Anatolian Clinic Journal of Medical Science / Anadolu Kliniği Tıp Bilimleri Dergisi

141-148

Authors: Filiz Fusun Bolukbas, Seyda Ignak, Ozlem Unay Demirel3, Yavuz Furuncuoglu, Ferhan Mantar, Sercen Cansu Sertel, Filiz Yarımcan Saglam, Cengiz Bolukbas

Aim: Non-alcoholic fatty liver disease (NAFLD) is the most frequent chronic liver disease. Because NAFLD is a complex disease, finding highly specific and sensitive biomarkers for diagnosis is very difficult. We investigated the possible relation between steatosis and fibrosis stages determined by FibroScan technique and serum vitamin B12 levels as a non-invasive biomarker in patients with NAFLD. Materials and Methods: A total of 129 patients (45.68±12.9 years of age, 29 females) with NAFLD and 50 healthy subjects (43.44±15.3 years of age, 21 females) were included in this study. FibroScan was performed in all patients for the staging of fatty liver fibrosis. Liver enzymes were also analyzed in addition to serum vitamin B12 and C-reactive protein (CRP) levels. Results: There was no difference with respect to age and gender between NAFLD and control groups. The serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and CRP levels were significantly higher in the patients with NAFLD than the controls (p<0.05). On the contrary, serum vitamin B12 vitamin levels were lower in the patients with NAFLD, compared to the controls (352.8±125.2pg/mL vs 435.2±134.4, p<0.01). There was a significant difference in mean serum B12 vitamin levels between the control group (435.2±134.4pg/mL) and the NAFLD subgroups with fibrozis staged F0 and F3 (366.17±129.7pg/mL, 285.22±101pg/mL, p<0.01). Discussion and Conclusion: Serum vitamin B12 levels were found to be significantly low in the patients with NAFLD in comparison to the control group. This decline in serum vitamin B12 levels was even more prominent as hepatic inflammation and fibrosis stage increased (F0–F3), but not in advanced fibrosis stage (F4).

157-162

Authors: Zafer Özmen, Eda Albayrak

Aim: In this study, we aimed to investigate the adult incidence of asymptomatic Bochdalek hernia detected incidentally by multislice computed tomography and the relation between Bochdalek hernia and obesity as well as diaphragmatic crus thickness. Materials and Methods: Eight hundred and seventy multislice computed tomography images of the thorax and abdomen were screened retrospectively to investigate Bochdalek hernia presence, prevalence, and localization. In the patients with Bochdalek hernia, diaphragmatic crus thickness at defect border and subcutaneous fat tissue thickness in the right paramedian area at umbilicus level were measured in the axial sections. Defect size and hernia sac volume were also calculated on the same images. Then, possible correlation of defect size and hernia sac volume with diaphragmatic crus thickness and subcutaneous fat tissue was investigated. Results: Thirty-four Bochdalek hernia (3.9%) sacs were detected in 30 patients. Bochdalek hernia was on the left side in 13 patients (43.3%), on the right side in 13 patients (43.3%), and bilateral in 4 patients (13.3%). The hernia sac consisted of omental fat tissue in 32 patients (94%), of liver in 1 patient (3%), and of colon in 1 patient (3%). The segmental volume of hernia was 153 [84–361] μl in female patients and 339 [202–432.5] μl in male patients, and the difference was statistically significant (p=0.032). Neither segmental volume of hernia nor defect size was found to be correlated with diaphragmatic crus thickness or subcutaneous fat tissue (p>0.05). Discussion and Conclusion: In our study, incidence of Bochdalek hernia detected by multislice computed tomography is 3.9% and segmental volume of hernia was found to be significantly lower in females compared to males. Although obesity plays an important role in pathogenesis of intraabdominal hernia, no significant correlation was detected between defect size of asymptomatic incidental Bochdalek hernia and obesity as well as diaphragmatic crus thickness.

