E-ISSN: 2148-4570 • ISSN:2148-4570
Volume: 22  Issue: 3 - 2022
1.How Russian-Ukrainian War Changed the Usage of Telemedicine: A Questionnaire-Based Study in Ukraine
Vitalii Poberezhets, Anna Demchuk, Yuriy Mostovoy
doi: 10.5505/amj.2022.08455  Pages 305 - 318
INTRODUCTION: Russian military aggression caused the biggest crisis in Ukraine since WWII. Telemedicine could become a solution for Ukrainian healthcare to cope with these challenges, considering previous experience and available resources. We aimed to assess features of telemedicine in Ukrainian during the war.
METHODS: We used a cross-sectional approach to receive feedback from 125 Ukrainian medical practitioners performing clinical practice in Ukraine during the war. E-questionnaire was distributed among doctors via social media announcements, specific doctors' associations in messengers and direct messages.
RESULTS: We found that 99.20% of doctors (n=124) continued using telemedicine during the war. 56.80% of the respondents (n=71) highlighted that the war resulted in the acceleration of telemedicine usage. The most popular telehealth services were instant messaging apps (97.60% of doctors, n=122) and phone calls (84.80% of doctors (n=106). Compared to less experienced colleagues, medical practitioners with more than 10 years of clinical practice more intensively used e-mail (46.15% vs 19.18%; χ2=10.444, p=0.001), SMS (34.62% vs 15.07%; χ2=6.512, p=0.011), remote pulse oximetry (19.23% vs 5.48%; χ2=5.774, p=0.016), blood glucose monitoring (11.54% vs 2.74%; χ2=3.925, p=0.048). The main restriction of using telemedicine was an inability to perform an effective objective examination.
DISCUSSION AND CONCLUSION: Our research showed that the ongoing Russian-Ukrainian war had accelerated the use of telemedicine by Ukrainian medical practitioners. The most common telemedical services were messengers and direct phone calls. Experienced doctors more frequently used e-mail, SMS and devices for remote patient monitoring.

2.Prevalence of Sexual Dysfunctions in Men Aged 18-65 and Related Factors: A Meta-Analysis and Meta-Regression Study from Turkey
Mustafa Uğurlu, Görkem Karakaş Uğurlu, Ali Caykoylu
doi: 10.5505/amj.2022.46338  Pages 319 - 335
INTRODUCTION: Studies on male sexual dysfunctions around the world point to high prevalence rates. Although there are studies on the prevalence of sexual dysfunctions in men in Turkey, these studies report different results due to regional and methodological differences. Therefore, more robust and consolidated data are needed on the prevalence of sexual dysfunctions in men.
METHODS: For this meta-analysis study, "Google Scholar" and "ULAKBIM" databases were searched. Studies have been conducted in Turkey between January 2000 and April 2019 were included in the study.
RESULTS: The prevalence of male sexual dysfunction, erectile dysfunction and premature ejaculation were found to be 28%, 18% and 24%, respectively
DISCUSSION AND CONCLUSION: This study is the first meta-analysis on the prevalence of male sexual dysfunction in Turkey. Our results reveal the importance of preventive and therapeutic health services in male sexual dysfunctions.

3.Glycemic Regulation in Patients with Type 2 Diabetes Mellitus: Effects of Motivational Interviewing
Mehmet Akif Kıral, Güven Barış Cansu
doi: 10.5505/amj.2022.87854  Pages 336 - 346
INTRODUCTION: Motivational interviewing (MI) is a convenient and effective counseling technique with positive effects on patients with Type 2 Diabetes Mellitus (T2DM), which provides a positive influence on their treatments/follow-up and help them to adopt health-enhancing behaviors. This study investigates whether MI has an effect on improving glycemic control in T2DM patients.
METHODS: This is a retrospective study enrolling 76 follow-up T2DM patients at a family health center who received MI. As a control group, age- and gender-matched 33 T2DM patients who were followed at the same family health center and did not receive MI were recruited. All patients were compared for their age, gender, marital status, education status, duration of diabetes, and HbA1c levels.
RESULTS: In the MI group, T2DM patients had a mean follow-up duration of 22.63±11.93 (3-38) months vs. 24.33±11.29 (3-36) months in the non-MI group (p=0.489). At the end of this follow-up period, the HbA1c level dropped from 8.30±2.10% to 7.68±1.48% (p=0.006) in the MI group, whereas the decrease in the non-MI group was from 8.12±2.14% to 7.93±1.16% which was not statistically significant (p=0.504).
DISCUSSION AND CONCLUSION: In this study, it was shown that MI provided a significant decrease in HbA1c levels in T2DM patients. MI helps blood sugar regulation by creating lifestyle changes in T2DM patients. MI is a method that can be applied in clinical practice by family physicians working in primary care, who play an important role in the follow-up and treatment of T2DM patients.

