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Volume : 49 Issue : 2 Year : 2022

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 49 (2)
Volume: 49  Issue: 2 - 2018
ORIGINAL RESEARCH
1.The RFC G80A Polymorphism in Children with Acute Lymphoblastic Leukemia and Its Correlation with MTHFR Polymorphisms
Dilara Fatma Akın, Ahmet Emin Kürekçi, Mehmet Nejat Akar
doi: 10.16948/zktipb.379688  Pages 180 - 183
INTRODUCTION: Folate metabolic pathway plays a significant role in leukemogenesis because of its necessity for nucleotide synthesis and DNA methylation. Folate deficiency causes DNA damage. Thus polymorphisms of folate-related genes may affect the susceptibility to childhood Acute Lymphoblastic Leukemia (ALL). MTHFR (Methylenetetrahydrofolate Reductase), DHFR (Dihydrofolate reductase), CBS (Cystathionine β-synthase), TYMS (Thymidylate Synthase) and RFC have an important role in folate pathway because of their activated variants modulate synthesis of DNA and levels of folate. In this study, we aimed to investigate whether polymorphisms in genes related to folate metabolic pathway influence the risk to childhood ALL.
METHODS: The patient groups who were diagnosed with 103 childhood ALL at Losante Children and adult Hospital were included to the study. RFC G80A and MTHFR genotyping was performed by RFLP (Restriction Fragment Length Polymorphism) analysis and Real Time-PCR.
RESULTS: No statistical difference was observed among the patient and control group according to results of genotype and allele frequencies. The association of RFC G80A and MTHFR polymorphisms was not statistically significantly.
DISCUSSION AND CONCLUSION: Our study displays also importance because of the first screening results to identify association with the RFC and MTHFR polymorphisms in Turkish patients with childhood ALL and determination of the frequency in Turkish population.

2.Comparision of Urodynamic Results of Patients Who Had Reduced Pelvic Organ Prolapse According to Position
Emin Erhan Dönmez, Selçuk Selçuk, Hasan Süt, Sevcan Arzu Arınkan, Çetin Çam
doi: 10.16948/zktipb.415708  Pages 184 - 187
INTRODUCTION: Detection of occult incontinence proportion inpatients who have pelvic organ prolapse quantitation system [POP-Q] stage II to IV with reducting of prolapse compartment.
METHODS: 2015.A total of 65 cases who had stage II to IV pelvic organ prolapse, patients with stage I prolapse were excluded. Occult incontinence rates was detected and urodynamic parameters were compared. Before the urodynamic study patients were answered the questionnaire about quality of life such as UDI-6, IIQ-7, PISQ-12 ve PQoL.
RESULTS: %55.4 ( n: 36) of the patients had stage II, %29.2 ( n: 19) of them hade stage III and %15.4 ( n: 10) of them had stage IV pelvic organ prolapsus. Four of women who had prolapse (%6.2) were also having evidant urinary incontinece.% 18.5 of patients had occult incontinence after reduction with speculum,and % 24.6 of patients had also occult urinary incontinence after passary reduction among the patients who hadn’t incontinece. But between this two group, there was not anystatistically significant difference in term of urodynamic parameters such as grup Pdet Qmax, Qmax, Qave, Qmax (liverpol), Qave ( liverpol),PVR ( p>0.05).And also between two groups there was not any statistically significant difference in terms of prolapse localization. Results of this questionnaire were similar with previous study,but there were not any statistically significant difference between reduction with speculum and pessary.
DISCUSSION AND CONCLUSION: Pelvic organ prolapse (POP) and urinary incontinence (UI) are common conditions.But patients who had serious prolapse have occult incontinence also. So Urodynamic testing is helpful when the diagnosis of urinary occult incontinence is unclea. Before prolapse surgery treatment patients should be evaluated in detail.

