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Volume : 53 Issue : 1 Year : 2022

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 53 (1)
Volume: 53  Issue: 1 - 2022
EDITORIAL
1.Cover

Pages I - III

2.Editorial Board

Pages V - X

ORIGINAL RESEARCH
3.Effect of perinatal period and obstetric characteristics on neonatal mortality and morbidity in preterm SGA and AGA babies with a birth weight of 1000–2000 g
Habibe Ayvacı Taşan, Nazan Usal Tarhan, Engin Deniz, Pakize Kartal, Nihan Uygur Külcü, Ateş Karateke
doi: 10.14744/zkmj.2022.70594  Pages 1 - 7
INTRODUCTION: Our study aimed to present obstetric follow-up data, neonatal mortality, short-term neonatal morbidity, and 2-year infant neuromotor development follow-up data in preterm, 1000–2000 g birth weight cases.
METHODS: The study was carried out with 148 cases. Two groups were formed with fetal birth weights below the 5th percentile and in the 5th–95th percentile range. Demographic and obstetric characteristics, fetal well-being tests, and antenatal and neonatal characteristics were evaluated. Neurological follow-up of babies continued at Metin Sabancı Spastic Children Foundation for 2 years.
RESULTS: The study groups consisted of 63 small for gestational age (SGA) and 85 appropriate for gestational age (AGA) infants. Neuromotor development follow-up of 75 living infants continued for 2 years. There was no statistically significant difference between the two groups for the nonstress test, umbilical arterial blood gas pH and base deficit values, 1st and 5th minute Apgar scores, infant general condition. The 1st and 5th minute Apgar scores were statistically highly significant for deceased newborns in both groups (p=0.020 and p=0.012, respectively). Early neonatal morbidity and mortality rates and neuromotor development problems at 6–12 months in SGA and AGA groups were similar. At the end of two years, no pathological diagnosis was reported for motor and reflex development in 75 cases.
DISCUSSION AND CONCLUSION: The gestational week of the SGA group is significantly ahead at birth, but the short- and long-term neonatal morbidities are similar for both groups. Our study reports the data of our clinic from 20 years ago. The infant mortality rate has shown a declining trend in recent years, but low birth weight infants are still at increased risk for mortality. Reinterpretation of morbidity and mortality data of preterm infants will be beneficial, together with innovations and improvements in neonatal care.

4.Retrospective analysis of surgical site infections after cesarean section: Rates, microbiological profile, and clinical features
Sami Açar, Betül Yılmazer, Erman Çiftçi, Pınar Kumru
doi: 10.14744/zkmj.2022.71224  Pages 8 - 16
INTRODUCTION: Surgical site infection (SSI) accounts for 31% of healthcare-associated infections and is associated with a 3% mortality rate. It increases the frequency of transition to the intensive care unit, the length of hospital stay, and the rate of readmissions. According to the National Health Service-Related Infections Surveillance Network 2017 data, the rate of infection in the surgical field in our country is 0.72%, and this rate is 1.0% in 25 of 60 types of surgery. Obstetric–gynecologic surgeries are in this group. Information on SSI after cesarean section is limited in the international and national literature. Our research is aimed to define the features of C-section SSI and contribute to the solution of the problems observed with the data to be obtained.
METHODS: A retrospective evaluation of SSIs in patients who underwent C-sections between January 1, 2018, and December 31, 2020, at Zeynep Kamil Maternity and Children’s Training and Research Hospital was conducted.
RESULTS: During the study period, SSI was observed in 191 (2.3%) of 8370 C-section cases, and the mean age of these patients was 30.5±6.3 years. Body mass index was at the level of 32.8±5.2 kg/m2 and body mass index value was >30 kg/m2 in 88% of the SSI group. Emergency C-section was applied in 145 (75.9%) cases and elective C-section in 46 (24.1%) cases. The skin incisions were closed with multifilament in 174 (91.1%), monofilament in 14 (7.3%), and skin stapler in 3 (1.6%) patients. After the diagnosis of SSI, the povidone iodine dressing was sufficient for wound healing in 184 (96.3%) patients. Secondary healing method was applied to 4 (2.1%) patients and negative pressure wound closure technique was applied to 3 (1.6%) patients.
DISCUSSION AND CONCLUSION: In terms of SSI, it is recommended to perform a preoperative risk assessment for pregnant women and to show appropriate approaches to risky people. Providing wound care training to patients at discharge, timely postpartum controls, and standardizing wound care products to be used will increase the success rate.

