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Volume : 4 Issue : 1 Year : 2021

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The Anatolian Journal of Family Medicine - anatol j fm: 4 (1)
Volume: 4  Issue: 1 - 2021
1.From The Editor
Reşat Dabak
Page I

REVIEW
2.A Review of Homocysteine as a Diagnostic Tool for Diabetic Retinopathy
Aleeza Fatima, Mohammed Channa, Kalina Trifonova, Kiril Slaveykov
doi: 10.5505/anatoljfm.2021.16056  Pages 2 - 6
The aim of this systematic review is to identify plasma homocysteine (Hcy) as a screening and diagnostic indicator for assessing diabetic retinopathy (DR) risk in patients with type 2 diabetes mellitus. Following PRISMA guidelines, data was gathered from publications between 2000−2019 from the Springer, JAMA, Lancet, and PubMed databases, as well as from diabetes-specific journals. Observational, experimental, and multi-ethnic studies, meta-analyses, systematic reviews were included and studies that did not measure plasma Hcy, or included only patients with type 1 diabetes were excluded. The collected results were pooled and analysed for this systematic review. The majority of studies suggested an affirmative relationship exists between hyperhomocysteinemia (HHcy) and DR, whereas some studies showed only limited clinical significance. HHcy is considered a pivotal risk factor for macular edema progression in patients with DR. Serum Hcy levels could be used to assess microvascular risksforthe development and progression of DR.

ORIGINAL RESEARCH
3.Antihypertensive Management in Children: A Two-years Experience of Indonesia’s National Referral Hospital
Henny Adriani Puspitasari, Nadia Indriasti, Eka Laksmi Hidayati
doi: 10.5505/anatoljfm.2020.18209  Pages 7 - 12
INTRODUCTION: The prevalence of hypertension (HT) in children has increased overtime. However, data related to antihypertensive options and outcomes are still limited in children, especially in Indonesia. This study aimed to describe pediatric HT cases and antihypertensive management in Cipto Mangunkusumo General Hospital (CMGH).
METHODS: A retrospective cross-sectional study was conducted in CMGH from January 2016 to December 2017. Inclusion criteria were children age <18 years with primary and secondary HT visiting pediatric nephrology clinic. Patients were excluded if no blood pressure records were found. Clinical and antihypertensive treatments data were recorded from medical records. Diagnosis was based on the Fourth Report classification.
RESULTS: This study included 176 children with HT. Secondary HT was found in 159 (90.3%) patients, and 82 (51.6%) of them had isolated kidney urinary tract disease. Dual antihypertensive therapy was prescribed for 53 (30.1%) patients, whereas 55 (31.3%) patients was monotherapy. The most common antihypertensive used in monotherapy was angiotensin converting enzyme inhibitors (ACEI), received by 31 (56.3%) patients. The median duration of therapy until achievement of target blood pressure was 28.0 (1.0-365.0) days.
DISCUSSION AND CONCLUSION: Pediatric HT is an often overlooked growing medical issue. Secondary HT was found more in children compare to primary HT. Secondary etiology was suspected if HT was found in children with kidney disease. The first-line antihypertensive drug used was ACEI, as single or combination therapy. The therapeutic effect of antihypertensive drugs was expected within 28 days of treatment.

4.Evaluation of Anti-Inflammatory Effect of Pitavastatin with Monocyte Count to HDL Cholesterol Ratio in Patients with Coronary Artery Disease
Şeyda Günay, Serhat Çalışkan
doi: 10.5505/anatoljfm.2020.95866  Pages 13 - 16
INTRODUCTION: Monocyte count to high-density lipoprotein cholesterol ratio (MHR) was proposed as a novel inflammation marker. Statins have some anti-inflammatory pleiotropic effects as well as lipid-lowering effects. This study aims to examine the effect of lipid-lowering therapy with pitavastatin on MHR in patients with coronary heart disease.
METHODS: This was a descriptive study, single-center study. Hospital registries between October 2018 and April 2019 were retrospectively reviewed. Eligible patients were those who had both stable coronary artery disease and hypercholesterolemia of low-density lipoprotein cholesterol (LDL-C) >100 mg/dL and started to take treatment (pitavastatin, 4 mg/day). Pre-and post-treatment complete blood count values and lipid parameters were evaluated, and MHR was calculated.
RESULTS: This study enrolled 150 patients. Pitavastatin (4 mg/day) was administered throughout median 3.0 (1.0-7.0) months. Mean total cholesterol level declined from 235.2±52.3 mg/dl to 186.9±48.8 mg/dl (p<0.001). Mean triglyceride level declined from 167.2±75.0 mg/dl to 152.8±66.7 mg/dl and mean LDL-C level declined from 153.9±45.0 mg/dl to 109.0±41.2 mg/dl (p=0.020 and p<0.001, respectively). Moreover, pre-treatment MHR declined from 1.4 (0.4-4.0) to post-treatment MHR 1.3 (0.5-3.4) (p=0.263).
DISCUSSION AND CONCLUSION: This study concluded that pitavastatin improved serum lipid levels but did not decrease MHR.

