Outcomes of the patients diagnosed incidentally appendicitis during cesarean section

Objectives: Appendicitis is the most common condition leading to an intraabdominal operation for a non obstetric problem in pregnancy and diagnosis of appendicitis is complicated by the physiologic and anatomic changes that occur during pregnancy. Although a surgical procedure carries the risk of fetal loss or preterm delivery, delay in diagnosis also increases the risk of complications in both mother and fetus. In this report we present our experience and analyze clinical characteristic and the pregnancy outcomes of appendicitis diagnosed incidentally during cesarean in the third trimester. Material and methods: The study population consisted of 23 pregnant women who were diagnosed incidentally with appendicitis during cesarean at Erzincan University Hospital between 2015 and 2016. Results: Appendectomy was performed on 23 patients during a caesarean section performed for any reason. The mean dia-meter of appendix was 7.82 ± 1.85 mm. The mean operation time was 67.39 ± 18.94 SD and antibiotic therapy was given to all patients. Postoperative complications were noted in 4 (17.4%) patients. Wound infection was seen in 4 (17.4%) patients, the other 19 patients revealed no postoperative complications. The mean of APGAR score of newborns in the postoperative period was 8.26 ± 0.86 SD and no complications were observed in both mothers and newborns. Histopathology of the specimen confirmed acute appendicitis in 23 (100%) cases. Conclusions: Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon’s preference and experience

Complication of lichen sclerosus [Liken sklerozus komplikasyonu]

Lichen sclerosus (LS) is a chronic, inflammatory disease which is mostly located to genital region, usually in women. Etiology of the disease is not exactly understood. It can be asymptomatic or it may also cause itching, scarring or malignity development. Diagnosis of LS is clinical but in some cases, a biopsy may be necessary. The cases who have cellular atypia besides the expected usual findings in the biopsy are considered to be risky for squamous cell carcinoma (SCC) development. Here in this case, the biopsy result from a forty-nine-year-old female patient with a complaint of resistant genital itching and afterwards development of a small tumoral structure has shown SCC findings. We presented this case for taking attentions to the malignity risk on the basis of LS and promoting alertness and early diagnosis. [Med-Science 2017; 6(1.000): 128-30

A case with pyoderma gangrenosum, after an abdominal surgery

Pyoderma gangrenosum (PG) is a pathergy positive, ulcerative neutrophilic dermatosis. Pathergy phenomenon is described as a sterile pustule and an ulcer development after minor skin traumas like a bump or bruise, or needlestick injury. In the literature, there are PG cases associated with the pathergy phenomenon on the post-surgical scar tissue. It presents as a necrotic and an ulcerative lesion clinically and, debridement is performed mostly with wrong pre-diagnoses. Debridement makes the lesion get wider and the morbidity increase. There are some PG case reports in the literature which were ended up with amputation due to debridement of a lesion which was an overlooked PG. Herein, we present a case with a giant abdominal pyoderma gangrenosum developed after a surgery in the abdominal drainage site and has reached to 30 cm size after debridement. [Med-Science 2019; 8(2.000): 451-3

Genetic algorithm-driven surface-enhanced raman spectroscopy substrate optimization

Surface-enhanced Raman spectroscopy (SERS) is a highly sensitive and molecule-specific detection technique that uses surface plasmon resonances to enhance Raman scattering from analytes. In SERS system design, the substrates must have minimal or no background at the incident laser wavelength and large Raman signal enhancement via plasmonic confinement and grating modes over large areas (i.e., squared millimeters). These requirements impose many competing design constraints that make exhaustive parametric computational optimization of SERS substrates pro-hibitively time consuming. Here, we demonstrate a genetic-algorithm (GA)-based optimization method for SERS substrates to achieve strong electric field localization over wide areas for recon-figurable and programmable photonic SERS sensors. We analyzed the GA parameters and tuned them for SERS substrate optimization in detail. We experimentally validated the model results by fabricating the predicted nanostructures using electron beam lithography. The experimental Raman spectrum signal enhancements of the optimized SERS substrates validated the model predictions and enabled the generation of a detailed Raman profile of methylene blue fluorescence dye. The GA and its optimization shown here could pave the way for photonic chips and components with arbitrary design constraints, wavelength bands, and performance targets

