E-ISSN 2757-8062
Volume : 53 Issue : 2 Year : 2022

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 53 (2)
Volume: 53  Issue: 2 - 2022
ORIGINAL RESEARCH
1.Cover

Pages I - IV

2.Editorial Board

Pages V - XII

3.Automated measurement of follicle volume for the determination of trigger day in poor responder IVF patients
Müstecep Kavrut, Semra Kahraman, Pınar Kumru
doi: 10.14744/zkmj.2022.04900  Pages 53 - 57
INTRODUCTION: To identify a cutoff value for volume using Sono-automatic volume calculation (Sono-AVC) that could be used to determine the appropriate time of human chorionic gonadotropin (hCG) during COH in antagonist cycles of low ovarian response in vitro fertilization (IVF) patients.
METHODS: Sixty-four IVF cases first underwent two-dimensional ultrasound. Subsequently, the follicles were analyzed via Sono-AVC. Using receiver operating characteristic (ROC) analysis, a cutoff value was identified for volume, to be used as the hCG criterion on the day of hCG measurement. A total of 544 follicles from 64 patients were screened by Sono-AVC and sorted descendingly. In all of the patients, the follicles in both ovaries had been visualized; only follicles identified manually as being larger than 10 mm and those measured by Sono-AVC to be over 0.4 cc in volume were screened and sorted.
RESULTS: ROC analysis was done using the number of mature oocytes, and an hCG volume of 1.06 cc or greater on the day of measurement was identified as a cutoff value with a sensitivity of 91% for estimating maturation.
DISCUSSION AND CONCLUSION: Using the Sono-AVC method to determine hCG timing in cases with a low ovarian reserve and/or those who are poor responders might enhance the efficacy and reliability of treatment.

4.Factors influencing intrapartum fetal weight estimation
Masum Kayapınar, Zafer Bütün, Gökhan Ünver, Enis Özkaya
doi: 10.14744/zkmj.2021.94809  Pages 58 - 62
INTRODUCTION: The aim of this study was to investigate the factors that influence intrapartum fetal weight estimation.
METHODS: A total of 173 pregnant women who were under follow-up at the Zeynep Kamil Maternity Hospital between May 2015 and April 2016 and who had singleton, live-term pregnancy between the gestational weeks of 37 and 42 with the head presentation were included in the study. Biometric measurements were made with ultrasonography. The amniotic fluid index (AFI) was measured and recorded. Newborn fetal weight measurements recorded in the birth registration book were compared with estimated fetal weight measurements. The effects of biometric measurements, AFI, gestational week, body mass index (BMI), engagement, and clinical experience on fetal weight estimation were compared.
RESULTS: A positive statistically significant association at the 32.3% level was determined between the birth weight and gestational week (p=0.001 and p<0.05). A positive statistically significant association at the 21.7% level was found between birth weight and BMI (p=0.004 and p<0.05). No statistically significant association was found between birth weight and BMI according to the presence of engagement (p=0.391 and p>0.05). When the professional seniority between physicians was evaluated, the rate of deviation from fetal weight was estimated to be 8.7%, and the difference was not found to be statistically significant (p>0.05).
DISCUSSION AND CONCLUSION: Gestational week and BMI were determined to be significant for deviation from estimated fetal weight and professional seniority differences; engagement and AFI were determined to be ineffective.