169-176

Authors: Aynur Görmez

Aim: In the literature there has been growing interest in caregiving burden of adults with intellectual disability (ID), following the increase in life expectancy of adults with ID. There is no adequate data concerning the caregiving burden of this age group in Turkey. In this study we aimed to determine family caregiving burden of adults with ID and to investigate the relationship between caregiving burden and various clinical and sociodemographic parameters. Materials and Methods: One-hundred and two adults with ID and their families were included in this study, all of whom were reached through polyclinics, rehabilitation centers, and schools. The data were collected by using a specifically designed, structured form, the Zarit Caregiver Burden Scale, and the Psychiatric Assessment Scale for Adults with Developmental Disabilities. Results: The mean caregiving burden score was 54.68±13.83. The primary factor increasing the caregiving burden was found to be a comorbid diagnosis of an autism spectrum disorder (ASD) in the individual with ID (p=0.001). Presence of behavioral problems was another factor increasing the caregiving burden (p=0.031). The highest caregiving burden score was observed in universitygraduate caregivers. No significant relationship was found between caregiving burden and gender, age, physical and mental illnesses, incontinence status, physical disability status, community services attendance, and verbal ability level of people with ID as well as the duration of the care given. Discussion and Conclusion: Prevention and appropriate management of behavioral problems, in addition to determining the needs and expectations of families of people with ID on the autism spectrum will be a critical step in lessening the caregiving burden on the families. Another remarkable point is that the highest caregiving burden reported belonged to university-graduate caregivers, who are likely to have a greater awareness of problems.

183-192

Authors: Özlem Çınar Özdemir, Ramazan Kurul, Elif Duygu1, M. Fatih Uysal, Yeşim Bakar, Ömer Osman Pala, Kemalettin Erdem, Handan Ankaralı

Aim: In this study, we aimed to investigate effects of low frequency pulsed electromagnetic field therapy (PEFT) therapy on edema, life quality, depression, and range of joint motion in patients with chronic venous insufficiency. Materials and Methods: Fifty-five patients with chronic venous insufficiency who were at C3–C6 according to the clinical–etiological–anatomic–pathophysiological (CEAP) classification were included the study. The demographic data of the patients were obtained and analyzed before the study. Clinical evaluations tools included the Venous Insufficiency Epidemiological and Economic Study–Quality of Life Questionnaire (VEINES-QOL), the Beck Depression Inventory (BDI), and range of joint motion and circumferential measurements. The patients were divided into two groups using random number generator as treatment (n=21) and control (n=24) groups. All tests were performed at both the beginning and the end of the study. Following the initial assessment, LFAM therapy was administered to the treatment group for 5 days a week for 6 weeks. The individuals were asked to use compression stockings for 6 weeks at the same time. The control group used only compression stockings for 6 weeks. Results: When the first and last measurements of the both groups were compared, there was a significant difference in the ankle dorsiflexion and plantar flexion and depression measurements (p<0.001, p = 0.007, p <0.001). When the groups were compared in terms of circumferential measurements, depression, and life quality, a significant difference was found in depression evaluation and circumferential measurements of the ankle (CB) and the area above the ankle (CB1) (p <0.05) Discussion and Conclusion: This study showed that low-frequency low-dose electromagnetic field (PEFT) therapy increases joint motion range and decreases edema and depression in individuals with chronic venous insufficiency. This is the first study in our country where magnetic field therapy has been used in other stages of chronic venous insufficiency. We believe that the repetition of the study on a larger sample with longer follow-up periods might contribute to the literature.

200-203

Authors: Hüseyin Karaaslan, Mehmet Nuri Turan, Mehmet Ali Eren, Tevfik Sabuncu

Milk-alkali syndrome was first described in patients using high dose antacid drugs for peptic ulcer. The triad of the syndrome is hypercalcemia, metabolic alkalosis, and acute renal failure. The incidence of the syndrome that decreased after the development of modern ulcer treatments has currently been increasing again due to the use of calcium-containing medicine for osteoporosis and renal osteodystrophy. In this report, we present a patient who had been under calcium carbonate and active vitamin D treatment due to idiopathic hypoparathyroidism and presented with life-threatening hypercalcemia, metabolic alkalosis, and acute renal failure.

