E- ISSN: 2822-4051
The Journal of Tepecik Education and Research Hospital - Tepecik Eğit Hast Derg: 32 (1)
Volume: 32  Issue: 1 - 2022
1.Cover

Pages I - VII (26 accesses)

CLINICAL RESEARCH
2.Validity and Reliability Study of the Turkish Form of the Birth Beliefs Scale
Selin Paker, Gül Ertem
doi: 10.4274/terh.galenos.2020.89814  Pages 1 - 8 (40 accesses)
Objective: The aim of this study was to determine the validity and reliability of the Birth Beliefs Scale (BBS), which was developed to assess the basic beliefs of women about birth, in our culture.
Methods: The study conducted between March 2017-June 2018 with pregnant women who applied to the obstetrics and gynaecology outpatient clinic of a training and research hospital affiliated to the Ministry of Health. The sample research group comprised of all pregnant who met the inclusion criteria and agreed to participate in the study. Data was collected using socio-demographic questionnaire and BBS.
Results: Expert scores and Content Validity Index for the translated items were calculated according to Davis technique and all items were found to be over 0.80. For construct validity, exploratory factor analysis and confirmatory factor analysis were applied and determined the scale under two factors. According to the reliability analysis of the scale, Cronbach’s alpha coefficient for the first sub-scale was 0.890; Cronbach’s alpha coefficient for the second sub-scale was found to be 0.868. The test-retest intraclass correlation coefficients in which time invariance was evaluated for the first subscale was 0.993 and for the second subscale was 0.984. The relationship between the two factors was statistically significant at a negative level of 0.752.
Conclusion: Adapted BBS is a highly valid and reliable tool that can be used in the field. In our country, especially caesarean behavior is recommended to be used to determine the underlying beliefs.

3.Serum Amyloid A Protein as a Potential Biomarker for Ectopic Pregnancy
Suna Yıldırım Karaca, İbrahim Gülhan, Giray Bozkaya, Mehmet Özeren
doi: 10.4274/terh.galenos.2020.81489  Pages 9 - 14 (36 accesses)
Objective: This study compared the concentrations of serum amyloid A (SAA), which is an inflammatory marker, in ectopic and intrauterine pregnancies.
Methods: This prospective case-control study was conducted at Tepecik Education and Research Hospital in İzmir, Turkey, between 2015 and 2016. It included 39 patients diagnosed with tubal ectopic pregnancies and 41 patients diagnosed with early intrauterine pregnancies. The SAA, β human chorionic gonadotropin, progesterone and C-reactive protein levels were measured in the serum samples taken from both groups. Data were presented as mean±standard deviation and a p value <0.05 was accepted as statistically significant. The distribution of the variables was measured using the Kolmogorov-Smirnov test, while the independent samples t-test and Mann-Whitney U test were used in the analysis of the quantitative independent data. The impact level and cut-off value were investigated using a receiver operating characteristic curve.
Results: SAA levels in the ectopic pregnancy patients (2.4±2.6 μg/mL) was significantly higher than in the intrauterine pregnancies (1.4±1.9 μg/mL) (p=0.008). When using the SAA cut-off value of 0.7 μg/mL for the ectopic pregnancy diagnosis, the sensitivity was 73.2% and the specificity was 63.4%.
Conclusion: The inflammation due to tubal tissue damage in an ectopic pregnancy may increase the SAA level in the maternal blood. Even though larger prospective studies are needed, our study suggests that the SAA is an important biomarker for the early diagnosis of an ectopic pregnancy.

4.Evaluation of Early and Late Period Choroidal Thickness in Non-arteritic Anterior Ischemic Optic Neuropathy Cases
Neslisah Kutlu Uzakgider, Seda Karaca Adıyeke
doi: 10.4274/terh.galenos.2020.57431  Pages 15 - 20 (24 accesses)
Objective: Non-arteritic ischemic optic neuropathy (NAION) is the most common clinical presentation of acute ischemic damage to the optic nerve. It is possible to evaluate choroidal changes in these cases with optical cohorens tomography (OCT).
Methods: The records of 48 patients with NAION (group 1) were retrospectively reviewed. The best corrected visual acuities, intraocular pressure, ophthalmologic examination findings and macular enhanced depth imaging optic coherent tomography (EDI-OCT) examinations were evaluated. The data were compared with the right eyes of the control group of 50 volunteers (group 2).
Results: The mean age of group 1 was 59.25±9.685 years, and the mean age of group 2 was 58.26±9.249 years. There was no statistically significant difference between the two groups in terms of age (p=0.08). When the macular EDI-OCT tests were evaluated in the acute period, the affected eye choroidal thickness was significantly higher when compared with unaffected eyes in subfovea, nasal and temporal areas and group 2 (respectively p=0.001, p=0.001, p=0.001). Group 1 unaffected eye subfovea, nasal and temporal OCT were significantly higher than control group (respectively p=0.001, p=0.001, p=0.001). In the chronic period, thinning was observed in the affected eye choroidal thickness, but it was not statistically significant when compared with group 2 [respectively (p=0.543, p=0.513, p=0.497)].
Conclusion: The choroidal thickness changes in the early and late stages of the disease in NAION cases. This change may be due to the protection and adaptation mechanisms of optic nerve head perfusion.

