E-ISSN: 2148-4570 • ISSN:2148-4570
ANKARA MEDICAL JOURNAL - Ankara Med J: 23 (1)
Volume: 23  Issue: 1 - 2023
ORIGINAL ARTICLE
1.Doctors’ Attitudes and Practises Regarding Human Papillomavirus Vaccination: A Qualitative Study
Hilal Aksoy, Pınar Döner
doi: 10.5505/amj.2023.09609  Pages 1 - 12
INTRODUCTION: Human papillomavirus (HPV) is one of the most common sexually transmitted viruses in the world that causes diseases of the genitourinary system. But it is still not included in the national immunization schedule. Our aim is to find out the attitudes and practices of physicians in Turkey regarding HPV vaccination.
METHODS: The study was qualitative in nature. It was conducted with 14 subjects consisting of specialists in general medicine, family medicine, gynecology and obstetrics, urology, pediatrics and diseases working in Turkey. A thematic framework analysis was used for the analysis.
RESULTS: No notable difference was found in the opinions of the doctors in relation to their age or gender. The analysis revealed three main themes: Prejudice and ignorance about the HPV vaccine, insufficient information to patients about the HPV vaccine, and the need to include the HPV vaccine in the national immunization schedule.
DISCUSSION AND CONCLUSION: The HPV vaccine is currently a paid vaccine, administered only on demand. Participants cited a lack of knowledge about the vaccine and the cost of the vaccine as the biggest barriers to vaccination. However, it is a vaccine that is considered necessary to be included in the "National Immunisation Schedule".

2.Evaluation of Prognosis, Mortality and Platelet Indexes, Platelet/Lymphocyte and Neutrophil/Lymphocyte Ratios of Palliative Care Patients
Eda Tapsız, Habibe Inci, Pınar Kalem, Didem Sunay
doi: 10.5505/amj.2023.87903  Pages 13 - 26
INTRODUCTION: In this study, it was aimed to evaluate the clinical significance of platelet indices, platelet, neutrophil, and lymphocyte values, as well as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) values and their relationship with mortality in palliative care patients.
METHODS: The data of 464 patients in the palliative care service were analyzed retrospectively. Sociodemographic characteristics of the patients, diagnosis, length of stay in the service, the way they were admitted to the palliative service and the way they were discharged from the palliative service, hospitalization and hematological parameters were recorded.
RESULTS: The mean age of the 464 patients included in the study was 75.15±13.63 years. It was seen that 68.30% of the patients were alive during the time period they were included in the study. When the admission and discharge blood values of the patients who died and the patients who survived were compared, the WBC and neutrophil values of the patients who died were found to be higher than the patients who survived, while the platelet and lymphocyte values of the patients who died were found to be lower. While admission and discharge NLR values, admission PLR values, discharge MPV values and discharge PDW values were found to be significantly higher in patients who died than in patients who survived, discharge PCT value was found low.
DISCUSSION AND CONCLUSION: Leukocytosis, thrombocytopenia, lymphopenia, and neutrophilia were dominant in the hematological parameters of the patients who died compared to the patients who survived. In contrast, the admission PLR value was found to be higher in patients who died than the patients who survived.

3.Nutritional status of home care patients and affecting factors throughout a six months follow-up period
Zeynep Gizem Yüce, Suleyman Gorpelioglu, Canan Emiroğlu, Cenk Aypak, Yasemin Kaplan Say
doi: 10.5505/amj.2023.46244  Pages 27 - 37
INTRODUCTION: Home care patients are highly susceptible to malnutrition. This study, it was aimed to determine the changes in nutritional status and the factors affecting this change in the patients who receive home care services.
METHODS: This study was conducted as a prospective descriptive field study. Patients were visited twice with an interval of 6 months, and the MNA test was applied in both visits. The test scores and the factors affecting them were examined with Student's t-test, Pearson Chi-square and correlation tests considering the compatibility of the data with the normal distribution. Data were analyzed with IBM SPSS ver.22 statistical program.
RESULTS: On the first visit, 38.13% of patients were malnourished, and 37.81 % were at risk of malnutrition, and at the second visit, 41.88% were malnourished, and 35.31% were at risk of malnutrition. A statistically significant relationship was found between the MNA classification and loss of appetite, economic problems, caregiver not providing nutritional support, lack of social security, polypharmacy, and inability to eat alone.
DISCUSSION AND CONCLUSION: Screening the nutritional status of patients given home health care with appropriate scales and at short intervals, identifying those at risk of malnutrition and improving their nutritional status with appropriate interventions will positively affect the general health status and quality of life of these patients.

