E-ISSN 2651-3455 (Online) | ISSN 2630-5593 (Print)
The Anatolian Journal of Family Medicine - anatol j fm: 5 (1)
Volume: 5  Issue: 1 - 2022
1.From the Editor
Mustafa Reşat Dabak
Page I

REVIEW
2.Role of Physical Therapy and Virtual Rehabilitation during and after COVID-19 Disease
Aakansha Saraf, Ishaan Gupta, Neha Sharma, Aksh Chahal, Mohammad Abu Shaphe, Fuzail Ahmad
doi: 10.5505/anatoljfm.2021.59672  Pages 2 - 7
Early physical therapy rehabilitation protocols have shown improved functional outcomes and a reduction in mortality rates. Virtual rehabilitation (VR) has allowed practitioners to provide safe treatment without any risk of viral contamination. This review aimed to evaluate the importance of physical therapy and rehabilitation during and after the infection of coronavirus (COVID-19). To do so, four electronic databases such as PubMed, ResearchGate, Science Direct, and Google Scholars were searched to retrieve articles published after the outbreaks of the COVID-19 pandemic. Six studies were included in the final review. It is a compilation and examination of physical therapy treatments provided by various hospitals and organizations during and after COVID-19. The present review throws light on physical therapy, going hand in hand with VR, to play a promising role in patients with mild to moderate symptoms, thus improving their quality of life. The necessary references, as well as the statistics gathered from the published articles, are available. A total of 12 046 patients were included. Of the total patients, 3085 (25.6%) had fatigue symptoms and 1866 (15.5%) had arthralgia/myalgia. Within an hour of being in the prone position, patients were found to have an increase in the oxygen saturation (SpO2) level from 94% to 98%. The pace of breathing also improved, dropping from 31 to 22 per minute. Physical therapy and VR have improved daily activities while assisting in the recovery of health, lifestyle, and lowering post-illness physical and mental deficiencies.

3.Effect of Probiotics on Recurrent Vaginal Candidiasis Infection
Zeynep Ayaz
doi: 10.5505/anatoljfm.2021.54775  Pages 8 - 11
Vaginal candidiasis is the second most common after bacterial vaginosis. It is accepted that 5%–10% of women with vaginal candidiasis are exposed to recurrent infections. For the case to be considered recurrent, it must have had at least four symptomatic attacks within 12 months. In the treatment of recurrent vulvovaginal candidiasis, suppressive and preventive treatment of episodes is recommended rather than individual treatment of episodes. Increasing drug resistance and drug side effects that may develop in long-term use make it necessary to consider alternative options in the treatment of recurrent vaginitis. Probiotics are nonpathogenic microorganisms that regulate microbial balance, especially in the gastrointestinal tract, and they can also be considered as a useful alternative in the treatment of recurrent candida. These agents regulate the immunoresponse of the host by reducing the invasion and colonization of pathogenic microorganisms by lowering the pH in their region. The aim of this review was to investigate the effectiveness of local probiotic use following conventional topical azole treatment on preventing recurrence of recurrent vaginal candida infections.

ORIGINAL RESEARCH
4.Evaluation of the COVID-19 Triage Results in an Education Family Practice Center
Yağmur Gökseven, Berksu Cürebal, Dilara Türköz, Büşra Yazla, Seda Ozmen, Güzin Zeren Öztürk, Banu Bayraktar, Hacı Mustafa Özdemir
doi: 10.5505/anatoljfm.2021.26928  Pages 12 - 16
INTRODUCTION: This study aimed to evaluate the COVID-19 triage results of the admissions made by patients in a certain region to the Education Family Practice Center (E-FPC) during the pandemic period.
METHODS: Patients aged 18 years and above, who were applied to the E-FPC between March 12 and April 30, 2020, were included in the study. Every patient had filled in a triage form. Potential cases were referred to a high-level healthcare center. Polymerase chain reaction (PCR) and chest computed tomography (CT) results of the referred patients were followed up and noted.
RESULTS: Four hundred sixty-one patients were included in the study. Twenty-seven (5.9%) patients had a fever, 219 (47.5%) patients had a cough, 34 (7.4%) patients had dyspnea, and 305 (66.2%) patients had other symptoms. Eighty-six (18.6%) of the patients were admitted to the hospital for PCR test of which 15 (17.4%) had a positive test result. Seventy-one (15.4%) patients underwent a chest CT and 25 (35.2%) of them had results compatible with COVID-19. Fever was detected in 8 (53.3%) of the patients with a positive PCR result and in 6 (8.5%) patients with a negative PCR result (p<0.001). Dyspnea was detected in 13 (52.0%) patients whose chest CT results were compatible with COVID-19 and in 5 (10.9%) patients whose chest CT results were not compatible with COVID-19 (p<0.001).
DISCUSSION AND CONCLUSION: Symptoms, CT imaging, and PCR results should be evaluated together in the diagnosis of COVID-19. Triage practices should be maintained in primary healthcare centers throughout the pandemic.

