ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of İstanbul - North Clin Istanb: 11 (5)
Volume: 11  Issue: 5 - 2024
EDITORIAL
1. Front Matter

Pages I - VIII

RESEARCH ARTICLE
2. The relationship between the degree of visceral pleural invasion and survival in non-small cell lung cancer
Seyma Ozden, Isil Gokdemir, Murat Kiyik
doi: 10.14744/nci.2023.25349  Pages 367 - 372
OBJECTIVE: The aim of this study was to evaluate the relationship between the degree of visceral pleural invasion (VPI) and survival in patients operated for non-small cell lung cancer (NSCLC).
METHODS: Between 2013 and 2015, 202 patients who were diagnosed with NSCLC in our center and followed up in our clinic were retrospectively evaluated. To examine the preoperative and postoperative prognostic factors of the patients, postoperative pathology results, demographic data and data on recurrence status were obtained from our hospital database and patient files.
RESULTS: VPI Survival analysis was performed by dividing 3 groups: PL0, PL1 and PL2. Mean survival (MS) was calculated as 39.528±1.469 (36.655–42.402; 95% CI) months for PL0, 35.136±3.115 (29.031–41.240; 95% CI) months for PL1, and 24.688±3.697 (17.441–31.934; 95% CI) for PL2 (p=0.020). When we consider PL0 and PL1 as a single group and compare it with PL2, the MS time of the PL0-PL1 group was 38.358±1.346 (35.721–40.995; 95% CI) months, while the MS time of the PL2 group was 24.688±3.697 (17.441–31.934; 95% CI) months (p=0.020).
CONCLUSION: Although PL0, PL1 and PL2 were classified into a single group (all considered as T2), this study showed that the presence of PL2 was associated with a poor prognosis in terms of survival, independent of lymph node involvement, histopathological subtype of the tumor and tumor size.

3. The importance of quantitative evaluation of constipation in children with lower urinary tract dysfunction
Tarik Emre Sener, Dogancan Dorucu, Sebahat Cam
doi: 10.14744/nci.2023.59827  Pages 373 - 381
OBJECTIVE: There is a known association between lower urinary tract dysfunction (LUTD) and constipation. The objective of this study was to investigate any correlation between voiding and bowel symptoms in children with LUTD.
METHODS: Children presenting with LUTD to our pediatric urology unit were prospectively included. Demographic data were recorded. All patients filled out the “Pediatric Lower Urinary Tract Symptom Score” (P-LUTSS) and “Constipation and Fecal Incontinence Symptom Severity” (CFISS) questionnaires. Symptom score correlation and associations with clinical findings were evaluated.
RESULTS: 76 patients were included. The mean P-LUTSS was 11±7.1; mean CFISS was 7.7±7.5. According to P-LUTSS risk groups, median CFISS score increased as the risk group was increased. There was direct correlation between P-LUTSS and CFISS for all patients. 6th, 7th, 8th, 9th, 10th and 13th questions of P-LUTSS were correlated with CFISS; the 1st and 7th questions of CFISS were correlated with P-LUTSS. Patients who responded not to have constipation on P-LUTSS had lower CFISS scores compared to those who had constipation. Patients who had a 0 score on CFISS had a mean P-LUTSS of 7.7±6.2, which put the majority of patients in low-risk group. Also, out of these 11 patients, 10 of them responded to have no constipation on P-LUTSS.
CONCLUSION: A relationship between LUTD and bowel symptoms, as well as the positive correlation between P-LUTSS and CFISS was demonstrated in this study. Patients presenting with LUTD should undergo meticulous evaluation using special questionnaires for bowel symptoms. Only by then, a complete treatment approach can be provided.