4.Assessment of sleep quality and anxiety levels of individuals who are in home isolation due to the COVID-19 Pandemic
Sibel Baktır Altuntaş, Güzin Zeren Öztürk
doi: 10.5505/amj.2023.33497  Pages 38 - 48
INTRODUCTION: This study aimed to evaluate individuals' sleep quality and anxiety levels in home isolation during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS: The study was planned in a descriptive cross-sectional design and was conducted between 01.07.2020–31.07.2020 with 186 individuals who were isolated at home due to contact with infected people and due to being infected with COVID-19. The subjects were asked to complete a sociodemographic data form, the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Index.
RESULTS: The mean Pittsburg Sleep Quality Index was 5.33, and the number of participants with poor sleep quality was found to be 92 (49.46%). A significant correlation was found between sleep quality and anxiety scores (r=0.705; p<0.001). Female participants who were infected with COVID-19 had higher anxiety scores (mean Beck Anxiety Inventory score: 8.93) and worse sleep quality (mean Pittsburg Sleep Quality Index score: 6.11, p = 0.002).
DISCUSSION AND CONCLUSION: The COVID-19 Pandemic affected anxiety and sleep quality in those isolated at home. This situation is more common among female participants and those confirmed as COVID-19 positive via RT-PCR (Reverse Transcription Polymerase Chain Reaction).



5.Association of reactive hypoglycemia with body mass index, homeostatic model assessment of insulin resistance and comorbidity
Alpaslan Mert, Ömer Faruk Tekin
doi: 10.5505/amj.2023.22844  Pages 49 - 60
INTRODUCTION: Untreated hypoglycemia at profoundly low levels restrains the delivery of energy to vital organs and causes a series of extreme adverse events, ultimately resulting in coma and death. The purpose of the study was to determine the relationship between body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR), and co-morbidities in patients experiencing hypoglycemia during an oral glucose tolerance test (OGTT).
METHODS: We retrospectively analyzed the medical records of all patients presented to the diet outpatient clinic between 2015 and 2020 for OGTT. After an overnight fast of 10-12 hours, the patient’s fasting insulin (HOMA-IR) and fasting glucose were recorded. A 330cc solution of glucose (containing 75 grams of dextrose anhydride) drink was used for the OGTT. Following this, blood glucose was measured at 30, 60, 120, 180, and 240 minutes. The obtained data were analyzed using descriptive and inferential statistics.
RESULTS: A total of 614 patients were analyzed. A positive correlation was found between BMI and HOMA-IR (p≤0.001), BMI and blood glucose (p≤0.001). Although hypoglycemia rates were higher in overweight and obese patients, the difference was not significant (p= 0.316). The presence of co-morbidity did not affect the incidence of hypoglycemia (p=0.413).
DISCUSSION AND CONCLUSION: We observed that increased BMI was associated with having HOMA-IR and high glucose levels at 0-30-60-120 minutes in OGTT. Although hypoglycemia during the OGTT was not associated with BMI in this study, large-scale studies are needed to reveal this relationship.

6.Fertility Rates Of Syrian Migrants In Turkey, Baby Boom And Possible Factors Related To Them
Seyma Handan Akyon, Tarik Eren Yilmaz, Büşra Sahin, Adem Ozkara
doi: 10.5505/amj.2023.16680  Pages 61 - 72
INTRODUCTION: Total fertility rate (TFR) is the average number of children born per woman of childbearing age. The baby boom refers to a noticeable increase in the birth rate and is believed to occur in migrants from war-torn and economically challenged countries. During the Syrian war in 2011, nearly 5 million Syrians had to leave their country. A significant part of the migration movement has been directed toward Turkey. In this study, it was aimed to investigate the baby boom presence of Syrian migrants in Turkey and to make comparisons.
METHODS: Our study is an observational, descriptive epidemiological study, and the data were reviewed and compiled retrospectively. A comparison of TFRs of Turkey and Syria according to the last 20 years of the United Nations' data and the Turkey Demographic and Health Survey of 2018 was done.
RESULTS: According to United Nations 2018 data, Turkey's TFR was 2.07, while Syria's was 2.8. According to 2018 Turkey's data, TFR in Syrian migrants is 5.3. When these rates are compared, it can be said that there is a significant increase in the fertility rate of Syrian migrants in Turkey, and this reveals the presence of a baby boom.
DISCUSSION AND CONCLUSION: In conclusion, when TFRs in the pre-war period and after the war are compared in literature, there was a post-war baby boom in the Syrian migrant in Turkey. The factors which may have effect on the fertility of Syrian migrants found as psychological, economic, social, cultural, religious, and socio-demographic characteristics.

