E-ISSN: 2148-4570 • ISSN:2148-4570
ANKARA MEDICAL JOURNAL - Ankara Med J: 22 (4)
Volume: 22  Issue: 4 - 2022
ORIGINAL ARTICLE
1.A Survey Study of Covid-19 Vaccine Hesitancy of Relatives of Patients Admitted to a Training and Research Hospital in Istanbul
Hilal Özkaya, Sibel Baktır Altuntaş, Mücahit Kapçı
doi: 10.5505/amj.2022.90001  Pages 461 - 471
INTRODUCTION: Treatment and immunization studies of the COVID-19 infection are still ongoing. Vaccine hesitancy or refusal, which is an important public health problem, has also come to the fore as a factor that negatively affects community immunization during the COVID-19 pandemic. In this study, it was aimed to analyze the thoughts and attitudes of the relatives of patients who were under observation in the hospital due to COVID-19 in the second wave of the pandemic, whether they should have the COVID-19 vaccine or not, and the factors that caused it.
METHODS: The study was carried out between 20.12.2020-20.01.2021 in Başakşehir Çam and Sakura City Hospital COVID-19 Emergency Clinic Yellow Zone. A 25-question questionnaire was applied to a total of 429 relatives of patients who gave consent to the study.
RESULTS: While 40.09% of the participants were considering getting the COVID-19 vaccine, 24.94% were not thinking, and 34.97% were not sure. Those who were positive about getting vaccinated mostly (69%) stated that they were worried about the serious infection of COVID-19 infection, and nearly half of those who did not plan to have the vaccine stated that they made this decision because the content of the vaccine was unknown. When asked which sources they trust more about COVID-19 and its vaccine, they said that they trust the official statements at the highest rate and then their family physician.
DISCUSSION AND CONCLUSION: The most effective method of protection against COVID-19 infection is vaccination. The fact that family physicians are the second source that people trust should be considered as a great opportunity for vaccine hesitancy and refusal problems.

2.Evaluation of Knowledge, Attitudes, and Behaviors of Mothers With 0-6 Age Group Children About Home Accidents
Ahmet Olcay İşler, Burak Altındağ, Naime Sevgi Karadağ, Gülseren Pamuk, Kurtuluş Öngel
doi: 10.5505/amj.2022.81904  Pages 472 - 484
INTRODUCTION: This study was performed to investigate home accidents experienced by children aged 0-6 in the last two weeks, the level of security measures taken by mothers towards home accidents, and the affecting factors.
METHODS: The data were collected through a questionnaire form and "The Scale for Diagnosing the Safety Measures of the Mother for Home Accidents in Children 0-6" with 289 mothers with children aged 0-6 who applied to a pediatric clinic.
RESULTS: The mean score of the scale used in the study was 165.56±16.84. The higher the education level of the mother, the higher the scale score and the relationship between them was found to be statistically significant (p=0.033). The scale means score of working mothers was found to be significantly higher than that of non-working mothers (p=0.006). The mean score of mothers whose children had no home accident was higher than those whose children had a home accident, but the difference was insignificant (p=0.694). It was found that children of 9.00% of the mothers had had a home accident in the last two weeks, and the most common type of home accident was a fall. Most children who had a home accident were between 0-2.
DISCUSSION AND CONCLUSION: It was determined that demographic characteristics of mothers, such as education and working status, were effective in their knowledge and attitudes about home accidents.