3.In Women who Apply for Postmenopausal Bleeding, is Endometrial Cytology Sufficient To Diagnose?
Dilşad Herkiloğlu, Mustafa Eroğlu, Sadık Şahin, Ahter Tayyar
doi: 10.16948/zktipb.416733  Pages 188 - 191
INTRODUCTION: Endometrial cancer is the most common invasive neoplasm of the female genital tract and its incidence has increased in recent years. There is no screening test for early detection of endometrium carcinoma and its precursors. To evaluate the safety and comparability of cytologic endometrial samples obtained with Uterobrush for the diagnosis of endometrial pathologies in women with postmenopausal bleeding in our study with endometrial biopsy.
METHODS: A total of 100 patients who were admitted to the gynecological policlinics of our hospital with postmenopausal bleeding between August 1, 2015 and April 1, 2017 were included in the study. Endoscopic and endometrial sampling were performed after local anesthesia, cytologic sampling, lithotomy position, and all cases after local anesthesia. Cytological sampling of endometrium was done by Uterobrush method. The brush was then taken to the solution for a liquid-based cytological examination. Endocervical and endometrial curettage was performed after dilatation.
RESULTS: Our study also evaluated the feasibility and reliability of endometrial cytology using the Uterobrush method. Postmenopausal bleeding was observed in 63% (31), thickening in endometrium (%) and intrauterine fluid in% (6) when 100 patients were evaluated in terms of USG findings and indications before the procedure. Brush cytology showed no (94) malignant cells, (3) atrophic cells, (2) ascus cells and% (1) HGSIL cells in the brush cytology. When brush cytology and probe curettage (pc) histopathological results were compared, there were no malignant cells in brush cytology in 2 patients who had PC end result of endometrial adenocarcinoma. Brush cytology was evaluated as an inactive endometrium of pc from 2 patients from ascus. The cytology, which is the predominant endometrium, was also seen as an inactive endometrium in PC.
DISCUSSION AND CONCLUSION: Uterobrush is a technique used to obtain endometrial cytological specimens. Histological examination is still used as the gold standard for investigating endometrial pathology. In our study, endometrial cytological evaluation of Uterobrush method using endocervical brush was found to be inadequate to diagnose endometrial pathologies and it was found to be transmitted to cervical cells during sampling. In the diagnosis of postmenopausal bleeding, probe curettage uterobrush is the preferred gold standard method.

4.Comparison of Fetal Ultrasonography and Fetal Magnetic Resonance Imaging for the Detection of Additional Anomalies In Cases of Fetal Ventriculomegaly
Vuslat Lale Bakır, A. Aktuğ Ertekin, Zeki Şahinoğlu, Nebiye Serra Sencer
doi: 10.16948/zktipb.417284  Pages 192 - 195
INTRODUCTION: To compare fetal US and fetal MRI techniques for the detection of additional findings in cases of fetal venticulomegaly diagnosed by antenatal US.
METHODS: 46 Patients diagnosed with ventriculomegaly by ultrasonography between May 2009 – April 2010 have been included in the study. Gestational (FETAL age mi demek gerek, tam terimi bilmiyorum?) age (GA) was between 21 and 35 weeks. MRI examination couldn’t be performed in 4 patients due to clostrophoby and 2 patients didn’t give consent for the procedure. Those 6 patients have been excluded from the study and the examination was carried in 40 patients. The ventriculomegaly was graded in 2 groups as mild (10-14 mm) or as severe (15 mm or higher). MRI has been performed in maximum 4 days following ultrasonography with a 1,5 T MRI unit (Sympony, Siemens, Erlangen, Germany), using a “phased array” body coil. The fetal anatomy was evaluated by the “Half-Fourier acquisition single-shot turbo spin-echo” (HASTE) sequence (TR: 4.4, TE: 64, flip angle: 150°, slice thickness: 6 mm, gap: 0.1 mm, matriks: 160x256, FOV: 350 mm) in three planes adjusted to the fetal position. The frequency of the patients where MRI and US results were in concordance and teh frequency of the patients where MRI provided additional diagnostic information were given by a confidence interval of 95%. Chi-square test (Yates) was used to compare the groups. The significance was evaluated at p<0.05.
RESULTS: Mild ventirculomegaly (10-14 mm) was detected in 28 patients (Group 1), and severe ventriculomegaly (>15 mm) was detected in 12 patients (Group II). MRI detected additional findings compared to ultrasonography in 7 of the 28 patients in Group I (25% [CI 95%; 0.11-0.45]) and 5 of the 12 patients in Group II (%42 [CI 95%; 0.15-0.72]), a total of 12 patients (30% [CI 95%; 0.16-0.46]). When 2 groups were compared for the additional findings provided by MRI, MRI detected more abnormalities in severe ventriculomegaly group (42%), however the difference with mild ventriculomegaly group (25%) was not statistically significant ( x² yates: 0.459, p: 0.498). MRI changed patient management in 4 patients in Group I (14% [95% CI; 0.09-0.34]) and 3 patients in Group II (25% [95% CI; 0.14-0.94]). In total, MRI changed patient management in 17% [95% CI; 0.13-0.41] of the patients.
DISCUSSION AND CONCLUSION: Our study demonstrated that, while US has a high accuracy in diagnosing ventriculomegaly, fetal MRI examination can provide additional findings to US, especially in detecting co-existing CNS abnormalities