5.Relationship between umbilical artery Doppler indices and adverse pregnancy outcomes in women with insulin-dependent diabetes mellitus
Mucize Eriç Özdemir
doi: 10.14744/zkmj.2022.05945  Pages 17 - 22
INTRODUCTION: It is intended to research the value of umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices in predicting adverse pregnancy outcomes in women with insulin-dependent diabetes mellitus.
METHODS: The study was planned at Zeynep Kamil Women and Chil-dren’s Diseases Training and Research Hospital. Pregnant women were divided into two groups: group 1 consisted of 123 fetuses with normal pregnancy outcomes and group 2 had 74 fetuses with adverse pregnancy outcomes. The value of the UA sys-tole/diastole (S/D) ratio was questioned to predict possible adverse pregnancy outcomes. Differences in Doppler measurements between the groups with p<0.05 were considered statistically significant.
RESULTS: UA S/D ratios were established as ultrasonographical parameters in predicting normal pregnancy outcomes at 28th, 32nd, and 36th weeks of gestation, with cutoff values of 2.58, 2.56, and 2.62, respectively. Negative predictive values of these three cutoffs for adverse pregnancy outcomes were 70.21%, 72.53%, and 69.03%, respectively.
DISCUSSION AND CONCLUSION: UA S/D ratios may be helpful to the clinic as ultrasonographical measurements to predict the normal pregnancy outcomes at 28th, 32nd, and 36th weeks of gestation.

6.Effect of the COVID-19 pandemic on anxiety and depression in pregnant women
Deniz Kulaksız, Kübra Baki Erin, Recep Erin, Yeşim Bayoğlu Tekin
doi: 10.14744/zkmj.2022.19042  Pages 23 - 27
INTRODUCTION: To examine the effect of COVID-19, which caused the pandemic, on anxiety and depression in pregnant women.
METHODS: We analyzed the changes in the anxiety and depression levels of pregnant women before and after the declaration of COVID-19 as a pandemic, using the Beck Depression Inventory II (BDI-II) and Beck Anxiety Inventory (BAI), which was administered to pregnant women before the oral glucose tolerance test for another study. We compared the BDI-II and BAI scores before and after the pandemic with paired sample t-test in the same pregnant women.
RESULTS: According to the Kolmogorov–Smirnov test applied to all groups before and after the pandemic, the variables age, gravida, body mass index, number of living children, education level, and gestational diabetes status were in accordance with the normal distribution. When the results of the BDI-II and BAI before and after the pandemic were compared, we found that both anxiety and depression scores increased statistically with the pandemic (p≤0.05).
DISCUSSION AND CONCLUSION: The COVID-19 pandemic not only affects the people physically but also affects pregnant women psychologically.