3.Evaluation of The Relationship Between Death Anxiety and Personality Traits in Hospitalized Patients with COVID-19
Vildan Cakir Kardes, Fatma Fidan, Metin Yiğit
doi: 10.5505/amj.2022.15679  Pages 485 - 498
INTRODUCTION: Death anxiety is often described as a feeling of panic and/or fear associated with thoughts of death and the afterlife. This impact of death anxiety is often triggered by severe disease or losing someone close. The outbreak of Novel Coronavirus Disease has also affected patients mentally as well as physically. Our study aims to investigate the prevalence of death anxiety among hospitalized patients with COVID-19 and the related factors of this anxiety during the current pandemic.
METHODS: We conducted a study among 283 adult participants to determine their anxiety and depression levels after being hospitalized due to COVID-19 infection by using the Ten Item Personality Inventory (TIPI), Hospital Anxiety and Depression Scale (HADS), and Templer Death Anxiety Scale (DAS).
RESULTS: Death anxiety was significantly higher in females and in patients with prior psychiatric disorders. A positive correlation was found between death anxiety and the risk of anxiety (p<0.001 and r=0.472) and depression (p<0.001 and r=0.344). The risk of anxiety and depression was found to increase with DAS scores. Death anxiety was found to be common and associated with three significant personality traits: conscientiousness, extraversion, and emotional stability.
DISCUSSION AND CONCLUSION: Hospitalized patients with COVID-19 should be closely monitored regarding death anxiety, and awareness should be raised regarding the mental impacts of severe diseases on patients, and these impacts should be identified more often. A professional support system of a psychological call or online guidance should be constituted to identify the affected groups that are vulnerable to mental impacts.

4.The Effect of Treatment Methods and Continuity of Follow-up on Success Rates in Patients Followed in the Smoking Cessation Polyclinic
Özge Börklü Doğan, Memet Taşkın Egici, Hilal Ozkaya
doi: 10.5505/amj.2022.88725  Pages 499 - 509
INTRODUCTION: Smoking causes addiction with physical and psychosocial factors. This study aimed to reveal factors that affected the success rate and continuity of follow-up in people who presented to the smoking cessation polyclinic
METHODS: The study included 154 patients who presented to the smoking cessation polyclinic (SCP) of a training and research hospital between September 1st, 2018, and February 28th, 2019. Varenicline or nicotine replacement therapy (NRT) was given to eligible patients, along with cognitive behavioral therapy (CBT). The demographic characteristics, number of cigarettes smoked daily, number of outpatient visits, treatment received, Fagerström Test for Nicotine Dependence (FTND) results, and treatment success at the end of the third month and first year were examined retrospectively in all patients.
RESULTS: Among those who received pharmacotherapy, 33 (21.43%) received varenicline and 37 (24.02%) had NRT. As a result of the analysis, the smoking cessation rate in the entire group was 33.11% at the end of 3 months and 20.78% at the end of 1 year. Three-quarters (75.76%) of patients using varenicline and 54.05% of patients using NRT quit smoking. Although the rate of quitting in patients using varenicline was higher than in those using NRT, it was not statistically significant (p=0.059).
DISCUSSION AND CONCLUSION: According to the results of this study, there was no significant difference between varenicline + CBT and NRT + CBT in smoking cessation. Male sex, receiving treatment, and regular follow-up visits are factors that increase the chances of success.

5.Effect of marital typology, reproductive coercion, and contraceptive methods in abortion rate, Istanbul 2021
Okcan Basat, Melike Mercan Başpınar
doi: 10.5505/amj.2022.11298  Pages 510 - 519
INTRODUCTION: Abortion is both a reason for maternal mortality and a consequence of unintended pregnancies. This study aimed to propose the effect of marital typologies, reproductive coercion, and contraception methods on abortion presence among married Turkish women.
METHODS: An observational study including married women was done in the family medicine clinic of a tertiary hospital in İstanbul. It was completed between 15 May 2021 and 15 June 2021. A survey was applied to supply sociodemographic data, asking about contraceptive method use, reproductive coercion scale, and marital typology scale questions.
RESULTS: In the reproductive history of the 199 women whose mean age was 37.32±7.54 years, abortion and unintended pregnancy frequencies were found to be 35.17% and 37.18%. The reproductive coercion score was 0.47±0.82 out of a total of 5 points. The most common contraceptive methods were condom use (59.79%) and withdrawal (41.70%), whose success depended more on the male partner. Logistic regression analyses identified young age, early childbearing mother age and unintended pregnancy presence as predictors of abortion presence (OR=0.914; 95% CI: 0.863-0.968; p=0.002, OR=0.862; 95% CI: 0.778-0.954; p=0.002 and OR=5.413; 95% CI: 2.487- 11.780; p<0.001, respectively).
DISCUSSION AND CONCLUSION: In light of this study, one out of three married women had a spontaneous or induced abortion history, regardless of the contraceptive method, marital typology, and reproductive coercion score. Therefore, the physician must be aware of the high abortion risk and the information needed for both healthy pregnancy and safe abortion care for a young married woman with an unintended pregnancy.