5.Evaluation of Management of Patients with Diabetes Mellitus at Primary and Tertiary Healthcare Services
Elif Fatma Özkan Pehlivanoğlu, Hüseyin Balcıoğlu, Göknur Yorulmaz, Pınar Yıldız, Uğur Bilge, İlhami Ünlüoglu
doi: 10.5505/anatoljfm.2021.04909  Pages 17 - 22
INTRODUCTION: This study aimed to evaluate the management of type 2 diabetes mellitus (DM) patients who apply to primary healthcare services (PHS) and tertiary healthcare services (THS).
METHODS: This is a cross-sectional study that used information about patients diagnosed with DM for at least 1 year from 25 family health centers considered PHS and Health Application and Research Hospital Endocrinology and Internal Diseases Polyclinics considered THS. A questionnaire including sociodemographic characteristics, DM-related features, and laboratory parameters was applied to the DM patients.
RESULTS: This study included 979 patients with DM: 515 (52.6%) patients from THS, and 464 (47.4%) from PHS. The HbA1c value was measured in 509 (98.8%) of the patients who were followed up in THS and 449 (96.8%) of the patients who were followed up in PHS (p=0.026). It was determined that 68 (13.2%) of the patients in the THS and 61 (13.1%) of the patients in the PHS had a history of cardiovascular disease (p=0.979). Hypoglycemia was detected in 66 (12.8%) of DM patients managed in THS and 34 (7.3%) of DM patients managed in PHS (p=0.005). There was no difference between PHS and THS in terms of diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy (p=0.098, p=0.100 and p=0.073, respectively).
DISCUSSION AND CONCLUSION: DM is a chronic metabolic disease that requires continuous medical care, and the role of PHS in DM management needs to be increased.

6.Impact of Statins Used for Hyperlipidemia on Development of New-Onset Depression and Anxiety: A Prospective Study
Nadiye Karabulut, Seda Ayşe Demirel Dengi, Seçil Arıca
doi: 10.5505/anatoljfm.2021.54376  Pages 23 - 27
INTRODUCTION: Hydroxymethylglutaryl-coenzyme A inhibitors (statins) are used in hyperlipidemia (HL) treatment and are the most efficacious and widely used drug, especially in decreasing low-density lipoprotein cholesterol, have been found to reduce mortality and morbidity in coronary artery disease in a great number of studies. However, the development of depression in patients under statin treatment has been evaluated in very few studies. Thus, this study aims to evaluate the influence of therapy by statin and statin derivatives on anxiety and depression.
METHODS: This study was a prospective observational study included in patients who were started on statin HL treatment. The patients were found to be administered atorvastatin (10 mg) or rosuvastatin (10 mg) for HL treatment. Those patients were followed up for 10 months. Pre- and post-treatment status of anxiety and depression of the patients was evaluated using the hospital anxiety and depression scale.
RESULTS: This study was performed on a total of 219 patients who were diagnosed to have HL. Moreover, 194 (88.5%) and 25 (11.5%) patients were administered atorvastatin and rosuvastatin, respectively. The anxiety score was found 9.0 (5.0–12.0) before the treatment and 8.0 (5.0–12.0) after the treatment (p=0.062). In addition, the depression score was found 5.0 (3.0–9.0) before and 5.0 (3.0–9.0) after the treatment (p=0.078).
DISCUSSION AND CONCLUSION: Statins are among the most frequently used drug groups for long-term HL treatment. However, this study did not find any significant association between statin therapy and depression or anxiety scores.

7.Evaluation of Therapeutic Abortion in a Secondary Level Public Hospital
Ülkü Ayşe Türker, Tuğberk Güçlü
doi: 10.5505/anatoljfm.2021.81300  Pages 28 - 31
INTRODUCTION: Abortion is one of the most common complications of pregnancy. The World Health Organization defines abortion as the fetus being expelled from the uterus under 20 weeks or the discarded fetus weighing less than 500 g. The aim of the study was to determine the causes of medical abortion.
METHODS: The data of this descriptive study were obtained from women who applied to Kars Harakani State Hospital Gynecology and Obstetrics Clinic and underwent medical abortion between January 2019 and December 2020. All data were obtained from hospital records retrospectively.
RESULTS: Totally, 391 women enrolled in the study. It was found that 217 (55.5%) medical abortions were anembryonic, 50 (12.8%) were spontaneous abortions, 111 (28.4%) were intrauterine exitus, 7 (1.8%) were due to babies with chromosomal abnormalities, and 6 (1.5%) were performed due to maternal chronic disease. Two hundred and eighty-one (71.9%) patients were in the age range 20–35 years, 277 (70.8%) had no history of abortus, and 33 (8.4%) of them were university graduates.
DISCUSSION AND CONCLUSION: Anembryonic pregnancy, chromosomal anomaly, and spontaneous abortion were the most frequent reasons for medical abortion. Pregnant women at risk should be directed to the upper center for further diagnosis and treatment.

