E-ISSN: 2148-4570 • ISSN:2148-4570
ANKARA MEDICAL JOURNAL - Ankara Med J: 22 (2)
Volume: 22  Issue: 2 - 2022
ORIGINAL ARTICLE
1.The effects of intuitive eating on mental well-being and eating behaviors of health workers
Sedef Duran, Gülsüm Bozkurt, Dilek Doğan, Sümeyye Aygen, Ezgi Yıldırım
doi: 10.5505/amj.2022.99897  Pages 172 - 181
INTRODUCTION: Intuitive eating is identified as eating by hearing to and adapting to the physical hunger, satiety and satisfaction reactions given by the body naturally. The aim of this study was to research the effects of intuitive eating on mental well-being and eating behaviors in healthcare workers.
METHODS: The plan of this study included all health workers in the state hospital in Edirne. The questionnaires were filled by the researchers according to the answers given by the participants to the questions. The five sections in the questionnaire consist of demographic information, anthropometric measurements, Beck Depression Inventory (BDI), The SCOFF Questionnaire to screen for eating disorders and the Intuitive Eating Scale-2 (IES-2). Health workers were separated into two groups according to the intuitive eating scale-2 median score (Group 1: below 3.60; Group 2: 3.60 and above).
RESULTS: The participants' IES-2 mean score was 3.50 ± 0.59 (1.50 - 4.80). The BDI mean score of the participants in Group 1 was higher than that of those in Group 2. The number of participants with normal mental well-being according to the BDI score was lower in Group 1 than in Group 2. The number of participants exhibiting risky eating behavior according to the SCOFF score was higher in Group 1 than in Group 2.
DISCUSSION AND CONCLUSION: The health workers who ate intuitively had better mental well-being and fewer eating disorders than those who did not intuitively eat.

2.Knowledge, attitudes and behavior of physicians towards influenza infection and vaccination during pregnancy
Sibel Baktır Altuntaş, Gizem Kara Elitok, Bülent Altuntaş, Dilek Toprak
doi: 10.5505/amj.2022.23230  Pages 182 - 193
INTRODUCTION: In our study, we aimed to determine the knowledge, attitudes and behaviors of Family Physicians (FP) and obstetrics and gynecology (OB-GYN) physicians about influenza infection during pregnancy and the influenza vaccine administered during pregnancy, as well as the factors that influence them.
METHODS: This descriptive cross-sectional study included 419 OB-GYN and FP practicing in Istanbul between November 15, 2017, and March 15, 2018. A 14-item survey was administered face-to-face to assess sociodemographic factors, influenza vaccination recommendation status, and knowledge level regarding influenza infection and vaccination.
RESULTS: A total of 11.48% of the participants themselves had been vaccinated against influenza during pregnancy, and 48.68% of the participants recommended influenza vaccination during pregnancy. There was a statistically significant difference between vaccination recommendation status (p=0.014) and age (p=0.014), the institution of employment (p=0.002), specialty (p=0.008), having received the influenza vaccine during pregnancy (p<0.001), and find it beneficial to include pregnant women in the risk group for influenza vaccination (p<0.001). The independent variables of knowledge regarding influenza infection and vaccination during pregnancy (OR=2.60, p=0.034) and survey total score (OR=1.36, p<0.001) were found to be significantly associated based on the results of a multiple logistic regression analysis of influenza vaccine recommendation.
DISCUSSION AND CONCLUSION: The knowledge and awareness of physicians should be improved to increase influenza vaccination rates during pregnancy. Furthermore, incorporating influenza vaccines into the standard maternal immunization schedule might help in increasing the vaccination rates.

3.Analysis of intramuscular injections administered in a family health center
Onur Öztürk, Taner Tunç, Murat Esen, Muhammed Okuyucu, Muhammet Ali Oruç
doi: 10.5505/amj.2022.09068  Pages 194 - 203
INTRODUCTION: In this study, the objective was to evaluate the intramuscular injections administered to patients admitted to a family health center with sociodemographic characteristics.
METHODS: This is a cross-sectional, analytical and, retrospective file review study. The sample population was formed by patients who had intramuscular injections administered between the dates of January 01, 2017 – and December 31, 2019. A total of 5648 injections for 2059 adults/children were evaluated. The data set was analyzed using SPSS 17.0 (IBM, USA) statistical package program.
RESULTS: An average of 2.74 injections per person was administered. The rate of myorelaxant injection administration was higher among women (p<0.001), and the rate of antibiotic and analgesic + myorelaxant injection administrations was higher among men (p<0.001 for both). With the increase of age, the rate of analgesic injection administrations increases (p<0.001) and the rate of antibiotic injection administrations decreases (p<0.001). The highest analgesic + myorelaxant injection administration rate was during autumn, and the lowest was during winter (p=0.001).
DISCUSSION AND CONCLUSION: The results showed that the frequency of analgesic, myorelaxant, antibiotic, steroid, vitamin/mineral, hormone and combination drugs used for intramuscular injection were affected by demographic variables such as age, gender and season. Identifying family health center dynamics may contribute to creating rational health policies.