6.The Impacts of Diabetes on Families with a Child Diagnosed with Type 1 Diabetes Mellitus and Influencing Factors
Seher Karahan, Ezgi Agadayi, Nurullah Çelik
doi: 10.5505/amj.2022.44522  Pages 520 - 532
INTRODUCTION: This study aimed to determine the impacts of diabetes on families with a child diagnosed with Type 1 Diabetes Mellitus (DM) and influencing factors using the Diabetes Family Impact Scale (DFIS).
METHODS: The population of our study, which is a descriptive cross-sectional type, consists of the parents of 289 school-aged children diagnosed with Type 1 DM and followed for at least one year in the Department of Pediatric Endocrinology of Sivas Cumhuriyet University Faculty of Medicine. The study questionnaire was completed in a face-to-face interview with the parents of 121 of the 289 children who volunteered to participate in the study. The first 21 questions of the research questionnaire were related to sociodemographic data, and the following 14 questions, which included some characteristics of the disease, were related to DFIS.
RESULTS: The mean DFIS scale score of the participants was 14.60±10.82. In our study, the mean DFIS scale score and the mean scores of the School and Work subscales were significantly higher in families with a child who had a high mean HbA1c and had been hospitalized for diabetes in the last year. It was also found that the DFIS scale score was significantly higher in low-income families than in high-income families. While there was a negative correlation between the DFIS scale score and the child's age with Type 1 DM, and the mother's age, there was a positive correlation between the DFIS scale score and the HBA1c values.
DISCUSSION AND CONCLUSION: The impact of Type 1 DM on families is widespread and multifactorial. In our study, as the diabetic control deteriorates and the age of the child decreases, the level of influence of the families in different aspects increases.

7.Evaluation of Large Unstained Cells (LUC) and Nitric Oxide in Diabetes Mellitus
Funda Eren, Arzu Kösem, Esra Fırat Oğuz, Salim Neselioglu, İhsan Ateş, Ozcan Erel
doi: 10.5505/amj.2022.65707  Pages 533 - 541
INTRODUCTION: The large unstained cells (LUC) is a differential count parameter measured by routine hematology analyzers and reflects activated lymphocytes and peroxidase-negative cells in leukocytes. Nitric oxide (NO) is produced in all tissues in enzymatic and non-enzymatic ways. This study aimed to determine the levels of LUC and NO products (nitrite and nitrate) and to evaluate the LUC/NO ratio in patients with Diabetes Mellitus (DM).
METHODS: The study included 103 DM patients and 84 healthy controls. HbA1c, LUC/%LUC and total NO levels were measured. All the statistical calculations were performed using the Statistical Package for Social Sciences (SPSS) software program.
RESULTS: Nitric oxide levels of the patients were statistically significantly lower compared with the control group (p=0.004). LUC levels, LUC% values, LUC/NO, and LUC%/NO ratios were significantly higher in the DM group (p=0.002, p=0.009, p= <0.001, and p= <0.001, respectively). Statistically significant correlations were observed between HbA1c and nitrite, nitrate, NO, LUC/NO ratio, and LUC % /NO ratio.
DISCUSSION AND CONCLUSION: In this study, we determined the LUC/NO percent ratio and LUC%/NO percent ratio for the first time, according to our knowledge. We predict that these two parameters may be useful markers in the diagnosis and the follow-up of the disease and may provide target pathways for further studies that may contribute to the etiopathogenesis of the disease.