4.A Cross-sectional Study Evaluating COVID-19 Vaccine Literacy: The Example of Antalya Province
Aysima Bulca Acar, Sinem Akın
doi: 10.5505/amj.2022.49932  Pages 347 - 358
INTRODUCTION: It is believed that the COVID-19 pandemic, which is a significant health concern, can be restrained through effective vaccination. In this regard, however, people’s hesitancy toward vaccines stands out as an important obstacle to achieving community immunization. The aim of this study is to evaluate the factors that affect individuals’ decisions to get a COVID-19 vaccine and to identify their literacy status for COVID-19 vaccines.
METHODS: This study consisted of 388 people aged 18 and over who presented to the COVID-19 adult vaccination outpatient clinic at the University of Health Sciences Antalya Training and Research Hospital between July 1st and September 1st, 2021. The participants were asked a number of questions contained in the COVID-19 vaccine literacy scale, and answers were recorded.
RESULTS: The participants’ mean vaccination literacy score was considered moderate within the range of 2.95 ± 0.54. The results revealed that the higher the education level of the participants, the higher the COVID-19 vaccine literacy, and that the COVID-19 vaccine literacy was higher among individuals who voluntarily got vaccinated.
DISCUSSION AND CONCLUSION: By recognizing that individuals may have hesitancy about vaccination, relevant strategies should be developed for the vaccination with the aim of giving information to and instilling confidence in society rather than causing fear.

5.Evaluation of Knowledge Level and Approaches of Physicians Working in Primary Health Care Institutions in Denizli Province on Diabetic Neuropathy
Mahmut Tanırlar, Mehmet Arslan, Tamer Edirne, Nilüfer Emre, Aysun Özşahin
doi: 10.5505/amj.2022.43402  Pages 359 - 369
INTRODUCTION: Diabetic neuropathy is a complication seen in diabetic patients and involves motor, sensory or autonomic nerve fibers due to minor vessel damage. This study was planned to determine the knowledge and awareness levels of physicians working in family health centers about diabetic neuropathy and their approach to diabetic neuropathy.
METHODS: Our study is a cross-sectional descriptive study conducted in 111 family health centers. Two hundred seventy-nine physicians were included in the study, and 219 physicians (78.49%) agreed to participate in the study. The researchers created the questionnaire form by conducting a literature review. The data were obtained by survey method under supervision.
RESULTS: Of the 219 people participating in the study, 70.78% (n = 155) were male and 6.85% (n = 15) were family medicine specialists. 94.06% of the participants (n=206) gave the optimal glycemic control response as the most effective method to prevent diabetic neuropathy and delay its progression. 74.42% of the participants (n = 163) stated that they did not use any diabetic neuropathy diagnosis and screening tests in their daily practice. 31% (n = 68) of the participants stated that their level of knowledge of diabetic neuropathy was either poor or very poor. 89.49% (n = 196) of the participants stated that they needed training on diabetic neuropathy. Those who rely on their knowledge and clinical experience in diagnosing, monitoring, and treating diabetic neuropathy were 44.29% of the participants (n = 97).
DISCUSSION AND CONCLUSION: As a result, although the rate of those who correctly knew the primary and secondary prevention of diabetic neuropathy was found to be high among the physicians participating in our study, it was determined that the diabetic neuropathy knowledge level of the participating physicians was insufficient. Simple tests and methods for physicians working in primary care should be included in the daily polyclinic routine.