4.Retrospective analysis of 32,749 patients: A pilot orthopedic trauma registry study in Ankara province
İshak Şan, Mustafa Akkaya, Burak Bekgöz, Mehmet Emin Şimşek, Safa Gürsoy, Özgür Kaya
doi: 10.5505/amj.2022.17136  Pages 204 - 214
INTRODUCTION: Musculoskeletal injury is a public health concern that substantially increases the workload of emergency healthcare providers and hospitals in developing countries. Successful management of the diagnosis and treatment processes reduces healthcare costs and shortens the duration of preventable disabilities in patients with musculoskeletal injuries. Here, we aimed to investigate the musculoskeletal trauma distribution within five years within the borders of Ankara province.
METHODS: In this study, preliminary diagnoses of the patients with musculoskeletal injury made within five years (2014 – 2018) by emergency healthcare providers in Ankara were retrospectively screened through the Emergency Health Automation System – EHAS. The patients were classified according to age, gender and diagnosis.
RESULTS: This study included data for the time period between 2014 and 2018 from 32,749 patients, i.e., 19,523 male and 13,226 female patients in Ankara province. The number of patients was recorded for each year, and it was found that there was an increase in the number of patients between years. Musculoskeletal trauma was most commonly seen in the 19-64 (adult) age group, and the highest number of cases was observed in April. Hips and thighs were the most common trauma regions in the body.
DISCUSSION AND CONCLUSION: This study is the first to analyze data obtained from emergency healthcare providers in Turkey, and it can be considered a pilot study that can be utilized to eliminate the existing drawbacks and optimize registry systems by updating them.

5.Influence of Covid-19 pandemic on sexual life: What is the situation in an urban region of Turkey?
Begum Kurt, Sanem Nemmezi Karaca
doi: 10.5505/amj.2022.64614  Pages 215 - 229
INTRODUCTION: It was aimed to evaluate the effect of the Covid-19 pandemic on couples' sexual life and to investigate whether any difficulties were faced in supplying the proper counseling in family planning.
METHODS: Volunteers who attend to family medicine outpatient clinic were recruited in the study to complete a cross-sectional online survey. Participants were asked to sociodemographic characteristics, used family planning methods, difficulty in accessing the method, development of unplanned pregnancy, Covid infection of the spouses, and retrospectively report their sexual behavior frequency, desire, and relationship satisfaction during and before the pandemic. Then International Index of Erectile Function (IIEF), and the Female Sexual Function Index (FSFI) were administered.
RESULTS: A total of 195 volunteers whose mean age was 40±7.94 participated in the study. Difficulty in accessing family planning methods was 3.59%, and the unintended pregnancy rate was 57.14%. Sexual intercourse frequency was once a month or less for 17.95% and once a week or more for 67.18%. A decrease in sexual intercourse was observed in 33.33%. Erectile dysfunction was detected in 68.92%. Sexual dysfunction was found in 52.07% of the women. The mean FSFI score was 23.77 ± 8.27, while the median IIEF score was 60. The frequency of sexual intercourse, and change in sexual desire were not influenced by Covid-19 pandemic.
DISCUSSION AND CONCLUSION: Sexual life in both genders was not regressed, but access to methods and counseling about family planning was negatively affected by Covid-19 pandemic. Moreover, unintended pregnancies were observed at higher rates even in a highly educated population during the Covid-19 pandemic.

6.Can ischemia modified albumin level be regarded as an indicative marker of ulcerative colitis and its activity?
Mustafa Cengiz, Abdurrahman Sahin, Oktay Sarı
doi: 10.5505/amj.2022.44342  Pages 230 - 238
INTRODUCTION: We studied the effectivity of serum ischemia-modified albumin (IMA) levels in the diagnosis and clinical activity of patients suffering from Ulcerative Colitis (UC).
METHODS: Eighty-eight clinically and pathologically confirmed UC patients and 48 age- and sex-matched healthy volunteers were included in the study. The patients were classified according to the Rachmilewitz Score [Endoscopy activity index (EAI)], and those with a score below five were considered in the remission group, and those above five were considered as active disease group. The IMA levels were calculated by the colorimetric method.
RESULTS: When UC patients were compared to the control group, higher IMA levels were observed in the patient’s serum (0.48±0.25 g/L vs. 0.28±0.08 g/L), and the difference was statistically significant (p<0.001). Among UC patients, higher IMA levels were found in the active group (n: 36) compared to the remission group (n: 52) (0.72±0.20 g/L vs. 0.32±0.12 g/L, and p<0.001). Positive and statistically significant correlations between serum IMA levels and EAI scores (r: 0.81, p<0.001) were detected.
DISCUSSION AND CONCLUSION: Serum IMA level may be a suitable biomarker for the diagnosis and the clinical and endoscopic activity of UC disease. It may have diagnostic and prognostic features in UC disease.