8.The Relationship of Neutrophil and Platelet Markers with Clinical Variables and Disease Activity in Patients with Ankylosing Spondylitis
Ender Erden, Ayla Cagliyan Turk, Ebru Erden, İlker Fatih Sarı
doi: 10.5505/amj.2022.11129  Pages 542 - 555
INTRODUCTION: The aim of this study is to show the relationship between neutrophil and platelet levels and clinical criteria such as disease activity and pain in ankylosing spondylitis (AS) patients.
METHODS: The study included 48 AS patients (Group 1) and 47 healthy controls (Group 2). Clinical and laboratory evaluations, including the measurement of the hemogram, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), were performed. The AS patients were divided into two subgroups according to their disease activity was evaluated by using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (≥4 high activity, <4 low activity).
RESULTS: Mean age of the patients was 42.44 ±12.32 years in Group 1 and 46.30 ± 9.10 years in Group 2 and showed no significant difference between groups (All p values >0.05). The ESR, CRP, NLR, PLR, and plateletcrit (PCT) values were significantly higher in Group 1, while the hemoglobin values were significantly lower in Group 2 (All p values <0.05). The platelet count was significantly higher in the subgroup with high disease activity according to the BASDAI score (All p values <0.05). A significantly negative weak correlation was found between MPV and BASMI and MPV and ESR (r=-0.303, p=0.037; r=-0.492, p<0.001, respectively). According to the receiver operating characteristic (ROC) analysis, PLR and MPV had diagnostic value in demonstrating disease activity.
DISCUSSION AND CONCLUSION: While NLR, PLR, and PCT can be used in the initial evaluation of inflammation in AS patients, PLR and MPV were found effective in demonstrating disease activity.

9.Predictors of Early-Onset Overt Hypothyroidism in Hyperthyroid Patients Treated with Radioiodine
Nazım Coşkun, Elif Özdemir
doi: 10.5505/amj.2022.58159  Pages 556 - 566
INTRODUCTION: Radioiodine (RAI) treatment with iodine-131 is a safe and effective approach that is widely used for treating hyperthyroidism. Although euthyroidism is the optimal outcome of this treatment, some patients will eventually develop hypothyroidism requiring hormone replacement. In this context, we aimed to investigate the predictive factors for early-onset overt hypothyroidism developing within two months after the RAI treatment.
METHODS: All hyperthyroid patients treated with RAI between March 2019 and March 2022 were screened retrospectively. Patients with thyroid function tests within two months after the treatment were included in the final analyses. Baseline clinical characteristics, including pre-treatment imaging modalities and laboratory tests, were retrieved from the institutional database. Predictors of early-onset overt hypothyroidism were determined with a multivariable logistic regression model.
RESULTS: Seventy-two patients (44% female, median age 42 years) were included in the study. Twenty-four patients (33.3%) developed overt hypothyroidism within two months after the treatment. Multivariable logistic regression analysis revealed that the appearance of a diffuse goiter in ultrasound (OR= 4.33, 95% CI= 1.15–16.28, p= 0.030) and the dose of RAI per thyroid volume (OR= 4.30, 95% CI= 1.38–13.45, p= 0.012) were independently associated with the risk of early-onset hypothyroidism after RAI treatment.
DISCUSSION AND CONCLUSION: The RAI dose per thyroid volume and the appearance of a diffuse goiter in ultrasound were significantly associated with an increased risk of early-onset overt hypothyroidism after RAI treatment. If validated in larger cohorts, these parameters could have a role in predicting the need for early hormone replacement in hyperthyroid patients treated with RAI.

CASE REPORT
10.One of the Causes of Recurrent Urinary Tract Infection: Bifid Collecting System- A Case Report
Hilal Aksoy, Halise Keçik, Filiz Bayar, İzzet Fidancı, Duygu Ayhan Başer
doi: 10.5505/amj.2022.70456  Pages 567 - 571
Although genitourinary system anomalies are frequently diagnosed in childhood, they are also clinically important in the adult population. Patients with these anomalies are at risk for recurrent urinary tract infections and also obstructions. Urinary system anomalies should be considered in the patients who come with recurrent urinary tract infection complaints to the family medicine outpatient clinic. In this article, a case with recurrent urinary tract infections, which were later diagnosed with a double collecting system, is presented.

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