5.Using of Iron, Vitamin D, Multivitamin in Pregnant Women and the Related Factors
Sümbüle Köksoy, Emine Öncü, Aysun Kazak, Gamze Aktaş
doi: 10.5505/anatoljfm.2020.88700  Pages 17 - 25
INTRODUCTION: The aim of this study is to determine the frequency of iron, vitamin D and multivitamin supplement usage among pregnant women and the factors associated with it.
METHODS: This cross-sectional study was conducted between March 15, 2018 and September 30, 2018 among a total of 400 pregnant women by the questionnaire form consisted of 27 questions. Hemoglobin values below 11g/dl were considered as anemia.
RESULTS: The mean age of the pregnant women was 28.2±5.2 years, and 170 (42.5%) of them had anemia. Among the pregnant women, 302 (75.5%) had been recommended to use iron, 208 (52.0%) had been recommended to use Vit D and 308 (77.0%) had been recommended to use multivitamin. Among the pregnant women 250 (62.5%) of them use iron, 146 (36.5%) of them use vitamin D and 262 (65.5%) of them use multivitamin.
DISCUSSION AND CONCLUSION: Although programs for iron and vitamin D have been carried out for many years, the use of vitamin D and iron in pregnant women were not at the desired level. Although there is not a routine recommendation, multivitamin use during pregnancy was found to be quite common.

6.Prevalence of Obesity among University Students: A Cross-Sectional Study
Serkan Köksoy
doi: 10.5505/anatoljfm.2020.38358  Pages 26 - 30
INTRODUCTION: Obesity is a global public health problem awaiting a solution. The body mass index (BMI) is one parameter out of the many measurements used to evaluate obesity. There are limited studies comparing the BMI of students studying and those not studying health protection and promotion. Therefore, this study aims to evaluate the BMI of students studying in the department of health, social science, and engineering in university with various independent variables.
METHODS: This cross-sectional study was conducted in Burdur Mehmet Akif Ersoy University during May 2018 to August 2018. Independent variables such as sociodemographic variables and dependent variable such as BMI, were included in the study.
RESULTS: Of the total 2193 people participating in the study, 719 (32.8%) were from department of health, 696 (31.7%) were from department of social sciences and 778 (35.5%) were from department of engineering. The mean BMI of the departments was found to be 23.4±4.1 kg/m2 for health, 22.5±3.4 kg/m2 for engineering and 22.5±3.5 kg/m2 for social sciences (p<0.001).
DISCUSSION AND CONCLUSION: According to the data of our study the mean BMI of the health department was higher than other departments and the percentage of people with a BMI below 18.5 kg/m2 was higher in the participants aged 18 to 21 years.

7.Effect of Sleep Hygiene Training on Treatment Seeking Smokers with Poor Sleep Quality: A Randomized Controlled Study
Mustafa Bülent Üçkardeş, Melike Mercan Başpınar, Çağlar Şimşek, Okcan Basat
doi: 10.5505/anatoljfm.2020.14632  Pages 31 - 35
INTRODUCTION: This study aimed to investigate the effect of sleep hygiene training on sleep quality among smokers.
METHODS: A randomized controlled study was planned between May and November 2017 at a tertiary hospital’s family medicine clinics. First, treatment-seeking smokers with poor sleep quality were included in the study. Subsequently, patients randomized to the order of the study sample patient list were divided into sleep hygiene training intervention (n=50) and control (n=50) groups. A comparison between the first Pittsburgh Sleep Quality Index (PSQI) score (before education) and final score (after education) of the two groups was evaluated.
RESULTS: This study included 59 (59.0%) men, with a mean age of 35.8±10.6 years. The first and final PSQI scores were 7.1±2.6 and 7.1±2.5, respectively. No significant change was found in the PSQI score of control and intervention groups (p=0.317 and p=0.083, respectively). Also, no relationship was found between daily smoking with first and last PSQI scores (p=0.051 and p=0.052, respectively).
DISCUSSION AND CONCLUSION: Although no significant change was found in the sleep quality in the quitting process of smokers with hygiene education, this result showed that not only sleep hygiene training is needed, but also holistic behavioral therapy methods.

