Volume : 11 Suppl : 1 Year : 2025
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Kocaeli Medical Journal - Kocaeli Med J: 11 (1)
Volume: 11  Issue: 1 - April 2022
1. Cover

Page I

2. Editorial Board

Pages III - V

3. Contents

Pages VI - VIII

ORIGINAL ARTICLE
4. Five-Years Bacteremia Surveillance in the Intensive Care Unit
Gülten Ünlü, Gönül Şengöz, Filiz Pehlivanoğlu, Şemsi Nur Karabela, Kadriye Kart Yaşar
doi: 10.5505/ktd.2022.65785  Pages 1 - 8
INTRODUCTION: Intensive care units are the areas where nosocomial infections and bacteremia are most common. With the surveillance study, it is aimed to determine the agents, to know their characteristics, to create the resistance profile, to prevent cross-infection and contamination, and to reduce the rates of nosocomial infections. In this study, it was aimed to examine the distributions and susceptibility rates of the agents in nosocomial bacteremia in patients followed up in the Haseki Training and Research Hospital ICU between 2009 and 2013. Our study was carried out in ICU between January 1, 2009 and December 31, 2013.
METHODS: Bacteremia surveillance of the patients hospitalized in the ICU was evaluated according to the surveillance follow-up form and the invasive vehicle surveillance follow-up form. Bacteria grown in blood cultures were identified from vials with positive growth signal after incubation in the BacT/Alert system using conventional methods and Vitek 2 identification device. Antibiotic sensitivities were determined according to Kirby Bauer disc diffusion method and interpreted according to CLSI criteria.
RESULTS: In the ICU, 327 episodes of bacteremia were detected in a five-year period. Of these, 181 were peripheral blood samples, 146 were CVC-associated bacteremia, 76.2% of the isolated bacteremias were Gram-negative agents, 19.5% were Gram-positive agents, and 3.6% were fungal agents. The most frequently isolated bacteria is Klebsiella spp. (22.9%). Respectively, Acinetobacter spp. (19.8%), Pseudomonas spp. (17.7%), Enterobacter spp. (7.1%), E. coli (3.1%) were the most frequently observed Gram negative bacteria. Significant changes were found in the antibiotic susceptibility of bacteria by years.
DISCUSSION AND CONCLUSION: Compared to total nosocomial infections in the ICU, the rate of bloodstream infections decreased significantly over the years, and an increase was observed in CVC-related bloodstream infections over the years. In bacteremia developing in the ICU, the agents are more resistant and the patients are more complicated. Surveillance studies are of great importance in controlling hospital infections.

5. The Association Between Red Cell Distribution Width and Bone Marrow Fibrosis in Patients with Philadelphia-Negative Myeloproliferative Neoplasms
Ceyda Aslan, Abdülkadir Karışmaz, Rafet Eren, Şermin Altindal, Mehmet Hilmi Doğu, Elif Suyanı
doi: 10.5505/ktd.2022.69926  Pages 9 - 14
INTRODUCTION: Red cell distribution width (RDW) was shown to be increased in primary myelofibrosis (PMF) patients and it is intriguing whether RDW could be used instead of biopsy in predicting presence of bone marrow fibrosis (BMF) to some extend in Philadelphia-negative myeloproliferative neoplasms (MPNs) comprising polycytemia vera (PV), essential thrombocytosis (ET) and PMF. Our aim is to evaluate the relationship between BMF degree and RDW values in patients with MPNs.
METHODS: We retrospectively reviewed the data of 118 patients, who were followed with the diagnosis of MPNs at our Hematology Clinic between 2010 and 2017.
RESULTS: 52 patients had PV, 60 had ET, 4 had PMF and 2 had unclassifiable MPN. Twentynine (24.6%) patients were with grade 0 and grade 1 reticulin fibrosis were considered to be free of BMF, and the remaining 89 (75.4%) patients with ≥ grade 2 reticulin fibrosis were considered to have BMF. The median RDW value was 14.6% (range 12,4-23,1%). The median RDW value revealed with 14.1% (range, 12.4-17.8) in patients without BMF and 15% (range, 12.4-23.1) in patients with BMF (p=0.054). In subgroup analysis of 8 patients with advanced BMF of grade 3, the median RDW value was 18.45% (range, 16.4-23.1) and it was 14.45% (range, 12.4-23) in the remaining 110 patients (p=0.008).
DISCUSSION AND CONCLUSION: Although the present study does not provide a precise conclusion about the association between RDW and BMF, it seems that increased RDW can point out the presence of advanced BMF in patients with MPNs.

REVIEW ARTICLE
6. Molecular Mechanism of Metastasis in Colorectal Cancer and Organotropism
Zeynep Sağnak Yılmaz
doi: 10.5505/ktd.2022.64624  Pages 15 - 25
Metastasis is a multistep molecular and biological process called the metastasis cascade that involves the anatomically spread of cancer cells to distant organ regions and their subsequent adaptation to foreign tissue microenvironments. Metastasis is the major cause of death in colorectal cancer (CRC) patients. Liver and peritoneum are the most common metastasis sites of CRC. The epithelial-mesenchymal transition (EMT) constitutes the most important and wide area in the metastasis cascade. EMT is a process in which many factors such as transcription factors, signal pathways and miRNAs are effective. Epithelial characteristics of the primary tumor, integrins and exosomal integrins, cancer stem cell phenotype, miRNA expression, factors affecting angiogenesis and extravasation, physiological characteristics of organs and vascularization contribute to the determination of the metastatic pathway, namely organotropism. These mechanisms that are effective in organotropism are discussed in detail in this review. A better understanding of the mechanisms underlying metastasis development in CRC will greatly contribute to targeted therapy in metastatic CRC patients.

