E-ISSN 2757-8062
Volume : 52 Issue : 2 Year : 2021

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Volume: 52  Issue: 2 - 2021
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2.Investigation of plasminogen activator inhibitor-1 4G/5G gen polymorphism in Turkish preeclamptic patients
Önder Tosun, Mahmut Erdemoğlu, Ebru Çöğendez
doi: 10.14744/zkmj.2021.87609  Pages 61 - 66
INTRODUCTION: The plasminogen activator inhibitor type-1 (PAI-1) is a genetic risk factor that plays a role in the pathogenesis of pre-eclampsia and elevated levels of PAI-1 may lead to an increased risk of thrombosis. At preent, there is considerable controversy about the association between PAI-1 gene polymorphism and preeclampsia. The aim of this study is to investigate whether the pattern of PAI-1 gene polymorphism is a useful marker for preeclampsia or not.
METHODS: Our study included 83 hypertensive pregnant women (64 preeclamptic women, 12 pregnant women with HELLP syndrome, and 7 eclamptic women) genotyped for PAI-1 gene polymorphism (4G/4G, 4G/5G, and 5G/5G) and 20 healthy pregnant women. The Chi square analysis was used to evaluate the differences in genotype and allele frequencies between hypertensive pregnant women and healthy controls.
RESULTS: The highest PAI-1 gene polymorphism rate was found in the hypertensive group and healthy controls in the 4G/5G allele distribution. No significant difference was determined between the hypertensive group and healthy controls regarding the distribution of PAI-1 4G/4G, 4G/5G, and 5G/5G polymorphic alleles.
DISCUSSION AND CONCLUSION: According to the results obtained from present study, we think that PAI-1 gene polymorphism does not contribute to individual differences for the sensitivity of preeclampsia development. However, prospective cohort studies with larger sample sizes are needed to clearly demonstrate the contribution of PAI-1 gene polymorphism to serious pregnancy complications such as preeclampsia.

3.Which vaginal cuff closure route produces better clinical results after laparoscopic hysterectomy? Laparoscopic or the vaginal route
Eren Akbaba
doi: 10.14744/zkmj.2021.06978  Pages 67 - 72
INTRODUCTION: The aim of this study was to compare the complications and clinical outcomes of laparoscopic closure of the vaginal cuff and cuff closure through the vaginal route after total laparoscopic hysterectomy (TLH).
METHODS: This retrospective study conducted from February 2012 to December 2021 involved a total of 362 patients who underwent TLH. Of these patients, 148 received vaginal cuff closure using no. 0 Vicryl™ (polyglactin 910), which is endoscopically absorbable, and 214 received vaginal cuff closure through the vaginal route using the same suture material. The gynecological examination findings 1 and 6 months after the operation were obtained from the electronic medical records of the postoperative treatment interventions and from the patients’ files. Together with the major complications that occurred, complications such as vaginal cuff dehiscence, hematoma, cuff cellulitis, granulation, spotting, vaginal discharge, and cuff prolapse were recorded.
RESULTS: The operation duration was found to be significantly shorter for the patients whose vaginal cuffs were sutured through the vaginal route than for the patients whose vaginal cuffs were endoscopically sutured (107.75±7.19 and 83.55±8.44, respectively; p<0.01). It was also found that laparoscopic suturing is more advantageous than suturing through the vaginal route in terms of the formation of vaginal cuff granulation, abnormal vaginal discharge, and abnormal mucosal band-shaped adhesion in the vaginal cuff.
DISCUSSION AND CONCLUSION: Laparoscopic suturing and knotting is a process that requires much experience and skill and that may lengthen the operation duration. However, the laparascopically closure of the vaginal cuff seems safer.