4. Oxygen titration with Oxygen Reserve Index in minimally invasive repair of pectus excavatum, a randomized controlled trial
Agshin Mirzayev, Gul Cakmak, Ruslan Abdullayev, Tunc Lacin, Zuhal Aykac, Ayten Saracoglu
doi: 10.14744/nci.2023.45556  Pages 382 - 390
OBJECTIVE: Perioperative hypoxemia is common during minimally invasive repair of pectus excavatum (MIRPE). Oxygen Reserve Index (ORI™) is a noninvasive method that shows blood oxygenation status. In addition, this method provides information about hypoxemia earlier than pulse oximetry. The primary aim of this study was to examine the value of ORI monitoring as an early predictor of hypoxemia during surgery. The secondary aim was to evaluate the value of ORI monitoring as a guide for oxygen titration to prevent hyperoxemia.
METHODS: This randomized controlled study enrolled 128 pediatric patients aged 8-18 years scheduled for elective MIRPE surgery. Patients were followed up with continuous peripheral oxygen saturation (SpO2) measurement in the control group (Group C) and continuous ORI monitoring in the study group (Group O). After pneumothorax, a decrease of 1% in basal SpO2 and 0.05 from basal ORI was considered clinically significant. Patient demographics, pre-induction, pre-first and second pneumothorax, and postoperative ORI, mean arterial pressure, temperature, perfusion index, end-tidal carbon dioxide values, length of hospital stay, anesthesia, and surgery durations were recorded.
RESULTS: Desaturation time was 59.46±15.57 seconds in Group O based on ORI, and 177.64±20.94 seconds in Group C according to SpO2, and the difference was significant (p<0.001). Use of FiO2>0.6 was lower in Group O, compared with Group C (p<0.05). Length of hospital stay was lower in Group O (p=0.002).
CONCLUSION: ORI may detect hypoxemia earlier than SpO2 monitoring during MIRPE surgery. ORI monitorization decreases exposure time to high oxygen concentrations and may increase patient safety during MIRPE surgery in pediatric patients.

5. Relationship of post-treatment radiological findings with relapses in idiopathic granulomatous mastitis patients
Gunay Rona, Meral Arifoglu, Kenan Cetin, Muhammet Fikri Kundes
doi: 10.14744/nci.2023.32309  Pages 391 - 397
OBJECTIVE: The aim of this study is to investigate the relationship between post-treatment radiological findings and recurrences in idiopathic granulomatous mastitis (IGM).
METHODS: Clinical data, ultrasound (US) and magnetic resonance imaging (MRI) examinations of 160 patients with IGM (mean age 34.6±7 years; range 20–56 years) who received only steroid or steroid+surgical treatment were evaluated retrospectively. Patients were grouped as radiological complete response (RCR) or radiological incomplete response (RIR).
RESULTS: Only in the steroid group, 79 (54.1%) patients were in the RCR group and 67 (45.9%) patients were in the RIR group. Recurrence occurred in 42 (26.3%) patients, 27 (16.9%) in the same breast and 15 (9.4%) in the contralateral breast. Most of the recurrences in the same breast had residual lesions up to recurrence (74.1%).
CONCLUSION: Residual lesion after treatment is a risk factor for recurrence, and treatment can significantly reduce recurrences until the lesions disappear. The lesion size on MRI after treatment is not associated with recurrence.

6. The evaluation of potential drug–drug interactions with antibiotics in hospitalized patients
Nurten Nur Aydin, Murat Aydin
doi: 10.14744/nci.2023.82473  Pages 398 - 405
OBJECTIVE: Drug-drug interactions (DDIs) occur when one drug alters the effect of another drug. The aim of this study was to evaluate potential drug-drug interactions (pDDIs) associated with the use of systemic antibiotics in hospitalized patients.
METHODS: The study included patients over the age of 18 who were hospitalized in our hospital on 12.07.2022 and were using at least two systemic drugs concurrently, with at least one being a systemic antibiotic. The study was conducted using the point prevalence method. The patients’ medication was evaluated for pDDIs using the UpToDate®/Lexicomp® database system. According to this screening tool, pDDIs were classified into 4 groups according to their severity: B, C, D, and X, ranging from mild to severe.
RESULTS: Out of the 296 patients included in the study, at least one pDDI was detected in 190 patients (64.2%). One hundred seventy-seven patients (59.8%) had at least one pDDI with non-antibiotic drugs. Fifty-seven patients (19.3%) had at least one pDDI with antibiotics. One hundred and six patients (35.8%) had no drug interactions. Patients with pDDIs related to antibiotics had significantly higher age, number of comorbidities, total number of medications and number of antibiotics (p=0.010, p=0.004, p<0.001, p<0.001, respectively) compared to patients without pDDIs related to antibiotics (n=239). For antibiotics, potential pDDIs were observed 25, 75, 6, and 6 times in groups B, C, D, and X, respectively. Out of the total of 398 antibiotics, penicillins (24.9%, n=99) and cephalosporins (24.4%, n=97) were the most frequently used. Respectively, eight and two pDDIs were detected with these drugs. While quinolones were used 47 times (11.8%), 74 pDDIs (59.7%) were identified with quinolones. Out of the 47 patients who used quinolones, 37 had pDDIs with antibiotics. The most frequent pDDI with antibiotics was associated with the use of quinolone systemic corticosteroids (15 patients). The second most prevalent interaction involves quinolone-angiotensin converting enzyme inhibitors or angiotensin 2 receptor blockers (13 patients).
CONCLUSION: Antibiotics should be checked for pDDIs before being prescribed. While beta-lactam antibiotics are generally considered safer in terms of pDDIs, greater caution should be exercised, particularly when prescribing quinolones.

