).

Conclusion: In conclusion, majority of cases of PIN were found in association with adenocarcinoma. Isolated PIN was distinctly low in our setup.

2.Impact of Diabetes on Clinical Outcomes of Prostate Cancer
Melike Özçelik, Gökhan Yaprak, Cengiz Gemici, Abdilkerim Oyman, Ibrahim Çil, Serhat Özçelik
doi: 10.14744/ejma.2022.72792  Pages 100 - 104
Objectives: Diabetes is both a risk factor associated with increased incidence and a prognostic determinant for various cancer types. This study aimed to evaluate the impact of diabetes on prostate cancer outcomes.

Methods: The study included patients diagnosed with prostate cancer either at non metastatic stage at diagnosis and later developed metastasis or at metastatic stage at diagnosis. The characteristics of disease including patient age, date of diagnosis, gleason score (GS), stage, PSA level, time-to-distant metastasis for non-metastatic disease at diagnosis and time-to-castration resistance for metastatic disease, presence of diabetes, last date of control were reviewed retrospectively.

Results: A total of 149 patients were included in the study. Median overall survival of patients with diabetes was 32 months whereas it was 66 months for those without diabetes (HR=2; 95% CI: 1.33–3; p=0.001). For non-metastatic disease at diagnosis, median time-to-distant metastasis was 48 months for those with diabetes, and 63 months for those without (p=0.13). Median time-to-castration resistance was 12 months vs. 27 months for patients with diabetes and without diabetes (HR=3.66; 95% CI: 2.46–5.45; p=0.000).

Conclusion: Presence of diabetes is a robust and reliable prognostic marker for predicting poor survival outcomes including time-to-distant metastasis, time-to-castration resistance and overall survival in prostate cancer.

3.The Effect of Positive Inotropic Therapy on Serum Adiponectin Level in Patients with Acute Decompensated Heart Failure
Mustafa Kaplangoray, Nizamettin Toprak
doi: 10.14744/ejma.2022.68552  Pages 105 - 110
Objectives: Our aim in this study is to investigate the effect of levosimendan and dobutamine treatment on serum adiponectin levels in patients with acute decompensated heart failure (ADHF) who need positive inotropic therapy.

Methods: This study included 44 patients with ADHF who had a functional capacity (FC) of 4 according to NYHA, and had a positive inotropic treatment indication with a left ventricular ejection fraction (LVEF) of less than 35% on echocardiography. LVEF, serum adiponectin level, BNP level, pulmonary artery systolic pressure (PAP) and FC measurment of the patients were taken before the treatment and on the third day of the treatment. The delta (Δ) value, which is the difference between the basal and post-treatment values of these parameters, was calculated.

Results: A decrease in serum adiponectin after treatment was observed in the levosimandan group (p=0.029). In addition, when the rates of change in LVEF (p=0.001), PAP (p=0.005), FC (p=0.041) between both treatment arms were compared, the improvement resulted in favor of levosimendan for these parameters as well.

Conclusion: Adiponectin, which increases proportionally with the severity of HF and is associated with mortality, decreases more with levosimendan treatment than dobutamine.

4.The Effect of Hypochlorous Acid on Preventing Postoperative Peritoneal Adhesions: An Experimental Study
Özge Öztürk, Akgun Oral, Malik Ergin
doi: 10.14744/ejma.2022.44153  Pages 111 - 117
Objectives: Postoperative peritoneal adhesion is a devastating complication without an ideal preventive and therapeutic modality. There is controversy about the effect of hypochlorous acid solutions and whether they contribute to the development or prevention of experimental peritoneal adhesions, given their anti-inflammatory and microbicidal properties. Therefore, the objective of this study is to evaluate the effect of the intraperitoneal hypochlorous acid application on the extension and severity of peritoneal adhesions in an experimental model.

Methods: A total of 24 Wistar-albino rats were divided into three groups: Group 1 (Sham surgery), Group 2 (peritoneal adhesion using cecal serosal abrasion with parietal peritoneal excision and intraperitoneal saline), and Group 3 (peritoneal adhesion using cecal serosal abrasion with parietal peritoneal excision and intraperitoneal hypochlorous acid). On the postoperative 14th day, abdominal cavities were explored. Linsky's and Knightly's macroscopic adhesion classifications reflected the extent and intensity of adhesions. Zühlke’s classification was used to grade the adhesions microscopically.

