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Volume : 52 Issue : 1 Year : 2024

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 52 (1)
Volume: 52  Issue: 1 - 2021
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ORIGINAL RESEARCH
2.Comparing the first trimester and second trimester fifty grams oral glucose tolerance test values in gestational diabetes mellitus
Hasan Turan, Zafer Bütün, Sinan Erdoğan, Ebru Çöğendez, Erdal Kaya
doi: 10.14744/zkmj.2021.48278  Pages 1 - 9
INTRODUCTION: The present study aimed to assess the results of pregnant women who have been applied a 50 g oral glucose tolerance test (OGTT) in the first and second trimesters and investigate this method’s role in the diagnosis of gestational diabetes mellitus (GDM) and risk factors associated with this disease.
METHODS: This retrospective study was performed on 153 pregnant women who were admitted to our hospital’s antenatal clinics between March 2011 and August 2011. Fifty grams OGTT was applied to the same pregnant women both in the 1st trimester (between 8th and 14th weeks) and second trimester (between 24th and 28th weeks); values of the test results were then compared. A 100 g OGTT diagnostic test was performed on those with a 50 g OGTT value of ≥140 mg/dl in both trimesters. The study patients were divided into two groups as non-GDM and GDM based on venous plasma glucose values measured 1 h after 50 g of oral glucose load given. The non-GDM group consisted of those with plasma glucose levels <140 mg/ dl and plasma glucose levels between 140 mg/dl and 200mg/dl, GDM group plasma glucose levels ≥200 mg/dl. First trimester and second-trimester OGTT values and possible risk factors for GDM (age, gravida, parity, number of abortions, smoking, a previous GDM history, etc.) were compared between non-GDM and GDM groups.
RESULTS: GDM, diagnosed in 4.5% (7) in the first trimester (between 8th and 14th weeks) and 6.5% (10) second trimester, was detected in 11% (17) of 153 pregnant women in the present study. GDM, diagnosed in 41.2% (7 patients) in the first trimester and 58.8% (10 patients) second trimester, was found with a higher rate in pregnant women over 30 years (p=0.000 <0.05). The mean fasting blood glucose (FBG) level was 96 mg/dl in the GDM group and 83 mg/dl in the non-GDM group, with a statistically significant difference, which existed (p<0.05). The mean 50 g OGTT value was 170 mg/ dl in pregnant women diagnosed with GDM in the first trimester, and it was 140 mg/dl in those diagnosed in the second trimester, with this difference was considered statistically different (p<0.05). Age, parity, a family history of DM, FBG, a previous GDM history, gravida, a previous macrosomia history, and a previous history of preeclampsia
were determined as risk factors that significantly increase the risk of GDM (p<0.05). The half of patients was diagnosed with GDM in the early period of pregnancy. In the present study, 41.2% of cases were diagnosed in the first trimester and 58.8% in the second trimester. In general, the patients diagnosed in the first trimester were those being under risk in terms of GDM. According to the present study, it is recommended that the pregnant women should be scanned for GDM in the early period.
DISCUSSION AND CONCLUSION: With screening tests to be applied to risky groups in early pregnancy, a significant number of cases with GDM recently be detected on time. Thereby, maternal and fetal morbidity and mortality rates might be considerably reduced thanks to providing proper treatments and regular monitoring. Furthermore, for obtaining specific data concerning the factors with potential influence on the risk of GDM, further studies on this topic need to be performed.

3.The value of measurement of vaginal fluid creatinine and beta-human chorionic gonadotropin in the diagnosis of premature rupture of membranes
Zafer Bütün, Gokhan Unver, Masum Kayapınar, Gokalp Senol, Kamuran Suman
doi: 10.14744/zkmj.2021.24572  Pages 10 - 15
INTRODUCTION: The purpose of the present study is to evaluate β-human chorionic gonadotropin (β-hCG) and creatinine levels in the vaginal fluid regarding to diagnosis of premature rupture of membranes (PROM).
METHODS: This study was conducted on 150 pregnant women in the third trimester (28–40 weeks). The patients were grouped as: (1) PPROM group (75 cases) and (2) intact membranes as control group (75 cases). Three milliliters of sterile normal saline were inserted into the posterior fornix of the vagina and then vaginal fluid was aspirated. Creatinine and β-hCG levels in the vaginal fluid were measured β-hCG and creatinine levels were compared between the two groups.
RESULTS: The mean vaginal fluid level in Groups 1 and 2 was 0.60±0.72 (0.37) and 0.22±0.11 (0.2) for creatinine and β-hCG which was positive in 411.69±605.65 (146) and 12.71±24.63 (3.9), respectively. There was a statistically significant difference regarding to mean creatinine and β-hCG levels between two groups (p<0.001). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were all 66.67%, 96%, 94.3%, 74.3%, and 81.3% for creatinine and 94.6%, 82.6%, 84.52%, 93.94%, and 88.67% for β-hCG in detecting PROM with a cutoff value of 0.21 mg/dl for creatinine and 16 mIU/ml for β-hCG.
DISCUSSION AND CONCLUSION: Measuring of β-hCG level in vaginal fluid is accurate, cheap, and simple methods in the diagnosis of PROM. Furthermore, measuring of creatinine level is a simple and accurate method with a lower sensitivity and accuracy than for β-hCG.

