E-ISSN 2757-8062
Volume : 52 Issue : 3 Year : 2021

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 52 (3)
Volume: 52  Issue: 3 - 2021
1.Cover

Pages I - III

2.Contents

Page IV

3.Editorial Board

Pages V - VII

EDITORIAL
4.Call for emergency action to limit global temperature increases, restore biodiversity, and protect health Wealthy nations must do much more, much faster
Lukoye Atwoli, Abdullah H. Baqui, Thomas Benfield, Raffaella Bosurgi, Fion Godlee, Stephen Hancocks, Richard Horton, Laurie Laybourn-langton, Carlos Augusto Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, Marcel Olde Rikkert, Eric J. Rubin, Peush Sahni, Richard Smith, Nicholas J. Talley, Sue Turale, Damián Vázquez
doi: 10.14744/zkmj.2021.97658  Pages 113 - 115
Abstract | Full Text PDF

REVIEW ARTICLE
5.An overview of anaphylaxis in children
Nevin Cambaz Kurt
doi: 10.14744/zkmj.2021.60437  Pages 116 - 120
Anaphylaxis is an acute and life-threatening systemic hypersensitivity reaction. Anaphylaxis is an immunoglobulin (Ig) E-mediated reaction, Food allergy is the most common cause of anaphylaxis, followed by drugs. Patients with anaphylaxis commonly present with symptoms involving skin or mucous membranes, followed by respiratory and gastrointestinal symptoms. Epinephrine is the drug of choice for treating anaphylaxis. Patients and caregivers should be educated on the use of epinephrine auto injectors and symptoms of anaphylaxis.

ORIGINAL RESEARCH
6.Effects of topical povidone-Iodine on thyroid functıon in surgical newborns
Sırma Mine Tilev Erzurum, Ayşenur Celayir, Burcu Arı, Tuba Erdem Şit
doi: 10.14744/zkmj.2021.76258  Pages 121 - 126
INTRODUCTION: Excessive iodine exposure during the neonatal period can lead to neonatal hypothyroidism due to their thinner and more permeable nature of skin. This study was conducted to evaluate the effects of povidone-iodine on postoperative thyroid functions among surgical neonates.
METHODS: Surgical neonates with known preoperative and postoperative thyroid function tests who had been operated by our department between January 2014-2016 were included this study. The postoperative thyroid function tests of these neonates were obtained between postnatal 7-21th days. Preoperative and postoperative measurements of free Thyroxine 4 and Thyroid Stimulating Hormone levels were analyzed retrospectively.
RESULTS: Nineteen male and fourteen female surgical neonates were included in this study. Their mean gestational age and age at operation were 37weeks+1day and 10 days. Mean duration of hospitalization was 12.6 days and mean number of dressings per day during hospitalization was one. Mean preoperative and postoperative values of free Thyroxine 4 and Thyroid Stimulating Hormone were 1.12mIU/L, 1.14mIU/L, 6.1 mIU/L and 2.77mIU/L, respectively.
During the postoperative period, free Thyroxine 4 values mildly increased and Thyroid Stimulating Hormone levels decreased, however, all values remained within reference values. The change in Thyroid Stimulating Hormone levels between preoperative and postoperative periods was statistically significant. Patients did not require thyroid hormone replacement therapy.

DISCUSSION AND CONCLUSION: Although not necessitating hormone replacement therapy, the use of topical povidone iodine significantly and transiently affects the thyroid functions of surgical neonates due to transdermal iodine absorption.

