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Kocaeli Medical Journal - Kocaeli Med J: 10 (2)
Volume: 10  Issue: 2 - 2021
1. Cover

Pages I - II

2. Editorial Board

Pages III - V

3. Contents

Pages VI - VIII

ORIGINAL ARTICLE
4. Comparison of Vitamin D Levels and Thyroid Function Tests in Postmenopausal Women With and Without Metabolic Syndrome
Meryem Kuru Pekcan, Gültekin Pekcan, Gülnur Özakşit
doi: 10.5505/ktd.2021.00086  Pages 1 - 5
INTRODUCTION: The aim of the study was to evaluate the relationship between metabolic syndrome (Met S) components, thyroid stimulating hormone (TSH) and vitamin D levels in postmenopausal patients.
METHODS: This retrospective single-centered study included 191 patients who were admitted to the menopause clinic of our hospital. Data were obtained from the hospital records and patients’ files. Demographic, antropometric and laboratory measures were recorded. Revised National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) were used for diagnosis of Met S. TSH and vitamin D levels were recorded.
RESULTS: A total of 191 postmenopausal women were included in the study. The menopausal age of patients in the metabolic syndrome group was 55,28±4,31 and that in the non-metabolic syndrome group was 56,8±3,64 years. The prevalence of metabolic syndrome was observed in 51.8% patients in this study. Waist circumference, body mass index, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, insulin, HbA1c, HOMA-IR and triglyceride values were found significantly higher in patients with Met S (p <0.05 ). While no significant difference was found between the two groups in terms of TSH levels, the vitamin D level was significantly lower in the group with Met S (p <0.05)
DISCUSSION AND CONCLUSION: The incidence of Met S increases in the postmenopausal period. These risks can be reduced by detecting vitamin deficiency and hormonal disorders that play a role in the development of Met S.

5. Protective Effect of 5-HTTLPR (S) and VNTR (10) Allele Combinations of 5-HTT Gene Against Adenotonsillary Hypertrophy
Sami Engin Muz, Sibel Özdaş, Talih Özdaş, Mahmut Huntürk Atilla, Sibel Baştimur, Işılay Öz, İpek Canatar
doi: 10.5505/ktd.2021.04557  Pages 6 - 15
INTRODUCTION: Serotonin transporter protein which is coded by 5HTT gene is responsible for presynaptic reuptake of serotonin. In this study, we investigated the relationship between polymorphisms in the promoter region (5-HTTLPR) and in the second intron (VNTR) in the 5-HTTgene and adenotonsillar hypertrophy (ATH) in pediatric cases.
METHODS: Genotyped of the 5-HTT gene promotor 5-HTTLPR and intronic VNTR of in 197 children were analyzed using Snap Shot, Multifactor Dimensionality Reduction (MDR) software and carried out to assess the interactions among two polymorphisms and phenotype.
RESULTS: A total of 119 children with ATH (48 girls, 71 boys age range: 3-10 years; mean age: 5.38 years) and 78 healthy children (27 girls, 51 boys, age range: 4-13 years; mean age: 6.76 years) were included in this study. The frequencies of the genotype in all of inheritance models of the 5-HTTLPR and the VNTR (10) allele showed no significant differences between ATH patient and healthy controls (for all P> 0.05). However, frequency of the 5-HTTLPR (S) allele and VNTR_5-HTTLPR (10/S) haplotype and (10/10+S/S) diplotype were significantly higher in the control group compared to ATH cases (P= 0.048, P= 0.041, P= 0.13).
DISCUSSION AND CONCLUSION: In this study, we observed that S/S genotype, 10/S haplotype and 10/10 + S/S diplotype of 5-HTT gene could have protective effect against ATH.

6. Microorganisms Isolated from Urine Cultures and Their Antibiotic Sensitivity
Kemal Mağden
doi: 10.5505/ktd.2021.09581  Pages 16 - 21
INTRODUCTION: Itwas aimed to evaluate the change in the ratesofurinary tract infections(ITU), which were isolation and increased in ratesof antibiotic resistance allUTI agents atthe population especiallyEscherichia coli, for about ten years, retrospectively.
METHODS: In this study were examined urine cultures that their antibiotic resistance rates and demographic characteristicsofthepatients,thattheysentfromdepartments(intensivecareandnon-intensivecare),fromJanuary 2009 to December 2018. Statistical analyzes were made using the SPSS 20.0 program.
RESULTS: Total of 6916 urine cultures were evaluated retrospectively, of which 4903 (70.9%) were taken in women (mean age: 67.19±15.77) and 2013(29.1%) in men (mean age: 51.70±22.55). Whereas mostly Staphylococcus(28.9%), Klebsiella(12%), Pseudomonas(12.8%), Acinetobacter(11.7%), Escherichia coli(9.4%) and candida(8.5%) were isolated in 3028(43.8%) urine culturesthatsent fromintensive care, E. coli(57.2%) was frequently isolated in 3888(56.2%) urine culturesthatsentfromnon-intensive care units and polyclinics.WhileE. coli(53.8%) was isolated the most common in the 18-30 age group, Staphylococcus species(21.6%), E. coli(17.7%), Pseudomonas(12.3%), Klebsiella(11.9%), candida species(9.8%), Acinetobacter(8.2%) and Enterococci species(4%) were observed in the 71-80 age group. Most common Staphylococcus(19.7%) and Acinetobacter(13%) were isolated in the group over the age of 90. There was increasingly antibiotic resistance during the ten years.
DISCUSSION AND CONCLUSION: E. coli is highly resistant to ampicillin, TMX / sulfomethoxazole and ciprofloxacin which is frequently isolated from urine cultures, However, it is more sensitive to fosfomycin and nitrofurantoin. As a result, it can be understood that these two antibiotics can be used in all UTIs.