7.Normocalcemic Primary Hyperparathyroidism is not innocent as it sounds
Şefika Burçak Polat
doi: 10.5505/amj.2022.82231  Pages 239 - 248
INTRODUCTION: Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia. A group of patients who were admitted with PHPT and had normal calcium levels with high parathyroid hormone (PTH) levels was defined as normocalcemic PHPT (NPHPT). The data of PHPT operated patients were retrospectively analyzed, and biochemical and clinical characteristics of hypercalcemic and normocalcemic patients were compared.
METHODS: The data of patients diagnosed with PHPT between January 2012 and January 2019 were retrospectively evaluated. A total of 318 patients were divided into two subgroups, hypercalcemic and normocalcemic, according to their calcium level. The two groups were compared regarding clinical and biochemical properties.
RESULTS: Female gender was dominant in both groups (P = 0.072). The mean age was similar in both groups (P = 0.362). As expected, serum corrected calcium (Ca), PTH levels, and urinary Ca excretion were higher in the hypercalcemia group (P < 0.001). There was no difference between the two groups in alkaline phosphatase, creatinine, and vitamin D levels. The percentage of localization with preoperative was similar. Also, there was no difference in adenoma features (echogenicity, cystic appearance) and localization on ultrasonography (US). The positive result obtained on neck MRI and MIBI scanning was similar. There was no difference between the two groups in terms of kidney stone and osteoporosis prevalence
DISCUSSION AND CONCLUSION: In our cohort, the NHPT phenotype was found to be like the hypercalcemic group. These findings suggest that the frequency of surgical indications is similar.

8.What are the parameters that predict the development of nephrolithiasis and osteoporosis in patients with primary hyperparathyroidism?
Hüsniye Başer, Beril Turan Erdoğan, Pervin Demir, Cevdet Aydın, Abbas Ali Tam, Reyhan Ersoy, Oya Topaloglu, Bekir Cakir
doi: 10.5505/amj.2022.85429  Pages 249 - 259
INTRODUCTION: Primary hyperparathyroidism (PHPT) is associated with an increased risk of nephrolithiasis and osteoporosis, and predicting the development of these diseases will reduce PHP-related morbidities.
METHODS: A total of 311 patients with PHPT due to parathyroid adenoma were evaluated retrospectively. The patients were divided into groups, as patients with and without nephrolithiasis and those with and without osteoporosis. Demographic and biochemical variables that could predict the development of nephrolithiasis and osteoporosis in these groups were examined.
RESULTS: Nephrolithiasis was observed in 24.44% of 311 PHPT patients. Serum creatinine (Cr), serum calcium (Ca), adjusted Ca (adj Ca), albumin and 24-hour urinary phosphorus (24h uP) levels were higher, and serum P-value was significantly lower in patients with nephrolithiasis than those without nephrolithiasis. In the Receiver Operating Characteristic (ROC) analysis, serum Cr ≥0.66 mg/dl, adj Ca ≥10.72 mg/dl, serum P ≤2.71 mg/dl and 24h uP ≥635 mg/day cut-off values were found to have high sensitivity and low specificity values on the risk of developing nephrolithiasis. Of all patients, 43.09% had osteoporosis, and it was determined that only ≥50.50 years (sensitivity 81.34%, specificity 49.51%) and intact parathyroid hormone ≥ 201.50 pg/mL (sensitivity 75.14%, specificity 41.04%) values could predict osteoporosis (Area Under the ROC curve ranged from 0.57 to 0.67).
DISCUSSION AND CONCLUSION: While biochemical parameters are useful in predicting nephrolithiasis in patients with PHPT, the development of osteoporosis seems to be less related to biochemical parameters.