Recurrent angiolymphoid hyperplasia with eosinophilia during several pregnancies

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign vascular tumor. Although its etiology is not clearly known, infection, hormonal factors, and trauma are the suspected reasons. There are few cases considered to be related to pregnancy described in the literature. Granulomas are rarely seen in the histopathology and only four patients with granulomas have been described. Herein, we will present a 28-year-old woman who has been pregnant three times; in every pregnancy, she developed pink nodular lesions on the back of her ear. In the first two pregnancies, the lesions had appeared during the pregnancy and regressed completely in the postpartum period. In her third pregnancy, the condition emerged again and lasted 1.5 years after birth of her child. Histopathology exhibited ALHE with granulomas. Although the relationship between ALHE and pregnancy is already known, there are few cutaneous ALHE cases associated with pregnancy reported in the literature. This association is further supported by this case having recurrent ALHE during each pregnancy period. Also, the presence of naked granuloma in histopathology, unlike most of the cases, contributes to the current histopathological data

Differences between rural and urban primary care units in Turkey: Implications on residents′ training

Context: Family practice training takes place at primary care based training centers linked to Education and Research State Hospitals in Turkey. There is a discussion if these units are adequate to train primary care staff and if the patients of these units reflect the applicants of primary care. Aims: The aim of our study is to investigate the demographic characteristics, the effect of distance on primary care utilization, and most common diagnosis of the patients who applied to two different outpatient clinics: One urban and one rural. Settings and Design: Study was conducted from the electronic health records of the patients applied to outpatient clinics of Ankara Diskapi Yildirim Beyazit Training and Research Hospital Department of Family Medicine between 1 January and 31 December 2009. Results: Total number of patients applied to both of the outpatient clinics was 34,632 [urban clinic: 16.506 (47.7%), rural clinic: 18.126 (52.3%)]. Leading three diagnoses were upper respiratory tract infection (URTI), general medical examination (GME), and hypertension (HT) in the most common 10 diagnosis. Conclusion: In our study, the rural outpatient clinic is regarded as a primary care unit in the neighborhood of living area and the urban clinic as close to working environment. We found statistically meaningful differences in most common diagnosis, gender, age, and consultation time between the rural and urban clinics. According to our results, family practitioners′ field training should take place at different primary care units according to sociodemographic characteristics of each country

The potential for using different substrates in green roofs

This research was carried out in Izmir-Turkiye and investigated the potential of using three different substrates (cocopeat, loofah and perlite) in the design of green roofs with succulents (Crassula ovata) in aim to improve their performance. In this research, four different groups (G1: Soil-Cocopeat, G2: Soil-Loofah, G3: Soil-Perlite and G4: Soil) were created according to the plant growing media used in the planting layer. The researchers conducted measurements of the drained irrigation water’s EC (Electrical Conductivity) value, pH value and drainage amount, the plant growing media’s temperature and moisture, the plant’s height and leaf number, and the amount of subsidence in the planting layer. In line with the results obtained from the evaluations of the analyses, it is possible to say that perlite (G3) offers more advantages than its alternatives in terms of many variables. However, according to the conclusive results, it has been understood that the use of a single type of substrate as plant growing media would not be sufficient to encourage the maximum performance of green roofs. To ensure that, considering the advantages of each substrate group, it is proposed that their combined use would be more beneficial

Evaluation of Blood Pressure Control Levels and Treatment Compliances of Hypertensive Patients

Purpose: The aim of the study is to evaluate the knowledge of patients about hypertension (HT), compliance with lifestyle changes and to determine their blood pressure levels under antihypertensive therapy. Method: Hypertensive patients that applied to Family medicine outpatient clinics of Diskapi Yildirim Beyazit Education and Research Hospital for the first time, in 2012 (between February 1 to April 30), were included in our cross-sectional study. Patients are evaluated primarily for the control and the factors that can affect high blood pressure and the rate on achieving treatment goals. Results: Three hundred and forty patients were included in the study. The mean age of the patients was 60.5±10.7 years and 222 of them (65.3%) were female. The blood pressure was not under control in 108 (31.8%) patients. The mean body weight of male patients was statistically higher than females (p=0.015). The number of the patients that knew the normal blood pressure value was 249 (73.2%). Among those 155 (62.2%) were women and 179 (71.9%) were younger than 65 years of age (p=0.0001). Forty one patients (12.1%) were still smoking, 46 (13.5%) patients were exercising regularly and 32 (9.4%) were consuming regular diet. Blood pressure was better controlled in the group that was exercising regularly (p=0.001). The rate of male patients that were on regular exercise and diet, were higher than females (p=0.09). Only 86 patients (25.3%) knew the name of their antihypertensive medication and 65 of patients (19.1%) knew the dose of their medication. Female patients knew the name of their medication better than males (p=0.002). 156 patients (45.9%) were using two kinds of antihypertensive medication. 58 patients (17.1%) were skipping doses a few times a week. Conclusion: The knowledge of hypertensive patients on their illness and their compliance on non-drug treatments were inadequate. The compliance of patients should be improved by development of patient-doctor should be improved by development of patient-doctor relationship according to up-to-date guidelines [Cukurova Med J 2013; 38(2.000): 224-232