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ERCİYES MEDICAL JOURNAL - Erciyes Med J: 42 (1)
Volume: 42  Issue: 1 - 2020
EDITORIAL COMMENTS
1.Mesenchymal Stem Cell Therapy for Severe Sepsis and Septic Shock
Zeynep Burçin Gönen, Gökçen Dinç, Mehmet Doğanay
doi: 10.14744/etd.2019.35336  Pages 1 - 2
Abstract | Full Text PDF

REVIEW
2.The Association Between Placenta Previa and Pre-Eclampsia: A Meta-Analysis
Ensiyeh Jenabi, Yousef Veisani, Salman Khazaei
doi: 10.14744/etd.2019.66742  Pages 3 - 6
There are contradicting results regarding the effect of previa on pre-eclampsia. Therefore, the aim of the present study was to systematically review the relevant literatures and to determine the association between placenta previa and pre-eclampsia in pregnant women. Electronic scientific databases including Scopus, PubMed, and Web of Science were searched to identify relevant published studies. Two independent authors studied the selected studies and extracted data. I2 statistics was used to assess the variation across studies. The random effects model was used to assess pooled effect sizes. Data were analyzed through Stata software version 12. The results of the present meta-analysis of nine studies indicated a significant relationship between placenta previa and risk of pre-eclampsia. The odds of pre-eclampsia were 0.55 (95% confidence interval (CI) 0.26–0.85) in placenta previa cases compared with the control groups and 0.17 (95% CI 0.07–0.27) in studies with adjustment on confounder variables. Our results showed that placenta previa is associated with a decrease incidence of pre-eclampsia.

ORIGINAL ARTICLE
3.Does Vitamin D Level Affect Grip Strength: A Cross-Sectional Descriptive Study
Sevtap Badıl Güloğlu
doi: 10.14744/etd.2019.15428  Pages 7 - 11
Objective: Although there is increasing evidence about the role of vitamin D on muscle function, its relationship with grip strength is still a controversial issue. The aim of this cross-sectional clinical study was to evaluate the relationship between vitamin D and grip strength in premenopausal Turkish women.
Materials and Methods: A total of 127 women with an age range of 40–50 (44.7±4.3) years who were premenopausal and sedentary were included in this cross-sectional descriptive study. The mean body mass index (BMI) was 30.2±5.3 kg/m2. Dominant and nondominant grip strengths were measured by digital hand dynamometer.
Results: The mean dominant and nondominant grip strengths were 24.2±5.9 kg and 22.5±5.7 kg, respectively. Mean serum 25-hydroxyvitamin D (25OHD) concentration was 16.4±9.7 ng/ml. Participants were divided into three groups as vitamin D deficiency (70.9%), insufficiency (18.1%), and sufficiency (11.0%). No statistically significant difference was found between the groups with respect to age, BMI, and dominant and nondominant grip strengths (p>0.05). Furthermore, no significant relationship was found between serum 25OHD concentration and dominant and nondominant grip strengths (p>0.05). In addition, BMI was not associated with dominant and nondominant grip strengths (p>0.05).
Conclusion: These results of this study provide evidence that vitamin D is not effective on grip strength at least in premenopausal Turkish women.

4.Effects of Triclosan-Impregnated Suture Materials on Colonic Anastomosis
Mustafa Atabey, Ayça Taş, Ömer Topçu, Yavuz Silig
doi: 10.14744/etd.2019.70973  Pages 12 - 17
Objective: Symptomatic anastomotic leakage observed after colorectal surgery is one of the major complications. One of the factors affecting the anastomosis healing is the type of suture material used. This study aims to investigate the effects of the suture material polydioxanone (PDS, Ethicon), which is late absorbable and has a monofilament structure, and the suture material polyglactin 910 (Vicryl, Ethicon), which is absorbable and has a multifilament structure, on the healing of colonic anastomosis, and to compare the traditional forms of these sutures with their antibacterial effective triclosan-impregnated forms (PDS Plus, Ethicon and Vicryl Plus, Ethicon).
Materials and Methods: The rats were divided into four equal groups consisting of 10 subjects each: Group I: Vicryl; Group II: Vicryl Plus; Group III: PDS; and Group IV: PDS Plus. The presence of wound infection, whether the integrity of the abdominal wall was maintained, intra-abdominal adhesion scoring, the presence of intra-abdominal abscess, and whether the macroscopic integrity of anastomosis was maintained were evaluated.
Results: According to the results of this experimental study, while the highest ABP and hydroxyproline levels were observed in the PDS Plus group, the lowest values were observed in the Vicryl group. However, the difference was not statistically significant.
Conclusion: Slowly absorbable and monofilament PDS suture material causes less tissue reaction and inflammatory response compared to the Vicryl suture material that is absorbable in the colonic anastomosis line and multifilament.