8.Frequency of Psychiatric Symptoms and Associated Factors During Pregnancy
Ece Büyüksandalyacı Tunç, Hasan Çılgın
doi: 10.5505/anatoljfm.2020.63935  Pages 36 - 42
INTRODUCTION: Psychiatric disorders are a significant health concern during the perinatal period. Therefore, this study determined the prevalence of psychiatric symptoms and their associated factors during pregnancy.
METHODS: All pregnant women who presented to Kafkas University gynecology and obstetrics outpatient clinic for examination between February 4 and May 4, 2019, and consented to participate in this study were included. This study employed the General Health Questionnaire, sociodemographic characteristics of the pregnant women, and perceived health status.
RESULTS: Notably, 190 (45.6%) of pregnant women had psychiatric symptoms. Regarding the risk factors, they were 1.920 times more in pregnant women living in the villages or towns than those living in cities or city centers (95% CI: 1.224–3.014); 1.986 times more in unemployed pregnant women than those with a steady income (95% CI: 1.139–3.461); 0.469 times more in those who desired the pregnancy than those with undesired pregnancy (95% CI: 0.261–0.844); 1.650 times more in first pregnancies than those with more than two pregnancies (95% CI: 1.069–2.548).
DISCUSSION AND CONCLUSION: Pregnant women living in rural areas like villages or towns, those unemployed and pregnant for the first time, were determined to be at high risk for psychiatric symptoms. Therefore, physicians at primary healthcare institutions should be periodically trained regarding perinatal psychiatric disorders.

9.The Knowledge, Awareness and Primary Care Applications of Women about Urinary Incontinence: A Survey in Primary Care
Duygu Ayhan Baser, Murat Çevik, Elif Hilal Ünverdi, Raziye Şule Gümüştakım, Mustafa Cankurtaran
doi: 10.5505/anatoljfm.2020.96977  Pages 43 - 48
INTRODUCTION: The aim of study was to evaluate the prevalence, knowledge, and awareness of urinary incontinence (UI) in women, to examine women’s primary care applications for UI, and their reasons for not applying even if they had complaints.
METHODS: This observational study was conducted in two different family health centers in Turkey. The data were collected using a self-administered questionnaire consisting of two parts prepared by the investigators. For illiterate participants, the questionnaire was completed by the investigators through a face-to-face interview.
RESULTS: Three hundred eighty women participated in this study. Of the participants, 75 (19.7%) had UI problems in the past and163 (42.8%) were found to have UI, of whom 69 (42.3%) described the condition as a “UI/ health problem”. Thirteen (28.3%) of the participants who not applying to health center for UI complaints were thinking that “UI is normal with advancing age.”
DISCUSSION AND CONCLUSION: Despite the high prevalence of UI, this study suggests that women’s awareness about UI was low. Although the study was conducted with patients who applied to the family health centers, the low awareness of the patients about the disease and the low rates of admissions to family physicians indicate that awareness-raising studies should be started as primary care.

