E-ISSN 2757-8062
Volume : 55 Issue : 2 Year : 2024

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Volume: 55  Issue: 2 - 2024

Pages I - II

2.Editorial Board

Pages III - XI

3.Predictors of pediatric non-alcoholic fatty liver disease (NAFLD) in obese children and adolescents: Is serum ALT level sufficient in detecting NAFLD?
Yavuz Özer, Ceren Yapar Gümüş
doi: 10.14744/zkmj.2024.67209  Pages 59 - 66
INTRODUCTION: The prevalence of obesity and related comorbidities is increasing in children and adolescents. This study aimed to specify the prevalence of non-alcoholic fatty liver disease (NAFLD) in obese children and adolescents and to identify the predictive factors associated with NAFLD.
METHODS: Obese children and adolescents aged 6 to 18 years were included in the study. The presence and degree of hepatosteatosis were evaluated using liver US. The groups with and without NAFLD were compared in terms of demographic, anthropometric, and biochemical parameters.
RESULTS: One hundred fifty-five obese children and adolescents with a median age of 13.8 (4.93) years (43 males, 131 pubertal) were included in the study. We found that 57.4% of obese cases had NAFLD. In the group with NAFLD, serum ALT level, AST level, HOMA-IR, and triglyceride level were significantly higher (p<0.001, p<0.001, p=0.015, p=0.021, respectively), and serum HDL-C level was significantly lower (p=0.001) compared to the group without NAFLD. In the binomial logistic regression analysis, age (β=0.213, OR=1.23, p=0.040) and serum ALT level (β=0.047, OR=1.04, p=0.011) were determining factors for hepatosteatosis. The diagnostic accuracy of elevated serum ALT level in detecting NAFLD was found to be 65.8% with a sensitivity of 77.3% and a specificity of 57.3% (+LR 1.81 and -LR 0.40).
DISCUSSION AND CONCLUSION: The prevalence of NAFLD determined with US in obese children and adolescents was 57.4%. Age and serum ALT level were found to be predictive factors for hepatosteatosis. Increased ALT alone shows insufficient performance in detecting NAFLD.

4.Clinical features in children and adolescents with Hashimoto’s thyroiditis
Didar Arslan, Feyza Mediha Yıldız, Heves Kırmızıbekmez
doi: 10.14744/zkmj.2023.58751  Pages 67 - 70
INTRODUCTION: Hashimoto’s thyroiditis (chronic autoimmune thyroiditis) is the most common cause of goiter and acquired hypothyroidism among children and adolescents. It is an autoimmune disease intrinsic to thyroid tissue. In our study, we aim to review the files of children and adolescents with Hashimoto’s thyroiditis, being followed up in the Department of Pediatric Endocrinology, and to compare these results with findings in the literature.
METHODS: In the study, the files of 114 children and adolescents with Hashimoto’s thyroiditis, being followed up in Zeynep Kamil Maternity and Children’s Diseases Health Training and Research Center, Pediatric Endocrinology Department, were reviewed retrospectively. Patients were grouped by age at diagnosis and the clinical parameters were compared between the groups.
RESULTS: There were 102 females (89.5%) and 12 males (10.5%), with a female/male ratio of 8.5/1. The average age of the patients at diagnosis was 11.91±3.26 years. 77 (67.5%) patients have a positive family history. 14 (12.28%) patients have a concomitant autoimmune disease. On the first admission to the hospital, 47 (41.2%) patients were euthyroid, 46 (40.4%) patients were subclinical hypothyroid, 10 (8.8%) patients were overt hypothyroid, 3 (2.6%) patients were subclinical hyperthyroid, and 8 (7.0%) patients were overt hyperthyroid. Antithyroid peroxidase antibodies were positive in 109 (95.6%) and antithyroglobulin antibodies were positive in 105 (92.1%) of the patients. In the group under 12 years old, there were 7 (13.2%) patients with radiation exposure, whereas in the group over 12 years old, there was only 1 (1.9%) patient with radiation exposure, and thus the difference between the two groups was statistically meaningful.
DISCUSSION AND CONCLUSION: Patients who have clinical and laboratory evidence of thyroid disease should be examined for autoimmune thyroiditis. Especially, it is very important that patients who have clinical evidence of other autoimmune diseases, have a family history of autoimmune thyroiditis, and/or a history of radiation exposure should be examined periodically and followed up closely.