4.Prenatal diagnosis and management of hypoplastic left heart syndrome: Single center results
Yunus Emre Purut, Gurcan Turkyilmaz
doi: 10.14744/zkmj.2021.50479  Pages 16 - 20
INTRODUCTION: Hypoplastic left heart syndrome (HLHS) is the most common reason for neonatal deaths among congenital heart defects. Numerous studies showed that prenatal diagnosis improves prognosis. We aimed to review the prenatal assessment of associated extracardiac anomalies, postnatal outcomes, and surgical management in cases of HLHS that were detected in our center.
METHODS: The records of patients diagnosed with HLHS evaluated between March 2017 and April 2020. A detailed anatomy scan was performed, and karyotype analysis was recommended to all patients. Due to poor perinatal prognosis, termination of pregnancy (TOP) was offered an option to families. Serial ultrasonographic examinations every 2–4 weeks. Postnatal echocardiography was performed, and the prenatal diagnosis was confirmed in all offspring. Surgical outcomes were recorded.
RESULTS: Sixteen patients were recruited in our study. The mean gestational age at diagnosis was 20.2±5.1 weeks. About 68.7% of cases were defined as classical type HLHS, and the remaining 31.3% were determined as variant type HLHS. TOP was performed in 9 (56.7%) patients. The mean follow-up interval was 16.4±4.7 months. Urge septostomy was performed in 2 (28.5%) cases after birth due to foramen ovale restriction. Three (42.8%) cases died before the first operation. Norwood procedure was performed in 4 (57.1%) cases. Two cases died after this operation. Glenn shunt and Fontan procedure were performed in the remaining two offspring. The total survival rate was 28.5%.
DISCUSSION AND CONCLUSION: HLHS has high perinatal morbidity and mortality. Prenatal diagnosis allows the family for the fate of pregnancy and planned delivery in a tertiary center.

5.Validity and reliability of the Turkish version of the Birth Experiences Questionnaire
Fadime Bayrı Bingöl, Meltem Demirgöz Bal, Melike Dişsiz, Sümeyye Tokat, Melek Işık
doi: 10.14744/zkmj.2021.73645  Pages 21 - 26
INTRODUCTION: The aim of this study was to examine the validity and reliability of the Turkish version of the Birth Experiences Questionnaire.
METHODS: This methodological study was carried out with 110 couple who were admitted to a in Istanbul between January and December 2019. This research is a methodological study. This study was conducted with 110 couple who gave birth in a public hospital in Istanbul between January and December 2019. The data of the study were obtained using Personal Information Form and Turkish version of Birth Experiences Questionnaire. Birth Experiences Questionnaire measurements were tested with validity and reliability analyzes. For this purpose, validity analysis of data; scope validity index, exploratory factor analysis, confirmatory factor analysis (CFA), reliability analysis; Pearson moment product correlation and Cronbach Alpha reliability coefficient tests were used. In the evaluation of data, t-test, correlation analysis, Cronbach α analysis, and CFA were used.
RESULTS: It is a 10-item self-rating scale. To assess the consistency of the questionnaire overtime, test-retest measurement was performed with an interval of 1 day. As a result, no difference was found between the mean scores (p>0.05). In the analysis conducted for the internal consistency in the reliability study of the Birth Experiences Questionnaire, the Cronbach alpha reliability coefficient all scales was determined for all scales as ∝=0.78 for mothers and ∝=0.86 for fathers.
DISCUSSION AND CONCLUSION: In this study, it was shown that the Turkish version of the scale was valid and reliable.

