E-ISSN 2757-8062
Volume : 52 Issue : 4 Year : 2022

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 52 (4)
Volume: 52  Issue: 4 - 2021
1.Frontmatters

Pages I - X

ORIGINAL RESEARCH
2.Serum endocan concentration in women with placenta accreta
Çiğdem Yayla Abide, İlter Yenidede, Çetin Kılıççı, Evrim Bostancı, Ahmet Eser, İsmail Dağ, Önder Tosun, Enis Özkaya
doi: 10.14744/zkmj.2021.15046  Pages 165 - 169
INTRODUCTION: Placenta accreta was shown to be associated with abnormal attachment, invasion, and penetration of the chorionic villi to the myometrium. Endocan was shown to have a significant role in the regulation of cell adhesion, inflammation, and tumor progression. The aim of this study was to investigate serum endocan levels in pregnant women with and without placenta accreta.
METHODS: This study was conducted on 27 pregnant women with placenta accreta, 27 pregnant with total placenta previa, and 27 healthy pregnant women matched for gestational age. Maternal levels of serum endocan were measured with the use of an enzyme-linked immunosorbent assay kit.
RESULTS: A significantly lower median level of endocan was detected in the group with placenta invasion compared to the other two groups (132.2 vs. 153.2 and 296.4). The differences among these three groups were statistically significant.
DISCUSSION AND CONCLUSION: These findings suggest a possible protective role of endocan in the pathogenesis of placental invasion. It may be utilized as a biomarker for the detection of placenta accreta during early pregnancy.

3.Evaluation of gestational trophoblastic diseases; 10 years’ experience in tertiary obstetric care center
İbrahim Kale, Cumhur Selçuk Topal
doi: 10.14744/zkmj.2021.04557  Pages 170 - 176
INTRODUCTION: The aim of this study is to review the demographic characteristics and clinical outcomes of patients diagnosed with gestational trophoblastic disease (GTD).
METHODS: Data of patients with histopathologically confirmed diagnosis of GTD between 2010 and 2020 were retrospectively reviewed from hospital records.
RESULTS: There were 94 partial hydatidiform mole (PHM), 61 complete hydatidiform mole (CHM), 23 exaggerated placental site (EPS), and 22 placental site nodule (PSN) cases with the prevalence of 0.18%, 0.12%, 0.045%, and 0.039%, respectively. As gestational trophoblastic neoplasia, 1 invasive mole, 1 choriocarcinoma, and 1 placental site trophoblastic tumor were detected. While the PHM group and the CHM group were similar in terms of obstetric history, the mean age and body mass index were lower in the CHM group (p=0.04, p=0.00, respectively). Mean platelet volume and plateletcrit levels were lower and neutrophil lymphocyte ratio was higher in CHM compared to PHM (p=0.00 p=0.02, p=0.00, respectively). At diagnosis, the serum β-hCG level was higher and the gestational week was earlier, and the rate of detecting molar pregnancy by ultrasound was higher in the CHM group than in the PHM group (p=0.00, p=0.02, p=0.00, respectively). The need for a second evacuation and methotrexate chemotherapy were higher in the CHM group than in the PHM (p=0.02, p=0.00, respectively). While molar pregnancy and EPS coexistence were diagnosed in four patients, no such coexistence was found in PSN.
DISCUSSION AND CONCLUSION: Compared to PHM, CHM, which is more common in young people, requires more second evacuation or methotrexate treatment, and ultrasonography seems to be more effective in diagnosis. Unlike PSN, EPS can be seen with molar pregnancies and is rarely a cause of postpartum hemorrhage.

4.Negative pressure wound therapy in gynecological oncology
Dilek Yüksel, Cihat Murat Alınca, Çiğdem Kılıç, Caner Çakır, Taner Turan, Gunsu Kimyon Cömert, Sevgi Koç, Nurettin Boran, Fulya Kayıkçıoğlu
doi: 10.14744/zkmj.2021.43760  Pages 177 - 182
INTRODUCTION: The aim of this study was to describe the clinical and surgical characteristics of patients who underwent surgery for gynecological cancer and were applied with negative pressure wound therapy (NPWT) for wound failure that developed postoperatively, and to investigate the effect of NPWT on wound healing.
METHODS: A retrospective analysis was made of patients treated with NPWT for wound failure at a single academic institution between 2010 and 2019. Patient demographic data, pre-operative and intraoperative information, and outcomes were extracted from the registry. The primary outcome was the effect of NPWT on complete wound healing.
RESULTS: The study included 20 patients who had undergone laparotomy for a gynecological malignancy and received NPWT due to wound failure. NPWT was applied to all patients in the post-operative period, to 10 after primary surgery, and to 10 patients after secondary laparotomy. The mean time to wound failure was 25±22 days and the mean duration of vacuum therapy was 18.9±17.2 days. NPWT was used in an outpatient setting for 4 (20%) patients. Complete wound recovery was obtained in 18 (90%) patients. No complications related to the use of NPWT were observed in any patient.
DISCUSSION AND CONCLUSION: In the post-operative period, NPWT can be used to accelerate wound healing and shorten the post-operative recovery time.

