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The Anatolian Journal of Family Medicine - anatol j fm: 3 (1)
Volume: 3  Issue: 1 - 2020
1.From the editor
Mehmet Sargın
Page I

2.Bacterial Profile and Antibiogram of Neonatal Sepsis in Nigeria: Literature Review
Uchenna Ekwochi, Stanley Kelechi Onah, Ikenna Kingsley Ndu
doi: 10.5505/anatoljfm.2020.37450  Pages 2 - 9
Bacterial neonatal sepsis is one of the foremost causes of morbidity and mortality in the newborn period. Determining the causative organism and corresponding treatment with sensitive antibiotics remain the standard of care. However, this is not easily achievable in developing and resource-poor settings. This study explored the inter-regional spread of bacterial isolates and the antibiogram of neonatal sepsis in Nigeria to guide the recommendation of effective and empirical use of antibiotics. Review of the published studies on neonatal sepsis in Nigeria addressed between 2009 and 2019 as culled from Google Scholar, Cochrane and PubMed search. A total of eleven studies conducted between 2009 and 2019 were reviewed and sorted geographically into Northern, Western, Eastern and Southern regions of Nigeria. Generally, the isolated bacteria and antibiogram of the studies across the regions were similar. Klebsiella pneumonia (63.6%) and Staphylococcus aureus (63.6%) topped the prevalence table across the regions, followed by Escherichia coli (36.4%) and subsequently the Coagulase Negative Staphylococcus, Streptococcus pneumonia and Pseudomonas aueruginosa which had an equal prevalence of 27.3%. Ciprofloxacin 8+ and Ofloxacin 5+ had the highest sensitivity, followed by Ceftriaxone 4+, Gentamycin 4+ and Meronem 3+. All the organisms tested were resistant to ampicillin. The inter-regional similarity of the bacterial isolates and antibiogram is striking. This finding could be utilized in making an evidence-based decision on the choice of antibiotics in the treatment of neonatal sepsis where a local pattern is challenging to establish.

3.Evaluation of the Social Determinants of Health in Communities across the South-Eastern Region of Nigeria
Ngozi Joe-Ikechebelu, Chidiebere Donatus Ignatius Osuorah, Basil E Nwankwo, Williams Ngene, Ezinne I Nwaneli
doi: 10.5505/anatoljfm.2019.40085  Pages 10 - 16
INTRODUCTION: Apart from lifestyles and genetic make-ups, a wide range of social, economic and environmental factors may affect personal and population health. Attaining sustainable health for all requires frequent evaluation and tackling these socio-economic and environmental factors.
METHODS: This cross-sectional study aimed to evaluate the existence of the World Health Organization’s (WHO) recognized social determinants health (SDH) in communities across south-east Nigeria. This study recruited 214 leaders in the state ministry of health who were stakeholders in the commission on SDH that attended a conference in Onitsha. Participants were enrolled using a purposive sampling method. Data on parameters of SDH in the communities were obtained on a scale of I to 5 using self-administered WHO-validated questionnaires for SDH.
RESULTS: The existence of SDH in communities across the South-Eastern region in Nigeria is poor. Only 9.5-13.0% and 4.2-7.2% of the respondents respectively reported with high and very high certainty the existence of the parameters of SDH in their respective communities. Employment/job skills centers, police and security, legal aids, insurance policies and substance abuse help centers were the SDH parameters reported commonly as non-existent in most communities. The majority of the respondents reported education 88 (14.1%), employment organizations 58 (9.3%), healthcare 52 (8.3%) and transportation 44 (7.1%) as the health determinant with the strongest presence and greatest impact on lives of community residents, while access to mental health 24 (3.8%), substance abuse treatment 20 (3.2%), personal space 19 (3.0%), insurance 22 (3.5%) and parks 18 (2.9%) for relaxation and leisure were reported as parameters with the weakest presence and least impact on health of community residents.
DISCUSSION AND CONCLUSION: Continued assessment of the SDH in addition to the evaluation of its effects on personal and population health is imperative to deliver equitable healthcare and enhance the quality of life across communities in Nigeria.

