E- ISSN: 3023-6215
ANATOLIAN JOURNAL OF GENERAL MEDICAL RESEARCH - Anatol J Med : 33 (3)
Volume: 33  Issue: 3 - 2023
1.Cover

Page I (64 accesses)

CLINICAL RESEARCH
2.Pregnancy Results of Intracytoplasmic Sperm Injection in Infertile Males with Non-obstructive Azoospermia: A Retrospective Study
Can Köse, Mehmet Zeynel Keskin
doi: 10.4274/anatoljmed.2023.46504  Pages 301 - 304 (309 accesses)
Objective: This study investigated the number of live births in men with non-obstructive azoospermia (NOA) using a combination micro-testicular sperm extraction and intracytoplasmic sperm injection.
Methods: A total of 434 patients who underwent micro-testicular sperm extraction because of NOA were included in the study. Data such as date of birth, duration of infertility (in years), number of mature oocytes obtained from the spouse, number of embryos transferred, day of transfer, medical histories of the spouses, physical examination findings, and comorbidities were recorded.
Results: Ultimately, 19 live births were achieved through successful implantation.
Conclusion: The combination of micro-testicular sperm extraction and intracytoplasmic sperm injection in NOA cases continues to be the most ideal and current treatment method for couples who want to have children.

3.Pregnancy Rates Following High-quality Blastocyst Transfer in Patients with Variable Indications for ART Treatment
Can Köse
doi: 10.4274/anatoljmed.2023.87597  Pages 305 - 309 (230 accesses)
Objective: In recent years, blastocyst transfer has emerged as a significant advancement in assisted reproductive technology (ART), offering improved implantation potential and higher pregnancy rates than earlier-stage embryo transfers. This study aimed to investigate pregnancy outcomes following blastocyst transfer among diverse etiologies of infertility.
Methods: Analyses were conducted on 378 patients who underwent ART treatment between 2013 and 2022 at the Clinic of Obstetrics and Gynecology of University of Health Sciences Turkey, İzmir Tepecik Education and Research Hospital. Subgroups were formed based on the causes of infertility: Poor ovarian reserve, hormonal ovulatory deficiency, male factor, tubal factor, and unexplained infertility. Demographic characteristics of patients, causes of infertility, blastocyst transfer outcomes, and resulting pregnancy rates were collected and analyzed.
Results: Three hundred seventy-eight patients underwent blastocyst transfer, and among them, 202 were pregnancy positive, resulting in a pregnancy rate of 53%. The subgroup success rates were as follows: Unexplained infertility, 16.4%; poor ovarian reserve, 6.1%; hormonal ovulatory deficiency, 17.8%; male factor, 18.3%; and tubal factor, 3.2%.
Conclusion: Our results showed that clinical pregnancy rates do not vary significantly across different etiologies.

4.Fine Needle Aspiration Cytology (FNAC) vs. Tru-cut Biopsy in Liver with Iron Overload: An Experimental Study
Yasemen Adalı, Hüseyin Avni Eroğlu, Mustafa Makav, Sunay Sibel Karayol, Gülname Fındık Güvendi, Mustafa Gok
doi: 10.4274/anatoljmed.2022.55632  Pages 310 - 315 (83 accesses)
Objective: Fine needle aspiration cytology (FNAC) is safer, simpler, faster and cost effective, compared to tru-cut biopsy, and patient compliance is generally better. There is not much data on the use of FNAC, which is used in many organs and lesions, in parenchymal diseases in the liver. Therefore, in this study, the benefit of FNAC in showing iron deposition and injury of liver is evaluated.
Methods: There were 2 control groups in the study. At the end of the study, FNAC and tru-cut biopsy samples were taken from these groups, where no administration was performed. FNAC and tru-cut biopsy procedures were also performed to the study groups after the iron overload was created by intraperitoneal iron dextran (88 mg/kg) administration for 28 days. Hepatocyte injury, inflammation and iron deposition were evaluated histopathologically in the preparations. The sensitivity, specificity, positive and negative predictivity and diagnostic accuracy of both methods were calculated based on the hepatectomy material.
Results: In hepatocyte injury; sensitivity (60%), diagnostic accuracy (66.7%) and negative predictivity (50%) were found to be significantly higher in tru-cut group. It was observed that the methods were not superior to each other in the evaluation of inflammation, and FNAC almost approached tru-cut biopsy rates (100%) with a sensitivity of 83.3% and diagnostic accuracy in iron deposition.
Conclusion: In iron-induced liver damage, the gold standard should be tissue examination, so tru-cut biopsy must be the first choice. However, based on the present study results, it is suggested that FNAC may be preferred over more invasive options in cases where tru-cut biopsy can not be used in terms of susceptibility to bleeding, situations where surgical accessibility is not available, patient orientation and cooperation is poor, or in presence of different accompanying diseases.