7. Effects of Hydrogel Contact Lens on Corneal Biomechanics and Intraocular Pressure
Sinan Bekmez, Erdem Eris, Faruk Balica, Tolga Kocatürk
doi: 10.5505/ktd.2021.10179  Pages 22 - 26
INTRODUCTION: To compare the corneal biomechanical parameters and intraocular pressure (IOP) measurements with Ocular Response Analyzer (ORA) and non-contact tonometry (NCT) before and after contact lens (CL) application.
METHODS: Fifty-eight healthy individuals were included in this prospective study. Only one eye of each individual was chosen randomly in. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated IOP (IOPg), corneal-compensated IOP (IOPcc) measured by ORA, and IOP measured by NCT were compared before and an hour after the hydrogel CL (with back vertex power of −3.00 Diopter) (1-Day Acuvue Moist-Etafilcon A, Johnson&Johnson) application. The data were analysed using a paired sample t-test.
RESULTS: Fifty-eight eyes of 58 participants were included in the study. 19 participants were female and 39 were male. The mean age of the participants was 26.53 ± 5.09. There was no statistically significant difference between the measurements of two different devices (measurements without and with CL p = 0.230 and p =0.790, respectively). All measurements with CL were lower than those without CL, but only NCT, IOPcc and IOPg values were statistically significantly lower (p values <0.001, 0.023, and 0.001, respectively).
DISCUSSION AND CONCLUSION: ORA measurements with CL caused lower values in all ORA parameters, and these differences reached statistically significant levels in IOPcc and IOPg values. CH and CRF values were not statistically significantly affected by CL wear. Similar to ORA, low IOP measurements were found with NCT.

8. Investigation of the Relationship between Temporomandibular Disorder and Postural Analysis
Gizem Ergezen, Mustafa Sahin, Candan Zeliha Algun
doi: 10.5505/ktd.2021.22043  Pages 27 - 32
INTRODUCTION: Muscular and ligamentous structures connect the temporomandibular joint (TMJ) to the cervical region to form a functional unit. Changes in one of the two regions, either TMJ or cervical spine, may affect the other region due to changes in the muscle segment. Our aim is to evaluate and compare whether individuals with temporomandibular disorders differ from healthy individuals in the global postural alignment by objective evaluation method.
METHODS: Group 1 (N=30) consist of mixed type temporomandibular disorder (TMD), Group 2 (N=30) consist of healthy temporomandibular joint, totally 60 individuals between the ages of 18-35 were included in this study. Posture Screen Mobile® (PSM) and New York Posture Scale (NYPS) were used for assessment of posture and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for diagnosis of TMD and healthy joints.
RESULTS: Knee translations from sagittal plane, were higher in Group 1 (p<0.05). No appreciable postural differences were found in other regions (p≥0.05). NYPS total scores were significantly lower in Group 1 (p<0.05).
DISCUSSION AND CONCLUSION: It may be beneficial to consider that some postural disorders can be caused by TMD or that TMD can lead to this posture. Being careful about postural alignment in these patients may be important in terms of multidisciplinary approach to TMD patients for proper treatment program and prevention of possible disorders.

9. Retrospectıve Evaluatıon of Our Surgıcal Approach and Treatment Results in Subaxıal Cervıcal Spıne Injury
Durmuş Oğuz Karakoyun, Oğuzhan Uzlu, Ali Yılmaz, Hasan Serdar Işık
doi: 10.5505/ktd.2021.43403  Pages 33 - 38
INTRODUCTION: The aim of the study is to evaluate the treatment management applied to the cases operated by a single spinal surgeon for Subaxial cervical trauma (SCT) according to the Subaxial cervical spine injury classification (SLIC) and AOSpine criteria, and to analyze the clinical and radiological results of the cases retrospectively.
METHODS: The clinical and radiological results of 9 patients who were operated for SCT in our clinic between 2019-2020 were evaluated.
RESULTS: The age distribution of the cases was between 18 and 74 (mean = 46.2). The follow-up period of the cases was 5-27 (mean = 17.3) months. When the trauma levels were examined, it was seen that there were lesions at the C5-C6 level in 7 (77.8 %) cases and at the C6-C7 level in 2 (22.2 %) cases. The SLIC scores of the cases were in the range of 5-9 (mean =6.4). When the preoperative American Spinal Injury Association (ASIA) scores of the cases were examined, it was seen that it was A in 2 cases, C in 4 cases, and D in 3 cases.
DISCUSSION AND CONCLUSION: SCT are pathologies with high morbidity and mortality risk. By performing decompression with anterior, posterior or combined approaches, spinal stability and neurological recovery can be achieved. Facet joints should be carefully evaluated in terms of fractures in SCT and 360° fusion should be performed in the presence of radiological findings suggesting that the stabilization is insufficient.

10. Do the Amount of Fluid, Histopathology, Radiology and Pleurodesis Status Affect the Survival in Malignant Pleural Effusions?
Filiz Güldaval, Ceyda Anar, Gülru Polat, Aysu Ayrancı, Mine Gayaf, Günseli Balcı, Özgür Batum, Gülistan Karadeniz, Fatma Üçsular, Bilge Salık, Emel Tellioğlu, Berna Komurcuoglu, Dursun Tatar, Seher Susam, Yasemin Özdoğan, Nimet Aksel, Melih Büyükşirin
doi: 10.5505/ktd.2021.44341  Pages 39 - 44
INTRODUCTION: The primary objective of this study was to identify the most common pleural malignancies leading to malign pleural effusion (MPE). The secondary objective was to evaluate the relationship between the amount of fluid and radiological findings, etiologies, treatment methods and survival.
METHODS: We retrospectively included cases of MPE with a tissue diagnosis.
RESULTS: The most common causes of MPE were lung cancer (73%), breast cancer (8.3%) and mesothelioma (7%). In patients who were offered chemical pleurodesis, pleurodesis was successful in nearly 31.1%. No relation wasfound between the amount of pleural fluid and cell type,survival, pulmonary, extrapulmonary malignancy and mesothelioma, Patients live longer if pleurodesis was successful (p = 0.005). Median survival of patients with MPE due to pulmonary, extrapulmonary and mesothelioma, respectively were 77 ± 12.8, 150 ± 48.4 and 365 ± 0 days. The survival of the patients with mesothelioma was significantly longer than others (P: 0.000).
DISCUSSION AND CONCLUSION: The main cause of MPE was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE. Successful pleurodesis had a significant contribution to the survival.