5.Adaptation With the Chronic Disease and Expectations from Nurse
Hilal Kuşcu Karatepe, Derya Atik, Ulviye Özcan Yüce
doi: 10.14744/etd.2019.83446  Pages 18 - 24
Objective: This study has been made to determine physical, social, and psychological adaptation levels and general adaptation levels of patients with chronic diseases who are under medical treatment at the hospital and to evaluate their expectations from nurses within the course of the said process.
Materials and Methods: This study is definitive and cross sectional. The sample of the research is composed of 240 patients who have been under inpatient medical treatment in internal diseases clinics in between March and May 2018. Data were collected with a Personal Information form and an Adaptation to Chronic Illness Scale (ACIS).
Results: As a result of the statistical analysis, the adaptation of the patients, included in the scope of the study, to the disease was determined to be 83.03±10.58. The social adaptation level of women, physical adaptation level of high school and university graduates, general adaptation, physical adaptation, and social adaptation levels of individuals who have never stayed at hospital, psychological adaptation level of individuals who had information related to their disease, and physical adaptation level of individuals with normal body mass index (BMI) were determined to be at higher statistically significant levels (p<0.05, p<0.01).
Conclusion: In conclusion, the gender, level of education, experience of hospital stays, information status related to his/her disease, BMI, medical diagnosis, and expectation models of nurses were determined to affect adaptation to the chronic disease to an important extent, from physical, social, and psychological aspects.

6.Comparison of the Results of Thyroidectomy and Second Fine-Needle Aspiration Biopsy of the Old Age Group with the Previous Bethesda III group: Is the second Biopsy necessary?
Volkan Atmış, Berna Evranos Öğmen
doi: 10.14744/etd.2019.80378  Pages 25 - 29
Objective: We aimed to detect if there were any radiologic, demographic, or clinical findings that were valuable for differentiating benign nodules from malignant nodules in old aged patients, when the results of the first fine-needle aspiration biopsy (FNAB) were reported as atypia of undetermined significance (AUS).
Materials and Methods: Patients aged 65 years and older who were biopsied from thyroid nodules were analyzed retrospectively in this study. A total of 1264 patients with 1374 nodules were enrolled and of these, 203 patients with 216 nodules were recorded to have diagnosis of AUS in pathological evaluation. We excluded 104 nodules on which FNAB had been performed only once and included 112 nodules, on which FNAB had been performed twice. Out of these included patients, a total of 43 patients were thyroidectomized. Preoperative ultrasonographic nodular findings, echogenicity, marginal [ir]regularity, calcification, exophytic configuration, and halo were recorded.
Results: The median patient age was 69 years. There was no statistically significant difference between the results of the first and second FNABs. Hypoechogenicity was the only statistically significant different characteristic found in thyroid nodules that could effectively discriminate between malignant and benign groups.
Conclusion: The second FNAB does not increase the likelihood of diagnosing malignancy in old aged patients and there is no need for this procedure when recommending surgery. Suspicious USG findings are more frequent among malignant nodules, as reported in the histopathological evaluation of the old aged patients. A multidisciplinary team should take part in the decision-making process for the treatment of old aged patients after the first FNAB, with due consideration of the history, physical examination, USG, FNAB laboratory findings, and patient preference.

