E-ISSN 2757-8062
Volume : 54 Issue : 4 Year : 2024

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 54 (4)
Volume: 54  Issue: 4 - 2023
FRONTMATTERS
1.Cover

Page I

2.Editorial Board

Pages II - IX

REVIEW ARTICLE
3.Day-case surgery patient selection and discharge criteria in children
Feride Mehmetoğlu
doi: 10.14744/zkmj.2023.24540  Pages 173 - 178
Day-case surgery (DCS) is a planned procedure, in which patients are admitted for surgery and discharged on the same day. DCS confers major advantages for the child and the family, as it reduces the potential negative impact of an overnight stay and allows for the patient to have familiar surroundings during recovery. Children are excellent candidates for DCS because they are usually healthy, free of systemic disease, and typically require straightforward, minor, or intermediate surgical procedures. While there are numerous well-accepted benefits of DCS for patients and health-care organizations, one problem with this approach is determining if the procedure is feasible and safe. Effective patient selection and postoperative assessment with protocol-driven discharge is fundamental for DCS but requires experience and an understanding of the criteria for each intervention. This study aimed to present the criteria for patient selection and discharge of pediatric surgery patients who underwent DCS.

ORIGINAL RESEARCH
4.Assessment of the relationship between non-alcoholic fatty liver disease and serum zinc levels in obese children and adolescents
Eren Er, Didem Gülcü Taşkın
doi: 10.14744/zkmj.2023.54926  Pages 179 - 183
INTRODUCTION: As obesity rates increase, the prevalence of non-alcoholic fatty liver disease (NAFLD) increases as well. Numerous micronutrient deficiencies are associated with NAFLD. The development of NAFLD is thought to be influenced by zinc (Zn) deficiency. This study aims to investigate the relationship between NAFLD and serum Zn levels as well as some other parameters in obese children.
METHODS: This study examined the medical records of children and adolescents with obesity in the pediatric gastroenterology polyclinic 1 at the Adana City Training and Research Hospital between October 01, 2017 and August 31, 2022. Participants were evaluated in two groups, group 1 (NAFLD patients) and group 2 (non-NAFLD patients). Anthropometric and laboratory data were obtained from the patient’s file.
RESULTS: There were 91 patients (32 [35.1%] boys and 59 [64.8%] girls) who were 11.67±3.42 years old. Forty-two (46.1%) of the patients were affected by NAFLD, whereas 49 (53.8%) had normal results. The mean serum Zn level of the patients was 84.36±20.02 μg/dL. A statistically significant increase in serum Zn levels in group 2 compared to group 1 (89.96±7.99 μg/dL, 80.48±24.58 μg/dL; p=0.030) was observed. Other parameters did not show a significant difference between the groups (p>0.05). In logistic regression analysis, there was a significant negative correlation between NAFLD the presence and serum Zn level (p=0.049), but there was no significant correlation between the other parameters (p>0.05).
DISCUSSION AND CONCLUSION: The present study is the first to examine the relationship between NAFLD and serum Zn in obese children in the literature. There was a statistically significant negative correlation between the presence of NAFLD and the level of serum Zn. According to these findings, Zn supplementation may be one of the treatment options for NAFLD management, and further studies with more patients are needed to investigate this possibility.

5.The importance of HPV types and endocervical curettage in colposcopic examination for the diagnosis of cervical lesions
Irem Yaman, Yunus Emre Purut, Çağrı Ateş, Burak Giray, Zehra Meltem Pirimoğlu
doi: 10.14744/zkmj.2023.25349  Pages 184 - 188
INTRODUCTION: Cervical cancer is the third most common gynecologic cancer diagnosis. It is a type of cancer that can be predicted with effective screening because there is a factor such as human papillomavirus (HPV), which can be considered etiologically responsible. The main objectives of our study are to investigate whether high-risk HPV (hrHPV) 16, 18 and other hrHPV genotypes revealed by HPV genotyping require a different approach and to evaluate whether simultaneous endocervical curettage (ECC) is required during colposcopy.
METHODS: HPV genotypes, colposcopic biopsy, and ECC results of HPV DNA-positive patients between the ages of 25–65 years. HPV types other than HPV 16 and 18 were grouped as hrHPV types. Smear results, biopsy results, and ECC results were compared. The correlation between colposcopic biopsy and ECC results was evaluated.
RESULTS: The mean age of the 111 patients included in the study was 44.48±8.34 years. There was a statistically insignificant relationship between HPV 16 and/or 18 and other genotypes (p=0.067). A similar trend was present in terms of ECC (p=0.072). In the comparative evaluation of the patients who underwent ECC with colposcopic biopsy, it was found that colposcopic biopsy was significantly more effective in diagnostic terms (p<0.001). However, cervical intraepithelial neoplasia (CIN) was detected in ECC in 6.8% of the patients whose colposcopic biopsy did not reveal CIN.
DISCUSSION AND CONCLUSION: Even if the lesion margins are clear during the biopsy of the lesion in colposcopy examination, ECC may increase diagnostic accuracy.

