E- ISSN: 2822-4051
THE ANATOLIAN JOURNAL OF MEDICINE - Anatol J Med : 33 (2)
Volume: 33  Issue: 2 - 2023
1.Cover

Pages I - IX

CLINICAL RESEARCH
2.Evaluation of the Behaviors and Attitudes of the Parents of the Primary School Students Among the Rational Use of Antibiotics
Özlem Bakbak, Aliye Bastuğ, Nilay Ünver, Sevcan Eşiyok, Sevim Yıldız Sağlam, Mehmet Ziya Tuncer, Nazım Bakbak
doi: 10.4274/terh.galenos.2023.71324  Pages 155 - 162
Objective: Inappropriate use of antibiotics leads to an increase in antibiotic resistance. It is aimed to determine the attitudes of parents about the rational use of antibiotics in primary school students.
Methods: The parents of primary school students in Hatay province were included in the study. Parents were asked to fill in a 25-question google questionnaire. The results were analyzed with SPSS v24. P<0.05 was considered significant.
Results: A total of 481 parents participated voluntarily. Of them 46.4% stated that they first applied to the family physician when their child got sick. If both parents graduated from high school or higher degree, the rate of preference for family physicians was determined as 60.7% (n=139) (p<0.001). Multivitamin use was also higher in this group (32.2%, n=85, p<0.001). About half of the parents (47.4%) use antibiotics two-to-three times a year for their children. While the rate of those who stated that they used it for the duration and dose recommended by the physician was 97.5%. It was determined that 13.5% of them used a scale other than the antibiotic scale when the same question was asked differently. Of the parents, 35.6% stated that they were not informed by the healthcare professional about the possible side effects of antibiotics. Those who think that they have knowledge about the harms of using inappropriate antibiotics are 71.5%.
Conclusion: There is still a lack of information about the damages of inappropriate antibiotic use, at a rate of 30-35%. More information should be given about the rational use of antibiotics.

3.Pressure Ulcers and Demographic Characteristics of Patients in a Training and Research Hospital Home Healthcare Unit
Mehmet Burak Öztop, Serap Öksüz
doi: 10.4274/terh.galenos.2023.77775  Pages 163 - 168
Objective: The main feature of the concept of home care is that healthcare services are provided to the person at home by healthcare professionals. Pressure ulcer development is common in patients receiving home healthcare services. The study aimed to determine the prevalence of pressure ulcers and the risk factors for pressure ulcer development in patients followed up in Atatürk Training and Research Hospital Home Health Unit.
Methods: The files of 387 patients who were followed up and treated for ulcers in the Home Healthcare Unit of Atatürk Training and Research Hospital between 01.01.2022 and 31.12.2022 were reviewed for the study. The files of 267 patients with pressure ulcers were included in the study.
Results: A total of 267 patients, 170 (63.7%) of whom were female, were included in the study. The mean age of the patients with pressure ulcers was 80.3±12.2 years. The most common sites of pressure ulcers were the gluteus (36%), sacrum (30%), heel (8%), back (7%), and coccyx (6%). Twenty seven (7%) ulcers were classified as stage 1, 214 (57%) as stage 2, 114 (31%) as stage 3, and 19 (5%) as stage 4 pressure ulcers. There were 109 (40.8%) patients who were tube fed and 120 (44.9%) patients who were fed with an oral nutritional solution.
Conclusion: The assessment of risk factors should be part of the initial examination of every patient admitted to the home healthcare system. The importance of nutritional support in patients in the high-risk group should be emphasized.

4.Effects of RDW and MPV on Mortality in Patients with Pulmonary Thromboembolism
Bahattin Işık, Emine Sarcan, Seda Özkan, Kadir Küçükceran, Muhittin Serkan Yılmaz
doi: 10.4274/terh.galenos.2023.74429  Pages 169 - 174
Objective: Pulmonary thromboembolism (PTE) is an important cause of mortality. This condition, which is increasing in frequency, needs early diagnosis and prognostic indicators. The present study showed the importance of mean platelet volume (MPV) and distribution width (RDW) in its prognosis.
Methods: A total of 121 patients who were diagnosed with PTE and who were admitted to the emergency department between 2014 and 2017 were included in the present study. Vital signs, hemograms, biochemistry, and blood gas parameters of the patients were recorded. In hospital mortality status was determined and a prognostic comparison of the risk factors of survivors and those who died and MPV and RDW was made.
Results: The median age of the patients was 69 years, 57% of the patients were women, and 57.9% of the patients were tachycardic. The median saturation value was 90%. In hospital mortality occurred in 19 patients. The MPV value of the patients who died was significantly lower than that of the patients who survived. According to the receiver operating characteristic analysis, age, saturation, and MPV yielded significant p values. Age had the highest area under the curve (AUC) value of 0.723 and MPV had 0.655 AUC. Although the risk of mortality increased 7.048-fold in patients over the age of 76, MPV below 7.9 increased it 3.194-fold.
Conclusion: The results of the present study showed that there was no direct relationship between RDW and MPV as a prognostic indicator of PTE, but a decrease in MPV in patients with PTE increased the risk of mortality.