7.Is preoperative colonoscopy in all gynecologic cancer patients necessary?
İlhan Taşdöven, Hakan Balbaloğlu
doi: 10.14744/zkmj.2022.87049  Pages 28 - 31
INTRODUCTION: The aim of this study was to evaluate the necessity of preoperative colonoscopy in gynecologic cancer patients.
METHODS: Retrospectively, patients diagnosed with gynecologic cancers and undergoing preoperative colonoscopy between January 2013 and April 2020 in Zonguldak Bülent Ecevit University were included in the study, and their information was recorded.
RESULTS: A total of 186 patients with gynecologic cancers were included in the study. Of these, 64 (35%) were less than 50 years of age, and 122 (65%) were 50 years or older. The mean age was 58.83±14.20 years (min: 31, max: 85). In the study, 96 (51.6%) of the patients had endometrial cancer, 54 (29%) had ovarian cancer, 34 (18.3%) had uterine-cervix cancer, and 2 (1.1%) patients had vulvar cancer. Extrinsic compression in 18 (9.7%), colonic polyps in 16 (8.6%), primary colorectal cancer in 4 (2.2%), and metastases to the rectum or sigmoid colon in 2 (1.1%) of patients were detected.
DISCUSSION AND CONCLUSION: Colonoscopy permits more excellent detection of colorectal lesions and may give surgeons some vital information about the spreading of gynecologic cancer, which may, in turn, alter the treatment modality.

8.Ultrasound-guided liver mass biopsy
Ali Burak Binboğa, Mehmet Onay
doi: 10.14744/zkmj.2022.79847  Pages 32 - 36
INTRODUCTION: This study aimed to present the histopathological results and demographic characteristics of patients who underwent an ultrasoundguided liver mass biopsy.
METHODS: Medical information of patients who underwent a liver mass biopsy in the interventional radiology clinic between September 2016 and September 2021 were retrieved retrospectively from the hospital data processing system and the interventional radiology archive. Baseline demographic characteristics of the patients and the technical success and the complication rate of the biopsy procedure were investigated.
RESULTS: A total of 283 liver mass biopsies were performed on 162 women and 121 men, with a mean age of 52.3 years. All biopsies were performed under ultrasound guidance with an 18 gauge fully-automatic Tru-Cut biopsy needle. After the biopsy, the histopathological diagnosis was malignant in 95.4% (n=270) and benign in 4.5% (n=13) of the masses. The most common malignant diagnosis was breast cancer metastasis (25.8%) and the most common benign diagnosis were cirrhotic nodule (1.4%) and granulomatous inflammation (1.4%). The technical success rate was 100% in this study. The most common complications were a subcapsular hematoma (n=5) and pain (n=2). There was a significant relationship between subcapsular hematoma formation and the histopathological diagnosis (p<0.05). The subcapsular hematoma was more common in patients with hepatocellular cancer and cirrhotic nodules. No massive bleeding, pneumothorax, or death occurred.
DISCUSSION AND CONCLUSION: An ultrasound-guided liver mass biopsy is a safe and effective method because of low complication rates and adequate tissue sampling.

9.AMH and FSFI scores improved after recovery from COVID-19 pneumonia
Niyazi Tuğ, Ceyhun Kılınç, Pınar Eker, Emre Yavuz, Edip Emir, Murat Yassa, Pınar Birol, Gaye Karagün Arslan
doi: 10.14744/zkmj.2021.80488  Pages 37 - 39
INTRODUCTION: The aim of this study was to investigate the effect of SARS-CoV-2 infection on female genitalia and sexual behavior.
METHODS: In this prospective cohort study in a COVID-19 pandemic clinic, women between 20 and 45 years of age with COVID-19 pneumonia but did not require intensive care were included. Serum anti-Müllerian hormone (AMH) measurements and female sexual function index (FSFI) scores were obtained during SARS-CoV-2 infection and 60–100 days after recovery.
RESULTS: Mean serum AMH concentrations at and after COVID-19 pneumonia were 2.29±1.84 and 2.92±2.46, respectively (p=0.017). FSFI scores after COVID-19 pneumonia were higher than those before the infection in all domains (p<0.05).
DISCUSSION AND CONCLUSION: SARS-CoV-2 infection seems to decrease AMH levels transiently in patients with pulmonary involvement, and recovery from the disease improves FSFI scores during the pandemics.