7.Time Spent on the Internet, Blood Pressure, and Loneliness in Adolescents: A Cross-Sectional Study
Orhan Çakır, Aynur Çetinkaya
doi: 10.14744/etd.2019.68815  Pages 30 - 36
Objective: The purpose of this study was to examine the relationship among the time spent on the internet, blood pressure values, and loneliness levels in adolescents.
Materials and Methods: The study was planned with an analytical cross-sectional approach in the Manisa province, Turkey. The study was conducted in five high schools in a Turkish city in 2016. The study was carried out with 686 high school students in the Manisa province, Turkey. Data collection tools used in the study were “personal information form”, “height and blood pressure measurement form”, and “UCLA loneliness scale.”
Results: According to this study, 34.4% of participants were found to be excessively spending their time on the internet. The prevalence of hypertension and prehypertension in adolescents was found to be 10.3% and 5.4%, respectively. There was no relationship between the time spent on the internet and blood pressure levels of adolescents (p=0.751). However, there is a relationship between the time spent on the internet and loneliness levels of adolescents (p=0.041).
Conclusion: Particularly, integrating these dimensions of adolescent health into school guidance and psychological counseling units and primary health care services is considered to be important.

8.Comparison of Different Bleeding Risk Scores to Predict in-Hospital Major Bleeding in Patients with Acute Pulmonary Embolism who Underwent Thrombolytic Treatment
Veysel Ozan Tanık, Tufan Çınar, Barış Şimşek, Sadık Açıkel
doi: 10.14744/etd.2019.59480  Pages 37 - 43
Objective: Certain bleeding risk scores have been proposed to predict major bleeding (MB) events in patients with acute pulmonary embolism (APE) during anticoagulation therapy. Since patients who undergo thrombolytic treatment are usually excluded from such studies, it is unknown whether these scores may provide an adequate prognostic value for in-hospital major MB. Consequently, we evaluated some well-known bleeding scores to predict in-hospital MB in patients with APE who were treated with thrombolytic therapy.
Materials and Methods: A total of 99 consecutive patients with APE who underwent thrombolytic therapy from June 2011 to August 2015 were included in the retrospective study. For each patient, we estimated the bleeding risk using the Kuijer, Riete, Atria, Has-Bled, and PRECISE-DAPT scores.
Results: In total, 22 MB events occurred in 99 (19%) patients following admission. A receiver operating characteristic curve analysis showed that the PRECISE-DAPT score might have an adequate prognostic value for MB (area under curve [AUC] value, 0.770). Meanwhile, the other abovementioned risk scores had poor predictive values (AUC values, 0.612–0.658) for MB.
Conclusion: Despite being developed and validated to determine MB in patients receiving dual antiplatelet treatment, the PRECISE-DAPT score may be useful in estimating the risk of MB in patients with APE who underwent thrombolytic therapy.

9.The Prognostic Value of the GRACE Score for Acute Kidney Injury in Patients with ST Elevation Myocardial Infarction Complicated with Cardiogenic Shock
Mert İlker Hayıroğlu, Tufan Çınar, Ahmet İlker Tekkeşin
doi: 10.14744/etd.2019.60487  Pages 44 - 49
Objective: The Global Registry of Acute Coronary Events (GRACE) risk score has been proposed in predicting short-term death in patients who are diagnosed with acute coronary syndrome. The aim of the present study was to investigate the significance of the GRACE score for acute kidney injury (AKI) in patients with cardiogenic shock (CS)–ST elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PPCI).
Materials and Methods: We retrospectively examined a total of 492 consecutive patients with CS–STEMI who had undergone PPCI. The GRACE score was calculated for each patient. Patients were stratified by tertiles (T1, T2, and T3) according to the GRACE score, and the incidence of AKI was compared between the groups.
Results: In univariate analysis, the incidence of AKI was significantly higher for patients allocated into the T3 group than for patients in the T1 group (odds ratio (OR) 2.8, 95% confidence interval (CI) 1.8–4.1, p<0.001). Following including all confounding variables, participants in the T3 group had a 3.1-fold higher incidence of AKI (OR 3.1, 95% CI 1.9–5.4, p<0.001). In a receiver operating characteristic curve analysis, the GRACE score of the area under the curve value for AKI was 0.70 (95% CI 0.65–0.74, p<0.001) with 69.2% sensitivity and 68.8% specificity.
Conclusion: The GRACE score provides an independent prognostic marker of AKI in patients with CS related with STEMI. Based on our data, we propose that the GRACE score is a simple and clinically applicable directive tool for rapid risk stratification of AKI in patients with STEMI complicated with CS.