5.Comparison of Vitamin 25(OH)D and Anti-Müllerian Hormone Status in Infertile Patients with Polycystic Ovary Syndrome and with Diminished Ovarian Reserve
Mustafa Şengül, Halime Şen Selim
doi: 10.4274/terh.galenos.2023.43926  Pages 175 - 182
Objective: This study aimed to investigate the relationship between anti-Müllerian hormone and vitamin 25(OH)D levels in infertile patients with low ovarian reserve and polycystic ovary syndrome (PCOS).
Methods: The data of 153 infertile patients who applied to the infertility outpatient clinic were evaluated. Patients who met the PCOS criteria according to the Androgen Excess Society guidelines (group 1-PCOS) and patients with diminished ovarian reserve (DOR) (group 2-DOR) who had serum anti-Müllerian hormone levels <1 ng/mL were compared.
Results: When comparing patients with PCOS (n=78) and DOR (n=75), a statistical difference was found between the groups in terms of body mass index (p=0.009) and vitamin 25(OH)D levels (p=0.009). A very weak and positive correlation (Rho=0.015) was found between anti-Müllerian hormone and vitamin 25(OH)D levels in the group with PCOS. A weak negative correlation (Rho=-0.174) was found between anti-Müllerian hormone and vitamin 25(OH)D levels in the DOR group. However, this relationship was not statistically significant in both groups (p=0.06; p=0.128, respectively).
Conclusions: There was insufficient evidence to comment on the role of 25(OH)D in the pathogenesis of polycystic ovarian syndrome and DOR, which are at the extremes of anti-Müllerian hormone levels. This suggests that the pathophysiology of PCOS and DOR may be independent of serum vitamin 25(OH)D levels.

6.The Evaluation of the Impact of the COVID-19 Pandemic on Urologic Emergencies
Hakan Görkem Kazıcı, Ahmet Emre Yıldız, Abdullah Akdağ, Arif Kol, Erhan Ateş
doi: 10.4274/terh.galenos.2022.49344  Pages 183 - 189
Objective: Evaluating the impact of the coronavirus disease-2019 (COVID-19) pandemic on emergency urology patient profile and assessment of the approach to these patients.
Methods: Records were kept on the age, gender, application time, reason for application, comorbidities, hospitalization requirement, hospitalization duration, anticoagulant use, places of residence, complications, and treatment approaches for emergency urology patients with urological consultation requirement. The period between March 11, 2020 when the first COVID-19 case was encountered in Turkey and June 01, 2020 when the transition to gradual social life started was defined as the “COVID period”, whereas the period between March 11, 2019-June 01, 2019 was defined as the "non-COVID period" parameters for both periods were compared via statistical methods.
Results: A total of 63 patients applied during the non-COVID period, whereas 27 patients applied during the COVID period. A statistically significant difference was not observed between the two periods about age, gender, time of application, reason for application, and treatment approach for the patients (p>0.05). However, it was determined during the COVID period that hospitalization duration decreased (p=0.027), number of applications of patients using anticoagulants increased (p=0.015), and the number of patients from rural areas decreased at a statistically significant level (p=0.023). No statistically significant difference was observed between the interventional and medical treatment approaches (p=0.28). No complications were observed during either period.
Conclusion: The COVID-19 pandemic is a process in which urological emergency applications, the ratio of patients coming from rural areas, and the hospitalization duration decrease.

7.Relationship of Sex Hormones with Obesity and Non-alcoholic Fatty Liver Disease in Boys with Gynecomastia
Deniz Özalp Kızılay, Hale Tuhan, Eren İsmailoğlu, Şebnem Ateş, Aslı Süner
doi: 10.4274/terh.galenos.2022.43799  Pages 190 - 196
Objective: We aimed to investigate the relationship between sex hormone levels [estradiol (E2), total testosterone (TTest)] and lipid profiles, body fat distributions, and non-alcoholic fatty liver disease (NAFLD) in obese boys with gynecomastia.
Methods: This prospective study included 79 obese boys with idiopathic pubertal gynecomastia between 10 and 18 years. The cases were divided into two groups as with (n=48) or without (n=31) NAFLD determined by ultrasonography.
Results: E2 levels had a significant positive correlation with age, body mass index, and fat mass of the patients and had a negative correlation with high-density lipoprotein-cholesterol (HDL-C) (p<0.05). TTest levels had a significant positive correlation with age of the patients and a negative correlation with HDL-C, percent of body fat (PBF) (%), and percent of trunk fat (PTF) (p<0.05). There was no significant difference in terms of sex hormone levels between the two groups with and without NAFLD (p>0.05).
Conclusion: The results of this study reveal that as the PBF and PTF increase, the TTest levels of the patients decrease and as the fat mass increases, the E2 levels increase significantly. We could not find a significant relationship between sex hormones and the presence of NAFLD.