11. Treatment Experience in Patients with COVID-19: Preliminary Results from Kocaeli Turkey
Sıla Akhan, Birsen Mutlu, Emel Azak, İlknur Başyiğit, Haşim Boyacı, Serap Argun Barış, Müge Toygar Deniz, Sevtap Doğan, Aynur Karadenizli, Murat Sayan, Nuh Zafer Canturk, Nihat Zafer Utkan
doi: 10.5505/ktd.2021.76402  Pages 45 - 50
INTRODUCTION: The first case of pandemic was reported on March 11th of 2020 in Turkey.
METHODS: We attempted a retrospective analysis of COVID-19 patients who were admitted at first month of pandemic in Kocaeli University Hospital. Cases were defined as COVID-19 by clinical, laboratory (RT-PCR) and imaging (CT) criteria. From March 15th to April 20th, 80 cases were hospitalized. Hydroxychloroquine (HCQ), azithromycin (AZM) and oseltamivir (OSM) are recommended for treatment. We aim to share the results of this early treatment strategy.


RESULTS: Among the 80 patients; 14 (17.5%) received HCQ alone, 25 (31.2%) received HCQ and AZM, and 41 (51.2%) received HCQ, AZM and OSM. In the group receiving HCQ treatment, 3.7% were hospitalized for less than 5 days and 13.8% for 5 days and longer; In the group receiving HCQ and AZM treatment, 20% were hospitalized for less than 5 days and 11.3% for 5 days and longer. In the group treated with HCQ, AZM and OSM, 42.5% were hospitalized for less than 5 days and 8.8% for 5 days and longer. (p= 0.0001). The co-administration of the three drugs may be synergistic. When used in combination with AZM and OSM in the early period, it shortened the duration of hospitalization. Since there is not much data about it in the literature yet, we wanted to share our positive experience.
DISCUSSION AND CONCLUSION: Early treatment resulted in early recovery, decreased requirement for intubation, and a very low mortality rate. In this cohort, early diagnosis and treatment with COVID-19 appear to be associated with good outcome.

12. Clinical Effects of T790M Mutation in EGFR Tyrosine Kinase Inhibitor Resistant NSCLC Patients
Filiz Güldaval, Ceyda Anar, Melih Büyükşirin, Merve Ayık Türk, Günseli Balcı, Mine Gayaf, Murat Akyol, İbrahim Onur Alıcı, Gülru Polat, Gülistan Karadeniz, Aysu Ayrancı, Fatma Demirci Üçsular, Kadri Murat Erdoğan, Yaşar Kutbay, Şener Arıkan, Özgür Batum, Berna Kömürcuoğlu, Sinem Ermin
doi: 10.5505/ktd.2021.82856  Pages 51 - 56
INTRODUCTION: To compare patient characteristics between the T790M-positive and T790M-negative 29.06.2021 populations, and to analyze the post-progression survival (PPS) after initial tyrosine kinase inhibitor (TKI) failure in order to investigate the prognosis in patients undergoing rebiopsy.
METHODS: We investigated the patient characteristics, including the initial EGFR-TKI response and T790M status at the time of rebiopsy or liquid biopsy, subsequent treatment after resistance to the initial EGFR-TKI (the presence of EGFR-TKI re-challenge), treatment just before biopsy and/or rebiopsy (EGFR-TKIs or chemotherapy), the timing of the rebiopsy (just after the initial EGFR-TKI failure or others).
RESULTS: No difference was found between the two groups with T790M mutation positive and negative in terms of age, gender, and metastasis location. Only patients with positive T790M mutation had higher progression after TKI use compared to negative ones (p: 0.000). The progression-free median survival in patients using TKI was 19.33 months in the group with T790M mutation and 22.25 months in the negative group. Overall survival was found to be 75 months and 27.5 months in the T790M positive and negative group, respectively, and this was statistically significant. (p: 0.009).
DISCUSSION AND CONCLUSION: Overall survival was significantly longer in the T790M positive group than in the T790M negative group. In addition, liquid biopsy can be performed several times for patients with progression after EGFR-TKI use and who do not want to undergo tissue biopsy.

13. The Effect of Body Mass İndex to Functional Results After Arthroscopic Rotator Cuff Repair
Sinan Oguzkaya, Turan Bilge Kizkapan
doi: 10.5505/ktd.2021.83357  Pages 57 - 62
INTRODUCTION: Rotator cuff tear is a common cause of shoulder pain and dysfunction. Many factors, including age, comorbidities, pre-operative muscle atrophy, and fatty degeneration, may affect functional outcomes after rotator cuff repair (RCR). The purpose of the study was to evaluate the effect of obesity on functional outcomes and complication rates after arthroscopic RCR.
METHODS: A total of 154 patients who underwent arthroscopic RCR between 2017 and 2019 were included in the study. Patients divided into two groups as non-obese (Group 1 [n=118], 76.6%, 56 females, 62 males) and obese (Group 2 [n=36], 23.4%, 25 females, 11 males). Constant-Murley Score (CS), American Shoulder and Elbow Surgeon’s score (ASES), Visual analogue scale (VAS) score, and Short-Form 36 (SF-36) quality of life scale were used in the measurement of outcomes. Length of surgery, hospital stay, and complications were compared between the two groups (P=0.000).
RESULTS: Both pre-operative and postoperative CS, ASES, and SF-36 scores were significantly lower in the obese group (P=0.000). Also, the VAS score was higher in Group 2. The re-tear rate was significantly higher in obese group (27% vs. 4.2%, P=0.000). The duration of the surgery and hospital stay were significantly higher in the obese.
DISCUSSION AND CONCLUSION: Obese group have worse pre-operative and postoperative functional outcome scores and life quality measures when compared to non-obese patients. Also, re-tear rates are higher in obese patients.