7.Thyroid Cancer in Adolescents and Young Adults
Nagihan Bestepe, Ahmet Dirikoç, Husniye Baser, Mustafa Omer Yazicioglu, Aysegul Aksoy Altinboga, Didem Ozdemir, Oya Topaloglu, Reyhan Ersoy, Bekir Cakir
doi: 10.5505/amj.2023.09734  Pages 73 - 86
INTRODUCTION: The incidence of thyroid cancer (TC) is increasing in adolescent and young adult (AYA) patients. Many types of cancer diagnosed in the AYA age group differ significantly in clinical and pathological features from cancers diagnosed in older age groups, but data on TC are limited. Our aim was to compare the clinicopathological features of TC in AYAs and adults ≥40 years old.
METHODS: In total, 1013 patients with TC were retrospectively reviewed. Thyroid functions, ultrasonographic features of malignant nodules, cytological and histopathological findings, and recurrence and persistence rates were compared in AYAs and patients ≥40 years old.
RESULTS: There were 229 (22.61%) AYA patients and 784 (77.39%) patients ≥40 age group. Of all cancer types, 93.12% in AYAs and 93.58% in the ≥40 age group were papillary thyroid cancer (PTC) (p=0.772). Multifocal thyroid tumors were detected in 62 (27.07%) of AYAs and 269 (34.31%) of the ≥40 age group (p=0.039). Incidental thyroid tumors were detected in 113 (37.05%) of AYAs and 583 (52.01%) of the ≥40 age group (p<0.01). The extrathyroidal extension (ETE) was detected in 9.61% of AYAs and 16.33% of patients ≥40 years old (p=0.012). Capsular and vascular invasion, lymph node metastasis, distant metastasis, persistence, and recurrence rates were similar.
DISCUSSION AND CONCLUSION: There was no increase in the aggressive clinical and pathological features of TC in AYAs. ETE, multifocal tumors and incidental tumors were less common in AYAs than in patients ≥40 years old. PTC is the most common type in both groups, while the follicular variant PTC (FVPTC) subtype is increased in AYAs. Thyroid nodules should be carefully evaluated in AYAs, and diagnostic procedures should be recommended without delay. However, when TC is diagnosed in AYAs, the overtreatment potential of a disease with an excellent prognosis should also be considered.

8.Exploring electrophysiology students’ learning styles and attitudes toward online learning
Ülkühan Düzgün
doi: 10.5505/amj.2023.22804  Pages 87 - 97
INTRODUCTION: A learning style can be described as an individual difference in perceiving and processing information in one’s mind. The previous research suggested that one may attain greater achievement when teaching is organized according to their learning style. Moreover, upon comparing online and traditional learning environments, learning styles may also need to be considered in distance education. The present study aimed to explore the attitudes of electrophysiology students toward online learning by their learning styles.
METHODS: This cross-sectional study recruited 101 students, 20.79% (n=21) males and 79.21% (n=80) females, enrolled in the electrophysiology program in the 2021-2022 academic year. The data were collected using a demographic information form, the VARK Learning Styles Questionnaire, and the Online Learning Attitude Scale (OLAS).
RESULTS: Almost all participants (93.07%; n=94) attended distance education during the pandemic. The findings revealed that the participants mostly adopted all of the Visual-Auditory-Read/Write-Kinesthetic (39.60%; n=40) learning styles, while kinesthetic learning style was adopted the most (13.86%; n=14) as a unimodal learning style. Besides, while having a high attitude toward online learning, the students scored the highest on the OLAS APPEFF subscale (3.54±1.02). Finally, it was concluded that the students with bimodal and quadrimodal learning styles had significantly higher attitudes toward online learning than those adopting a unimodal learning style (p=0.034 and 0.011, respectively).
DISCUSSION AND CONCLUSION: Overall, the participating electrophysiology students had high attitudes toward online learning and often adopted a multimodal learning style.

