E-ISSN 2757-8062
Volume : 54 Issue : 3 Year : 2024

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 54 (3)
Volume: 54  Issue: 3 - 2023
FRONTMATTERS
1.Cover

Page I

2.Editorial Board

Pages II - IX

ORIGINAL RESEARCH
3.The evaluation of extraintestinal manifestations in children diagnosed with inflammatory bowel disease: A single-center experience
Didem Gülcü Taşkın, Arzu Gülseren
doi: 10.14744/zkmj.2022.94830  Pages 113 - 118
INTRODUCTION: We aimed to examine the relationship between the disease activity index rates at the time of diagnosis and the development of extraintestinal manifestations (EIMs) in children and adolescents with inflammatory bowel disease (IBD).
METHODS: Our study was conducted with 57 children and adolescent patients diagnosed with IBD between 2018 and 2022. The records of the patients were reviewed retrospectively. For the evaluation of IBD activity, Pediatric Crohn’s Disease Activity İndex and Pediatric Ulcerative Colitis Activity İndex measurements were made.
RESULTS: Fifty-seven patients with a diagnosis of IBD were included in the study. When the activity status of the disease was classified as mild, moderate, and severe, there were 11, 14, and 32 patients, respectively. The most common EIM was arthralgia, and it was shown to occur in 23 (40.4%) patients. The presence of EIM was analyzed in 2 (18.2%) patients in mild disease, in 5 (35.7%) patients in moderate disease, and in 17 (53.1%) patients in severe disease, and there was no significant difference between the groups (p=0.110). The area under curve value was found to be 0.623 in the receiver operating characteristic curve to detect the presence of EIM for ulcerative colitis patients (p=0.242).The ideal cutoff value was determined as 67.5, the sensitivity was calculated as 61.5%, and the specificity was calculated as 42.1%.
DISCUSSION AND CONCLUSION: It was found that the presence of EIM at the time of diagnosis was more common in the presence of severe disease, but the result was not significant.

4.Obstetric relaparotomies: 13 years of tertiary care experience
Fatih Mehmet Fındık, Mehmet Sait İçen
doi: 10.14744/zkmj.2023.98752  Pages 119 - 122
INTRODUCTION: Postpartum hemorrhage is the most common cause of maternal morbidity and mortality. Relaparotomy (RL) is the most serious complication after delivery (normal delivery or cesarean section). RL is very rarely required and mostly performed due to intra-abdominal bleeding. This study aims to show the indications for obstetric RL due to hemorrhage and reveal hemorrhage areas.
METHODS: A total of 120 patients with an RL history due to cesarean and vaginal postpartum hemorrhage were included in the study. Data such as age, gravida, parity, the procedure performed in an RL, the time between surgeries, complications, and the need for blood transfusion were obtained from clinical files. De-scriptive statistical analysis was performed.
RESULTS: The RL incidence was 0.44%. Of all RLs, 18.3% (n=22) occurred after vaginal delivery while 81.7% (n=98) occurred after cesarean sections. The indications for an RL were intra-abdominal hemorrhage (83.4%, n=100) and atony (16.6%, n=20). Surgical procedures during an RL were hysterectomy (37.5%, n=45), vascular ligation (19.1%, n=23), secondary suturing (24.1%, n=29), rectus muscle repair (13.3%, n=16), and uterine rupture repair (5.8%, n=7).
DISCUSSION AND CONCLUSION: Close follow-up of the patient after delivery is vital in terms of postpartum hemorrhage. The postpartum RL requirement is 0.44% and it is life-saving. Active management during this period is very significant in terms of reducing maternal morbidity and mortality.

5.Being “HPV positive” in the 7th year of the national cervical screening program: A cross-sectional study in a tertiary hospital in southern Türkiye
Sevda Baş, Şahin Yuksek
doi: 10.14744/zkmj.2023.54670  Pages 123 - 129
INTRODUCTION: Human papillomavirus (HPV)-based cervical cancer screening program has been conducting in Türkiye since 2014. Because of the sexually transmitted nature of the virus and the risk of developing cancer, HPV screening has challenges arising from the concerns of women who receive positive test results. The primary aim of this study was to assess women’s knowledge of being a carrier of HPV at the 7th year of the screening. Second, we measured the anxiety and general distress levels of women, and we sought to describe contributing factors to such feelings.
METHODS: This prospective observational study was conducted in a tertiary hospital between January 2021 and August 2021. Participants were women referred to our outpatient clinic because of a positive high risk HPV test result. State-Trait Anxiety Inventory-State (STAI-S), General Health Questionnaire (GHQ-12), and seven-item questionnaire developed by our group were completed by all participants.
RESULTS: There were 115 eligible women for the study. The mean±standard deviation (SD) age was 43±8 years. 71 (61.7%) women reported that they had never heard of the screening program. 67 (58.2%) women stated that they thought they had cervical cancer, and 22 (19.1%) women said they would have cancer in the future. 53 (46.1%) women specified that the family physician provided insufficient information about the results. The mean STAI-S scores of the participants ranged from 48 (SD=6.4), and GHQ scores ranged from 3.2 (SD=3.4). There was no significant difference in these scores regarding patients’ age, education level, or working status (p>0.5).
DISCUSSION AND CONCLUSION: Women with positive screening results who applied to our hospital had low knowledge of HPV and screening program. They also had high levels of anxiety and psychological distress. These unpleasant feelings may negatively affect patients’ compliance with screening. Family physicians or nurses working in cervical screening should be aware and well-trained about HPV.