ORIGINAL ARTICLE
7. YouTube as a Source of Information About Eye Health
Ecem Önder Tokuç, Sevim Ayça Seyyar
doi: 10.5505/ktd.2022.54280  Pages 26 - 34
INTRODUCTION: To evaluate the credibility, quality, and popularity of eye-health-related YouTube videos.
METHODS: This is a retrospective, cross-sectional, register-based study. A YouTube search was conducted using the keyword “eye health” without changing the website’s default search parameters. All of the videos were categorized based on their publishers, presenters, and topics. The duration of the videos, title, number of views, time since upload, view rate (views/day), number of comments, number of likes and dislikes, and rate of likes were all recorded. The mDISCERN questionnaire (0–5), Journal of the American Medical Association (JAMA) (0–4) score, and Global Quality Score (GQS) (0–5) were used to analyze the video content’s quality and reliability.
RESULTS: A total of 120 videos were analyzed, with 103 of them meeting the inclusion criteria. The mean viewing duration was
17.85 ±18.94 minutes(range: 0.30-59), and the mean number of views was 27825.11±153493.35(range; 23-1302227). The mean JAMA, mDISCERN, GQS, and VPI scores of the videos were 1.82±0.38(range: 1-2), 2.26±0.88(range: 0-4), 2.5±0.94(range: 1-4), and 0.66±152.27(range; 0-1085), respectively. 85.43% (n=88) of the narrators in the videos were ophthalmologists. According to the content of the videos, the number of videos related to pediatrics eye health was higher. (36.89%). There was a statistically significant positive correlation between mDISCERN and JAMA(ro=581 p<0.001), GQS and JAMA(ro=582, p<0.001) and mDISCERN and GQS(ro=857, p<0.001).
DISCUSSION AND CONCLUSION: This study showed that eye health videos on YouTube were insufficient to inform the patients. As a result, during patients interviews, physicians should be aware of the quality and diversity of online information and correct inaccurate information.

8. Autologous Corticocancellous Bone Graft Viability After Reversed Placement
Emrah Kağan Yaşar, Can İlker Demir
doi: 10.5505/ktd.2022.48243  Pages 35 - 42
INTRODUCTION: The aim was to present early and late period findings in patients who underwent reconstruction with corticocancellous bone grafts using the technique of inverting the cancellous side of the graft to the side with better blood supply.
METHODS: Patients repaired with corticocancellous bone grafts using this technique between 2018 and 2019 were retrospectively reviewed. The etiology and localization of the defects, the size of the bone graft, the type of soft tissue and early and late complications were documented. Six months later, bone scintigraphy was examined and the viability of the grafts was checked.
RESULTS: There were seven patients with an average age 42. Three patients had maxillary, two mandibular and two frontal bones have defects with the sizes between 3x1.5 cm and 10x4 cm. Random flaps for coverage and plates for fixation were used in all patients except one. Graft fail occurred for one patient and bone reconstruction was postponed until after debridement. All grafts show osteoblastic activity on scintigraphy, except the patient with osteomyelitis.
DISCUSSION AND CONCLUSION: Using the cancellous side of the corticocancellous bone grafts to be applied to the side where the blood supply is relatively better gives good results.

9. Comparison of the Effectiveness of Early and Late Convalescent Plasma Treatment Given in Patients Diagnosed with Coronavirus Disease in Intensive Care Unit
Yeliz Bilir, Akın Bilir, Fulya Ciyiltepe, Elif Bombacı, Ayten Saraçoglu, Kemal Tolga Saraçoğlu
doi: 10.5505/ktd.2022.39260  Pages 43 - 51
INTRODUCTION: Passive vaccination with convalescent plasma(CP) therapy has gained popularity in patients with SARS-CoV-2 infection (COVID-19).However, there is no controlled study that will clearly define the use of this treatment in which the patient group, at what dose, and at what optimal time interval. The present study aimed to compare early and late CP treatments in critically ill patients in theintensive care unit (ICU) for efficacy and mortality.
METHODS: We retrospectively evaluated 20 patients who were admitted toICU of Kartal Dr. Lütfi Kırdar City Hospital with the diagnosis of COVID-19 and given CP therapy between April and June 2020 and compared early (Group1) and late (Group2) outcomes of therapy.
RESULTS: Of 20 patients, 5(25.0%) were female and 15(75.0%) were male. The average age of patients was 61±8.6 years. In Group1, the mortality rate and the length of stay in ICU were significantly lower compared to Group2(p=0.025, p=0.001, respectively). A positive correlation was observed between the day that CP was given after diagnosis and total number of days spent in ICU. As CP administration day was delayed, the length of stay in ICU also increased and this was statistically significan.
DISCUSSION AND CONCLUSION: The treatment modalities and timing to be selected are very important in COVID-19, which is fast and deadly and competes with time to increase survival. This study showed that CP therapy is well-tolerated, that early treatment options can reduce mortality and length of stay in ICU and it is not a final stage rescue therapy.

10. Evaluation of Neurologic Symptoms in Patients with Polymerase Chain Reaction- positive COVID-19 and Viral Pneumonia
Meltem Karacan Gölen, Dilek Yılmaz Okuyan
doi: 10.5505/ktd.2022.03604  Pages 52 - 62
INTRODUCTION: The most frequent symptoms affecting the respiratory system in COVID-19 are fever, dry cough, sore throat, and dyspnea. It has been shown that infections due to COVID-19 disease are not always limited to the respiratory tract, there may also be neurologic involvement, which may occur as a result of the spread of the virus to the central nervous system through various mechanisms. Neurologic involvements include headache, dizziness, seizures, encephalitis, stroke, neuromuscular disorders, and peripheral nervous system involvement.
METHODS: In this study, neurologic findings,laboratory parameters and other characteristics of 179 patients with COVID-19
pneumonia were evaluated retrospectively.
RESULTS: Headache, dizziness, altered consciousness, myalgia, loss of smell, and taste disturbance were observed in 101/179 (56.4%), 33/179 (18.4%), 20/179 (11.2%), 80/179 (44.6%), 62/179 (34.6%), and 52/179 (29%) patients, respectively. Acute ischemic cerebrovascular disease was observed in 5/179 patients (2.8%) and hemorrhagic cerebrovascular disease was observed in one patient (0.6%). Lymphopenia was observed in 51% and thrombocytopenia was detected in 25.4%. Increased C-reactive protein, ferritin level, creatine kinase, lactate dehydrogenase, and D-dimer levels were observed in 89%, 27%, 17%, 20%, and 34% of the patients, respectively.We found a significant relationship between myalgia and increased CK levels (p = 0.001).
DISCUSSION AND CONCLUSION: Neurologic symptoms can be the first and only symptom of COVID-19. It is thought that the variety of complications that may develop, the relationship of COVID-19 with neurologic diseases, and disease management will become more understandable with future studies conducted with a multidisciplinary approach.