9.The Impact of Contact Lens Duration on Ocular Discomfort
Ayşe Güzin Taşlıpınar Uzel, Ahmet Peçen, Yeşim Altay
doi: 10.5505/amj.2023.57689  Pages 98 - 105
INTRODUCTION: To compare contact lens discomfort (CLD) using the Contact Lens Dry Eye Questionnaire (CLDEQ-8) questionnaire in short and long-term CL wearers.
METHODS: This prospective study included 98 patients who applied to the Department of Ophthalmology of Ufuk University between January 2020 and January 2021 and had a history of wearing contact lenses for over a month. Participants who wore contact lenses (CL) for six months or less were categorized as short-term CL users, while those who wore them for more than six months were categorized as long-term CL users. Contact lens compliance and the CLDEQ-8 questionnaire results were compared between the groups.
RESULTS: The mean age was 21.70±2.81 years in 55 short-term CL wearers, and 80% were female. In 43 long-term CL wearers, the mean age was 28.69±8.48 years, and 86% were female (respectively, p<0.001, p=0.592). The duration of CL wear was 2.36±1.06 months in short-term CL wearers and 10.11±5.6 months in long-term CL wearers (p<0.001). The mean CLDEQ-8 score was 11.52±6.59 in short-term CL wearers and 14.37±6.55 in long-term CL wearers (p=0.015). In addition, 40% of short-term and 65.1% of long-term users had a CLDEQ-8 score greater than 12 (p=0.016).
DISCUSSION AND CONCLUSION: Long-term CL wearers experienced much more CLD, and several considered removing their lenses at various times. Contact lens discomfort has to be investigated, especially in long-term CL users, and solutions should be developed to avoid CL dropout.

10.The effect of postnatal education on breastfeeding self-efficacy and predictors of newborn weight changes in the first 10 days: a prospective study
Tuğba Güler Sönmez, Ebru Uğraş Tiryaki, Nilgün Altuntaş
doi: 10.5505/amj.2023.30906  Pages 106 - 119
INTRODUCTION: To investigate the role of postnatal verbal and visual education in improving breastfeeding self-efficacy (BSE) and factors effective in weight gain or loss in the first ten days.
METHODS: Conducted between March-June 2020, this prospective study included a total of 145 healthy women with third-trimester pregnancies who received postpartum breastfeeding education (verbal and visual). Prenatal (pre-training) and postnatal (post-training) BSE Scale-Short Form (BSES-SF) scores, birth weights, The Edinburgh Postnatal Depression Scale and LATCH scale scores at the 10th day after birth, 10th-day newborn weight and differences in birth weight were recorded. Grouping was done according to whether or not the newborn reached birth weight at day 10 (decreased weight: DW group, same or increased weight: SIW group).
RESULTS: Mean maternal age was similar in the DW (30.61 ± 4.72) and the SIW groups (30.47 ± 4.88). Median BSES-SF scores after training were significantly higher than before training (p<0.001). Multiple logistic regression analysis revealed that regular follow-up during pregnancy (p=0.014) and high LATCH score (p<0.001) were independently associated with being in the SIW group on the 10th day, whereas additional formula feeding (p=0.006) and high EPDS score (p=0.004) were independently associated being in the DW group.
DISCUSSION AND CONCLUSION: BSE can be improved by using postnatal verbal and supervised video breastfeeding training. LATCH and EPDS scores can be used to easily identify mothers at high risk for postpartum breastfeeding problems and depression.

11.Comparison of risk factors for warfarin-associated bleeding
Şafak Meriç Özgenel, Ahmet Muzaffer Demir
doi: 10.5505/amj.2023.95825  Pages 120 - 131
INTRODUCTION: Warfarin is the most commonly used oral agent for long-term anticoagulation. Nevertheless, bleeding is the most frequent side effect of warfarin, increasing mortality and morbidity and thereby restricting its use. Risk factors for bleeding include age, comorbid diseases, use of drugs that may interact with warfarin, and previous history of stroke or gastrointestinal bleeding. Using a questionnaire-based method, this study aimed to compare the risk of bleeding in two groups of warfarin users with and without a history of warfarin-related bleeding.
METHODS: A total of 201 patients, including 100 who had bleeding during warfarin use in our outpatient clinic and 101 patients who were followed up with the international normalization rate, were included in the study. Risk factors in warfarin-related bleeding were evaluated by the researcher with a questionnaire created as a result of the literature review. Data were statistically analyzed.
RESULTS: The prevalence of bleeding was 2.8 times higher in patients aged 65 years and older (confidence interval: 1.40-5.56) and 5.6 times higher in patients with comorbid diseases (confidence interval: 1.376-22.770). A history of stroke increased major bleeding 3.2 fold (confidence interval: 1.08-9.61). We also observed that lack of education might be a risk factor for warfarin-related bleeding.
DISCUSSION AND CONCLUSION: We believe that older patients under warfarin treatment should be informed according to their education status, and their medications and comorbid diseases should be monitored regularly by the same centers.

