ISSN: 2630-5720 | E-ISSN: 2687-346X
Volume: 62  Issue: 3 - 2022

Pages I - X

2.Common Mistakes Made in Clinical Research Ethics Committee Applications: Experience of a Training and Research Hospital
Güldem Mercanoğlu, Cağatay Nuhoğlu, Fisun Vural, Sebahat Aksaray, Nimet Emel Lüleci, Kadir Kayataş, Barış Güngör, Mehmet Ali Uzun, Seyhan Hıdıroğlu, Murat Sargın, Mehmet Erbakan, İhsan Oğuz Tanzer
doi: 10.14744/hnhj.2022.67944  Pages 239 - 247
INTRODUCTION: It is the responsibility of the ethical committees to ensure that the studies carried out on volunteers are carried out in accordance with ethical rules. In this study, it is aimed to analyze the deficiencies in the 2018-2021 application forms of the Istanbul Haydarpaşa Numune Training and Research Hospital Clinical Research Ethics Committee.
METHODS: The number of applications and revisions, the quality and type of research, area of application and acceptance rate were analyzed retrospectively in the archives of the ethics committee, in 598 files that were finalized between January 2018 and December 2020.
RESULTS: In the examined period, the total number of applications has doubled as of the end of 2020 compared to January 2018 (131, 194 and 273 for the years 2018, 2019 and 2020, respectively), and almost all of the applications are non-pharmacologic clinical trials. Among these studies, the highest number of applications are individual research projects, and more than half of them are prospective (63.06%, 66.46% and 58.30%, respectively). The number of applications for which corrections were requested is 77 (58.77%), 107 (55.15%) and 107 (39.19%) according to years. Most of the corrections requested are method related. The highest increase in the number of revisions was in the misidentification of the research type (0.78%, 6.02% and 6.94% for 2018-2020, respectively).
DISCUSSION AND CONCLUSION: It was determined that the researchers had difficulties in the study methodology, informed consent and preparation of the scientific basis. Planning periodical Good Clinical Practices (GCP) trainings on an institutional basis under the leadership of ethics committees and that the specialty students have completed their current GCP training before starting their specialty thesis studies will ensure that the research projects to be carried out will be of higher quality in terms of ethics and science.

3.Surgical Strategies for Distal Anterior Cerebral Artery Aneurysms
Ali Arslan, İsmail İştemen
doi: 10.14744/hnhj.2020.18894  Pages 248 - 252
INTRODUCTION: Distal anterior cerebral artery (DACA) aneurysms are rare and possess different features in terms of surgical treatment and follow-up. We present our clinical experience about DACA aneurysms in this manuscript.
METHODS: Retrospective analysis of 411 patients who were operated in our clinic for intracranial aneurysm between April 2015 and May 2019 was presented. These patients were evaluated in terms of age, sex, clinical and radiological features, grade of the aneurysm according to the World Federation of Neurological Surgeons, surgical strategies, prognostic factors affecting surgical results, and patient discharge scores named as modified Rankin scores (mRSs).
RESULTS: In our study, 21 DACA aneurysms were detected and gender distribution was observed in the form of 10 male and 10 female patients. Twenty had saccular aneurysm and one had infundibular aneurysm. Eleven of 20 patients had multiple aneurysms and 17 had subarachnoid hemorrhage. It was detected incidentally in three patients. When patients were evaluated according to the aneurysm diameter, 19 had aneurysms of 3–7 mm in diameter and two had aneurysms of 8 mm in diameter. Frontotemporal approach was performed for 11 patients with multiple aneurysms, whereas interhemispheric approach was used for nine patients with isolated DACA aneurysms. mRS was 0 for 15 patients, 1 for two patients, 5 for two patients, and 6 for one patient (exitus).
DISCUSSION AND CONCLUSION: Although DACA aneurysms are small in size, they should be treated surgically or endovascularly. Coexistence with multiple aneurysms is frequent. Elder age and coexistence with multiple aneurysms are poor prognostic factors.