5.Determination of Confirmation Rate of Anti-HCV Test Pozitivity with HCV-RNA
Güneş Şenol, Meral Coşkun, Osman Kaftan, Can Biçmen, Ayriz Tuba Gündüz, Mahmut Mete Demirel, Ferhat Demirci
doi: 10.4274/anatoljmed.2022.02679  Pages 316 - 321 (73 accesses)
Objective: Timely diagnosis of the disease is important to prevent late complications in hepatitis C infection. Anti-hepatitis C virus (HCV) tests are regularly requested in screening test panels. However, it is seen that even seropositive patients cannot be followed appropriately. In this study, it was aimed to reveal the missed opportunities in terms of diagnosis and treatment of HCV infection in the seropositive patient group detected by screening tests.
Methods: It was investigated retrospectively whether the seropositive patients for HCV were followed up in accordance with the diagnosis of HCV infection protocol in our hospital.
Results: A total of 9.878 anti-HCV tests were studied between November 2016 and February 2019, and 133 Anti-HCV positivity (1.3%) were detected. In total, HCV-RNA test was requested from only 58 (45%) of 129 patients. HCV-RNA was found positive in 12 (20.7%) patients. It was observed that S/CO value was above 10 in 28 (21.7%) of 71 patients in whom HCV-RNA was not wanted, and the probability of virus RNA being positive was high. Infectious diseases consultation was not requested from any of these patients; it was thought that there were missed opportunities for diagnosis of HCV infection.
Conclusion: It will be very important to consult the infectious diseases branch of patients with anti-HCV positive, to organize in-service training seminars for physicians of other specialties, and to provide warnings in case of anti-HCV positivity on the hospital automation system in order to increase awareness and ensure that the patients are followed appropriately.

6.Differentiation of Posterior Fossa Schwannomas from Meningiomas Using ADC Values
Merve Yazol, Halil Özer, Ali Yusuf Öner
doi: 10.4274/anatoljmed.2022.82542  Pages 322 - 327 (75 accesses)
Objective: To assess the diagnostic efficiency of apparent diffusion coefficient (ADC) values in differentiating posterior fossa schwannomas and meningiomas.
Methods: A total of 55 patients who were referred for magnetic resonance imaging (MRI) of posterior fossa extra-axial lesions were retrospectively enrolled in our study. Tumors were classified based on the patients’ conventional MRI findings. The mean ADC values of the tumor and reference value from contralateral cerebellar parenchyma were obtained by using region of interest from ADC maps by two radiologists in consensus. ADC ratios were calculated. Differences between schwannomas and meningiomas in mean ADC, and ADC ratio values were statistically analyzed.
Results: 52.7% of patients were male, 47.3% were female with a mean age of 53.4. Based on conventional MRI features, 29 were interpreted as schwannoma, 26 as meningioma. Mean ADC values (×10-3 mm2/s) of schwannomas and meningiomas were 1.087±0.224 and 0.729±0.130, respectively. Mean ADC ratios were 1.56±0.34 for schwannomas and 1.08±0.17 for meningiomas. Mean ADC values and ADC ratios of schwannomas were significantly greater than meningiomas (p<0.001). The area under the curve (AUC) of ADC value for differentiating schwannomas from meningiomas was 0.957, and the sensitivity and specificity were 92% and 89%, respectively (p<0.001). The AUC of ADC ratios was 0.932, and the sensitivity and specificity were 92% and 79%, respectively (p<0.001).
Conclusion: The ADC value and ADC ratios may helpful in discriminating schwannomas and meningiomas. Although diagnosis of schwannoma and meningioma is based on typical imaging features, ADC value and ratio can provide a clue for a discrepancy in controversial cases.