208-211

Authors: Ahmet Selim Özkan, Sedat Akbaş, Mehmet Rıdvan Yalın, Emine Özdemir

The Seckel syndrome is a rare autosomal disease that can cause difficult airway problems due to microcephaly, retrognathia, and the typical facial structure. In anesthesia management of patients with Seckel syndrome, it is important to take the necessary precautions against possible difficult venous access and difficult airway problems, and it should be noted that alternative tools can also be helpful in airway management.

220-223

Authors: Abdulhalim Şenyiğit, Mustafa Kanat

Despite modern treatment approaches, glycemic control is inadequate in more than %50 of diabetic patients. In addition to the factors associated with the patient, physician and health system, the progressive character of the disease also plays an important role in inadequate glycemic control. This paper reviews the main principles in type 2 diabetes treatment and the place of pioglitazone as an insulin sensitizer.

73-74

Authors: Özgür Can Eren, Emine Elif Vatanoğlu Lutz

International treaties are included among the sources of written law. According to Article 90 of the Constitution of the Republic of Turkey, “the ratification of treaties concluded with foreign states and international organizations on behalf of the Republic of Turkey shall be subject to adoption by the Grand National Assembly of Turkey by a law approving the ratification.” The article further states that “international agreements duly put into effect have the force of law” (1). In the legal system, international treaties are hierarchically more powerful norms than national laws. In the hierarchy of norms, international treaties are above the laws. Therefore, unlike laws, no appeal to the Constitutional Court can be made with the claim that an international treaty violates the Constitution (2).........

85-94

Authors: Safinaz Ataoğlu, Handan Ankaralı, Seyit Ankaralı

Aim: Fibromyalgia syndrome (FMS), a complex and multidimensional clinical syndrome, disrupts quality of life, causing many somatic and psychological problems. In this study we aimed to determine which measuring instrument should be chosen for the fastest and most efficient assessment of life quality in patients diagnosed with FMS. The reliability and validity of the SF- 12, SF-8, and SF-6D were also assessed concurrently. Materials and Methods: Fifty-nine patients diagnosed with FMS at Department of Physical Medicine and Rehabilitation, Medical Faculty of Duzce University, who consented to participate in the study and filled out the forms fully were evaluated. Life quality of the patients was investigated by using the instruments SF-36, WHOQOL-BREF, QuickDASH, SF-12, SF-8, and SF-6D. Results: The internal consistency and repeatability of these scales were found to be high in light of the obtained data. When the relation between the SF-36 scores and the scores obtained from the other three short forms (SF) was investigated, the SF-12 and SF-6D scales were found superior to the SF-8 in terms of validity. Discussion and Conclusion: In light of the entire data resulted from our assessment of validity, we suggest that the SF-12 and SF-6D might be preferred over the SF-36 in measuring life quality in patients with FMS. Because its lower efficiency than the SF-12 and SF-6D in all subdimensions and its lack of a mental health-related sub-dimension, the SF-8 is not an appropriate tool for this purpose in FMS.

103-106

Authors: Mehmet Aslan, Yeşim Kutlutürk

Aim: In this study, we aimed to determine demographic, clinical and laboratory characteristics of patients diagnosed with carbon monoxide intoxication at Inonu University Turgut Özal Medical Center’s Pediatric Emergency Department in the last seven years. Materials and Methods: Fifty-seven children who had been diagnosed with carbon monoxide intoxication in the last 7 years between April 2009 and April 2016 were included in the study. The statistical analysis of the data was performed by using SPSS (Ver. 17.0) software package. The comparisons were performed assessing frequency and using minimum, maximum and mean values, standard error rates, and case number (n) and percentage (%) parameters. Results: The mean age of the fifty-seven patients was 8.8±4.8, and of them thirty-six were female (63.2%). It was seen that CO intoxication had most frequently occurred in the year 2013 (36.8%) and in the month January (43.9%). The cases were seen to have most frequently occurred between 7.00 p.m. and 7.00 a.m., peaking between 3.00 and 5.00 a.m. (14%). The most common complaint of the patients was nausea (36.8%), and the most common laboratory finding was leukocytosis (52.6%). Discussion and Conclusion: Our study shows that CO intoxication most frequently occurs in winter and at night after midnight. The most common symptoms are nausea, vomiting, dizziness, and headache. Slightest negligence may result in a tragedy that can involve the entire family. To avoid this, regular maintenance of chimneys and stoves is essential and the stove must be off while the household is asleep. Immediate transfer of the patient from the toxic environment to a safer place is the first rule in the management of these cases.