4.Using Osirix for Pre-Surgical Planning in Microvascular Decompression Surgeries
Ali Fatih Ramazanoğlu
doi: 10.14744/hnhj.2022.60963  Pages 253 - 256
INTRODUCTION: Both trigeminal neuralgia (TN) and hemifacial spasms (HFS) cause vascular compression of the fifth and seventh cranial nerves, respectively, at the root entry zone. This study proposes a new technique for using both three-dimensional (3D) constructive interface in steady state (CISS) magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and computerized tomography angiography (CTA) to show vascular compression on the trigeminal and facial nerves.
METHODS: The study included 10 patients presenting with TN and HFS. The post-processing software Osirix was used to combine pre-operative 3D CISS MRI, MRA, and CTA to render a manipulative 3D image. This 3D image can be printed and used to show the vascular compression before the surgery.
RESULTS: Of the 10 patients, four were male and six were female. All radiological imaging was imported to the Osirix DICOM Viewer. The vascular compression was shown in nine of the patients. In nine patients displaying vascular compression were found to have anatomic consistency (determined during surgery) to that of the 3D model. One patient did not display vascular compression in either the 3D models or images.
DISCUSSION AND CONCLUSION: The use of 3D CISS MRI, MRA, and CTA to create manipulative 3D images and models was shown to be useful in pre-operative surgical planning for patients with symptoms of vascular compression, for whom previous medical interventions had failed. If venous compression is not observed, it is important to be aware of the potential to compression of a vein and various other non-vascular lesions.

5.Etiology and Prognostic Factors of Community-Acquired Pneumonia
Esin Sonkaya, Selma Aydoğan Eroğlu, Hasan Kaynar, Metin Akgün
doi: 10.14744/hnhj.2020.32650  Pages 257 - 263
INTRODUCTION: Community acquired pneumonia (CAP) is an important health problem because of its high prevalence and mortality. In empirical treatment decision, clinical data have critical importance. In this study, we aimed to determine the etiological factors and prognostic markers in the patients who have CAP.
METHODS: The present study was conducted with 65 patients with CAP, who were referred November 2011 and November 2012. For etiologic evolution, sputum, bronchial lavage, direct microscopic examination, and cultures of blood samples and bronchial lavage were performed. For prognostic evolution, complete blood count, C-reactive protein, sedimentation, and biochemical parameters were evaluated. The patients were classified according to ATS, PSI, and CURB-65 critera and their associations with prognosis were analyzed.
RESULTS: According to the Turkish Thorax Society 2009 CAP Guideline, there were 44 patients (67.7%) in Group 1, 15 (23.1%) in Group 2, and 6 (9.2%) in Group 3. The most common used antibiotics were new generation quinolones, third generation cephalosporins, and macrolid combinations. The most common lung involvement was lober. In sputum culture and direct microscobic examination, the most common etiologic agent was coagulase negative staphilococci and there was no resistance to those antibiotics. The duration of treatment was ranged between 15 days.
DISCUSSION AND CONCLUSION: In the etiologic investigation, any agent was isolated in approximately 30% of patients. For this reason, empirical antibiotic therapy is important in prognosis. It should be started without delay in the presence of guidelines and considering the patient’s clinical findings and previous antibiotic use. Prospective studies involving large numbers of patients are needed to investigate regional data.

6.Blood Indices and CHA2DS2VASC Score in Patients who Underwent Manual Compression Repair for Femoral Artery Pseudoaneurysms
Sinan Varol, Fahrettin Katkat, Gökmen Kum, Serkan Ketenciler, Ertuğrul Okuyan
doi: 10.14744/hnhj.2020.90377  Pages 264 - 270
INTRODUCTION: Manual compression repair (MCR) for femoral artery pseudoaneurysm (FAP) is an earlier and well-known nonsurgical procedure. Relationship with the success of MCR and CHA2DS2VASC score, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), and red-cell distribution width (RDW) were unknown.
METHODS: We investigated 17,391 catheterization procedures from April 2009 to December 2015. 118 FAPs were suitable for MCR. Age, sex, concomitant vascular disease, and laboratory findings were compared between patients who have non-thrombosed pseudoaneurysm (NTP) and those who have thrombosed pseudoaneurysm (TP) after one or more MCR attempts.
RESULTS: 81 FAPs were successfully sealed after one or more MCR attempts. The success rate was 38.9% at the first attempt and 68.6% at the third attempt. The dual antiplatelet usage rate was high (68.5%) in the study population. FAP dimensions, fistula tract width, or length did not differ between groups. Patients who have sealed pseudoaneurysm have a higher CHA2DS2VASC score (2 [1–3.5] vs. 3 [2–4], p=0.019). There is no difference in terms of NLR, PLR, RDW, and MPV. Patients in TP group were found to have a thicker left ventricular posterior wall (PW) on transthoracic echocardiogram (1.0±0.2 vs. 1.1±0.2, p=0.047).
DISCUSSION AND CONCLUSION: MCR may be considered as a therapeutic option for FAPs. It is well-known, a practical procedure without the need for costly equipment. MCR treatment was successful at older ages, high CHA2DS2VASC score, and a thicker PW on transthoracic echocardiography. Multiple attempts should be used for clinical success.