10.Usefulness of SPECT/CT Imaging in the Management of Patients with Differentiated Thyroid Carcinoma
Sibel Uçak Semirgin
doi: 10.14744/etd.2019.75010  Pages 50 - 53
Objective: Whole-body I-131 scanning (WBS) is a standard method in the evaluation of patients with differentiated thyroid carcinoma (DTC). However, it has some limitations in terms of distinguishing between physiological and pathological tracer uptake and in defining the exact anatomical location of pathological foci. The purpose of our study was to determine the additional diagnostic value of SPECT/CT imaging in patients with DTC.
Materials and Methods: A total of 142 patients, each with a history of previous total thyroidectomy and who had undergone diagnostic or post-therapeutic WB imaging, were included in this retrospective study. The distinction between physiological and pathological uptake could not be clearly established and/or the localization of pathological uptake could not be clearly defined on the WBS, both of which were considered inconclusive findings. Subsequently, the regional SPECT/CT images of these patients were evaluated.
Results: The number of pathological foci detected by WBS and SPECT/CT was 64 and 59, respectively. The exact anatomical localization was determined in 85.9% of the lesions with SPECT/CT. Benign accumulations (inflammatory/physiological) were determined in 12.5% of inconclusive foci. In 14.1% of WBS-detected foci, no significant tracer uptake was observed on the SPECT/CT images. Four additional foci were detected on SPECT/CT (3 thyroid remnants, 1 bone remnant).
Conclusion: SPECT/CT improves the specificity of I-131 scanning and contributes to the management of DTC patients.

11.The Efficacy of Continuous Venovenous Hemodiafiltration with Cytokine Filter on Sepsis
Mehtap Yıldırım, İclal Özdemir Kol, Onur Avcı, Zuhal Gülsoy, Kenan Kaygusuz, Sinan Gürsoy
doi: 10.14744/etd.2019.22599  Pages 54 - 59
Objective: Continuous renal replacement therapy is made with high biocompatibility membranes that have high current power by using diffusion and convection together or separately. The aim of the present study was to compare the EMIC-2 and AV600S filters used for continuous venovenous hemodiafiltration (CVVHDF) with respect to the effects on sepsis, the elimination of toxins that are elevated due to acute renal injury, and the effects on inflammatory mediators in severe sepsis.
Materials and Methods: The study included 38 patients who were diagnosed with severe sepsis and were treated with hemodiafiltration in the intensive care unit. Acute Physiology and Chronic Health Evaluation—2 (APACHE-2) and Sequential Organ Failure Assessment (SOFA) scores of the patients were calculated before CVVHDF starts. Hematocrit (Hct), white blood cell, blood pressure, heart rate, and body temperature values were measured and recorded. Procalcitonin (PCT), tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, and IL-1 values on blood were also recorded before the process and at 8, 16, and 24 h of the process.
Results: When the AV600S filtered and EMIC-2 filtered groups are compared, TNF-α values are low in the EMIC-2 filtered group (p<0.05). There is no significant difference between the groups with respect to the measurements about APACHE-2, SOFA, IL-1β, IL-6, PCT, Hct, body temperature, mean blood pressures, and heart rate.
Conclusion: We think that the filters do not cause a significant change on the elimination of inflammatory cytokines, except TNF-α, on limited numbers of patients who have sepsis with acute renal injury undergoing CVVHDF with EMIC-2 and AV600S.