4.PET/CT dilemma in para-aortic lymph node assessment in locally advanced cervical cancer?
Mehmet Sait Bakır, Özer Birge, Ceyda Karadağ, Hasan Aykut Tuncer, Selen Doğan, Tayup Şimşek
doi: 10.14744/zkmj.2021.70299  Pages 73 - 77
INTRODUCTION: We aimed to discuss the relationship between the maximum standardized uptake value (SUVmax), which is the degree of involvement obtained in the radiopharmaceutical 18-Fluor-labeled glucose-utilized positron emission tomography-computed tomography (PET-CT), which is widely used in locally advanced cervical cancer, and para-aortic lymph node positivity as a result of histopathology in the light of the literature.
METHODS: The pre-operative PET-CT results of 66 patients who had been examined and treated for locally advanced (Stage IB3-IVA) cervical cancer between 2015 and 2020 were retrospectively examined and the relationship between the SUVmax values and para-aortic lymph node positivity in the histopathology results was evaluated. Patients with SUVmax 4≤ in PET-CT were accepted to have paraaortic lymph node involvement. In terms of para-aortic lymph involvement, a cross tabulation was created with PET-CT results and the final pathology, which is the gold standard, and the sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated.
RESULTS: The mean age of 66 patients included in our study was 48.2±13.2 years. The majority of our patients were at stage 1B3 (36.4%), while eight were at stage 3C2P. While para-aortic evaluation was performed through the laparoscopic method in 36 (54.5%) patients, it was performed by laparotomy in the remaining 30 (45.5%) patients. When the complaints of the patients were assessed, it was seen that the highest rate was that of post-coital bleeding in 32 patients (48.5%) and pelvic pain was observed in two patients (3%). The mean body mass index (BMI) was 22.69±4.14 and the squamous type was the most common in 44 patients (66.7%) in terms of histopathological typing. When we evaluated the results of 66 patients, the prevalence rate was around 12% and when we compared the SUVmax uptake rates found in PET-CT, which we used as a new diagnostic test with the pathology results, which is our gold standard test, the sensitivity and specificity rates were 50% and 48%, respectively. The PPV, the NPV, and accuracy were calculated as 11.7%, 87.5%, and 48.8%, respectively.
DISCUSSION AND CONCLUSION: Considering the high risk of para-aortic lymph node metastasis in locally advanced cervical cancer through assessment of the high SUVmax values in PETCT, it is necessary to confirm the status of the para-aortic lymph node with minimally invasive surgery in the foreground by experienced surgeons.

5.Evaluation of the relationship between method of delivery and breastfeeding characteristics
Feyza Ustabaş Kahraman, Beyza Maşlak, Selçuk Uzuner
doi: 10.14744/zkmj.2021.25582  Pages 78 - 81
INTRODUCTION: Many factors affect breastfeeding such as maternal method of delivery. The objective of this study was to evaluate the relationship between delivery method and breastfeeding characteristics.
METHODS: This study was conducted between January and May 2019. A total of 210 mothers were analyzed who were registered in the Child Health and Diseases Outpatient Clinic and were still breastfeeding at the time of enrollment. A 28-item questionnaire survey was administered to the participants regarding their family’s socio-demographic characteristics, delivery method, and breastfeeding characteristics.
RESULTS: Of the participants, 79 (37.6%) and 131 (62.4%) gave birth by vaginal delivery (VD) and by cesarean delivery (CD), respectively. A total of 55 (69.6%) mothers had VD breastfed their baby within the first ½ h of birth. The difference between the time of initial breastfeeding and the delivery method was statistically significant (p<0.001). A significantly higher proportion of babies born by VD (94.9%) received breast milk as their first food than babies born by CD (p<0.001). Moreover, significantly higher proportion of mothers who had VD exclusively breastfed their baby at 6 months than mothers who had CD (p<0.001).
DISCUSSION AND CONCLUSION: This study found that the delivery method has a significant effect on breastfeeding characteristics, such as the time of initial breastfeeding and exclusive breastfeeding.

6.The role of functional platelet indices in dietary monitoring of children with celiac disease
Nevzat Aykut Bayrak, Burcu Volkan
doi: 10.14744/zkmj.2021.57855  Pages 82 - 85
INTRODUCTION: Determining the value of platelet count, mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) on histologic disease stage and compliance to gluten-free diet (GFD) in children with celiac disease (CD).
METHODS: Children diagnosed as CD and healthy subjects were recruited. CD patients were classified into two groups: Newly diagnosed and on GFD for over 1 year. CD patients on GFD were further divided into two groups according to their dietary adherence determined by anti tissue transglutaminase IgA levels. Samples for complete blood count were obtained from all participants.
RESULTS: A total of 236 CD patients (60 newly diagnosed, 83 with good GFD adherence, and 93 with poor GFD adherence, mean age: 11±3.9 years, 59.3% female) and 92 healthy subjects (mean age: 10.7±3.8 years, 52.2% female) were studied. Platelets, MPV, PCT, and PDW values of newly diagnosed CD and poor GFD adherence cases were statistically similar (p>0.05) while they were statistically higher than the controls and good GFD adherents (p<0.01). In ROC analysis, MPV had the highest area under the curve (0.758). The sensitivity and the specificity of MPV were 70.3% and 71.7%, respectively, for the cutoff value of 8.65 fL. Only PCT was found correlated with modified Marsh stage in newly diagnosed CD patients (r2: 0.302, p<0.05).
DISCUSSION AND CONCLUSION: This is the first report about platelet functions in children with CD. Functional platelet indices, especially MPV and PCT, would be a promising tool for indirect determination of GFD adherence and villous atrophy stage, respectively, at a low cost compared to other modalities.