10.Utilization of Antenatal Care Services in Bangladesh: A Cross-sectional Study Exploring the Associated Factors
Ashis Talukder, Tanjim Siddiquee, Nabila Noshin, Meher Afroz, Benojir Ahammed, Henry Ratul Halder
doi: 10.5505/anatoljfm.2020.97269  Pages 49 - 56
INTRODUCTION: The study aims to identify the associated factors with antenatal care (ANC) service utilization by pregnant women in Bangladesh.
METHODS: Using Bangladesh Demographic and Health Survey, 2014, Chi-square association test detected significant explanatory variables for the number of ANC visits. For adjusted effects estimation, the study considered multinomial logistic regression (MLR) with relative risk ratio (RRR) and proportional odds model (POM). Akaike Information Criterion (AIC) compared and selected a better-fitted model.
RESULTS: This study included 4488 responses who are women aged from 15-49 years. From MLR, primary educated women (RRR=1.344, 95% CI=1.253-1.747, p<0.001) with highly educated partners (RRR=1.478, 95% CI=1.255-1.908, p<0.001) were more likely to use ANC services. Besides, women belonging to the middle (RRR=1.209, 95% CI=1.114-1.644, p<0.001) and rich (RRR=1.506, 95% CI=1.307-1.970, p<0.001) wealth index had more chances of utilizing ANC services. However, ANC attendance decreased significantly with the increment in birth order (p<0.001). ANC visits was also lower for rural women (RRR=0.711, 95% CI=0.555-0.891, p<0.001), Dhaka (RRR=0.623, 95% CI=0.493-0.955, p<0.001), Khulna (RRR=0.457, 95% CI=0.388-0.687, p<0.001), and Rangpur (RRR=0.579, 95% CI=0.484-0.780, p<0.001) divisions.
DISCUSSION AND CONCLUSION: To increase the ANC attendance, improvement of maternal education in rural areas is highly recommended. Dhaka, Khulna, and Rangpur divisions also need special focus.

11.Readability of Turkish Websites Containing COVID-19 Information
İbrahim Solak, Betul Kozanhan, Enes Ay
doi: 10.5505/anatoljfm.2020.21939  Pages 57 - 62
INTRODUCTION: This study aims to evaluate the readability levels of the information published on Turkish online sites about coronavirus-19 (COVID-19) as well as their contents.
METHODS: The data of this descriptive study was obtained through http: //www.google.com.tr, a frequently used search engine in Turkey. In May 2020, 464 websites accessed in the first 10 pages were evaluated using searches obtained using the keywords “Coronavirus,” “COVID-19,” and “What is the Coronavirus.” The websites have been subsequently classified, analyzed, and divided into two groups according to the person, institution, organization, and so on uploading the information. The first group includes websites prepared by hospitals, government agencies, universities, and the second group includes websites prepared by news agencies and others.
RESULTS: This study included 73 sites, 25 (34.2%) and 48 (65.8%) in the first and second groups, respectively. The median Ateşman and Bezirci-Yılmaz readability values of all sites included in the present study were 52.2 (46.2–57.3) and 11.9 (10.5–13.8), respectively. Moreover, the median number of syllables in the words, the median number of words in the sentence, and the median number of words in the sentence with 4 syllables or more were 2.8 (2.7–2.9), 12.4 (10.8–13.6), and 3.5 (3.0–4.2), respectively. Thus, the readability range of all sites included in the study is of medium difficulty according to Ateşman.
DISCUSSION AND CONCLUSION: Consequently, the readability levels of Turkish websites about COVID-19 are determined to be of moderate difficulty and high school according to Ateşman and Bezirci-Yılmaz, respectively.

12.The Frequency of Antidepressant Medication Use in Patients with Type 2 Diabetes Mellitus
Mirac Vural Keskinler, Güneş Feyizoğlu, Kübra Yildiz, Aytekin Oguz
doi: 10.5505/anatoljfm.2021.46330  Pages 63 - 67
INTRODUCTION: To determine the rates of antidepressant drug usage and its associated factors in patients with type 2 diabetes mellitus (DM).
METHODS: Patients with type 2 DM between the ages of 18 and 85 years who were followed-up in the DM outpatient clinic of a university hospital between May and September 2019 were included. The data of patients were analyzed retrospectively and age, dura­tion of DM, comorbid diseases, information on smoking, anthropometric measurements such as, height and weight and antidepressant drug use were assessed from the hospital system. Also, the patients were assesed about their application to the psychiatry clinic and whether or not they were using any antidepressant drug.
RESULTS: The study included 463 patients with type 2 DM and 24 (68.6%) of the patients were female. It was found that 56 (12.1%) of the patients applied to the psychiatry outpatient clinic in the last three years and 23 (41.1%) of these patients used antidepressant medication. Patients who did not apply to the psychiatry outpatient clinic were also found to be using antidepressant drugs, accounting for 48 (11.8%) of all patients. Forty-eight (67.7%) of the antidepressant drug users were female and 23 (32.3%) were male (p=0.002). Median body mass index was 32.4 (24.6–45.9) kg/m2 in antidepressant drug users and 30.3 (19.0–52.0) kg/m2 in non-users (p=0.024).
DISCUSSION AND CONCLUSION: The frequency of antidepressant use in DM patients is quite common, depression and type 2 DM are intertwined diseases.