6.Five years outcomes of hysteroscopy experience in a tertiary center
Burak Sezgin, Melike Nur Akın, Eren Akbaba, Ercan Saruhan
doi: 10.14744/zkmj.2019.801519  Pages 27 - 31
INTRODUCTION: We aimed to document our hysteroscopy (HS) experience for a period of 5 years in an academic hospital.
METHODS: Data from patients who underwent HS for any indication were retrospectively analyzed. The clinical and histopathological outcomes of patients with diagnostic or operative HS were documented.
RESULTS: The mean age of 202 patients included in the study was 42.83±9.58 years, their mean gravidy was 2.67±1.29, and their mean parity was 2.04±0.95. One hundred and sixty-two (80.2%) of the patients were at premenopausal period and 40 (19.8%) of them were at postmenopausal period. The most common comorbidities detected in patients were hypertension (9.4%), diabetes mellitus (4.5%), thyroid disease (4%), and breast cancer (3.5%), respectively. The mean pre-operative endometrial thickness was 12.80±6.10 mm. One hundred and thirty-five patients underwent saline infusion sonohysterography (SIS) procedure before HS, and a mass like lesion in the uterine cavity was detected in 97.8% of them. The average largest diameter of these intracavitary masses detected was 13.72±6.21 mm. Seven (3.5%) of all patients needed HS again. The most common indications for HS were menometrorrhagia (54.5%), polymenorrhea (14.4%), postmenopausal bleeding (10.9%), and infertility (9.4%). As a complication, uterine perforation was detected in 1 (0.5%) of cases and excessive bleeding in 2 (1%) of them. The most common localization of the masses in the uterine cavity was fundus (43.4%). As a result of histopathological examination, endometrial polyps were reported in 59 cases (70.3%) and myoma uteri in 21 (9.4%) cases.
DISCUSSION AND CONCLUSION: The most common reason for HS in our clinic was endometrial polyp. The most common symptom and surgical intervention were determined as menometrorrhagia and resection of polyp, respectively. In the detection of intracavitary lesions, the use of SIS before HS was a common procedure. Our complication rate was found to be low in line with the literature.

7.The Evaluation of Children with Cerebral Palsy Admitted to the Pediatric Neurology Outpatient Department
Handan Hakyemez Toptan, Sabiha Paktuna Keskin
doi: 10.14744/zkmj.2021.64935  Pages 32 - 37
INTRODUCTION: Cerebral palsy (CP) is a neurological condition that occurs as a result of non-progressive damage in the immature brain and is characterized by impairment of muscle tone and posture. This study aims to evaluate the risk factors and imaging findings of patients with CP.
METHODS: Medical records of patients with CP at the Pediatric Neurology Clinic of Cerrahpasa Medical School were evaluated retrospectively. Demographical and clinical characteristics were collected from medical records: gestational age, birth weight, intrauterine growth retardation (IUGR), delivery mode, type of CP, risk factors, accompanying diseases, computed tomography (CT), magnetic resonance imaging (MRI), and electroencephalography (EEG) findings were recorded.
RESULTS: A totally of 169 patients were enrolled in the study. The mean age at diagnosis was 27.3±26.1 months. One hundred eight (66.2%) patient were term and 55 (33.7%) were preterm. The delivery mode was vaginally in 99 (58.6%) cases and cesarean section in 70 (40.4%) cases. Ninety-six cases (56.8%) were male and 73 (43.2%) were female. Birth weights were <2500 g in 59 cases (34.9%) and 2500-4500 g in 110 cases (65%). The types of CP were spastic (n=144, 86%), dyskinetic (n=13, 7.7%), mixed (n=6, 3.6%), and ataxic-hypotonic type (n=5, 3%). In subgroup analysis 65 (38.5%) cases were quadriparetic, 43 (25.6%) cases were diplegic, 35 (20.7%) cases were hemiparetic, and 2 (1.2%) cases were monoparetic. The reasons for CP were asphyxia (n=99, 58.9%), low birth weight (n=61, 36.1%), prematurity (n=55, 32.5%), hyperbilirubinemia (n=16, 9.5%), meningitis (n=7, 4.1%), intracranial vascular processes (n=7, 4.2%), sepsis (n=6, 3.6%), hydrocephalus (n=5, 3%), genetic anomalies (n=5, 3%), and hypoglycemia (n=1, 0.6%). No risk factors could be determined in eight (4.7%) cases. Imaging techniques (CT and/or MRI) showed encephalomalacia in 45 (26.6%) cases which was considered as the main finding of hypoxic-ischemic encephalopathy (HIE). Imaging results of 15 (8.9%) patients were normal.
DISCUSSION AND CONCLUSION: This study results showed that asphyxia, low birth weight, and prematurity are the main reasons for the development of CP. Encephalomalacia is the most common imaging finding, but imaging may be also normal in some patients with CP.



