E-ISSN 2757-8062
Volume : 53 Issue : 3 Year : 2022

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 53 (3)
Volume: 53  Issue: 3 - 2022
ORIGINAL RESEARCH
1.Cover

Pages I - IV

2.Editorial Board

Pages V - XII

REVIEW ARTICLE
3.Surgical treatment of the rectal prolapse in children: A review
Cengiz Gül, Sabri Cansaran, Ayşenur Celayir
doi: 10.14744/zkmj.2022.15493  Pages 107 - 109
Rectal prolapse, defined as protrusion of the rectal mucosa from the anus, usually responds to conservative treatment in the first 4 years of life. In rectal prolapses that cannot be treated conservatively, the prolapse will turn into a chronic process unless the causes are eliminated. Rectal prolapse is usually a chronic condition in children over the age of four. This article aims to review the surgical treatment of rectal prolapse in children who do not respond to conservative treatment or with recurrent rectal prolapse.

ORIGINAL RESEARCH
4.Serum follistatin-like-3 levels in the diagnosis of tubal ectopic pregnancy
Işıl Ayhan, Ahter Tanay Tayyar, Ismail Dağ, Melike Altıntaş, Hakan Bilgesoy, Betül Yılmazer
doi: 10.14744/zkmj.2022.71601  Pages 110 - 115
INTRODUCTION: Activin is necessary for maintaining normal pregnancy; follistatin and follistatin-like-3 (FSTL3) are known antagonists of activin. FSTL3 also has a role in the migration and invasion of trophoblasts. We aim to measure the value of serum FSTL3 levels in the diagnosis of tubal ectopic pregnancy.
METHODS: Seventy-six pregnant women including 39 women with surgically confirmed tubal ectopic pregnancy and 37 healthy, singleton controls whose gestational ages were between 5 and 8 weeks. Serum FSTL3 levels were measured in both groups through ELISA. Receiver operator characteristic (ROC) curve analysis was performed for the prediction of tubal ectopic pregnancy using serum FSTL3.
RESULTS: Serum FSTL3 levels were significantly lower in the ectopic pregnancy group than in controls (p<0.001). ROC analysis showed that the area under the curve in the curve (AUC) was 0.811 (0.713–0.909; 95% confidence interval). The highest value of the sum of sensitivity and specificity in the ROC curve is the point where the FSTL3 level was 2160.7535 (cutoff value) with a sensitivity and specificity of 75.7% and 79.5%, respectively. Furthermore, the subset analysis of patients with prior ectopic pregnancy showed that serum FSTL3 was the highest in patients without any previous ectopic pregnancy (p<0.001).
DISCUSSION AND CONCLUSION: Low levels of serum FSTL3 may be a potential biomarker in the early diagnosis of tubal ectopic pregnancy.

5.The pregnancy and newborn outcomes of Syrian refugees and Turkish women in a tertiary center, in İstanbul, Türkiye
Ayça Özgürel Bozkurt, Nazan Usal Tarhan, Enis Özkaya
doi: 10.14744/zkmj.2022.76376  Pages 116 - 121
INTRODUCTION: The objective of the study was to compare the pregnancy characteristics and neonatal outcomes of Syrian refugees and those of Turkish citizens who had been given birth in a tertiary referral center in İstanbul, Türkiye.
METHODS: This retrospective study included 100 Syrian refugees and 100 Turkish pregnant women who gave birth in University of Health Sciences, Zeynep Kamil Maternity and Children’s Training and Research Hospital, conducted between January 2015 and August 2018. The primary goal was to figure out whether the pregnant wom-en get enough healthcare and the effects on maternal and early neonatal outcomes.
RESULTS: Syrian pregnant’s hemoglobin, hematocrit, and mean corpuscular volume values were found to be lower than the Turkish women but not lower than the lower limit accepted for anemia during pregnancy. The rate of having antenatal screening tests and the mean number of hospitalizations was significantly lower among Syrian pregnant women than that of Turkish pregnant women.
DISCUSSION AND CONCLUSION: Although providing regular and free healthcare in Türkiye, Syrian refugees cannot receive adequate healthcare due to reasons such as language limitations, cultural differences and low socioeconomic level. The initiatives related to Turkish language educations and keeping qualified translators could improve the negative conditions.