7.Evaluation of blood pressures measured at the clinic and during exercise test in children
Nurdan Erol, Ilke Aktaş, Çiğdem Erol
doi: 10.14744/zkmj.2021.38991  Pages 127 - 131
INTRODUCTION: In pre-participation examinations, an exercise test is required in addition to normal examination in order to evaluate cardiorespiratory functions and ensure safety during exercise if complaints related to effort or risk factors in the patient’s personal and/or family history are observed. This study aimed to examine the blood pressure findings in clinical and exercise tests of children athletes who applied to our outpatient clinic.
METHODS: The histories, physical examinations, blood pressure values, electrocardiography and echocardiography findings, and exercise test data of the patients who applied to our polyclinic between 01.10.2018-30.09.2019 for pre-participation examinations have been evaluated retrospectively.
RESULTS: The study group consisted of 14 females and 36 males whose mean ages were 12.76±2.27 years and mean body mass index was 20.62±3.47. The electrocardiograms were normal. No cardiac dysfunctions were observed in echocardiographies. In exercise tests, the mean endurance time was 9.96±2.12 minutes, the maximum heart rate was 174.4±17.9/min, the maximum systolic blood pressure was 169.34±28.52 mmHg, the maximum diastolic blood pressure was 86.82±20.21 mmHg. The blood pressure of 16% cases were above 200 mmHg.
DISCUSSION AND CONCLUSION: In our study, exercise-induced hypertension was detected in some cases. The follow-up of these cases is important to determine future cardiovascular risks.

8.Seroprevalence of Varicella-Zoster in first trimester of pregnancy
Altuğ Semiz, Kenan Keskin
doi: 10.14744/zkmj.2021.41713  Pages 132 - 135
INTRODUCTION: : This study aims to evaluate the seroprevalence of VZV in pregnant women admitted to our hospital for pregnancy follow-up.
METHODS: : The results of the blood samples sent to the microbiology laboratory of xxxx xxxxxx xxxxxxxx with VZV IgG and VZV IgM requests from the pregnant women who applied to xxxx xxxxxx xxxxxx for pregnancy follow-up between January 1, 2012, and December 30, 2019, were examined. VZV IgG test VIDAS® system and VZV IgM test ELISA method were used in blood samples. Values <0.9 for VZV IgG were considered negative and vales >0.9 positive; values <10 for VZV IgM were considered negative and values >10 were considered positive.
RESULTS: 488 pregnant women were included in the study. The median maternal age was 31 years ( 19-45) and the median gestational week at which the sampling was performed was 7 weeks ( 5-9). VZV IgG positivity was detected in 265 pregnant women (54.3%) and VZV IgG negativity was detected in 223 pregnant women (35.7%). No VZV IgM positivity was detected in the samples taken.


DISCUSSION AND CONCLUSION: VZV IgG sensitivity was 54.3% in the scanned group. VZV screening during the first-trimester pregnancy examination will provide more accurate counseling during pregnancy even though VZV screening is not recommended during routine pregnancy follow-up. There will be an opportunity to vaccinate pregnant women who are susceptible after pregnancy.

9.Assessment of perinatal outcomes of pregnancies conceived by in vitro fertilization-intracytoplasmic sperm injection
Alper Kahraman, Fırat Tülek, Bülent Berker
doi: 10.14744/zkmj.2021.60590  Pages 136 - 141
INTRODUCTION: Objective of this study is to compare maternal and perinatal outcomes of singleton pregnancies obtained by IVF/ICSI treatment and spontaneously conceived singleton pregnancies.
METHODS: Patient records of women conceived by in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and spontaneously conceived women that delivered in Ankara University Department of Obstetrics and Gynecology after 24th gestational week and whom the postnatal follow-ups of the infants were conducted in Ankara University Department of Pediatrics were retrospectively evaluated. Study group consists of 180 women with singleton IVF/ICSI pregnancies were. Control group included 624 spontaneously conceived women with singleton pregnancies that gave birth within the selected study period.
RESULTS: Median maternal age of the IVF/ICSI group was found significantly higher than the control group(p=0,031). A significantly higher incidence of hypertensive complications in pregnancy was found in IVF/ICSI group(p=0,001). Incidence of gestational diabetes mellitus was found significantly higher in IVF/ICSI group(p<0,001). Cesarean section rates were significantly higher in IVF/ICSI group in comparison with spontaneously conceived pregnancies(p<0,001). Preterm delivery rate is significantly higher in IVF/ICSI group(p<0,001). Infants born by IVF/ICSI pregnancies were showed a significantly higher rate of neonatal intensive care unit requirement in comparison with infants born by spontaneously conceived pregnancies(p<0,001). However the statistical significance of the difference was observed to disappear after adjusting the data for gestational week at birth(p=0,161). Secondary sex ratio was found significantly lower in IVF/ICSI pregnancies(p=0,001).
DISCUSSION AND CONCLUSION: Singleton pregnancies conceived by IVF/ICSI presents higher risk for some adverse perinatal outcomes and should be followed accordingly.