5.Long-term Outcomes of Gestational Diabetes Mellitus, a Retrospective Cohort Study
Alper İleri, Hande İleri, Can Ata, Ayşe Rabia Şenkaya, Umut Gök Balcı
doi: 10.4274/terh.galenos.2020.58234  Pages 21 - 28 (26 accesses)
Objective: Gestational diabetes mellitus (GDM) is defined as glucose intolerance that begins or is first detected during pregnancy. GDM is associated with adverse outcomes in pregnancy and infants. Postpartum outcomes have been introduced in recent studies. In our study, we report long-term complications of GDM.
Methods: In our study, pregnant women between 19 and 35 years old who were diagnosed with GDM for the first time and healthy pregnant were compared. In these patients, we assessed gestational age, type of delivery, birth weight fasting plasma glucose, postprandial plasma glucose, HbA1c, alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, creatine, urinalysis and thyroid stimulating hormone, lipid profile, diagnosis and pharmacological agents prescribed between indexed pregnancy and 5th year postpartum screening.
Results: One hundred-fifty two GDM cases and 202 healthy pregnant’ data were recruited. We demonstrated that fasting and postprandial plasma glucose, HbA1c, ALT, AST, urea, creatine, urine protein, glucose, ketone, total cholesterol, triglyceride and low-density lipoprotein were significantly higher in pregnant with a history of GDM in the 5th year follow-up. Furthermore, we observed pregnant with GDM were diagnosed significantly higher with diabetes mellitus, hypertension, obesity, hyperlipidemia, coronary hearth diseases, angina, cerebrovascular disease in follow-up. These post-GDM patients were also found most probably using anti-diabetic, anti-hypertensive, anti-lipidemic, and anti-platelet agents.
Conclusion: Women with a history of GDM are at increased risk of diabetes and related diseases. Postpartum GDM follow-ups should include ALT, AST, urea, creatine, urine analysis in addition to well-documented tests as fasting glucose, postprandial glucose, HbA1c and lipid screenings.

6.The Effect of Hyperbaric Oxygen Therapy on Wound Healing in Lower Extremity Thermal Burns of Diabetic Patients
Figen Aydın, Mustafa İncesu
doi: 10.4274/terh.galenos.2021.94103  Pages 29 - 33 (30 accesses)
Objective: Diabetes and complications related to diabetes are increasing in our country as well as all over the world. Neuropathy is one of the most common complications of diabetes and exposes the lower extremities to trauma. Therefore, thermal burns are an important cause of foot ulcers in diabetic patients. Hyperbaric oxygen (HBO) therapy is an adjunct treatment method used in diabetic foot ulcers.
Methods: In this study, the results of HBO therapy of twelve diabetic patients with lower extremity ulcers due to thermal burns were shared.
Results: An average of 39.1 (24-60) sessions of HBO therapy was applied to 12 patients included in the study. All patients recovered without the need for additional surgical intervention.
Conclusion: Thermal burns are common in diabetic patients due to neuropathy. The addition of HBO therapy to standard treatments in the early period, wound healing may be accelerated and surgical procedures may be reduced.

7.The Success of Intravaginal Dinoprostone in the Induction of Labor of Term Pregnancies with Intrauterine Growth Restriction
Suna Yıldırım Karaca, Mehmet Adıyeke
doi: 10.4274/terh.galenos.2021.02170  Pages 34 - 39 (24 accesses)
Objective: In this study, it was aimed to evaluate the use of dinoprostone ovul in labor induction and the induction success of fetuses with growth restriction.
Methods: In this retrospective study, 134 pregnant women who were diagnosed with intrauterine fetal growth restriction (IUGR) and used vaginal dinoprostone for labor induction were included. The gestational week of all patients is >37 and Bishop score <6. The success of induction was evaluated as vaginal delivery. Demographic characteristics, maternal and neonatal outcomes of the patients were recorded.
Results: Eighty-three (61.9%) of our patients had vaginal delivery (successful induction) and 51 (38.1%) had cesarean delivery (unsuccessful induction). Bishop score (2.8±0.8 and 2.3±0.5 p=0.01, respectively) and gravidas of patients with successful induction were higher (1.81±0.78 and 1.58±0.88, respectively, p=0.03). In addition, the patients in the successful induction group had a had more labor induction history in their previous pregnancies (p=0.04). No correlation was found between induction success with the parameters of gestational week, maternal body mass index, fetal birthweight, low abgar score, presence of meconium, neonatal intensive care need.
Conclusion: Successful labor induction with dinoprostone in fetuses with IUGR is associated with increased number of pregnancies, high Bishop score and presence of induction in previous delivery.

