E-ISSN: 2587-0351 | ISSN: 1300-2694
Van Medical Journal - Van Med J: 31 (2)
Volume: 31  Issue: 2 - 2024

Pages I - III

2.Is ultrasound a reliable method for quantifying postvoid urine volume?
Faraj Afandiyev, Belma Çevik
doi: 10.5505/vmj.2024.04003  Pages 77 - 81
INTRODUCTION: In the treatment and follow-up of patients with Benign Prostatic Obstruction (BPO), uroflowmetry and evaluation of post voiding residual urine volume (PVR) are of great importance. Methods such as urethral catheter and suprapubic ultrasonography are generally used to measure PVR. In this study, we aimed to compare the accuracy of urethral catheter and suprapubic ultrasonography methods in detecting PVR.
METHODS: We included patients who underwent catheterisation for various clinical reasons. A total of 103 patients were included in the study. All patients were evaluated by suprapubic ultrasonography (USG) in the supine position to confirm that their bladders were empty. After 200 ml of saline was injected into the bladder with the help of a urethral catheter, the catheter was removed and the patients were instructed to urinate into a graduated cup.PVR was calculated by subtracting the volume voided by the patient from the volume injected into the bladder (200 ml).Abdominal USG was performed again within 5 minutes after voiding. Finally, the PVR values obtained were compared.
RESULTS: The accuracy of urethral catheter measurements was higher than suprapubic ultrasonography (p= 0.028). The sensitivity and specificity of suprapubic ultrasonography were found to be 100% (1.000 (0.904-1.000)) and 94% (0.940 (0.856-0.977)), respectively..

DISCUSSION AND CONCLUSION: Conclusions: USG demonstrating high specificity and sensitivity in assessing postvoid residual urine volume.

3.Effect of depression, anxiety, and rumination on sleep quality in healthcare workers
Mesut Yıldız
doi: 10.5505/vmj.2024.14633  Pages 82 - 88
INTRODUCTION: Depression, anxiety and sleep problems are commonly seen among healtcare workers. This study aimed to evaluate the relationship between rumination, anxiety, depression, and sleep quality in healthcare workers and find which factors affect sleep quality in this population
METHODS: Participants (n=373)were evaluated with The Hospital Anxiety Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PUKİ), and The Ruminative Thought Style Questionnaire (RDBÖ).
RESULTS: The mean age of the participants was 35,83 ± 9,75 and 267 (71.6 %) were female. Within the whole group; 198 (53.1%) of them had poor sleep and 175 (46.9%) had good sleep quality. About HADS scores, 173 (46.4%) had minimal, 100 (26.8%) had borderline anxiety and 100 (26.8%) had abnormal anxiety scores; 224 (60.1) had minimal, 87 (23.3%) had borderline depression and 62 (16.6%) had abnormal depression scores. Participants having poor sleep according to PSQI had significantly higher HADS-A, HADS-D, and RTSQ scores compared to good sleepers (p<0.001, p<0.001, and p<0.001 respectively). Individuals who scored above average on the RTSQ scale had significantly higher PSQI, HADS-A, and HADS-D scores compared to individuals having scores below average on the RTSQ (p<0.001, p<0.001, and p<0.001). Regression analysis showed that HADS-A and HADS-D contributed more than all other variables for predicting sleep quality in the present study.
DISCUSSION AND CONCLUSION: Poorer sleep is associated with higher anxiety and depression scores. Higher rumination is associated with higher anxiety, depression, and worse sleep. The best predictors of sleep quality in healthcare workers are depression and anxiety scores according to HADS.

4.Safe inhalational anesthetics in patients with coronary artery disease: Effects of sevoflurane and desflurane on ischemia-modified albumin levels
Celaleddin Soyalp, Ömer Türk, Ersoy Öksüz, Nureddin Yuzkat, Canan Demir, Halit Demir
doi: 10.5505/vmj.2024.18209  Pages 89 - 94
INTRODUCTION: Sevoflurane and desflurane are commonly used anesthetic agents with known cardiac side effects. Ischemia-modified albumin (IMA) is a useful biomarker that increases in cardiac conditions. This study investigates the effects of desflurane and sevoflurane on cardiac parameters and IMA levels in patients with coronary artery disease (CAD).
METHODS: Sixty CAD patients aged over 18 years scheduled for elective surgery were enrolled. Patients were randomly divided into two groups: group I, desflurane (D) (n=30) and group II, sevoflurane (S) (n=30). Pre- and post-operative cardiac parameters were recorded for each patient. IMA measurement in serum was determined spectrophotometrically.
RESULTS: Postoperative IMA levels were significantly higher than preoperative IMA levels in both groups (p<0.001 for both). The rate of change between post- and pre-operative IMA levels was significantly lower in group S than in group D (p<0.001). Postoperative heart rate (HR) and mean arterial pressure (MAP) levels were significantly lower than preoperative HR and MAP levels in both groups (p<0.001), whereas no significant differences were found between the two groups with regard to pre- and post-operative HR and MAP levels.
DISCUSSION AND CONCLUSION: Sevoflurane is safer and has fewer cardiac side effects in CAD patients than desflurane. However, there is a need for comprehensive new studies evaluating large patient groups investigating this situation.