10.Efficacy of transcutaneous posterior tibial nerve stimulation in women with an idiopathic overactive bladder
Ekin İlke Şen, Nalan Çapan, Gülşah Gula, Funda Güngör Uğurlucan, Cenk Yasa, Sina Esmaeilzadeh Arman, Ayşe Karan
doi: 10.14744/zkmj.2021.80106  Pages 142 - 146
INTRODUCTION: The aim of this study is to assess the efficacy of transcutaneous posterior tibial nerve stimulation (TTNS) in women with urge incontinence.
METHODS: The study included 20 patients with an idiopathic overactive bladder refractory to anticholinergic treatment. TTNS was applied to all patients on three days per week for eight weeks; each session lasted 30 minutes. Pelvic floor muscle strength, urinary frequency and the number of episodes of urge urinary incontinence were recorded before and after the treatment.
RESULTS: After 8 weeks of TTNS treatment, a statistically significant increase was found in pelvic floor muscle strength, assessed by digital palpation (p=0.008), whereas there was no significant improvement in perineometry values (p=0.118). Bladder diary assessment revealed that patients experienced a significant reduction in the average number of incontinence episodes and voiding frequency (p=0.003 and p=0.001, respectively). There were no adverse effects during the treatment.
DISCUSSION AND CONCLUSION: This study results showed that TTNS is an effective and well-tolerated treatment in women with an idiopathic overactive bladder who have not benefited from anticholinergic medications. Further studies need to be performed to determine a standardized treatment protocol and long-term efficacy.

11.Ectopic pelvic kidney: Prenatal diagnosis and management
Gürcan Türkyilmaz, Bilal Çetin
doi: 10.14744/zkmj.2021.21033  Pages 147 - 151
INTRODUCTION: Ectopic pelvic kidney (EPK) is one of the most frequent renal anomalies detected in newborns as 1 /500-700. Although it is generally asymptomatic, its association with recurrent urinary infections, vesicoureteral reflux, predisposition to stone formation and genital anomalies has been shown. This study aimed to present the prenatal findings and postnatal outcomes of cases diagnosed with unilateral EPK.
METHODS: Twelve cases were recruited for this study between January 2018-June 2020 in xxxxxxx. EPK diagnosis was achieved if the kidney was located in the pelvis, the separation of the kidney-specific cortex-medulla was present, and the renal pelvis was detected. EPK diagnosis was confirmed by renal USG in all cases postnatally. Long-term results of all cases were analyzed retrospectively from patients records. Statistical analysis was achieved by calculating the mean and standard deviation values with the SPSS 20 (Statistical Package for Social Sciences, Chicago, USA).
RESULTS: Mean gestational age at diagnosis week was 25.2 ± 4.2 weeks. Left EPK was detected in 7 (58.3%) and right EPK in 5 (41.7%) cases. Pelvis dilatation was detected in EPK in 2 (16.6%) cases and the kidney versus 3 (25%) fetuses. An additional structural anomaly was observed in 1 (8.3%) case. A genital anomaly was not observed in any case during the prenatal period. The mean follow-up interval was 11.2 ± 2.8 months. 7 (58.3%) were female, and 5 (41.7%) were male. Renal functions were normal in all cases. A total of 3 (25%) cases, including grade-1 vesicoureteral reflux in 1 case, recurrent urinary infection in 1 case, and hypospadias in 1 case, anomaly associated with EPK was detected.
DISCUSSION AND CONCLUSION: The presence of EPK should be investigated in all fetuses with an empty renal fossa. All cases should be followed up after delivery in terms of accompanying anomalies.