5.Struma ovarii: Analysis of a single institution
Çiğdem Kılıç, Dilek Yüksel, Caner Çakır, Rıza Dur, Fulya Kayıkçıoğlu, Sevgi Koç, Vakkas Korkmaz, Yaprak Üstün, Nurettin Boran
doi: 10.14744/zkmj.2022.38980  Pages 63 - 67
INTRODUCTION: The aim of this study was to evaluate the clinicopathological features and oncologic outcomes in patients with struma ovarii (SO) treated and followed up in our hospital.
METHODS: The presented study included 14 patients diagnosed with SO in a single institution for a period of 25 years.
RESULTS: Histopathological diagnosis revealed benign SO in 13 patients and follicular carcinoma in 1 patient with malignant transformation in final pathology reports. The patient with malignant SO was follicular type and stage Ic2. This patient did not receive adjuvant therapy. The median follow-up time of the study cohort was 31 months and ranged between 3 and 134 months. No recurrence was detected in the patient with malignant SO during 44 months of follow-up.
DISCUSSION AND CONCLUSION: Surgical intervention is adequate for treatment in patients with benign SO. For patients with malignant transformation, a conservative surgery may be suitable for fertility sparing. Additionally, staging surgery including retroperitoneal lymph node dissection is recommended for determining adjuvant therapy decisions. Due to the absence of well-defined and precise guidelines for treatment, a multidisciplinary approach is suitable for patients with malignant SO. Therapy modalities should be individualized according to intraoperative and postoperative findings in this patient group.

6.Semen analysis results are negatively affected in patients with vitiligo: A cross-sectional study from Turkey
Müstecep Kavrut, Nur Dokuzeylül Güngör, Arzu Yurci, Kağan Güngör, Kaan Çil
doi: 10.14744/zkmj.2022.48802  Pages 68 - 74
INTRODUCTION: Male fertility can be affected by a variety of organ diseases, commonly including the testis, in the form of cryptorchidism and hypogonadism. The evidence related to the fact that male infertility depends on skin disease is still not adequate. The aim of the study was to evaluate the clinical features and semen analysis results of vitiligo patients and control cases.
METHODS: This cross-sectional study was conducted between January 2015 and January 2021 by retrospectively evaluating patients who underwent sperm analysis at İstanbul Medeniyet University Göztepe Training and Research Hospital. Patients with vitiligo (n=76) were included in the study as the vitiligo group. The control group was selected from age- and body mass index-matched patients who underwent semen analysis (n=71).
RESULTS: The mean age was 30.29±4.18 years, the mean age at onset of vitiligo was 23.66±3.96 years, and the mean disease duration was 6.36±2.80 years in the vitiligo group. The free T4 (FT4) levels were significantly lower in the vitiligo group than in the control group (p<0.001). When we evaluated semen analysis results, we found sperm concentration (p<0.001), A + B motility (p<0.01), and morphology (p<0.001) significantly better in the controls than in the patients with vitiligo.
DISCUSSION AND CONCLUSION: We found that the FT4 level was lower, and semen analysis results were negatively affected in patients with vitiligo. The clinical management of vitiligo should also include its effects on the semen and the male reproductive system.

7.Frequency of glucose-6-phosphate dehydrogenase enzyme deficiency in newborns with prolonged jaundice
Hüseyin Taştanoğlu, Rabia Gönül Sezer Yamanel, Abdulkadir Bozaykut
doi: 10.14744/zkmj.2021.88709  Pages 75 - 79
INTRODUCTION: The aim of the study was to determine the frequency of glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency in preterm and term newborns with prolonged jaundice.
METHODS: A total of 670 preterm and term newborns who applied to Zeynep Kamil Training and Research Hospital Pediatric Health Polyclinic with neonatal jaundice between January 1, 2014, and April 1, 2018, were retrospectively screened and included in the study. Birth weight, sex, gestational week, postnatal age, gender, phototherapy, and need for exchange transfusion were recorded. Laboratory evaluations included blood group typing of mother and newborn, serum total and direct bilirubin levels, reticulocyte count, and erythrocyte G6PD level. SPSS 22.0 was used as an evaluation program.
RESULTS: G6PD enzyme level was detected in 374 (55.8%) of the cases. Enzyme deficiency was detected in 12 (3.2%) cases. There was no statistically significant difference between the G6PD-deficient group and the G6PD-normal group in terms of all parameters except the total biluribin level. There was no case in whom exchange transfusion was performed with high bilirubin values. However, phototherapy was applied in 231 cases due to high bilirubin levels. It was determined that there was no need for phototherapy in all cases with G6PD levels.
DISCUSSION AND CONCLUSION: G6PD enzyme deficiency should be investigated in patients with prolonged jaundice.