8.Turkish adaptation of the postpartum hemorrhage-specific self-efficacy scale: validity and reliability
Dilek Coşkuner Potur, Gülten Karahan Okuroğlu, Yeliz Dogan Merih
doi: 10.14744/zkmj.2021.47855  Pages 38 - 45
INTRODUCTION: The aim of the study is to define the validity and reliability of the Turkish version of postpartum hemorrhage-specific self-efficacy scale.
METHODS: The study was conducted in methodological type. The sample of the study consisted of 238 physicians, nurses, and midwives, working in the delivery room, postnatal, and birth emergency areas for at least 2 years. The data were collected by introductory information form, generalized self-efficacy scale, and postpartum hemorrhage-specific self-efficacy scale in February-December 2018. The structural validity of the scale was evaluated by exploratory factor analysis. In the context of reliability analyses, Cronbach’s alpha, the item-total score correlation and the parallel test methods were used.
RESULTS: According to the factor analysis results, it was found that the two-factor structure explained 69.38% of total variance and that item loads ranged between 0.31 and 0.88. Item total score correlations were found to be between 0.42 and 0.77. Cronbach’s alpha value was 0.92 for the whole scale. Positive and middle level correlation was found between both scales as a result of parallel testing (r=0.301; p=0.000). It was determined that the self-efficacy sub-dimension of the scale consisted of eight items and the collective efficacy sub-dimension of 13 items, and a total of 21 items. Fit indices were found to be at an acceptable level as a result of the confirmatory factor analysis (χ2/df=3.08, RMSEA=0.09, GFI=0.91, AGFI=0.77, IFI=0.92, CFI=0.92, NFI=0.89, RFI=0.87).
DISCUSSION AND CONCLUSION: The Turkish version of the Postpartum Hemorrhage-Specific Self-Efficacy Scale was found valid and reliable. The scale can be used to evaluate physicians, nurses, and midwives’ self-efficacy perception specific to postpartum hemorrhage.

CASE REPORT
9.Report of a pregnant woman with mosaic Turner syndrome
Yunus Emre Topdağı, Seray Kaya Topdağı, Emsal Pınar Topdağı Yılmaz, Ali İrfan Guzel
doi: 10.14744/zkmj.2021.38233  Pages 46 - 48
Spontaneous pregnancy in women with Turner syndrome is rare (5%) and relatively high risk. A number of methods to preserve fertility in such women have been discussed. Careful follow-up is required during these pregnancies due to the high incidence rates of neonatal, obstetric, maternal, and cardiovascular complications. A 39-year-old multigravid woman (G5, P3, A2) with mosaic Turner syndrome with a history of three spontaneous pregnancies and two miscarriages was evaluated at our clinic. The analysis showed mos 45,X [9]/46,XX [38] mosaic Turner syndrome. Her first and fourth pregnancies resulted in miscarriages during the first trimester. Here, we discuss a pregnant woman with mosaic Turner syndrome with unaffected fertility but with a history of spontaneous pregnancies/miscarriages, with reference to the current literature.

10.Recurrent pericarditis caused by familial Mediterranean fever: A case report
Ali Karaman, Doğan Nasır Binici
doi: 10.14744/zkmj.2021.85579  Pages 49 - 52
Familial Mediterranean fever (FMF) is characterized by clinically recurrent fever attacks and inflammation associated with serositis. The Mediterranean fever gene is found in 16p13.3 and its mutations are known to lead to FMF. Here, we present a patient with FMF and recurrent pericarditis who responded to colchicine treatment. Therefore, regular follow-up of FMF patients who are mutation carriers is important in terms of cardiovascular risk.

REVIEW ARTICLE
11.Approach to feeding problems in babies with cleft lip and/or palate
Fatih Sırıken, Arif Aktuğ Ertekin, Osman Enver Aydin, Abdullah Barış Akcan, Ender Ceylan, Gulden Pekcan
doi: 10.14744/zkmj.2021.13008  Pages 53 - 60
Cleft lip and/or palate is one of the most common craniofacial congenital anomalies and is most common in the orofacial region. The incidence of this congenital anomaly in newborn babies is around 15%. Although the pathogenesis of these congenital malformations is not fully known, there is evidence that both dietary and genetic factors play a role, and this evidence is increasing day by day. Children with cleft lip and/or palate may be malnourished after birth due to nutritional difficulties. Children with these deformities are often impaired in growth compared to healthy children. A multidisciplinary approach is mandatory for the evaluation of these babies. Feeding newborns with cleft lip and/or palate in the beginning is a major concern for parents. Nutritional interventions such as breastfeeding, modified bottles and/or nipple, occlusive pads and maternal counseling and support are needed, so this article aims to review some nutritional issues and adaptations in this regard.

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