4.Comparison of the Infant Deaths of 2016-2017 Years
Serkan Yıldız, Burak Mete, Vedat Söyiler, Erkan Pehlivan
doi: 10.5505/anatoljfm.2019.73745  Pages 17 - 21
INTRODUCTION: Infant mortality is closely related tothe welfare and development level of society. Primary care interventions can be effective in preventing these deaths. The present study aims to investigate the prevalence of infant mortality in Bingöl province in 2016-2017, which is one of Turkey's eastern cities, the reasons and factors that maybe related to the prevalence of infant mortality.
METHODS: The type of this research is routine surveillance study. The data were collected retrospectively by examining the deaths of 99 infants in Bingöl province in 2016 and the deaths of 69 infants in 2017 through their medical record files in this study.
RESULTS: The infant mortality rate, which was 0.18% in 2016, decreased to 0.12% in 2017. In 2016, the most common cause of infant mortality was prematurity 43 (43.4%) and congenital anomalies 35 (35.4%). The most common cause of death in 2017 was a congenital anomaly 28 (41.7%) and prematurity 25 (37.3%).
DISCUSSION AND CONCLUSION: In our study, infant mortality rates in Bingöl were higher than the national average in 2016 and 2017. Congenital anomaly and prematurity were the most common causes of infant mortality in both years. Such studies showing the causes of infant mortality and their changes over the years can be a guide for health policymakers.

5.Prevalence and Factors Associated with Tobacco Consumption Among Students of a Selected Private University in Bangladesh
Salman Mohamed Farah, ABM Alauddin Chowdhury, Lucila Nascimento, Dionéia Monte-Serrat, Rosanna De La Rosa-eduardo, Russell Kabir, Kamrul Hossain
doi: 10.5505/anatoljfm.2019.30974  Pages 22 - 30
INTRODUCTION: Tobacco consumption has a significant association with several health problems. Among the eight leading causes of morbidity and mortality, tobacco consumption is the major risk factor for six causes. This study aimed to find out the prevalence and the factors associated with tobacco consumption among the students at a private university.
METHODS: This cross-sectional study was conducted at Daffodil International University from January to May 2017, and data were collected using a structured questionnaire.
RESULTS: A total of 384 students participated in this study. The findings showed that 184 (48.4%) of the students of a private university were smoking any form of tobacco. Age, place of residence, knowledge of the consequences of tobacco consumption, health problems that the respondents were suffering, an affair of love, the frequency of library had a significant association with tobacco consumption.
DISCUSSION AND CONCLUSION: Identifying associated risk factors is important to develop a prevention program and mitigate the epidemic situation of tobacco consumption among the students.

6.Stigma toward Worker with Occupational Diseases: A Qualitative Study
Ayşe Coşkun Beyan, Yücel Demiral, Serhat Erdal
doi: 10.5505/anatoljfm.2019.14633  Pages 31 - 39
INTRODUCTION: Despite a growing awareness of the prevalence of such stigma, there is little research that focuses on the sources, nature and consequences of stigma workers with occupational diseases (OD), which directly arises from risks in the workplace. The present study aims to advance knowledge related to stigma towards workers with OD, specifically to explain the nature and processes stigma and their effects on workers.
METHODS: This study was qualitative research. The workers with OD were selected to represent the most common diagnoses, then invited for an interview. Thirteen in-depth individual interviews were recorded, transcribed and evaluated using content analysis. The stigmatization was analyzed in two axes as its internal and external features.
RESULTS: A large diversity in the stigmatizing actions and attitudes toward workers with the occupational disease were identified in this study. It was observed that 12 (92.3%) participants had experienced internal and external stigmatization in work-life.
DISCUSSION AND CONCLUSION: In general, variables, such as the continuation of work, type of occupational disease, presence of complaints and drug use due to illness, were revealed as factors determining the severity of stigma. If occupational health professionals are aware of the stigmatization due to occupational diseases, they may have an effective role in the workplace.

