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Volume : 53 Issue : 4 Year : 2022

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 53 (4)
Volume: 53  Issue: 4 - 2022
FRONTMATTERS
1.Cover

Pages I - IV

2.Editorial Board

Pages V - XII

ORIGINAL RESEARCH
3.Perinatal outcomes of 91 cases of non-immune hydrops fetalis
Emre Erdoğdu, Resul Arısoy, Lütfiye Uygur, Selim Sancak, Furkan Kayabaşoğlu, Sevcan Arzu Arınkan, Oya Pekin, Murat Muhcu
doi: 10.14744/zkmj.2022.90377  Pages 163 - 169
INTRODUCTION: We aimed to investigate the proportion of etiologically identified non-immune hydrops fetalis (NIHF) cases and perinatal outcomes of all the cases that were diagnosed and managed in a single tertiary perinatal center over a 7-year period.
METHODS: Perinatal outcomes, background disorders, and clinical details of the patient and the surviving fetus were retrospectively analyzed.
RESULTS: The etiology was identified prenatally in 60 (65.9%) out of 91 cases. Cystic hygromas and cardiac abnormalities were the most common identifiable causes. Of 91 cases, 48 (52.7%) elected to terminate their pregnancy. Among the 43 patients who elected to continue with their pregnancy, 12 (27.9%) resulted in intrauterine fetal death and 31 (72.1%) survived to birth. The survival rate at discharge was 23.2%.
DISCUSSION AND CONCLUSION: NIHF is a complex problem associated with high mortality. Many patients elect the termination of their pregnancy, and the survival rate is 23.2% in cases who elect to continue with their pregnancy.

4.Calcium ionophore enhances blastocyst formation, embryo quality, and live birth delivery rates in patients with previous IVF failures
Fırat Tülek, Alper Kahraman
doi: 10.14744/zkmj.2022.14471  Pages 170 - 175
INTRODUCTION: The objective of the study was to evaluate the impact of artificial oocyte activation (AOA) with calcium ionophore (A23187) on in vitro fertilization outcomes of patients with previous history of cycle cancellations due to arrested embryos before formation of day 5 blastocysts.
METHODS: This retrospective study was conducted by evaluating records of patients that admitted for in vitro fertilization between 2013 and 2021. Patients with the previous history of developmental arrest in whole embryo cohort without fertilization failure were included in the study. Cycle outcomes of women with and without AOA were compared.
RESULTS: This retrospective study was conducted by evaluating records of patients that admitted for in vitro fertilization between 2013 and 2021. Patients with the previous history of developmental arrest in whole embryo cohort without fertilization failure were included in the study. Cycle outcomes of women with and without AOA were compared.
DISCUSSION AND CONCLUSION: AOA with A23187 appears to improve progression to blastocyst rates, embryo quality, clinical pregnancy rates, and live birth delivery rates in women with a previous history of complete embryo development arrest before formation of day 5 blastocysts.

5.Can systemic inflammatory markers predict sperm retrieval with the micro-TESE procedure in patients with non-obstructive azoospermia? A tertiary IVF center experience
Belgin Devranoğlu, Ali Aras, Gökşen Derya Reis Köse, Elif Tozkır, Pınar Kumru, Enis Özkaya, Ilhan Şanverdi, Ebru Çöğendez, Nurullah Peker
doi: 10.14744/zkmj.2022.46704  Pages 176 - 182
INTRODUCTION: We aim to investigate the relationship between the pro-inflammatory markers and sperm retrieval (SR) in microdissection testicular sperm extraction (micro-TESE) procedure in patients with non-obstructive azoospermia (NOA).
METHODS: This retrospective study was conducted with 318 patients who applied to our in vitro fertilization Unit between April 2017 and December 2020 and underwent micro-TESE for NOA. Patients with (Group 1) and without (Group 2) sperm retrieved were compared in terms of age, infertility duration, body mass index (BMI), hormone profile, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-eosinophil ratio (MER), platelet-to-lymphocyte ratio (PLR), and a new marker of eosinophil-to-lymphocyte ratio (ELR).
RESULTS: SR from the micro-TESE procedure was achieved in 183 (57.5%) of 318 patients. Testicular tissue biopsies were performed simultaneously in all cases. There was no statistically significant difference between the groups concerning BMI. When the groups were compared regarding the pro-inflammatory markers, while the NLR, MER, and PLR were found to be statistically higher in Group 2 cases; ELR was similar among groups.
DISCUSSION AND CONCLUSION: The MER, NLR, and PLR were determined to be associated with negative micro-TESE results. Particularly PLR seems to have a poor prognostic value in these patients. A prognostic value of the ELR which was a new biomarker was not determined in SR from the TESE procedure.