Results: Animals in all groups developed cecal and peritoneal adhesions to variable extents and at various severity levels, except for two (28.6%) animals in Group 3. Nevertheless, there was no significant difference between the groups in scores obtained from the Linsky’s peritoneal adhesion extent classification, the Knightly’s peritoneal adhesion severity classification, and the Zuhlke’s microscopic adhesion classification systems (p>0.05 for all).

Conclusion: Intraperitoneal hypochlorous acid application did not lead to any significant improvement in the macroscopic and microscopic peritoneal adhesion scores.

5.Determination of Chemotherapy Associated Fatty Liver Disease Among Colorectal Cancer Patients by Non-Invasive Methods
Ugur Sahin, Musturay Karçaaltıncaba, Suayib Yalcin
doi: 10.14744/ejma.2022.53825  Pages 118 - 125
Objectives: Chemotherapy-associated steatohepatitis (CASH) may increase the risk of cardiovascular, metabolic and liver-related complications. This study aimed to evaluate the frequency and severity of CASH and possible related factors during adjuvant chemotherapy for colorectal cancer (CRC) non-invasively.

Methods: Patients scheduled for adjuvant CRC treatment (FOLFOX-4 or FUFA) were assigned to prospective cohort (PC) or early (9-18 months) (ELT) and late (>18 months) long-term (LLT) follow-up and control groups (CG). PC was evaluated at baseline, third and sixth months for changes in anthropometric measurements, hemogram, blood biochemistry, inflammation markers, serum adipokine levels and hepatic steatosis by magnetic resonance spectroscopy (HS-MRS). The results of ELT, LLT and CG were compared.

Results: Of 21 patients included in PC, 66.7% received FOLFOX-4 and 33.3% FUFA. Males constituted 57.1%. Median age was 62.0 (48.0-77.0). Baseline characteristics were similar for both regimens. HS-MRS significantly increased at third and sixth months compared to baseline (p=0.02). ELT, LLT ve CG included 10, 10, and 20 patients, respectively. Age, gender distribution and anthropometric measurements were similar. HS-MRS tended to be higher in ELT (p=0.11).

Conclusion: Steatosis and CASH frequently develop during 5-fluorouracil and oxaliplatin treatment and may persist for months. Hepatic MRS and biomarkers may allow for non-invasive diagnosis.

6.In silico Molecular Characterization of Helicobacter pylori based on Tandem Repeat Number and 16S rRNA gene
Arijit Sankar Mondal, Ritu Sharma, Arunava Das, Ashish Warghane
doi: 10.14744/ejma.2022.76476  Pages 126 - 135
Objectives: Helicobacter pylori is the major cause of gastrointestinal carcinoma. The presence of tandem repeats are mainly responsible for increasing the mutation rate, thereby enhancing the virulence and adaptation of the pathogen to its host. Similarly, 16S ribosomal RNA sequence analysis has been widely used for determining the phylogenetic and taxonomic classification of bacterial strains.

Methods: The sequences of H. pylori were retrieved from GenBank, the National Centre for Biotechnology Information database, in order to identify specific tandem repeats. In our study, the genomic instability in H. pylori due to the presence of consecutive and non-consecutive sequences has been comparatively analyzed using MEGA X software, with consecutive sequences representing the tandem repeats.

Results: Based on the occurrence of Tandem repeats in the retrieved isolates of H. pylori, the consecutive sequences were classified into four different classes (Class I-IV). Further, the tandem repeat and 16S rRNA sequences were classified using phylogenetic analysis into two different clades for determining species variability and evolutionary relationships, respectively.

Conclusion: The data obtained from this study can be used to characterize different H. pylori strains, gain a better understanding of its genome variability leading to a higher mutation rate and depict the intra-species evolutionary relationship.

7.Determination of Risk Factors for Community-acquired Skin and Soft Tissue Infections and Comparison of Antibiotics Commonly Used in the Treatment
Nurcan Arikan, Ayse Batirel
doi: 10.14744/ejma.2022.29591  Pages 136 - 141
Objectives: It was aimed to determine the risk factors for the development of skin and soft-tissue infections (SSTI), to compare duration of therapy of mostly used antibiotics and to compare laboratory parameters of complicated and uncomplicated SSTI.

Methods: In this study; patients with community-acquired SSTI who were hospitalized and treated in our clinic between November 2010 and October 2014 were evaluated retrospectively. Clinical and laboratory parameters of the patients, and the risk factors predisposing to SSTI were investigated. The patients were grouped into three according to the antibiotic used in treatment (Ampicillin-sulbactam, tigecycline and piperacillin-tazobactam) were the three most commonly used antibiotics in our clinic). Those three antibiotic therapy groups were also compared according to clinical features, laboratory parameters of the patients.