8.Cavitron Ultrasonic Surgical Aspirator Makes it Easier for Neurosurgeons. What About Pathologists?
Mahmut Çamlar, Mustafa Eren Yüncü, Emel Ebru Pala, Nijat Bayramlı, Ali Karadağ, Merve Ören, Füsun Demircivi Özer, Nurperi Gazioğlu
doi: 10.4274/terh.galenos.2022.43078  Pages 197 - 202
Objective: In recent years, the cavitron ultrasonic surgical aspirator has become an indispensable surgical tool for many neurosurgeons. The aim of the present study was to determine the relationship between the use of the cavitron ultrasonic surgical aspirator and the volume of the material obtained for pathological studies.
Methods: The study was conducted with data from 80 consecutive patients undergoing surgical removal of a brain tumor between 2015 and 2019. Clinical records were analyzed retrospectively. Preoperative and postoperative tumor volume measurements were performed on magnetic resonance images using the Aquarius Intuition Client Viewer program available on our picture archiving and communication system. Excised tumor volumes were calculated. The effect of using the cavitron ultrasonic surgical aspirator on the amount of excised tissue, histopathological diagnosis, and excision time of the material sent to our pathology department for histopathological examination was calculated.
Results: Mean age was 52.9 years. Preoperative tumor volumes and resected tumor volumes were significantly higher in group 1 (p=0.026; 0.03 respectively). Operation time spent per excised tumor volume was significantly shorter in group 1 (p=0.005). The amount of material sent to pathology was higher in group 2 (p=0.026). There were no complications related to the resection using the cavitron ultrasonic surgical aspirator and it was found to be useful for tumor removal.
Conclusion: The cavitron ultrasonic surgical aspirator is a highly helpful tool for surgical intervention. This method based on aspiration may have some negative effects on pathological specimens if cavitron ultrasonic surgical aspirator aspirate material not transferred to the pathology department.

9.Relationship Between Systemic Immune-inflammation Index and Coronary Slow Flow
Mustafa Duran, Mehmet Burak Özen
doi: 10.4274/terh.galenos.2022.36675  Pages 203 - 209
Objective: The coronary slow flow (CSF) phenomenon is frequently observed during coronary angiography (CAG) and is associated with adverse cardiac events. Despite various known underlying factors, the pathophysiology is still poorly understood. The previously documented systemic immune-inflammation index (SII) is an infallible predictor of adverse events in multiple cardiovascular conditions. However, the relationship between SII and CSF has yet to be determined. Herein, we aimed to elucidate the relationship between SII and CSF.
Methods: The records of 162 patients who underwent CAG with the preliminary diagnosis of stable angina pectoris and detected CSF between January 1, 2021 and December 31, 2021 and 272 patients who did not detect CSF after CAG were retrospectively reviewed. For each group; demographic and clinical characteristics, laboratory values, and two-dimensional quantitative coronary angiographic measurements were analyzed. Epicardial coronary blood flow was quantified visually using the thrombolysis in myocardial infarction frame count method.
Results: According to our data, the calculated SII score was significantly higher in patients with CSF compared with control subjects (719±20 vs 590±2, p<0.01). Regarding the receiver operating characteristic curve, the optimal cut-off value was calculated as 612.4 using the Youden index (area under the curve: 0.751, 95% confidence interval: 0.699-0.804, p<0.001). The multivariate Cox regression model also showed that in the calculated predictors, SII was the best predictor of CSF.
Conclusion: Our data showed that SII is an independent predictor of CSF among patients with stable angina pectoris.