7.Management of adnexal masses recognized incidentally during the cesarean: Our 5 years only central experience
Özlem Gül, Hilmi Baha Oral
doi: 10.14744/zkmj.2021.80947  Pages 86 - 89
INTRODUCTION: The objective of the study was to review our approach to adnexal masses detected incidentally during cesarean section and the data in the literature.
METHODS: This study was carried out by retrospectively scanning the files of patients who delivered by cesarean section between January 2015 and February 2020 in Süleyman Demirel University Faculty of Medicine Gynecology and Obstetrics Clinic. Patients with adnexal mass found in pre-operative examinations were excluded from the study. A total of 111 patients were included in the study.
RESULTS: January 2015–February 2020 in our hospital between 3700 cesarean deliveries was realized one of them in their 111 (3% of cesarean births); adnexal mass was detected during cesarean section. Main patient age was 32.26±6.03 (18–43) and the mean pregnancy number was 1.95±1.07 (1–6). Cephalopelvic disproportion is the most common (32.4%) cesarean indication; previous cesarean (21.6%) was followed up in the second frequency. Mean week of gestation performed by cesarean was 37.09±2.39. The mean adnexal mass size was 2.77±1.73 (1–10 cm). Fifty (45.1%) of the adnexal masses were observed in the right adnexal area, 55 (49.5%) in the left adnexal area, and 6 (5.4%) were followed them bilaterally. While cyst excision was performed in 110 patients, oophorectomy was performed in one patient. Pathology of 1 (0.9%) patient was reported as malignant.
DISCUSSION AND CONCLUSION: In pregnant women in the first trimester, obstetric ultrasonography performed routinely since both adnexal and should be examined in detail. Pelvic masses determined dimensions during cesarean section increases, whereas above 5 cm, especially torsion, hemorrhage or rupture must be removed because they have a risk of malignancy development.

8.An evaluation of depression levels in asthmatic children and their mothers during the course of the disease
Nilüfer Çetiner, Müferet Ergüven, Elif Yüksel Karatoprak, Hasan Hüseyin Mutlu
doi: 10.14744/zkmj.2021.70037  Pages 90 - 95
INTRODUCTION: Asthma, which has gradually increased in children in recent years, imposes limitations on their development from various perspectives. This study was planned to investigate whether asthma, a chronic illness, causes depression in children and their mothers, and to provide psychological support if necessary.
METHODS: Two hundred and fifty asthmatic children randomly selected from children diagnosed with asthma, aged between 6 and 14 years, and under follow-up for at least 6 months, together with their mothers, were included in the study. One hundred and twenty-five volunteer children from the same age group admitted to the general pediatric clinic, and their mothers, were included in the control group. The Children’s Depression Inventory was applied to the children under the guidance of a specialist psychologist, and the Beck Depression Inventory was administered to the mothers, and the data were then collected.
RESULTS: Statistically significant differences were found between the asthmatic children
and control group in terms of mean depression scale test for children scores
(p=0.01). When asthmatic children were evaluated among themselves, a significant
relationship was found between severity of asthma and frequency of depression. A
significant relationship was found between length of disease and frequency of depression
in asthmatic patients (p=0.01). Depression scores were higher in patients
diagnosed with asthma and under follow-up for 4 years or more than the 3–4 years
follow-up group. The frequency of depression was higher in the mothers of patients
than in the control group mothers (p=0.001).
DISCUSSION AND CONCLUSION: Every clinician involved in the treatment of asthma should be aware of the important role that psychological and social factors can play in children and their mothers. Psychological support should be provided for children and their mothers during the treatment of the disease.