CASE REPORT
11. A Patient with Human Immune Deficiency Virus Mimicking Systemic Lupus Erythematosus
Neslihan Gökçen, Hacer Kaya, Fatma Tuncer, Ayten Yazıcı, Ayşe Cefle
doi: 10.5505/ktd.2022.27136  Pages 63 - 67
Background: Human immunodeficiency virus (HIV) can cause rheumatological manifestations due to infectious itself or treatment. Among these findings take part arthralgia, arthritis, photosensitivity, oral ulcer, sicca syndrome, fever, hypergammaglobulinemia, cytopenia, neuropathy and anti-nuclear antibody (ANA) positivity, which have been also observed in systemic lupus erythematosus (SLE). Not only does HIV imitate SLE, but also it might coexist with.
Case Report: A 40-year-old man who presented with oral lesions, blurry vision, vertigo, speech difficulty and ataxic gait admitted to the clinic. Cerebellar tests were abnormal. He could not walk in tandem gait. After observing leukopenia, lymphocytopenia and mildly increased liver function tests in laboratory and encephalitis on magnetic resonance imaging (MRI), autoantibodies and viral panel were requested. While autoantibodies were negative, HIV Enzyme-Linked Immunosorbent Assay (ELISA) was found positive.
Conclusion: HIV can lead to systemic autoimmune and autoinflammatory conditions. Notably, ruling out HIV in patients who have rheumatological findings is necessary.

ORIGINAL ARTICLE
12. Assessment of Mental Health Status and Associated Factors Among Physical and Rehabilitation Medicine Physicians Amid the Covid-19 Pandemic
Onur Engin, Başak Şenel Kara, Ömer Faruk Dadaş, Banu Dilek
doi: 10.5505/ktd.2022.29795  Pages 68 - 77
INTRODUCTION: The present study analyzes the mental health status and sleep patterns of Physical Medicine and Rehabilitation (PMR) physicians (physiatrists), as well as other associated factors, during the COVID-19 pandemic.
METHODS: The physiatrists that made up the sample were reached via an online questionnaire form collecting data on their demographic characteristics and the working conditions in PMR and pandemic outpatient clinics, while the Depression, Anxiety and Stress Scale-Short Form (DASS-21) and Insomnia Severity Index (ISI) were applied to measure mental status and sleep quality, respectively.
RESULTS: The study included 309 PMR physicians. The results of the DASS-21 identified symptoms of depression in 58.6%, stress in 40.5% and anxiety in 54.4% of the physicians during the pandemic, while the results of ISI revealed insomnia symptoms in 45.3%. The DASS-21 depression, anxiety and stress subscales, and the ISI scores of the physicians were found to have increased during the pandemic at a statistically significant degree. Multiple regression analyses revealed a strong relationship between total DASS-21 score, and the adequacy of information about COVID-19, performing procedures requiring close contact with patients, the presence of a person with chronic disease in the household and the female gender. Satisfaction with workplace hygiene, in turn, was found to significantly reduce the respondents’ ISI scores.
DISCUSSION AND CONCLUSION: The mental health and sleep quality of physiatrists have been affected significantly amid the pandemic. Necessary support should be provided to reduce the stress and anxiety experienced by physiatrists during and after the pandemic.

REVIEW ARTICLE
13. Kounis Syndrome
Cihan Örçen
doi: 10.5505/ktd.2022.32392  Pages 78 - 83
Kounis syndrome is defined as the concurrent occurrence of acute coronary syndrome with allergy, hypersensitivity, anaphylaxis or anaphylactoid conditions. The degranulation of mast cells, which are the main inflammatory cells, and the release of various mediators, mainly histamine, play a role in the pathophysiology. Clinical symptoms and signs are associated with cardiac symptoms accompanied by allergic reactions. Three different variants of the syndrome have been defined and the most important point in diagnosis is to suspect this syndrome with the combination of history, clinical and laboratory findings.

ORIGINAL ARTICLE
14. Examining the Correlation between the School Satisfaction Levels and Academic Achievement Scores of Faculty of Health Sciences Students
Kıymet Koç, Burcu Arkan
doi: 10.5505/ktd.2022.73554  Pages 84 - 92
INTRODUCTION: This study has been performed to determined the school satisfaction levels of nursing students and to investigate the relationship between academic success mean and school satisfaction mean.
METHODS: After obtaining the necessary permissions for Research, Faculty of Health Sciences of the Uludag University in Bursa 2018-2019 studying in fall semester, which volunteered to participate in the study and complete fill out forms that are made with 413 nursing students. In the data collection method, ıt was used Socio-demographic Form and Student Satisfaction Scale Form. The academic success mean was gathered from student information system after all grades data were entered into the system. To analyze the data, Shapiro-Wilk test, t-test, one dimensional variance analysis and Pearson correlation factor analysis were used
RESULTS: The total score obtained from student satisfaction scale form is 181,18±29,55 (minimum 65, maximum 265 points). When analyzed on the basis of sub-scales; the scores are decisional involvement scale (3,54± 0,64), instructor (3,51±0,61) and educational quality (3,43±0,64), school management (3,36±0,66), scientific, social and technical facilities (3,28±0,67), respectively. According to statistical analysis results, there is not a statistically significant relationship between student academic success scores and student satisfaction scores (p>0,05).
DISCUSSION AND CONCLUSION: As a result; the satisfaction level of the students was found to be slightly above the middle level and it was not associated with academic achievement.