13.Results of Newborn Hearing Screening in Tepecik Education and Research Hospital
Muhammet Ali Oruç, Yasemin Alan, Gül Caner Mercan, Cuneyt eftal Taner, Mehmet Yekta Oncel, Murat Alan, Abdulmecit Öktem
doi: 10.5505/anatoljfm.2021.83997  Pages 68 - 73
INTRODUCTION: This study aimed to emphasize the significance of newborn hearing screening for detecting congenital hearing loss within the first 6 months of birth.
METHODS: The data of 5399 infants born in the Izmir University of Health Science Tepecik Training and Research Hospital, Izmir, Turkey, and screened for hearing between January 2018 and December 2018 was presented in this study. All term, preterm, and asphytic newborn deliveries in the aforementioned hospital were included. The hearing screening was conducted using the auditory brainstem response (ABR) method. The first step involves the evaluation of the results of all infants before being discharged from the hospital and, the second step involves infants with problems in the results of their first step and subjected to advance testing.
RESULTS: This study included 5399 infants in the first and second steps. Of these infants, 5231 (96.9%) passed the first step. Consequently, 136 (2.5%) of the 168 infants evaluated in the second step passed it, while 32 (0.6%) of the infants were evaluated again in more detail in the third step. Six (0.2%) of the infants were not called for further evaluation, and 5 (0.2%) were diagnosed with advanced/very advanced bilateral sensorineural hearing loss.
DISCUSSION AND CONCLUSION: Congenital hearing loss negatively affects the child's language, speaking, communication, and cognitive skills. Newborn hearing screening has an important place in the early diagnosis of congenital hearing loss. The number of diagnosed and treated babies suffering from hearing loss is increasing as the number of hearing screening tests becomes widespread in Turkey.

14.Assessment of Obesity and Related Conditions in Middle School Children
Hakan Şan, Süleyman Ersoy, Emin Pala
doi: 10.5505/anatoljfm.2021.03016  Pages 74 - 79
INTRODUCTION: This study investigated the relationship between obesity and hyperlipidemia, hypertension and blood glucose in secondary school children.
METHODS: Children between 12 and 17 years old who applied to the Family Health Centers were included. The body mass index, blood pressure, fasting blood glucose, and lipid levels of the children were retrospectively evaluated. All participants were divided into four groups (underweight, normal, overweight, obese) according to body mass index. In the second stratification, children were examined as two groups (obese, non-obese).
RESULTS: Three hundred seven children 53 (17.4%) of whom were obese participated in the study. The mean systolic blood pressure was 119.6±14.5 mm/Hg in obese children and 113.1±11.7 mm/Hg in non-obese children, while mean diastolic blood pressure was 72.2±9.7 mm/Hg in obese group and 68.3±8.9 mm/Hg in non-obese group (p=0.001 and p=0.005, respectively). LDL-cholesterol levels were found as 102.0 [32.0] mg/dL in obese group and 89.5 [32.0] mg/dL in non-obese group, triglyceride as 96.0 [50.0] mg/dL in obese group and 76 [43.0] mg/dL in non-obese group, and total cholesterol as 170.0 [35.0] mg/dL in obese group and 155.0 [35.0] mg/dL in non-obese group (p<0.001, p=0.015 and p=0.006, respectively). In correlation analysis, body mass index and systolic blood pressure, diastolic blood pressure, LDL-cholesterol, triglyceride, and total cholesterol levels was significantly positive (r=0.230 and p<0.001; r=0.155 and p=0.007; r=0.139 and p=0.015; r=0.149 and p=0.009; r=0.123 and p=0.032, respectively).
DISCUSSION AND CONCLUSION: In the present study obese children were found to be closely related to dyslipidemia and hypertension.

