E-ISSN: 2148-4570 • ISSN:2148-4570
ANKARA MEDICAL JOURNAL - Ankara Med J: 22 (1)
Volume: 22  Issue: 1 - 2022
ORIGINAL ARTICLE
1.Assessment of Pregnancy Follow-Ups For Cases Registered in a Family Health Center
Halil Alper Aslan, Raziye Desdicioglu, Gülin Feykan Yeğin
doi: 10.5505/amj.2022.37108  Pages 1 - 12
INTRODUCTION: Our research aimed to evaluate the antenatal care (ANC) and pregnancy outcomes for pregnant cases registered with a family practice unit providing primary health services.
METHODS: Data for 385 pregnant cases aged 18 to 40 years registered with a family health center from 15/07/2010 to 01/02/2019 were screened from the "Family Practice Information Management System" database. Data regarding antenatal visits were statistically investigated and the p-value below 0.05 was accepted as significant.
RESULTS: The mean age was 28.66±5.36 years. The mean pregnancy week of first attendance was 9.59±5.52. Of pregnant cases, 89.61% received iron, 47.79% vitamin D and 63.63% folic acid supplements. Of the patients, 81.81% had the first trimester, and 76.88% had second-trimester screening tests. 71.42% of patients had gestational diabetes screening, and 88.83% had detailed ultrasonography. 78.44% of patients had tetanus-diphtheria vaccination, while no pregnant case had influenza vaccination. The age and gravida did not affect receiving ANC, vitamin D, iron supplementation and tetanus-diphtheria vaccination status. Vitamin D use was higher in groups receiving education compared to those not receiving education. When the educated group was assessed among themselves, the use of supplements reduced as the educational level increased.
DISCUSSION AND CONCLUSION: There is a need to increase referrals for iron, vitamin D, and folic acid supplementation and for screening during antenatal follow-up. The tetanus-diphtheria vaccination rate was observed to be lower than ideal. Additionally, it appears administration of seasonal flu vaccines is deficient, and necessary steps should be taken to reduce concerns related to vaccination.

2.Evaluation of the General Demographic Characteristics of Colon Cancer Patients: Is There a Difference between Male and Female Patients?
Rıdvan Erten, FATMA KAPLAN EFE, Büşragül Yılmaz, Mehmet Poyrazer, Atacan Aras, Ümmügül Üyetürk
doi: 10.5505/amj.2022.41103  Pages 13 - 23
INTRODUCTION: Colon cancer (CC) is seen in both sexes at the third frequency, and it is the cause of cancer-related deaths at the second frequency despite the advances in diagnosis and treatment. This study, it was aimed to evaluate the patients diagnosed with CC and their general demographic features in Bolu.
METHODS: CC patients' gender, age, body mass index (BMI), the primary location of the tumor, pathological diagnosis, grade, staging, location of metastasis and treatments administered were recorded retrospectively.
RESULTS: Those diagnosed with CC constituted16.54% of all cancer patients during the study period. 199(60.49%) of 329 patients included in the study were male, and 130 (39.51%) were female. The median diagnosis age in men and women was 64 years, the maximal age range of diagnosis was 60-69 years (32.66% and 32.22%, respectively). It was found that 6.53% of men and 26.15% of women were obese. The pathological diagnosis of 317 (96.35%) of the patients was adenocarcinoma, and the highest Grade 2 tumors subsisted (48.63%) (p= 0.696). The most diagnosed stage was stage III in men (36.68%) and stage II in women (38.46%) (p=0.044). While the appeal with the metastatic stage was 25.13% in men, it was seen at 17.69% in women (p=0.044).
DISCUSSION AND CONCLUSION: In Bolu, CC is among the cancers in the early stage diagnostic screening program. It is important to increase the training and participation in these programs and to provide healthy nutrition and exercise training to avoid obesity which plays an important role, especially in women, in CC etiology. In addition, prospective studies should be carried out to prevent data loss and to reach healthy statistical results in our country.