7.AIDS-Defining Illnesses and Mortality in a Cohort of 336 HIV-Infected Patients
Heval Can Bilek, Aydın Deveci, Esra Aksakal Tanyel
doi: 10.14744/hnhj.2020.82335  Pages 271 - 275
INTRODUCTION: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) continues to be a serious worldwide public health problem despite widespread efforts to control the disease. Today, with the introduction of high-active antiretroviral therapy, AIDS-related mortality rates are significantly reduced and life expectancy for HIV-infected patients has increased. In this study, it was aimed to evaluate AIDS-defining illnesses during the clinical course of HIV infection and the effects of immune status on clinical outcomes.
METHODS: The medical records of HIV infected patients who were followed up between January 2005 and November 2018 were retrospectively investigated.
RESULTS: During the study period, 336 HIV-infected patients were followed up. Among 336 patients, 45 (13.3%) had experienced one or more, a total of 59 episodes of AIDS-defining illnesses during follow-ups. Of 45 patients who had experienced AIDS-defining illnesses, 42 (93,3%) were male, the mean age was 41.1±9.7 years and 12 of them were found to have died when this study conducted. The median count of CD4 T lymphocytes and the mean age at the time of diagnosis of 33 alive and 12 died patients were 106 cells/mm3, 40.1±9.9 years, and 94 cells/mm3, 43.9±8.5 years, respectively. There was no statistically significant difference between the median count of CD4 T lymphocytes and the mean age of alive and died patients. The most common AIDS-defining illness was Pneumocystis jirovecii pneumonia with 28.8%. The most common diagnosed cause of mortality was AIDS-related carcinomas with 33%.
DISCUSSION AND CONCLUSION: These findings reveal that the most important preventive measure for survival in HIV-infected patients is the early diagnosis of the disease and the initiation of antiretroviral therapy before the emergence of AIDS-defining illnesses due to severe immune deficiency.

8.The Impact of Transrectal Needle Biopsy Core Length on Prostate Cancer Diagnosis
Serdar Aykan, Aykut Çolakerol, Serkan Gönültaş, Yavuz Baştuğ, Enes Kılıç, Mustafa Zafer Temiz, Atilla Semerciöz
doi: 10.14744/hnhj.2020.54837  Pages 276 - 281
INTRODUCTION: Prostate cancer is diagnosed by histological evaluation of the prostatic glandular structure, and ultrasound-guided needle biopsy is the most commonly used method in diagnosis. Various strategies have been developed to overcome diagnostic limitations of prostate biopsy and to increase the rate of cancer detection. In this study, it was aimed to reveal the relationship between biopsy core lengths and cancer detection rates and to establish standardization criteria that can increase the diagnostic value of biopsy core length.
METHODS: Between January 2016 and September 2017, 394 patients who underwent transrectal ultrasound-guided prostate biopsy for abnormal digital rectal examination and/or prostate-specific antigen (PSA) >2.5 ng/mL were retrospectively evaluated. Under transrectal ultrasound, a total of 12 core biopsies were performed from each patient from the apical, medial, and basal regions of the both sides of the prostate. Each core length and tumor length were noted. Core lengths were compared in cancer and non-cancer patients and divided into Groups A and B, respectively. Statistical analysis was performed to determine an acceptable limit for biopsy length.
RESULTS: The mean age of the patients was 63.84±7.26, mean PSA was 15.88±7.40 ng/dl, and the mean prostate volume was 54.30±28.48 ml. Prostate cancer was seen in 24% of patients. Average core length was 12.7 mm in cancer group and 12.3 mm in non-cancer group. Although the core lengths are high in cancer patients, the relationship between average core length and cancer detection rates and also cancer grade was compared with the Kruskal–Wallis test and no statistically significant difference was found (p=0.232).
DISCUSSION AND CONCLUSION: In pathological evaluation, the relationship between the biopsy core length of prostate tissue and the diagnosis of prostate cancer could not be shown, and therefore, a cutoff value for the sufficient glandular tissue could not be determined. The presence of studies with similar and opposite results, relevant to this subject, showed that the need for further clinical studies.