8.The Effect of Thyroid Radiofrequency Ablation Therapy on Cosmetic and Symptom Score
Mehmet Sercan Ertürk, Bülent Çekiç, Barış Önder Pamuk
doi: 10.4274/terh.galenos.2021.92195  Pages 40 - 45 (24 accesses)
Objective: Currently, minimally invasive thermal ablation treatments are used more frequently to reduce symptomatic benign thyroid nodules. The aim of this study is to investigate the effect of thyroid radiofrequency ablation (RFA) therapy on symptom and cosmetic score, which are clinical indicators of nodule shrinkage.
Methods: A total of 40 thyroid nodules from 40 consecutive patients who underwent ultrasound-guided RFA for symptomatic benign thyroid nodules from September 2018 to July 2020 in the endocrinology outpatient clinic were included in the study. Volume of thyroid nodules, volume reduction rate (VRR%), symptom and cosmetic score were evaluated before and 1 year after RFA treatment.
Results: Eighteen (45%) of the cases were male, 22 (55%) were female, and the mean age was 46±9. The baseline cosmetic score decreased from 3.3±0.75 to 1.4±0.49 at the end of the 12th month (p<0.001). The initial symptom score decreased from 6.77±1.42 to 1.97±0.83 at the end of the 12th month (p<0.001). Thyroid nodule volumes after RFA decreased from the initial volume of 23.78±14.98 mL to 6.03±4.10 mL at the end of the 12th month (p<0.001). VRR was 69.70±10.86 and 74.88±8.86 for 6 and 12 months, respectively (p<0.001). There were no major or minor complications during the procedure. Treatment success was 100% in all nodules at the end of the 6th month.
Conclusion: This study showed a significant improvement in the cosmetic and symptomatic score of benign solid euthyroid nodules after RFA therapy. RFA appears to be a safe and effective technique for selected cases with low complications and effective nodule reduction.

9.Karydakis Procedure without a Drain for Sacrococcygeal Pilonidal Sinus Patients
Ufuk Uylas, Bülent Sultanoğlu, Kenan Demirbakan, Mehmet Burak Öztop
doi: 10.4274/terh.galenos.2021.21548  Pages 46 - 50 (22 accesses)
Objective: This study aimed to evaluate patients with sacrococcygeal pilonidal sinus (PS) disease who underwent the Karydakis procedure without any drains.
Methods: Ninety-eight patients presenting with PS at our center underwent the Karydakis procedure from September 2017 to April 2018. These patients were evaluated for fluid collection, failure of wound healing, wound infection and dehiscence on the postoperative first, third, the seventh days and the first month.
Results: A total of ninety-eight patients underwent Karydakis procedure, of which 84 were males and 14 females. Of the two patients had recurrent disease. Three patients had a serious collection on the third postoperative day. One patient had a wound infection on the seventh postoperative day and drainage was performed. One patient had wound dehiscence on the 10th postoperative day due to local trauma. The remaining 93 patients had normal physical examination findings on the first, third, seventh days and the first month after surgery.
Conclusion: We think that not using drains in the Karydakis procedure does not increase the complications. However, drain usage should be weighed according to its costs and benefits in every case, especially in patients with a body mass index greater than 30.

10.Diagnostic Value of Smears and Frozen Sections in Neuropathology Practice: Institutional Experience
Emel Ebru Pala, Eylül Doğan, Sümeyye Ekmekçi, Birsen Gizem Özamrak, Mahmut Çamlar
doi: 10.4274/terh.galenos.2021.23245  Pages 51 - 57 (24 accesses)
Objective: The intraoperative diagnosis of neurosurgical biopsy material is usually tricky due to small size, artifacts of freezed neural tissue. When we are using rapid techniques, we should be aware of the limitations. In this study, we evaluate the diagnostic value of smears, frozen sections in neuropathology practice.
Methods: We evaluated 65 neurosurgical biopsy materials sent for intraoperative diagnosis. All of them were interpreted with both smear and frozen section preparations. Results were grouped as inadequate (normal tissue, full of necrosis, technical artifacts), inflammatory/reactive or neoplastic. Difficulties, limitations of rapid methods were discussed.
Results: Frozen and paraffine diagnoses were concordant in 55 cases. Three were inflammatory/reactive and fifty-two were tumor [low grade glial tumor (11), ependymoma (1), glioblastoma (12), metastasis (5), meningioma (8), craniopharyngioma (2), pituitary adenoma (2), epidermoid cyst (1), central neurocytoma (1), medulloblastoma (2), schwannoma/neurofibroma (6), diffuse large B cell lymphoma (1)]. In two cases, the amount of the material was sufficient but we could not achieve a definitive diagnosis with squash and frozen sections. The paraffine result of these cases was giant cell ependymoma and vasculitis. In eight cases, the material was insufficient for diagnosis. The frozen material contained only necrosis in six cases [glioblastoma (4) and metastasis (2)]; normal parenchyma in a DNET case, cauterized tissue in a fibrous meningioma case.
Conclusion: The accuracy of intraoperative diagnosis of neurosurgical material is very high. Also, the results of smear preparation and frozen section are concordant in most entities. The main role of rapid techniques in neuropathology is to determine whether the tissue is representative and adequate for ancillary testing such as immunohistochemistry and molecular. We should always be keep in touch with neurosurgeon and complemented morphological findings with radiological and clinical characteristics for the most reliable diagnostic interpretation.