8.Evaluation of Healthcare Use among Patients Aged 65 and over Applying to the General Surgery Outpatient Clinic
Hasan Çantay, Saliha Şahin, Sevinç Sütlü
doi: 10.5505/anatoljfm.2022.41961  Pages 32 - 37
INTRODUCTION: The aim of the study was to evaluate and determine the associated factors of appropriate healthcare use of elderly patients presenting to the general surgery outpatient clinic of a tertiary hospital.
METHODS: This hospital-focused cross-sectional study was conducted on patients aged 65 years and over who applied to tertiary care services between March 2021 and September 2021. The data were collected with a questionnaire using a face-to-face interview technique. The data collection form consisted of two sections, which assess sociodemographic features and the medical status of the patients.
RESULTS: A total of 340 patients were included in the study. The frequency of using tertiary healthcare services appropriately was 41 (12.1%). When the use of tertiary healthcare services was evaluated with logistic regression models, living area (OR=2.994 [1.375–6.521], p=0.006), duration of education (OR=3.032 [1.424–6.454], p=0.004), transport to healthcare center (OR=3.157 [1.193–8.353], p=0.021) and to know the family physician (OR=0.425 [0.203–0.892], p=0.024) were found to be significant.
DISCUSSION AND CONCLUSION: The effective use of the referral chain in the healthcare system will enable more effective use of tertiary healthcare institutions.

9.Effect of Aerobic Exercise Program on Inflammatory Parameters and Framingham Risk Score in High Cardiac Risk Patients
Nart Zafer Baytuğan, Hasan Çağlayan Kandemir
doi: 10.5505/anatoljfm.2021.06078  Pages 38 - 43
INTRODUCTION: The aim of this study was to determine the effects of an 8-week aerobic exercise program on the inflammatory parameters and the Framingham risk score in patients with high cardiac risk.
METHODS: The patients with high cardiac risk according to National Cholesterol Education Program Adult Treatment Panel-3 criteria were studied. Totally, 50 patients were included in the study, and 25 (50.0%) patients were applied to an aerobic exercise program for 30 min/day for 3 days a week. There were 25 (50.0%) patients in the control group.
RESULTS: The study included 50 patients and the mean age of the patients was 61.0±5.0 years. At the end of the study, hs-CRP levels decreased in the exercise group [1.1 (0.1–4.2) mg/dL vs 0.9 (0.1–3.8) mg/dL] and in the control group [1.2 (0.2–4.3) mg/dL vs 1.0 (0.1–4.0) mg/dL] (<0.001 and p=0.008, respectively). Homocysteine levels [13.4 (4.8–27.3) μmol/L vs 11.8 (4.0–21.6) μmol/L] decreased in the exercise group, but they did not change in the control group [13.2 (5.1–28.2) μmol/L vs 13.4 (4.4–27.1) μmol/L](p<0.001, and p=0.776, respectively). Fibrinogen levels decreased in the exercise group [4.1 (1.6–5.9 g/L vs 3.4 (1.2–5.0) g/L], but they did not change in the control group [4.0 (1.4–6.1) g/L vs 3.9 (1.4–5.7) g/L] (p<0.001 and p=0.348, respectively). The Framingham risk score decreased in the exercise [24.1±2.9 vs 20.3±3.3] and control groups [22.8±2.7 vs 19.5±2.7] (p<0.001 and p<0.001, respectively).
DISCUSSION AND CONCLUSION: Regular aerobic exercise is effective and safe to prevent probable cardiovascular events in high cardiac risk patients in addition to medical therapy.

