E-ISSN 2757-8062
Volume : 55 Issue : 1 Year : 2024

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Volume: 55  Issue: 1 - 2024

Page I

2.Editorial Board

Pages II - IX

3.A review of pediatric infravesical obstructions
Sabri Cansaran, Olga Devrim Ayvaz, Ayşenur Celayir
doi: 10.14744/zkmj.2023.53824  Pages 1 - 7
The term infravesical obstruction is used for functional or anatomical disorders that are located distal to the bladder neck and cause disruption or interruption of urinary flow. Among these pathologies, the most common cause of urinary system obstruction in male newborns is the posterior urethral valve. In this study, it was aimed to review the diseases that may cause infravesical obstruction in children.

4.Preservation of Azygos vein in primary repair of esophageal atresia: Nine cases’ experience
Gül İlayda Sarar, Cengiz Gül, Sırma Mine Tilev, Ayşenur Celayir
doi: 10.14744/zkmj.2023.17136  Pages 8 - 12
INTRODUCTION: Studies on preserving the Azygos vein (AV) in primary esophageal atresia (EA) repair and its effects on complications such as stenosis, anastomotic leakage, and fistula are gradually increasing. We aimed to evaluate cases with preserved AV during primary repair of EA with thoracotomy.
METHODS: The demographic data, operation notes, and postoperative outcomes of primary EA repair cases with preserved AVs operated between 2016 and 2021 were evaluated from hospital records, retrospectively.
RESULTS: In 5 years, the AVs of 9 neonates with esophageal atresia + distal fistula were preserved in 6 males and 3 females. The mean birth weight was 2374 g. Four cases were preterm. Echocardiography revealed an Interatrial Septal Aneurysm in 1, Fallot’s Tetralogy in 1, and a right aortic arch in 1 patient. The mean age at surgery was 4 days (1–8 days); all patients were operated through a right thoracodorsal incision by the same surgeon. Extra-pleural thoracotomies were completed as intrapleural in four patients. The oblique-oblique anastomosis was tension-free in all cases. Enteral feeding began on the 4th day by nasogastric tube. The median duration of intubation was 6.6 days (1–11 days). Chest tubes were removed on the 10th day (8–14th day). No patient had anastomotic leakage, detachment, or fistula recurrence. The median hospitalization duration was 23.2 days (10–32 days). Four patients underwent esophageal dilation.
DISCUSSION AND CONCLUSION: Postoperative anastomotic leakage, fistula, and stenosis increase mortality and morbidity in children undergoing EA repair. During primary repair, the preservation of AV, which significantly contributes to esophageal drainage, should be preferred unless it increases intraoperative risk.

5.Clinical characteristics and treatment outcomes of pediatric Hodgkin lymphoma at a single center in Türkiye
Esra Arslantaş, Ali Ayçiçek, Cengiz Bayram, Sibel Akpınar Tekgündüz, Sultan Okur Acar, Züleyha Kadehci, Deniz Tuğcu, Gül Nihal Özdemir
doi: 10.14744/zkmj.2023.50465  Pages 13 - 18
INTRODUCTION: To review the 10-year experience of pediatric Hodgkin lymphoma at a single center in Türkiye.
METHODS: This study is a retrospective analysis of 82 pediatric Hodgkin lymphoma patients up to 18 years of age treated between 2009 and 2020.
RESULTS: The mean age of the patients was 11 years (range 3–17 years), and 68% of the patients were male. The distribution of patients by stage was as follows: stage I, n=2 (2%); stage II, n=32 (39%); stage III, n=35 (43%); and stage IV, n=13 (16%). The trend in histopathology was predominantly mixed cellularity at 49%. The most common treatment protocol was ABVD (adriamycin, bleomycin, vincristine, doxorubicin), used in 83% of cases. The majority of patients (n=76, 93%) received involved-field radiotherapy following chemotherapy. Complete remission was achieved with first-line chemotherapy in 90% of cases. The 2-year overall survival (OS) and event-free survival (EFS) rates were 97.5% and 92%, respectively. There was no significant difference in OS and EFS in terms of gender, stage, and the presence of B symptoms.
DISCUSSION AND CONCLUSION: Our data shows an excellent outcome for pediatric Hodgkin lymphoma, with results comparable to those of developed countries. Future studies should focus not only on treatment efficacy but also on identifying the best approaches to reduce long-term negative side effects.