11.A Retrospective Analysis of Fetal Cardiovascular System Anomalies in a Tertiary Center
İbrahim Ömeroğlu, Hakan Gölbaşı, Elif Uçar, Barış Sever, Halil Gürsoy Pala
doi: 10.4274/terh.galenos.2021.37029  Pages 58 - 62 (24 accesses)
Objective: We shared the frequency and our experiences of cardiac anomalies detected during routine ultrasound scanning in pregnant women who applied to our perinatology clinic.
Methods: 288 pregnant women who were admitted to İzmir Tepecik Education and Research Hospital Perinatology Clinic between January 2017 and January 2020 due to high-risk pregnancy and who were found to have cardiac anomalies included. The data were retrospectively scanned from the hospital digital archive and patient files.
Results: The demographic data of the pregnant women included in the study such as age, gestational week, gravida, and parity and the anomalies detected categorized. The mean age of the pregnant women was calculated as 27.99 (16-46) and the mean week of gestation as 25.2 (14-40). While the average gravida of the pregnant women was 2.29 (1-8), the mean parity was 0.97 (0-7). The most common cardiovascular system (CVS) anomaly was septal defects with a rate of 29.5%. When septal defects were examined, the most common ventriculoseptal defect (62.3%) followed by a atrioventrucouloseptal defect (27.05%) was found.
Conclusion: Three-dimensional ultrasonography has replaced two-dimensional ultrasonography with the developing technology and increasing physician experience. CVS anomalies can be detected safely with fetal echocardiography in three-dimensional ultrasonography. Early diagnosis and routine-detailed screening of pregnant women gain importance to determine the prognosis of detected structural anomalies and to provide healthy counseling service.

12.Depressive and Anxiety Symptoms Among People Living with HIV in Turkey: A Cross-sectional Study
Kadir Aşçıbaşı, Hazal Albayrak Uçak, Sabri Atalay, Ufuk Sönmez
doi: 10.4274/terh.galenos.2021.82957  Pages 63 - 72 (28 accesses)
Objective: This study was undertaken to determine the prevalence of depression and anxiety, to assess sociodemographic and clinical determinants of depression and anxiety symptoms, and to identify factors that impact antiretroviral therapy (ART) adherence in people living with HIV (PLWH).
Methods: The study was conducted at a third-level hospital. Many assessment tools have been used to collect data among PLWH, including the Sociodemographic and Clinical Data Form, Mini-Mental Test, Hospital Anxiety and Depression Scale (HADS), and Center for Epidemiologic Studies Depression Scale (CES-D).
Results: 56% of HIV-positive individuals were diagnosed with depression and 37% with anxiety disorder. Differences in terms of monthly income (HADdepression scale, χ2=6.037, p=0.028), smoking status (HAD-anxiety scale, χ2=8.104, p=0.009), and substance abuse (both HAD-depression and HAD-anxiety scales; χ2=14.367, p<0.000, and χ2=18.641, p<0.001, respectively) were found. There were significant associations between anxiety and current smoking [Odds ratio (OR)=5.46-95% confidence interval (CI): 1.77-16.88; p=0.03], as well as between depression and low monthly income [OR=3.77, (95% CI: 1.26-11.26; p=0.018)] and having a single-status (OR=2.68; 95% CI: 1.05-6.86; p=0.04). Individuals with an HIV positivity duration of less than 3 years, the adherence to therapy was lower (OR=9.71; 95% CI: 1.14-82.99; p=0.038).
Conclusion: This is the first study from Turkey using HADS and CES-D scales to assess depressive and anxiety symptoms among PLWH. Significant differences were noted between HAD-D and CES-D scales in terms of a diagnosis of depression. Regression analysis showed associations between current smoking and anxiety, between depression and low income and single-status, and between low ART adherence and HIV positivity duration of less than 3 years. Regular follow-up of HIV-positive individuals, especially in terms of depression diagnoses, is of great importance.

13.The Use of Hyperbaric Oxygen Therapy the Following Amputation in Patients with Diabetes
Figen Aydın, Mustafa İncesu, Elif Ebru Özer, Ahmet Kaya
doi: 10.4274/terh.galenos.2021.64507  Pages 73 - 78 (22 accesses)
Objective: Foot ulcers are a frequently seen complication in patients with diabetes, which progress with a long period of hospitalization, a high risk of amputation and amputation stump problems. However, there are very few studies in literature on this subject. Hyperbaric oxygen therapy (HBOT) is an adjuvant treatment method used in cases of diabetic foot ulcers and when wound healing is delayed.
Methods: The aim of this retrospective study was to present and discuss the results of 35 cases that underwent minor amputation because of diabetic foot ulcers and applied HBOT for delayed stump healing.
Results: The patients presented for HBOT at mean 33.1±42.55 days (range, 1-210 days) after amputation. Mean 29.77 (range, 5-45) sessions of HBOT were applied. Clinical healing was obtained without further amputation in 29 (82.86%) cases, further amputation was required in 4 (11.43%) cases and 2 (5.71%) patients terminated the therapy on their own request.
Conclusion: HBOT should be included within a multidisciplinary approach to be able to prevent healing problems following amputation in patients with diabetic foot ulcers.