6.IVF/ICSI outcomes in women of age 40 years and older who underwent Dual Trigger: A retrospective cohort study
Sanai Aksoy, Sinem Ertaş
doi: 10.14744/zkmj.2022.37880  Pages 183 - 188
INTRODUCTION: Female age is the critical factor determining the success in assisted re-productive technology cycles. The objective of this study was to observe the impact of using dual trigger (gonadotropin-releasing hormone [GnRH] agonists and recombinant human chorionic gonadotropin (r-hCG)] for ovulation induction on in vitro fertilization (IVF)/Intracytoplasmic sperm injection outcomes of women with advanced age (40 or above).
METHODS: This retrospective cohort study was conducted on 408 patients aged 40 years or older. Only the first cycles of the patients were implicated in the study. Flexible GnRH antagonist protocol was used for ovarian stimulation in all patients. Ovulation was triggered when at least two follicles reached a size of 17 mm or more. The study group included 67 cycles that applied dual trigger. The control group consisted of 341 cases in which final oocyte maturation was triggered by hCG alone. In addition to the basic characteristics and cycle parameters of the cases, pregnancy and live birth rates (LBR) of both groups were compared.
RESULTS: Statistically, there was no prominent difference in terms of average female age, duration of infertility, duration of stimulation, amount of gonadotrophin used, cycle cancellation rate, total oocyte rate, total MII oocyte rate, 2PN rate, fertilization rate, embryo utilization rate (usable embryo/2PN), and number of transferable embryos in dual trigger and hCG only groups. Oocyte maturation rate (Number of MII oocytes/total number of oocytes) was observed to be higher in study group. Clinical pregnancy rates and LBRs were the same in both groups.
DISCUSSION AND CONCLUSION: In women aged 40 years and older, dual trigger did not show a significant increase in the oocyte maturation, clinical pregnancy, and LBRs according to hCG-only trigger patients.

7.Karyotype analysis of products of conception in patients with recurrent pregnancy loss
Yeşim Özdemir, Resul Arısoy, Fatih Şanlıkan, Koray Özbay, Altuğ Semiz
doi: 10.14744/zkmj.2022.34735  Pages 189 - 192
INTRODUCTION: The purpose of this study is to discuss the results of products of conception (POC) karyotype analysis in cases with recurrent pregnancy loss (RPL).
METHODS: The data of the cases evaluated with the diagnosis of RPL were retrospectively obtained and the results were examined (n=485). Among them, 135 cases with karyotype analysis were included in the study. Maternal age, gestational week, and karyotype analysis results were recorded (n=129). Cases between 6 and 14 weeks of age were included in the study. Maternal age, gestational week, and karyotype analysis results of cases with RPL between 6 and 14 weeks of gestation were recorded as data. Genetic analysis of POC was made with conventional cytogenetic techniques.
RESULTS: One hundred and thirty-five cases diagnosed with RPL were included in the study. Mean maternal age was 34.43±5.41 years and mean gestational age was 8.36±1.58 weeks. Abnormal karyotype was detected in 40 cases (40/129, 31%). Karyotype analysis was normal in 89 cases and among these, two fetuses had 46, XX, 9qh+ polymorphism. In cases with abnormal karyotype, maternal age was found to be more advanced compared to euploid karyotypes (35.97±5.31 vs 33.57±5.31, p=0.0188). Again, in male fetuses (17/35), when compared to females (23/83), significantly more abnormal karyotypes were detected (p=0.048).
DISCUSSION AND CONCLUSION: The frequency of abnormal karyotype in RPL cases was 31%, and the most common abnormality was autosomomal trisomies (62.5%). Trisomy 22 was the most common of the trisomies (24%). We also emphasize that the frequency of abnormal karyotype increases with advanced maternal age, according to our results.