6.Evaluation of cardiovascular risk marker in patients with polycystic ovary syndrome: Homocysteine
Caner Topaloğlu, Tamer Topaloğlu, Cansu Önal Kanbaş
doi: 10.14744/zkmj.2023.57614  Pages 19 - 22
INTRODUCTION: The aim of the study was to investigate homocysteine (Hcy) levels in polycystic ovary syndrome (PCOS) patients without insulin resistance (IR) and metabolic syndrome (MS).
METHODS: This retrospective study involved 64 patients aged between 18-35 years who applied to the tertiary clinic between March 2022 and March 2023. A total of 32 PCOS patients without IR and MS and 32 healthy women were enrolled in the study. All participants underwent history taking, clinical physical examination, gynecological ultrasonographic evaluation, and laboratory tests. Laboratory screening tests, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (T), free T, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), and low-density lipoprotein (LDL), were performed. Normal insulin sensitivity was defined based on fasting serum glucose, fasting insulin level, serum insulin response to an oral glucose tolerance test, and the homeostatic model of insulin resistance.
RESULTS: There were no differences in terms of age, systolic and diastolic blood pressure, FSH, LH, total T, free T, SHBG, DHEAS, and LDL between the groups. PCOS patients had increased Hcy, waist-to-hip ratio (WHR), and body mass index (BMI) compared to the control group. Hcy was positively correlated with WHR and BMI. A strong correlation was found between Hcy and PCOS.
DISCUSSION AND CONCLUSION: Elevated Hcy is associated with cardiovascular risk factors in PCOS patients without IR and MS.

7.The effect of personality traits of pregnant women on the COVID-19 stress level
Melike Dişsiz, Beyzanur Işbay, Büşra Yılmaz
doi: 10.14744/zkmj.2023.42650  Pages 23 - 28
INTRODUCTION: This study aims to ascertain the effect of personality traits of pregnant women on the stress level related to the COVID-19 pandemic.
METHODS: This descriptive cross-sectional study was conducted between March and June 2022 with a sample of 253 pregnant women who met the inclusion criteria. A descriptive information form, COVID-19 stress scale, and the Five-Factor Personality Inventory were utilized to collect data. The statistical significance threshold was set at p<0.05 after data analysis.
RESULTS: The mean age of the pregnant women participating in the study was 29.53±5.49 years, and the average duration of education was 10.76±3.77 years. It was found that 15% of the pregnant women experienced pregnancy-related problems during the pandemic, 23.3% had their pregnancies adversely affected, 25.7% were subjected to social isolation, and 32.4% were placed in quarantine. Pregnant women scored high on the danger and contamination fear subscale of the COVID-19 stress scale. COVID-19 stress levels were significantly higher in pregnant women with introverted and neurotic personality traits (p<0.05) and significantly lower in pregnant women with extraverted and emotionally stable personality traits (p<0.05).
DISCUSSION AND CONCLUSION: Overall, it can be stated that pregnant women experienced stress related to COVID-19 and that their personality traits influenced their COVID-19 stress levels. Furthermore, stress related to COVID-19 was found to decrease in pregnant women with emotionally stable and extraverted personality traits, while the COVID-19 stress level significantly increased in pregnant women with introverted and neurotic personality traits.

8.The role of anti-mullerian hormone in determining ovarian reserve in patients with endometrioma and benign cysts
Ergül Demirçivi, Duygu Vardağlı, Ali İsmet Tekirdağ, Özgür Akbayır, Ahmet Gülkılık, Beyhan Ömer, Sezai Sahmay
doi: 10.14744/zkmj.2023.71084  Pages 29 - 33
INTRODUCTION: Our aim was to determine the effects of endometrioma by itself and its surgery on ovarian reserve via pre- and postoperative serial measurements of Anti-Mullerian Hormone (AMH) in patients with endometrioma and benign cysts.
METHODS: Our study was conducted at an education and research hospital as a prospective controlled clinical trial. Participants were divided according to their diagnosis into endometrioma and non-endometrioma groups. Serial blood samples of the patients for serum AMH levels were collected preoperatively, and postoperatively at the first week, first month, and third month, respectively.
RESULTS: A total of 46 patients (25 for the study and 21 for control groups) were included in the study. The mean age of our patients was 31.8±5.57 in the endometrioma group and 29.38±8.64 in the control group. The AMH value was lower in the endometrioma group, but the difference did not reach statistical significance (p>0.05). However, in the postoperative AMH levels measured at the 1st week, 1st month, and 1st year, the values were significantly higher in the non-endometrioma group compared to the endometrioma group (p<0.05).
DISCUSSION AND CONCLUSION: According to our study, we can conclude that endometrioma surgery affects ovarian reserve significantly and more negatively than benign cystectomies.

9.The relationship between cervical lesions and human papillomavirus subtypes: A retrospective third stage single-center study
Denizhan Bayramoğlu
doi: 10.14744/zkmj.2023.77698  Pages 34 - 38
INTRODUCTION: Cervical cancer is a preventable disease. Oncogenic HPV subtypes play a very important role in the development of many cancers, especially cervical cancer. In this study, we aimed to investigate the importance of HPV subtypes in cervical lesions.
METHODS: Two hundred seventeen women who were examined in the gynecological oncology outpatient clinic of the hospital, had a positive HPV test, and underwent colposcopic biopsy were retrospectively analyzed. The clinical and examination information of the patients were obtained from the hospital system and files.
RESULTS: Among the HPV subtypes in the patients, HPV subtype 16 was the most common. HPV subtype 16 was found most frequently in H-SIL and L-SIL lesions. In addition, cervical premalignant or malignant lesions were detected in 79 of 217 patients who underwent colposcopic cervical biopsy.
DISCUSSION AND CONCLUSION: Cervical cancer screening methods are one of the few screening methods that have been proven to reduce the mortality and incidence of invasive cancer. The most important risk factor in the etiology of cervical cancer is the HPV virus. As a result, we found that HPV subtype 16 was the most common, and HPV positivity decreased with age.