14.Factors Determining the Prognosis of Acute Mesenteric Ischemia
Tayfun Kaya, Dilek Kuzukıran, Semra Demirli Atıcı, İsmail Sert, Kenan Teker
doi: 10.4274/terh.galenos.2021.47135  Pages 79 - 84 (21 accesses)
Objective: Acute mesenteric ischemia (AMI) is a fatal vascular pathological condition requiring urgent surgical intervention, where early diagnosis significantly affects the prognosis. The aim of this study was to investigate the preoperative, perioperative and postoperative factors affecting mortality in patients who were operated with the diagnosis of AMI.
Methods: Patients who were operated with the diagnosis of AMI between January 2012 and January 2016 were evaluated. The patients were grouped as survivors (group 1) and non-survivors (group 2). Age, gender, concomitant disease history, clinical and laboratory findings, surgical treatment, the remaining bowel amount, short bowel syndrome, ileocecal valve intactness, ostomy opening status, the first 30-day mortality and morbidities were recorded.
Results: Among group 1 and group 2, respectively there was no statistically significant difference in terms of age, gender, concomitant disease, remaining bowel amount, short bowel syndrome, providing total parenteral nutrition support, ileocecal valve intactness and opening ostomy (p>0.05). Hemodialysis was found to be a risk factor for mortality (p=0.020).
Conclusion: AMI is a disease with high mortality, and prognostic factors that can predict pre-op and postoperative mortality are still being investigated. While it is observed that ileocecal valve intactness does not affect mortality, the preoperative urea and creatinine elevation and the need for postoperative hemodialysis may be a predictors of mortality.

15.Determination of Disease Perception and Anxiety Level in Preoperative Surgery Patients
Ayşegül Şavk, Eyüp Kebapçı, Samet Özcan
doi: 10.4274/terh.galenos.2021.34101  Pages 85 - 92 (24 accesses)
Objective: This study, which we conducted in preoperative surgery patients, aims to determine the relationship between the perception of illness and the level of preoperative anxiety in the light of sociodemographic data and scales, and to contribute to the management of the disease process before and after the surgery by determining the awareness and anxiety levels of the patients about their diseases.
Methods: The study was conducted with 195 patients hospitalized in the surgical units of İzmir Tepecik Training and Research Hospital after the approval of the ethics committee. Patients were randomly selected from patients over the age of 18, who were planned for elective surgery, who did not have any psychiatric disease, and who volunteered to participate in the study. The research is a descriptive and cross-sectional questionnaire, and a questionnaire consisting of a sociodemographic data questionnaire prepared by the researchers, the STAI State Anxiety Inventory and the Brief Illness Perception Scale (SCAS) was applied to the participants. Data were analyzed with Kruskal Wallis test, Mann-Whitney U test, Student’s t-test and Pearson correlation tests using Statistical Package for Social Science 15.0 program.
Results: 38.5% (n=75) of our patients were female, 61.5% (n=120) were male, and 12.8% (n=25) were 18-25 years old, 31.3% (n=61) were 26-45 years old, 37.4% (n=73) were 46-65 years old, 18.5% (n=36) were over 65 years old. Preoperative STAI-I values of female patients were higher than males (p<0.05). It was observed that the level of anxiety decreased as the age of the patients increased (r=-0.239, p<0.05). It was observed that the level of anxiety decreased as the age of the patients increased (r=-0.239, p<0.05). It was determined that the level of anxiety showed a statistically significant difference according to the education level and the reason for the operation (p<0.05). The highest anxiety score was observed in the group scheduled for surgery due to cervical-lumbar disc herniation (53±13.2). It was determined that the preoperative state anxiety levels of the patients were statistically significantly different according to the causes of the disease (p<0.05). The mean total score of the short illness perception scale (SCAS) was found to be 34.2±12.9. The total score of SCAS of female patients was higher than that of men. It was determined that the total score of SCAS showed a statistically significant difference according to the reason for the operation (p<0.05). There was a statistically significant positive correlation between the patient’s STAI-I state anxiety scale score and the short illness perception scale total score (p<0.05).
Conclusion: Informing the patients in the preoperative period and eliminating the question marks in the minds of the patients are very important for the prevention of anxiety and the postoperative treatment process. While informing the patients before the operation, their gender, education level, age, reason for the operation, comorbidities, and previous operation history should also be taken into consideration.