5.Obesity Management of Family Physicians in Van City; Attitudes, Approaches and Practices
Şule Tunçekin, Dilek Kuşaslan Avcı, Mehmet Emin Layık
doi: 10.5505/vmj.2024.29726  Pages 95 - 101
INTRODUCTION: Family physicians have an important role in the diagnosis and treatment of obesity, as most obese patients are first seen by the family physician. The aim of our study was to evaluate the obesity management of family physicians working in family health centers in Van province.
METHODS: This cross-sectional study was conducted between 04.05.2021-30.07.2021 with 126 volunteer family physicians working in family health centers representing Van province. The questionnaire including sociodemographic characteristics, obesity knowledge and self-efficacy questions were completed by the physicians themselves.
RESULTS: Only 13 (10.3%) of the physicians knew the number of obese patients registered in their units. Although 97 (77%) of the physicians stated the family physician was responsible for obesity management, 54 (42.9%) stated they calculated the body mass index of their patients "sometimes" and 48 (38.1%) "rarely". Seventy-one (56.3%) of the physicians thought family physicians had a great role in the prevention of obesity, while 63 (50%) argued the best role of the family physicians in obesity management isn’t treating these patients but referring them to the relevant fields. Among physicians who calculated BMI "often", 66.7% indicated that they were professionally prepared to treat overweight patients (p=0.030) and didn't consider themselves unsuccessful in getting their patients to lose weight (p=0.010).
DISCUSSION AND CONCLUSION: Our study shows that although obesity is included in chronic disease follow-up in primary care, it has not been put into practice. It is clear that there is a need to train family physicians on obesity management and to help them gain self-efficacy.

6.Mitral Annular Calcification as a Challenging Concomitant Factor for Patients Underwent TAVI
Aykun Hakgör, Arzu Yazar, Fatih Erkam Olgun, Semih Kalkan, Büşra Güvendi Şengör
doi: 10.5505/vmj.2024.43534  Pages 102 - 111
INTRODUCTION: Mitral annular calcification (MAC) is commonly observed in patients with cardiovascular diseases and has been associated with adverse clinical outcomes. This study aims to clarify the prevelance and impact of MAC on peri-procedural, in-hospital, and long-term outcomes in high-surgical-risk patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
METHODS: 403 patients underwent TAVI for severe AS was retrospectively evaluated. MAC was identified on transthoracic-echocardiography and confirmed on computed-tomography in 45.4% of patients. Clinical outcomes, including in-hospital mortality and two-year follow-up mortality, were evaluated, and potential predictors of MAC and mortality were analyzed using logistic and Cox regression models.
RESULTS: MAC was more prevalent in older, female patients with atrial fibrillation. Although the presence of MAC did not correlate with increased in-hospital (unadjOR: 1.77, 95% CI (0.88-3.54), p=0.106) or long-term mortality (unadjOR: 0.73, 95% CI (0.40-1.33), p=0.311), it was associated with a higher requirement for post-TAVI permanent pacemaker implantation (PPI) and moderate-to-severe paravalvular aortic regurgitation (PVAR). Multivariate analysis revealed left ventricular ejection fraction (adjHR: 0.97, 95% CI (0.94-0.99),p=0.015), mean transvalvular gradient, (adjHR: 1.02, 95% CI (1.00-1.04), p=0.0.25) systolic pulmonary artery pressure (adjHR: 1.04, 95% CI (1.01-1.0.6), p=0.001) and severe PVAR (adjHR: 3.16, 95% CI (1.25-7.96), p=0.015) as independent predictors of long-term mortality.
DISCUSSION AND CONCLUSION: In patients with severe AS undergoing TAVI, MAC is a marker of complex cardiac pathology but does not independently predict mortality. However, its presence may increase the need for PPI and the incidence of PVAR, which warrants attention in postoperative management and follow-up.