15.The Effect of Firework Explosion at the Fireworks Factory on Air Pollutant Levels
Seher Palanbek Yavaş, Caner Baysan, Ayşe Emel Önal
doi: 10.5505/anatoljfm.2021.49469  Pages 80 - 84
INTRODUCTION: Fireworks are used for show and entertainment purposes during celebrations of special days in many countries. However, fireworks negatively affect human health in many ways, especially air pollution. After the explosion of the fireworks factory in Sakarya, this study investigated the changes in the air pollutants in the region.
METHODS: The firework factory exploded on 3 July 2020. This date was the determiner, and daily air quality data (particulate matter with a diameter of <2.5 µm (PM2.5), nitrogen dioxide (NO2), nitroxide (NOx), carbon monoxide (CO), sulfur dioxide (SO2), and ozone (O3)) were collected 1 week before (26 June–2 July) and 1 week later (3–9 July). Air quality monitoring data were received from four air monitoring stations (Ozanlar, Merkez, Sakarya, and Hendek) in Sakarya.
RESULTS: Of the pre-explosion median, PM2.5 increased from 12.1 [12.9] to 18.2 [35.9] μg/m3 (50.4%), SO2 from 8.5 [2.8] to 12.1 [13.0] μg/m3 (42.4%) (p=0.010 and p=0.010, respectively). NOx decreased from 45.9 [29.1] to 42.1 [51.1], O3 increased from 21.6 [29.4] to 46.5 [33.8], CO from 1388.6 [209.2] to 1436.2 [93.4] (p=0.224, p=0.678 and p=0.225, respectively).
DISCUSSION AND CONCLUSION: This study suggests that the explosion of the fireworks factory led to short-term air pollution in the area. Thus, it may be appropriate to consider the potential health effects of air pollution in the studies to be carried out.

16.Smoking Status of Family Physicians and Their Attitude on Smoking Cessation
Ali Timuçin Atayoğlu, Mahmut Tokaç, Sibel Doğan, Abdullah Emre Güner, Erdoğan Kocayiğit, Muharrem Güner
doi: 10.5505/anatoljfm.2021.08760  Pages 85 - 91
INTRODUCTION: Quitting smoking plays a vital role in preventing chronic diseases. Family physicians have an important role in smoking cessation processes. This study aimed to investigate the smoking status of family physicians who were working in the Family Health Centers in Istanbul and their knowledge and attitudes toward smoking cessation.

METHODS: In this study, an online survey was used to collect data from family physicians in Istanbul in 2019. The survey questions were sent to the family physicians using an e-mail and the physicians were asked to voluntarily answer the questions in the survey.
RESULTS: Total 237 physicians filled out the questionnaires and 133 (56.1%) of participants was male. The number of participants with response to smoking status as current smokers, former smokers, and never smokers were 46 (21.1%), 45 (20.5%), and 128 (58.4%), respectively. Among the participants, 37 (15.6%) were family physicians who were specialists, 43 (18.2) were aged between 41 and 45 years, and 122 (51.5%) were practicing family medicine for 7 to 9 years. The median Fagerström score of smokers was 3.0 [5.0] points. Nicotine replacement therapy was the most prominent application in the smoking cessation process according to 195 (84.3%) participants.
DISCUSSION AND CONCLUSION: Family physicians need to be encouraged to quit smoking and provide smoking cessation counseling.

CASE REPORT
17.A Rare Case Report: Caudal Regression Syndrome in the Baby of a Mother with Hypothyroidism
Yusuf Atakan Baltrak, Seniha Esin Söğüt, Onursal Varlıklı, Nazan Karadeniz
doi: 10.5505/anatoljfm.2020.27928  Pages 92 - 94
Caudal regression syndrome (CRS) is part of a spectrum of conditions that include imperforate anus, sacral agenesis and syringomyelia. Most cases of caudal regression are sporadic or associated with gestational diabetes. In this case study, we describe a case of characteristic CRS in a patient of a mother with hypothyroidism with anal atresia, flexion contracture on the hips and knees, pes equinovarus, and the absence of a sacrum and coccyx.