14. Evaluation of Perspectives of Healthcare Professionals and Others Towards Cancer: Survey Study
Mehmet Nur Kaya, Burcu Caner, Ali Kırık, Nilüfer Avcı
doi: 10.5505/ktd.2021.96714  Pages 63 - 68
INTRODUCTION: Cancer patients may experience various physical and psychological problems depending on the disease. It has been determined that as the general attitudes taken towards cancer have become negative in healthy individuals, attitudes taken towards the curability of cancer have also become negative. We aimed to evaluate the differences in the perspective of healthy individuals on cancer, and to compare healthcare professionals and non-healthcare professionals from this point of view.
METHODS: The questionnaire was filled out face-to-face by two separate groups of people, one of which comprised healthcare professionals and the other comprised people that are not healthcare professionals. Both groups’approachesto cancer were evaluated by means ofthis questionnaire consisting of 11 questions, through which the demographic and professional characteristics of the participants were questioned first.
RESULTS: A statistically significant difference (p <0.01) was found between the two groups in terms of the answers given to the following five questions. No statistically significant difference was found between the two groups in terms of answers given to other questions.
DISCUSSION AND CONCLUSION: There was a significant difference between the two groups in terms of the answers given to certain questions included in the questionnaire. We think that the fact that healthcare professionals have more contact with cancer patients and especially that they can follow the diagnosis and treatment process of such patients more closely, compared to the group, which does not include any healthcare professionals, was effective in obtaining this result.

15. Results of Microvascular Decompression Surgery in the Treatment of Trigeminal Neuralgia
Mehmet Seçer, Aykut Gökbel
doi: 10.5505/ktd.2021.99710  Pages 69 - 73
INTRODUCTION: Trigeminal neuralgia (TN) develops as a result of the trigger of one or more branches of the trigeminal nerve by stimuli. Most cases of TN are usually caused by compression of the trigeminal nerve root, within a few millimeters from its exit from the pons. In this study, we aimed to present our experience regarding the microvascular decompression surgical approach and itsresults in the treatment of patients who applied to the clinic with a diagnosis of TN and who did not respond to any of the treatments.
METHODS: Microvascular decompression (MVD)surgery was performed on a total of 7 patients with TN who applied to the clinic between 2020 and 2021, and the information of the patients was retrospectively evaluated using surgery reports, epicrisis, and magnetic resonance images (MRI).
RESULTS: It was observed that all 7 patients with TN were initially administrated carbamazepine and/or oxcarbazepine, implemented radiofrequency thermocoagulation treatment and gamma knife radiosurgery. Subsequently, all the patients underwent MVD surgery. No complications developed in the postoperative period and complaints of TN in all patients completely resolved in the early period.
DISCUSSION AND CONCLUSION: In patients who are unresponsive to treatments, thin-section ‘constructive interference of steady state (CISS)’ sequence cranial MRI are useful to detect trigeminal nerve compression caused by intracranial pathologies, and MVD surgery is important in the treatment.

CASE REPORT
16. Descending Necrotizing Mediastinitis: A Rare Case
Erdem Altıparmak, Halil Erdem Özel, Ferit Bayakır, Serdar Başer, Saban Eyisarac, Erkan Esen, Ayşe Adin Selçuk
doi: 10.5505/ktd.2021.73792  Pages 74 - 77
Descending necrotizing mediastinitis (DNM) is a rare but highly mortal condition. It is a complication that develops commonly due to severe oropharyngeal or odontogenic infections. Early diagnosis, appropriate antibiotherapy and recovery with surgical intervention is possible. The spread of cervical infection via adjacent anatomical structures leads to mediastinitis. The infection spreads into the pleural and pericardial cavities and even into the abdomen, through the deep fascial spaces. DNM is an infection having high mortality rates (47%) by causing empyema, pleural and pericardial effusion, peritonitis, intrathorasic hemorrhage and cardiac tamponade. In this article, a case of DNM was presented due to its extremely rare incidence, high mortality rate and successful management.

ORIGINAL ARTICLE
17. Evaluation of Cases Applying to a Training and Reserch Hospital Probation Unit in Terms of Substance use Characteristics
Selim Polat, Buket Koparal, Burak Okumuş, Cicek Hocaoglu
doi: 10.5505/ktd.2021.37267  Pages 78 - 82
INTRODUCTION: In this study, we tried to evaluate the sociodemographic characteristics of the cases under probation, who were controlled in our hospital, in terms of variables such as the age of onset of the substance of variables such asthe age of onset of the substance and the type of substance used.
METHODS: In this study; 554 cases were referred to psychiatry policlinic between 01/01/2018 and 02/12/2018. These cases were evaluated in terms of their sociodemographic characteristics such as age, gender, educational status, and their clinical diagnosis. They were analyzed retrospectively in terms of patient statements.
RESULTS: In our study, 10 (1,8%) were and 544 (98.2%) were male and the mean age was 30,88 ± 10,304 (15-69) years. The level of education was 94 (17%) for primary school, 432 (78%) for secondary and 28 (5,1%) as high schools. Thc, 487 (87,9%), and at least Bzo, 2 (0.4%) cases were determined in terms of the substance used. The highest number of cases was 286 (51,5%) and 15-29 years old.
DISCUSSION AND CONCLUSION: It was deduced that the socio-demographic characteristics of the cases followed up within the probation unit were related to substance used and the duration of use, and it was found that the type ofsubstance used wasrelated to age and education levels. It has been observed that the average age islower than the studies conducted in the previous years. We think that our study will contribute to the literature in terms of revealing the rates of substance use with more concrete data.

18. Alterations in Blood Parameters According to Activation and Remission Status of Chronic Central Serous Chorioretinopathy
Buğra Karasu
doi: 10.5505/ktd.2021.83446  Pages 83 - 90
INTRODUCTION: The aim of this study was to investigate the changes in blood parameters during the activation and remission periods of chronic central serous chorioretinopathy (cCSCR).
METHODS: In this retrospective study, results of the blood parameters of 36 patients (Group 1) with cCSCR during activation period and 41 patients (Group 2) with cCSCR during remission period were recorded.
RESULTS: The mean serum white blood cell (WBC) values in Group 1 were 7.87 ± 2.21 (10 ^ 3 / LL) and in Group 2, 7.35 ± 1.26 (10 ^ 3 / LL) were not statistically significant (p = 0.390). The mean serum levels of red blood cells (RBC) were 5.07 ± 0.42 (10 ^ 6 / LL) in Group 1 and 4.98 ± 0.63 (10 ^ 6 / LL) in Group 2 (p = 0.321), respectively. The mean serum levels of platelet (PLT) were 237.58 ± 53.08 (10 ^ 3 / LL) in Group 1 and 218.72 ± 54.16 (10 ^ 3 / LL) in Group 2 (p = 0.149), respectively. Platelet crite (PCT) levels were significantly increased in Group 1 compared to Group 2 (p = 0.003). Mean platelet volume (MPV) values were significantly increased in group 1 (9.44 ± 1.17 fL) compared to group 2 (7.28 ± 0.76 fL) (p = 0.016).
DISCUSSION AND CONCLUSION: High MPV and PCT serum levels during the activation period can provoke the tendency of thrombosis in cCSCR and moreover may induce choroidal ischemia and microinfarct formation.