16.Human Papilloma Virus and Associated Cervical Lesions in Women Co-infected with HIV
Ufuk Sönmez, Hazal Albayrak Uçak, Sabri Atalay, Gürsel Ersan, Gökhan Tosun
doi: 10.4274/terh.galenos.2021.34654  Pages 93 - 99 (32 accesses)
Objective: Human papilloma virus (HPV) is one of the most important causes of cervical cancer, which is one of the AIDS-defining clinical conditions. In this study, it was evaluated the incidence of HPV and the cytopathological changes caused by HPV in the cervix, among human immunodeficiency virus (HIV)- positive women.
Methods: This study was conducted on HIV-positive women between 2010-2020. Patients were obtained cervical smear samples for HPV-DNA (PCR Roche- Cobas) analysis. Based on HPV test results, patients having one or both of the HPV 16 or 18 were designated as “HPV 16/18 positive”. Patients with at least one of the other high-risk HPV types were termed as “Other HR HPV-positive.”
Results: Twenty-two female patients were included in this study. Their mean age was 40.8 (range: 19-65) years. HPV subtypes were found as the following: HPV-16 in 1 patient (4.5%), HPV-18 in 3 (13.6%), and other HR-HPV in 9 patients (40.9%). In three individuals, HPV-18 co-existed with other HR HPV. The number of subjects with any type of carcinogenic HPV was 10 (45%). The cytological examination determined the presence of pre-cancerous lesions in five patients (22.7%), including atypical squamous cells of undetermined significance (ASCUS) in three (13.6%), and low grade squamous intraepithelial lesion (LSIL/CIN-1) and high grade squamous intraepithelial lesion (HSIL/CIN2-3) in one. Cervical lesions of all patients have regressed in the follow-up.
Conclusion: HIV-positive women have an increased rate of genital HPV infection and precancerous cervical lesions. Most infections in our study are caused by serotypes other than HPV 16 and 18 and all cervical lesions regressed in follow-up.

17.How Have Visits to the Outpatient Clinic and Emergency Unit of a Tertiary Hospital Changed during the COVID-19 Pandemic?
Mustafa Emiroğlu, Mehmet Zeynel Keskin
doi: 10.4274/terh.galenos.2021.47108  Pages 100 - 106 (21 accesses)
Objective: In this study, determined the attributes of non-Coronavirus disease-2019 (COVID-19) patients and the changes in visits to the emergency service and outpatient departments, hospital admissions and the number of performed surgeries in a tertiary hospital in Turkey during the first weeks of the COVID-19 outbreak. Additionally, the effect of this situation on the hospital’s current balance was aimed be analyzed and compared with the same period of the previous year.
Methods: Emergency services outpatient clinics hospitalization, surgery and checking account balance data from 2019April to 2020 April (excluding data of those diagnosed with COVID-19) were retrospectively analyzed. Data were statistically compared using the Mann-Whitney U test and analyzed in subgroups.
Results: All parameters declined during the pandemic period and only the decrease in the number of operations was not statistically significant. Particularly, approximately an 8-fold decrease was observed in the checking account balance.
Conclusion: The COVID-19 pandemic has had devastating effects worldwide and these effects persist. It disrupts all the routine practices of hospitals, from emergency services to surgeries. Many hospitals in Turkey have been declared as pandemic hospitals and only patients who presented with emergency conditions can be intervened on. A similar situation occurred in our hospital and a significant decrease was observed in all parameters.

18.The Effects of Predictive Factors on Patient Prognosis in the Administration of Medical and Surgical Treatment in Patients with Acute Pancreatitis
Kenan Teker, Mehmet Üstün, Mehmet Yıldırım, Cem Karaali
doi: 10.4274/terh.galenos.2021.06978  Pages 107 - 114 (24 accesses)
Objective: This study aimed to evaluate the effects of predictive factors on prognosis in medical and surgical treatment practices in patients with acute pancreatitis (AP).
Methods: Demographic data, laboratory parameters, co-morbidities, imaging method results, treatment procedures, Ranson Score (RS) and Balthazar Score (BS) of the patients who were diagnosed with AP and followed up and treated between January 2008 and February 2012 were retrospectively analyzed. The patients were divided into two groups as those who underwent medical and surgical treatment, and the effects of predictive factors were evaluated according to the treatment decisions of the patients and their mortality and morbidity during treatment.
Results: Coronary artery disease (n=31) as a co-morbidity in the medical treatment group was found to be statistically significant compared to the surgery group (n=2) (p=0.018). In the comparison of RS and related pancreatitis severity between both groups; In the comparison of severe or mild treatment choice, it was found statistically significant that the cases who underwent surgical treatment had mild severity. A statistically significant difference was found between late RS and morbidity and mortality (p=0.037). It was found that as BS increased, mortality increased significantly (p=0.008). The length of hospital stay was significantly shorter in patients who received medical treatment (p=0.001).
Conclusion: We found that coronary artery disease and length of hospital stay were more common in medically treated AP patients, and surgically treated patients were mildly severe. Additionally, we found that morbidity and mortality were relaeted with the increase in late RS, and mortality was releated with increase in BS.