15. Short Versus Long Head-up Tilt Test Protocols to Evaluate Vasovagal Syncope in Children
Murat Deveci, Özlem Kayabey, Eviç Zeynep Başar, Abdulkadir Babaoğlu
doi: 10.5505/ktd.2022.65625  Pages 93 - 100
INTRODUCTION: Vasovagal syncope is a common clinical problem in children and adolescents, for which the head-up tilt test (HUTT) is the standard diagnostic procedure. In this study, we evaluated sublingual nitroglycerine-stimulated HUTT protocols, comparing the results with passive phases of 20 minutes versus 45 minutes.
METHODS: A total of 293 patients aged 6 to 18 years with a history of recurrent syncope were studied. Physical examination, laboratory parameters, and echocardiographic examination were normal in all. The patients underwent standard HUTT with sublingual nitroglycerin used in the active phase. A short protocol was used for one group (n=143) with a passive phase of 20 minutes, while testing in the others (n=150) comprised a long protocol, with a passive phase of 45 minutes.
RESULTS: There were no significant differences between the two groups in terms of age, sex, and length of time between the first syncope and the tilt test. In the short protocol group, HUTT results were positive in 43(30.1%) in the passive phase, 40(28%) in the active phase, and 83(58%) overall, compared with 65(43.3 %), 32(21.3%), and 97(64.7%), respectively, in the long protocol group. Among those in the long protocol group, 26 of 32 (81.5%) who had a positive response in the passive phase developed syncope within the first 20 minutes.
DISCUSSION AND CONCLUSION: The HUTT protocol with a short passive phase has the advantage of saving time while providing results comparable with the long protocol, which might be preferable in children and adolescents.

16. The Role of Immunohistochemical Markers and Tumor Size on Prognosis in Gastrointestinal Stromal Tumors
Mehmet Ali Gök, Serkan Fatih Yeğen, Mehmet Tolga Kafadar, Aytaç Emre Kocaoğlu
doi: 10.5505/ktd.2022.97769  Pages 101 - 106
INTRODUCTION: Immunohistochemical staining methods are generally used in the diagnosis of gastrointestinal stromal tumors. Apart from these parameters, immunohistochemical staining characteristics are determined in determining the risk groups.
METHODS: In the 2008-2019 study, 66 patients who applied to the general surgery clinic were followed up and their files were scanned retrospectively. Age, gender, clinical presentation, tumor extinguishing, pathological purpose, mitotic index were evaluated.
RESULTS: The ratio of women / men with a diagnosis of GIST was 31/55, and the mean age was 62. When tumor localizations were examined, the most common localization was found to be stomach and small intestine. Following the immunohistochemical examination of the pathology results of the patients, it was found that CD117 was stained as positive and desmin was negative in all of them. The maximum tumor diameter was 40 cm, the minimum tumor diameter was 6 cm, and the mean diameter was
13.9 cm. the mean mitotic index was determined as 14.1.
DISCUSSION AND CONCLUSION: Considering that the tumor characteristic is not clearly understood and this characteristic has been modified over time, the importance of diagnostic and guiding parameters in treatment is better understood. We think that new and specific criteria will be found in the prognosis and survival prediction of the studies that are being done and to be done.

17. The Importance of C-Reactive Protein for Preoperative Evaluation, Inoperability and Survival in Patients with Peritoneal Metastasis
Yiğit Mehmet Özgün, Volkan Öter, Muhammet Kadri Çolakoğlu, Erol Pişkin, Osman Aydın, Erdal Birol Bostancı
doi: 10.5505/ktd.2022.81568  Pages 107 - 118
INTRODUCTION: C-reactive protein (CRP) is an inflammatory marker that has predictive value for survival in many types of cancer. The aim of this study is to examine the preoperative CRP level as a predictive biomarker for surgery due to peritoneal carcinomatosis whether the disease is resectable or not.
METHODS: A total of 126 patients who underwent laparotomy for cytoreductive surgery and HIPEC between 2014- 2019 were included in this study
RESULTS: In the comparative analysis, for operated and unresectable patients, CRP values measured in the same week preoperatively were found to be statistically significant markers for operability. The CRP values were found 4.3 and 18 g/L, respectively. This difference was found to be statistically significant (p = 0.03) In the subsequent subgroup analysis, in patient group with PCI ≥9, the CRP value was found to be significantly higher than the PCI <9 group (p = 0.006).
DISCUSSION AND CONCLUSION: We suggest that CRP can give us an idea as a simple and cheap biomarker in these group of patients. We suggest that CRP can give us an idea as a simple and cheap biomarker in these group of patients. It should be kept in mind that if the preoperative CRP value is high in patients who are planned to have CRS + HIPEC, patient could be unresectable. In patients undergoing cytoreductive surgery and HIPEC, high CRP levels were found to be associated with higher PCI and lower survival.

18. The Effect of Spiritual Well-Being on Surgical Fear in Geriatric Patients
Fadime Çınar, Semra Bülbüloğlu
doi: 10.5505/ktd.2022.65148  Pages 119 - 127
INTRODUCTION: This study; It was performed to examine the effects of the spiritual well-being of elderly patients scheduled for surgery on surgical fear.
METHODS: This study was conducted in a descriptive and cross-sectional manner in the general surgery clinic of a research and practice hospital with the participation of 110 elderly patients between 1-28 February 2021. Personal Information Form, Spiritual Well-being Scale and Surgical Fear Scale were used in data collection. After the data were coded by the researchers, data analysis was performed with Statistical Packed For The Social Sciences 25 IBM.
Descriptive statistics, Kolmogorov-Smirnov test, Chi-square test, one-way analysis of variance (ANOVA), regression and correlation analysis were used in the analysis of the data.
RESULTS: This study was conducted in a descriptive and cross-sectional manner in the general surgery clinic of a research and practice hospital with the participation of 110 elderly patients between 1-28 February 2021. Personal Information Form, Spiritual Well-being Scale and Surgical Fear Scale were used in data collection. After the data were coded by the researchers, data analysis was performed with Statistical Packed For The Social Sciences 25 IBM.
Descriptive statistics, Kolmogorov-Smirnov test, Chi-square test, one-way analysis of variance (ANOVA), regression and correlation analysis were used in the analysis of the data.
DISCUSSION AND CONCLUSION: Awareness of spiritual well-being should be developed in health care professionals, and it is recommended that they provide health care that provides moral and social support to patients.