6.Comparison of maternal and perinatal outcome in pregnant women of SARS-CoV-2 infection in the pandemic
Ergül Demirçivi, Hanne Selime Bulat, Canan Satır Özel, Oğuz Devrim Yardımcı, Abdulkadir Turgut
doi: 10.14744/zkmj.2023.59365  Pages 189 - 196
INTRODUCTION: The coronavirus-2019 pandemic has led to the deaths of many people in the world. Due to the changing physiology in pregnant patients, there is no consensus on the management of the disease. The effects of the disease have decreased over time with the changing virus variants and the spread of the vaccine during the pandemic.
METHODS: 231 pregnant patients hospitalized and treated in our clinic due to severe acute respiratory syndrome coronavirus 2 infection between April 2020 and April 2022 were retrospectively analyzed.
RESULTS: Patients were divided into three groups according to the time of occurrence of possible variants. Group 11 (n=99) includes patients with pre-delta, group 2 (n=79) delta, and group 3 (n=53) omicron variants. Considering the vaccine distribution, there is no vaccinated individual in group 1. Individuals in group 2 who are vaccinated in 2 doses have the highest percentage as 42% and group 3 has the highest percent-age as 66% (p<0.01). Steroid administration to improve respiratory parameters was mostly preferred in patients in groups 1 and 2 (78–57%) (p=0.022). O2 support was found to be statistically significantly higher in groups 1 and 2 compared to group 3. The number of patients who needed O2 support was found to be lower in group 3 than in the other groups. There was no significant difference between the groups in terms of maternal mortality and morbidity, delivery type, or caesarean section indications. When the length of hospital stay was compared, it was found to be the lowest in group 3 (p<0.001). Fetuses in group 3 had the least need for a neonatal intensive care unit.
DISCUSSION AND CONCLUSION: We think that the management of infectious respiratory diseases during pregnancy should be with a multidisciplinary and holistic perspective. More scientific studies should be conducted on the management of pregnant patients against the potential danger of a new pandemic.

7.Evaluation of sleep quality of mothers of children diagnosed with food allergy
Ercan Nain, Uğur Altaş, Zeynep Meva Altaş, Mehmet Yaşar Özkars
doi: 10.14744/zkmj.2023.35492  Pages 197 - 202
INTRODUCTION: The purpose of the study was to investigate the sleep quality among mothers of food-allergic children.
METHODS: The universe of the case–control study contains the mothers of children with food allergy who came to the pediatric allergy and immunology out-patient clinic for the case group. The control group was the mothers of children who applied to the pediatrics outpatient clinic without a diagnosis of food allergy and other chronic diseases. Within the scope of the study, a face-to-face questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were used for both the control group and the case group. Apart from PSQI, mothers’ age and self-assessments of quality of life were also evaluated in the study. The mothers’ quality of life was evaluated as self-assessment, scoring their general quality of life from 1 to 10 with a single question.
RESULTS: In the study, the mother of 55 children having food allergy diagnosis was the case group; mothers of 55 children with no diagnosis of food allergy were considered the control group. The case and control groups were statistically similar in terms of gender, age, and maternal age (p>0.05). The overall quality of life median value of the control group was higher (8.0 [6.0–9.0], 5.0 [1.0–8.0], respectively) (p<0.001). Except for the subdimensions of subjective sleep quality and use of sleeping pills, all of the PSQI scores and total PSQI scores were higher in the case group than in the control group. In other words, the sleep quality of the case group was significantly worse (p<0.001).
DISCUSSION AND CONCLUSION: The life and sleep quality of mothers may be adversely affected while coping with the children’s diseases as caregivers. Interventions with psychiatrists should be planned if there is a need.