5.Evaluation of Thyroid Functions After Hysterosalpingography Using Iohexol in Infertile Women
Meryem Kuru Pekcan, Ayşe Seval Erdinç, Aytekin Tokmak, Ali Irfan Güzel, Gülçin Yıldırım, Gülnur Özakşit, Yaprak Engin Üstün
doi: 10.16948/zktipb.394557  Pages 196 - 199
INTRODUCTION: To investigate the changes in serum free T3 (triiodothyronine), free T4 (thyroxine) and TSH levels before and after hysterosalpingography (HSG) using iohexol (Omnipaque ™), a water-soluble non-ionic radiopaque substance.
METHODS: This prospective study was conducted in 45 infertile euthyroid patients who applied to the infertility polyclinic of Zekai Tahir Burak Women’s Health Education and Research Hospital between January 2015 and March 2015. Patients with hepatic disease, renal insufficiency and acute infection, patients with thyroid disease and those using antithyroid drugs such as lithium, amiadarone and glucocorticoid were excluded from the study. Serum free T3, free T4 and TSH levels were measured before HSG and at 1 month after HSG in all patients whose menstruation was completed and who were shown not to be pregnant.
RESULTS: The mean age of the patients included in the study was calculated as 28.3 ± 5.5 (20-40). The free T3, free T4 and TSH levels before the procedure were 3,0 ± 0,4 pg / mL, 1,0 ± 0,2 ng / dL, 2,2 ± 1,5 mIU / mL, respectively, 3,1± 0.3 pg / mL, 0.9 ± 0.8 ng / dL, 1.9 ± 0.9 mIU / mL, respectively. While the decrease in free T4 and TSH levels was statistically significant (p = 0.016, p = 0.026), the decrease in free T3 was statistically insignificant (p = 0.083).
DISCUSSION AND CONCLUSION: Though the half-life is limited to a few minutes, changes in thyroid function occur in infertile women after HSG using iohexol. In these patients, thyroid dysfunction which may develop after the procedure should be kept in mind.

6.Retrospective Analysis of Acute Poisoning Cases in Pediatric Intensive Care Unit in Thrace Region
Ayşin Nalbantoğlu, Eda Güzel, Muhammet Demirkol, Nedim Samancı, Burçin Nalbantoğlu
doi: 10.16948/zktipb.359176  Pages 200 - 204
INTRODUCTION: The aim of this study is to determine the properties of intoxication cases in Thrace region that were followed-up and treated in Pediatric İntensive Care Unit (PICU) and to be a guide for precautions.
METHODS: Children who were hospitalised in PICU of the Namık Kemal University School of Medicine between January 2012 and August 2016 were included in the study.The necessary data were collected retrospectively by analysing the records of cases. Age, gender, poisoning effect, location and cause, application to hospital and treatment methods were evaluated. Data were evaluated using descriptive methods and chi-square test, statistical differences of p <0.05 were considered significant.
RESULTS: For the study, the files of 172 patients aged from 6 months to 18
years (mean 6.61 ± 5.36 years) were scanned; 113 (65.70 %) cases were female, 59 (34.30 %) were male. A high proportion (52 %) of intoxication cases were between 0 and 4 years of age. Most poisonings occurred at home (91.90 %) via the oral route (95.90 %). The season in which poisonings were most seen was summer. In 70.30 % of cases, the reason for intoxication was accidentally. 98 % of cases that were intoxicated as a result of a suicide attempt were girls. The most common substance for intoxication was drugs (78.60 %), followed by corrosives (10.80 %) and cleaning substances (3.80 %). Antidepressant drugs were the most common drug group (25.85 %) that caused intoxication. There was no report of mortality in those 172 acute childhood poisoning cases.
DISCUSSION AND CONCLUSION: The most frequent occurrence of poisonings in children between one and six years of age indicates how important it is for families to be trained. In our region, both accidental and suicidal poisonings were more common in girls. It is noteworthy that the poisonings that developed especially after the accident were seen more in girls in this region than in the literature. We believe that extensive research and training of families to prevent childhood poisoning will be effective in reducing mortality and morbidity.