7.Evaluation of Differences Between First and Second Waves of the COVID-19 Pandemic in Hospitalized Patients in a Tertiary Health Center
Sinem Ermin, Gülru Polat, Özer Özdemir, Damla Serçe Unat, Ömer Selim Unat
doi: 10.4274/anatoljmed.2022.97947  Pages 328 - 333 (69 accesses)
Objective: Coronavirus disease-2019 (COVID-19) pandemic started on March 2020 and is still ongoing with waves of activity. In this study, we aimed to comparethe clinical and laboratory characteristics and survival rates of 1st and 2nd waves of COVID-19.
Methods: Patients hospitalized with the diagnosis of COVID-19 pneumonia between 01.03.2020-31.12.2020 were included. Clinical characteristics, laboratoryparameters, radiological and treatment properties as well as clinical outcomes of patients were derived from hospital records. Statistical significance levelwas taken as p=0.05.
Results: A total of 1043 patients, with average age of 55.68±15.72, were included in the study. 57.8% of the study population was male. There were 469 patients(45%) in group 1 (first wave) and 574 patients (55%) in group 2 (second wave). Although the patients in group 2 were older (59.3±14.53 vs. 51.3±16.03, p<0.001),there was no significant difference of sex and smoking history (respectively, 58.8% males vs. 57% males, p=0.57 and 43.4% vs. 48.1%, p=0.24). There was moreCOVID-19 real time-polymerase chain reaction positivity in group 2 (61.4% vs. 74.7%, p<0.001), and patients had more comorbidity (47.4% vs. 62.3%, p<0.001).Patients in group 2 had significantly higher lactate dehydrogenase, C-reactive protein and D-dimer levels (p<0.001 for all) and lower lymphocyte levels(p=0.02). Corticosteroid treatment and low molecular weight heparin were more commonly used in group 2 patients (p<0.001 for both). But mortality andintensive care unit (ICU) admission were higher in group 1 [respectively, 50 (10.7%) vs. 25 (4.4%), p<0.001 and 57 (12.2%) vs. 47 (8.2%), p=0.04].
Conclusion: Although the patients in second wave of COVID-19 pandemic were older, had more comorbidities, and had worse laboratory parameters, they hadless need for ICU and better survival. This difference may represent increasing experience in patient care and construction of better treatment algorithms andguidelines in COVID-19 pneumonia patients.

8.Evaluation of Lesions with Increased Fluorine-18 Fluorodeoxyglucose Uptake in the Stomach and Colon Incidental Detected by Positron Emission Tomography/Computed Tomography
Damla Çağla Patır, Nurşin Agüloğlu, Ömer Burçak Binicier, Cengiz Ceylan
doi: 10.4274/anatoljmed.2022.67984  Pages 334 - 341 (81 accesses)
Objective: One of the most common incidental increased uptake areas with fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is the gastrointestinal tract. In this study, we retrospectively evaluated patients with gastric and colonic incidental increased 18F-FDG uptake on PET/CT.
Methods: Patients who underwent 18F-FDG PET/CT imaging and had incidental increased gastric and colonic uptake between June 2017 and June 2020 were evaluated.
Results: Of the 10,551 evaluated patients, 306 (2.9%) had colonic and 195 (1.8%) had gastric incidental 18F-FDG uptake on PET/CT. Within 120 days after imaging, 173 patients (56%) with increased colonic uptake (250 different uptake area) and 95 patients with increased gastric uptake (48.7%) who underwent endoscopic evaluation in our center were included in the study. Increased focal uptake pattern was seen in 86.4% of colonic uptake areas and 67.4% of gastric uptake areas. Malignant/premalignant diseases were identified in 80% of cases with colonic uptake, and in 21% of patients with gastric uptake areas. While maximum standardized uptake value (SUVmax) >5.9 in the colon differentiates inflammatory and malignant/premalignant diseases from benign diseases with 80% sensitivity and 97% specificity, SUVmax >5.0 in the stomach differentiates malignant/premalignant lesions from inflammatory benign diseases with 75% sensitivity and 72% specificity.
Conclusion: Focal incidental increased 18F-FDG uptake especially in the colon is associated with malignant/premalignant events, however, focal gastric uptake is not effective in differentiating malignant/premalignant lesions from benign lesions. Studies are needed for effective SUVmax values distinguish benign and malignant gastric lesions.