10.Evaluation of Neutrophil Lymphocyte Ratio and IDH Mutation in Patients with Glioblastoma
Çağlar Türk, Mahmut Çamlar
doi: 10.4274/terh.galenos.2022.59837  Pages 210 - 213
Objective: One of the prognostic factors for glioblastoma (GBM) is isocitrate dehydrogenase (IDH) status. In addition, it has been stated that the neutrophil lymphocyte ratio (NLR) in GBM effects prognosis. In this study, we aimed to reveal the relationship between preoperative NLR and IDH status in GBM patients.
Methods: Age, gender, preoperative NLR value, IDH status, Ki67 and p53%, and ATRX status of the patients were recorded in two groups: IDH mutant 7 patients and IDH wild type (IDH-Wt) 24 patients.
Results: When the two groups were examined, no statistical difference was found between the loss of ATRX expression, Ki67 and p53 markers, and preoperative NLR values. Only IDH mutant patients were younger (p=0.037).
Conclusion: Although it is seen that the pre-operative NLR value is not useful in determining the IDH status in GBM patients, it can be said that low NLR may have a positive effect on overall survival.

11.Can the Effect of Torsion Duration Change in the Decision of Orchiectomy in Children with Testicular Torsion?
Ahmet Hikmet Şahin, Murat Sabri Yılmaz
doi: 10.4274/terh.galenos.2022.46656  Pages 214 - 218
Objective: Acute scrotum is especially important in terms of testicular torsion that causes organ loss. In this study, some variables of the patients [age, duration of admission, scrotal Doppler ultrasonography (SDU) application time, time to surgery, testicular appearance during surgery] in cases who were found to have testicular torsion over a four-year period were evaluated to evaluate the factors affecting orchiectomy.
Methods: The study sample consisted of patients who applied to the hospital with the complaint of acute scrotal pain and/or swelling between January 2017 and December 2020.
Results: It was determined that 199 patients with scrotal pain and/or swelling were admitted to the hospital within the specified period. The mean age of patients with testicular torsion (n=26) was 8.93±5.25 years. In the testicular torsion group, the time elapsed between the onset of patients’ complaints and admission to the hospital was calculated, depending on the type of operation. While this period was 80.18±16.32 h in patients who underwent orchiectomy, it was determined as 17.46±8.75 h in patients whose testis was left in place. A significant difference was found between the onset of complaints and the time to hospital admission in cases where orchiectomy was performed and in cases where the testis was left in place.
Conclusion: As a result, in the case of acute scrotum, the time from the onset of the patient's complaints to hospital admission is important. The application of SDU to all acute scrotum cases may provide early detection of testicular torsion. In the literature, it has been stated that the chance of protection is high for testicles that are caught within 6 h, but in our series, testes that were torsion for 17.46±8.75 h could be preserved.

12.Comparison of Electrocardiographic Parameters in Young and Middle-aged Patients Presenting with non-ST Myocardial Infarction
Songül Usalp, Ramazan Gündüz
doi: 10.4274/terh.galenos.2022.82335  Pages 219 - 225
Objective: In this study, we aimed to examine the relationship between young and middle-aged patients and frontal QRS-T angle (FQRS-T A) by evaluating the demographic, clinical features and electrocardiographics (ECGs) of patients who presented with non-ST elevation myocardial infarction (NSTEMI).
Methods: The study was planned retrospectively, and 396 patients, young age (20-45 years, n=158) and middle-aged (46-65 years, n=238) who applied to the emergency department with chest pain and were diagnosed with NSTEMI underwent coronary angiography for the first time. The FQRS-T A is calculated by the frontal plane QRS axis and the T axis (FQRS-T A=QRS-T axis) from a 12-lead plane ECG.
Results: Hypertension (HT) (p<0.001) and diabetes mellitus (DM) (p<0.001), serum glucose (p=0.007), serum high-density lipoprotein cholesterol (HDL-C) level (p=0.005), SYNTAX score (p<0.001) and FQRS-T A (p<0.001) were higher in the middle-aged group. In multivariate analysis showed HT [odds ratio (OR): 4.084, 95% confidence interval (CI) (2.234-7.465), p<0.001], DM [OR: 1.452,95% CI (1.288-7.465), p=0.018], low HDL-C level [OR: 0.972, 95% CI (0.951-0.994), p=0.012], FQRS-T A [OR: 0.990, 95% CI (0.980-0.993), p<0.001], was determined as a possible independent risk factor for NSTEMI in middle-aged patients group. Analyzes showed that the optimal cut-off value for the degree of FQRS-T A to predict a middle-aged NSTEMI was >32.5%, with a sensitivity of 62% and a specificity of 52% (area under the curve: 0.633, 95% CI 0.579-0.687, p<0.001).
Conclusion: In our study, FQRS-T A was found to be higher in middle-aged NSTEMI patients, and it was found to be a possible independent risk factor for NSTEMI.