6.Acupuncture Decreases Attack Frequency and Improves Disability in Patients with Migraine Without Aura: A Randomized Controlled Trial
Rabia Rukiye Akinci, Yasemin Cayir, Nuray Bilge
doi: 10.5505/amj.2022.41196  Pages 370 - 380
INTRODUCTION: This study investigated the effect of acupuncture treatment on attack frequency, pain intensity, and disability in patients with migraine without aura that receives prophylaxis treatment.
METHODS: Eighty-four patients with migraine without aura were randomized to the intervention group (IG; n=42) and control group (CG; n=42). IG received 12 sessions of Acupuncture in addition to prophylaxis treatment. CG received only prophylaxis treatment. The primary outcome measures were monthly attack frequency, duration of attacks and pain severity during attacks. The secondary outcome measure included a change of Migraine Disability Assessment (MIDAS) scores from baseline to endpoints. All participants were followed up for three months.
RESULTS: A total of 80 participants completed the study. There were no statistically significant differences between the IG and CG for either socio-demographic features or the outcome measures at baseline. VAS score decreased from 8.8±0.9 to 3.9±1.5 in IG, while it decreased from 8.7±0.8 to 4.4±2.4 in CG (p=0.001). After three months mean monthly attack frequency decreased from 7.2±3.0 to 3.3±2.3 in IG, while it decreased from 6.3±3.3 to 4.4±2.4 in CG (p=0.040). The mean duration of attacks was 12.1± 2.6 hours before intervention; it decreased to 3.1±1.7 hours in IG (p=0.002). There was a significantly higher proportion of participants in IG who had MIDAS Grade 2 compared to those with CG (42.50% versus 2.50%) at the end of the study (p=0.001).
DISCUSSION AND CONCLUSION: Acupuncture may be suggested as a complementary treatment option to optimize the clinical management of patients with migraine without aura via decreasing attack frequency and pain severity, also improving disability.

7.Anxiety, Depression and Sleep Disturbance in Health Care Workers Taking Nasopharyngeal Swab Samples for COVID-19
Burcu Aykanat Yurtsever, Ceyhun Yurtsever, Mehmet Halit Baykal
doi: 10.5505/amj.2022.76258  Pages 381 - 393
INTRODUCTION: Health care workers (HCWs) fighting COVID-19 are at high risk of transmission. This risk and the increased workload place a heavy burden on HCWs. We aimed to determine anxiety, depression, and sleep disorders in HCWs who form mobile health units (MHUs) assigned to take samples for COVID-19 screening in Rize, Turkey.
METHODS: A single-center, a web-based questionnaire was conducted between 20 July - 25 August 2020, in which MHUs on duty with a nasopharyngeal swab sampling were included. Demographic characteristics and information about the MHUs mission and related to the COVID-19 pandemic were collected, and anxiety, depression, and sleep quality were evaluated by Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI). One hundred thirty participants were included in the study.
RESULTS: HCWs' median BAI, BDI and PSQI scores were 6, 10 and 5.5, respectively. The frequencies of anxiety symptoms, depression symptoms and sleep disturbances were 45.38%, 53.08% and 50%, respectively. Both the severity and frequency of anxiety and sleep disorders increased as the number of people sampled by healthcare professionals increased and prolonged the working time in the MHUs. Those who suspect they have had COVID-19 at any time and were concerned about transmitting COVID-19 to their family or friends had higher anxiety and sleep quality scores.
DISCUSSION AND CONCLUSION: In this study, high rates of anxiety, depression, and sleep disturbances were observed in HCWs. Special interventions to protect mental health will be beneficial for HCWs at risk of transmission.