7. Rheumatic diseases detected in patients presenting with uveitis
Esin Ozturk, Tuba Yuce Inel, Mahmut Kaya, Gercek Sen
doi: 10.14744/nci.2023.14564  Pages 406 - 413
OBJECTIVE: Uveitis may occur in the course of systemic inflammatory rheumatic diseases (IRD), or it may be the first clinical manifestation of these diseases. The aim of this study was to determine the incidence of IRD in patients whose initial clinical manifestation was non-infectious uveitis.
METHODS: The study included adult patients diagnosed as having noninfectious uveitis in the department of ophthalmology and referred to rheumatology for further investigation of potential rheumatic diseases as underlying etiology of uveitis. The patients’ demographic and clinical features, laboratory, and imaging findings were examined.
RESULTS: One hundred six patients who were diagnosed as having uveitis (42.4% anterior, 2.8% intermediate, 19.8% posterior, and 34.9% panuveitis) were included. Just over half (52.8%) of the patients were male and the mean age was 40.1±14.8 years. The mean age at the uveitis attack was 38.7±15 years. One-third (33%) of the patients were diagnosed as having rheumatologic disease (spondyloarthritis (SpA) n=10, Behcet disease (BD) n=17, vasculitides n=2, sarcoidosis n=2, undifferentiated connective tissue diseases n=3, rheumatoid arthritis n=1). SpA was diagnosed in 20% of patients presenting with anterior uveitis. BD was detected in 27% of patients referred with panuveitis and in 33.3% of patients whose first clinical finding was posterior segment involvement. Bilateral uveitis was detected in two-thirds of patients with posterior uveitis and tended to recur more frequently (p=0.014).
CONCLUSION: Rheumatic diseases have been identified in approximately one-third of patients presenting with different types of uveitis. Investigations addressing systemic rheumatic diseases are of paramount importance in patients with uveitis because they may change diagnosis and treatment processes.