8.Investigation of subclinical Vitamin D deficiency and other risk factors in community-acquired pneumonia in children
Necmiye Öztürk, Müferet Ergüven, Banu Işbilen Başok, Engin Aydın
doi: 10.14744/zkmj.2023.68094  Pages 203 - 208
INTRODUCTION: This study aimed to investigate subclinical Vitamin D deficiency and other risk factors in community-acquired pneumonia in children. In addition to the known infectious causes of pneumonia, we wanted to examine whether Vitamin D deficiency, which can change the characteristics of the immune system, is a risk factor for the disease.
METHODS: Ethical approval and study done at Istanbul Medeniyet Uni-versity Göztepe Training and Research Hospital Pediatric Clinic. Fifty-seven hospitalized patients with the diagnosis of pneumonia and 57 healthy controls were chosen for the study. Patients who have an underlying disease were excluded, and groups were compared. Informed consent was obtained, a questionnaire was prepared for the patients including patients’ demographic, familial, and socioeconomic characteristics, possible factors that may cause pneumonia were questioned. Measurements on a digital scale, infantometer, and stadiometer were used. The measurement of 25(OH)-D3 was performed by the chemiluminescence method in an immunoassay.
RESULTS: The age range was 27.89–26.21 months. In the patient group, the number of individuals living in the same house was higher (n: 5.35±2.69 vs. n: 4.11±0.86; p=0.002), the birth weights of subjects (3117.36±390.80 gr vs. 3340.63±501.71 gr; p=0.010), and serum 25(OH)-D3 levels (25.21±13.19 ng/mL vs. 31.97±12.08 ng/mL; p=0.005) were lower compared to the control group. Illiterate mothers in the patient group (21.1% vs. 0.0%; p=0.001) and mothers who graduated from high school in the control group (8.8% vs. 28.1%; p=0.016) were significantly higher. Serum 25(OH)-D3 levels were 25.21±13.19 ng/mL in the patient group and 31.97±12.08 ng/mL in the control group, showing a statistically significant difference between the groups. In the patient group, the mean serum 25(OH)-D3 levels were significantly low (p=0.005). Vitamin D insufficiency was present in 68.42% of the patients.
DISCUSSION AND CONCLUSION: In addition to the modifiable risk factors in pneumonia patients, adding Vitamin D supplementation to standard treatment, if necessary, may be effective in reducing the morbidity and mortality of the disease.

9.Retinopathy of prematurity malpractice cases: A medicolegal evaluation
Nicel Yıldız Silahlı, Mustafa Özsütçü, Hızır Aslıyüksek, Tülin Tiraje Celkan
doi: 10.14744/zkmj.2023.26986  Pages 209 - 215
INTRODUCTION: Retinopathy of prematurity (ROP) is a disease that is caused by abnormal proliferation of retinal vessels in preterm infants. Difficulties and delays in diagnosing ROP are thought to bring along claims of medical malpractice. We aimed to provide an assessment of medical malpractice claims regarding the ROP cases, which were evaluated in the 7th Specialization Board of the Council of Forensic Science.
METHODS: This study is a retrospective descriptive study. The cases with ROP diagnose were included in the study which was evaluated in the 7th Specialization Board of the Council of Forensic Science within 3 years between 2017 and 2020.
RESULTS: The number of cases included in the study was twenty-six cases. The mean gestational age was 30.26±2.12 weeks. While the mean birth weight was 1501±407.93 g. Medical malpractice was found in 16 (61.5%) cases. In 7 (26.9%) cases, malpractice was given because the pediatrician did not consult an ophthalmologist on time. In 9 (34.6%) cases, there was malpractice due to the diagnosis or follow-up fault of the ophthalmologist. Stage 4–5 ROP was found in all cases at the time of diagnosis.
DISCUSSION AND CONCLUSION: Most problems of ROP cases evaluated for malpractice were associated with diagnosis and follow-up. It is essential that specialized pediatric ophthal-mologists assess these cases. Multidisciplinary cooperation and standard manage-ment algorithms should be introduced. Delays in treatments were either due to failure of timely diagnosis and staging of ROP by ophthalmologists or incomplete documentation of patient files and consultation delays by pediatricians.

10.The effect of diabetic ketoacidosis in childhood on heart rate variability: Prospective study
Arzu Gülseren, Hasan Ağın, Timur Meşe, Özlem Nalbantoğlu, Cem Karadeniz, Rana İşgüder, Gökhan Ceylan
doi: 10.14744/zkmj.2023.04875  Pages 216 - 220
INTRODUCTION: The study aims to investigate the changes caused by diabetic ketoacidosis (DKA) on heart rate variability (HRV).
METHODS: This prospective study was conducted at a tertiary referral center. It is investigated patients with DKA under 18 years old between May 2016 and December 2016. 24-h rhythm Holter electrocardiography recorded during DKA and upward 72nd h after ketoacidosis.
RESULTS: A total of 18 patients with DKA were included in the study in the age range of 1 month–18 year. Repeat Holter electrocardiography recording in the patients took place within an average of 4.6±1.1 days. Heart rate change parameters were found to be shorter at the time of DKA. A statistically significant difference was observed between the values of HRV.
DISCUSSION AND CONCLUSION: It is an important factor affecting the development of cardiac autonomic neuropathy at acute blood glucose elevation such as DKA.

