Health of People Medical Journal

A common problem in primary care; elbow pain and developing an easy-to-approach algorithm

2023-01-11T18:57:46+00:00

Elbow pain is a common complaint in primary care. It can originate from any part of the joint such as tendons, bursae, bones. Elbow pain can occur at any time in life with varying accompanying symptoms. Situations that will require the primary care physician to be alerted; Swelling and dislocation after trauma, swollen joint or rapidly increasing mass. It means that 85% of the diseases seen in the society can be treated with a well-trained family physician specialist. This, in turn, eases the burden of the second and third levels, provides easier access to the patient in need of the upper level and provides a cost-effective healthcare service. In primary care, it is the first point of contact for patients with diseases that are common in the community. A detailed anamnesis, correct examination request, treatment and then follow-up examination, gradual referral to the second step, ascribes an indispensable role to the first step in the diagnosis, treatment and solution of many diseases.

The Clinic Analysis of Adult Patients with Acute Lymphoblastic Leukemia

2023-01-11T19:03:12+00:00

Abstract

Objectives: In this study, it was aimed to evaluate the demographic and clinical characteristics, prognostic factors, response to different treatment options, side effects caused by changing treatment choices, and overall survival rates of adult Acute Lymphoblastic Leukemia (ALL) patients.

Methods: Our study included 44 patients aged 18 and over, who were followed up with the diagnosis of ALL in our hematology clinic, and treated with treatment protocols containing hyperCVAD (cyclophosphamide, vincristine, Adriamycin, dexamethasone) chemotherapy regimen. Patients were classified according to their clinical findings, organ involvement, and demographic data at the time of diagnosis. The treatment response rates and treatment complications were compared.

Results: The median age of 44 patients included in the study was 34, 72.2% were male, and 27.7% were female. It was determined that 61% of the patients had B cell immunophenotype, and 6 (13.6%) had Philadelphia (+). The rate of the high-risk patient group was 81.8%. The complete remission rate was 72.7%, and the overall survival rate was 43.1%. It was observed that treatment-related sepsis and death rates increased, and complete remission rates and total survival time decreased in patients who added L-asparaginase to the HyperCVAD treatment regimen.

Conclusion: It was observed that the results obtained in our study were similar to other studies. It has been concluded that the current treatment options are not sufficient for adult ALL patients with a total survival rate of 27%, and new treatment protocols are required.

The incidence, risk factors and clinical outcome of pulmonary embolism in hospitalized patients with COVID-19

2023-01-11T18:48:45+00:00

Objectives: Coronavirus-19 disease can cause a broad spectrum of diseases. One of the significant mortal complications of the disease is a hypercoagulable state, including life-threatening pulmonary embolism. COVID-19 infections may predispose venous thromboembolism due to excessive inflammation, hypoxia, immobilization, and diffuse intravascular coagulation. This study aimed to evaluate the incidence and risk factors for pulmonary embolism in hospitalized patients with COVID-19 in Turkey and to determine the impact of pulmonary embolism on clinical outcomes.

Results: 69 patients who were hospitalized for COVID-19 pneumonia between 15 March and 30 April 2020 and underwent CT angiography on clinical suspicion were included in the study. All patients received at least standard doses of thromboprophylaxis. The incidence of PE was %24.4(n=17). In patients with pulmonary embolism, a higher frequency of males (88% vs. 61%,p=0.013 ), higher rates of smoking(75% vs. 37%,p=0.008 ), and chronic renal failure (19% vs. 4%,p=0.04 ) were noted. Pulmonary embolism was positively correlated with heart rate >100 bpm (r=0.479,p<0.001), more than two-fold increase in D-dimer (r=0.421,p<0.001), and active smoking (r=0.323,p=0.008).In three patients with pulmonary embolism, intensive care, non-invasive mechanical ventilation, and intubation were required, and mortality occurred only in 1 (6.0%) patient.

Conclusion: In our study, the frequency of pulmonary embolism in the patient population infected with COVID-19 was 24.4%, despite effective DVT prophylaxis. It should be kept in mind that pulmonary embolism is one of the most common complications in patients hospitalized for COVID-19 infection.

A Comparative Study of the Varying Effects of Acetylsalicylic Acid on Thromboxane B2

2023-01-28T11:15:02+00:00

Objective: In this study, we evaluated the antiaggregant efficacy of the standard dose ASA and very low doses of ASA, which we use in the clinic, by looking at the serum thrombocyte B2 level and investigated the difference between the two groups.

Method: The study was built on 20 mg (1/4), 40 mg (1/2), 80mg 1/1 of Babypirin and 150 mg (1/2) of Dispril doses. 10 patients were grouped for each one of the four prescribed doses.

Those patients with a history of gastrointestinal bleeding, peptic ulcer, hematological disorders, bronchial asthma, chronic obstructive pulmonary disease and allergy to ASA were excluded from the study . ASA doses were administered once a day.

Before ASA, blood was collected from all patients for serum thromboxane (Tx) B2 analysis. Then, after 14 days of ASA use, blood was drawn from the patients again for the second time to detect TxB2 decrease.

Results: There was no significant difference between the groups in terms of age and gender (p>0.05). There was a significant difference between the groups in terms of % decrease in TxB2 after treatment (p=0001). In the post hoc test, it was concluded that the % decrease in the 20mg group was significantly lower than the other three groups (p=0.002), and the % decrease between the 40,80 and 150mg groups was higher in all three groups compared to the 20mg group. On the other hand, there was no difference in % reduction in the 40,80 and 150 mg groups (p>0.05).

Conclusion: The use of low-dose ASA seems to be more beneficial when considered in all aspects. Our results are that there is no difference in doses up to 40mg when considered from the antithrombolytic point of view.

Adult Gitelman Syndrome: Case Report and Review of the Literature

2023-01-11T19:17:51+00:00

Gitelman Syndrome, the most frequently detected hereditary tubulopathy in adults, was first described by Gitelman et al. in 1966 in 3 adults who presented with tetany associated with hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria,. The estimated prevalence of Gitelman syndrome, which is considered as a variant of Bartter syndrome with autosomal recessive inheritance, is reported as 1:40,000. In this article, a case diagnosed with Gitelman Syndrome, who was hospitalized many times, including the intensive care unit, with symptoms such as constipation, weakness, nausea and vomiting since childhood is presented.