8.The effect of maternal obesity on cervical cerclage outcomes: A retrospective cohort study
Çağdaş Özgökçe, Aydın Öcal, Lütfiye Uygur, Ömer Gökhan Eyisoy, Oya Demirci
doi: 10.14744/zkmj.2022.04468  Pages 193 - 199
INTRODUCTION: The objective of the study was to investigate the relationship between body mass index (BMI) and gestational age at delivery in patients who underwent cervical cerclage.
METHODS: The population of this retrospective study comprised the patients aged 18–45 who underwent cervical cerclage procedure in Zeynep Kamil Hospital between 2014 and 2021. Maternal demographic data and clinical characteristics, including BMI at the time of the cervical cerclage, were recorded. Patients were categorized into three groups according to their BMI values: normal (BMI: <25 kg/m2), overweight (BMI: 25–29.9 kg/m2), and obese (BMI: ≥30 kg/m2) groups. The primary and secondary outcomes of this study were gestational age at delivery and the percentage of deliveries that occurred <37 weeks, respectively.
RESULTS: The study sample consisted of 151 patients with a mean age of 30.4±5.6 years. The mean gestational age at cervical cerclage was 18.0±4.0 weeks, and the median gestational age at delivery was 37.0 weeks. Gestational week at delivery was significantly lower, and significantly fewer deliveries at ≥37 weeks occurred in the obese group compared with the other two groups (p<0.001). There was a significant inverse correlation between maternal BMI and gestational age at delivery (r=−0.516, p<0.001).
DISCUSSION AND CONCLUSION: Gestational age at delivery is inversely correlated with BMI in the pregnancies which have undergone cerclage operation. Accordingly, the risk of preterm delivery is significantly associated with BMI values of ≥30 kg/m2 in patients with cervical cerclage. Maternal obesity is shown to decrease the success of cerclage.

9.Comparison of the pregnancy and newborn results of Turkish pregnant women and Syrian refugee pregnant women
Resul Karakuş, Zafer Bütün, Gökhan Ünver, Sultan Seren Karakuş, Erman Çiftçi
doi: 10.14744/zkmj.2022.45467  Pages 200 - 206
INTRODUCTION: The aim of the study was to compare the pregnancy and newborn out-comes of Turkish pregnant women and Syrian refugee pregnant women.
METHODS: This two-centered study was carried out retrospectively on 5505 pregnant women between 2016 and 2019 in Zeynep Kamil Maternity and Children’s Health Training and Research Hospital and Akçakale State Hospital.
RESULTS: The study was conducted with a total of 5505 pregnant women, whose ages ranged from 13 to 48. 2766 of the cases were Turkish and 2739 of them were Syrian. Antenatal follow-up rates of Syrian cases were significantly lower than of Turkish cases (p<0.001). The incidence of pre-eclampsia (PE) in Turkish cases (11.1%) was statistically significantly higher than in Syrian cases (2.6%) (p<0.001). The incidence of gestational diabetes mellitus (GDM) in Turkish cases (9.7%) was statistically significantly higher than in Syrian cases (1%) (p<0.001). The incidence of intrauterine growth restriction (IUGR) in Turkish cases (6.5%) was statistically significantly higher than in Syrian cases (1.9%). (p<0.001). While the rates of normal spontaneous vaginal delivery (NSVD) and cesarean section without episiotomy were higher in Turkish cases, the rate of NSVD with episiotomy was higher in Syrian cases (p<0.001). The mean values of antepartum, postpartum hemoglobin (Hb), and hematocrit of Turkish cases were statistically significantly higher than Syrian cases (p<0.001).
DISCUSSION AND CONCLUSION: In this study, we determined that adolescent pregnancy, pregnancy at younger age, inadequate antenatal follow-up rates, and the rate of birth with interventions were high in Syrian immigrants, and Hb values were low due to insufficient nutritional support. We also determined that PE, GDM, oligohydramnios, and polyhydramnios were common in Turkish population, and the need for neonatal intensive care and amount of postpartum bleeding was similar in both groups.