7.Investigation into Parvovirus B19 Antibodies in Serum Samples Sent with Pre-diagnosis of Arthritis-Arthralgia
Hilal Türkmen Albayrak, Ayfer Bakır, Mustafa Güney, Mehmet Tevfik Yavuz
doi: 10.5505/anatoljfm.2019.35220  Pages 40 - 44
INTRODUCTION: Parvovirus B19 belonging to the Erythrovirus genus is a single-stranded DNA virus in the family Parvoviridae. The present study aims to determine parvovirus B19 seropositivity in serum samples sent with pre-diagnosis of arthritis/arthralgia and to evaluate the age dispersion retrospectively.
METHODS: Parvovirus B19 IgM and IgG tests were investigated in serum samples with pre-diagnosis of arthritis/arthralgia sent to Virology Laboratory between January 2017 and February 2019 retrospectively. In serum samples of the patients, parvovirus B19 IgM and IgG tests were investigated using the enzyme immunoassay method.
RESULTS: Sixty-one patients with pre-diagnosis of arthritis/arthralgia were included in this study. The mean age of the patients was 45.2±17.8 years. Parvovirus B19 IgG and IgM positivity rates were 40 (65.6%) and 2 (3.3%), respectively. Parvovirus B19 IgG positivity was highest at the ages over 50 years and lowest at the ages under 30 years (p=0.362). Parvovirus B19 IgG seropositivity was the highest in females with a rate of 72.0% (p=0.241).
DISCUSSION AND CONCLUSION: As a result, parvovirus B19 IgG and IgM positivity rates in the patient group with pre-diagnosis of arthritis/arthralgia were 65.6% and 3.3%, respectively, in our study. As the parvovirus B19 seropositivity rate was found high when compared to the general population studies, latent parvovirus B19 infection should be investigated in synovial tissue in patients with chronical arthritis and arthralgia complaints.

8.Working in a Paid Job Effects on Breastfeeding in Turkey: A Qualitative Study
Emine Ayhan, Alaettin Ünsal, Didem Arslantaş
doi: 10.5505/anatoljfm.2019.42714  Pages 45 - 51
INTRODUCTION: Breast milk is the ideal food for babies and breastfeeding infants for the first six months is important for infant health. A mother's breastfeeding behavior depends on several factors, such as the social position and employment status of the mother.
METHODS: This study is a qualitative study conducted in Eskişehir Osmangazi University (ESOGU) office workers and cleaning staff. This study was carried out to reveal the effects of working in a paid job on breastfeeding using the feelings, thoughts and experiences of nursing women working as office workers and cleaning staff. ESOGU has 1106 women as working staff. The research population consisted of 45 (4.1%) women who have been working as office staff and cleaning workers between September 1, 2014, and March 01, 2015, had infants under two years old and returned to work life.
RESULTS: This research was conducted at ESOGU with 35 women. The findings showed that the maternity leave and breastfeeding rights of the women employed were insufficient and this situation had a negative effect on the breastfeeding.
DISCUSSION AND CONCLUSION: It was determined that working women in workers’ status have fewer rights than civil servants. As a result, breastfeeding room deficiencies should be completed. The recognition of equal rights to all women during the breastfeeding periods is strongly recommended.