18.Brugada Syndrome Diagnosed with COVID-19 Infection
Berat Uğuz, Selma Kenar Tiryakioglu, Mustafa Yılmaztepe, Selvi Öztaş, İsmet Zengin
doi: 10.5505/anatoljfm.2020.74745  Pages 95 - 97
The COVID-19 outbreak is a global public health problem, the disease has spread exponentially since the late December 2019, when the first cases of SARS-CoV-2 infection were detected in Wuhan, China. Fever is the most common symptom in about 88% of cases, cough (68%), vomiting (5%), and diarrhea (3.8%) are the other common symptoms. In this case report, a 34-year-old male patient admitted to the emergency department with fever lasting for 3 days. The first diagnostic study, including documented computed tomography scan, was consistent with viral pneumonia and the 12 lead electrocardiogram (ECG) showed a Brugada-type I pattern, ST segment elevation in the right precordial leads with no reciprocal changes. The patient had no chest pain, or syncope or a family history of sudden cardiac death. Cardiac enzymes were normal and echocardiographic examination showed normal wall motions and there was no pericardial effusion. The patient was hospitalized with a diagnosis of COVID-19 pneumonia confirmed by a positive nasopharyngeal swab test for COVID-19. Brugada syndrome is a rare disease manifested by ST-segment elevation in the right precordial leads. Fever may cause Brugada-like changes in the ECG. With the reduction of fever, the Brugada-like ECG changes also disappeared.

19.Aluminum-associated Lung Disease: A Case Report
Nejdiye Mazıcan, Seher Kurtul, Deniz Öngel Harbiyeli
doi: 10.5505/anatoljfm.2020.63325  Pages 98 - 101
Aluminum-associated fibrosis is a form of lung disease characterized by mixed-dust pneumoconiosis and interstitial pneumonia. Pneumoconiosisis a progressive disease resulting in non-nodular interstitial fibrosis located mainly in the upper and middle lobes of the lungs. It is primarily an occupational injury. This report describes the case of a patient who had worked in an aluminum sanding environment for 10 years and developed pneumoconiosis due to exposure to aluminum dust.

20.Rare Cause of Cholestasis: Caroli’s Syndrome
Didem Gülcü Taşkın, Ayşe Selcan Koç, Sibel Yavuz, Sinan Sözütok, Elife Aşut, Gökhan Tümgör
doi: 10.5505/anatoljfm.2020.39205  Pages 102 - 105
Caroli disease is a rare congenital disease characterized by multiple segmental cystic, saccular dilatations of the intrahepatic biliary tract. We diagnosed Caroli’s syndrome in our patient who applied with cholangitis attack with the 'Central Dot Sign' finding in abdominal computed tomography, which is a characteristic finding for Caroli’s Syndrome; we wanted to emphasize the value of radiological data in diagnosis. As it is a rare syndrome, it should be considered during the differential diagnosis of cholestasis. An 18-month-old girl was admitted to our hospital because of her jaundice that had not improved for a month. The patient had hypertransaminasemia and direct hyperbilirubinemia, because of the high markers of infection, antibiotherapy was started by considering cholangitis. In abdominal ultrasonography, liver parenchyma was interpreted as having multiple cystic lesions and dilatation in intrahepatic bile ducts. The patient's abdominal computed tomography had saccular, fusiform dilatations of the intrahepatic bile ducts in both liver lobes. 'Central Dot Sign' finding was observed in intrahepatic bile ducts. Portal, periportal fibrosis and bile duct proliferation, bridging, nodule formation were present in the patient's liver biopsy. In our patient who was investigated for neonatal cholestasis, we diagnosed Caroli’s syndrome on the presence of the 'Central Dot Sign', a characteristic finding in computed tomography. The early diagnosis of this very rare disease affects the prognosis after liver transplantation. Caroli’s syndrome should be considered in the differential diagnosis in every patient presenting with cholestasis, especially in the presence of recurrent cholangitis attacks.

LETTER TO THE EDITOR
21.Severe COVID-19 is Caused by an Overreacting Immune System: Highly Dosed Corticosteroids Could be a Lifesaver!
Jan Eize Siegersma
doi: 10.5505/anatoljfm.2020.00922  Pages 106 - 107
Abstract | Full Text PDF

22.Social Entrepreneurship in COVID-19 Pandemic Experience from Sri Lanka
Vishaka Kerner, Pathum Kerner, Shrikant D Pande
doi: 10.5505/anatoljfm.2020.26349  Pages 108 - 109
Abstract | Full Text PDF

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