5.Vaginal progesterone versus oral dydrogesterone for luteal phase support in intrauterine insemination cycles: A prospective cohort study
Nisan Helin Dönmez, Ergül Demirçivi, Abdulkadir Turgut
doi: 10.14744/zkmj.2023.82542  Pages 71 - 77
INTRODUCTION: To compare vaginal progesterone and oral dydrogesterone for luteal phase support in intrauterine insemination (IUI) cycles.
METHODS: This study was conducted with patients who applied to the Infertility Clinic of the Department of Obstetrics and Gynecology at İstanbul Medeniyet University Prof. Dr. Süleyman Yalçın City Hospital between June 2021 and December 2021. In this prospective cohort study, 109 IUI cycles of 49 patients were examined. Vaginal progesterone (Progestan® 200 mg Soft Capsule, Koçak Farma) 1×200 mg was given to 54 cycles in the control group, and oral dydrogesterone (Duphaston® 10 mg Film Tablet, Abbott) 2×10 mg was given to 55 cycles in the study group.
RESULTS: Eleven (20.4%) pregnancy test results in the vaginal progesterone group and six (11.1%) pregnancy test results in the dydrogesterone group were found to be positive. There was no significant difference between vaginal progesterone and dydrogesterone groups in terms of end-of-cycle pregnancy positivity, including the subgroup analyses for treatment type and infertility etiology (p>0.05). As a result of univariate analyses, it was determined that follicle-stimulating hormone (FSH) was negatively correlated with end-of-cycle pregnancy positivity (OR: 0.547; 95%CI: 0.328–0.913; p=0.021). One unit increase in FSH level reduces pregnancy positivity by 54%. According to the results of multivariate analysis, one unit increase in FSH level reduces pregnancy positivity by 56%, but it is not statistically significant (OR: 0.565; 95%CI: 0.315–1.012; p=0.055).
DISCUSSION AND CONCLUSION: Although there were higher pregnancy rates in patients who used vaginal micronized progesterone for luteal phase support in IUI cycles, compared to patients who used oral dydrogesterone, no statistically significant difference was found between the two groups.

6.The effect of serum biomarkers on the requirement for surgical intervention in tuboovarian abscess
Canan Satır Özel, Atilla Kunt, Mustafa Çakır, Ergül Demirçivi, Oğuz Devrim Yardımcı, Abdulkadir Turgut
doi: 10.14744/zkmj.2023.27879  Pages 78 - 82
INTRODUCTION: Tubo-ovarian abscess (TOA) is a complex infectious mass of the adnexa, which is treated by antibiotherapy or surgery. Antibiotherapy failure may occur during TOA treatment. The aim of this study is to assess the effect of TOA size and serum biomarkers on the requirement for surgical intervention.
METHODS: Eighty-four patients over five years in our clinic were evaluated. TOA size and laboratory values such as hemoglobin, white blood cell count, lymphocyte, monocyte, platelet, albumin, neutrophil, C-reactive protein (CRP) levels, and if antibiotics were switched to another treatment protocol or changed to a surgical approach, were also reported. Prognostic Nutritional Index (PNI), the platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and monocyte-lymphocyte ratio (MLR) were also used to evaluate medical therapy failure and the requirement for surgery.
RESULTS: Eighty-four patients hospitalized with the diagnosis of TOA, 13 of them required surgery due to antibiotherapy failure and the surgical intervention rate was calculated as 15.47%. Platelet count and TOA size were found to be statistically significantly higher and hospital stay was found to be statistically significantly longer in the surgery group. CRP and other laboratory values did not have a statistically significant difference between groups. Among the indexes, only PLR had a statistically significant prediction value (p=0.020).
DISCUSSION AND CONCLUSION: TOA volume and PLR were found to be effective predictors in antibiotherapy failure and surgical intervention.