8. Factors and outcomes related to new-onset acute kidney injury in septic medical intensive care unit patients
Kamil Inci, Gulbin Aygencel, Nazlihan Boyaci Dundar, Ozant Helvaci, Melda Turkoglu
doi: 10.14744/nci.2024.30040  Pages 414 - 421
OBJECTIVE: Sepsis-induced acute kidney injury (AKI) is a significant threat, contributing to worse outcomes in intensive care unit (ICU) patients. Thus, understanding the complex relationship between sepsis and renal dysfunction in ICU patients is crucial. We aimed to investigate the factors that may predispose to the development and the clinical consequences of new-onset AKI in septic medical ICU patients in this study.
METHODS: This retrospective cohort was conducted between December 2019 and April 2023 in the tertiary medical ICU of Gazi University Hospital, Ankara, Turkiye. Participants included septic medical ICU patients aged ≥18 without AKI on ICU admission. Data included demographics, comorbidities, disease severity and prognostic scoring, ICU admission, and ICU follow-up data. Statistical analyses, including logistic regression, were performed to identify independent risk factors for new-onset AKI development and ICU mortality.
RESULTS: Patients with new-onset AKI (36% incidence) had higher APACHE-II (21 [16–27] vs. 16 [12–18]) and SOFA (6 [3–9] vs. 3 [2–5]) scores and lower GCS (10 [6–15] vs. 14 [10–15]) on ICU admission (p<0.01 for all results). Independent risk factors for both new AKI development and ICU mortality included invasive mechanical ventilation (IMV) (OR (95% CI): 5.02 [1.59–15] for AKI and OR (95% CI): 13.2 [3–58.8] for ICU mortality, p<0.01), new-onset shock (OR (95% CI): 3.98 [1.42–11.1] for AKI, OR (95% CI): 14.5 [4.4–43.5] for mortality, p<0.01), and higher APACHE-II score (OR (95% CI): 1.08 [1.01–1.16]), for AKI, p=0.05 and (OR (95% CI): 1.04 [1.01–1.08], for mortality, p=0.01). AKI was more frequent in patients whose source of infection was the respiratory system (45% vs. 29%, p=0.01) and catheter-related bloodstream infection (CRBSI) (17% vs. 8%, p=0.03) than those who did not. New AKI development was associated with longer ICU stay (9 [5–18] vs. 5 [3–10] days, p<0.01) and was independently associated with ICU mortality (OR (95% CI): 28.6 [6.6–125], p<0.01).
CONCLUSION: This study reveals new-onset AKI incidence of 36% in septic medical ICU patients. Additionally, it underlines the potential impact of infection sources on new AKI development. New-onset shock, IMV, and disease severity were independently associated with both new-onset AKI and ICU mortality in this population.

9. Determining the effectiveness of a virtual service / patient-based education program on patient care and clinical decision making in nursing: A quasi-experimental study
Taner Onay, Mehmet Ali Gulpinar, Merve Saracoglu, Esra Akdeniz
doi: 10.14744/nci.2024.78095  Pages 422 - 433
OBJECTIVE: The aim of this study was to determine the effectiveness of a virtual service/patient-based program (vSPBP) developed for nursing education and its effect on the development of care plan preparation and clinical decision-making skills.
METHODS: The study was conducted in a quasi-experimental design with a sample of fourth-year nursing students. Partici-pants were assigned to the intervention group (n=44) and control group (n=51). The intervention group participated in a full-day vSPBP in addition to clinical training, whereas the control group received only the clinical training. Both groups were evaluated at the end of the intervention for care planning skills and at the beginning, middle, and end of the academic year for clinical decision-making skills. The Modified Simulation Effectiveness Tool (mSET) and focused group interview were used to evaluate the effectiveness of the vSPBP; nursing students’ Clinical Decision-Making in Nursing Scale (CDM-NS) and Care Plan Evaluation Form were used to evaluate learning outcomes. Quantitative data were analyzed using the t-test and ANOVA. Qualitative data were analyzed by three researchers, and themes were identified. Ethical permissions were obtained from the relevant units.
RESULTS: The total score of the Turkish Version of the mSET was 84.39±12.08 (51-95) and the education program was found to be highly effective. The mean care plan preparation skills scores of the intervention and control groups were 44.84±2.77 and 27.75±4.28 (0-50), respectively, and the total scores of the CDM-NS (at the last measurement) were 147.90±11.28 and 146.42±12.21. While there was a significant difference between the intervention and control groups in the ability to prepare a care plan (p=0.001), there was no difference between the groups in clinical decision-making skills over time (p=0.433), between the second and third measurements over time (p>0.05), but both measurements increased significantly compared with the first measurement (p=0.000).
CONCLUSION: The vSPBP was determined to be an effective learning activity for the development of care plan preparation and clinical reasoning skills, as well as effective in closing the gap between theoretical and clinical knowledge and adaptation to the nursing process when applied in an integrated manner with the existing nursing program.