6.Fetal megacystis at 11–14 weeks of gestation: 3-year experience of a tertiary center
Gökhan Bolluk, Özge Özdemir, Burak Demirdelen
doi: 10.14744/zkmj.2022.26122  Pages 122 - 125
INTRODUCTION: We aimed to present a comprehensive overview of the underlying etiologies and structural anomalies associated with megacystis and to investigate the history from diagnosis in utero to postnatal outcome.
METHODS: Fetal megacystis was defined in the first trimester as a longitudinal bladder diameter ≥7 mm. For each case, data on and measurements of fetal urinary tract and associated structural anomalies were collected. All available postmortem examinations and postnatal investigations were reviewed to establish the final diagnosis.
RESULTS: A total of 31 cases with fetal megacystis were included in this study. Megacystis was isolated in 24 cases and seven cases were associated with other abnormal ultrasound findings. Spontaneous resolution occurred before birth in 15 cases. Chromosomal abnormality was diagnosed in five cases, including two trisomy 21, one trisomy 18, one trisomy 13, and one Turner syndrome. Vesicoamniotic shunt was performed in three cases after the failure of vesicosentesis procedure.
DISCUSSION AND CONCLUSION: The etiology of fetal megacystis is not known exactly. It is generally a temporary finding in the first trimester, and its continuation in the following weeks is observed with increased chromosomal anomaly and additional anomalies. In fetal megacystis, detailed ultrasonoography and chromosomal analysis should be performed for additional anomalies.

7.The effect of embryo transfer technique on pregnancy and live birth rates in infertile women undergoing IVF treatment with freeze-all strategy
Serkan Oral, Alper Şişmanoğlu, Yaşam Kemal Akpak, Sebahattin Çelik, Nazan Yurtçu
doi: 10.14744/zkmj.2022.81489  Pages 126 - 131
INTRODUCTION: The aim of this observational retrospective cohort study was to define the effect of the embryo transfer (ET) technique on pregnancy and live birth rates.
METHODS: Infertile women with good prognostic factors undergoing in vitro fertilization treatment with freezing all the 5th day good quality embryos and consecutive frozen ET in 468 infertile good responders with first quality 5th day embryos were chosen for this study. Logistic regression analysis was performed to determine the effect of ET on the live birth rates.
RESULTS: Of the six predictive values, four were statistically significant: The easy passage of the external catheter, ultrasonographic visualization of the bubble, leaving the embryo at the desired location, and bleeding found in the external catheter after the catheter were excluded from the cervical ostium. While the probability of pregnancy decreased by 98.1% in cases where the embryo could not be left at the expected location, it was observed that the probability of pregnancy decrease was 96.4% in cases where no bubble could be seen, and 59.2% in cases with bleeding in the external catheter. Similarly, a 74.4% decrease in the probability of pregnancy was observed in patients in whom the passage of the catheter was difficult. Even though the tip of the transfer catheter during the ET is easily seen, the blood in the external catheter decreases pregnancy chance.
DISCUSSION AND CONCLUSION: Visualizing the internal catheter and the air bubble under the ultrasound guidance with the atraumatic placing of the embryo 1–1.5 cm away from the uterine fundus is crucial for the success of ET.

8.What did change in poor ovarian responders according to Bologna criteria over the 5 years? A tertiary IVF center experience
Halenur Bozdağ, Belgin Devranoğlu, Esra Akdeniz, Nazan Yurtçu, Nurullah Peker
doi: 10.14744/zkmj.2022.15010  Pages 132 - 139
INTRODUCTION: The objective of the study was to evaluate the changes in the prevalence, management strategies, and cycle outcomes of the cycle with the poor ovarian response (POR).
METHODS: This study was retrospectively designed. Poor responder infertile women who fulfilled Bologna criteria were included in the study. Data were obtained from medical records of infertile couples who underwent the intracytoplasmic sperm injection and embryo transfer program from January 2014 to December 2018.
RESULTS: Totally 776 cycles with POR were evaluated. The changing trend in the prevalence of the cycle with POR was estimated by rejecting the null hypothesis that there is no linear trend in the proportion of poor cycles across years (χ2(1)=9.28, p=0.002). A linear increasing trend in the proportion of poor cycles in the 5 years was found. A linear increase in the prefer of the antagonist protocol was found (χ2(1)=6.61, p=0.010), whereas there was a linear decrease in the minimal stimulation protocol with Clomiphene Citrate (χ2(1)=11.028, p<0.001). An increase in the usage of recombinant follicle-stimulating hormone (rFSH)/human menopausal gonadotropin (HMG) together was found (χ2(1)=76.28, p<0.001), whereas there was a decrease in the usage of the only FSH or HMG (χ2(1)=18.11 p<0.001; χ2(1)=18.62, p<0.001). There was no change in the trend of cycle outcomes during 5 years period.
DISCUSSION AND CONCLUSION: There is a clear increasing trend in the prevalence of cycles with POR over the 5 years. Ovarian stimulation protocols and choice of gonadotropins have shown a changing trend.