7.Evaluation of Varicella and Its Complications
Cüneyt Uğur, Aysu Züleyha Say
doi: 10.16948/zktipb.359715  Pages 205 - 208
INTRODUCTION: The aim of this study is to evaluate retrospectively the varicella patients who applied to the outpatient clinic and were hospitalized in the service due to complications.
METHODS: In this study, the outpatient clinic registries of 676 varicella patients who applied to Zeynep Kamil Training and Research Hospital, Children’s Outpatient Clinic between January 2000 and January 2003; and the patient files of those who were hospitalized in the service were analyzed. Those applying to the outpatient clinic were registered in terms of age, gender, and seasonal distribution; and those hospitalized in the service, on the other hand, were recorded by being examined in terms of hospital admission rate, age, gender, seasonal distribution, average period of hospital stay, and type of complication.
RESULTS: It was found that the average age of 676 varicella patients applying to the patient clinic was 5.04±3.13 years; 53% were male and 47% were female; the seasonal distribution was as follows; spring (35.4%), summer (20.8%), fall (12.1%), and winter (31.7%). It was found that 5.8% (39) of the patients were hospitalized in the service because of the complication. The average age of patients hospitalized in the service was 2.08±1.93 years; 61.5% were male and 38.5% were female; the seasonal distribution was as follows: spring (30.8%), summer (23.1%), fall (12.8%), and winter (33.3%). It was found that the average period of hospital stay was 8.00±6.86 days. The most frequent reason for the stay was bronchopneumonia (43.6%); which was followed by secondary bacterial skin infection (15.4%) and febrile convulsion (10.3%).
DISCUSSION AND CONCLUSION: The varicella is generally benign, easily diagnosed clinically, the rate of patient hospitalized due to complication in the service is low, in patients who developed complication have not been observed severe morbidity and mortality have not been identified.

8.The Importance of Ki-67, p16, C-erb-B2, and Cyclin D1 Expressions in LSIL, HSIL and Cervical Squamous Cell Carcinoma Biopsies
Birgül Tok, Şafak Ersöz, Gülname Fındık Güvendi
doi: 10.16948/zktipb.377749  Pages 209 - 213
INTRODUCTION: The squamous cell carcinoma (SCC) of the cervix is the most common malignant tumor of gynecological cancers. Squamous intraepithelial lesions (SILs) are known as a preinvasive lesion. Due to problems in the grading of these lesions that are effective in the development of cervical cancer, immunohistochemical markers are reported to be useful in the differentiation of lesions. In this study, the expression and intensity of the staining pattern of Ki-67, p16, cyclin D1, and c-erb- B2 in HSIL and LSIL cases were investigated.
METHODS: 40 patients with SCC, 40 patients with low grade SIL (LSIL), and 40 patients with high grade SIL (HSIL) who were diagnosed in Department of Pathology of XXX University Medical Faculty between 2003-2011 years were included in this study. C-erb-B2, Ki-67, p16, and cyclin D1 expressions was investigated in the preparations of the patients.
RESULTS: C-erb-B2 in 4 cases with SCC (10%), in 6 cases with HSIL (15%), and in 2 cases with LSIL (5%) showed positive staining. There was no statistically significant difference between the three groups (p>0.05). However, in cases with SCC, a strong correlation between c-erb-B2 and the disease stage was observed (p<0.05, r = 0.891). Ki-67 expression was present in average 20% of LSIL cases, average 35% of cases of HSIL, and average 40% of SCC cases. The difference between groups was statistically significant (p<0.05) and due to LSIL. Nuclear staining of cyclin D1 was mainly observed in cases with LSIL, however, cytoplasmic staining was mainly observed in cases with HSIL and SCC. No statistically significant difference between groups was observed with cyclin D1 (p>0.05). p16 expression was found in 39 (97.5%) cases with HSIL, 12 cases (30%) with LSIL. The difference was statistically significant (p<0.05).
DISCUSSION AND CONCLUSION: In conclusion, c-erb-B2 and cyclin D1 expression is not useful in the differentiation of these lesions. However, the Ki-67 may be used to separate LSIL from HSIL and SCC. Also, p16 expression was concluded to be useful in the differentiation of HSIL and LSIL.