13.Evaluation of Thought and Language Functions in Patients with Obstructive Sleep Apnea Syndrome
Burcu Oktay Arslan, Zeynep Zeren Uçar, Esra Aydınlı
doi: 10.4274/terh.galenos.2021.72473  Pages 226 - 232
Objective: Patients with obstructive sleep apnea syndrome (OSAS) could display disorders in cognitive areas including attention, long-term visual and verbal memory, structural abilities, and executive functions. There are contradictory results regarding language ability and psychomotor functions. We evaluated the thought and language functions of patients with OSAS and their relationship with disease severity.
Methods: Patients who applied to the sleep disorders center with a preliminary diagnosis of OSAS were included in the study. According to the polysomnographic (PSG) results, 95 patients diagnosed with OSAS were accepted as the patient group, and 31 patients without OSAS were accepted as the control group. All patients were administered the thought-language index (TLI) by a psychologist. TLI scores were calculated and the differences between patient and control groups were evaluated. It was also examined the relationship between rapid eye movement (REM)-related OSAS and TLI scores.
Results: There was no significant difference between the patient and control groups regarding total TLI score. However, the “poverty of speech” score, which is a subcategory of TLI, was found to be significantly higher in the control group than in the patient group (p=0.266, p=0.025 respectively). No patient scored in the category of thought disorder. There was also no significant relationship between the severity of OSAS and TLI score, poverty of speech, weakening of purpose, and perseveration (p=0.846, p=0.111, p=0.839, p=0.059 respectively). When the patient group was classified as REM-related and non-REM-related OSAS, no significant.
Conclusion: In the evaluation of patients with OSAS through TLI, no impairment was found regarding thought and language functions. The poor performance of individuals who were diagnosed with OSAS were excluded in terms of “poverty of speech” may be related to snoring and accompanying arousal and excessive daytime sleepiness. No negative effect of REM-related OSAS on thought and language functions was detected. Further studies are required to evaluate thought and language functions in patients with OSAS.

14.Pericapsular Nerve Group Block (PENG Block); Rising Value in Anesthesia
Pınar Ayvat, Cem Ece
doi: 10.4274/terh.galenos.2022.31549  Pages 233 - 243
Objective: Pericapsular nerve group block (PENG block) emerges in the search of effective methods in hip joint block. It was aimed to analyze the bibliometric analysis of publications related to this method and to examine the world literature.
Methods: Articles, case reports, conference presentations, papers, and letters to the editor published in peer-reviewed journals published in the PubMed database about PENG block were examined.
Results: This new block was first implemented in Canada, followed by Japan and India. It was seen that case series and original research started to be done worldwide, while only case reports were made from Turkey. It was seen that 65% of the publications on this subject were published in Science Citation Index (SCI) and SCI-Expanded (SCI-E) journals. While the average number of citations per publication related to the PENG block was 5.75 in SCI and SCI-E journals, it was found to be 1.42 in other indexed journals (p<0.05). The mean number of cases in the publications was higher in case series (17.07) in SCI and SCI-E journals than in other indexed journals (10.14) (p<0.05). It was revealed that more cases were required to publish case series in SCI and SCI-E journals (p<0.05).
Conclusion: Although the method is new and effective, it is important that it be published in well-indexed journals for citation. We think that because of understanding why and how this block is implemented in which countries, the number of publications on this subject will increase in our country.

15.What is the Diagnostic Value of Computed Tomography in Pre-school Children with Minor Head Injuries?
Necati Üçler, Ersin Özen, Niyazi Taşkıran, Ramazan Fesli
doi: 10.4274/terh.galenos.2021.36002  Pages 244 - 249
Objective: In this study, we evaluated whether computed tomography (CT) examination would be required or not, based on complaints and findings after minor head trauma in pre-school children.
Methods: In our retrospective study, the history of pre-school patients with minor head trauma, physical examination findings, Glasgow coma scale, cranial radiography, CT findings, and injury were evaluated retrospectively. The duration of unconsciousness and amnesia, presence of post-traumatic seizure, history of vomiting, and presence of scalp injury/hematoma were examined in the patient’s records. Clinical and radiological information was obtained retrospectively, and patients were re-evaluated one year later by phone. The fractures, edema, contusion, pneumocephalus, epidural hematoma, subdural hematoma, intraparenchymal hematoma, and intraventricular hemorrhage were evaluated on CT examination.
Results: Between May 2014 and May 2018, 884 patients under 7 years of age with minor head injuries were evaluated in the emergency department. Among these, anterior-posterior and lateral cranial radiography and CT were performed in 262 patients. None of the patients had neurological deficits. Scalp laceration/hematoma was detected in 36 (16%) patients. Fifty-two (24%) patients vomited once, whereas 12 (5%) and 5 (2%) vomited twice and thrice, respectively. A loss of consciousness (LOC) duration of <5 min was observed in 25 (11%) patients. None of the patients had a history of LOC duration of more than 5 min. However, all three patients with skull fracture had a history of LOC.
Conclusion: We believe that clinical examination and other imaging methods may reduce the need for CT evaluation in pre-school childhood patients with minor head trauma.