9.Anxiety Level of Pregnant Women before Pregnancy Termination for Fetal Abnormality
Merve Geylani, Sibel Doğan, Ali Timuçin Atayoğlu
doi: 10.5505/anatoljfm.2019.05706  Pages 52 - 58
INTRODUCTION: Holistic approaches in health care services consider all aspects of individuality. This research was conducted as a descriptive study to evaluate the anxiety level of pregnant women before the termination of the pregnancy for fetal abnormalities.
METHODS: This descriptive and cross-sectional study comprised pregnant women who were admitted to the prenatal diagnosis and treatment unit before pregnancy termination for a severe fetal abnormality. As the data collection tool, a questionnaire containing the descriptive and obstetric characteristics of the pregnant women, their feelings and thoughts about pregnancy and the State-Trait Anxiety Inventory were used in this research. In the evaluation of the research data, percentage values, arithmetic mean, standard deviation, median, minimum and maximum values were given as descriptive statistics of the data.
RESULTS: This study consisted of 83 pregnant women. The findings showed that 49 (59.0%) of pregnant women experienced sadness, and 41 (49.4%) needed psychological support before the termination of pregnancy. The mean State-Trait Anxiety Inventory score of the pregnant women was 60.7±11.6, and that they experienced high levels of anxiety.

DISCUSSION AND CONCLUSION: The findings suggest that pregnant women before the termination of pregnancy for severe fetal abnormalities should be evaluated and supported psychosocially.

10.Emergency Department Visits due to the Bleeding Complication of Warfarin
Bahar Gülcay Çat, Umut Yücel Çavuş, Mesut Bakır, Duygu Yılmaz, Sinan Yıldırım
doi: 10.5505/anatoljfm.2019.25743  Pages 59 - 63
INTRODUCTION: Warfarin is an anticoagulant that is used in case of thromboembolism risk or events as a prophylactic or therapeutic agent. In this study, we investigated the emergency visits due to the bleeding complication of warfarin.
METHODS: The patients admitted to emergency department with bleeding and using warfarin were included this study in a three year period. Age, gender, liver and kidney function tests, the time period of the warfarin use and the frequency of the control visits were recoded.
RESULTS: The patients admitted to emergency department with bleeding and using warfarin were included this study in a three year period (n=243). The regular follow up of coagulation parameter was observed in 92 (42.8%) patients. One hundred six (43.6%) of the patients had had a bleeding complication before. The most frequently observed bleeding region was urinary system (n=87, 35.8%). The INR level was greater than five in 223 (91.8%) of the patients. Fresh frozen plasma was used 193 (75.3%); prothrombin complex concentration was used in 15 (6.2%) patients; conservative management was preferred in 45(18.5%) patients. Mortality rate was 22 (9.1%) and 97 (39.9%) of the patients were discharged from emergency department without hospitalization. Female gender, low hemoglobin level, abnormal liver and kidney tests, INR level over 10 and irregular INR follow up were associated with both mortality and major bleeding (respectively; p=0.750, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001).
DISCUSSION AND CONCLUSION: The interaction with other medications or foods, bleeding complications, its requirement of regular follow up of coagulation parameters and dose adjustment make difficult its use. We should tell the patients the importance of following the INR level regularly, especially in patients with co-morbid diseases.

11.Oral Cancer Awareness in Turkish Dental Patients
Kader Cesur Aydın, Aslıhan Akbulut
doi: 10.5505/anatoljfm.2019.62533  Pages 64 - 70
INTRODUCTION: This study aims to provide data from dental patients about their oral health attitudes, dental visits, oral cancer predisposing factors and general knowledge about early signs of oral cancer.
METHODS: This study was conducted on dental examination patients, involving both genders with an age range of 12–77 years. All questions were asked through a written questionnaire.
RESULTS: This study included 254 cases with a mean age of 31.8±16.4 years. One hundred and fifty three (60.2%) of the study group consisted of females and 101 (39.8%) were males. Smoking and alcohol consumption were frequent among the working group and males (p=0.001). Regarding general knowledge about early cancer signs, there was no significance among genders. Considering attitudes of the last dental visits of individuals according to their occupation, the working group displayed significance (p=0.005). The total rate for information about oral cancer, causes and symptoms 20 (7.9%) individuals had positive knowledge. Only 5 (0.02%) of the participants would refer to a dentist for neck swelling.
DISCUSSION AND CONCLUSION: General knowledge of signs and symptoms of oral cancer are low in Turkish dental patients, most declare that early diagnosis is important. The main predisposing factors of oral cancer (smoking and alcohol) are statistically more consumed by the working group but showed no gender predisposition.