9.The Effect of Levetiracetam Therapy on Lipid Profile in Epileptic Children
İpek Dokurel Çetin, Meliha Demiral
doi: 10.4274/anatoljmed.2022.49765  Pages 342 - 348 (70 accesses)
Objective: The aim of this study was to evaluate the effect of levetiracetam (LEV) therapy on lipid metabolism in euthyroid nonobese epileptic children.
Methods: In this case-control study, we recruited 37 epileptic children receiving LEV monotherapy for at least 12 months and 54 healthy controls. Fasting blood samples were obtained for analyzing serum thyroid-stimulating hormone, free triiodothyronine (FT3), free thyroxine, total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, Triglyceride/HDL ratio, and transaminases at the administration.
Results: There were nonsignificant elevated concentrations of TC HDL, LDL, aspartate aminotransferase (AST) and alanine aminotransferase in epileptic children with LEV monotherapy relative to healthy controls (p=0.32, p=0.29, p=0.80, p=0.27, and p=0.44 respectively). Although all subjects were euthyroid, serum level of FT3 was significantly elevated in individuals with epilepsy compared with healthy controls (p<0.001). Among prepubertal epileptic children receiving LEV monotherapy, LDL, TC, and AST levels were significantly higher compared to pubertal ones (p=0.02, p=0.03, and p=0.018 respectively).
Conclusion: Epileptic children who were treated with LEV monotherapy are susceptible to lipid metabolism alterations. Although they have the protective effect of elevated HDL from cardiovascular disease, they are also slightly at risk of dyslipidemia resulting from elevated LDL and TC. Therefore, close monitoring of individual risk groups like prepubertal children and male sex for dyslipidemia-associated diseases is mandatory.

10.Risk Factors and Morbidity in Late-preterm Infants: A Comparison with Early-term and Full-term Infants
Aykut Eşki, Gökhan Ceylan, Ayşegül Zenciroğlu
doi: 10.4274/anatoljmed.2023.40799  Pages 349 - 356 (79 accesses)
Objective: Although late-preterm infants tend to be considered term infants, they are at risk for postnatal morbidities and mortality. We aimed to identify prenatal and obstetric risk factors with postnatal morbidity and mortality in late-preterm infants.
Methods: We conducted a retrospective study on late-preterm infants (340/7-366/7 weeks) and term infants (370/7-416/7) born in a tertiary hospital between January and December 2012. Term infants were classified as early- (370/7-386/7 weeks) and full-term infants (390/7-416/7 weeks). Data on demographic characteristics, risk factors, morbidity, and mortality were collected from medical records.
Results: There were 468 babies in the study, and 156 (33.3%) were late-preterm infants. Rates of maternal smoking, premature rupture of membranes, in vitro fertilization, and caesarian section were significantly higher in late-preterm infants than in full-term infants. Compared to full-term infants, admission to the intensive care unit was more common in late-preterm and early-term infants (11.9 and 1.6 times, respectively). Transient tachypnea of the newborn, pneumonia, hypocalcemia, hypoglycemia, feeding problems, sepsis, and indirect hyperbilirubinemia was statistically more frequent in late-preterm than early-term and full-term infants. Late-preterm infants (12.2%) had a higher rehospitalization rate after discharge than full-term infants (2.9%). While two late-preterm infants died, no death in early-and full-term infants. Conclusion: Late-preterm infants have an increased risk of respiratory, metabolic, gastrointestinal, and infectious problems, as well as higher rates of hospital readmissions and mortality. This study emphasizes the importance of obstetric decision-making when considering late-preterm delivery and the need to establish better strategies to improve the outcomes of these newborns.