10. Male breast cancer in a single-center experience: Diagnosis, clinicopathological features, and treatment strategies
Deniz Isik, Oguzcan Kinikoglu, Ezgi Turkoglu, Heves Surmeli, Neslihan Buyukmurat
doi: 10.14744/nci.2024.32815  Pages 434 - 439
OBJECTIVE: Although breast cancer is the most common cancer type in women worldwide, it is a rare tumor in men, accounting for less than 1% of all male cancers. Therefore, the characteristics of the tumor, the management of the disease, and our overall survival data are quite limited.
METHODS: We retrospectively analyzed the data of 51 male patients diagnosed and treated for breast cancer, whose follow-up processes continue, at our hospital. We examined in detail the patients’ age, comorbid diseases, history of concomitant malignancies, family history, stage of the disease, tumor size, lymph node status, estrogen receptor (ER)/progesterone receptor (PR) along with Human Epidermal Growth Factor Receptor-2 (HER-2) status. Additionally, we analyzed the type of surgery, history of radiotherapy, and chemotherapy and hormonal treatments in the adjuvant and metastatic periods.
RESULTS: In our study, where we determined a median survival time of 122 months (29–214), we found that the stage at diagnosis, Eastern Cooperative Oncology Group (ECOG) performance status, and discontinuation of adjuvant endocrine therapy significantly affected survival. While the median survival was not reached in stage 1 patients at diagnosis, the median survival times for stage 2, 3, and 4 patients were 118, 83, and 39 months, respectively. The differences between the groups were statistically significant (p=0.005). Similarly, the median survival was not reached for patients with an ECOG performance status of 0, but it was 84 months for those with a status of 1 and 98 months for those with a status of 2. The differences among these three groups were also statistically significant (p=0.001). The median survival was not reached for patients who completed adjuvant endocrine therapy, whereas it was 83 months for those who discontinued the therapy, with the difference being statistically significant (p=0.021). Besides these data, the presence of perineural invasion was found to be a factor close to statistical significance in terms of survival (p=0.066). Histological subgroups, grade, lymphovascular invasion, adjuvant chemotherapy, and Ki-67 were not significant parameters for survival.
CONCLUSION: Despite the differences in the stage at diagnosis, response to treatments, lower awareness of the disease, older age at diagnosis, and consequently, the increase in accompanying comorbid diseases, male breast cancer is managed according to studies and guideline recommendations for female breast cancer due to the lack of sufficient randomized studies. By presenting our clinical experience, we have emphasized the necessity for further studies in this field.

11. Experimental investigation of the effect of thymoquinone on the viability of random patterned skin flaps
Gulsum Cebi, Tugba Feryal Yildiz, Eda Merve Kurtulus, Yagmur Aydin, Merdan Serin
doi: 10.14744/nci.2024.51482  Pages 440 - 450
OBJECTIVE: The purpose of this study is to demonstrate the potential effects of thymoquinone, a well-known antioxidant agent, on random flap viability and thus to improve the clinical use of these flaps.
METHODS: In this study, 24 Sprague Dawley female albino rats weighing between 200–250 grams were used. Three groups consisting of randomly selected 8 rats were formed, as study, sham and control groups. Modified McFarlane flap model sized 3x9 cm. was used. In control group, only local wound care was carried out for ten days after flap elevation. In sham group, daily intraperitoneal dimethyl sulfoxide (DMSO) solution was injected in the post-operative 10-day period. In the study group thymoquinone and DMSO solution were injected intraperitoneally together. 10 days later, the study was terminated and flaps were photographed for necrotic area measurements, tissue and blood samples were taken out for biochemical and histopathological studies. In biochemical studies, tissue and serum total antioxidant capacity (TAC) and thiobarbituric acid reactive substrates (TBARS) levels were measured. Histopathological studies included inflammatory cell infiltration, collagen, fibroblast formation and angiogenesis.
RESULTS: There was significant decrease in the necrotic areas of flaps in the study group. Serum and tissue antioxidant levels were significantly high and TBARS levels were significantly low. Histopathological examination showed no significant difference in inflammatory cell infiltration, fibroblast formation or angiogenesis between the groups. However, collagen density in the study group was found to be more than the other groups and the structure was better formed.
CONCLUSION: Thymoquinone increases the flap viability due to its antioxidant properties and it has a positive contribution to wound healing, although it has no significant anti-inflammatory or anjiogenetic activity. In the future, we think that it can be clinically useful for preventing distal flap necrosis in patients with high risk.