19.Effects of Anemia on Overall Survival in Muscle Invasive Bladder Cancer
Elçin Erdoğan Yücel, Mahmut Can Karabacak, Yusuf Özlem İlbey, Sibel Demiral Sezer, Uygar Miçooğulları, Mehmet Yiğit Yalçın, Mehmet Yoldaş, Mehmet Zeynel Keskin
doi: 10.4274/terh.galenos.2021.91129  Pages 115 - 121 (28 accesses)
Objective: The aim of this study was to investigate the effect of preoperative anemia on overall survival in patients with muscle-invasive bladder cancer.
Methods: We retrospectively analyzed the medical data of patients with a diagnosis of muscle-invasive bladder cancer who underwent consecutive cystectomy. The patients were divided into two groups as those with and without anemia before the operation. These two groups were compared in terms of age, gender, smoking status, American Society of Anesthesiologists score, the history of neoadjuvant chemotherapy, pathological tumor (pT) stage, pathological node stage, number of lymph nodes removed, positive surgical margin, concomitant carcinoma in situ (CIS) presence, lymphovascular invasion, perineural invasion, history of adjuvant chemotherapy, overall survival, recurrence status, urinary diversion type, tumor multiplicity and grade.
Results: A statistically significant difference was found between the groups in terms of overall survival. There was no statistically significant difference between the groups in terms of other variables. Overall survival in group 1 was 61.8 months, and overall survival in group 2 was 32.6 months. Overall survival in all patients was 47.9 months. Five-year overall survival was 54% in group 1 and 20% in group 2.
Conclusion: We detected that the presence of preoperative anemia was associated with poor overall survival rates in patients with muscle-invasive bladder cancer. We consider that preoperative anemia and pT stage are variables that can be used to predict overall survival

20.Is a Bioceramic Glass Bone Graft Superior to Spongious Allografts in Femoral and Tibial Benign Bone Lesions?
Gökhan İlyas, Ahmet Kaya, Mustafa İncesu
doi: 10.4274/terh.galenos.2021.76402  Pages 122 - 130 (25 accesses)
Objective: this study aimed to examine the results of spongious and bioceramic bone graft applications in benign lesions of the lower extremity long bones.
Methods: Forty-seven patients, who applied to our hospital between the years 2007 and 2013; who received curettage-grafting for benign bone lesions in the long bones carrying lower extremity weight were examined retrospectively.
Results: In the bioceramic glass bone graft group, an increased average consolidation ratio, which is statistically significant compared to the spongious allograft group (p=0.002), was observed. When the fibrous dysplasia patients were considered a subgroup, the consolidation ratio in the bioceramic glass bone graft group was found to be significantly high compared to the spongious allograft group (p=0.029).
Conclusion: Bioceramic glass bone grafts are bone filler materials that hold radiologically superior and clinically similar results compared to spongious allografts. Having a statistically significant radiological consolidation success in fibrous dysplasia, which is a benign aggressive tumor, bioceramic glass bone grafts may be thought to be capable of being an advantage option for benign aggressive tumors.

21.Evaluation of JAK/STAT Signaling Pathway-associated Protein Expression at Implantation Period: An Immunohistochemical Study in Rats
Can Köse, Seda Vatansever, Sevinç İnan, Cengiz Kırmaz, Çevik Gürel, Derya Erışık, Gökçe Ceren Kuşçu, Kemal Özbilgin
doi: 10.4274/terh.galenos.2021.22599  Pages 131 - 141 (26 accesses)
Objective: The implantation period of gestation is a complex process in which numerous molecular pathways play a role. The Janus kinase/signal transducers and activators of transcription (JAK/STAT) pathway is one of the evolutionarily conserved cascades used to transduce a multitude signals for several biological events such as implantation and uterine receptivity. Previous studies have indicated that the implantation process is disrupted by the lack of proteins involved in this pathway. However, our literature knowledge showed that there is no study evaluated the expression of JAK/STAT signaling pathway-associated proteins during the implantation period. This study investigated the expression patterns of JAK/STAT signaling pathway-associated proteins in rats by immunohistochemical (IHC) staining according to gestational days.
Methods: In this study, thirty Wistar Albino rats weighing 250-300 g, without any problems in their menstrual cycles, were used. The pregnant animals were sacrificed on the 4th, 5th, and 6th days and histochemical and IHC analysis were performed on the uterine tissues taken from these animals.
Results: In this study, protein expression of JAK1, JAK2, JAK3, STAT2, STAT3, STAT4, STAT5, and STAT6 belonging to the JAK/STAT pathway was evaluated in the uterine surface epithelium, gland structures, antimesometrial region, cells of the immune system, myometrium, mesometrial region and decidual cells, which are associated with the implantation process. The result of this evaluation reveals that the expression levels of these proteins in the JAK/STAT pathway vary in different days of the implantation period in implantation-related structures.
Conclusion: This study indicates that JAK/STAT signaling pathway-associated proteins can function actively in the regulation of the immunological response of the uterus and embryo-uterus interaction during the implantation period in rats. However, the findings obtained from advanced research on JAK/STAT pathway can be used for treating recurrent pregnancy failures and in enhancing assisted reproductive technology.