9.Comparison of Oncological Results of Patients who Developed Systemic Metastasis After Radical Prostatectomy and Patients Receiving Androgen Deprivation Treatment due to Primary Systemic Metastatic Disease
Berkan Şimşek, Uğur Boylu, Eyüp Veli Küçük, Ahmet Bindayı, Abdurrahman İnkaya, Resul Sobay
doi: 10.14744/hnhj.2020.67689  Pages 282 - 289
INTRODUCTION: In this study, we aimed to compare the overall survival and the time until castration resistance developed between the patients who developed systemic metastasis after radical prostatectomy and who started androgen deprivation therapy (ADT) and those who started ADT due to primary systemic metastasis.
METHODS: In our clinic, between 2009 and 2017, we compared 61 patients who have metastatic prostate cancer at the time of diagnosis and ADT was initiated primarily and 28 patients who developed systemic metastasis after radical prostatectomy and after ADT was initiated, in terms of the overall survival, development status of castration resistance, the duration of development to castration resistance, and prostate specific antigen (PSA) changes in follow-up retrospectively. LHRH agonist + antiandrogen (for only 1 month) therapy was started immediately after diagnosis in ADT group (Group 1). In the radical prostatectomy group (Group 2), LHRH agonist + antiandrogen therapy (1 month) was initiated due to PSA elevation or developing systemic metastasis.
RESULTS: In the study, at Group 1, the age of patients (69.18±7.7 vs. 64.21±5.03, p=0.001), PSA values before biopsy (7508.24±26406.98 vs. 21.24±19.62, p=0.001), and total gleason score mean (p=0.001) were significantly higher than Group 2. Between two groups There was no significant different in terms of the rate of development to castration resistance (49.2%vs. 39.3%, p=0.38), time to castration resistance (46.8 months vs. 48.9 months, p=0.068), and overall survival (130.48 months vs. 97.43 months, p=0.207).
DISCUSSION AND CONCLUSION: In our study, if radical prostatectomy was performed before systemic metastasis developed, there was no difference in terms of castration resistance development, time to castration resistance, and overall survival with primarily metastatic disease.

10.Vitamin D Deficiency to the Age and Season of Turkish Patients Admitted to Family Medicine: A Retrospective Hospital-based Study in Istanbul
Burcu Çaykara, Güler Öztürk, Hacer Hicran Mutlu
doi: 10.14744/hnhj.2020.33600  Pages 290 - 296
INTRODUCTION: In our study, we aimed to determine the prevalence of Vitamin D deficiency and evaluate Vitamin D levels according to age, gender, and season.
METHODS: The data of Vitamin D levels, age, and gender of persons who admitted to Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Family Medicine between 2012 and 2017 were collected. SPSS22 was used for statistical analysis and p<0.05 was considered as statistically significant.
RESULTS: The data of 4227 patients, 80.44% women and 19.56% men, were included in the study. We found Vitamin D levels as follows: 1038≤10 ng/ mL, 1348 between 10 ng/mL and 20 ng/mL, 931 between 20 ng/mL and 30 ng/mL, 886 >30 ng/mL and 24 >150 ng/mL. Vitamin D levels were found significantly higher in autumn than winter season in the age groups 6.1–17, 18–44, 45–64, and ≥ 65 (p<0.001). We found Vitamin D deficiency and insufficiency 56.45% and 78.48%, respectively. Sufficient Vitamin D levels were found in only 21.53% of subjects. About 80.9% of the participants in the winter season and 73.9% in the autumn period had Vitamin D levels below normal.
DISCUSSION AND CONCLUSION: Our results show that Vitamin D deficiency is quite high in our population. As we expected, sufficient Vitamin D levels were lower in winter than the autumn due to low sun exposure. While, we found higher Vitamin D levels in women than men and Vitamin D values increased with increasing age. To increase Vitamin D levels in our society, increasing sun exposure time or Vitamin D supplementation might be considered.