8.Breastfeeding status and complementary feeding preferences of mothers in children aged 12–36 months: Data from a tertiary university hospital
Ayça Kömürlüoğlu Tan, Hüseyin Taştanoğlu
doi: 10.14744/zkmj.2021.59140  Pages 80 - 87
INTRODUCTION: The aim of this study was to question the practices of mothers on breastfeeding and complementary feeding (CF) in infancy and early childhood in a babyfriendly university hospital and investigate child- and family-related factors on child nutrition practices.
METHODS: Mothers of 12–36-months-old babies who applied to Sivas Cumhuriyet University Hospital Pediatric Clinic for any reason and had no disease that prevented breastfeeding were included in the study. Sociodemographic characteristics, birth information of the baby, breastfeeding status, and CF practices were questioned to the participants.
RESULTS: A total of 245 mothers who had children between 12 and 36 months participated in the study. The mean age of the mothers was 30.5±5.3 years; 54.3% of them were housewives. Of the total mothers, 100 were currently actively breastfeeding, and 145 mothers (59.2%) had stopped breastfeeding. Overall, 98% of all participants had breastfed for some time. The rate of breastfeeding in the first hour after birth was 53.1%. The rate of exclusive breastfeeding (EB) in the first 6 months was 32.2%. There was no statistically significant relationship between maternal age, birth week of the baby, gender, delivery type, maternal age, maternal education level, maternal employment status, mother’s smoking status, and EB in the first 6 months. The mean duration of breastfeeding in mothers who stopped breastfeeding (n=145) was 13.67±8.73 months. The median time to start CF was 6 months. The first complementary foods given to the children were 37.1% yogurt, 19.6% vegetable puree, 13.5% fruit, and 13.1% vegetable soup. Early initiation of CF decreased as maternal age increased and education level decreased (p<0.05). Smoking mothers started CF earlier.
DISCUSSION AND CONCLUSION: Although breastfeeding is common in Turkey, EB is not at the desired level. For healthy child development, parents must be educated about breast milk, breatfeeding, when to start CF, and about food ingredients. In this regard, health professionals and social media have important duties as they are the sources of information to families.

9.Cerebrospinal fluid drainage in posthemorrhagic ventricular dilatation and its effects on cerebral hemodynamics
Emre Dincer, Sevilay Topçuoğlu, Abdulhamit Tüten, Handan Hakyemez Toptan, Selahattin Akar, Güner Karatekin
doi: 10.14744/zkmj.2022.71677  Pages 88 - 92
INTRODUCTION: Posthemorrhagic ventricular dilatation (PHVD) is an important complication of intraventricular hemorrhage in preterm neonates. The definitive treatment of PHVD is ventriculoperitoneal shunt application, but being over 2500 g is expected for the operation, and there is still debate on the choice and timing of temporizing interventions until shunt application. In this prospective study, we aimed to observe the effects of ventricular decompression via lumbar puncture or reservoir on cerebral hemodynamics, ventricular measurements, and head circumference.
METHODS: A total of 19 cerebrospinal fluid drainage applications in 10 patients ≤34 weeks gestation with PHVD was included. Ventricular size and medial cerebral artery Doppler measurements in ultrasonography, cerebral tissue oxygenation using near infrared spectroscopy, and head circumference of the patients who required ventricular decompression were recorded 1 h before and 2 h after interventions.
RESULTS: Ventricular measurements significantly decreased after intervention. Ventricular dilatation (ventricular index right/left and anterior horn width left/right: p=0.001/p=0.02 and p<0.001/p=0.003, respectively), Doppler measurements (resistivity index: p<0.001, pulsatiliy index: p<0.001), and cerebral tissue oxygenation (cerebral tissue oxygen saturation: p<0,001, fractioned oxygen extraction: p<0.001) significantly improved after intervention. No change in head circumference was observed 2 h and 24 h after decompression (p=0.46 and p=0.571, respectively).
DISCUSSION AND CONCLUSION: In infants with PHVD, the ventricular enlargement is accompanied by hemodynamic disturbance, which can be corrected with decompression. Doppler studies and ventricular measurements may be considered as “alarming” parameters for ventricular decompression and may contribute to protection of rapidly growing and delicate premature brain from the negative effects of the increased cerebral pressure.