19. The Role of Thyroid Function Tests in Prediction of the Effect of the Severity of Pre-eclampsia on Perinatal Outcomes
Oğuz Güler, Hasan Cemal Ark, Diana Sevil
doi: 10.5505/ktd.2021.05925  Pages 91 - 95
INTRODUCTION: To investigate the relationship between impaired thyroid function tests in pregnancy and pre-eclampsia, to determine the role of this relationship in the prediction of the severity of pre-eclampsia, and to evaluate the effect on perinatal outcomes.
METHODS: The study included 60 consecutive patients in the 28th-41st gestational week of a single pregnancy, diagnosed with pre-eclampsia, and a control group of 44 healthy, normotensive patients at the same stage of a single pregnancy with no medical problems. The pre-eclamptic patients were separated into two groups as severe pre-eclampsia and other pre-eclampsia. The groups were compared in respect of demographic data.
RESULTS: This prospective, controlled study included 60 pregnant patients diagnosed with pre-eclampsia and 44 healthy pregnant patients. When the severe pre-eclampsia, other pre-eclampsia and the healthy control groups were compared in respect of thyroid function tests, TSH was determined to be statistically significantly higher in severe pre-eclampsia group than in other pre-eclampsia group and the control group (6.04 ± 9.63 μlU/ml, 2.76 ± 1.86 μlU/ml ve 2.72 ± 1.70 μlU/ml, respectively, p<0.001). TT3 and TT4 were lower in both the severe pre-eclampsia and other pre-eclampsia groups compared to the healthy control group
DISCUSSION AND CONCLUSION: TSH levels were increased and the TT3 and TT4 levels were decreased in all the pre-eclamptic pregnancies. In the sub-group analyses, there was a statistically significant increase in the TSH levels of the severe pre-eclampsia group compared to those of the other pre-eclampsia group. It can therefore be considered that TSH levels may be useful in determining the severity of pre-eclampsia.

20. Evaluation of Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis; Experiences of a Stroke Center
Serhan Yıldırım, Pınar Bekdik Şirinocak
doi: 10.5505/ktd.2021.21549  Pages 96 - 101
INTRODUCTION: Intravenous thrombolytic (iv-tPA) treatment is a recommended treatment in acute ischemic stroke (AIS). We aimed to evaluate the effectiveness and side effects of this treatment on our patients.
METHODS: We retrospectively evaluated the datas of patients with AIS treated with 0,9 mg/kg iv-tPA between 2018-2020.
RESULTS: Forty-nine patients were treated with iv-tPA between 2018 and 2020. NIHSS scores at 24th hour were found significantly decreased compared with at onset(8,3±4,1 at onset, 4,9±5,1 at 24th hour, p=0,000). Thirty-eight (%77,6) patients had good clinical outcome. Intracerebral hemorrhage (ICH) was spotted in 3 (6,1%) patients. Systolic blood pressure (ICH group: 163±59 mmHg, non-ICH group: 141±25 mmHg p=0,014), serum glucose level(ICH group: 173±117 mg/dl, non-ICH group: 124±45mg/dl, p=0,007) and mean door-needle time (ICH group: 125±9 min., non-ICH group: 137±54 min. p=0,029) were found significantly increased in patients with ICH. Total 4 (8,2%) patients died after iv-tPA treatment.
DISCUSSION AND CONCLUSION: Our study showed that iv-tPA improves the clinical findings of AIS. Additinally high serume glucose level and systolic blood pressure may increase the risk of ICH.

CASE REPORT
21. Neuropathy Mimicking Radiculopathy After Extracorporeal Shock Wave Lithotripsy Treatment: A Case Report
Mahmut Taha Ölçücü, Kayhan Yılmaz, Çağatay Özsoy, Yasemin Bicer Gomceli, Mutlu Ateş
doi: 10.5505/ktd.2021.83436  Pages 102 - 105
We presented a 57-year-old female patient with neuropathy mimicking radiculopathy who underwent extracorporeal shock wave lithotripsy (ESWL) treatment for renal stone. After the second session of ESWL, the patient reported severe pain on the left side of the waist and sole of the left foot, tingling and burning of the sole of the left foot. She had no complaints before ESWL. After neurological examination, the patient was diagnosed as neuropathy due to the possible effects of ESWL on the spinal cord roots. Pregabalin 75 mg twice a day was started and her symptoms were gradually recovered during the six months. This case demonstrates that neuronal structures in the regions adjacent to the targeted ESWL region can be affected by shock waves.

ORIGINAL ARTICLE
22. Effect of 2100 MHz Radio Frequency Radiation on Oxidative Stress on Testicular Tissue of Hypertensive and Non-Hypertensive Rats
Dilek Kuzay, Çiğdem Özer, Bahriye Sırav Aral, Fatih Şentürk
doi: 10.5505/ktd.2021.48751  Pages 106 - 110
INTRODUCTION: Nowadays exposure to radiation has been increasing with the advancement of technology. Although considerable research has focused on the effects of radiation exposure on biological systems, its effect on hypertensives has previously never been addressed. In this study, the effect of 2100 MHz radio frequency radiation (RFR) on oxidative stress on testicular tissue of hypertensive and non-hypertensive rats is aimed to be investigated.
METHODS: Twenty-four male Wistar Albino rats were allocated into four groups: 1) Control (C), 2) Control +Hypertension (C+H), 3) Radiation (R), 4) Hypertension+ Radiation (H+R). In order to induce hypertension in rats, 60 mg/kg L-NAME dissolved in 1 ml tap water was orally administered to rats for one month. Rats were exposed to 2100 MHz RFR for 60 min /day, 5 days/ week for 8 weeks. Following the experiments, the rats were decapitated under anesthesia and malondialdehyde (MDA), Nitrite+nitrate (NOx) and glutathione (GSH) levels were examined on testicular tissue. Results were compared with One-way ANOVA followed by post hoc Tukey tests. Values of p<0.05 were accepted as significant.
RESULTS: When testicular tissues of R and H+R groups were compared with those of C and H groups, MDA and NOx levels were seen to increase while GSH levels decreased (p<0.01).
DISCUSSION AND CONCLUSION: Radiation exposure led to an equal amount of increase of oxidative stress on testicular tissues of hypertensive and non-hypertensive rats. Oxidative stress caused by radiation exposure may negatively affect male reproductive system in both hypertensives and non-hypertensives.