19. Long-Term Prognostic Value of Procalcitonin Level in Patients with Acute ST Segment Elevation Myocardial Infarction
Turab Yakışan, Mehmet Gül, Muhammet Hulusi Satılmışoğlu, Abdurrahman Eren
doi: 10.5505/ktd.2022.71235  Pages 128 - 135
INTRODUCTION: Previous studies have suggested that there is a relationship between coronary artery disease (CAD) and procalcitonin (PCT) levels. We aimed to evaluate the relationship between PCT levels and long-term major adverse cardiovascular events (MACE) and all-cause mortality in patients with ST segment elevation myocardial infarction (STEMI).
METHODS: Patients were divided into two groups based on their serum PCT values. Patients with PCT levels <0.05 ng/ml were accepted as low PCT group (n=235) and those with PCT levels >0.05 ng/ml as high-PCTgroup (n=87). MACE were defined as cardiovascular mortality, reinfarction, or target vessel revascularization (TVR). MACE and all-cause mortality were retrospectively screened from their files during the mean follow-up of 55 months of the patients included in the study. Demographic and laboratory values were recorded in SPSS.
RESULTS: MACE and all-cause mortality were found to be significantly higher in the high-PCT group than in the low-PCT group (p=0.003 and p=0.002, respectively). In multivariate analysis, high PCT levels and age were identified as significant independent predictors of long-term all-cause mortality after adjusting for other risk factors. Moreover, white blood cell, C-reactive protein, glucose, and Hemoglobin A1c were higher in the high-PCT group.
DISCUSSION AND CONCLUSION: High PCT levels during hospitalization in patients with STEMI are associated with long-term MACE and all- cause mortality. Although PCT is widely used in infectious diseases, it is an ideal inflammation marker for long-term adverse outcomes in patients with STEMI.

20. Predictive Value of Preoperative NLR and PLR in Short-term Survival in Rectal Cancer
Hakan Uzunoğlu, Selçuk Kaya
doi: 10.5505/ktd.2022.55632  Pages 136 - 143
INTRODUCTION: It was aimed to investigate the use of NLR and PLR values both in diagnosis and as prognostic markers for 2- and 3-year short-term survival in rectal cancer cases.
METHODS: The study included 121 patients who were operated for rectal and followed up in the General Surgery clinic of our hospital, and 120 healthy individuals who applied to our clinic for various purposes.
RESULTS: The mean age was 61.7±11.5 (min.-max.: 35-86) years. The 2- and 3-year survival rates were 63.2% and 54.9%, respectively. The mean NLR and PLR were 3.6±5.2 (min.-max.: 0.2-55) and 171.8±169.7 (min.-max.: 29.4-2000), respectively. The mean 2- and 3-year survival times were 19.6±8.3 and 26.2±13.9 months, respectively.
In the patient group, the median neutrophil count, platelet count, NLR and PLR were significantly higher than the control group, while the median lymphocyte count was significantly lower (p<0.001 for each). No significant difference was found in terms of median laboratory values between patients who survived and those who died according to overall, 2-year and 3-year survival. There was no significant correlation between laboratory values and recurrence, overall survival, 2-year survival and 3-year survival (p>0.05 for each).
DISCUSSION AND CONCLUSION: The findings obtained in the present study show that NLR and PLR values can be used as markers in the detection of rectal cancer, however that they do not provide significant information about 2- and 3-year survival.

REVIEW ARTICLE
21. A Comparison of the Information Provided by Paraffin, Epon Semi-Thin and Thin Sections on the Examination of Prepubertal Rat Testicular Tissue
Gülnaz Kervancıoğlu, Elif Kervancıoğlu Demirci
doi: 10.5505/ktd.2022.15679  Pages 144 - 147
The aim of this study is to examine how light microscopic examinations can be made better visible in the use of prepubertal testicular tissue in fertility restoration by adding our own experiences.
Researches go on testicular tissues to ensure that boys who will receive cancer treatment continue to have their own generations in the future. Prepubertal testicular tissues are frozen and stored for later use. In vitro studies continue for the use of these tissues. Therefore, further researches necessitate for the effective determination of prepubertal testicular tissue elements.
Prepubertal testis tissue contains Sertoli cells and few gonocytes / spermatogoniums in seminiferous tubules, myoid and leydig cells in the interstitial area. Prepubertal testes, there aren’t germinal serial cells other than stem cells as in adults. The areas where the cells are located different from the adult testicular tissue. Sertoli cells are dispersed. Tight junction complexes and blood-testis barrier have not yet formed.
Gonocytes aren’t yet settled in the basement membrane or just migrating towards the base. Especially, it can be difficult to distinguish between Sertoli cells and gonocytes / spermatogoniums by light microscopy examinations. In order to evaluate the results of the applications, it is necessary to prepare the recognizable preparations of these tissues under the light microscope.
Paraffin sections prepared are insufficient in examining and distinguishing especially intratubular cells.
Semi-thin sections from epon blocks are more appropriate than paraffin sections for these morphology definitions.
Electron microscopy can be performed in centers with electron microscope because tissue monitoring requires special application.

ORIGINAL ARTICLE
22. Identifying Occult Metastase Ratio and the related Factors in Early Stage Oral cavity Carcinoma
Mehmet Akif Abakay, Selçuk Güneş, Filiz Gülüstan, Ercan Atasoy
doi: 10.5505/ktd.2022.68466  Pages 148 - 154
INTRODUCTION: Management of clinical node-negative neck in early-stage oral cavity squamous cell carcinoma is still controversial. There are three main options to consider as watch-and-wait, elective neck dissection, and sentinel node biopsy.
METHODS: Patients were grouped as clinical node-negative and pathologic node-negative (group 1) and clinical node-negative and pathologic node-positive (group 2). Factors thought to affect occult metastasis such as age, tumor diameter, tumor thickness, perineural invasion, lymphovascular invasion, and differentiation were investigated using the Mann-Whitney U test, the Chi- square test, and Fisher’s exact test.
RESULTS: From 27 eligible patients, there were 12 (44.4%) females and 15 (66.6%) males. Sixteen patients were evaluated in group 1 and 11 were evaluated in group 2. The mean age of the patients was 58.20±14.05 years. The occult metastasis rates were 34% and 51% for T1 and T2 tumors, respectively. The mean tumor diameter was 24.78±12.79 mm, and the mean tumor thickness was 11.37±7.62 mm. The difference in mean values of tumor thickness between the groups was significant (p=0.024), but age (p=0.622) and tumor diameter (p=0.443) were not significantly different. The ROC analysis cut-off values for age, tumor diameter, and tumor thickness were 60 years, 23 mm, and 9.5 mm, respectively. Tumor thickness and lymphovascular invasion were significantly different between the groups, but age, differentiation, clinical T stage, and perineural invasion were not different.
DISCUSSION AND CONCLUSION: The high rates of occult metastasis in our series imply that elective neck dissection seems a more appropriate choice for early-stage oral cavity squamous cell carcinoma rather than watch-and-wait.