9.Effect of COVID-19 on anesthesia preferences in cesarean section: An observational study
Meryem Onay, Sema Şanal Baş, Ümit Akkemik, Ayten Bilir
doi: 10.14744/zkmj.2022.82652  Pages 140 - 145
INTRODUCTION: During the pandemic, everyone including healthcare professionals were under stress. Regional blocks in the cesarean section were considered safer during this period. We aimed to evaluate the effect of this stress on the patient’s choice of anesthesia.
METHODS: Pregnant women were surveyed preoperatively during the coronavirus disease 2019 (COVID-19) pandemic. The survey investigated the demographic data, pregnancy information, previous delivery type, anesthesia experiences, known panic attack/anxiety diagnosis, and anesthesia preferences before and after COVID-19 and factors affecting this decision.
RESULTS: A total of 108 patients, including elective (n=63) and urgent (n=45), were included in this study. The anesthesia techniques applied to the patients were spinal anesthesia (n=98), epidural anesthesia (n=1), and general anesthesia (n=9). When enquired on the change in their preferences due to COVID-19, only 16.6% (n=18) stated that the patients were affected. In addition, 94.4% of the patients (n=17) underwent regional anesthesia and 5.5% (n=1) underwent general anesthesia owing to anticoagulant use. Furthermore, 58.3% of the patients (n=63) were subjected to their preferred anesthesia technique, whereas 36.1% (n=39) underwent regional anesthesia based on the physicians’ recommendations for maternal/fetal health during the COVID-19 pandemic.
DISCUSSION AND CONCLUSION: We investigated the effect of the anxiety associated with COVID-19 on the anesthesia preferences of pregnant women and found that only a small percentage of patients had a change in their preferences due to COVID-19.

10.Evaluation of the relationship between dental caries and urinary tract infections
Fedli Emre Kılıç, Habip Almiş, İbrahim Hakan Bucak, Mehmet Turgut
doi: 10.14744/zkmj.2022.14632  Pages 146 - 150
INTRODUCTION: The most common infections in childhood and adolescence are the upper respiratory tract and urinary tract infections (UTI). Tooth decay is a multifactorial and infectious disease resulting from bacteria multiplying within the mouth and settling on the teeth and gums. The purpose of this study was to investigate whether any relationship exists between tooth decay and UTIs.
METHODS: This study was performed between January and June 2017 at the Adıyaman University Faculty of Medicine Department of Pediatrics. One hundred and forty-one cases were included. Patients’ age, sex, tooth brushing habits, hematological, biochemical and serological tests, complete urine examination, urine culture, blood culture, urinary system ultrasonography parameters, and numbers of decayed teeth were separately recorded.
RESULTS: Comparison of the cystitis and pyelonephritis groups revealed significantly greater tooth decay in the pyelonephritis group. Escherichia coli was the most common agent in all groups. Positive acute phase reactants such as white blood cell (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESH) were high in the group with tooth decay and pyelonephritis, while red blood cells (RBC), Hct, albumin, amylase, calcium, chloride, iron, and phosphorus levels were low.
DISCUSSION AND CONCLUSION: Our study shows a positive association between pyelonephritis and tooth decay. We think that examination in terms of tooth decay among children under going pyelonephritis attacks will be beneficial to diagnosis and treatment. Further studies are now needed on this subject.