3.Determination of Physical Activity Levels of Patients with Diabetes Mellitus and Evaluation of Its Relationship with Treatment Compliance
Halil Okur, Sibel Tunç Karaman, Okcan Basat
doi: 10.5505/amj.2022.41713  Pages 24 - 36
INTRODUCTION: Physical activity is a crucial component of the treatment of Diabetes Mellitus (DM). This study aimed to determine the physical activity levels of patients with DM and evaluate the relationship between their adherence to treatment.
METHODS: The study was designed as a single-center, prospective, analytical study. It was conducted with patients who applied to the Family Medicine Outpatient Clinic for any reason, those who had a diagnosis of DM for at least one year. Sociodemographic data, anthropometric measurements, fasting blood glucose, and HbA1C levels were recorded. Physical activity levels were assessed using the General Practice Physical Activity Questionnaire (GPPAQ) and the International Physical Activity Questionnaire (IPAQ). The levels of compliance with drug treatment were assessed using the Modified Morisky Medication Adherence Scale-8 (MMMAS-8).
RESULTS: The mean age of 237 people included in the study was 51.32 ± 8.62 years (25-65), and most were women (n=141; 59.49%). The majority of the participants were physically inactive. (according to IPAQ n=143, 60.34%; GPPAQ n=161, 67.93%). 55.70% (n=132) had a moderate-high level of treatment compliance. No statistically significant correlation was determined between both scales measuring physical activity level and compliance of individuals to drug treatment (p=0.110 for GPPAQ; p=0.714 for IPAQ).
DISCUSSION AND CONCLUSION: No significant correlation was found between the physical activity levels of patients with DM and their compliance with drug therapy. However, it has been observed that the results obtained with GPPAQ, a new measurement tool that can be easily applied in primary care, are also instructive.

4.Differences between office and ambulatory blood pressure measurements in patients using triple antihypertensive treatment
Tahir İsmailoğlu, Umit Aydogan, Cem Barcin
doi: 10.5505/amj.2022.60133  Pages 37 - 48
INTRODUCTION: It has been suggested that blood pressure (BP) measurements in the office/clinic may fall short of detecting phenomena such as a white coat or masked hypertension (HT). In this cross-sectional study, we aimed to evaluate the differences in office and ambulatory BP measurements (ABPM) and investigate the secondary causes in patients using triple antihypertensive medication.
METHODS: Of the included 57 patients using triple antihypertensives, 28 had high office BP measurements (HOM-HT group), whereas 29 had normal office BP values (NOM-HT group). Both groups underwent an ABPM. Also, serum biochemistry, 24-hour urine tests, Epworth Sleepiness Scale, and renal artery Doppler assessments were performed to detect secondary causes of HT. Groups were compared regarding ABPM values, tests, scale results, and secondary causes.
RESULTS: No significant differences were found between the demographics and serum tests. According to the ABPM, white coat HT was detected in 15 patients (53.67%) in the HOM-HT group, whereas five (17.24%) in the NOM-HT group had masked HT (p=0.018). In three patients, secondary causes were detected (hyperaldosteronism, renal artery compression, and sleep apnea), all of whom were in the HOM-HT group. The groups did not differ significantly regarding the frequency of secondary causes (p=0.112). In contrast to when the ABPM is taken into account (16.66% vs. 0% p=0.028).
DISCUSSION AND CONCLUSION: Data of the present study showed that ABPM is necessary to detect white coat and masked HT. Also, depending on ABPM rather than office/clinic measurements may save time and expenses when investigating secondary causes.