12.Assessment of Post-transplantation Liver Function Tests in Patients Undergoing Allogeneic Stem Cell Transplantation
Melih Kızıltepe, Esra Yıldızhan, Ali Ünal, Mustafa Çetin, Bülent Eser, Leylagül Kaynar
doi: 10.14744/etd.2019.26986  Pages 60 - 65
Objective: Allogeneic hematopoietic stem cell transplantation is a treatment with a considerable rate of complete cure in hematological disorders. Hepatic complications are common causes of morbidity and mortality affecting the survival after stem cell transplantation. This study was conducted to identify risk factors for hepatic dysfunction and related potential factors affecting the survival in patients undergoing allogeneic hematopoietic stem cell transplantation.
Materials and Methods: We retrospectively evaluated the data from 300 allogeneic hematopoietic stem cell transplantation recipients between March 2004 and May 2014 in the Erciyes University Hematology and Bone Marrow Transplantation Center, Turkey. The study included 300 patients and their serial monitorization of the liver function tests, examined before and after transplantation.
Results: The transplantation in 30 patients was performed from haploidentical donors and in 13 patients from unrelated donors. We identified the liver function abnormalities in 71.7% of patients in the post-transplantation period. The most common causes were graft-versus-host disease (43.6%), drug toxicity (24.7%), and sepsis (13.9%). Post-transplantation liver abnormalities were more common in patients with acute leukemia (p=0.02), iron overload (p<0.001), and in those who also had transaminitis in the pretransplantation period (p<0.001). Relapsed underlying disease (p<0.001), iron overload, and a bilirubin level >2 mg/dL in association with hepatic dysfunction during the post-transplantation period were identified as major factors influencing mortality following transplantation (p<0.001).
Conclusion: We concluded that liver function abnormalities are frequent in the hematopoietic stem cell transplantation process. For a successful management, it is important to monitor the liver function and to identify additional risk factors before and after transplantation.

13.Assessment of Anterior Segment Parameters and Specular Microscopy Findings in Patients with COPD
Nurdan Gamze Taşlı, Hasan Ölmez, Adem Uğurlu, Turgay Uçak, Erel İçel, Yücel Karakurt, Hayati Yılmaz
doi: 10.14744/etd.2019.33349  Pages 66 - 70
Objective: The aim of the present study was to assess the anterior segment parameters of patients with chronic obstructive pulmonary disease (COPD) by corneal specular microscopy and biometry and to compare the results with healthy controls.
Materials and Methods: Our prospective study consisted of 122 eyes of 61 patients with COPD and 110 eyes of 55 patients without any systemic diseases. A comprehensive medical history was obtained, and corrected visual acuity, bio microscopic and fundus examination, intraocular pressure (IOP) measurement with applanation tonometry, and non-contact specular microscopy were performed in all participants.
Results: The endothelial cell density was lower in the COPD group than in the control group (p<0.001). The coefficient of variation (CV) was higher, central corneal thickness was significantly higher, and hexagonal cell ratio (HEX) was lesser in the COPD group than in the control group (p<0.001). Any significant difference between the control and the COPD groups was not determined in comparison with IOP, mean axial length keratometry (Kmean), anterior chamber depth (ACD), and white-to-white limbus length (WTW) measurements. Patients were grouped into two regarding the disease severity as mild–moderate (group 1, n=20), and moderate–severe (group 2, n=41) according to the Global Initiative for Chronic Obstructive Lung Disease criteria. The number of endothelial cells was lesser, the CV was higher, and the HEX was lower in the moderate–severe COPD group than in the mild–moderate COPD group (p<0.001). The duration of smoking was significantly longer in the moderate–severe group than in the mild–moderate COPD group (p<0.001).
Conclusion: We suggest that in patients with COPD, due to the reduction of endothelial functional preserve, the risk of corneal endothelial damage is increased in intraocular surgery. In patients with end-stage COPD, caution should be exercised with regard to endothelial decompensation, frequent disease in the general population, corneal parameters, and to define the alterations that the ocular surgeons should be cautious about. Data regarding the alterations in anterior segment parameters in patients with COPD are highly limited in the previous literature.