CASE REPORT
12.Paroxysmal Tonic Upgaze Mimicking Infantile Seizure
Fatime Akyol, Zehra Nur Ağ, Serkan Kırık
doi: 10.5505/amj.2023.56563  Pages 132 - 136
Non-epileptic paroxysmal events are very important in daily clinical practice. Paroxysmal tonic upgaze is a rare neuro-ophthalmologic non-epileptic paroxysmal condition characterized by episodes of continuous conjugated upward deviation of the eyes and normal horizontal gaze. Its pathogenesis is unknown, and its etiology is heterogeneous. The prognosis is often benign, but it's often confused with epilepsy. We present a case of "paroxysmal tonic upgaze" with a benign clinical course and spontaneous remission.

REVIEW
13.A new concept in protective healthcare: Quinary prevention
Erhan Şimşek, Basri Furkan Dağcıoğlu
doi: 10.5505/amj.2023.37431  Pages 137 - 150
Quinary Prevention; It is a set of policies, conditions, actions and measures aimed at reducing the risks associated with disseminating inappropriate health-related information and minimizing the impact of such misinformation on the progression or development of diseases. Quinary Prevention is under the multi-layered responsibility of health professionals, professional organizations and legislators. Legislators should prepare laws/regulations to prevent and deter the spread of health-related misinformation. Health service providers should assume the primary responsibility of Quinary Prevention, constantly update themselves in the discipline they choose, disseminate correct information and increase health literacy, inform the public through professional organizations or sites where relevant experts are the controllers, and report those who share false information to the necessary authorities. The public should not blindly believe every information conveyed through social media and should consult a healthcare professional. In social media, the impact of which is increasing day by day, the legal infrastructure should be prepared for an accurate information presentation by taking the necessary precautions, and health service providers, who are experts in their work, should contribute to the health literacy of the public by providing information on these platforms. Family physicians, who provide preventive and curative health services together, must know the protection steps within the scope of preventive medicine and update themselves in this regard. In this context, 'Quinary Prevention', the newest preventive care steps, was mentioned to guide health service providers, especially family physicians.

14.Literature Review on the Effectiveness of Medicinal Leech Therapy in the Wound Healing
Kübranur Ünal, Mehmet Emre Erol, Hüseyin Ayhan
doi: 10.5505/amj.2023.20280  Pages 151 - 164
Medical leech therapy, which has a history of thousands of years, is still the subject of many scientific studies today. These studies have shown that medicinal leech therapy has anticoagulant, antimicrobial, anti-inflammatory and analgesic effects, as well as increases blood flow in the bite area. Due to these stated effects of leech therapy, it has potential benefits for patients experiencing wounds of the skin and tissues. This review focused on presenting the studies in which medical leech therapy is used to promote wound healing, particularly in post-traumatic wounds and non-healing chronic wounds. Additionally, this review aims to recognize medicinal leech therapy, introduce the leech species that have therapeutic effects and indicate the effect mechanisms of leech saliva on wound healing. The case series, single case reports and review articles on the use of medicinal leech therapy in wound healing were inspected. The original animal-based studies on wound healing were also investigated in this review for additional information. Various reports indicate that medicinal leech therapy has potential benefits for patients experiencing venous congestion of the skin and tissues, as well as varied types of ulcers. Medicinal leech therapy has promising potential in the healing of post-traumatic and chronic non-healing wounds. Nevertheless, more studies are needed for the potential effects of medicinal leech therapy in wound healing should be clarified by further studies.Results and Conclusion: Various reports indicate that the medicinal leech therapy has potential benefits for patients experiencing venous congestion of the skin and tissues, as well as varied types of ulcers. The medicinal leech therapy has a promising potential in the healing of post-traumatic and chronic non-healing wounds. Nevertheless, more studies are needed for the potential effects of medicinal leech therapy in wound healing should be clarified by further studies.

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