10.Prevalence of iron deficiency in infants aged 6–12 months and its relationship with socioeconomic level and iron prophylaxis use
Merve Işeri Nepesov, Züleyha Aysu Say
doi: 10.14744/zkmj.2023.91489  Pages 39 - 44
INTRODUCTION: Iron deficiency anemia is a widespread public health issue globally, with adverse effects across multiple systems. However, it can be prevented through simple recommendations and prophylactic supplementation. This study aimed to assess the prevalence of iron deficiency anemia, the impact of prophylactic iron supplementation, and the effect of socioeconomic status on the development of iron deficiency and anemia.
METHODS: The study encompassed 198 children aged 6–12 months (103 male and 95 female). Hematological parameters were evaluated in relation to the history of nutrition, prophylactic iron supplementation, and the families’ socioeconomic status.
RESULTS: The prevalence of iron deficiency was 55.4%, while iron deficiency anemia was observed in 17.9% of cases. Iron supplementation positively influenced hemoglobin and iron levels. Infants fed with formula exhibited higher levels of iron, serum ferritin, and transferrin saturation compared to those who were breastfed. Higher levels of iron, ferritin, and transferrin saturation were significantly associated with a higher monthly income. A greater proportion of mothers with only primary school education was observed in the group with iron deficiency anemia.
DISCUSSION AND CONCLUSION: Iron deficiency remains highly prevalent in our country. Key strategies for addressing iron deficiency should focus on nutritional improvement and maternal education. Iron supplementation is also advisable.

11.The effect of the COVID-19 pandemic on vaccine hesitancy and vaccine refusal in children with food allergies
Murat Özer, Selçuk Doğan, Rahime Duygu Temeltürk, Hüsniye Yücel, İlknur Bostancı
doi: 10.14744/zkmj.2023.43925  Pages 45 - 52
INTRODUCTION: Food allergies are an important factor causing hesitancy towards child-hood vaccines. This study aimed to investigate the effect of the COVID-19 pandemic on vaccine hesitancy and vaccine refusal in children with food allergies.
METHODS: This study was conducted with 104 children and their par-ents, who applied to the pediatric allergy clinic between October 1, 2020, and March 30, 2021. The children were classified as “fully vaccinated,” “incompletely vaccinated,” and “unvaccinated.” Moreover, fully vaccinated children were divided into two subgroups: “fully vaccinated on time” and “fully vaccinated with a delay.” Their vaccination statuses and histories of COVID-19 were questioned. The Beck Anxiety Scale was applied to the parents in the patient and control groups.
RESULTS: Although there were no unvaccinated children, there were 12 (11.5%) incompletely vaccinated children, 57 (54.8%) children who were fully vaccinated on time, and 35 (33.6%) children who were fully vaccinated with a delay. Logistic regression analysis determined that living outside the city center (OR: 6.9) and having a family history of COVID-19 (OR: 5.8) caused a delay in vaccination. The analysis also revealed that a high anxiety score (OR: 1.8) led to missed vaccinations.
DISCUSSION AND CONCLUSION: The rate of delay in vaccination administration increased among individuals living outside of a city center and those with a family history of COVID-19 infections. It was also found that the rate of missed vaccinations increases with increased parental anxiety.

12.Challenging diagnosis in the COVID-19 era: Pediatric brucellosis - a retrospective observational study
Salih Demirhan
doi: 10.14744/zkmj.2023.80269  Pages 53 - 58
INTRODUCTION: Brucellosis is the most common bacterial zoonotic disease worldwide, with an annual incidence of half a million cases. It predominantly affects rural areas of developing countries, and the actual disease burden is likely much higher than reported. This study aims to retrospectively evaluate the demographic, laboratory, and clinical characteristics of pediatric brucellosis cases in the pre- and post-COVID-19 era.
METHODS: Between April 1, 2019, and April 1, 2021, all children under 18 diagnosed with brucellosis at our secondary care hospital were retrospectively examined. Clinical, laboratory, and demographic data were retrieved from electronic medical records.
RESULTS: Over the two-year study period, 59 children were diagnosed with brucellosis. The most common symptoms at presentation were arthralgia (81.4%) and fever (37.3%), with nearly two-thirds of the patients presenting as afebrile. Blood cultures were performed for 21 (35.6%) patients, with nine yielding positive results (42.9%). Patients with bacteremia were more likely to be admitted to the hospital and had higher C-reactive protein (CRP) levels and lower hemoglobin levels compared to non-bacteremic patients.
DISCUSSION AND CONCLUSION: The symptoms of COVID-19 and brucellosis in children overlap, making the diagnosis of brucellosis particularly challenging in areas with low prevalence. It is crucial not to overlook brucellosis in afebrile patients, given the high proportion of children with brucellosis who do not present with fever. CRP levels may be indicative of bacteremia and the need for hospital admission.

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