114-118

Authors: Halil Kara, Murat Kaçar

Exposure to bullying impedes the development of children and adolescents particularly and leaves marks that may have lifelong negative effects. It is also important in the sense that it can trigger development of some psychopathologies. In this paper, we discussed peer bullying over two clinical cases that involve emotional bullying and cyber bullying. In the both cases, depressive symptoms became prominent and problems concerning the families’ attitudes were observed. We need that precautions be taken against bullying and a useful type of empirical social support be determined.

125-130

Authors: M. İhsan Karaman

This paper aims to address female circumcision (FC) from sociocultural, medical, ethical and religious/Islamic perspectives. FC is performed primarily in Africa today; its prevalence varies across countries. None of the sociocultural justifications developed historically for FC is scientifically valid. FC provides no health benefits, but, on the contrary, severely impairs the physical, psychological and social health of the victim in the short and long term. As for sexual health and satisfaction, the outcome is disastrous. Hoodectomy as another relevant surgical intervention, however, can be distinguished as an exception because it can be for the benefit of the woman. When we assess FC ethically, we see that all of the generally accepted, major principles of medical ethics are violated. Finally when we look at FC from an Islamic perspective, the Quran does not contain any verses to ground or adjudicate arguments on FC. The hadiths reporting about the justification of FC have been determined by the hadith scholars to be weak. They have not been accepted as sound justificatory sources that a fatwa can be based on.

8-15

Authors: Funda Koçak, İlker İnanç Balkan, Aygül Doğan Çelik, Bülent Durdu, Aslıhan Demirel, Serap Gencer, Hava Yılmaz, Fatma Ekşi Polat, Bahri Teker, Aziz Öğütlü, Aynur Engin, Alper Şener, Mesut Yılmaz, Serpil Öztürk Özkan, İlknur Esen Yıldız, Derya Öztürk Engin, Muhammed Emin Doğan, Oğuz Karabay

Aim: We aimed to determine the rates of compliance with current guidelines for practices of perioperative antimicrobial prophylaxis (PAP) and the factors affecting these rates. Materials and Methods: Four hundred and ten surgeons from seven different branches attended the survey conducted between May 30 and June 30, 2013, in fifteen different centers. A 40-question questionnaire consisting of multiple choice and open-ended questions was prepared and applied by interviewing the surgeons.Results: The mean age was 38.01 ± 9.1 years; and 83.4% of the participants were male. Of the surveyed surgeons 46.2% stated that they had no information about the existence of any guidelines for surgical prophylaxis in their institutions and 34% stated that institutional guidelines were available and their prophylaxis practices were in accordance with them. Surgeons who were trained on surgical prophylaxis within the last three years were found to have a statistically higher (p<0.001) rate of compliance with the guidelines. Compared to surgeons from other branches, compliance rates in cardiovascular surgeons were statistically significantly higher (p=0.012). The duration of prophylaxis applied was longer than 24 hours in 56% of the participants. In procedures involving drains, 63.7% of the surgeons stated that they preferred to terminate surgical prophylaxis after removing the drainage tube. It was found that urologists used second and third generation cephalosporins statistically significantly more frequently (p<0.001; p=0.002). Of the surgeons 87.6% stated that they did not rotationally change the antibiotics they used for surgical prophylaxis. It was found that 33% of the centers did not have 24-hour infection consultation and microbiology laboratory facilities. The question “What are the most important reasons for failure in compliance with surgical prophylaxis guidelines?” was left unanswered by 50% of the participants. The most important reasons of incompliance were found to be “lack of regular feedback about hospital infections and the pathogenic microorganisms” (30%), “failure in application of the prophylactic agent in accordance with the timing and dosing determined by the healthcare personnel” (27%), and physicians’ view that institutional PAP guidelines were insufficient (17%). Discussion and Conclusion: Besides the existence of institutional guidelines for the establishment of evidence-based PAP practices, it is also crucial to provide active participation of surgical healthcare units in the preparation of these guidelines and to maintain regular training and feedback meetings and active communication between medical branches.