11.A Review of the Contralateral Ears in Chronic Otitis Media
Çiğdem Tepe Karaca, Sema Zer Toros, Çiğdem Kalaycık Ertugay, Ayşegül Verim
doi: 10.14744/hnhj.2020.92499  Pages 297 - 300
INTRODUCTION: Our aim is to determine the incidence of the contralateral ear (CLE) pathologies in patients with chronic otitis media (COM) and to review the literature.
METHODS: Total of 271 patients who had been diagnosed as having COM with or without cholesteatoma were evaluated. Pathologic alterations such as tympanic membrane perforations, adhesive otitis, cholesteatoma, retraction pockets, and tympanosclerosis in the CLE were determined.
RESULTS: Of all patients, 39.1 % had pathologic alterations in their CLE. The 60.9% of the CLE s were normal. The most frequent finding in these patients was dry perforation of the tympanic membrane (26.9%). The remaining pathologies were retractions (7.3%), cholesteatoma (1.9%), sclerosis (2.2%), and adhesive otitis media (0.7%).
DISCUSSION AND CONCLUSION: A considerable percentage of the CLE s of the patients with COM were affected with a spectrum of pathologies at some degree.

12.Our Sleep Laboratory Results: Etiological Investigation of Snoring
Süleyman Erdoğdu
doi: 10.14744/hnhj.2021.58234  Pages 301 - 306
INTRODUCTION: I aimed to investigate the presence of obstructive sleep apnea syndrome (OSAS), body mass index (BMI), hypertension (HT), diabetes mellitus (DM), and obesity in patients with snoring complaints and to determine the relationships between them.
METHODS: I detected the people with HT and DM and Apnea-Hypopnea Index (AHI) found by detecting apnea and hypopneas, BMI calculated in the light of age, height, and weight data of patients admitted to our hospital with snoring complaints between January 2019 and January 2021.
RESULTS: A total of 501 patients, 330 (65.9%) of the patients were male. One hundred and seventy-one (34.1%) were female. Thirty-nine of the patients (7.78%) simple snoring; 134 of them (26.75%) mild OSAS; 108 (21.56%) of them were determined as moderate OSAS and 220 (43.91%) of them were determined as severe OSAS. In the total study group, 98 (19.56%) HT and 170 (33.93%) DM patients were determined.
DISCUSSION AND CONCLUSION: No significant difference was found between AHI and age. As BMI increases, so does AHI, and this relationship was significant. The patients with severe OSAS have higher BMI. As BMI and AHI increase, the number of HT and DM patients also increases. In this study, no patients with weak BMI and snoring were found.

13.Decreased Uric Acid and Phosphorus Levels in Active Juvenile Systemic Lupus Erythematosus
Nadide Melike Sav, Nuran Çetin, Bilal Yıldız
doi: 10.14744/hnhj.2022.16779  Pages 307 - 314
INTRODUCTION: The aim of the present study was to investigate serum phosphate and uric acid levels (UA) in juvenile systemic lupus erythematosus (jSLE) and to ascertain their relationship, if any, with disease activity and lupus nephritis.
METHODS: Included in the study were 18 children with jSLE who were investigated retrospectively during the active phase (AP) and remission phase (RP) of jSLE.
RESULTS: Serum phosphate and UA levels were found to be significantly lower in AP than in the RP (2.5±0.3/4.2±0.08 mg/dL, p=0.0001 and 2.9±0.3/5±0.2 mg/dL, p=0.0001, respectively). Serum phosphate levels were strongly correlated with serum albumin levels (r=0.772, p=0.0001) and platelet count (r=0.735, p=0.001) and negative associated with D-dimer (r=−0.750, p=0.0001) in AP. No correlation was identified between serum phosphate and UA or creatinine levels in patients with AP, while serum phosphate and UA levels were similar in children with and without nephritis (p>0.05). Serum phosphate levels were correlated with platelet count and UA levels and were inversely related with D-dimer levels in jSLE patients with nephritis (p<0.05).
DISCUSSION AND CONCLUSION: Serum phosphate and UA levels can reflect the activation and low serum levels may be useful biomarkers for the detection of AP in jSLE patients with and without nephritis.