10.Reference ranges of nasal bone length, pre-nasal thickness, and pre-nasal thickness-to-nasal bone length ratio in low-risk pregnant women: A retrospective and cohort study from Türkiye
Münip Akalın, Merve Kara, Emine Eda Akalın, Koray Gök, Gizem Kul, Esra Esim Büyükbayrak
doi: 10.14744/zkmj.2022.24865  Pages 207 - 212
INTRODUCTION: The aim of this study was to determine the reference ranges of second trimester nasal bone length (NBL), pre-nasal thickness (PT), and PT/NBL ratios of low-risk pregnant women in Turkish population.
METHODS: Pregnant women of 16–28th gestational age who underwent ultrasonographic fetal screening between November 2021 and June 2022 were retrospectively analyzed. Fetuses with congenital malformations, high risk in antenatal screening tests, diagnosed with aneuploidy, and pregnant women of non-Turkish ethnic origin were excluded from the study. Fetuses were classified as ≤19+6 weeks, 20+0–20+6 weeks, 21+0–21+6 weeks, 22+0–22+6 weeks, 23+0–23+6 weeks, and ≥24+0 weeks. NBL, PT, and PT/NBL ratio was evaluated for each gestational age separately.
RESULTS: A total of 242 fetuses were included in the study. The mean NBL and mean PT increased with gestational age (6.42±0.65 at 20+0–20+6 weeks versus 7.65±0.79 at 23+0–23+6 weeks and 3.10±0.62 at 20+0–20+6 weeks vs. 3.55±0.63 at 23+0–23+6 weeks, respectively). Both NBL and PT were positively correlated with gestational age whereas the PT/NBL ratio was constant throughout the second trimester (PCC=0.81, p<0.001, PCC=0.56, p<0.001, and PCC=−0.07, p=0.255, respectively). The mean PT/NBL ratio in the second trimester was calculated as 0.46 (95% CI, 0.45–0.47, 5th p=0.35 and 95th p=0.62).
DISCUSSION AND CONCLUSION: The reference ranges for NBL, PT, and PT/NBL ratio may vary in different populations. Therefore, the use of population-specific nomograms may lead to higher success rates in Down syndrome screening.

11.Perception of COVID-19, distress, depression, and anxiety among pregnant women during the COVID-19 pandemic
Leyla Kaya, Esra Keleş, Zahide Kaya, Neşe Yakşi
doi: 10.14744/zkmj.2022.82653  Pages 213 - 217
INTRODUCTION: The objective of the study was to examine the relationship between the mental health of pregnant women and their perception of COVID-19 pandemic.
METHODS: In this cross-sectional study, from December to January 2021, stress, anxiety, depression, and perception of causes of COVID-19 were measured using the Depression, Anxiety, and Stress Scale (DASS-21) and Perception of Causes of COVID-19 Scales.
RESULTS: A total of 300 pregnant women with a median age of 29 years (range: 19–39) were included. Anxiety, depression, and stress and age were mildly correlated (r=0.117, p=0.043). With regard to the development of mental problems in babies due to the COVID-19 pandemic, 43.8% of pregnant women had severe anxiety levels, while 31.3% had no anxiety (p=0.011). Pregnant women who had anxiety about development of anomaly in babies due to COVID-19 pandemic had significantly severe depression levels (p=0.011). Severe stress was found to be higher in pregnant women who had anxiety about miscarriage due to COVID-19 pandemic (p=0.016). No significant correlation was found between the DASS-21 subscales and the perception of causes of COVID-19 subscales.
DISCUSSION AND CONCLUSION: The present study found that a majority of women experienced elevated levels of stress, anxiety, and depression caused by COVID-19 pandemic. Pregnant women experienced high levels of depressive symptoms about the development of their baby will be adversely affected by the pandemic. We also found higher levels of stress in pregnant women who were worried about miscarriage due to COVID-19 pandemic. Our research did not find a relationship between the mental well-being of pregnant women and COVID-19 perception.