6.Duration of abstinence and TMSC are significant predictors for IUI outcome
Müşerref Banu Yılmaz, Belgin Devranoğlu, Selma Atiye Kolcu, Zeynep Çelik, Enis Özkaya
doi: 10.14744/zkmj.2023.55798  Pages 130 - 136
INTRODUCTION: The aim of this study is to assess the impact of pre- and intracycle spermiogram parameters on treatment outcome in Intrauterine Insemination (IUI) cycles of couples with optimal female cycle characteristics.
METHODS: The study group comprised infertile couples diagnosed as anovulation, grade 1–2 endometriosis, and unexplained or male factor infertility. Women included in this study underwent ovulation induction and women with optimal cycle characteristics were included in the analysis to figure out the individual impact of sperm parameters on cycle outcome in terms of clinical pregnancy.
RESULTS: Precycle sperm concentration, semen volume, duration of abstinence, total progressive sperm counts, and pre- and intracycle progressive motile sperm concentrations were significant predictors for clinical pregnancy. In addition, parameters of abstinence and total progressive motile sperm count evaluated on IUI day were found to significantly predict favorable outcomes. Multivariate regression analysis was conducted to show adjusted associations and analysis revealed that intracycle duration of abstinence and precycle total progressive motile sperm counts were significantly associated with clinical pregnancy.
DISCUSSION AND CONCLUSION: It is shown that intracycle duration of abstinence and precycle total progressive motile sperm counts were significant predictors for IUI cycles with optimal female partner reproductive properties.

7.Mental health of pregnant women during the Delta and Omicron SARS-CoV-2 waves
Esra Keles, Leyla Kaya, Zahide Kaya, Zeynep Çelik, Neşe Yakşi
doi: 10.14744/zkmj.2023.48751  Pages 137 - 145
INTRODUCTION: The objective is to investigate whether is there any differences in the mental health of pregnant women during Delta and Omicron COVID-19 waves and to determine the variables related to the symptoms of depression, stress, and anxiety of pregnant women.
METHODS: A cross-sectional study was conducted from April to June 2021 (Delta wave) and March to June 2022 (Omicron wave). Pregnant women were evaluated using a questionnaire consisting of sections assessing sociodemographic characteristics, the perceived burden of the COVID-19 pandemic, and psychometric instruments: depression anxiety and stress scales-21 (DASS-21), and perception of causes of COVID-19 scale.
RESULTS: DASS anxiety, depression, and stress subscales scores were higher in the Delta wave than in the Omicron wave (p<0.001). Mothers’ anxiety and fears about their own health and the health of their babies were higher in the Delta wave than in the Omicron wave (p<0.001). DASS symptoms were found to be associated with ed-ucation level, employment, income, and weight gain during pregnancy (all p<0.05).
DISCUSSION AND CONCLUSION: This study indicated that stress, anxiety, and depressive symptoms were higher in pregnant women in the Delta wave than in the Omicron wave. This study recommended the implementation of mental health promotion, prevention, and intervention strategies to support pregnant women during epidemics.

8.Fetal anatomy screening at 11–14 weeks’ ultrasonography, comparison of TAUSG and TVUSG
Gamze Kırpınar, Lütfiye Uygur, Aylin Yılmaz, Didar Kurt, İbrahim Kalelioğlu
doi: 10.14744/zkmj.2023.50570  Pages 146 - 151
INTRODUCTION: This study aimed to evaluate the success of fetal anatomy screening at 11–14 weeks’ ultrasonography and also to compare the superiority by performing fetal anatomy screening for both transabdominal and transvaginal probes.
METHODS: A total of 73 patients who applied to Istanbul University, Istanbul Faculty of Medicine, Department of Obstetrics and Gynecology Perinatology Department for 11–14 weeks of screening tests between May 2018 and December 2018 were evaluated. It was designed as a prospective, single-center clinical study. Fetal anatomical structures were determined by reference to the guideline published by the International Society of Ultrasound in Obstetrics and Gynecology for first-trimester ultrasound and were evaluated as normal, abnormal, and unevaluated both for transabdominal and transvaginal probes.
RESULTS: Nasal bone and nuchal translucency were found to be seen at a higher rate in transabdominal ultrasound. The heart, kidneys, and bladder were significantly higher in transvaginal ultrasound.
DISCUSSION AND CONCLUSION: In the 11–14-week ultrasonography, the anatomical evaluation of the fetus is possible in addition to the screening test, and transvaginal ultrasound is a complement to the transabdominal ultrasound evaluation. All anomalies cannot be detected in 11–14 weeks of ultrasonography and it is not appropriate to replace the ultrasonography of 18–23 weeks. The evaluation should be completed with transvaginal ultrasound examination when suspicion of anomaly occurs, some structures with abdominal ultrasound cannot be visualized, or when image quality is insufficient due to obesity.