12.Malignant Brenner Tumor of the Ovary: One Single Institute Experience and a Review of the Literature
Malek Bouhani, Maher Slimane, Sarah Sghaier, Amine Bouida, Riadh Chargui, Khaled Rahal
doi: 10.5505/anatoljfm.2019.66375  Pages 71 - 75
INTRODUCTION: Malignant Brenner tumors (MBT) of the ovary are rare diseases, representing 1% of all ovarian cancers and 3-5% of Brenner tumors. They carry a poor prognosis. They generally affect women during the perimenopausal and postmenopausal periods. The standard treatment is surgery; however, the indication of adjuvant chemotherapy remains controversial. The present study aims to report our experience in the treatment of MBT of the ovary, to better characterize this disease.
METHODS: In this study, a retrospective case series involving four patients diagnosed with MBT of the ovary and treated between 2006 and 2014.
RESULTS: Four cases of MBT of the ovary were diagnosed over a seven-year period. The mean age of our patients was 59.3±11.1 years. Three patients were in the menopause period. The tumor was staged as IC in one case, IIC in one case, and IIIC in two cases of the International Federation of Gynecology and Obstetrics classification. All patients underwent surgery, followed by adjuvant chemotherapy. Three patients underwent a loco-regional recurrence that occurred respectively, after nine months in one patient and 11 months in two patients. The treatment was based on chemotherapy combined with surgery in one case. Two patients presented distant metastasis. The treatment consisted of chemotherapy and surgery. The median follows up period was 49.0 (14.0-64.0) months.
DISCUSSION AND CONCLUSION: The treatment approach of MBT of the ovary is not well established since its scarcity and poor prognosis. Thus, more case series and meta-analysis should be conducted.

13.Esophageal Perforation and Imaging Findings in a Four Years Old Child
Halil İbrahim Şara, Turgay Kara, Avni Merter Keçeli
doi: 10.5505/anatoljfm.2019.86580  Pages 76 - 80
Esophageal perforation is a rare pathologic condition with high mortality. Iatrogenic, endoscopic interventions are the most common cause. Early diagnosis and treatment should be performed. The diagnosis of esophageal perforation is based on the clinical suspect and radiographic evidence. In this case study, a 4-year-old boy, who swallowed a coin and experienced endoscopic intervention leading iatrogenic esophageal perforation and pleural empyema, is presented usingimaging findings (direct chest X-ray, contrast-enhancedfluoroscopy, thorax computed tomography) and brief literature knowledge.

14.Aplastic Anemia in an Automotive Paint Shop Worker
Seher Kurtul, Meral Türk
doi: 10.5505/anatoljfm.2020.68442  Pages 81 - 84
Various chemicals are known to cause aplastic anemia due to bone marrow toxicity. Long-term exposure to benzene in the workplace has been associated with hematological disorders (thrombocytopenia, aplastic anemia, acute myeloid leukemia, lymphoma). Although the use of pure benzene was banned and substituted with other solvents, benzene is still used in the form of mixtures. The automotive painting sector, in particular, is one of the areas where benzene and its derivatives are used more frequently. Benzene and its derivatives are used to increase the fluidity of paints and are included in paints, thinners, and varnishes. Hematotoxicity of benzene is related to the amount and duration of exposure. In Turkey, there are serious difficulties in the implementation of occupational health and safety measures in small-scale enterprises. In this case report, it was described how aplastic anemia developed in a patient who had worked in a small-size automotive painting business with inadequate occupational health and safety measures for 23 years might be related to occupational benzene exposure. It is recommended that such businesses should be inspected concerning occupational health and safety and necessary precautions should be taken in order to prevent such serious, preventable occupational diseases.

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