23. Diagnostic Performances of Dynamic Contrast Enhanced Magnetic Resonance Perfusion Imaging and T2 Relaxometry in Soft Tissue Masses
Hande Uslu, Mesude Tosun, Gür Akansel, Yonca Anık, Ercüment Çiftçi
doi: 10.5505/ktd.2021.46667  Pages 111 - 118
INTRODUCTION: Our study aims to evaluate the diagnostic performances of Dynamic Contrast-Enhanced Magnetic Resonance Perfusion Imaging (DCE-MRPI) and T2 relaxation (T2 Mapping) parameters in the differentiation of benign and malignant soft tissue masses.
METHODS: The study included 36 patients with 36 soft tissue masses (17 malignant and 19 benign). Imaging was performed using a 3 Tesla MRI, T2 perfusion and T2 relaxation studies were performed and Index, Negative Integral (NI), Mean Transit Time (MTT), Time to Peak (TTP), Time of Arrival (T0), and mean value of T2 relaxation time were calculated. Then, these parameters were compared between benign and malignant lesions.

RESULTS: The differences of the maximum dimension of the lesions and NI values between benign and malignant masses were found statistically significant (p = 0.01 and p = 0.001 respectively). There was a statistically significant relationship between the presence of peritumoral edema and malignancy (p =0.05).
DISCUSSION AND CONCLUSION: For the differentiation of benign from malignant soft tissue masses NI value may provide added information, when combined with conventional MRI and clinical findings. T2 relaxation times were not helpful in this regard due to significant overlap between benign and malignant masses.

24. Does Asymptomatic Leukocytospermia Affect Ovulation Induction's Outcome?
Sezin Ertürk Aksakal, Elif Gülşah Diktaş, Tugba Altun Ensari, Aslı Öcal, Berna Dilbaz
doi: 10.5505/ktd.2021.60437  Pages 119 - 124
INTRODUCTION: The aim of the study was to investigate whether the asymptomatic leukocytospermia, detected in the spermiogram evaluation performed during the first admission of patients who underwent ovulation induction therapy due to unexplained infertility, affects pregnancy rates.
METHODS: Patients with an unexplained diagnosis of infertility, who were administered CC-IUI, or KOH-IUI, with the ages in a range of 22-40 years were included in the study. Age of the patients, duration of infertility, treatment protocol [(CC-IUI) vs (KOH-IUI)], the cycle of treatment, β-hCG level on the 12th day after IUI, clinical pregnancy and live birth rates were compared between patients with and without leukocytospermia.
RESULTS: There was no difference between the groups in terms of age, duration of infertility, number of cycles, treatment protocol, β-hCG positivity, and clinical pregnancy. The live birth rate in the group with leukocytospermia (+) was lower than the group with leukocytospermia (-) (5.7% vs. 23.7%, respectively, p ˂ 0.05). While β-hCG positivity and clinical pregnancy were not different between groups in patients receiving CC-IUI treatment (p˃0.05), the live birth rate in the leukocytospermia (-) group was higher than the group with leukocytospermia (+) (p = 0.037). In patients who received KOH-IUI treatment, β-hCG positivity, clinical pregnancy rate, and live birth rate were found to be higher in the group with leukocytospermia (-) than the group with leukocytospermia (+) (respectively, p = 0.016, p = 0.004, p = 0.002).
DISCUSSION AND CONCLUSION: Asymptomatic leukocytospermia affects clinical pregnancy and live birth rates in patients who underwent ovulation induction due to unexplained infertility.

25. Percutaneous Cholecystostomy as an Alternative Treatment Choice for Acute Cholecystitis in Elderly and High-Risk Surgical Patients
Ali Çiftçi, Samet Genez, Murat Burç Yazıcıoğlu, Ahmet Yalnız
doi: 10.5505/ktd.2021.32848  Pages 125 - 130
INTRODUCTION: Acute cholecystitis (AC) is a common surgical emergency. Although surgery is a definite solution, (PC) is effective and safe for the decompression of an infected gallbladder in elderly patients with severe comorbidity or high surgical risk. This study aimed to evaluate the results of percutaneous cholecystostomy PC in elderly or high-risk surgical patients.
METHODS: A total of 41 patients with AC aged over 65 years with American Society of Anesthesiologists scores of III or IV and high surgical risk that had undergone a PC due to comorbidity between February 2017 and December 2019 were included in this study.
RESULTS: Of the 41 patients, 22 (53.66%) were male, and 19 (46.34%) were female. The median age was 76.44 ± 8.46 (range 65–93). The most common comorbidities were cardiovascular diseases (73.17%) and diabetes mellitus (51.22%), and 43.90% of the patients had a multisystem disease. Either the transhepatic or transperitoneal route was used for the PC. No complications or mortality related to the PC procedure were observed. The average time of tube indwelling was 5 (range 0–12) weeks. Surgery was performed on eight patients 4–6 weeks after the procedure. Seven patients (17.1%) died in the intensive care unit after PC. The mean hospitalization time was 7.20 ± 6.31 (range 1–30) days.
DISCUSSION AND CONCLUSION: This study found that PC is an inexpensive, easy-to-apply alternative treatment method that can be safely used in the treatment of elderly patients with AC who do not respond to medical therapy and have high surgical risk.