16.Investigation of the Effect of 4-Hydroxyphenylboronic Acid on Endothelial Damage due to LPS-Induced Endotoxemia in the HUVEC Line via Endocan
Pelin Aydın, Muhammet Çelik
doi: 10.4274/terh.galenos.2022.21284  Pages 250 - 257
Objective: In our study, the effect of 4-hydroxy phenylboronic acid (4OHFBA), a derivative of boronic acid, on lipopolysaccharide (LPS) induced endothelial damage was investigated in the human umbilical vein endothelial cell line (HUVEC). It has been shown that 4 hydroxy phenylboronic acid may be effective in LPS induced cell death and endothelial damage.
Methods: The study was conducted on the HUVEC line. The cells were treated with 10 μg/mL LPS for 12 h. They were treated with 4 different doses of 4OHFBA 1 h after LPS administration. Cell viability percentage and endocan levels were measured after 24th and 48th hours.
Results: When the endocan levels were examined at 24th and 48th hours, it was observed that the endocan level in the LPS group was significantly higher compared to the healthy group (p<0.05). The endocan levels were significantly lower in the groups treated with 31.25 μM, 62.5 μM, 125 μM, and 250 μM 4OHFBA compared to the LPS group (p<0.05). It is seen that this decrease is much greater in the 62.5 μM + 4OHFBA group and this is the group that is closest to the healthy group (p<0.05).
Conclusion: These findings show that 4OHFBA acid may be effective for LPS-induced cell death and endothelial damage.

17.Newborn Metabolic and Endocrine Disease Screening Program: Example of Giresun Province Between 2015 and 2020
Emine Ela Küçük, Muhammet Bulut, Ünal Özek, Selçuk Takır
doi: 10.4274/terh.galenos.2023.39297  Pages 258 - 263
Objective: In this study, we aimed to evaluate the cases diagnosed within the scope of the newborn metabolic and endocrine disease screening program carried out by the provincial health directorates between 2015 and 2020 in Giresun province.
Methods: In our study, the results obtained from the newborn metabolic and endocrine disease screening program between 2015 and 2020 were evaluated. Diagnoses/records between September 20th, 2021 and October 10th, 2021 were reviewed retrospectively. A total of 114 cases were identified in the 6-year period diagnosed with phenylketonuria, congenital hypothyroidism, cystic fibrosis, and biotidine deficiency.
Results: 43.9% (n=50) of the diagnosed newborns were girls and 56.1% (n=64) were boys. There was no significant difference in terms of gender distribution among those diagnosed (p>0.05). In 2015, 4 newborns were diagnosed with hyperphenylalanemia, and no newborn was diagnosed with phenylketonuria. Eleven newborns were diagnosed with congenital hypothyroidism. In 2016, 7 newborns were diagnosed with hyperphenylalanemia, one neonatal phenylketonuria, one neonatal cystic fibrosis, one neonatal biotidinase deficiency. In 2020, 4 newborns were diagnosed with hyperphenylalanemia, and no newborn was diagnosed with phenylketonuria. Four newborns were diagnosed with congenital hypothyroidism, and one newborn were diagnosed with biotidine deficiency.
Conclusion: Among the cases diagnosed within the scope of newborn metabolic and endocrine disease screening program, frequency of congenital hypothyroidism was found to be high in 2015, 2017, and 2019. It is recommended that the families of the diagnosed newborns be contacted and the current development and health status of the children be evaluated.

18.Awareness of Physiotherapy and Rehabilitation Students on Descriptive Figures Related to Health
Özlem Özcan, Hayriye Kul Karaali
doi: 10.4274/terh.galenos.2023.02779  Pages 264 - 267
Objective: Our aim was to evaluate the awareness of students of the Physiotherapy and rehabilitation department about descriptive figures.
Methods: A total of 483 physiotherapy and rehabilitation students (74.9% female, 25.1% male) participated in the study. In addition to demographic information, the status of having completed a school in the field of health and working as a professional in the field of health was questioned using the data registration form. In addition, an evaluation form developed by the authors was used to evaluate the level of knowledge about descriptive figures.
Results: Only 82 of the students (17.0%) stated that they had knowledge about descriptive figures. Students who state that they have information about descriptive figures mostly reach the information through internet search engines (40.24%). When students were asked about descriptive figures, 239 (49.5%), 254 (52.6), 257 (53.2%) and 241 (49.9%) students correctly answered droplet isolation, respiratory isolation, contact isolation and falling risk, respectively.
Conclusion: This study evaluates the level of knowledge of physiotherapist candidates about descriptive figures. The result of the study reveals the necessity for our students to be educated about descriptive figures.