Results: In a total of 192 patients, presence of obesity, diabetes mellitus, peripheral vascular disease, saphenectomy, trauma, and tinea pedis were determined as the most common risk factors predisposing to SSTI. In complicated SSTI, the lesions were more deeply located, erythrocyte sedimentation rate and hemoglobin a1c levels were found to be higher, and hemoglobin levels were lower. The duration of hospital stay in patients who were treated with ampicillin/sulbactam was significantly lower than those who received tigecycline and piperacillin/tazobactam. Also, the duration of hospital stay in patients who were treated with tigecycline was significantly lower than those who received piperacillin/tazobactam. The patients with complicated SSTI had significantly higher use of piperacillin/tazobactam compared to tigecycline, which was used more frequently than ampicillin/sulbactam in those patients.

Conclusion: Determination of risk factors for the development of SSTI and the risk factors that would cause them to be more complicated are important in both implementation of necessary precautions before their development and initiation of the most appropriate antibiotic treatment in order to decrease morbidity and mortality.

8.Hepatitis B Virus Reactivation in a Case With Non Hodgkin Lymphoma Treated by Rituximab Containing Regimen: Treatment With Dual Anti-Viral Combination
Reyhan Sevil Soysal, Semra Paydas
doi: 10.14744/ejma.2022.83997  Pages 142 - 145
Rituximab is a chimeric monoclonal antibody targeting CD20 expressed on pre-B and mature B lymphocytes. This antibody has been used for a more than 20 years in cases with B cell non-Hodgkin lymphomas (B-NHL). The use of rituximab has some complications and one of the most important complications is Hepatitis B reactivation (HBV-R). HBV-R can lead to severe complications like hepatitis reactivation and death. Here we present a case with B-NHL developing HBV reactivation and successful treatment with combined anti-viral treatment.

9.Eplerenone (Mineralocorticoid Receptor Antagonist) Induced Bilateral Gynecomastia
Weng Chio Tam, Màrio Évora
doi: 10.14744/ejma.2022.42714  Pages 146 - 147
Mineralocorticoid receptor antagonist (MRA) is also known as potassium-sparing diuretics which is commonly used for the treatment of heart failure and hypertension. Spironolactone is the first generation of MRA but it may have some adverse effects, particularly gynecomastia. This adverse effect may be related to its properties of androgen suppression. In contrast to spironolactone, eplerenone is the second generation of MRA which may be less potent in blocking the activation of androgen receptors resulting in less gynecomastia. However, despite limited sexual and hormonal side effects, we should still keep cautious regarding the anti-androgen effect of eplerenone. In this report, we demonstrated one 88-year-old male patient with eplerenone induced gynecomastia.

10.Ribociclib-Induced Acute Pancreatitis in Metastatic Breast Cancer
Muzaffer Uğraklı, Melek Karakurt Eryılmaz, Mehmet Asıl, Ülkü Kerimoğlu, Engin Hendem, Muhammed Muhiddin Er, Mustafa Karaağaç, Murat Araz, Mehmet Artac
doi: 10.14744/ejma.2022.69188  Pages 148 - 153
Ribociclib is an inhibitor of cyclin-dependent kinase 4 and 6, whose inhibitors are used in treatment of hormone receptor positive and human epidermal growth factor receptor 2 negative advanced breast cancer. They have been recently used widely in breast cancer, and new side effects have emerged with its increased use.

We describe a 57-year-old female with breast cancer treated with ribociclib and letrozole. She presented to our hospital with complaints of back pain and epigastric pain. After she was investigated for these complaints, she was diagnosed with acute pancreatitis.

After ruling out other common causes of acute pancreatitis, ribociclib was considered as a cause of acute pancreatitis. Ribociclib was immediately discontinued and her medical treatment was re-arranged. She was free of symptoms on the third day. One week later, she presented again with the complaints of abdominal and back pain, after which we learned that the patient had continued ribociclib and letrozole. The treatment of the patient was discontinued and the symptoms disappeared again.

We report a case in which the symptoms and laboratory findings of acute pancreatitis emerged twice while on ribociclib; acute pancreatitis were not found as a side effect of ribociclib in previous publications or in the side effect guidelines. Acute pancreatitis in cancer patients is associated with poor prognosis and prolonged hospital stay. Possibility of ribociclib-induced acute pancreatitis should be considered in order to achieve early diagnosis and prevent significant mortality in cancer patients.