5.Comparison of outcomes of frozen-thawed transfer of day 5 blastocysts and day 6 blastocysts
Fırat Tülek, Alper Kahraman
doi: 10.14744/zkmj.2021.09326  Pages 183 - 187
INTRODUCTION: The aim of this study was to evaluate and compare the outcomes of frozen-thawed embryo transfer of blastocysts that were expanded at the 5th day of fertilization and blastocysts expanded at the 6th day of fertilization.
METHODS: Patients who underwent frozen-thawed embryo transfer cycles between 2012 and 2020 in a single infertility center were retrospectively evaluated. A total of 1814 women with frozen embryo transfers of day 5 blastocysts and 227 women with frozen embryo transfers of day 6 blastocysts were included in the study. Outcomes of embryo transfer cycles of day 5 and day 6 blastocysts were compared.
RESULTS: Cancellation rate in day 6 blastocyst transfer group was significantly higher than day 5 transfers (5.7% vs. 0.3%; p<0.001). Post-thaw embryo quality in day 5 blastocyst group was better than day 6 blastocyst group. Clinical pregnancy rates (34% vs. 16.7%), multiple pregnancy rates (3.9% vs. 0.9%) and live birth delivery rates (31.4% vs. 15.7%) in day 5 blastocyst transfer group were significantly higher (p<0.001, p<0.001 and p<0.001). Gestational ages at birth (37.15±3.23 weeks vs. 37.97±2.52 weeks; p=0.308) and mean birthweights of infants (3153.20±681.96 g vs. 3127.72±656.75 g; p=0.994) were similar among groups. Significantly increased number of miscarriages were observed in day 5 blastocyst group (5.3% vs. 1.8%; p=0.019).
DISCUSSION AND CONCLUSION: Clinical pregnancy and live birth delivery rates of frozen-thawed transfer of day 5 blastocysts are significantly higher in comparison to transfer of their day 6 counterparts.

6.Evaluation of the relationship between ocular surface symptoms and platelet-to-lymphocyte ratio in COVID-19 patients
Betül Önal Günay, Ahmet Kalkışım, Cenap Mahmut Esenülkü, Gökhan Çelik
doi: 10.14744/zkmj.2021.59489  Pages 188 - 192
INTRODUCTION: This study aims to evaluate ocular surface symptoms and their association with platelet-to-lymphocyte ratio (PLR) in patients who were clinically confirmed with coronavirus disease 2019 (COVID-19) using Ocular Surface Disease Index (OSDI) questionnaire.
METHODS: Thirty-five COVID-19 hospitalized patients were included in the study. All patients had positive severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction test results of nasopharyngeal and throat swab specimens as well as positive findings on computed tomography consistent with COVID-19. Ocular and medical histories were obtained from patients. Laboratory findings were noted. OSDI questionnaire was used to evaluate ocular surface symptoms.
RESULTS: There were 20 females (57.1%) and 15 males (42.9%) with a mean age 40.5 (95% CI: 35.8–45.2) years in the study. The mean OSDI scores were 12.6 (95% CI: 7.8–17.5). OSDI scores were significantly correlated with PLR (r=−0.516, p=0.028).
DISCUSSION AND CONCLUSION: Ocular surface problem is likely to occur in COVID-19 patients even in the absence of apparent ocular surface findings. PLR may have a relevance to ocular surface symptoms in COVID-19 patients.