19.The Efficacy of Combination Therapy for Treating Enuresis Nocturna
Ufuk Şenel, Mehmet Yoldaş, Bahri Elmas, Osman Demir, Ersin Konyalıoğlu, Tuba Kuvvet Yoldaş, Hakan Üçok, Esat Kaan Akbay, Mehmet Zeynel Keskin
doi: 10.4274/terh.galenos.2023.59219  Pages 268 - 272
Objective: Monosymptomatic enuresis nocturna treatment at pharmacological and non-pharmacological treatments are used in In our study, we aimed to compare the long-term results of desmopressin (DP) treatment and combined DP-enuresis alarm device (DP/EA) treatment.
Methods: A total of 39 patients with the diagnosis of monosymptomatic enuresis nocturna, 25 using DP treatments and 14 using DP/EA treatments, were included in the study. Long-term data of the patients were obtained and compared retrospectively.
Results: While there was no significant difference in terms of recurrence in both groups after the treatment, it was observed that the duration of drug use and the dose of drug used by the patients in the combined treatment group were similar. It was observed that duration at drug used for 8.80±6.12 months (n=25, p=0.0025) in the DP group and 5.71±1.33 months (n=14, p=0.025) in the DP/EA group. It was observed that the total drug dose used in the DP group was 880.8±520.09 micrograms (n=14, p=0.022) and 542.14±194.94 micrograms (n=14, p=0.022) in the DP/EA group. In long-term follow-ups, recurrence was observed in 28% (n=25, p=0.445) patients using DP and 18% (n=14, p=0.445) patients using DP/EA.
Conclusion: When DP and DP/EA treatment are compared, it is observed that there is no difference when long-term recurrence is considered. However, it is observed that DP/EA combined treatment shortens the duration of treatment and reduces the dose of drugs used during treatment.

CASE REPORT
20.The Diagnosis of Pulmonary Tuberculosis in a Patient with AA Amyloidosis of Unknown Etiology
Zeynep Öndeş, Görkem Vayısoğlu Şahin, Harun Akar, Zekiye Aydoğdu, Filiz Güldaval
doi: 10.4274/terh.galenos.2022.00378  Pages 273 - 278
It is of utmost importance to consider tuberculosis as a differential diagnosis while investigating secondary amyloid A (AA) amyloidosis, especially in developing countries. An early diagnosis of tuberculosis as the primary cause of secondary AA amyloidosis is important for precise treatment and recovery of the patient. In this case report, we aimed to increase awareness of tuberculosis as an underlying cause of secondary amyloidosis by discussing the clinical features with a review of the literature. A 74-year-old female patient presented with dyspnea. A detailed clinical and laboratory examination revealed impairment in renal function tests, leukocytosis, anemia, high procalcitonin values, pleurisy and pneumonic infiltration in the left lung. From her history, it was learned that 2 years ago, liver and inguinal lymph node lymph node biopsy was reported as systemic AA amyloidosis. Due to the increased serum creatinine values and a decrease in urine output, the patient underwent hemodialysis for a short period of time, and a decrease in urea and creatinine levels was observed after dialysis and adequate urine output was achieved. Mycobacterium tuberculosis complex was detected in the Bronchoalveolar lavage sample taken during bronchoscopy. Congo red staining of the pathology material was compatible with amyloid in the vessel wall, and immunohistochemical staining was positive for AA. The patient was transferred to the tuberculosis service for anti-tuberculosis treatment. In this case, chronic inflammation due to tuberculosis is thought to be in the etiology of secondary amyloidosis. The authors emphasize that secondary amyloidosis should be among our differential diagnoses in patients with nephrotic syndrome and previous tuberculosis history.

21.Rapidly Progressive Pediatric Intervertebral Disc Calcification
Atilla Hikmet Çilengir, Mehmed Fatih Yılmaz, Adil Özturk, Ali Kürşad Ganiyusufoğlu
doi: 10.4274/terh.galenos.2022.70845  Pages 279 - 282
Intervertebral disc calcification is rare in childhood. Genetic, metabolic, inflammatory, and infectious factors have been shown in its etiology. It may be asymptomatic or present with sudden physical and neurological findings. Laboratory tests are generally nonspecific. Imaging modalities are helpful both in diagnosis and follow-up. Conservative treatment is beneficial in most cases for the resolution of calcification and symptoms. In this report, we present the case of a 4-year-old male patient with sudden onset neck pain and stiffness rapidly progressing intervertebral disc calcification with direct X-ray, computed tomography, and magnetic resonance imaging.