8.Evaluation of Vitamin Prescribing by Physicians at a University Hospital
Burcu Güney, Önder Sezer, Hamdi Nezih Dagdeviren
doi: 10.5505/amj.2022.25564  Pages 394 - 403
INTRODUCTION: Vitamins are frequently included in physicians' prescriptions. Our study aims to determine the physicians' knowledge about vitamins and nutrition, detect the factors affecting their vitamin prescribing, and gain information about their vitamin prescribing behaviors.
METHODS: Our study included 368 physicians who volunteered to participate in the study. We prepared and used a questionnaire, which consisted of 7 questions about sociodemographic data, 13 questions about nutrition knowledge, 13 questions about physicians' attitudes towards prescribing vitamins, and seven questions about the factors affecting the vitamin prescribing behaviors of physicians.
RESULTS: The most frequently recommended supplements by physicians were vitamin D (62.50%), vitamin C (56.25%), and vitamin B12 (54.89%). Physicians with 11 years or more years in the profession (p<0.001) and internal medical sciences physicians (p<0.001) gave more correct answers to the knowledge questions. About the frequency of prescribing and recommending vitamins to their patients as supplements, 93 (25.27%) participants said they never did that, 242 (65.76%) said they rarely did that, and 33 (8.97%) said they frequently did that. 90 physicians (24.46%) stated that they prescribed vitamins only upon the patient's request. Only 37 (10.05%) participants considered themselves competent in terms of nutrition knowledge about vitamins. Female physicians used vitamin supplements more (p<0.001). Moreover, 305 (82.88%) physicians said that patients who requested vitamin supplements were mostly women.
DISCUSSION AND CONCLUSION: We found that the majority of our participants gave a negative response to the requests to prescribe vitamins as supplements. Participants considered themselves lacking in nutrition knowledge about vitamins.

9.The Role of in Vivo Tests in the Diagnosis of Hypersensitivity Reactions Due to Quinolones and Their Importance in Cross-Reactions
Hale Ates, Kurtuluş Aksu, Dilek Çuhadar Erçelebi, Süleyman Türkyılmaz, Buket Basa Akdogan, Özlem Özdedeoğlu, Gözde Köycü Buhari, İlkay Koca Kalkan
doi: 10.5505/amj.2022.02222  Pages 404 - 414
INTRODUCTION: There are conflicting results regarding the sensitivity of skin tests and cross-reactions between quinolones in quinolone allergy. In our study, we aimed to evaluate the results of skin tests and provocation tests performed with quinolones and to investigate the value of these tests in the diagnosis of hypersensitivity reactions due to quinolones and their usefulness in detecting possible cross-reactions between quinolones.
METHODS: We analyzed the file records of the patients who applied to our clinic for the reason of antibiotic drug allergy and who underwent diagnostic or alternative in vivo diagnostic tests with quinolone group drugs between January 2006 and September 2020. We recorded and evaluated the results of these cases with demographic characteristics such as age, gender, atopy history, concomitant allergic diseases, suspected antibiotic(s), allergic reaction type and time of occurrence, skin tests for diagnosis, and drug provocation tests.
RESULTS: The study included 715 patients, 73.56% of whom were women. Of the patients, 92.72% had a history of early-type drug allergic reactions. Skin tests had been applied to 219 patients. Of the 119 skin tests performed for diagnostic purposes, 48 were positive. A provocation test was performed in 31 of these patients whose skin test was found to be sensitive; 27 of them were negative. In 47 patients, 83 safe cross-over alternative drugs were obtained through provocation tests.
DISCUSSION AND CONCLUSION: Provocation tests are necessary for the diagnosis of quinolone hypersensitivity reaction and in the evaluation of cross-reactivity. Before provocation tests, evaluation should be made with skin tests.