9.Thoughts, experiences, and emotions of pregnant women during COVID-19 pandemic: A qualitative study
Zeynep Meva Altaş, Seyhan Hıdıroğlu, Begüm Timuroğlu, Merve Ölüç, Alperen Kılıçarslan, Murathan Yıldırım, Saniye Köseoğlu, Dilşad Save
doi: 10.14744/zkmj.2023.03360  Pages 152 - 158
INTRODUCTION: Pregnant women are one of the most vulnerable groups affected negatively by the COVID-19 pandemic process. It was aimed to evaluate the thoughts, feelings, problems, individual experiences of pregnant women about pandemic.
METHODS: For the qualitative type of study, the participants were selected among pregnant women aged 18–45 who came to the Obstetrics and Gynecology Polyclinic of a state hospital in Istanbul. Interviews were recorded, if the participant gave consent. Written notes were taken when recording was not allowed. The data collection process was terminated with 12 participants with the content saturation.
RESULTS: The minimum age of the 12 participants was 23, and the maximum age was 40. Six different themes were created: Emotional Status of Being Aware of Coronavirus, Information Source About Coronavirus, Pregnancy and Pandemics, Precautions/COVID-19 Vaccination, Disease Process, and Social Relationships in Pandemic. Almost all of the participants mentioned that their physical and mental health were negatively affected by the pandemic. Most of the participants talked about the anxiety of getting the disease and its possible effects on themselves and their babies.
DISCUSSION AND CONCLUSION: Pandemic had negative effects on both physical and mental health for participants. Interventions are needed for pregnant women for improvement of their health.

10.Behavioral characteristics of pediatric surgery patients and their parents and treatment planning during the closure period of the COVID-19 pandemic
Olga Devrim Ayvaz, Ayşenur Celayir, Erkan Pehlivan
doi: 10.14744/zkmj.2023.20092  Pages 159 - 164
INTRODUCTION: We aimed to determine the behavioral attitudes and diagnostic/interventional characteristics of the patients relatives who applied to our polyclinic during the closure period of COVID-19 pandemic.
METHODS: This prospective study was conducted between June and July 2020. All results were statistically analyzed.
RESULTS: Hundred and five (61.8%) male, 65 (38.2%) female patients who applied to our outpatient clinic. The median age was 2 years. A total of children came with their parents, and 99.4% were wearing masks. Although 93.5% of the parents were wearing their masks correctly. At least one of the additional protective outfits was used by 7.1% of parents. Forty (23.5%) parents adapted at least one of the health protective behaviors. About 52.4% of patients were not wearing masks; and 92.6% of masked people were wearing them correctly. Surgery was performed in 10.5% of the patients under general anesthesia.
DISCUSSION AND CONCLUSION: The use of masks in children of working mothers and elderly fathers was increased; and correct use of masks in children was affected by the father’s professions. The use of additional health protective methods in patients in those who come by their own vehicle was decreased. In the rate of mask use as the child’s age gets older, they were found to be statistically significant parameters.

CASE REPORT
11.A rare case of Poland syndrome accompanied by lower extremity anomaly
Ceren Yapar Gümüş, Elif Uysal
doi: 10.14744/zkmj.2023.24993  Pages 165 - 168
Poland syndrome (PS) is a rare congenital anomaly characterized by hypoplasia of the pectoralis major muscle, variable degrees of upper extremity deformities, breast tissue, and anterior chest wall deformities. A 13-year-old male patient had brachydactyly of the fingers of the left hand and symbrachydactyly. On physical examination, the left breast tissue and areola were significantly hypoplasic compared to the right. The patient’s right leg was hypoplasic compared to the left. Lower extremity anomalies are rarer compared to upper extremity anomalies in PS. Since hypoplasia of the upper extremities is one of the common findings of PS, we think that hypoplasia of the lower extremities found in our patient may be a rare component of PS.

12.Two cases of fetal congenital oral masses
Gökalp Şenol, Zafer Bütün, Kamuran Suman, Ahu Korkut, Burcu Özek Ör, Sezin Uludağ, Melih Velipaşaoğlu, Hüseyin Mete Tanır
doi: 10.14744/zkmj.2023.86729  Pages 169 - 172
Fetal oral masses rarely occur in utero. Their detection is of paramount importance because the mass may close the oral cavity, leading to polyhydramnios and eventually resulting in preterm labor and/or fetal loss due to postpartum asphyxia. We present two cases of fetal oral masses diagnosed with fetal congenital epulis and fetal thyroglossal duct cyst each, in which the masses were excised by ex utero intrapartum treatment during cesarean deliveries.

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