14.Is There a Relationship Between Microvascular Complications and the Severity of Type 2 Diabetes Mellitus?
Funda Çatan, Abdülbari Bener, Mustafa Öztürk
doi: 10.14744/etd.2019.33230  Pages 71 - 77
Objective: The aim of this study was to determine the relationship between microvascular Type 2 diabetes mellitus (T2DM) complications and the severity and duration of diabetes in the light of sociodemographic and lifestyle variables.
Materials and Methods: This is a prospective cohort study based on 899 (527 females, 372 males) patients with T2DM aged 25–70 years. Patient information including socio-demographic variables; body mass index (BMI); lifestyle habits and duration of diabetes; treatment of diabetes; values for hemoglobin A1c (HbA1c); development of diabetes complications; and the presence of neuropathy, nephropathy, and retinopathy were recorded. A univariate and multivariate statistical analysis were performed.
Results: Significant differences were found between diabetics with HbA1c ≤7 and >7 in terms of the education level, occupation, household income, duration of diabetes, the number of children, smoking, physical exercise, eating fast food, control regularity, and diabetes education. A total of 17.1% of patients had diabetic retinopathy, 17.0% had neuropathy, and 13.7% had nephropathy. Among diabetics, 2.3% had three microvascular complications, whereas 66.6% had none of them. The prevalence of diabetes complications was lower in patients who had good glycemic control than those who had poor glycemic control. Furthermore, the highest reduction in the level of HbA1c was for sulfonylurea usage.
Conclusion: A high prevalence of diabetes complications is a burden for both the patients and the health care system. Screening, early diagnosis, management of the glucose level, and the follow-up may result in delayed diabetes complications.

15.Relationship Between the Vitamin D Status and the Season, Place of Living, Age, Gender, and Chronic Disease
Sevil Okan, Fatih Okan, Osman Demir
doi: 10.14744/etd.2019.45577  Pages 78 - 83
Objective: The aim of the present study was to investigate the variations in 25-OH Vitamin D levels considering age, gender, the place of living, season, and presence of chronic disease.
Materials and Methods: Individuals whose 25-OH Vitamin D levels were measured in seven state hospitals in the Tokat Province, Turkey, between September 2016 and August 2017 were selected using the hospital information system and included in this retrospective study.
Results: The study included a total of 22,044 individuals aged ≥18 years. Vitamin D deficiency and insufficiency were observed in 89.4% of the individuals surveyed. Of all participants, 78.7% (n=17.328) were female, and 74.3% (n=16.377) were living in urban areas. An average 25-OH Vitamin D level was significantly low in people living in urban areas (15±12.4 ng/ml) compared to those living in rural areas (15.4±11.5 ng/ml; p=0.03). An average seasonal 25-OH Vitamin D level was the lowest in the winter (13.4±11.5 ng/ml) and the highest in the summer season (17±12.1 ng/ml; p<0.001). An average 25-OH Vitamin D level was 15.1±12.2 ng/ml, which was significantly higher in men (17.6±9.9 ng/ml) than in women (14.4±12.6 ng/ml) (p<0.001). The average 25-OH Vitamin D level of subjects who did not have a chronic disease was significantly lower than in those who had only hypertension, heart disease, or multiple sclerosis (14.40±11.73, 15.67±12.72, 17.42±13.13, and 19.50±14.88, respectively; p<0.005).
Conclusion: It was found that Vitamin D deficiency was associated with the place of living, age, gender, and season of the year. An average 25-OH Vitamin D level was significantly higher in individuals with hypertension, heart disease, and multiple sclerosis.

16.Evaluation of the Emotion Regulation Skill of Overweight–Obese Preschool Children and Maternal Mental Well-Being
Zehra Çalışkan, Gonca Özyurt
doi: 10.14744/etd.2019.08068  Pages 84 - 88
Objective: The aim of the present study was to investigate the emotion regulation skill of overweight–obese preschool children and to compare the maternal mental well-being of mothers with overweight–obese children with those of mothers with normal-weight children.
Materials and Methods: The sample of the study consisted of 219 4–6-year-old children studying in seven kindergartens in a city center located in the Cappadocia region of Turkey, as well as their parents. A questionnaire, the Emotion Regulation Checklist, and the General Health Questionnaire 12 were used to collect data. The body weight and height measurements of the children were obtained, and their body mass index was calculated.
Results: It was determined that 14.6% of preschool children were obese, 15.5% were overweight, and the median emotion regulation total scores of overweight–obese children were higher than those of normal-weight students (p=0.027). In addition, it was found that although the mental well-being status of mothers with overweight–obese children was similar to those of mothers with normal-weight children, mothers with obese children were more overweight than mothers with normal-weight children (p=0.020).
Conclusion: It is considered appropriate to monitor the weight and height of children at regular intervals and to evaluate children at risk along with their mothers (parents) to identify and prevent childhood obesity at an early stage.