22.Breast Carcinoma Presenting with Thymic Metastasis: A Case Report
Emine Bihter Eniseler, Ferhat Ekinci, Fatma Can, Atike Pınar Erdoğan, Gamze Göksel
doi: 10.4274/terh.galenos.2022.25991  Pages 283 - 286
The thymus is a primary lymphoid organ located in the superior and anterior mediastinum. Thymic tumors constitute almost all anterior mediastinal tumors. Although thymomas are the most common tumors of the thymus in adults, metastasis of a tumor to the thymus is extremely rare. The diagnosis of space-occupying formations in the thymus is often made by clinical and radiological findings. It is confirmed by histopathological examination. In this article, a case of breast cancer with solitary thymus metastasis observed in the 9th year after mastectomy is presented.

23.Entrapped Ureteral Access Sheath: An Unusual Problem
Erkin Karaca, Tufan Süelözgen, Mert Hamza Özbilen, Çağdaş Bildirici, Yusuf Özlem İlbey
doi: 10.4274/terh.galenos.2021.15579  Pages 287 - 290
Flexible ureteroscopy is well-known and performed procedure by urologists, yet instrument related complications may suprise even experienced surgeons. In this study, we present a unique instrument related complication during flexible ureteroscopy. A 68 year old male patient with 1.9 cm left upper ureteral stone presented to us. With semi-rigid ureteroscope laser lithotripsy performed. Stone got retropulsed into lower pole of the kidney. The procedure was converted to retrograde intrarenal surgery. Within Porges-Coloplast Retrace® Ureteral Access Sheath 12 Fr and 35 cm (UAS) with Karl Storz Flex-X2 fiber-optic ureteroscope (fURS) stone fragmentation completed. After removal of fURS from the patient, UAS got tried to pull away but it got stuck into the patient. Hanging part of the UAS below the external meatus cut-off and the internal spiral part withdrew. But it didn’t come off. So pulling the residual piece of UAS from the orifice level tried with cystoscope and foreign body forceps. It didn’t work out and sheath got split to two pieces from the orifice level. After that another enterance to the bladder had performed with cystoscope and left orifice had incised. 8 mg dexamethasone had administerated to the patient and lidocaine including lubricant gel got injected inside and around the UAS. It didn’t come off. Decision made that ending the procedure after placing double-J stent, then after 3-4 weeks when the ureteral edema got regressed removal of the residual UAS. Four weeks later with cystoscope and foreing body forceps residual UAS got removed by two pieces. Ureteral edema can led entrapment UAS inside of the ureter. Most of the cases moderate traction and withdrawing the internal spiral part of UAS is enough to pull away. In cases that these solutions are insufficient, stenting and planning another endoscopic procedure after a few weeks may help avoiding unnecessary open surgery.

REVIEW
24.Tumor Cell Surface Antigens
Melek Pehlivan, İbrahim Pirim
doi: 10.4274/terh.galenos.2021.48243  Pages 291 - 298
Cancer immunotherapy has made rapid developed over the past decade, including increasing knowledge about how cancer cells can escape of the immune system and the development of new therapies that have been successful in cancer patients. Tumor cells produce antigens that can remain on the cell surface. These antigens, known a tumor antigens, are one of the central factors that play a role in the developments in immunotherapy. These antigens are sometimes presented only by tumor cells and not by normal cells. In this case, these are called tumor-specific antigens (TSAs). Tumor associated antigens (TAA) can also be expressed by normal cells, although they are associated with a malignant cell phenotype. TAAs and TSAs have been an important research subject due to their role in the elimination of tumor cells, and have been reclassified under more specific groups in the following periods. According to the modern classification, tumor antigens are grouped as viral antigens, cell-type specific differentiation antigens, antigens encoded by cancer-testis genes, overexpressed antigens, mutant protein antigens, oncofetal antigens, glycolipids and glioproteins. Nowadays, it is tried to increase their effectiveness by using surgery to prevent or manage cancer, chemotherapy, targeted or radiation treatments, and in combination with immunotherapy methods. Thanks to immunotherapies using tumor antigens (cancer vaccines, bispecific antibodies and chimeric antigen receptor-T therapy), a serious progress has been made in the treatment of cancer today. In this review, subgroups of tumor antigens and their roles in cancer immunotherapy are discussed.

LETTER TO THE EDITOR
25.The Effects of Two Major Earthquakes in Türkiye: An Example of Burying the Dead
Çağatay Üstün, Seçil Özçiftçi
doi: 10.4274/terh.galenos.2023.59376  Pages 299 - 300
Abstract |Full Text PDF

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