5.The positivity rate of COVID-19 PCR test performed for screening before thyroid fine needle aspiration biopsy
Müge Keskin, Sefika Burcak Polat, Belma Ozlem Tural Balsak, Narin Nasiroglu Imga, Husniye Baser, Rahmet Guner, Cevdet Aydın, Oya Topaloglu, Reyhan Ersoy, Bekir Cakir
doi: 10.5505/amj.2022.51333  Pages 49 - 58
INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome. Coronavirus 2 (SARS-CoV-2) is spreading rapidly around the world. Asymptomatic infection is highly contagious, potentially leading to viral spread. We aimed to determine the rate of patients positive for COVID-19 PCR performed for safety measures before thyroid fine-needle aspiration biopsy (FNAB).
METHODS: The patients applied to Ankara City Hospital, Endocrinology and Metabolism Clinics between 15.03.2020 and 15.08.2020 and underwent routine COVID-19 PCR test before FNAB were evaluated retrospectively. Age, gender, history of hypertension and Type 2 Diabetes Mellitus (T2DM), use of levothyroxine (LT4) or antithyroid drug, 25-hydroxyvitamin D3 [25(OH)D3], TSH, freeT3 (fT3), free (fT4) levels, FNAB results were obtained from the records.
RESULTS: Asymptomatic COVID-19 infection was detected in 29 (2.43%) of 1195 patients who underwent FNAB. There was no statistically significant difference between patients with COVID-19 PCR test positive asymptomatic and negative patients in terms of age, gender, median values of 25(OH)D3, TSH, fT3, fT4, the ratio of hypertension and T2DM.
DISCUSSION AND CONCLUSION: The healthcare professionals work devotedly against COVID-19 infection, demonstrating a great example of struggle worldwide. FNAB is an invasive procedure requiring close contact. It should be known by the clinician that COVID-19 infection is associated with a high risk of transmission in asymptomatic patients. The rate of 2.43% in the population can not be underestimated and indicates the importance of the use of personal protective equipment and taking infection prevention measures.

6.Assessment of Smoking Habits of Healthcare Professionals during the Covid-19 Pandemic Period
Muhammet Sinan, Duygu Yengil Taci, İzzet Fidancı, Ismaıl Arslan, Mustafa Çelik
doi: 10.5505/amj.2022.69926  Pages 59 - 68
GİRİŞ ve AMAÇ: Çalışmamız, koronavirüs hastalığı-2019 (COVID-19) pandemisinde en ön sırada yer alan ve enfeksiyon kapma riskine en çok maruz kalan sağlık çalışanlarının sigara içme alışkanlıklarını ve bu alışkanlıkları etkileyen faktörleri değerlendirmeyi amaçlamıştır.
YÖNTEM ve GEREÇLER: Salgın sırasında halen sigara kullanan, kullanmayı bırakan ya da bu dönemde sigaraya kullanmaya başlayan 18 yaş ve üzeri 285 sağlık çalışanının tamamı çalışmaya dahil edildi. Katılımcılara yüz yüze görüşme yöntemiyle sosyodemografik veri formu ve envanterleri uygulanmıştır.
BULGULAR: Pandemi öncesi dönemde, 31 (%10.88) katılımcının tamamı sigara kullanmayıp pandemi döneminde sigara kullanmaya başlamış; 230 (%80.70) katılımcının pandemi öncesi dönemde sigara kullandığı ve halen sigara kullanmaya devam ettiği ve 24'ü (%8.42) katılımcılar pandemi öncesi dönemde sigara kullanırken pandemi nedeniyle sigara kullanmayı bıraktı. Sigarayı kullanmayı bırakıp bırakmamayı düşünen ve sigaranın COVID-19 enfeksiyonundan ölümleri artırdığını düşünen sağlık çalışanlarının daha fazla kaygı yaşadıkları görüldü (sırasıyla p=0,012; p=0,027).
TARTIŞMA ve SONUÇ: COVID-19 olan ve yakınını COVID-19 nedeniyle kaybeden sağlık çalışanları arasında anksiyete puanları yüksek bulundu. Anksiyete puanı yüksek olan sağlık çalışanlarının içtikleri sigara miktarının önemli ölçüde azaldığı belirlendi.
INTRODUCTION: Our study aimed to assess the smoking habits of healthcare professionals who are at the forefront of the coronavirus disease-2019 (COVID-19) pandemic and are most exposed to the risk of getting infected and the factors affecting those habits.
METHODS: All of 285 healthcare professionals who are 18 years old and over and are still smoking or quit smoking during the pandemic or started smoking during this period were included in the study. A sociodemographic data form and inventories were administered to the participants through the face-to-face interview method.
RESULTS: All of 31 participants (10.88%) did not smoke in the pre-pandemic period but started smoking during the pandemic period, 230 participants (80.70%) were smokers in the pre-pandemic period and still continued to smoke, and 24 (8.42%) participants quit smoking due to the pandemic while they were smoking in the pre-pandemic period. It was observed that healthcare professionals considering whether or not to quit smoking and considering that smoking increased deaths from COVID-19 infection experienced more anxiety (respectively p=0.012; p=0.027).
DISCUSSION AND CONCLUSION: Anxiety scores were found to be high among healthcare professionals who had COVID-19 and those who lost someone close to them due to COVID-19. It has been determined that the number of cigarettes smoked by healthcare professionals with high anxiety scores has decreased significantly.