14.The Role of Pulse Oximetry in the Diagnosis of Congenital Heart Disease Screening
Baran Cengiz Arcagök, Ayla Oktay
doi: 10.14744/hnhj.2022.15986  Pages 315 - 319
INTRODUCTION: Congenital heart defects (CHD) are common congenital malformations and cause mortality and morbidity in the neonatal period. Therefore, the diagnosis of critical CHDs is important. In this study, we aimed to present our critical congenital heart disease screening results with pulse oximetry and to emphasize the importance of screening.
METHODS: All newborns born in our hospital between January 2020 and January 2021 and with a gestational age >34 weeks were included in the study. A total of 1605 newborns were screened with pulse oximetry device.
RESULTS: The median birth weeks of 1605 newborns screened to detect critical congenital heart disease were 38 weeks (34–41 weeks), and their birth weight was 3065 g (2035–5040 g). Of the newborns included in the study, 767 (47.8%) were male and 838 (52.2%) were female. While 1591 (99%) of the babies included in the study passed the screening, 14 (1%) remained. False negativity was detected in one of the babies who underwent the screening. Critical CHDs were observed in three (21.4%) of the patients, while false positivity was detected in 11 (78.6%) of the infants who failed the screening. The false positive rate of the screening test in all babies was 0.6%. In our study, the sensitivity of CHD screening with pulse oximetry was 75%, the specificity was 99.3%, the positive predictive value was 21.4%, and the negative predictive value was 99.9%.
DISCUSSION AND CONCLUSION: We thought that since its incidence is not low, it is a life-threatening condition, and early diagnosis and effective interventions are available, CHD screening with pulse oximetry should be performed on all newborns and included in the newborn screening program.

15.Transabdominal and Transvaginal Ultrasonographic Assessment of Lower Uterine Segment Thickness in Pregnant Women Before Repeat Cesarean Section
Arzu Bilge Tekin, Bilge Doğan Taymur, Emre Yavuz, İlkhan Keskin, Murat Yassa, Güldeniz Toklucu, Canberk Usta, Pınar Birol, Niyazi Tuğ
doi: 10.14744/hnhj.2021.48254  Pages 320 - 326
INTRODUCTION: The selection of repeat cesarean delivery instead of trial of labor after cesarean (TOLAC) has a great contribution to cesarean rate. Ultrasonographic measurement of lower uterine segment (LUS) thickness for prediction of real uterine thickness was investigated by several researchers. In this study, LUS transvaginal (TV) and transabdominal (TA) ultrasonography (USG) measurements were evaluated for usefulness in patients with the previous cesarean scar.
METHODS: Pregnant patients between 37 and 40 weeks of gestational age who were admitted to our clinic with the decision of repeat cesarean delivery were evaluated by TV and TA USG by measuring the LUS full-thickness and myometrium before cesarean delivery. The patients were divided into two groups: Translucent LUS and intact myometrium. The real myometrial thickness also assessed by vernier caliper in the operation. Correlations between ultrasonographic and vernier caliper measurements were analyzed and cutoff values for the ultrasonographic measurements of LUS were evaluated.
RESULTS: Manual caliper measurements had a correlation (r) of 0.347 with TA USG full thickness, 0.337 with myometrial measurements, 0.443 with TV USG full thickness, and 0.475 with myometrial measurements. The extremely thin LUS ratio was 7.07% (n=14). Receiver operating curve, cutoff values are 3.55 mm for TA USG full-thickness LUS measurements, 2.75 mm for TV USG full-thickness, and 1.35 mm for TV USG myometrial LUS measurements.
DISCUSSION AND CONCLUSION: LUS USG measurements are useful for predicting the intact LUS and can be used in clinical decision-making for TOLAC, but the low positive predictive value suggests that it cannot be recommended in the prediction of extremely thin LUS.

16.A Mobile Application Platform to Increase Physical Activity in Individuals with Type 2 Diabetes During the Coronavirus (COVID-19) Pandemic
Eren Timurtaş, Eda Çınar, Neslihan Karabacak, Yaşar Sertbaş, Mine Gülden Polat
doi: 10.14744/hnhj.2022.48295  Pages 327 - 333
INTRODUCTION: Mobile health applications for individuals with type 2 diabetes (T2DM) have the potential to improve physical activity (PA) during the coronavirus (COVID-19) pandemic; yet, there is a need to identify the content of a mobile application (app) in the light of conceptual framework and the delivery features to increase the usability of the app. The aim of this study is to improve the mobile application based on a framework that conceptually determines the needs of individuals with T2DM. At the same time, it is to determine the presentation features of the application to increase its usability for individuals and health professionals using it.
METHODS: The content and delivery features of a PA app were determined using the Delphi method considering the diabetes core sets of the international classification of the functioning framework, including experts in the area of T2DM for the app's content and heterogeneous participants for the delivery features of the app. A mobile application was created according to the data obtained by this method after the application was created by this way.
RESULTS: Delphi experts suggested 64 ideas for the content of the app, of which 46 reached sufficient agreement (72.5–100%). In the second step, participants generated 27 ideas, yet, the consensus was reached on 12 delivery features (70–100%). The application was created by transforming these ideas into app content.
DISCUSSION AND CONCLUSION: This study addressed the content-related limitations and usability challenges in the pre-existing studies. During the lockdown, the developed PA app can be implemented using different mobile devices.