23. Cartilage Degradation Biomarkers are Elevated in Younger Adults with Patellofemoral Pain Syndrome
Elif Aydın, Çiğdem Yenisey, Serkan Sabancı, İmran Kurt Ömürlü, Gülcan Gürer
doi: 10.5505/ktd.2022.69376  Pages 155 - 162
INTRODUCTION: Little is known regarding the altered cartilage composition in patients with patellofemoral pain syndrome. Biomarkers can identify early stages of cartilage damage before the overt morphological changes develop. We investigated cartilage degradation biomarkers in order to reveal cartilage damage in patellofemoral pain syndrome.
METHODS: Serum samples of twenty patients with patellofemoral pain syndrome and twenty healthy control subjects obtained and four different assays were used: Serum levels of C-terminal cross-linked telopetides of type-II collagen (sCTX-II), cartilage oligomeric matrix protein (sCOMP), Collagen Type II- specific neopeptide (sC2M) and Chondroitin sulfate epitope 846 (sCS846). Pain status and functional status were assessed with VAS, The Western Ontario and McMaster Universities Arthritis Index (WOMAC), Kujala patellofemoral scoring system (PFSS) and timed up and go test (TUG).
RESULTS: Significant increases in serum cartilage degradation biomarkers except sCTX-II were observed in patellofemoral pain syndrome. In correlation analysis, there were not any significant association between pain scores, functional status and biomarker levels except, a reverse relationship between sC2M levels and the TUG scores.
DISCUSSION AND CONCLUSION: Higher levels of cartilage degradation markers revealed ongoing cartilage destruction in patients who suffer patellofemoral pain syndrome and reflect altered cartilage composition in these patients.

24. Investigation of Clinical, Laboratory and Breastfeeding Transmission Characteristics of Newborns Born to COVID-19 Diagnosed Mother
Meltem Karabay, Olena Erkun, Didem Altunsoy, Hande Toptan, Elif Köse, Hilal Uslu Yuvacı, İbrahim Caner
doi: 10.5505/ktd.2022.57778  Pages 163 - 171
INTRODUCTION: It was aimed to determine the characteristics, clinical and laboratory findings, treatment requirements and post-discharge situation of newborns that mothers with a diagnosed COVID-19 infection.
METHODS: This is a descriptive study examining the characteristics of 65 newborns born to mothers diagnosed with COVID-19 in the neonatal intensive care unit (NICU). COVID-19 was analyzed by PCR in the breast milk of mothers with a diagnosis of COVID-19. p<0.05 was considered statistically significant.
RESULTS: Of 65 mothers with COVID-19, 45 (69.2%) were followed in outpatient, 17 (26.2%) hospitalized and 3 (4.6%) intensive care units. Two (3.1%) of the three mothers who were followed in the intensive care unit with severe COVID-19 infection died. While 63 (96.9%) of the infants were COVID-19 PCR negative, only two (3.1%) infants were COVID-19 PCR positive. Respiratory support was given in 10 (15.4%) of the infants. Eosinophil values (p=0.002) and creatine kinase were lower in infants of mothers with COVID-19 (p<0.001). 64 (98.5%) of the infants were discharged with good recovery. COVID-19 PCR was found to be negative in the breast milk of 40 mothers who had just given birth with a diagnosis of COVID-19.
DISCUSSION AND CONCLUSION: Vertical transmission and typical clinical symptoms of COVID-19 were not found in infants born to mothers with COVID-19. No COVID-19 PCR positivity was detected in breast milk. It was thought that COVID-19 positivity in the mother would not pose a risk of serious illness in the newborn.

25. The Importance of Percutaneous Cholecystostomy Placement Time in Patients with Grade-III Acute Cholecystitis
Erol Pişkin, Volkan Oter, Muhammet Kadri Çolakoğlu, Mehmet Akif Üstüner, Yiğit Mehmet Özgün, Osman Aydın, Erdal Birol Bostancı
doi: 10.5505/ktd.2022.56588  Pages 172 - 179
INTRODUCTION: The current treatment modality for acute cholecystitis is laparoscopic cholecystectomy. In some cases, it may be necessary to use alternative methods such as percutaneous cholecystostomy (PC), especially in grade III patients. Based on this problem, the aim of our study is to determine the effects of percutaneous cholecystostomy placed in the early (first 72 hours) or late (72 hours and later) periods, on mortality and morbidity, in patients with Grade III acute cholecystitis.
METHODS: Patients with acute cholecystitis treated between January 2012 and December 2018 were evaluated. The patients were divided into 2 groups as the group with PC placement in the first 72 hours of the symptoms started (Group-I, n= 19) and the group with PC placement after 72 hours (Group-II, n=13).
RESULTS: A total of 32 patients with grade III acute cholecystitis who underwent percutaneous cholecystostomy between this period were included in the study. Early morbidity was observed in 7 (21.87%) patients, while hospital mortality was observed in 11 patients (34.37%). While there was no significant difference in morbidity between early PC (first 72 hours, Group-I) and late PC (72. hour and later, Group-II) in patients with grade III acute cholecystitis (p=0.67), there was a significant difference in mortality in Group-II compared to Group-I ( p=0.001).
DISCUSSION AND CONCLUSION: According to our study results, we strongly recommend that the procedure be applied to the required patients within the first 72 hours by making a quick decision on the implantation of a PC in a multidisciplinary manner.