22.Predicting Resection in Incarcerated Hernia with Simple Markers
Mehmet Üstün, Göksever Akpınar
doi: 10.4274/terh.galenos.2022.82473  Pages 142 - 146 (24 accesses)
Objective: This study analyzes the resection prediction power of simple markers derived from complete blood count and blood chemistry.
Methods: Data from 196 patients who underwent emergency surgery for incarcerated hernia between the January 2013 and the December 2018 were retrospectively analyzed. The patients with femoral hernia (n=19) were further excluded from the statistical analysis to prevent the interference of hernia type on resection decision. The patients were divided into two groups according to their resection status.
Results: Demographic data were similar in both groups. The calculated cut-off value for neutrophil/lymphocyte ratio (NLR) was 5.8175 with sensitivity of 83.7% and specificity of 51.2 NLR was found to have the strongest predictive value with (Odds ratio=5.38 and p-value=0.001).
Conclusion: Elevated NLR level can be used as a predictive biomarker to predict the need for resection in incarcerated abdominal wall hernias.

23.Intracavitary Bacillus Calmette-Guérin Treatment for Bladder Cancer: Is it Protective Against COVID-19?
Mehmet Zeynel Keskin, Mert Hamza Özbilen, Kenan Teker
doi: 10.4274/terh.galenos.2022.61214  Pages 147 - 150 (23 accesses)
Objective: To investigate whether the intravesical Bacillus Calmette-Guérin (BCG) administered to non-muscle invasive bladder cancer (NMIBC) patients has a protective effect against Coronavirus disease-2019 (COVID-19).
Methods: Six hundred and ninety-nine patients with NMIBC were enrolled in the study. The patients were divided into 2x2 groups based on the conditions of having received BCG treatment and having had a COVID-19 infection. The normality of the distribution was analyzed using the Shapiro-Wilk test. Statistical relationships between the groups were analyzed using the chi-square test. P<0.05 was considered statistically significant.
Results: There were 34 individuals who had a history of COVID-19 infection and 665 who did not, and 273 individuals who received BCG treatment and 426 who did not. A history of COVID-19 infection was encountered in 18 (6.6%) of the 273 patients who received BCG treatment and in 16 (3.8%) of the 426 patients who did not receive BCG treatment. The 2x2 statistical association between the groups was analyzed using the chi-square test and a statistically significant relationship was not determined (p=0.065).
Conclusion: As we initiated the study, we expected lower rates of COVID-19 infection in patients who received intravesical BCG; however, the results of this study showed us that this was not the case. The disease was encountered at higher rates in those who received intravesical BCG in contrast with our expectations; however, this difference was not statistically significant.

CASE REPORT
24.A Case of Pilomatricoma Associated with Neurofibromatosis Type 2 in Childhood
Pınar Gençpınar, Deniz Kızmazoğlu
doi: 10.4274/terh.galenos.2021.69783  Pages 151 - 154 (24 accesses)
Neurofibromatosis type 1 is the most common neurocutaneous syndrome, however neurofibromatosis type 2 (NF2) is extremely rare in childhood. It is inherited as autosomal dominant. Spontaneous mutation is detected in half of the cases and there is no family history. It is caused by a mutation of a tumor suppressor gene located on the chromosome 22. NF2 affected individuals also have a much higher rate of cancer. For the diagnosis, Manchester diagnostic criteria are used: Bilateral vestibular Schwannoma (VS) or family history of NF2 plus unilateral VS or any two of meningioma, glioma, neurofibroma, Schwannoma, posterior subcapsular lenticular opacities. We reported a case of NF2 presented with peripheral Schwannoma associated with scalp-located pilomatrixoma.

25.An Unusual Presentation of Renal Mass in a Healthy Adult: Acute Lobar Nephronia Case Report and Review of the Literature
Okan Nabi Yalbuzdağ, Barış Karademir, Burak Karabacakoğlu, Cemal Selçuk İşoğlu, Tufan Süelözgen, Uygar Miçooğulları, Mehmet Zeynel Keskin, Yusuf Özlem İlbey
doi: 10.4274/terh.galenos.2022.53323  Pages 155 - 157 (21 accesses)
Acute lobar nephronia (ALN) is a kidney infection that can be confused with space-occupying solid masses. It is usually seen in children and renal abscess may develop in 25% of the cases. First-line treatment of ALN is medical treatment. Here, a 30-year-old female patient was admitted to the emergency department with nausea, vomiting, flank pain and fever. Computed tomography (CT) showed an appearance of a wedge-shaped mass in the right renal parenchyma. On the 6th day of antibiotherapy, his right side pain was completely recovered and there was no costovertebral angle tenderness on physical examination. The patient was discharged after completing 21 days of treatment without any complications. There was no mass appearance in the CT images taken on the day of discharge. Although ALN is more frequently seen in children and immunosuppressive patients, it can be seen in young adult patients as in this case.

ERRATUM
26.Erratum

doi: 10.4274/terh.galenos.2022.e001  Page 158 (20 accesses)
Abstract | Full Text PDF

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