17.Frequency of Sacroiliac Joint Dysfunction (SIJD) in Patients with Failed Back Surgery Syndrome (FBSS), and Affecting Demographic and Surgical Factors
Hatun Deniz Aytaç, Duygu Geler Külcü, Nilgün Mesci
doi: 10.14744/hnhj.2020.35492  Pages 334 - 341
INTRODUCTION: We aimed to investigate the frequency of “sacroiliac joint dysfunction (SIJD)” in patients who have undergone “failed back surgery syndrome (FBSS)” and surgical factors and the demographical data of the patients with or without SIJD.
METHODS: In our cross-sectional study, 50 patients between the ages of 18 and 75 who have undergone to FBSS were included in the study. Patients with the positive results in at least three of the specific SIJD tests and the positive result in diagnostic injection test were diagnosed as SIJD. The frequency of SIJD was determined in patients with FBSS. The demographical data, clinical features, and surgical factors were compared in groups with or without SIJD.
RESULTS: We found the frequency of SIJD is %30 in patients with FBSS. There was no difference that was found in demographic data and the characteristics of the patient groups (p>0.05).
DISCUSSION AND CONCLUSION: FBSS is a very important cause of disability that negatively affects the patient socially and psychologically. Therefore, it is very important to manage the treatment correctly. Patients should be evaluated in all respects and the pain should not be attributed only to surgical factors. Hip examination and the existence of SIJD should be evaluated all the times.

18.Investigation of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio Parameters in Chronic Gastritis with Helicobacter Pylori
Emine Alev Yalın, Kadir Kayataş
doi: 10.14744/hnhj.2020.72325  Pages 342 - 345
INTRODUCTION: Easily accessible parameters are needed to predict the presence of Helicobacter pylori (HP) and to decide on endoscopy at the right time in chronic gastritis cases. Today, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) parameters have been found to be useful in demonstrating inflammation. In our study, we aimed to investigate the relationship between HP and NLR and PLR.
METHODS: In patients who were found to have antral gastritis according to biopsies which were taken during the gastroscopy procedure at the Health Sciences University Haydarpaşa Numune Health Application and Research Center between on March 1, 2016 and March 1, 2019, HP presence and hemogram parameters were recorded. Patients with chronic or active inflammatory disease, taking regular medications, or antibiotics in the past 2 months were excluded from the study. IBM SPSS Statistics 22 for statistical analysis (SPSS IBM, Türkiye) programs was used. p<0.05 was considered as significant.
RESULTS: In the histopathological examination of a total of 271 cases, 135 (49.8%) patients with HP positivity were evaluated as study group, and 136 (50.2%) patients with negativity were evaluated as control group. In the study group, NLR was 1.86±0.51 and PLR was 118.58±32.18 and in the control group, NLR was 1.92±0.63 and PLR was 117.21±34.82. There was no statistically significant difference between the groups in terms of NLR and PLR (p>0.05).
DISCUSSION AND CONCLUSION: In predicting the presence of HP and deciding on endoscopy at the right time, prospective studies with larger numbers of cases and different parameters can contribute to clinicians.

19.Evaluation of Stereoacuity and Binocular Functions in Patients with Anisometropic Amblyopia Through Titmus, TNO, and Synoptophore
Yunus Karabela, İlknur Akyol Salman
doi: 10.14744/hnhj.2022.33716  Pages 346 - 352
INTRODUCTION: The aim of the study was to evaluate the effect of amblyopia on binocular functions in patients with anisometropic amblyopia.
METHODS: This prospective study was conducted on 45 patients with anisometropic amblyopia. The difference between the best-corrected visual acuities of the two eyes (DVA) for the depth of amblyopia, the spherical equivalent difference between two eyes (D-SE) and root-mean-square spherical equivalent (RMS-SE) for the degree of anisometropia, the Titmus and the TNO tests for the stereoacuity and synoptophore for the fusion capabilities was used.
RESULTS: The mean age was 21.44±7.45 years. Twenty-three patients had moderate-severe amblyopia and 22 had mild amblyopia. There was a correlation between D-SE and TNO and RMS-SE and TNO in the mild group; DVA and Titmus, DVA and TNO, and RMS-SE and Titmus in the moderate-severe group; DVA and RMS-SE, DVA and Titmus, DVA and TNO, and D-SE and TNO in all patients without grouping. The stereoacuity levels were subnormal and decreased in relation to the depth of amblyopia. About 31.1% of patients with the Titmus and 17.8% with the TNO had good stereoacuity. None of the patients could reach the best threshold value with the TNO test. Three patients were able to achieve the best threshold value with the Titmus. All patients had first-degree fusion. About 95% of mild amblyopia and 75% of moderate-severe amblyopia had second and third-degree fusion.
DISCUSSION AND CONCLUSION: This study shows a relationship between the depth of amblyopia and the stereoacuity levels and the amount of anisometropia. The RMS-SE as an anisometropia index and the Titmus or the TNO test as a stereoacuity test may be used to predict the depth of amblyopia in patients with anisometropic amblyopia.