11.Distribution of urinary Enterobacterales isolates and antibiotic resistance profiles: Three-year
Ali Korhan Sığ, Tuğba Kula Atik, Alev Çetin Duran, Nermin Özen, Onur Irmak
doi: 10.14744/zkmj.2023.13284  Pages 221 - 228
INTRODUCTION: Urinary tract infections (UTIs) are one the most frequent human infections. Increasing trend of antimicrobial resistance (AMR) and difficult-to-treat resistance cases are of serious concern. This study aimed to investigate the order of Enterobacterales urinary isolates and AMR profiles for 3 years in a tertiary hospital.
METHODS: Clinical urinary cultures of patients obtained from January 2017 to December 2019 in Balıkesir Atatürk City Hospital were included in the study. Isolated Enterobacterales strains and their antibiotic susceptibilities were retrospectively evaluated. Antimicrobial susceptibility tests were performed by conventional and automated methods according to guidelines of The European Committee on Antimicrobial Susceptibility Testing.
RESULTS: Among a total of 9297 urine isolates, 78.5% were members of order Enterobacterales (n=7300). The majority of strains were isolated from intensive care units (n=3979; 54.5%). Most of the patients were female (62.9%) and 52.4% of the patients had an indwelling urinary catheter (catheter-associated UTIs). The carbapenem re-sistance was 13.6% in Klebsiella spp., followed by Morganella spp. (7.5%). Extended-spectrum β-lactamases (ESBLs) were detected most frequently also in Klebsiella spp. (over 50%), followed by Escherichia coli (over 30%) and Enterobacter spp. (over 30%). E. coli and Klebsiella spp. showed significant change in resistance to ceftazidime, while Proteus and Morganella spp. showed a change in resistance to cefepime and fluoroquinolone, additionally. Alterations in Amoxicillin and Clavulanic acid and cefepime resistance of Enterobacter and other rare species were also significant.
DISCUSSION AND CONCLUSION: Antibiotic consumption is strongly related to AMR and Türkiye seems to have a serious struggle with both antibiotic consumption and AMR. Local and/or national antimicrobial policies are effective in Türkiye, but further measures are required.

12.The effect of maternal metabolic factors and lipid profile on birth weight in pregnant women with gestational diabetes and normal glucose tolerance
Lütfiye Uygur, Gizem Boz İzceyhan, Ceren Ünal, Işıl Ayhan, Murat Muhçu
doi: 10.14744/zkmj.2023.50375  Pages 229 - 235
INTRODUCTION: The objective of the study is to investigate the impact of maternal metabolic syndrome parameters and lipid profiles on fetal growth in pregnancies with gestational diabetes and with normal glucose tolerance. The second aim was to compare the metabolic profiles of pregnant women with gestational diabetes mellitus and with normal glucose tolerance.
METHODS: Pregnant women who applied for an oral glucose tolerance test were recruited and followed up prospectively. They were also examined for metabolic syndrome, including serum lipid profile between 24th and 28th weeks. The group diagnosed with gestational diabetes and those with normal glucose tolerance were compared in terms of obesity, hypertension, serum lipid profile, and neonatal birth weight. Hypertriglyceridemic and normotriglyceridemic patients were compared regarding maternal metabolic syndrome criteria and neonatal birthweight.
RESULTS: Diabetic pregnant women had significantly higher body mass index (BMI) and triglyceride levels and lower high-density lipoprotein (LP) levels than non-diabetics. The hypertension rate was also higher; however, it was not statistically significant. Those with hypertriglyceridemia had higher BMI, hemoglobin (HbA1c) level, and neonatal birth weight in the diabetic group, whereas triglyceride level did not impact neonatal birthweight in non-diabetic patients. Obesity, high HbA1c, and triglyceride levels, and low high-density LP levels were the parameters leading to fetal macrosomia in gestational diabetes.
DISCUSSION AND CONCLUSION: Increased accumulation of glucose toward the fetus is not the only mech-anism of macrosomia. Parameters of metabolic syndrome affect fetal growth concomitantly. Diabetic women should be evaluated in the context of metabolic syndrome.

REVIEWER LIST
13.Reviewer List

Page 236
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