12. Real-life neovascular AMD treatment considering reimbursement in Turkiye: One-year comparison of switching to intravitreal ranibizumab or aflibercept after treatment failure with three loading intravitreal bevacizumab injections
Mehmet Orkun Sevik, Nimet Zeynep Tiras, Aslan Aykut, Didem Dizdar Yigit, Ozlem Sahin
doi: 10.14744/nci.2024.75688  Pages 451 - 459
OBJECTIVE: To compare one-year anatomical and functional results of switching to an on-label intravitreal anti-vascular endothelial growth factor (anti-VEGF) agent (intravitreal ranibizumab [IVR] or aflibercept [IVA]) after treatment failure with three loading doses of off-label intravitreal bevacizumab (IVB), which is mandatory in the treatment of neovascular age-related macular degeneration (nAMD) to get reimbursement from Social Security Institution in Turkiye.
METHODS: This comparative, real-life, retrospective cohort study included treatment-naïve nAMD patients treated starting with three loading doses of IVB, switched to three loading doses of IVR and IVA due to treatment failure after IVB loading, and followed up one year with a treat-and-extend (T&E) protocol with 2-week extension/shortening intervals. The primary outcomes were changes in best-corrected visual acuity (BCVA; logMAR) and central macular thickness (CMT, µm) one year after the switch, and the secondary outcomes were maximum treatment intervals, number of injections, and disease activity rates.
RESULTS: The mean age (72.9±8.2 and 72.2±6.7, p=0.677) and gender (60.0% and 47.4% females, p=0.398) were similar among the IVR (35 eyes/patients) and IVA (38 eyes/patients) groups. The median BCVA and CMT were significantly improved during the study period (p<0.001) with no significant intergroup differences. The ratio of 4-, 6-, 8-, 10-, and 12-week maximum treatment intervals were 28.6%, 17.1%, 14.3%, 8.6%, and 31.4% in the IVR, and 13.2%, 15.8%, 21.1%, 15.8%, and 34.2% in the IVA group (p=0.492). The median (IQR) number of injections in the IVA group (8 [7–9]) was significantly lower than the IVR group (9 [8–12]) during the one-year T&E period (p=0.026). The disease activity rates were 34.3% and 26.4% one month (p=0.610) and 37.1% and 21.1% one year (p=0.195) after the switch in IVR and IVA groups.
CONCLUSION: This real-life comparison study indicates that, after the treatment failure with three loading doses of IVB, switching to either on-label anti-VEGF agent can be regarded as comparable considering functional and anatomical results. However, although maximum treatment intervals were not significantly different, fewer injections were required with aflibercept during the one-year T&E follow-up period.

13. Evaluation of the teratogenic effects of pregabalin usage during pregnancy: A multicenter case-control study
Mert Kaskal, Busra Kuru, Ilknur Erkoseoglu, Huseyin Yilmaz, Baris Karadas, M. Zafer Goren
doi: 10.14744/nci.2024.57702  Pages 460 - 465
OBJECTIVE: Information regarding pregabalin use is limited. We aimed to assess the outcome of the patients who have taken pregabalin at a certain time during their pregnancies.
METHODS: 31 patients used pregabalin treatment during pregnancy and 93 control patients were included in the study who applied to hospital between the years 2013–2022. In this multicenter case-controlled study, the outcome of the pregnancies and the health condition of the newborn in the pregabalin and control groups were evaluated.
RESULTS: Preterm delivery rates (5/27 (18.5%) vs. 5/87 (5.7%); OR 0.26, 95% CI 0.07–1.01, p=0.04) and lower birth weight (6/27 (22.2%) vs. 5/81 (6.6%); OR 4.34, 95% CI 1.20–15.65, p=0.016) were found higher in the pregabalin group compared to the control group. However, significant difference was not found between the birth dates of babies in pregabalin and control groups with the log-rank test (p=0.30). Spontaneous abortion rates were not significantly different (2/31 (6.4%) vs. 4/93 (4.3%); OR 1.52, 95% CI 0.26–8.72, p=0.63). Although major malformation rates in pregabalin were higher than those in controls (3/27 (11%) vs. 4/88 (4.5%); OR 0.38, 95% CI 0.07–1.82, p=0.21) the outcomes were statistically insignificant.
CONCLUSION: Preterm delivery rates and lower birth weight were higher in pregabalin group. Also, it should not be ignored that chronic diseases of the pregnant women in pregabalin group may affect the outcomes poorly.