20.Early Surgical Treatment of Colonoscopic Perforations
İsmail Aydın, Tuğrul Kesicioğlu
doi: 10.14744/hnhj.2020.65768  Pages 353 - 358
INTRODUCTION: Colonoscopy is widely used for diagnostic and therapeutic purposes in colon, rectum, and anal canal diseases. Although colonoscopic perforations are rare, they can lead to serious morbidity and mortality. The aim of this study was to examine the diagnosis, treatment, and follow-up results of the patients operated for colonoscopic perforation in the light of the literature.
METHODS: The results of the patients, who were operated in our clinic with the diagnosis of colonoscopic perforation between January 2015 and November 2019, were evaluated retrospectively. The patients’ demographic characteristics, colonoscopy findings, disease diagnoses, time of surgery, and surgery performed and follow-up results were analyzed.
RESULTS: A total of 7802 colonoscopy procedures were performed. Ten patients (0.12%) developed colonoscopic perforation. Of the patients, 6 (60%) were female and 4 (40%) were male. The mean age was 71.5 years. Perforation developed during the diagnostic procedure in 7 patients (70%) and during polypectomy in 3 patients (30%). Perforation localization was the sigmoid colon in seven patients, the rectosigmoid junction in two patients, and the right colon in one patient. All patients were operated within 6 h after the procedure. Six patients underwent primary repair, three patients underwent segmental colon resection + end-to-end anastomosis, and one patient underwent multiple surgeries. While two patients developed minor complications, one patient died on the 6th day after the procedure due to intra-abdominal sepsis.
DISCUSSION AND CONCLUSION: Although the incidence of colonoscopic perforation is low, it causes serious morbidity and mortality when it develops. Patients and their relatives should be informed in detail about possible complications before colonoscopy. Although there is no gold standard treatment, we believe that the diagnosis should be made as early as possible and appropriate treatment should be performed without delay.

21.Hypertrophic Pyloric Stenosis in Severe Jaundiced Infantile Case Tried to be Treated with Al-Hijamah
Sabri Cansaran, Ayşenur Celayir, Oktav Bosnalı, Serdar Moralıoğlu, Abdulkadir Bozaykut
doi: 10.14744/hnhj.2020.38801  Pages 359 - 363
Cupping therapy, in its traditional name in the Middle East as al-hijamah, is a traditional and complementary treatment method that generally uses containers placed on the skin to create negative pressure through suction, and has been used all over the world from past to present. Infantile hypertrophic pyloric stenosis is a disease in which the outlet of the stomach undergoes almost complete obstruction due to the hypertrophy of the pyloric canal. It is seen in infants in the 1 months after birth and it’s the most effective treatment is surgery. This study discusses a patient with infantile hypertrophic pyloric stenosis, in whom the traditional alternative medicine method was performed due to severe jaundice, and then treated surgically.

22.Utility of Cross Suture Technique for Stabilize the Intraocular Lens Against Vitreous Pressure During Penetrating Re-Keratoplasty: Case Report
Haci Uğur Çelik
doi: 10.14744/hnhj.2020.27132  Pages 364 - 367
We reported a simple, effective, and exceptional blocking technique to prevent possible complications during penetrating re-keratoplasty. A 54-year-old female patient was admitted to the clinic with the complaint of opening corneal surgical wound. After careful corneal dissection from the graft host wound dehiscence, the intraocular lens implantation was tried. However, the vitreous pressure blocked the intraocular lens placement. We decided to do cross sutures to prevent both vitreous pressure and intraocular lens stabilization to finish the corneal transplantation. After the transplantation, the sutures were removed easily and the surgery completed successfully.

LookUs & Online Makale