9.Characteristic of First Fetal Movement Maternal Perception and the Relationship with Pregnancy Outcomes at Term
Hatice Akkaya, Barış Büke
doi: 10.16948/zktipb.370481  Pages 214 - 217
INTRODUCTION: To investigate the relationship between properties of gestational period in which pregnant women feel their baby’s movements for the first time, and pregnancy outcomes at term
METHODS: This longitudinal prospective study conducted at a tertiary center between June 2016 and September 2016. Of all, 272 pregnant women who gave birth at our clinic, were given a questionnaire at the time of a routine follow-up visit between 12 and 25 gestational weeks and were evaluated their pregnancy outcomes.The patient cohort was divided into two groups according to the gestational week in which fetal movements were felt for the first time by the pregnant women and comparisons were made between the groups.
RESULTS: The gestational week in which fetal movements were felt for the first time by the pregnant women were affected by placental settlement, maternal educational levels, and routine coffee consumption.There were no statistically significant differences between two groups regarding to the time at birth, gender of baby, birth weight and lenght, mode of delivery, value of low 5 min APGAR score(<7), fetal distress for emergency ceserean delivery and admission of neonatal intensive care unit. We were found significant differences between the groups according to low 1 min APGAR score ( <7), increase postterm pregnancy, contact their care provider for decreased fetal movements and admission to the hospital due to non reassuring NST(p=0.043,p=0.001, p=0.001, p=0.002, respectively).
DISCUSSION AND CONCLUSION: In pregnant women who delayed perception of first fetal movements, there was a significant increase in worrying complaints for pregnant women and care providers during the advanced gestational weeks.But, delayed maternal perception of first fetal movements is not associated with increased adverse pregnancy outcomes.

10.Ultrasonography and Hysterosalphynography Reliable in the Diagnosis of Hydrosalpinx?
Dilşad Herkiloğlu, Canan Kabaca
doi: 10.16948/zktipb.416720  Pages 218 - 222
INTRODUCTION: Although the first step evaluation of infertile patients with uterine cavity and fallopian tubes is ultrasonography (USG), hysterosalpingography (HSG) is widely used because it is cheap, easily accessible and easy to interpret, although other advanced and effective methods are available at the next stage. In our study, we aimed to evaluate the correlation of HSG and USG with laparoscopy of patients with hydrosalpinx presumptive diagnosis and to show whether HSG and USG are superior to each other in hyphrosalpinx diagnosis.
METHODS: Between August 1, 2015 and April 1, 2017, 48 patients who were admitted to our obstetric gynecology out patient clinic for infertility, or who underwent hydrosalpinx in USG were included in the study.All patients underwent laparoscopy under general anesthesia. Laparoscopy was used to evaluate the incidence of free methylene blue in both tuba. Correlation of HSG or USG result with laparoscopy result was assessed as false diagnosis of HSG or USG. In the case of pathological findings on laparoscopy, HSG or USG diagnosis was accepted correctly.
RESULTS: Of the 48 patients, 30 were primer infertile 18 were secondary to infertile. 26 patients were considered hydrosalpinx with HSG. Hydrosalpinx was confirmed in 15 (57.7%) of the patients after laparoscopy. Twenty-five patients underwent laparoscopy with USG and hydrosalpinx anterior diagnosis. In 17 (68%) hydrosalpinx was confirmed. In 3 patients, both USG and HSG had hydrosalpinx. The correlation of USG findings with laparoscopy was evaluated in these patients. There was no statistically significant difference between the diagnostic accuracy of HSG (57.7%) and the diagnostic accuracy of USG (68%) (P = 0.638).
DISCUSSION AND CONCLUSION: USG and HSG, which are the first-line evaluations of infertility, can diagnose hydrosalpinx cheaply and easily.

CASE REPORT
11.Removal of An Intrauterine Device Migrated to the Bladder with Cystoscopy in the Second Trimester
Emin Erhan Dönmez, Hatice Dülek, Murat Özdamar, Gültekin Köse, Orhan Koca
doi: 10.16948/zktipb.390265  Pages 223 - 225
With this case study, we intended to discuss the patient management during pregnancy after the migration of an intrauterine device (IUD) to the bladder which is a rare complication of IUDs. A 20 year old 15 weeks pregnant woman with 3 a history of 3 vaginal births and 4 pregnancies presented to our outpatient clinic with complaints for recurring dysuria, hematuria, and difficulty in walking. It was found out that an IUD had been inserted in the patient 6 weeks after her second normal vaginal birth in 2013; and then the patient got pregnant for the third time and she was told that the IUD had fallen out and therefore she got pregnant again and then received infection treatment for recurring hematuria, dysuria and inguinal pain and that her complaints subsided after the third delivery but had similar complaints that emerged earlier in her fourth pregnancy. A single live fetus compatible with 15 weeks and echoes caused by a IUD in the bladder lumen were observed during the obstetric ultrasonography of the patient. IUD was removed with cystoscopy. Patients who have a history of IUD insertion and for whom no IUD was detected during their follow up examinations should be evaluated in detail and further examinations should be performed to localise the IUDs.Uterine perforation should be considered if IUDs cannot be viewed in the uterine cavity.

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