7.Foreign body in esophagus of children with previous esophageal surgery history
Olga Devrim Ayvaz, Ayşenur Celayir, Bekir Erdeve
doi: 10.14744/zkmj.2021.82335  Pages 193 - 197
INTRODUCTION: In cases with esophageal atresia, foreign bodies can be impacted in the anastomotic area due to both the family’s efforts to feed solid food and anastomotic stenosis or fibrosis. Admittions of foreign body ingestions in cases with a history of esophageal surgery were evaluated in this study.
METHODS: The demographic features of esophageal atresia cases operated between January 2004 and January 2019 who underwent esophagoscopy for foreign body ingestion were evaluated retrospectively.
RESULTS: During the 15-year study period, esophagoscopy was performed 21 times due to foreign body ingestion to 10 of 137 surviving cases (7.3%) who underwent repair of esophageal atresia. The mean age of the patients was 32 months (10–72 months), and 7 (70%) were male and 3 (30%) were female. Six (60%) had undergone primary esophageal repair with fistula ligation and two (20%) had undergone gastric tube replacement. Three (30%) required esophageal dilatation; one had resection + anastomosis after 6 dilatations and one had antireflux surgery. Nine (90%) patients presented with dysphagia, 4 (40%) with vomiting, 1 with retching, and 1 with hypersalivation. Five (50%) patients had a history of ingesting foreign bodies (juice bag, money, carrot, plum seed, gum), three of which had complaints for 1 month, and 7 presented in an average of 2 days (1–5 days). In one of the patients, direct X-ray showed a coin in the esophagus. Esophagography showed foreign body in 4 of 6 cases. One was not effective due to incompatibility in a patient with cerebral palsy, and he vomited the plum core as soon as the opaque solution was administered orally. Esophagoscopy revealed no foreign body in two patients, organic food in five, shell of peanut in one, money in one, and chunks of gum and paper in one. In seven patients, the foreign body was lodged at the site of the anastomosis; dilatation was performed in 4 due to anastomotic strictures. In the follow-up period, five patients were admitted for the same reason. No foreign bodies were detected in re-esophagoscopy in three patients. Apple-plum seeds were removed twice from one patient, and various organic and inorganic materials [food, watermelod seed, gum, piece of paper (thrice)] were removed six times from another patient. The mean length of stay was 2.8 days (2–5 days).
DISCUSSION AND CONCLUSION: Although it was thoroughly explained to the parents of cases with esophageal atresia that the transition to semi-solid/solid foods should occur after the age of five years, when the children learned to chew and swallow, the patients were not fed with suitable food for their age.

8.A major diagnostic criterion for acute rheumatic fever: Clinical and sub-clinical carditis accompaniment with Sydenham chorea
Nurdan Erol, Merve Özen, Abdülkadir Bozaykut
doi: 10.14744/zkmj.2021.36002  Pages 198 - 201
INTRODUCTION: Acute rheumatic fever is a prevalent cause of heart disease affecting the whole world. Sydenham chorea, caused by the group A β-hemolytic streptococcus bacteria and characterized by non-rhythmic involuntary movements, is one of the major symptoms of acute rheumatic fever. While Sydenham chorea can be the only symptom in some acute rheumatic fever cases, in others it can also be accompanied by carditis findings. We have conducted this study to examine the co-occurrence of Sydenham chorea with clinical and sub-clinical carditis.
METHODS: The records of the cases diagnosed with Sydenham chorea and monitored in our hospital between November 2015 and November 2020 were scanned retrospectively. SPSS 21 was used for data analysis.
RESULTS: The sample consisted of 22 (84.6%) females and 4 (15.4%) males. Chorea was accompanied by arthritis in 6 cases (23%) and by carditis in 22 cases (84.6%), while 4 cases had pure chorea. The severity of the valve involvement was mild in 8, moderate in 10, and severe in 4 cases. During the follow-up of the 22 cases with carditis, valve involvement disappeared in 27.3%, decreased in 36.35%, and remained the same in 36.35%. Valve involvement developed during the follow-up of one case that did not previously have heart involvement (3.8%).
DISCUSSION AND CONCLUSION: In our study carditis was observed at a significant rate in Sydenham chorea cases. Echocardiography plays an important role in the diagnosis of carditis, hence the diagnosis of acute rheumatic fever, which is a serious problem especially in developing countries.

CASE REPORT
9.Profilactic usage of N-acetyl cysteine in the treatment of tuberculosis in children may be effective in protection from hepatotoxicity: A case experience
Erkan Yetmiş, Nevzat Aykut Bayrak, Çağatay Nuhoğlu
doi: 10.14744/zkmj.2021.60352  Pages 202 - 205
Tuberculosis (TB) disease: Despite developed advanced diagnostic methods and new treatments, its frequency is increasing especially in developing countries and continues to cause death worldwide. Most of the drugs used in the disease process are hepatotoxic. These drugs are generally well tolerated, but their simultaneous use enhances each other’s hepatotoxic effect. The toxic hepatitis that develops during treatment, affects treatment compliance and treatment results can be fatal when it is not noticed, and adequate precautions are not taken. In our case, we wanted to report the protective effect of adding oral N-acetyl cysteine to quadruple (izoniazid, rifampicin, pyrazinamide, and ethambutol) TB treatment against recurrent hepatotoxicity that occurs during the treatment of TB.

10.Anaphylaxis that develops following application of egg white on an area of burn
Zeynep Şengül Emeksiz, Serap Özmen
doi: 10.14744/zkmj.2021.46794  Pages 206 - 208
Anaphylaxis is the most clinically severe type of IgE-mediated allergic reaction since it develops rapidly and is often life threatening. This case was presented to demonstrate that in patients with egg allergy, anaphylaxis can also develop the following contact of egg with injured skin (besides oral intake).

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