11.Retrospective Evaluation of the Effect of Age and Obstetric History on Tubal Location in Tubal Ectopic Pregnancies
Osman Ökmen, Esin Kasap, İbrahim Gülhan, Hande İleri, Fırat Ökmen, Suna Yıldırım Karaca, Mehmet Özeren
doi: 10.4274/anatoljmed.2023.93685  Pages 357 - 361 (63 accesses)
Objective: Ectopic pregnancy is one of the most common early complications of pregnancy. It can cause severe morbidity and even mortality. We aimed to determine the relationship between maternal age, parity, and side of tubal ectopic pregnancy (TEP) in cases with a TEP that underwent surgery.
Methods: The present study included 241 patients who were diagnosed with TEP. The side of TEP was determined by laparotomy or laparoscopy. The patients were stratified according to their age as 20-24 years old, 25-29 years old, 30-34 years old, 35-39 years old and ≥40 years. Besides, the patients were subdivided based on parity as nullipara, primipara, and multipara.
Results: The tubal ectopic pregnancies were right-sided in 69.3% and left-sided in 30.7%. Right-sided localization was significantly more common than leftsided localization (p<0.001). When localization of tubal ectopic pregnancies was assessed according to age, it was found that tubal ectopic pregnancies in age groups of 30-34, 35-39, and ≥40 years were more commonly localized at the right tuba (p<0.001). In age groups of 20-24 and 25-29 years, no significant difference was found in ectopic tubal pregnancy localization.
Conclusion: When TEP localization was assessed according to parity, it was found that tubal ectopic pregnancies were more commonly localized at the right tuba in primary and multipara groups.

12.Modeling the Earliest Stages of Gliomagenesis Using Human iPSC-derived NPCs in A Three-dimensional Alginatebased Matrix
Burcu Ekinci, Tutku Yaraş, Yavuz Oktay
doi: 10.4274/anatoljmed.2023.27880  Pages 362 - 373 (65 accesses)
Objective: The development of gliomas is believed to be triggered by isocitrate dehydrogenase (IDH1/2) mutations, but there is limited information on how IDH1/2 mutations trigger gliogenesis. This is because studies over the years have often used patient humor samples, transformed cells, or normal stem cells with driver mutations to explore the early stages of glioma development. In this study, we constructed a model to understand the specific effects of IDH1-R132H mutation alone by preparing an alginate-based 3D culture with NPCs and hence sought to avoid the effects of other driver mutations.
Methods: Human induced pluripotent stem cells were differentiated into neural progenitor cells (NPCs). NPCs embedded in an alginate-based 3D matrix were incubated in neural progenitor medium for 1 day (day 0). Neural Progenitor Medium was then removed from the NPC-alginate beads and incubated for 14 days with conditioned media from immortalized human astrocytes (IHAs) that produced doxycycline-induced wild-type IDH1 and mutant IDH1. On day 14, IHA-conditioned media were replaced with Neural Progenitor Medium and incubated for 3 days (day 17). RNA was isolated from NPCs on days 0 and 17, and key genes [Tet methylcytosine dioxygenase 1 (TET1) and Mesenchyme Homeobox 2 (MEOX2)] previously reported to be altered in IDH1-mutant gliomas, were evaluated by RT-qPCR.
esults: Optimal alginate-based 3D culture conditions were established using NPCs. Expression of key genes was examined on days 0 and 17. In the NPCalginate bead 3D culture model, TET1 was upregulated and MEOX2 tended to be downregulated after exposure to IHA-IDH1-R132H conditioned medium.
Conclusion: We have developed a novel NPC-alginate bead 3D culture model for the first time in the literature. By recapitulating the earliest stages of gliomagenesis, this model will allow the study of the effects of the IDH1-R132H mutation without confounding the effects of the other mutations.

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13.2023 Referee Index

Page E1 (39 accesses)
Abstract |Full Text PDF

14.2023 Author Index

Pages E2 - E4 (38 accesses)
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15.2023 Subject Index

Pages E5 - E7 (35 accesses)
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