17.Microcephaly Agent of Zika Virus and Unknowns by Healthcare Personnel
Çiğdem Eda Balkan Bozlak, Hayrunnisa Bekis Bozkurt
doi: 10.14744/etd.2019.72473  Pages 89 - 92
Objective: The Zika virus is an important viral agent that presents the risk of pandemic disease. Infection with the virus can cause microcephaly in infants, as well as other potential effects. The aim of this study was to evaluate the level of knowledge about the Zika virus among healthcare personnel in Turkey.
Materials and Methods: A total of 290 healthcare personnel from a secondary and a tertiary health institution were included in this study. The data were collected using a survey form prepared by the researchers and statistically analyzed.
Results: Among the respondents, there was awareness of the Zika virus in 68.7%, 75.0%, 75.9%, and 77.0% of women, individuals over 35 years of age, doctors, and those with a healthcare career of at least 10 years, respectively. The results revealed that 58.9% knew the true means of transmission, 36.0% were aware of prevention efforts, 41.1% were familiar with potential complications, 0.5% reported knowledge of treatment, and 16.8% responded correctly regarding the availability of a vaccine. The primary source of information about the virus was TV and radio for 68.5% of the participants, and 3.6% cited scientific papers.
Conclusion: The Zika virus is a potential pandemic agent. The knowledge level of the healthcare personnel studied was insufficient to meet such a challenge. The ministry of health and universities should provide the appropriate training to healthcare personnel.

18.Comparison of the Aquacel Ag Surgical Dressing vs Standard Dressing in the Treatment of the Wound Site Infection and Patient Comfort in Total Knee Arthroplasty
Mutlu Akdoğan, Halis Atilla
doi: 10.14744/etd.2019.24482  Pages 93 - 97
Objective: The present study aimed to evaluate the effects of the Aquacel Ag surgical dressing on wound site infections and patient comfort in total knee arthroplasty (TKA).
Materials and Methods: The study included a total of 274 patients diagnosed with primary gonarthrosis, who underwent TKA at our clinic during 2016 and 2017. The Aquacel Ag surgical dressing was applied in 139 patients (Group 1), and a conventional gauze sponge was used in 135 patients (Group 2). Patient outcomes including the frequency of changing the dressing, pain due to dressing change, patient satisfaction, wound site infections, and formation of blisters were compared between the groups retrospectively.
Results: The formation of blisters (p=0.770) and superficial infections (p=0.500) were similar in both groups. The duration of hospital stay (p<0.001) and the number of dressing changes (p<0.001) were significantly higher in the conventional gauze dressing group. Patient satisfaction was significantly higher, and pain scores during dressing change were significantly lower, in the Aquacel Ag group (p<0.001 for both). Also, the number of patients who could take a shower during the first 3 days following surgery was significantly higher in the Aquacel Ag group (p<0.001).
Conclusion: The results of the present study showed that the Aquacel Ag surgical dressing significantly improved patient outcomes after the TKA surgery by decreasing postoperative complications and enhancing patient satisfaction.

19.Screening Results of Non-communicable Diseases in Adults and Elderly People Living in the Rural Area: A Cross-sectional Descriptive Study
Ayla Tuzcu, Leyla Muslu
doi: 10.14744/etd.2019.31889  Pages 98 - 104
Objective: The aim of this study is to determine the prevalence, risk, and cancer screening results of the non-communicable diseases (NCDs) in the province of Antalya, Turkey.
Materials and Methods: The sample in this cross-sectional descriptive study included 441 volunteers (universe 3841) aged >40 years living in four rural areas in Antalya. The questionnaire used in the study was divided into three parts: descriptive characteristics, Finnish Diabetes Risk Score (FINDRISK), depression risk questionnaire, and cancer screening sections.
Results: In total, 91.6% of the participants were aged ≥45 years, and at least one in 50.3% had a chronic disease. According to FINDRISK, 23.8% were in high, and 7.9% were in a very high risk group, 34.5% were slightly overweight, 56.2% were obese, and 26.7% had metabolic syndrome (MS). In total, 22.2% of the individuals were at a risk of depression. In cancer screenings, 32.1% of the women underwent mammography in the past 2 years, 33.6% underwent breast self-examination, and 60.3% underwent cervical cancer screening in the last 5 years. It was determined that 17.2% of participants underwent immunochemical fecal occult blood test.
Conclusion: It was observed that approximately one-third of the participants are under risk in term of hypertension and diabetes mellitus. Compared with previous studies, screening rates have increased in recent years, but they are not at the desired level. There is a need to promote encouraging practices for individuals living in rural areas aimed at prevention of NCDs, screening, and effective management of these diseases.