10.Coronary computed tomography angiography findings in young adults
Tuğba Eldes, Uğur Kesimal
doi: 10.14744/zkmj.2022.82713  Pages 93 - 98
INTRODUCTION: Various clinically significant cardiovascular anomalies of coronary arteries that are not associated with atherosclerosis have been previously described. This study aimed to evaluate coronary anomalies or variations on coronary computed tomography angiography (CCTA) images in patients aged under 40 years and to com-pare them with clinical findings, thereby contributing to the literature.
METHODS: Patients under 40 years who underwent CCTA with current clinical indications between 2015 and 2018 were included in the study. The scans were performed using a 128-slice CT device and electrocardiography triggering in different phases. During the examination, 35%–75% of phases were frequently evaluated although the percentage varied according to the heart rate. Outlet, course, internal structure and termination anabolites, and pathologies, as well as anatomical dominance of coronary arteries, were evaluated. However, unlike this classification, myocardial bridges (MBs) were specified as variations. Coronary artery disease reporting and data system (CAD-RADS) was used to standardize stenosis rates in the walls of coronary arteries and their lumen.
RESULTS: Of the 927 CCTAs taken over a 3-year period, 188 belonged to patients under 40 years. The study included 156 men and 32 women with a mean age of 34.99±4.78 years. In the comparison between the patients with and without chest pain in terms of the presence of CAD-RADS 1 and above, a statistically significant higher rate of CAD was found in the group with chest pain (p<0.05). Abnormal cardiac findings and variations were detected in 103 patients (55%), including 16 with multiple abnormalities. Of these 103 patients, 49 (26%) had MBs.
DISCUSSION AND CONCLUSION: Considering the presence of anomalies and variations in young adults with cardiac complaints, the reasons for the ambiguous symptoms may become clear with the use of noninvasive methods, such as CCTA. Thus, cardiovascular anomalies that may cause serious and acute events in the future, including sudden death can be detected in advance, allowing early interventions to be undertaken.

CASE REPORT
11.Acute cerebellar ataxia in a child: Rotavirus coinfection with SARS-CoV-2
Sevgi Yimenicioğlu, Ayşen Aksoy Genç, Ayşe Tekin Yılmaz, Murat Şahin
doi: 10.14744/zkmj.2022.00921  Pages 99 - 101
Acute cerebellar ataxia (ACA) is more common in childhood. Stroke, infectious, toxic, immune-mediated, paraneoplastic, structural, and metabolic diseases, and vitamin deficiency are the main diseases causing ACA. There may be neurological symptoms in rotavirus and SARS-CoV-2 infection. The objective of this case report is to highlight ACA which was seen as a coinfection in the course of rotavirus infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) without fulminant course.

12.Two-stage surgical repair of anovaginal fistula following Bartholin abscess treatment
Sami Acar, Erman Çiftçi
doi: 10.14744/zkmj.2022.68335  Pages 102 - 106
Anovaginal fistulas (AVFs) are aberrant pathways located between the anal canal and the vagina. They frequently occur in resource-limited countries as a result of pressure necrosis on the rectovaginal septum caused by prolonged or obstructed labor. In addition, it is observed as a result of improper repair of third- and fourth-degree anal sphincter injuries after birth, injuries that are not noticed during delivery, and infections that develop in the episiotomy area. Delayed treatment of perirectal, perianal, and Bartholin abscess or cyst, and surgical interventions on the posterior vaginal wall, rectum, and perineum, are all contributing factors. The aim of this study was to describe the surgical treatment method applied to a patient with an anovaginal fistula, who was admitted with a complaint of gas and stool passage through the vagina for 3 months with the drainage of a Bartholin abscess in its etiology, which affects the anal sphincter complex trans-sphincterically and which was detected to be open to the distal dentate line on proctological examination. The development of an AVF has a considerable negative impact on an individual’s quality of life. It is a difficult condition both individually and socially. Achieving successful results requires effective evaluation and examination.

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