14. Evaluation of conventional anorectal manometry and biofeedback therapy in adolescents with functional constipation
Neslihan Gulcin, Ali Ihsan Anadolulu, Meltem Caglar, Huseyin Murat Mutus, Cigdem Ulukaya Durakbasa
doi: 10.14744/nci.2023.85126  Pages 466 - 470
OBJECTIVE: The aim was to evaluate the outcomes of conventional anorectal manometry (ARMM) testing and biofeedback therapy in adolescents with functional constipation.
METHODS: A retrospective analysis of ARMM findings in patients aged 10–18 years with intractable constipation over a 4-year period was conducted.
RESULTS: Of the 41 patients (mean age, 13.5±2.44 years) included, 20 (48.7%) were male. Rectoanal inhibitory reflex (RAIR) was positive in all patients. Group 1 had 31 patients with dyssynergic defecation (DD) and Group 2 had 10 patients without DD. Anal canal resting pressure, squeeze test pressure, rectal defecation pressure, and first and urge sensation volumes were similar between the groups. Maximum tolerated volume and the relaxation percentage of RAIR were higher in Group 1 than in Group 2 (p<0.05). Among 31 patients referred for biofeedback therapy, 8 (25.6%) completed the program with complete resolution of their symptoms. The mean follow-up period for these patients was 21±14.7 months.
CONCLUSION: DD is relatively common in patients with psychosocial adjustment disorders, and it can be diagnosed via ARMM. Despite the low rate of adherence to the therapy in the presented series, biofeedback therapy was highly effective in resolving the symptoms including soiling.

15. Evaluation of bladder capacity in pediatric patients with nocturnal enuresis using voiding diary and uroflowmetry: A retrospective study
Sevim Yener, Zekeriya Ilce
doi: 10.14744/nci.2024.89990  Pages 471 - 475
OBJECTIVE: This retrospective study was conducted in a tertiary hospital in Turkiye, it was aimed to evaluate the results of kidney and bladder ultrasonography, uroflowmetric study and volume frequency chart in children diagnosed with bedwetting at night.
METHODS: This study focused on patients aged 5-17 years who were treated for nocturnal enuresis in the single-center pediatric urology clinic of a tertiary hospital between 2017-2021. Patients’ comorbidities, surgical history, urinary ultrasonography findings, uroflowmetry examination results, and two-day voiding diary were requested.
RESULTS: The number of pediatric patients diagnosed with enuresis nocturna was 956. Abnormal ultrasonography findings were observed in 13.9% of patients. Almost half of the patients had a positive family history, and 13.4% had a history of previous surgical procedures. While the voiding diary indicated that 54.2% of patients had bladder volumes equivalent to the expected bladder capacity, uroflowmetry examination revealed low bladder capacity in 65% of patients.
CONCLUSION: This study underscores the significance of comprehensive evaluations, including detailed ultrasonography and voiding diary measurements, in pediatric patients with monosymptomatic enuresis nocturna. Our study suggests that bladder volume measured through a two-day weekend voiding diary may provide more effective information for estimating optimal bladder capacity compared to measurements obtained through uroflowmetry.