CASE REPORT
20.Leiomyoma of the Hand in an Adolescent
İbrahim Karaman, İbrahim Kafadar, Ali Eray Günay
doi: 10.14744/etd.2019.56588  Pages 105 - 107
Leiomyoma is a solitary benign tumor of the smooth muscle and vascular tissue. It can occur anywhere in the body where smooth muscles are present, although it is seen in <1% of all soft tissue tumors of the upper extremities. It is rarely reported in the hand or in children and is usually seen in patients aged 5–84 years and in males. In this report, we describe the case of a 16-year-old patient presenting with leiomyoma of the hand.

21.Neoadjuvant Doxorubicin and Docetaxel in Breast Cancer Patients Applied Neutropenic Enterocolitis
Hatice Aslan Sırakaya, Mevlüde İnanç
doi: 10.14744/etd.2019.39114  Pages 108 - 109
Neutropenic enterocolitis is an acute complication of neutropenia induced by chemotherapy, characterized by inflammatory processes involving the colon and cecum that can lead to necrosis, hemorrhage, perforation, and septicemia. Usually, this condition develops after use of cytotoxic drugs, and fever and abdominal pain are the main symptoms. We present a case of a 38 year old female patient with breast cancer who received doxorubicin and docetaxel and presented typhlitis.

22.Emphysematous Cystitis: A Case Complicated with Bilateral Hydroureteronephrosis
Ümran Sümeyse Ertürk, Kadir Yıldırım
doi: 10.14744/etd.2019.40327  Pages 110 - 111
Emphysematous cystitis is a urinary tract infection with gas formation. Because of life-threatening complications, early diagnosis and treatment of emphysematous cystitis are essential. Many predisposing factors have been described, such as diabetes mellitus and neurogenic bladder. Hydronephrosis without an obstructive lesion has been reported in some emphysematous cystitis cases. In this case report, a 74-year-old female patient was diagnosed with emphysematous cystitis and bilateral hydronephrosis without any predisposing factor. We present the characteristics of the case in this report.

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23.Concomitant Bilateral Sacroiliitis and Lumbar Spondylodiscitis Secondary to Staphylococcus aureus Sepsis
Hasan Tahsin Gözdaş, Mustafa Hızal
doi: 10.14744/etd.2019.23865  Pages 112 - 113
Abstract | Full Text PDF

24.Pulmonary Alveolar Microlithiasis
Saeed Hoseininia, Susan Mohammadi Kebar, Afshin Habibzadeh
doi: 10.14744/etd.2019.06332  Page 114
Abstract | Full Text PDF

LETTER TO THE EDITOR
25.Recalling the Clinical Diagnosis of Wernicke–Korsakoff Syndrome
Steven Yale, Halil Tekiner, Eileen Yale
doi: 10.14744/etd.2019.84665  Pages 115 - 116
Abstract | Full Text PDF

HISTORY OF MEDICINE
26.Ethics in Mental Disorder Treatment: How Ancient Greece Contributed to Modern Psychiatry
Konstantinos Laios, Spyros N. Michaleas, Marianna Karamanou
doi: 10.14744/etd.2019.75547  Pages 117 - 118
In the early 19th century, the French physician Philippe Pinel (1745–1826) propagated a humane treatment for the care of mentally ill patients, thereby founding the field of psychiatry. Pinel rejected the popular notion that mental illness was caused by demonic possession/other magical forces and unchained patients, subsequently proving that they could positively respond to a humane treatment. However, the humane treatment for mentally ill patients was introduced by ancient Greek physicians and philosophers. In the writings of Alcmaeon of Croton (5th century BC), Hippocrates (460–377 BC), Aretaeus of Cappadocia (c. 2nd century AD), and Soranus of Ephesus (98–138 AD), a rational approach can be found for mental illness and its treatment focusing on patients.

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