26. Short And Mid Term Results Of Transcatheter Aortic Valve Implantation: A Single-Center Experience
Ali Yasar Kılınç, Refik Emre Altekin, Fulya Avci Demir, Mehdi Onac, Gündüzalp Saydam, İbrahim Demir
doi: 10.5505/ktd.2021.24445  Pages 131 - 139
INTRODUCTION: Patients with severe aortic stenosis and symptomatic should be treated surgically. Because of advanced age and comorbidities, 30% of patients cannot be treated. For this purpose transcatheter aortic valve replacement (TAVR) procedure has been developed. The purpose of our study is to analyze real life results of patients who underwent TAVR.
METHODS: 136 patients were analyzed retrospectively. Primary endpoint was perioperative mortality (POM), secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE), developed during the 6-month post-procedure period and permanent pacemaker (PPM) requirement in postoperative period.
RESULTS: In patients, developed POM; PPM, transfusion and intubation requirements were higher, postoperative hemoglobin was lower, postoperative BUN, leukocyte and 48th hour creatinine were higher. PPM requirement was higher in women and patients with left bundle branch block on ECG after procedure. In patients who developed MACCE, presence of chronic obstructive pulmonary disease, intubation and transfusion requirement, preoperative CRP and postoperative CRP and leukocyte were higher.
In multivariate regression analyzes, independent risk factors of POM were transfusion and PPM requirement, MACCE risk factors were intubation and transfusion requirement, and PPM risk factor was female gender.
DISCUSSION AND CONCLUSION: TAVR is an appropriate treatment option with low mortality risk in patients who cannot be operated due to high surgical risk.

27. The Effects of Anxiety Levels and Physicosocial Factors on Sleep Bruxism Among Children: A Case Control Study
İffet Yazıcıoğlu Sanrı, Perihan Çam Ray
doi: 10.5505/ktd.2021.48991  Pages 140 - 146
INTRODUCTION: Sleep bruxism is frequently observed in childhood and it occurs with the combination of many different factors and its frequency decreases with the age. The aim of this study is to evaluate the effects of parafunctional habits, sleep habits, familial and environmental factors and children's anxiety levels on sleep bruxism.

METHODS: A total of 76 children aged 6-11 years, 38 with bruxism and 38 without bruxism were included in the study. Screen for Child Anxiety and Related Disorders (SCARED) form was given to the mothers, and detailed patient history for bruxism, including the parafunctional habits of the children and family history, was taken from the mothers
RESULTS: Bruxism was observed more frequently in children with learning, behavioral or anger problems (p = 0.001) and in children who experienced a recent stressful event (p = 0.001). Among the SCARED subscales used as an anxiety screening scale among children with and without bruxism; Somatic panic (p = 0.413), general anxiety (p = 0.616), separation anxiety (p = 0.637), social anxiety (p = 0.614), school fear (p = 0.582), and SCARED total scores (p = 0.617). There was no significant difference.
DISCUSSION AND CONCLUSION: A relationship between the anxiety level of the child declared by the mother and bruxism was not found, but it was shown that exposure to an event causing stress and learning, behavioral or anger problems in children were effective in the emergence of bruxism.

28. Attitude of Psychiatry Clinic Patients Towards Digital Health Applications with Internet and Smartphone Usage
Buket Cinemre, Mustafa Nogay Coskun, Müge Topcuoğlu, Ali Erdoğan
doi: 10.5505/ktd.2021.70973  Pages 147 - 155
INTRODUCTION: A new field called digital health has been created by combining technology and health practices. In Digital Health, mobile health(m-health) methods have an important place. The aim of this study is to obtain information about the frequency of internet and mobile phone usage among people who apply to university hospital psychiatry outpatient clinic and their approach to the use of digital media in their own health management and in future scientific research.
METHODS: 300 people who have applied to the Akdeniz University Psychiatry outpatient clinic between May and July 2020 were included in the study. Individuals younger than 18 years old and persons who did not want to participate in the study were excluded. Participants in the study were asked to fill out a questionnaire in a pen-and-paper form prepared by the researchers. The questionnaire includes 18 questions prepared in accordance with the aims of the research together with the sociodemographic information.
RESULTS: In this study, the rate of internet usage was found to be 93.33%. Moreover, 93% of the participants have found to be owning a mobile phone. Whereas, 91.4% of the participants have found to be owning a smartphone. Only 35.69% of the participants have downloaded a phone application related to health. Also, 79.7% of the participants use phones to acquire information on their illness and/or health.
DISCUSSION AND CONCLUSION: People who apply to psychiatry clinics have high rates of smartphone and internet usage. Digital technologies can be used in a wide range of healthcare departments, especially for young and/or educated participants.

29. The Effect of Antenatal Education Class on The Type of Delivery
Pakize Özge Karkın, Gözde Sezer, Selma Şen, Müberra Duran
doi: 10.5505/ktd.2021.10692  Pages 156 - 159
INTRODUCTION: To detect the type of delivery of pregnant women rather attending or not attending antenatal class education and to determine the effect of antenatal class education on type of birth.
METHODS: In our research, 145 participants of antenatal education class and 235 non-participants were searched retrospectively between January 2018 and June 2020.
RESULTS: The mean age of 145 antenatal education participants and 235 non-participants were found 28,99±5,39 and 27,81±4,36 respectively.
In the research, while antenatally educated group delivered 60%vaginally, non-educated group gave birth 41,7% vaginally. There was a statistical difference between two groups by chi-square analysis(p<0.05).
When nulliparous research population was studied, C-Section ratio was found 39,5% in educated group and 58,9% in non-educated group. There was a statistical difference between two groups by t-test (p<0.05).

DISCUSSION AND CONCLUSION: According to our search results, pregnant women attending antenatal education class had high rates of normal vaginal births also it is true to say that C-Section ratios can be lowered by antenatal education.