9.Evaluation of etiological, laboratory, and anthropometric characteristics of patients treated with the diagnosis of precocious puberty
Semih Bolu, Fatih Işleyen, Ayşegül Danış
doi: 10.14744/zkmj.2021.10337  Pages 96 - 101
INTRODUCTION: This study aimed to determine the etiological distribution of patients treated for precocious puberty and to compare the results of gonadotropin-releasing hormone (GnRH) analog treatment with clinical and laboratory data during the administration and follow-up period.
METHODS: The files of patients treated with a diagnosis of precocious puberty between October 2016 and July 2019 in the pediatric endocrinology outpatient clinic were retrospectively analyzed.
RESULTS: While 39 (88.6%) of our patients with precocious puberty were female, five (11.4%) were male. True precocious puberty (TPP) was found in 42 patients (95.5%) and combined precocious puberty (CPP) in two patients (4.5%). While 37 (88.1%) of TPP patients were diagnosed with idiopathic precocious puberty, an organic cause was found in five patients. Both of the patients treated for CPP had late-onset congenital adrenal hyperplasia. The mean estimated adult height (EAH) before the treatment was 151.88±6.77 cm in our patients between the ages of 6 and 8 who were started on GnRH analog treatment with a diagnosis of TPP, while the mean EAH after treatment was 155.16±7.82 cm (p<0.001). An increase in body mass index-standard deviation score was found in patients who received triptorelin acetate treatment, but no statistically significant difference was found.
DISCUSSION AND CONCLUSION: Precocious puberty is more common in girls, and idiopathic TPP constitutes the majority of cases. GnRH analog treatment may contribute positively to the EAHs of girls with TPP, especially those younger than 8 years old.

10.Bilateral serous macular detachment as a complication of preeclampsia: A case report
Nazife Aşıkgarip, Özkan Kocamış, Emine Temel, Kemal Örnek
doi: 10.14744/zkmj.2021.16769  Pages 102 - 104
The objective of the study was to report a case of preeclamptic pregnant woman with bilateral serous macular detachment following cesarean section. This is a case report of a 29-year-old pregnant woman with bilateral serous macular detachment following cesarean section due to severe preeclampsia. The patient applied with a complaint of sudden vision blur in both eyes after an emergent cesarean delivery. Ophthalmologic examination revealed visual acuity of 1/10 on the right eye and 4/10 on the left eye. She had bilateral serous macular detachment. Within 10 days, visual acuity improved to 7/10 in both eyes. Optical coherence tomography revealed disappearance of the subretinal fluid with distribution of retinal photoreceptor layer in both eyes. Preeclampsia may lead to a transient serous macular detachment with visual sequelae.

11.Oncologic breast surgery of retroareolar breast cancer with racquet mammoplasty technique
Sami Acar, Erman Çiftçi
doi: 10.14744/zkmj.2021.00821  Pages 105 - 108
Oncoplastic breast surgery is increasingly preferred method of intervention today. Surgery allows for the removal of mass with clear borders while keeping the appearance within the acceptable standards. The success of breast conserving surgery is evident only after the radiotherapy received. Oncoplastic techniques that allow filling of the defect by shifting the breast tissue are the best option for the treatment. An invasive ductal carcinoma with dimensions of 23 mm × 21 mm, located in the retroareolar area on the upper outer quadrant of the right breast was detected in a 59-year-old postmenopausal female patient. Taking into the consideration of tumor-breast ratio, localization of tumor, the density of the breast and skin features, racquet mammoplasty technique was used. In today’s world, breast cancer is considered to be a chronic disease by the World Health Organization. In a well-staged condition, the surgical intervention must be applied with an acceptable cosmetic appearance.

12.Acute dystonia after domperidone use: A rare and an unexpected side effect
Salih Demirhan, Özlem Erdede, Rabia Gönül Sezer Yamanel
doi: 10.14744/zkmj.2021.73644  Pages 109 - 111
Domperidone is a dopamine receptor antagonist with gastrokinetic and anti-emetic effects. Domperidone is widely used worldwide as an anti emetic and in the treatment of gastroparesis and gastroesophageal reflux. Because domperidone does not readily cross the blood-brain barrier, central nervous system side effects are not expected. Herein, we reported a 12-year-old girl who presented with dystonia after domperidone usage. We present a 12-year-old girl with a 40 kg body weight who was admitted to our pediatric emergency department with numbness, stiffness, and twisting in the neck, hands, arms, and tingling in the legs and back. We administered 3 mg biperiden, an anticholinergic, through slow intravenous infusion. The patient’s dystonic reaction recovered 10 min after biperiden infusion. Based on our literature search, we presented one of the few acute dystonia cases after domperidone use in children. To the best of our knowledge, our case is the first case report in children who were successfully and rapidly treated with anticholinergic, biperiden.

13.Erratum: Correction of the Authors' List
Levent Yaşar, Süha Sönmez, Yakup Şensoy, Kadir Savan, Asiye Toklar, Osman Özyurt, Ziya Çebi, Fehmi Yazıcıoğlu, Mehmet Aygün, Sefa Kelekci
doi: 10.14744/zkmj.2021.13471  Page 112
Abstract | Full Text PDF

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