7.The Knowledge about Sexuality and Sexually Transmitted Diseases of Syrian Women and Men Immigrated to Hatay-Antakya: A Qualitative Study
Kadriye Şahin, Pınar Döner Güner
doi: 10.5505/amj.2022.71677  Pages 69 - 80
GİRİŞ ve AMAÇ:

YÖNTEM ve GEREÇLER: Çalışma, Suriye'den göç etmek zorunda kalan 12 kadın ve 12 erkek katılımcı ile derinlemesine görüşmelerden oluşmaktadır. Araştırmada nitel yöntem kullanılarak, bulgular betimsel analiz tekniği yorumlanmıştır.
BULGULAR: Araştırma sonucunda kadın ve erkeklerin evlilik öncesi cinsellik konusunda farklı bilgi düzeylerine sahip oldukları, özellikle kadınların bunu evlilikten sonraki ilk gece yaşadıkları ve erkeklerin cinselliğe daha aşina oldukları belirlenmiştir. Evlilik öncesi cinsellik ve cinsel yaşam üzerine konuşmak hem tabu hem de kadınların namusu ile ilişkili tutulmaktadır. Yeterli eğitim almadıkları için cinsel yolla bulaşan enfeksiyonlar (CYBE) hakkında gerekli bilgiye sahip değillerdir.
TARTIŞMA ve SONUÇ: Erken yaşta evlendirilmeye zorlanan kız çocukları erken yaşta cinsel deneyimler yaşamakta; cinsellik, inanç ve kültürel gerçekler konusunda yetersiz bilgi ve tecrübeleri bazı travmatik süreçlere neden olmaktadır. Kadın ve erkeklere cinsellik konusunda verilen eğitim ve CYBE konusunda farkındalık arttırılmalıdır.

INTRODUCTION: The aim of this study is to comparatively present the knowledge and experiences about sexuality and the sexually transmitted infections in both the men and women migrating from Syria to the nearest province, Hatay-Antakya in Turkey, due to the ongoing internal conflicts in Syria.
METHODS: The study consists of in-depth interviews with 12 female and 12 male participants who had to migrate from Syria. In the research, using the qualitative method, the findings were interpreted using the descriptive analysis technique.
RESULTS: In consequence of the study, women and men were determined to have different knowledge levels on sexuality before marriage, especially women to have experienced it at first night after marriage and men to be more familiar with sexuality. To have a speech on sexuality and sex life before marriage is taboo, and it's keeping the "honor" under control for women. As they have not received sufficient education, they do not have enough information about sexually transmitted diseases (STD).
DISCUSSION AND CONCLUSION: As a result, girls having been forced to get married at an early age have sexual experiences prematurely; their inadequate knowledge and experience about sexuality, belief and cultural truths cause certain traumatic processes. The education provided to men and women on sexuality and awareness about STD should be raised.

8.The Relationship Between Children with Psychiatric Disorder and Personality Traits of Their Mothers
Dilşad Yıldız Miniksar
doi: 10.5505/amj.2022.76402  Pages 81 - 92
INTRODUCTION: The aim of our study was to determine whether there is a relationship between maternal personality traits and the child's psychiatric disorder.
METHODS: The data for this cross-sectional case-control study were collected from mothers of 134 children with a psychiatric disorder who applied to the child psychiatry department of a university hospital between February and June 2021 and the mothers of 92 children without any psychiatric disorders. Participants were evaluated by using Eysenck Personality Questionnaire Revised-Short Form.
RESULTS: A total of 226 mothers participated in our study, 59.29% (134) of whom were the mothers of a child diagnosed with a psychiatric disorder, and 40.71% (92) were the mothers of a healthy child. The neuroticism and psychoticism scores were significantly higher in the mothers of the patient group, and the extraversion score was significantly higher in the mothers of the control group. (p <0.001). There was no significant difference between the two groups in terms of lie traits scores (p = 0.309). While the highest maternal extraversion scores were seen in the group with skin picking disorder followed by attention deficit and hyperactivity disorder (ADHD), the highest lie traits score was found in the mothers of children with ADHD. Neuroticism and psychoticism scores were the highest, while extraversion scores were the lowest in mothers of children with intellectual disabilities.
DISCUSSION AND CONCLUSION: We determined that there was a significant relationship between the presence of psychiatric disorders in children and the personality traits of the mothers.