30. The Relationship Between Parenchymal Findings of Chest Computed Tomography and C Reactive Protein in COVID-19 Patients at Hospital Admission
Derya Deniz Altıntaş, Ayhan Şenol
doi: 10.5505/ktd.2021.43410  Pages 160 - 166
INTRODUCTION: In this study, we aimed to investigate the relationship between the parenchymal findings of COVID-19 pneumonia on chest Coumputed Tomography (CT) and C reactive protein (CRP) at hospital admission.
METHODS: 192 consecutive COVID-19 patients with pulmonary findings on chest CT, who were admitted to the hospital between 1st April to 30th May 2020, were included in the study. COVID-19 pulmonary findings were evaluated in admission chest CT
RESULTS: Median age of 192 patients was 44 (31-59) years and 46.8% (90) of them were female. Median CRP value was found to be 15.2mg/L (2.0-55). Chest CT findigs of the patients were as follows: 69.2% (133) with ground glass opacity, 33.8% (65) with consolidation, 6.2% (12) with reversed halo, 11.9% (23) with crazy-paving, 20.8% (40) with discrete nodula, 5.7% (11) with pulmonary vascular enlargement, 3.6% (7) with bronchiectasis and 17.1% (33) with fibrosis. The mean CRP was found to be 42.8±59.1 in patients with nodule presentation and 34.7±53.2 in patients without nodule presentation. In order to determine independent predictors related to CRP; chest CT parameters described above were assessed in the linear regression. Association with statisticaly significance were determined between the presence of nodule on chest CT (-26.1CI 95%; (-49.0,-3.1), p = 0.026), BSTI-CT score (20.6, CI 95%; 7.6, 33.6, p= 0.002) and CRP values.
DISCUSSION AND CONCLUSION: In our study, we found that patients with atypical findings as nodules had lower CRP levels than those with typical findings on chest CT in symptomatic COVID-19 patients admitted to the hospital.

31. Prognostic Factors in Membranous Nephropathy Patients
Bülent Kaya, Saime Paydaş, Tolga Kuzu, Mustafa Balal
doi: 10.5505/ktd.2021.55563  Pages 167 - 173
INTRODUCTION: Membranous nephropathy (MN) is the most common cause of nephrotic syndrome (NS) in adults. In our study, we aimed to determine the factors affecting remission in patients with MN at the end of the first year
METHODS: Our retrospective study was performed on patients over 18 years of age diagnosed with MN between 2015-2018. In MN patients, baseline, 6th, 12th-month laboratory values (serum albumin, proteinuria, eGFR) and treatment response at the end of the 12th month was evaluated.
RESULTS: Forty-three MN patients (24 (55.8%) women) with a mean age of 42.2±12.5 were evaluated. MN patients were divided into two groups at the end of the 12-month treatment period, remission and non-remission. In the remission group, female gender was higher (p=0.022), diastolic blood pressure was lower (p=0.025), mycophenolate use was less (p=0.019), serum creatinine was lower (p<0.001), eGFR was higher (p=0.008), LDL (p=0.039), HDL (p=0.035), erythrocyte sedimentation rate (ESR) (p=0.012) and CRP (p=0.016) levels were higher. In patients in remission, proteinuria was found at a lower level at sixth (p<0.001) and 12th months (p <0.001), and serum albumin at 12th months (p <0.001) compared to non-remission patients.
DISCUSSION AND CONCLUSION: At the time of diagnosis, the male gender, eGFR, diastolic blood pressure, LDL, HDL, ESR, and CRP are factors that can affect remission at the end of the first year in MN patients. We can say that proteinuria is an early indicator of response to treatment than eGFR and serum albumin.

32. Turkish Adaptation Study of the Landing Error Scoring System
Sabriye Ercan, Esma Arslan, Cem Çetin, Ferdi Başkurt, Zeliha Başkurt, Mukadder İnci Baser Kolcu, Giray Kolcu
doi: 10.5505/ktd.2021.67625  Pages 174 - 178
INTRODUCTION: In this study, it is aimed to adapt the Landing Error Scoring System (LESS) to Turkish.
METHODS: LESS, developed by Darin Padua et al., was translated into Turkish separately by 6 researchers. Then, the translations were converted into a single "tool” in a consensus at a meeting. Expert opinion was taken 3 times to ensure the comprehensibility of the tool. The final version of the tool was created with the feedback received. After the content validity of the Turkish version was provided, pilot jump tests were performed on 9 participants to evaluate the reliability. The pilot jump tests were analyzed by both domain expert and non-domain expert raters. Afterwards, another 45 participants performed jump tests and these tests were analyzed by two raters who are experts in the domain.
RESULTS: The Turkish version provided scope validity in its third version. The tool's (v.3) I-CVI value was 0.78 minimum and 0.97 maximum; the lowest S-CVI value was 0.80 and the highest was 1.00; SCI / Ave value was found 0.88. The reliability level of all raters’ intra-rater (0.81-0.92) and inter-rater (0.94-0.96) participating in the pilot study was found excellent. After the pilot analysis, the reliability level of intra-rater (0.82-0.83) and inter-rater (0.89) was found excellent in the evaluation made by only domain experts from 45 different participants.
DISCUSSION AND CONCLUSION: Turkish version of LESS is a tool that can be used by professionals interested in sports and athlete's health.

33. Evaluation of Factors Affecting Intra-Abdominal Pressure and Foot Perfusion During Hip Arthroscopy
Ali İhsan Kılıç, Ortaç Güran, Ramadan Özmanevra, Onur Hapa
doi: 10.5505/ktd.2021.87059  Pages 179 - 183
INTRODUCTION: The purpose of the present study was to investigate the correlation between intra-abdominal pressure and great toe perfusion pressure and saturation level at different stages of the hip arthroscopy surgery.
METHODS: Eight patients whom were elected to undergo hip arthroscopy for femoroacetabular impingement were included in the study. Intra-abdominal pressure, great toe perfusion pressure, saturation, foot temperature, body temperature, blood pressure, heart rate, operation time, mean traction time were measured at the beginning of surgery (BS), beginning of traction (BT), end of the traction (ET), after releasing of the traction (RT), at hip flexion position(Flex), at hip extension position (Ext) and end of the surgery (End).
RESULTS: The operation time was negatively correlated with End perfusion(r: -0.729, p=0.04). ET Intraabdpress was negatively correlated with ETSaturation (r: -0.84,p=0.009). BT Intraabd press was positively correlated with BT body temp (r: 0.85, p=0.007). Intra-abdominal pressure at the end of traction was lower than that at the beginning of operation (p=0.02). Foot perfusion and saturation level at the end of traction was lower than that at the beginning of the operation (p=0.001 and p=0.002, respectively).
DISCUSSION AND CONCLUSION: As a conclusion, traction during hip arthroscopy decreases intra-abdominal pressure, foot perfusion pressures and saturation. The operation time negatively correlated with foot perfusion pressure.