26. Effect of COVID-19 Pandemic on Anxiety in Rheumatology Patients Taking Immunosuppressive Drugs
Tuğba İzci Duran, Seyyid Bilal Açıkgöz, Cemal Gürbüz, Ayşegül Uçar, Gökhan Yavuz Bilge, Metin Özgen
doi: 10.5505/ktd.2022.43926  Pages 180 - 190
INTRODUCTION: The purpose of this study was to determine the prevalence of anxiety due to Coronavirus disease-2019 (COVID-19) pandemic in patients with rheumatic and musculoskeletal diseases (RMDs) who used immunosuppressive drugs during the initial stage of the COVID-19 pandemic and to identify the risk and protective factors that cause anxiety.
METHODS: A total of 145 patients with RMDs who used regular immunosuppressive drugs and 95 healthy controls were included. An anonymous survey comprising questions regarding the COVID-19 pandemic was used, and the Beck anxiety inventory (BAI).
RESULTS: About 42.1% patients reported that the epidemic caused concern due to the drug they were using, 33.8% rated their concerns as moderate and severe. According to the BAI scores, 16.5% patients had moderate to severe anxiety symptoms; and comparison of the groups showed that the anxiety level of the patient group was significantly higher (38.6% vs. 18.9%, p=0.001). Female had more anxiety symptoms in both groups (p<0.005). In addition, anxiety was lower in patients with higher education levels (p=0.039).
DISCUSSION AND CONCLUSION: It should be ensured that patients in the high-risk group are not provided false information, the patients are individually informed, and they trust the treatment team. Providing online or smartphone-based psychoeducation and psychological interventions may be considered for these patients with high anxiety levels.

LETTER TO THE EDITOR
27. Adrenal Insufficiency: An Extremely Rare Complication Due To Bilateral Neuroblastoma
Gözde Atasever Yıldırım, Şeref Selçuk Kılıç, Süreyya Soyupak, Seyda Erdogan, Serhan Küpeli
doi: 10.5505/ktd.2022.37084  Pages 191 - 193
Abstract |Full Text PDF

ORIGINAL ARTICLE
28. Cardiac Findings after COVID-19 Treatment and Completed Quarantine Process
Gülay Aydın, Ebru Gölcük
doi: 10.5505/ktd.2022.33340  Pages 194 - 202
INTRODUCTION: Our aim was to determine late-term which cardiac effects were in hemogram, biochemical parameters, cardiac biomarkers, Electrocardiography (ECG) and Transthoracic echocardiography (TTE) and which cardiac complaints were in the patients admitted to the Cardiology outpatient clinic after the Coronavirus disease 2019 (COVID-19) treatment and quarantine process was completed.
METHODS: 132 consecutive patients included in this retrospective study. ECG and TTE were performed, hemogram, biochemical parameters, cardiac biomarkers; high sensitive cardiac troponin T (hs-cTn), N terminal Pro B type natriuretic peptid (NT-pro BNP) and D-dimer were studied in all patients on admission.
RESULTS: In this study, we found the following findings in the patients: the most common co-morbidite was hypertension in 39 (29.5%) patients, the most common complaints of the patients presenting to the Cardiology outpatient clinic was chest pain in 48 (36.40%) patients, the most common EGG finding was sinus tachycardia in 11 (8.3%) patients, the most common TTE finding was mild tricuspid regurgitation in 63 (47.70%) patients. In this study we have found systolic pulmonary artery systolic hypertension rate 6.10% and the rate was higher than compared to the normal population. It was remarkable that pericardial hyperechocenicity was detected in 18 (13.60%) patients. We detected elevated D-dimer levels were detected in 24 (18.20%) patients, elaveted NT-pro BNP levels in 15 (11.40%) patients and elevated hs-cTn levels in 9 (6.8 %) patients.
DISCUSSION AND CONCLUSION: The patients should be evaluated in the Cardiology outpatient clinic to investigate whether they have late-term cardiac effects due to COVID-19 infections.

29. Social Media Addiction and Related Factors among Turkish Nursing Students
Rukiye Pınar Bölüktaş
doi: 10.5505/ktd.2022.33341  Pages 203 - 210
INTRODUCTION: Nursing is a profession which is in direct contact with people and requires face-to-face communication. However, in recent years, social media addiction (SMA) has become widespread among nurses and nursing students. It is obvious that the inactive time spent on social media will negatively affect the quality of the nursing service provided. For that reason, nursing students should be taught to use social media effectively in the context of information technology during their education. To do this, first of all, it is necessary to determine whether there is an addiction problem in the use of social media in nursing students. Therefore, this study aims to investigate SMA and the affecting factors among Turkish nursing students.
METHODS: In this descriptive study, 197 nursing students were completed the Social Media Addiction Scale. Independent unpaired t-tests, one-way ANOVA test, chi-square test, and Pearson’s correlation coefficient were used as statistical tests.
RESULTS: In this descriptive study, 197 nursing students were completed the Social Media Addiction Scale. Independent unpaired t-tests, one-way ANOVA test, chi-square test, and Pearson’s correlation coefficient were used as statistical tests.
DISCUSSION AND CONCLUSION: Social media addiction was commong among nursing students. The limitation of the use of mobile telephones in theoretical, laboratory and clinical practice in nursing education may be a useful to prevent or minimize SMA.

30. Evaluation of Abdominal Ultrasonography Findings in Pediatric Patients with Functional Dyspepsia
Sibel Yavuz, Cemil Oktay
doi: 10.5505/ktd.2022.32309  Pages 211 - 218
INTRODUCTION: Dyspepsia is a condition involving the upper digestive tract and is characterized by one or more upper abdominal symptoms such as epigastric pain or discomfort, unusual postprandial fullness, bloating, nausea, heartburn, and early satiety. Gastroscopy and ultrasonography are the most frequently used examinations in dyspeptic patients. The aim of our study is to retrospectively evaluate the abdominal ultrasonography (US) findings of cases with functional dyspepsia.
METHODS: Patients who were diagnosed with dyspepsia and had abdominal ultrasonography between June 2019 and December 2020 in the pediatric gastroenterology outpatient clinic were included in the study. The patients’ ages, genders, anthropometric measurements and ultrasonographic findings were evaluated.
RESULTS: 103 patients (62 girls, 41 boys) were included in the study and the mean age was 140.8 months. Normal abdominal ultrasonography findings were present in %75.7 (n=78) of the patients. Cholelithiasis was the most common pathology detected in ultrasonography with %5.8 (n=6).
DISCUSSION AND CONCLUSION: Dyspepsia is a common and important health problem among the reasons for applying to health institutions. Ultrasonography is an effective, practical, economical and non-invasive examination in distinguishing organic and functional dyspepsia.