12.Anxiety, quality of life, eating behaviors, and sexual life in women with PCOS
Kemine Uzel, Paşa Uluğ, Tunay Kiremitli, Sevil Kiremitli, Gülfem Başol
doi: 10.14744/zkmj.2021.71501  Pages 152 - 159
INTRODUCTION: This study aimed to reveal the effects of polycystic ovary syndrome (PCOS) on quality of life, anxiety, eating behavior, and sexual functions, and the relationships or interactions of these factors with each other.
METHODS: This cross-sectional study was performed in women diagnosed with PCOS. Sexually active 54 participants (28 with PCOS + 26 control) aged 22-35 years applying to the gynecology outpatient clinics due to menstrual irregularities were included. The diagnosis of PCOS was made according to the Rotterdam 2003 criteria. Participants filled out data collection forms, including the Beck Anxiety Inventory (BAI), the Short Form-36 (SF-36) Health Survey, the Three-Factor Eating Questionnaire, and the Female Sexual Function Index. Laboratory findings were obtained from the hospital’s electronic patient registry.
RESULTS: The PCOS group’s BMI (29.6±7.1), was significantly higher than the control group (24.7±3.9), (p=0.004)). The PCOS group scores were significantly lower than the control group regarding the physical functionality (p=0.006), role limitations due to emotional problems (p=0.002), energy/fatigue (p=0.015), and emotional well-being (p=0.025) items of the short-form health survey. Additionally, BAI score was higher (p=0.001), and female sexual function index total score was lower (p=0,036) in the PCOS group. There were significant correlations between luteinizing hormone (LH) and role limitations due to emotional problems (r=0.547, p=0.003), uncontrolled eating (r=0.415, p=0.028), emotional eating (r=0.413, p=0.029), and body-mass index (r=0.487, p=0.009).
DISCUSSION AND CONCLUSION: PCOS can cause anxiety, decreased quality of life, and increased anxiety, but it does not affect eating disorders. LH levels should be taken into account for weight control in women with PCOS. Women with menstrual irregularities need support concerning anxiety, even if they don’t have PCOS.

CASE REPORT
13.External anal sphincter repair by the overlapping method in obstetric anal sphincter injury syndrome
Sami Acar, Erman Çiftçi, Filiz Akyüz
doi: 10.14744/zkmj.2021.82687  Pages 160 - 164
Introduction
Obstetric anal sphincter injuries (OASIS) are complications that occur during vaginal delivery. These injuries, also called third-and fourth-degree perineal tears, include the anal sphincter complex and, in more serious cases, the anal mucosa. OASIS contributes to short-term morbidities such as wound site problems and perineal pain. It is also the leading risk factor for upcoming loss of bowel control in women.
Case
Our study aimed to present the diagnosis and treatment process of our 36-year-old patient who had her first and second birth vaginally and developed OASIS in her third birth. After third vaginal delivery, an external sphincter injury was noticed, and surgery was performed at that time, which was not successful. About 9 months have been waited for surgical treatment to be applied to eliminate the problem. In the process, the patient's quality of life was negatively affected as a result of the procedure, as she changed underwear five times a day and used diapers.
Conclusion
For OASIS treatment, it is necessary to use the proper diagnostic methods, ensure appropriate conditions and the teamwork is required. Every vaginal delivery comes with a chance of perineal injury, and all measures should be taken to prevent it. Once it is detected, it is recommended to be treated surgically as soon as possible with the appropriate technique. If the conditions are not suitable, it should be postponed to a suitable time. It is adventegous to avoid the complications that may occur if the surgery is conducted by a surgeon with significant experience in the field.

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