24-29

Authors: Mehmet Ali Sungur, Handan Ankaralı, Şengül Cangür

Aim: The rate of statistical software use among researchers today is very high. In this study we aimed to develop a web-based decision tree at the least possible confusion level that can provide guidance in choosing the appropriate test statistics for researchers who want to perform the basic statistical analyses in univariate models on their own. Materials and Methods: The decision tree developed as a guide in determining the appropriate test statistics in the statistical analysis of simple or multiple univariate models was created by using PHP and JavaScript languages. Technical information on the concepts and tests was provided in pop-ups for the guide user’s convenience. Results: The questions posed within this decision tree that is quite easy to reach and use help reduce possible appropriate methods by fixing the research’s aim, design and data type and lower the researcher’s possibility to make mistakes due to lack of knowledge or misguidance. In addition, the information provided on the existence and nature of more advanced statistical methods emphasizes for the researcher the importance of consulting with an expert during the statistical analysis of a study’s results.Discussion and Conclusion: Choosing the right test is crucial for the accuracy and reliability of findings to be obtained from a statistical analysis. What is essential is the ability to choose the right test for statistical analysis, not the ability to perform a statistical test or use statistical software. In addition to emphasizing the importance of consulting with an expert, a decision tree as developed in this study will contribute to lowering the possibility of making mistakes of researchers who want to perform statistical analyses on their own, at least while their choice of method.

36-45

Authors: Dilek Akkuş, Aysel Karaca, Dilek Konuk Şener, Handan Ankaralı

Aim: Tobacco and alcohol use among adolescents is an important issue that has been frequently addressed in recent years. In this study we aimed to determine the prevalence of tobacco and alcohol use among high school students and the factors affecting the use of these substances. Materials and Methods: This cross-sectional study was carried out with 1997 students from three different high schools in the 2015–2016 academic year. All of the students who volunteered were included in the study that was designed by cluster sampling method. The data were analyzed by mean, standard deviation, number and frequencies, chi-square and multiple polytomous logistic regression analyses. Results: The rate of the students who have smoked at least once in their lives was found to be 35%, and the rate of those who were smoking almost every day 20.1%. These rates for alcohol use were 18.7% and 1.8%, respectively. It was found that the rates of tobacco and alcohol use were statistically significantly higher in students from industrial vocational high schools, male students, 12th grade students, students who perceived their academic success to be low, students who had received a disciplinary punishment, and those who were frequently absent from school, had gotten into trouble with the police, had friends using tobacco, alcohol or another substance, or had undergone psychological treatment (p<0.001). Discussion and Conclusion: The rates of tobacco and alcohol use among the students were found to be similar to those reported in studies previously performed in Turkey and other countries. Based on these results, we suggest that preventive/protective interventions be planned at schools by taking into consideration the individual, familial, and school characteristics of pre-high school students.

50-52

Authors: Ibrahim Adak, Ilyas Kaya, Murat Coskun

Hyperhidrosis (excessive sweating) is a rarely reported side effect of methylphenidate treatment in young subjects with attention-deficit/hyperactivity disorder. There are few reports of hyperhidrosis associated with methylphenidate overdose in children and adolescents with diagnosis of ADHD. Here we report a case of an adolescent boy who developed hyperhidrosis after taking osmotic-controlled release oral delivery system methylphenidate (Concerta®) for his attention-deficit/hyperactivity disorder.

58-63

Authors: Pervin Somer, E. Elif Vatanoğlu-Lutz

Although the great achievements in today’s medicine offer remedies for many illnesses, there are still cases where physicians are helpless despite their highly improved technological abilities and medical knowledge. Patients who cannot get well despite such medical treatments or have been diagnosed with a terminal illness might seek different solutions. In this context, applications of traditional and complementary medicine become prominent. We can also see that Western medicine is not as distant as it used to be toward traditional and complementary medicine. It is noticeable in the recent literature that physicians worldwide now tend to be knowledgeable with these practices, and that although they do not make them a part of their treatments yet, they inform their patients about them and do research on them. In this paper, the new Regulations on Traditional and Complementary Medicine in Turkey is evaluated from legal and ethical perspectives.