9.Effects of active/passive smoking exposure in patients with COPD
Nurgul Bozkurt, Ali İhsan Bozkurt
doi: 10.5505/amj.2022.79026  Pages 93 - 103
INTRODUCTION: Smoke exposure of COPD (Chronic Obstructive Pulmonary Disease) patients increases the frequency of exacerbations and affects the quality of life. However, most patients still continue to active/passive smoking exposure after being diagnosed with COPD. In this study, the effects of active/passive smoking exposure on symptoms exacerbation/pulmonary functions in COPD patients were investigated.
METHODS: Totally 151 COPD patients were included in the study. Patient data on active/passive smoking exposure and exacerbation frequency, and COPD Assessment Test(CAT), modified Medical Research Council dyspnea scale(m-MRC), and pulmonary function tests(PFT) were recorded. As well as active smoking exposure, these parameters were especially evaluated in ex-smoker COPD patients according to passive smoking exposure. The data were evaluated in SPSS 22.0 program; X2 and student t-tests were applied.
RESULTS: Active/passive exposure was determined (26.49% and 43.05%, respectively). Total cigarette consumption was 1.5 times higher in men, and passive smoking exposure (69.56%) was higher in women. In addition, it was determined that the m-MRC score increased statistically significantly as exposure to passive cigarettes increased. It was observed that the number of exacerbations increased in ex-smoker COPD patients with passive exposure. Another finding in the study; was determined that the increase in each standard deviation in cigarette consumption caused a 19% decrease in pulmonary function capacity and an increase in m-MRC, CAT scores.
DISCUSSION AND CONCLUSION: Active/passive smoking exposure was detected in most COPD patients. It was determined that continuous smoking exposure in patients caused an increase in the number of exacerbations and a deterioration in the quality of life. Therefore, it is necessary to increase awareness of passive smoking exposure in the management of COPD patients.

10.An examination of the effectiveness of digital applications for obese patients whose follow-up and treatment were disrupted due to the COVID-19 pandemic
Remziye Nur Eke, Yalcin Albayrak, Seçil Kuru, Hatice Esen
doi: 10.5505/amj.2022.96729  Pages 104 - 117
INTRODUCTION: This study aimed to investigate the effectiveness of digital technologies in the follow-up and treatment of obesity patients during the COVID-19 pandemic.
METHODS: Prospective case-control study was carried out at the Obesity Centre of Antalya Training & Research Hospital. While 30 obese patients in the project group were followed and guided 7/24 for three months with smartphones/smart wristbands, 27 control patients were followed up with face-to-face meetings every two weeks as standard. Project group patients were evaluated in terms of calorie consumption, conditions regarding exercises, sleep and stress, and laboratory data in addition to anthropometric measurements at the beginning and end of the project, while control group patients were evaluated only in terms of anthropometric measurements.
RESULTS: Mean age of patients in the project group was 42.57 ± 7.57 years, and the control group was 54.63 ± 6.20 years. Of all the patients, 94.74% of them were female, while 5.26% were male. At the end of the project, the weight of the project group patients dropped from 92.25 kg to 89.70 kg, and their BMI from 35.60 kg/m2 to 34.80 kg/m2 (p<0.001). In addition, a statistically significant decrease was found in laboratory parameters such as HbA1c and triglyceride levels, as well as systolic and diastolic blood pressures. There was a minimal decline in weight and BMI of the control group, which was not statistically significant.
DISCUSSION AND CONCLUSION: Online and/or smartphone/smart wristband-based follow-up and guidance can be used as an effective method in the treatment of patients with obesity who do not tend to go to the hospital due to pandemics.