7.The Association between Smartphone Addiction, Type D Personality Traits, and Insomnia in University Students
Hilal Uygur, Ali Kandeger, Ömer Pınar, Ömer Faruk Uygur, Ebru Erdoğan
doi: 10.5505/vmj.2024.69775  Pages 112 - 118
INTRODUCTION: We aimed to investigate the mediating role of smartphone addiction in the relationship between Type D personality and the severity of insomnia.
METHODS: The study is a cross-sectional study conducted among university students. Participants completed a Sociodemographic Data Form, Insomnia Severity Index (ISI), Type D Personality Scale (DS-14), Smartphone Addiction Scale-Short Form (SAS-SF), and Subjective Vitality Scale (SVS). We compared the mean scores of the scales between individuals with and without Type D personality. A correlation analysis was performed between the scales and the mediating role of smartphone addiction in the relationship between Type D personality traits and insomnia severity was examined.
RESULTS: The study included 375 participants with a mean age of 22.10 ± 3.95 years, ranging from 18 to 53 years. The results showed that individuals with Type D personality had significantly higher scores on the SAS-SF and ISI, but lower scores on the SVS. We also found a significant positive correlation between smartphone addiction, Type D personality traits, and the ISI. Additionally, there was a statistically significant negative correlation between SVS and the other scales. Type D personality had a significant effect on ISI scores directly (path c; β = 0.119; p < 0.001; 95% CI = 0.07–0.16) and totally (path c + a x b; β = 0.148; p < 0.001; 95% CI = 0.10-0.19) as well.
DISCUSSION AND CONCLUSION: Type D personality traits and smartphone addiction should be questioned in the intervention of insomnia in university students, and specific therapies should be developed.

8.The Predictive Value of Inflammatory Indices and CHA2DS2-VASc Score for NOAF in Covid-19 Patients and the Effect of NOAF on In-Hospital Outcomes
Mehdi Karasu, Yücel Karaca, Orhan Doğdu, Mehmet Ali Kobat
doi: 10.5505/vmj.2024.92072  Pages 119 - 126
INTRODUCTION: It has been reported that atrial fibrillation (AF) is frequently observed in patients with severe COVID-19. Various mechanisms may be involved in the pathogenesis of AF in these patients. COVID-19 infection increases susceptibility to atrial AF acutely during the infectious stages and sometimes in the post-convalescence period.
METHODS: The current retrospective multicenter review consists of consecutive patients hospitalized for COVID-19-related infection in 3 different medical centers. Patients hospitalized for COVID-19 infection between September 2021 and February 2022 were studied.
RESULTS: The incidence of New-onset AF (NOAF) was 7.8%. N/L ratios on days 1, 3, and 7 were significantly higher in the NOAF group. In-hospital all-cause mortality, embolic events, and major bleeding were significantly higher in the NOAF group. Hospital stay was significantly longer in the NOAF group.
DISCUSSION AND CONCLUSION: CHA2DS2VASc score, D-Dimer, and N/L ratio are independent predictors of NOAF in COVID-19 patients. NOAF is associated with worse clinical features during hospitalization in terms of more bleeding events, death, and embolic events. NOAF is also associated with a longer hospital stay.

9.The Protective Role of Syringic Acid on Ovarian Injury Created by Ischemia Reperfusion
Emsal Pınar Topdağı Yılmaz, Ayhan Tanyeli, Ersen Eraslan, Mustafa Can Güler, Fazile Nur Ekinci Akdemir, Derya Güzel Erdoğan, Filiz Taspinar
doi: 10.5505/vmj.2024.93609  Pages 127 - 132
INTRODUCTION: Syringic acid (SA), a natural phenolic substance, possesses anti-inflammatory and antioxidant properties. We investigated the likely preventive effects of SA on organ damage to the reproductive system caused by bilateral ovarian ischemia-reperfusion (I/R).
METHODS: 32 female Sprague-Dawley rats in total were used; they were split into four groups: a sham group for control (group I), I/R group (group II), I/R group given 10 mg/kg SA (group III), and an I/R group given 50 mg/kg SA (group IV). Group I underwent only an abdominal incision without I/R. In groups II, III, and IV, I/R procedures were conducted for 3 hours. SA was given intraperitoneally to groups III and IV for 30 minutes before reperfusion at 10 mg/kg and 50 mg/kg, respectively. The ovarian tissues were surgically removed for analysis.
RESULTS: TNF-α, MDA, IL-1β, MPO, TOS and OSI levels in group II were found to be significantly higher than in group I. Additionally, a decrease was detected in TAS and SOD values in group II. In contrast, SA administration led to significant increases in the level of antioxidant enzymes in both groups III and IV. Also, in the SA-given groups, significant decreases were detected in OSI and TOS levels, along with a decrease in MPO, MDA, TNF-α, and IL-1β levels.
DISCUSSION AND CONCLUSION: It has been demonstrated that SA has a protective effect against organ damage caused by bilateral ovarian I/R in the reproductive system. This is the first study to show that SA can reduce ovarian damage due to I/R injury.