12.Comparison of asthma control scales and quality of life in children
Almala Pınar Ergenekon, Merve Selçuk, Cansu Yılmaz Yeğit, Mürüvvet Yanaz, Aynur Gulieva, Mine Kalyoncu, Şeyda Karabulut, Ela Erdem Eralp, Yasemin Gökdemir, Bülent Karadağ
doi: 10.14744/zkmj.2022.08216  Pages 218 - 222
INTRODUCTION: Asthma control levels can be detected through questionnaires such as Asthma Control Test (ACT), childhood ACT (c-ACT), and Asthma Control Questionnaire (ACQ). The quality of life of the child and parent can be affected by asthma. The current study aims to compare asthma control scales and assess how asthma control affects quality of life.
METHODS: This study included the children with asthma. Children and their families completed ACT, c-ACT, ACQ, and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). While high scores on the ACQ test indicate poor asthma control, high scores on the ACT tests indicate well asthma control. High score on the PAQLQ shows that quality of life is also in high level.
RESULTS: Ninety-four patients were included in the study. Median age of the patients was 9.6 (7.9–12.3) years. A comparison of asthma control scales showed that according to both tests, 25.5% (n=24) of patients were under total control. In totally controlled group of patients according to ACQ test, 48.9% were either partially controlled or uncontrolled according to ACTs. There was a negative correlation between ACT and ACQ (p<0.001, r=-0.70); c-ACT and ACQ (p<0.001, r=-0.57) and between ACQ and PAQLQ (p<0.001, r: -0.69). A positive correlation was found between ACTs and PAQLQ (p<0.001, r=0.71).
DISCUSSION AND CONCLUSION: Quality of life was significantly impaired especially in uncontrolled asthmatic children. Control of asthma is crucial to increase the quality of life and improve the respiratory condition. Due to the discordance between currently used scales, determining the exact control seems difficult. New tests are urgently required to deter-mine how well children’s asthma is controlled.

13.Google Trends (or social media) and its effects on pediatric emergency department visits during the pandemic period
Sevgi Akova, Neslihan Özkul Sağlam
doi: 10.14744/zkmj.2022.93764  Pages 223 - 228
INTRODUCTION: During sudden epidemics, the public needs access to timely and reliable information on disease symptoms and prevention. The aim of this study is to reveal the effect of social media in the field of health by evaluating the relationship between the information learned about the COVID-19 pandemic in Google Trend searches and pediatric emergency applications.
METHODS: The data were obtained from pediatric emergency visits in 2017–2020, covering the period from January 1 to May 31. The main study period aiming to analyze the relationship between pediatric emergency department visits and “interest over time (IOT)” was determined as January 1–May 31, 2020. Visits to the pediatric emergency department and Google Trends search data were analyzed. The relationships between the urgency ranking determined according to the triage system applied in our hospital and the Google Trends search data were evaluated.
RESULTS: Until the first case of COVID was reported in Türkiye, it was observed that while the green zone patients were dominant in the visits to the pediatric emergency department, the yellow zone patients’ visits became dominant in the period after this date. A strong negative correlation was found between Google Trends search popularity and green zone (r=−0.0693, p<0.05, IQR=5.353). In our Google Trends analysis during the pandemic study period, as of March 11, 2020, which had the highest 100 IOT value, and as Google search trends increased, it was determined that the number of pediatric patients with non-COVID symptoms decreased and with COVID-like symptoms increased.
DISCUSSION AND CONCLUSION: People avoided unnecessary applications as a result of learning the transmission routes of COVID-19, the symptoms of the disease, morbid, and mortal results with the search term “corona” from the search engine. The use of social media data in the field of health information can prevent unrealistic emergencies in Türkiye and around the world.

REVIEWER LIST
14.Reviewer List

Page 229
Abstract |Full Text PDF

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