16. Evaluation of school achievements in adolescents with primary hypertension
Emre Leventoglu, Akif Kavgaci, Furkan Cagri Kavas, Fatma Canbeyli Hayvaci, Bahar Buyukkaragoz
doi: 10.14744/nci.2024.34438  Pages 476 - 484
OBJECTIVE: Primary hypertension (HT) is a global public health problem with increasing prevalence in recent years. HT may have caused decreased neurocognitive functions and learning difficulties. In this study, clinical characteristics of adolescents with primary HT were examined and the relationship between semester grade point average (GPA) and HT was evaluated.
METHODS: This is an observational, cross-sectional, descriptive study conducted on adolescents with primary HT attending high school. Patient records (number of hospital visits, HT-related complaints, blood pressure measurements, and laboratory tests) were evaluated retrospectively. End-of-semester report card grades of Mathematics, Turkish Language and Literature and English courses were noted, and compared with the clinical characteristics of the patients.
RESULTS: The study included 83 patients with a mean age of 15.6±1.2 years. Patients with higher body mass index had lower grades in Mathematics (p=0.007) and Turkish Language and Literature (p=0.004). Patients with HT-related symptoms such as headache, epistaxis and palpitations had lower GPAs for all courses. Also, patients with hyperuricemia or proteinuria had lower semester GPAs compared to patients with normal serum uric acid levels or without proteinuria (p<0.05). GPAs for Mathematics (p=0.000) and Turkish Language and Literature (p=0.006) decrease as the number of hospital visits increases.
CONCLUSION: HT may cause not only cardiovascular complications but also decreased neurocognitive functions through various mechanisms and may have a negative impact on academic skills. Therefore, HT should be followed up with a multidisciplinary approach and intensive efforts should be made to approach the goal of normotension.

17. Seroprevalence of Marburg virus: A modeling study in endemic area
Amnuay Kleebayoon, Viroj Wiwanitkit
doi: 10.14744/nci.2023.47048  Pages 485 - 487
OBJECTIVE: An old disease called the Marburg virus infection has just recently started to appear in some African nations in recent years. The disease is currently being scrutinized for its potential to become a new global public health issue.
METHODS: The authors of this work employed a mathematical modeling technique to determine the final seroprevalence rate.
RESULTS: The seroprevalence rate can be estimated based on the results of the current investigation. This incidence may indicate that the endemic nation has an asymptomatic Marburg virus infection.
CONCLUSION: This may also point to the significance of a possible asymptomatic Marburg virus sickness, which may be the cause of the disease’s broad transmission. In light of the resurfacing Marburg virus disease concern, it is important to recognize this problem. (NCI-2023-5-15)

CASE REPORT
18. A rare paraneoplastic condition in Hodgkin lymphoma: Evans syndrome and literature review
Unal Atas, Kubra Cerci, Sema Tuncer, Volkan Karakus
doi: 10.14744/nci.2022.66742  Pages 488 - 491
Evans syndrome (ES) is a spectrum of diseases in which the combination of autoimmune hemolytic anemia and immune thrombocytopenia or sometimes neutropenia. ES has been accepted usually as an idiopathic condition, but it may be secondary. The coexistence of autoimmune cytopenias and Hodgkin lymphoma (HL) is rarely observed and the rate of ES in HL patients is not clear. Here we describe a 56-year-old male patient who presented with ES and was diagnosed with HL. After corticosteroids, intravenous immunoglobulin (IVIG) and ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) treatment, immune cytopenias were completely resolved. The literature is also reviewed and we found 16 cases in which HL and ES coexist. Although AIHA and immune thrombocytopenia usually develop simultaneously, they rarely occur at different times. Many aspects of the pathogenesis are unknown, but it is thought to be a complex immunological background. Corticosteroids and/or IVIG are the most commonly used first-choice drugs in the initial treatment of ES. Response rates to treatment are variable and response to treatment may be poor, particularly with underlying conditions. If detected, the underlying lymphoma should be treated.

LETTER TO THE EDITOR
19. Conducting risk assessments and case detection in online environments in the scope of fight with COVID-19
Banu Cakir
doi: 10.14744/nci.2023.56659  Pages 492 - 494
Abstract |Full Text PDF

20. Reply to letter to the editor: "Conducting risk assessments and case detection in online environments in the scope of fight with COVID-19"
Suayip Birinci, Mustafa Mahir Ulgu, Sahin Aydin, Eray Ozcan
doi: 10.14744/nci.2024.18942  Pages 493 - 494
Abstract |Full Text PDF

LookUs & Online Makale