31. The Effect Of Ranolazine Treatment Administered Before Coronary Artery Bypass Surgery On Perioperative Myocardial Damage In Patients With Stable Angina Pectoris
Mehmet Fatih Yılmaz, Süleyman Cağan Efe, Emrah Acar, Çetin Geçmen, Mehmet İnanir, Can Yücel Karabay, İbrahim Akın İzgi, Cevat Kırma
doi: 10.5505/ktd.2022.20438  Pages 219 - 225
INTRODUCTION: Ranolazine is a piperazine derivative that has been approved as an antianginal agent. It is primarily used as a second- line antianginal agent in stable coronary artery disease. The study was designed considering that the active ingredient ranalozine, which has antiischemic effects through ischemic sodium channels, can reduce ischemia in the perioperative period and reduce the frequency of perioperative myocardial infarction.
METHODS: The study included patients with stable angina pectoris who underwent coronary angiography between January 1, 2015 and June 30, 2016 at Koşuyolu Training and Research Hospital and who were diagnosed with multi-vessel disease or LMCA disease, and then for whom the joint council of Cardiology-Cardiovascular Surgery made a decision in favor of coronary artery bypass grafting.
RESULTS: The mean age was 61.2 ± 8.6 years in the ranolazine group, while the mean age of the patients receiving standard therapy was 57.9 ± 8.8 years (p = 0.073).The EuroSCOREs of the patients before the operation which were used to predict intraoperative mortality were similar. Mean troponin value of Group 1 patients at 0 hour was 1.70 (1.13-2.77), while mean troponin value of the patients in Group 2 at 0 hour was 2.76(1.69-6.20) (p=0,01).
DISCUSSION AND CONCLUSION: In the present study, the immediate postoperative troponin 0 value was found to be lower in the ranolazine group. There was no statistical difference in terms of troponin values measured at 12 and 24 hours. In this study, we showed that early myocardial damage was significantly reduced with ranolazine treatment.

32. Pilomatrixoma: Clinical and Histopathological Analysis of 78 Cases
Özlem Durak, Gamze Erkılınç, Yaşar Arslan, Nermin Karahan, Mustafa Asım Aydın
doi: 10.5505/ktd.2022.79446  Pages 226 - 233
INTRODUCTION: Pilomatrixoma (PM) is a tumor that arises from the pluripotent precursor matrix cells of hair follicles. Including two different types of cell are seen in histopathological examination which are basaloid cells with nuclei and ghost cells with eosinophilic appearance that have lost their nucleus. In ghost cells, dystrophic calcification, osseous metaplasia, and foreign body type multinuclear giant cell reaction and inflammation developing against keratin can be seen around the lesion. It often presents as a well-circumscribed mass under the skin. It is most often localized in the head and neck.
METHODS: Between 2007-2019, 78 cases diagnosed with PM were included in the study the Hematoxylin&Eosin stained preparations of the cases were evaluated retrospectively.
RESULTS: The age of the cases ranged from 1 to 80 years old, and most of them were observed in the 2nd decade (33.3%). The female / male ratio is 1.3 / 1. The most common localization was determined as head and neck (48.7%). The average diameter of the lesions was 1.25 cm. Histopathological examination revealed foreign body reaction and inflammation in 16 (20.5%) cases, osseous metaplasia in 7 (9%) cases, calcification in 12 (15.3%) cases, cystic areas in 11 (14.1%) cases. Ulceration was observed on the surface of 2 (2.6%) cases and proliferation, pleomorphism and slightly increased mitosis were observed in 1 (1.3%) case in basaloid cells.
DISCUSSION AND CONCLUSION: Pilomatrixoma is benign tumor and it should be kept in mind in differential diagnosis of subcutaneous lesions, especially in head and neck localization in young patients.

33. Evaluation of Sedation With Sevoflurane in Magnetic Resonance Imaging in Pediatric Patients
Tahsin Şimşek, Hande Gürbüz Aytuluk, Mehmet Yılmaz, Aynur Kaynar Şimşek, Ayse Zeynep Turan Cıvraz, Kemal Tolga Saraçoglu
doi: 10.5505/ktd.2022.56244  Pages 234 - 238
INTRODUCTION: Deep sedation is needed in children during magnetic resonance imaging (MRI). A lot of different anesthetic drugs have been used for this purpose. In this study, it was aimed to retrospectively evaluate the use of sevoflurane for sedation during MRI in pediatric patients.
METHODS: For the study, the records of patients aged 0-12 years who underwent MRI between January 2018 and February 2019 at Derince Training and Research Hospital were examined. Patients demographic information, hemodynamic data, procedure types, procedure time, complications and recovery time were statistically evaluated.
RESULTS: 187 patients who were classified as American Society of Anesthesiologists (ASA) 1-2 risk groups were included in the study. The average duration of anesthesia was 19.88 minutes + 11.73 minutes. There was no significant difference between the beginning and end values of the patients heart rate, end-tidal carbon dioxide pressure, and peripheral oxygen saturation
(p>0,05). The time to get an Aldrete recovery score of 8 and above was 1.42+0.68 minutes
No complications were observed in 99% of the patients, only in two patients saturation is decreased to 88%.
DISCUSSION AND CONCLUSION: In this study, in which the use of sevoflurane was evaluated, findings such as the patients were hemodynamically stable during the procedure, no complications developed in 99% of the patients, and the shortness of recovery period were evaluated as important findings
As a result, it was concluded that sevoflurane is an anesthetic agent that can be used safely in pediatric MRI.