10.Evaluation of Fetal Central Nervous System Anomalies Diagnosed Prenatally: Prenatal and Postnatal Outcomes
Mustafa Bağcı, Kazım Uçkan, Hanım Güler Şahin, Onur Karaaslan, Erbil Karaman, Yusuf Başkıran
doi: 10.5505/vmj.2024.77487  Pages 133 - 141
INTRODUCTION: The aim of this study is to examine the diagnosis types and rates of patients with central nervous system (CNS) anomalies detected in the prenatal period between 2021-2022 in our perinatology clinic and to contribute to the literature.
METHODS: Our study included 191 patients with CNS anomaly and whose pregnancy results were reached. Demographic characteristics of the patients, additional detected anomalies, fetal Magnetic Resonance Imaging (MRI) and genetic results, obstetric and neonatal results were evaluated if requested.
RESULTS: Neural tube defects (NTD) were found most frequently at 75.3%, and among these, acrania was found most frequently at 27.2%. While 74.3% of the detected CNS anomalies were isolated anomalies, it was found that 5.2% were accompanied by additional CNS anomalies and 21.9% were accompanied by additional extracranial anomalies. Abnormal karyotype was obtained in 12.1% of the patients who wanted to have a prenatal diagnosis test. It was found that 11% of the patients requested fetal MRI and ventriculomegaly was the most common fetal MRI indication. While the pregnancies of 56.5% of the patients were terminated, 37.7% of them gave live births. The rate of surgical intervention in live-born babies with CNS anomalies was found to be 56.9%. A total mortality rate of 43% was found in live-born babies.
DISCUSSION AND CONCLUSION: Since CNS anomalies are associated with serious morbidity and mortality; Prenatal diagnosis is very important so that families can be offered a pregnancy termination option and those who will continue to be pregnant should be informed about the treatment and rehabilitation processes of their babies.

11.Investigation of relationship between lumbar Modic changes and serum vitamin D concentrations
Server Ilter, Veysel Delen, Murat Toprak, Remziye Akçalı
doi: 10.5505/vmj.2024.46855  Pages 142 - 146
INTRODUCTION: There is limited and inconsistent data on the relationship between vitamin D deficiency and Modic changes (MCs). Also, which type of MCs is associated with vitamin D is not clear. Vitamin D has anti-inflammatory effects, while type 1 MCs have inflammatory nature. Accordingly, patients with type 1 may have lower vitamin D levels than those with type 2 MCs. This study aimed to compare type 1 and type 2 MCs for serum vitamin D concentrations.
METHODS: Between May 2019 and July 2020, a total of 53 patients with type 1 or type 2 MCs were included in this study. Patients’ demographics were recorded, and back pain severity was assessed by using visual analog scale. Serum levels of vitamin D were measured as total 25 hydroxy vitamin D. Accordingly, serum levels of vitamin D (µg/L) are graded as deficient (<20), insufficient (20-30), and sufficient (30-80).
RESULTS: Type 1 MCs (n=26) and type 2 MCs (n=27) groups were similar in age (p=0.199), gender (p=0.372), BMI (p=0.418), work status (p=0.593), pain duration (p=0.947), vitamin D concentration (p=0.402), degree of vitamin D deficiency (p=0.773), and spinal levels (p=0.726). Type 1 MCs patients had more painful low back than type 2 MCs patients (p=0.016).
DISCUSSION AND CONCLUSION: Type 1 MCs are similar to type 2 MCs for serum vitamin D concentration. The more painful low back of type 1 MCs may be related to its inflammatory nature, but may not be associated with vitamin D insufficiency.

12.Coexistence of familial mediterranean fever and guillain barre syndrome
İsmail Tunçekin, Murat Toprak
doi: 10.5505/vmj.2024.32042  Pages 147 - 150
Familial Mediterranean Fever (FMF) is the most common autoinflammatory disease characterized by recurrent episodes of abdominal pain, fever and serositis. It is more common in countries around the Mediterranean. Guillain Barre Syndrome (GBS) is an acute, immune-mediated polyneuropathy affecting peripheral nerves and nerve roots. Central nervous system involvement is not common in the course of FMF. Guillain Barre Syndrome developed in a patient who was followed with colchicine treatment for 1 year due to Familial Mediterranean Fever. In a literature study, no association of these two diseases was found. This case is presented to draw attention to the coexistence of immune-mediated Familial Mediterranean Fever and Guillain Barre Syndrome.

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