7.Relationship between first trimester maternal PAPP-A (pregnancy associated plasma protein-A) and free β-hCG (human chorionic gonadotropin) levels with fetal birth weight
Gökhan Kılıç, Gülin Feykan Yeğin, Elçin İşlek Seçen, Hüseyin Levent Keskin, Ayşe Filiz Yavuz
doi: 10.14744/zkmj.2023.60362  Pages 83 - 87
INTRODUCTION: The aim of this study was to evaluate the relationship between maternal serum PAPP-A (pregnancy-associated plasma protein A) and free β-hCG (human chorionic gonadotropin) values with fetal birth weight.
METHODS: 554 patients who applied to Yıldırım Beyazit University Atatürk Training and Research Hospital Obstetrics Clinic between January 2009 and December 2016 for first trimester combined screening tests were included in the study. Antenatal follow-up and pregnancy outcomes were examined. The relationship between adjusted multiples of median (MoM) values of maternal serum PAPP-A and free β-hCG levels and fetal birth weight (FBW); small for gestational age (SGA—fetal birth weight <10th percentile) and large for gestational age (LGA—fetal birth weight > 90th percentile) were analyzed.
RESULTS: Maternal serum PAPP-A level was found to have a relationship with SGA development (p=0.03). Every decrease per unit in the adjusted MoM value of maternal serum PAPP-A level increases the risk of SGA development three times (RR, 1/0.333; 95% CI, 0.1–0.8, p=0.030).
DISCUSSION AND CONCLUSION: Correlation between PAPP-A value and SGA was found to be statistically significant. However, a similar prediction was not eligible between maternal serum PAPP-A level and LGA fetuses. On the other hand, maternal serum free β-hCG level did not have a statistical significance as a predictor for both SGA and LGA fetuses.

8.Non-reassuring fetal heart rate patterns in association with umbilical artery acidosis
Ömer Gökhan Eyisoy, Ahmet Göçmen
doi: 10.14744/zkmj.2023.58219  Pages 88 - 93
INTRODUCTION: The main purpose of the study was to evaluate the clinical outcomes of fetuses who had intrapartum non-reassuring fetal heart rate tracings.
METHODS: Patients who underwent cesarean section as an emergency operation due to non-reassuring fetal heart rate patterns were included in the study. All FHR paper traces were reevaluated by an expert obstetrician, blinded to the neonatal outcomes, based on the guidelines of the NICHD workshop. Patients were placed into five groups considering the variability and accompanying deceleration type. Clinical outcomes, Apgar scores, and umbilical artery blood parameters were evaluated.
RESULTS: The study consisted of 84 patients; Group 1, normal variability with late decelerations (n=32); Group 2, normal variability with variable decelerations (n=16); Group 3, decreased variability (n=10); Group 4, decreased variability with late decelerations (n=14); Group 5, decreased variability with variable decelerations (n=12). Groups with decreased variability and decelerations (groups 4 and 5) had higher rates of NICU admission than the groups with normal variability with decelerations (groups 1 and 2) (p<0.05). In the decreased variability with late decelerations group (Group 4), umbilical artery blood pH and ABE were significantly lower while lactate levels were higher than in groups 1, 2, and 3 (p<0.001). Among all patients, inverse correlations were shown between umbilical artery blood lactate and pH (r=-0.734, p<0.001), and also between lactate and ABE (r=-0.581, p<0.001). For the prediction of umbilical artery blood pH<7.1 and/or ABE<-12, the optimal umbilical artery blood lactate cut-off level is 7 mmol/L with a sensitivity of 88.9% and specificity of 89.3%.
DISCUSSION AND CONCLUSION: Decreased variability in non-reassuring intrapartum fetal heart rate patterns should be considered as important as decelerations. In the evaluation of intrapartum fetal asphyxia, lactate appears to be as good a marker as pH and ABE.