10.Less Known and Neglected Renal Complication of Primary Hyperparathyroidism: Renal Cysts
Şefika Burçak Polat, Leyla Akdoğan, Müge Keskin, Gökhan Yüce, Berna Evranos Öğmen, Oya Topaloglu, Bekir Çakir
doi: 10.5505/amj.2022.89588  Pages 415 - 423
INTRODUCTION: Simple renal cysts are lesions that are epithelial in origin, with a prevalence changing between 5 to 15% in the normal population. In animal studies, it was shown that PTH might stimulate cyst formation via intracellular signaling systems triggering epithelial cell proliferation. Our primary aim was to detect the simple cyst prevalence in a large cohort of PHPT and compare it with sex and age-matched health individuals. The secondary aim was to detect determinants of cyst formation in PHPT.
METHODS: A total of 307 PHPT patients and 112 healthy controls were enrolled in our study. PHPT group was compared with the control group regarding the biochemical parameters and presence, size and bilaterality of renal cysts in the US performed by a single experienced radiologist.
RESULTS: Prevalence (43.65% vs 25%, p=0.020) and size [28.40 mm (min-max: 4-82) vs 12.20 mm (min-max: 3-94) (p=0.013)] of simple renal cysts were higher in the PHPT group compared to controls. The presence of renal cysts was correlated with age but not sex and positively correlated with the serum PTH level in regression analysis. Serum Ca, P, and 24-hour urinary Ca excretion were not found to be associated with cyst formation.
DISCUSSION AND CONCLUSION: Simple renal cysts are a benign renal complication of PHPT that does not alter renal function significantly, and their presence is directly correlated with the hypersecretion of PTH.

11.The Association between Sleep and Quality of Life in Patients Diagnosed with Subclinical Hypothyroidism
Samet Sayılan, Elif Ok, Emel Çetinkaya
doi: 10.5505/amj.2022.94830  Pages 424 - 433
INTRODUCTION: Thyroid disorders are frequently associated with sleep problems, and quality of life is adversely affected at the same time. The purpose of this study was to determine the effect of sleep problems on quality of life in patients with subclinical hypothyroidism (SH).
METHODS: This descriptive, cross-sectional study was performed with patients presenting on an outpatient basis to two separate clinics in the internal diseases department of a training and research hospital between February and July 2021. The study population consisted of 103 patients. p values <0.05 were considered significant.
RESULTS: The mean age of the participants was 44.46±14.12 years, and the mean duration of disease was 7.01±4.90 years. The participants' total Rolls Royce Quality of Life score mean was 104.99±18.48, and the mean PSQI total score was 7.11±3.75. A moderate negative correlation was observed between the participants' mean Pittsburg Sleep Quality Index and mean cognitive function, social relationships and quality of life scores. According to the linear regression analysis performed to examine the effect of sleep quality on quality of life, 10% of the change in the quality of life is explained by sleep quality.
DISCUSSION AND CONCLUSION: In this study, the quality of life of the participants was below moderate, and it was determined that the impairment of sleep quality adversely affected the quality of life. Since sleep quality affects the quality of life in patients followed up with subclinical hypothyroidism, sleep assessment is recommended. In addition, it is recommended to take initiatives to increase sleep quality and to investigate different factors affecting the quality of life.

12.Peripheral Lymphadenopathy and Infections: Evaluation of 197 Cases
Özlem Aydın, Begüm Bektaş, Pınar Ergen, Bengu Cobanoglu
doi: 10.5505/amj.2022.39214  Pages 434 - 443
INTRODUCTION: In our study, we aimed to evaluate the causes of peripheral lymphadenopathy (LAP).
METHODS: Patients older than 18 years old who were diagnosed with LAP and underwent peripheral lymph node biopsies between 01.11.2017 and 01.01.2020 were included in the study. The demographic data and histopathological findings of the patients were retrospectively reviewed on the computer database of the hospital.
RESULTS: One hundred ninety-seven adult patients in total were included in the study, 51.27% (n=101) of whom were female. The rates of fever, night sweats, and weight loss symptoms were detected as 8.63%,13.70%,and20.30%, respectively. Excisional biopsy was performed in 93.40%of the patients, and the most frequently excised lymph node was the axillary node at a rate of 40.10%. According to the results of the histopathological analyses, the most common etiology was malignancy, and the second one was infectious, at 31.98% and 29.95%, respectively. Malignancy was caused by lymphoma in 93.65% of the cases, whereas the infectious etiology was caused by tuberculosis at 74.58%. A specific diagnosis could not be made for 26.90% of the cases, and their outpatient follow-up was continued.
DISCUSSION AND CONCLUSION: Although LAP is often associated with infections, it also occurs as a manifestation of malignant diseases. In our study, the most common etiology was malignant diseases. Infections were the second most common etiology, and among infections, tuberculosis was the leading one.LAP is a frequently encountered clinical condition that is difficult to manage. To avoid delays in diagnosis, patients should be carefully evaluated and followed closely. Although a specific diagnosis cannot always be made, histopathology remains the gold standard for diagnosis.