11.Evaluation Of The Relationship Between High-Density Lipoprotein Cholesterol Levels And Community-Acquired Pneumonia Severity In Adult Patients
Habibe Hezer, Ebru Sengul Parlak, Afra Alkan, Hatice Canan Hasanoglu, Emine Argüder, Berker Öztürk, Aysegul Karalezli
doi: 10.5505/amj.2022.98957  Pages 118 - 128
INTRODUCTION: Inflammation and acute phase reactions lead to altered high-density lipoprotein cholesterol (HDL-C) concentrations. This study aimed to evaluate HDL-C levels in community-acquired pneumonia (CAP) and to determine the predictive value of disease severity in CAP.
METHODS: In this prospective cross sectional study was conducted in the Department of Pulmonary Diseases. One hundred twenty-five adult patients with CAP were included in the study. Patients were classified into three groups as follows: Group 1; outpatients, Group 2; hospitalized patients and Group 3; patients admitted to the intensive care unit. C-reactive protein (CRP), procalcitonin (PCT) and HDL-C levels were evaluated at baseline, 7th and 30th days in all CAP patients. The relationship between CRP, PCT and HDL-C levels was investigated. Diagnostic performance of baseline HDL-C levels was assessed using receiver-operating characteristic (ROC) curve analyses.
RESULTS: HDL-C levels were found to be decreased in all groups compared to their normal ranges. There was a significantly negative correlation between HDL-C and CRP and PCT (Spearman’s r= -0.557, r= -0.841, respectively; p< 0.001). The sensitivity and specificity of HDL-C cut-off value were 0.738 (95% CI: 0.580-0.861) and 0.875 (95% CI: 0.732-0.958), with an overall accuracy of 0.861 (95% CI: 0.728-0.935).
DISCUSSION AND CONCLUSION: HDL-C levels can be used as an acute phase reactant in patients with CAP.

12.The Effect of Bariatric Surgery on Calcium Metabolism
Müge Keskin, Doğan Öztürk, Arzu Or Koca, Leyla Ipek Rudvan Al, Derun Taner Ertuğrul, Hakan Buluş
doi: 10.5505/amj.2022.70298  Pages 129 - 139
INTRODUCTION: Obesity is one of the most important chronic metabolic diseases that includes many comorbidities. Lifestyle changes play the most important role in the treatment of obesity. Despite this, medical treatment and bariatric surgery procedures gain importance in patients whose weight control can not be achieved. In recent years, sleeve gastrectomy (SG) has become very popular. Nevertheless, its effects on gastrointestinal system physiology and bone metabolism are still not known properly.
METHODS: Fifty-two patients who underwent SG between 2018 and 2019 were included in our observational study. Calcium, albumin, albumin-adjusted calcium (AAC), phosphorus (P), 25-hydroxyvitamin D [25(OH)D], alkaline phosphatase (ALP), parathyroid hormone (PTH), creatinine, glomerular filtration rate (GFR) and body mass index (BMI) of the patients were recorded both in the pre-operative period and three months postoperatively. Patients were grouped as patients with low calcium (10.2mg/dL) according to pre-operative and post-operative calcium levels.
RESULTS: The mean age of the patients was 38.96±8.93 years. 1 (8.33%) out of 12 patients with high serum calcium levels in the pre-operative period had low serum calcium levels in the post-operative period, eight patients (66.67%) had normal reference values, three patients (25%) had high serum calcium levels, the difference was significant. Based on ACC, eight patients (15.38%) had high calcium levels postoperatively.
DISCUSSION AND CONCLUSION: Hypocalcemia, normocalcemia, and hypercalcemia may be observed during the follow-up after bariatric surgery. Although PTH and 25(OH)D play the most important roles in calcium metabolism, the interaction of bone- gut hormones is still unclear and complicated.