9.The effect of gestational diabetes mellitus on sexual function, anxiety, depression and quality of life in pregnant women
Canan Satır Özel, Özgür Efiloğlu, İlayda Loçlar Karalap, Asıf Yıldırım, Abdulkadir Turgut
doi: 10.14744/zkmj.2023.72324  Pages 94 - 101
INTRODUCTION: Gestational diabetes during pregnancy causes many adverse effects in mothers and affects them in various aspects. The aim is to investigate the impact of gestational diabetes during the course of pregnancy on patients’ quality of life, depression and anxiety levels, and sexual functions.
METHODS: The study was conducted on 131 third-trimester pregnant women (healthy pregnant women: 79, patients with GDM: 52) by using the WHO Quality of Life-BREF (WHOQOL-BREF), Female Sexual Function Index (FSFI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) between September 2020 and August 2021. The patients with GDM were then divided according to their treatment strategies (Lifestyle Modification: 43 and Insulin Therapy: 9) for further evaluations.
RESULTS: Healthy pregnant women have a higher score (69.30±14.68) on the general health domain of WHOQOL-BREF than patients with GDM (63.22±18.25) with statistical significance (p=0.037). The Insulin Therapy Group has a significantly (p=0.008) lower psychological health score (60.18±18.05) on the psychological health domain of WHOQOL-BREF than the Lifestyle Modification Group (76.06±15.05). There was no significant difference in FSFI, BAI, BDI, and other domains of WHOQOL-BREF scores between the two groups and treatment strategies.
DISCUSSION AND CONCLUSION: Suffering from GDM or using different treatment options has no impact on patients’ quality of life, levels of depression or anxiety, or sexual function.

10.Determining the anxiety levels, postpartum support needs, and the levels of received support in puerperae during the COVID-19 pandemic period
Yeliz Doğan Merih, Dilek Coşkuner Potur, Semra Keskin, Kerime Derya Beydağ
doi: 10.14744/zkmj.2024.15428  Pages 102 - 109
INTRODUCTION: This research was conducted to determine the anxiety levels, postpartum support needs, and the levels of received support in puerperae during the pandemic period.
METHODS: The cross-sectional study was carried out between April and August 2020 at the Postpartum Service of the Gynecology and Children’s Diseases Training and Research Hospital on the Anatolian side of Istanbul. Three hundred postpartum mothers who met the sampling criteria and volunteered to participate were included in the study. Data were collected using a survey form containing the participants’ demographic, individual, and obstetric characteristics, their opinions on the COVID-19 process, the Beck Anxiety Scale (BAS), and the Postpartum Support Scale (PSS).
RESULTS: It was determined that the average Beck Anxiety Scale score of the participants was 13.71±11.21, and 55% of them experienced moderate postpartum anxiety. The total Postpartum Support Scale mean score regarding the importance of support for the puerperae was calculated as 149.65±47.50, and the support received related to this need was found to be 118.32±48.58.
DISCUSSION AND CONCLUSION: It was determined that women experienced postpartum anxiety at a moderate level, needed considerable support during this period, but did not receive much support.

11.Budd-Chiari-like syndrome presenting with hydrothorax in a neonate with right diaphragmatic hernia
Didem Arman, Ayşenur Celayir, Hatice Akay, Sevilay Topcuoğlu, Koray Pelin, Ahmet Tellioğlu, Hüsnü Fahri Ovalı, Tuğba Gürsoy, Güner Karatekin
doi: 10.14744/zkmj.2023.60252  Pages 110 - 112
The diagnosis of congenital diaphragmatic hernia (CDH) is usually straightforward. However, cases with right-sided CDH can be challenging. We report a case of a neonate with right-sided diaphragmatic hernia presenting with hydrothorax.

12.Case report of a trochanter minor fracture management of a young patient after a scooter incident
Arın Celayir, Ece Davutluoğlu, Cansu Elibollar, Fırat Kargın, Ali Şeker
doi: 10.14744/zkmj.2023.51423  Pages 113 - 116
Trochanter minor fractures are generally seen in individuals aged 12 to 16 years, commonly associated with sports such as martial arts or self-defense techniques, while the growth plate is still open. The management of trochanter minor fractures in adolescents typically involves conservative methods including early quadriceps and hip exercises; surgery is reserved for a small number of cases. This case report discusses the management of a young patient who sustained a trochanter minor fracture following a scooter accident. The fracture was successfully treated using conservative measures during follow-up.

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