9.The association between platelet to lymphocyte ratio and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation
Mujgan Tek, Fatma Kaplan Efe
doi: 10.5505/amj.2022.89896  Pages 260 - 269
INTRODUCTION: To assess the diagnostic value of platelet to lymphocyte ratio (PLR) with respect to the risk of left atrial appendage thrombogenic milieu (LAA TM) in patients with nonvalvular atrial fibrillation (AF), which has not been studied before.
METHODS: This is a retrospective study that included consecutive patients with non-valvular AF who underwent transesophageal echocardiography (TEE) prior to electrical cardioversion or prior to AF catheter ablation. The potential association between PLR and LAA TM, which was defined as the presence of a thrombus, sludge and spontaneous echo contrast in LAA, was analyzed using multivariate logistic regression analysis.
RESULTS: A total of 120 patients (59 females, mean age: 66.15 ± 10.2 years) with nonvalvular AF were included in the study. The thrombogenic milieu was determined in 37 (30.83%) patients on TEE examination. Patients with LAA TM were found to have a higher mean CHA2DS2-VASc score (3.00 vs. 2.00, p=0.009), decreased LAA velocity (23.60 vs. 36.20 m/s, p=0.002) and left ventricular ejection fraction (49.70 vs. 56.90 %, p=0.010), greater left atrial diameter (4.70 vs. 4.30 cm, p= 0.001) and higher PLR value (157.91 vs. 126.13, p=0.023) compared to those without thrombogenic milieu. Only LAA velocity (OR=0.854; p=0.001) and PLR (OR=1.024; p=0.012) were found to be independently associated with LAA TM.
DISCUSSION AND CONCLUSION: PLR may be an independent risk factor for LAA TM in nonvalvular AF patients; however, beyond research purposes, the rather low sensitivity and specificity values must be interpreted with caution in the routine clinical setting.

10.Evaluation of infection agent and antibiotic resistance distribution in palliative care patients with pressure ulcers
Reyhan Öztürk, Filiz Yıldırım, Zuhal Yıldırım, Asiye Çiğdem Şimşek, Hasan Karageçili
doi: 10.5505/amj.2022.55632  Pages 270 - 281
INTRODUCTION: In our study, it was aimed to examine the distribution of infectious microorganisms, and antibiotic resistance status in palliative care patients with pressure ulcers followed in Ankara Polatlı Duatepe State Hospital Palliative Care Service in 2019- 2020.
METHODS: The sex, age, and detected diseases of a total of 178 palliative care patients included in our study were analyzed retrospectively. For determining the causative agents of pressure ulcer infections in these patients, Gram staining was performed on the bacterial cultures that developed in the wound samples, and the Vitek-2 (bioMérieux, France) automatic test device was used to identify these cultures and determine their antibiotic susceptibility.
RESULTS: It was observed that the single-agent microorganism grew in 26 of the cultures. When the 26 active microorganisms we detected in the wound culture growths were examined; it was observed that Escherichia coli (n=9, 34.62%) and Proteus mirabilis (n=3, 11.54%) grew more frequently in enteric bacteria and Pseudomonas aeruginosa (n=3, 11.54%) in non-fermentative bacteria. In our study, the absence of antibiotic resistance in Pseudomonas aeruginosa isolates was considered remarkable. In our study, 100% resistance was found to antibiotics such as Ampicillin, Cefepime, Ceftriaxone, Ciprofloxacin, Amoxicillin-clavulanate, and Gentamicin in gram (+) bacteria, while 100% resistance was found against antibiotics such as Ceftriaxone, Ciprofloxacin, and Trimethoprim/sulfamethoxazole in gram (-) bacteria.
DISCUSSION AND CONCLUSION: In the treatment of infection pressure ulcers, starting antibiotic therapy at the appropriate time and choosing the right antibiotic is one of the most important factors that determine the success of treatment.

REVIEW
11.A systematic review of effective bioagent in chronic wounds: The maggot biotherapy pyramid
Nevra Polat, Murat Koç, Hüseyin Ayhan, Salih Mollahaliloglu
doi: 10.5505/amj.2022.43109  Pages 282 - 304
Wound assessment is important in monitoring the effectiveness of treatment in chronic wounds. Therefore, a holistic approach is needed when evaluating effective wound treatment. Most chronic wounds require complementary treatment approaches and conventional treatments in modern medicine. This research was carried out by compiling studies on the past, present, and future of maggot (medical larvae) that cure nonhealing/hard-to-heal wounds; therapeutic larva types, therapy method, healing mechanism, wound healing effect with clinical studies, different usage areas and biological activities of the larvae and the metabolite components in the secretions that provide these activities. In conclusion, medical larvae applied with traditional and complementary medicine techniques to treat nonhealing, difficult-to-heal wounds have a wound-healing effect. However, more research is needed to identify the metabolite components in their secretions that provide their mechanism of action and biological activities.

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