13.Effects of reconstruction of health care on service delivery performance in Turkey: The Public Hospital Unions
Hasan Bağcı, Seyhan Çil Koçyiğit
doi: 10.5505/amj.2022.98958  Pages 140 - 154
INTRODUCTION: In this study, the performance of 555 public hospitals was evaluated to research the impact of the Public Hospital Unions (PHU) practice applied in Turkey.
METHODS: Performance has two dimensions: efficiency and effectiveness. The scores obtained as a result of Data Envelopment Analysis (DEA) and Malmquist Index (MI) methods were taken as efficiency indicators. The degree of achievement of the targets was taken as effectiveness indicators, and the evaluation of effectiveness was performed by examining to what extent it has gotten closer to the targeted values on the Strategic Plans prepared by Turkey Public Hospitals Authority (TPHA).
RESULTS: According to the results of the DEA-VRS model, the percentage of efficient hospitals; was 69% in 2012, 74% in 2013, 70% in 2014, 70% in 2015, and 71% in 2016. According to the results of the DEA-CRS model, the percentage of efficient hospitals; was 55% in 2012, 60% in 2013, 56% in 2014, 55% in 2015, and 53% in 2016. The efficiency changes of all hospitals between the period of 2012-2016 were analyzed by the MI method, and the Technical Efficiency Change (TEC), Technological Change (TC), and Total Factor Productivity (TFP) values of the hospitals were found to decrease by 45%, 87%, and 72%, respectively.
DISCUSSION AND CONCLUSION: The public hospital unions (PHU) model, which was created to use resources effectively and efficiently in the field of health, did not significantly enhance hospitals' performance.

14.How Does a Woman's Reproductive and Breast-Feeding History, Weight, Height, Body Mass Index, Breast Size and Breast Density Affect The Radiation Dose She Takes During Mammography?
Leman Günbey Karabekmez, Karabekir Ercan
doi: 10.5505/amj.2022.71224  Pages 155 - 166
INTRODUCTION: Mammography is the screening test for breast carcinoma. The radiation dose received during this imaging has always been a point of consideration. The aim of this study is to search the relation of radiation dose received during mammographic imaging and the patient's age, menarche age, menopause age, childbirth history, total time of breastfeeding, height, weight, body mass index, mammographic breast density pattern and breast size.
METHODS: Patients applying for mammography imaging were questioned about their menarche age, menopause status and age and their weight, height, and breast upper and inferior mammary fold sizes were measured. Their mammographic breast density and radiation doses were recorded. Statistical analysis was made with ANOVA and Pearson correlation.
RESULTS: Breast size, weight, body mass index are found to be related to the radiation dose received during mammography. Age, number of given births, weight, body mass index and breast size have an effect on the mammographic breast density, which is a factor in both developing and diagnosing breast carcinoma.
DISCUSSION AND CONCLUSION: Breast density on mammography can show differences according to the patient's reproductive history and body stature. Radiation dose taken during a mammography is found to be affected by body mass index and breast size. Breast tissue with increased adipose tissue is suitable for mammographic imaging in the aspect of radiation exposure.

CASE REPORT
15.Para-infectious Guillain Barre Syndrome in a Patient Diagnosed with COVID-19
Aliye Bastug, Hesna Bektas, Cansu Buyuktarakci, Hurrem Bodur
doi: 10.5505/amj.2022.61482  Pages 167 - 171
Accumulating evidence suggests the neurotropic characteristics of the SARS-CoV-2. Although the pathogenesis is unclear, the relationship between COVID-19 and Guillain Barre Syndrome(GBS) has been described previously. In this report, a 66-year-old male with para-infectious COVID-19-related GBS admitted with bilateral weakness in distal lower limbs was presented. Five days ago, since he had a risky contact with the COVID-19 patient, the SARS-CoV-2 PCR test was performed and resulted in positive. Favipiravir treatment was given as outpatient therapy. On the fifth day of antiviral treatment, he had applied to Emergency Department with two days of muscle weakness of lower extremities consistent with GBS; hence lumbar punction was performed. The cerebrospinal fluid examination revealed albumin-cytological dissociation. Despite the administration of immunoglobulin infusions, neurological findings worsened, dysphagia, and facial paralysis occurred. Although he was stable for COVID, he was followed up in the intensive care unit for plasmapheresis and then intubated for the respiratory involvement of GBS. Early diagnosis and treatment are critical in GBS related to COVID-19. Since para-infectious COVID-19-related GBS has poor outcomes, clinicians should be aware of this kind of complication to manage patients as it’s supposed to be.

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