11.Early cranial ultrasonographic findings of neonates born from mothers with premature rupture of membranes
Nihan Uygur Külcü, Züleyha Aysu Say, Habibe Ayvacı Taşan, Handan Çetiner, Zeynep Gamze Kılıçoğlu
doi: 10.14744/zkmj.2022.43765  Pages 151 - 155
INTRODUCTION: Premature rupture of membranes (PROM) has maternal, fetal, and neonatal implications. PROM can cause intrauterine infection and preterm birth. Maternal infection/chorioamnionitis is associated with neonatal neurodevelopment, cerebral palsy, and periventricular leucomalacia. In our study, we aimed to find out the rate of PROM associated-histologic chorioamnionitis (HCA) and corioamnionitis associated early neonatal brain damage findings with cranial USG.
METHODS: One hundred and fifteen neonates born in Zeynep Kamil Maternity and Children Hospital were enrolled to the study. Neonates were divided into four groups according to gestational age (term/preterm) and duration of PROM (>24 h). Data about route of delivery, birth weight, gender, and APGAR scores were collected and placentas were examined histopathologically. All neonates were evaluated with cranial USG by a radiologist unannounced of neonatal clinical condition and placental pathology. Term-preterm neonates, preterm PROM (+) and PROM (–) neonates and term PROM (+) and PROM (–) neonates were compared with each other.
RESULTS: Total 115 neonates (52 female and 63 male), 50 term (mean: 39 GW) and 65 preterm (mean: 33.8±1.3 GW) neonates were enrolled to the study. Duration from PROM to birth was 2.2±2.7days in term group and 4.8±4.3 days in preterm group (p=0.014). APGAR scores of preterm neonates were lower than term neonates (p<0.01). There was no difference of placental examination results, timing of cranial USG examination and USG findings between term and preterm neonates (p>0.05). HCA rate was 30% in term and 26.2% in preterm group (p=0.648). Time of cranial USG imaging was 11.9±10.4 days in term and 9.1±7.7 days in preterm group (p=0.096). Four neonates (6.2%) in preterm PROM (–) group had abnormal cranial USG findings.
DISCUSSION AND CONCLUSION: In our study, we cannot show early neonatal brain injury pathologic findings associated with HCA using cranial USG. Abnormal cranial USG findings in preterm group are due to prematurity independent of chorioamnionitis and PROM.

12.Evaluation of voiding functions with the micturition video: The preliminary results
Tuğçe Merve Orbay, Ayşenur Celayir, Cengiz Gül, Bekir Erdeve
doi: 10.14744/zkmj.2022.09709  Pages 156 - 158
INTRODUCTION: Normal voiding volume, duration, and calibration are related to hydration status and bladder capacity. The aim of this study was to determination of voiding functions especially in male children which known any abnormality of urinary system and urinary complaints by micturition videos.
METHODS: This prospective study was designed in male children who were referred to our department with complaints other than urinary system disorders who had no urinary anomalies. This study was carried with the consent of parents who agree to participate between January and April 2019. The micturation videos of their children were taken during first micturation in the morning of their children’s by parents with smartphones at home. All videos were bring us. Each micturation video was evaluated according to voiding time, flow rate, urine direction, and calibration.
RESULTS: During the 3 months, 20 male children jointed this study. The mean age was 7.5 years (3–13 years), and the mean voiding time was 31 s (13–67 s) by micturation video. The flow calibration and direction were normal. Although the micturation calibrations of six patients with a voiding time of more than 40 s were normal, urinary ultrasound was revealed normal bladder capacity measurement, and no residual urine after micturition and normal urinary tract; all values were within normal limits. In these six cases, the voiding videos should be seen at least 3 times intermittently, if urination time was long, uroflowmetric evaluation was planned.
DISCUSSION AND CONCLUSION: Voiding time and calibration can be safely evaluated with micturition videos filmed by the care-givers of the patients in their natural environment. This preliminary study evaluates normal voiding function with micturition videos, thus guiding future studies for evaluation of voiding disorders in all patients.

CASE REPORT
13.Case report: Vici syndrome
Kutlay Gür, Nihan Uygur Külcü, Özlem Erdede, Erdal Sarı, Rabia Gönül Sezer Yamanel, Abdulkadir Bozaykut
doi: 10.14744/zkmj.2022.49379  Pages 159 - 162
Vici syndrome (OMIM242840) is a rare neurodevelopmental disorder with multisystem involvement such as agenesis of corpus callosum, oculocutaneous hypopigmentation, cataracts, failure to thrive, combined immune deficiency, cardiomyopathy, and progressive microcephaly. EPG5 (18q12.3) gene is responsible for the pathogenesis of Vici syndrome. In this report, we present a 3-month-old girl who was admitted to our outpatient clinic with dysmorphic appearance, neurodevelopmental delay, and respiratory tract infection symptoms. The child has an ex-sibling with documented homozygous EPG-5 mutation (-/-). The infant has been hospitalized for 15 times due to urinary, respiratory system infections, and sepsis. The patient died at 14 months of age due to multisystem failure secondary to bacterial septicemia.

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