13.Sjögren’s Syndrome: Is it Just Dryness?
Melisa Sahin Tekin, Pinar Yildiz, Nazife Sule Yasar Bilge
doi: 10.5505/amj.2022.48344  Pages 444 - 450
INTRODUCTION: Sjögren's syndrome (SS) is the most common autoimmune, multisystemic rheumatic disease. The wide spectrum of the signs and symptoms of SS often causes difficulties in diagnosis. Patients can apply with different complaints to general practitioners and many different specialists, apart from internists and ophthalmologists, who frequently encounter the disease. Our aim in this study was to evaluate the initial complaints of the patients who have been diagnosed with SS.
METHODS: Sixty-six patients who were diagnosed with primary SS according to 2012 or 2016 classification criteria were included in the study. The clinical and laboratory features were retrospectively evaluated.
RESULTS: The female/male ratio was 60/6. The initial complaint of most patients (n: 34) was arthralgia or arthritis (51.51%). ANA was positive in 56 patients (84.84%), RF in 19 (28.78%), but not evaluated in 7 (10.6%), anti-SS-A in 29 (43.93%), and anti-SS-B in 16 (24.24%). Sixty-three patients had a positive Schirmer test. Minor salivary gland biopsy was obtained in 42 patients, and 28 had biopsy findings consistent with SS.
DISCUSSION AND CONCLUSION: SS is a common disease with a wide variety of clinical presentations. A detailed evaluation of patients is necessary to provide an accurate diagnosis and proper care.

14.Can We Use the Triglyceride/HDL Ratio to Determine Insulin Resistance in Obesity Screening and Follow-Up in Primary Care?
Zerrin Gamsızkan, Attila Onmez, İbrahim Ethem Sahin, Gökhan Erdemir, Safa Ünal
doi: 10.5505/amj.2022.38991  Pages 451 - 459
INTRODUCTION: Obese patients are followed up with periodic laboratory tests. Insulin resistance is also a parameter used in these tests. There is a need for parameters that can determine insulin resistance more easily and practically. The aim of our study is to investigate the discriminative power of triglyceride (Tg) and triglyceride/high-density lipoprotein cholesterol ratio (Tg/HDL) for Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) in our patient population by examining the laboratory findings.
METHODS: In this retrospective study, the laboratory data of patients who applied to the Family Medicine Obesity Polyclinic of Düzce University Hospital between April 2018 and April 2019 with the desire to lose weight and/or have healthy lifestyle suggestions were examined.
RESULTS: Of the 512 patients included in our study, 66.40% (n=340) were female and 33.59% (n=172) were male. In the examination performed on patients grouped according to their Body Mass Index (BMI), Total cholesterol, HDL, Low-density lipoprotein (LDL), Tg, HOMA-IR, Insulin and Tg/HDL ratios were significantly different between the groups. The cut-off value in the ROC analysis of the Tg/HDL parameter between patients with and without insulin resistance was found to be 2.29 with 66% sensitivity and 55% specificity (AUC: 0.634, p<0.001). In Spearman's correlation analysis of Tg/HDL and HOMA-IR, both parameters were found to have a statistically significant correlation (r: 0.248; p< 0.000).
DISCUSSION AND CONCLUSION: The significant relationship between the high Tg/HDL ratio and HOMA-IR detected in the results of our study shows that the Tg/HDL ratio can be used as a practical tool to evaluate insulin resistance in obese patients.


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