10.Parental chromosomal abnormalities in individuals with recurrent pregnancy loss
Biray Ertürk, Ömer Faruk Karaçorlu, Orhan Şahin
doi: 10.14744/zkmj.2021.66933  Pages 40 - 44
INTRODUCTION: Chromosomal abnormality is a frequent cause of recurrent pregnancy loss (RPL), which is described as the loss of two or more pregnancies before 24 weeks of gestation. The aim of this study was to investigate the type and frequency of chromosomal abnormalities in couples with a history of RPL.
METHODS: Consecutive 400 patients (200 couples) who were referred to our center with the complaint of RPL were included in the study. Routine karyotyping was performed using Giemsa-trypsin-Giemsa (GTG) or Giemsa-trypsin-Leishman (GTL) banding after obtaining a signed informed consent form. The patient data were then retrospectively retrieved.
RESULTS: The median age was 32±6.25 years. Chromosomal abnormalities were detected in 4% of the patients (n=16). Of the 16 patients with chromosomal abnormalities, 9 patients had reciprocal and 1 had Robertsonian translocations. Two had inversions. Two cases had mosaic monosomy X while the remaining two had mosaic trisomy X. No significant association was found between the presence of chromosomal abnormality and age or gender (p>0.05).
DISCUSSION AND CONCLUSION: The majority of the chromosomal abnormalities causing RPL result from balanced translocations, and other structural or numerical chromosomal abnormalities may also be the cause of pregnancy loss. Parental chromosome analysis is crucial in elaborating the cause of RPL, to provide accurate genetic counseling and preimplantation genetic diagnosis when possible.

CASE REPORT
11.Round block (Benelli mastopexy) technique in the surgical treatment of gynecomastia
Sami Açar, Erman Çiftçi
doi: 10.14744/zkmj.2022.72335  Pages 45 - 48
Gynecomastia is a benign condition characterized by an abnormal increase in the quantity of glandular tissue in one or both breasts. It manifests itself as a result of hormonal imbalances throughout puberty and later in life. Although gynecomastia is not a serious condition in most cases, individuals may experience embarrassment as a result of their circumstances. Depending on the underlying cause, some patients may heal spontaneously, while others may require medication or surgery. The intention of the case is to emphasize the mastopexy method as a mastectomy technique on a young adult patient who was diagnosed with idiopathic gynecomastia and had long-standing compliance. The technique is frequently performed in the oncoplastic surgical treatment of breast cancer. In our case, the cosmetic appearance was at an expected level, and the feared consequence of nipple-areola complex necrosis did not occur. In the treatment of gynecomastia, it is difficult to make a decision that will be beneficial for the patient, which requires a long-term examination process. Once the surgery is required as a treatment method, consideration should be given to the potential of recurrence following surgical treatment, as well as the scar formation of the chosen incision.

12.Iliopsoas muscle abscess after total hip arthroplasty mimicking adnexal mass: A case report
Koray Görkem Saçıntı, Bulut Varlı, Hakan Kocaoğlu, Bircan Yıldırım Baydemir, Ruşen Aytaç
doi: 10.14744/zkmj.2022.48091  Pages 49 - 52
Early and accurate diagnosis is difficult in clinical practice as the onset of iliopsoas abscess is commonly characterized by nonspecific symptoms. The coexistence of iliopsoas abscesses and prosthetic joint infections is extremely rare. In this case, we report a case of iliopsoas abscess mimicking adnexal mass after total hip arthroplasty (THA). A 52-year-old G2P2 woman visited the emergency department because of pain in the right lower quadrant of the abdomen. Gynecological and ultrasound examination showed a complex adnexal mass measuring 10×6 cm. The patient underwent THA for the right hip due to a failed treatment of collum femoris fracture 7 years ago. Laparotomy revealed a mass originating from the extrapelvic portion of the right iliac muscle. Intraoperative orthopedic consultation was necessitated. The solid mass was completely “shelled out” from the anterior abdominal wall. Though rare in incidence, we recommend that advanced imaging modalities such as computed tomography or magnetic resonance imaging could be performed as routine preoperative imaging on patients presenting with adnexal mass if there is a clinical history of hip arthroplasty.

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