10.Burnout of Healthcare Professionals Working in COVID-19 Contact Tracing Teams
Buğu Usanma Koban
doi: 10.5505/anatoljfm.2021.77200  Pages 44 - 49
INTRODUCTION: This study aims to determine the burnout level of healthcare professionals who worked in the contact tracing teams during the pandemic and the factors affecting it.
METHODS: In this cross-sectional study, healthcare professionals working in the contact tracing teams of health districts in Istanbul between March and June 2020 were included. The questionnaire created over Google Forms was shared via social media (WhatsApp) groups of the teams in all districts in Istanbul. In the first part of the questionnaire, working conditions during the pandemic and the psychosocial effects of the pandemic were questioned. The data obtained via Maslach Burnout Scale were analyzed statistically in the second part.
RESULTS: Of the 485 participants, 350 (72.2%) were females, and 280 (57.7%) were dentists. The weekly average working time was 36.0 (1.0 117.0) h. The median score for emotional exhaustion (EE), depersonalization (DP), and personal achievement was 31.0 (20.0–39.0), 12.0 (4.0–24.0), and 27.0 (14.0–40.0), respectively. There was a negative correlation between age and EE and DP (r=-0.128, p=0.005 and r=-0.254, p<0.001, respectively), and a positive correlation between age personal achievement (r=0.157, p=0.001). EE and DP were positively correlated with working duration (r=0.287, p<0.001 and r=0.177, p<0.001, respectively). Being away from home and experiencing disruption in the care of relatives significantly increased EE (p=0.009 and p=0.005, respectively).
DISCUSSION AND CONCLUSION: Factors affecting burnout in healthcare workers are psychosocial problems rather than intense working conditions. Providing social and psychological support to healthcare professionals and their families can be effective in dealing with burnout.

11.Attitudes of Family Health Professionals on COVID-19 Vaccines and an Evaluation of Underlying Factors in Samandağ, Hatay, Turkey
Duygu Kavuncuoğlu, Mehmet Mustafa Yıldırım
doi: 10.5505/anatoljfm.2021.69133  Pages 50 - 55
INTRODUCTION: This study aimed to evaluate the attitudes of family healthcare providers on coronavirus disease 2019 (COVID-19) vaccines.
METHODS: In this cross-sectional study, 67 (91.8%) of the total 73 family healthcare professionals in Samandağ, Hatay, Turkey, were included. A questionnaire comprising 17 questions, including questions on the sociodemographic and occupational characteristics of the health professionals and their attitude toward COVID-19 vaccines, was used.
RESULTS: In the study, 67 healthcare professionals were included. The median age was 40.0 (26.0–62.0) years, and 40 (59.7%) of the participants were females. Of the participants, 19 (28.4%) had been diagnosed with at least one chronic disease, and 14 (20.9%) were living together with an individual over 65 years of age. Of the participants, 24 (35.8%) stated their willingness to get vaccinated if a COVID-19 vaccine gets approved in Turkey, and 29 (43.3%) of the participants did not decide. Fifteen (22.4%) professionals stated lack of comprehensive information on the vaccine as the main reason for their refusal to get vaccinated for COVID-19. The rate of physicians stating that they would get vaccinated was 30 (69.8%) and the rate of midwives/nurses was 13 (30.2%) (p=0.001).
DISCUSSION AND CONCLUSION: Vaccine hesitancy and refusal against COVID-19 are very important issues among family healthcare professionals. It is extremely important to organize in-service training and to ensure that all professionals have access to knowledge on the COVID-19 vaccines.

CASE REPORT
12.Giant Pleomorphic Adenoma of Submandibular Gland
Shi Nee Tan, Rubinderan Muthusamy
doi: 10.5505/anatoljfm.2021.07830  Pages 56 - 58
Benign tumour of submandibular glands is rare, however amongst those which happen, pleomorphic adenoma (PA) is the most common type. Although it has been reported in several case reports, giant PA is extremely uncommon. These tumours are usually painless and slow growing but when neglected on some occasions, the long-standing size and weight can augment surgical excision. An unusual case of a giant submandibular PA in a 46-year-old male patient was reported and discussed here. Patient usually tend not to seek out for medical treatment till it became gigantic. Neglecting such tumors can cause unsightful appearance due to the gigantic mass and in a worse case scenario may even cause airway obstruction if it continues to enlarge.

13.Acute Pancreatitis Emerged by COVID-19 in a Pediatric Patient
Eren Yıldız, Yavuz Tokgöz
doi: 10.5505/anatoljfm.2021.17363  Pages 59 - 61
The COVID-19 outbreak continues to spread rapidly all over the world. COVID-19 is generally considered a respiratory disease. However, apart from the typical respiratory symptoms, gastrointestinal symptoms, such as diarrhea, nausea, vomiting, and abdominal pain, particularly in children, are increasingly encountered. A fiveyear-old male patient was admitted to the pediatric emergency service with complaints of severe abdominal pain and loss of appetite. Amylase and lipase blood levels were measured high. The patient was hospitalized with the diagnosis of acute pancreatitis. Polymerase chain reaction test for COVID-19 was performed and it was found positive. Other etiological causes were excluded in the differential diagnosis. In this case report, an extremely rare pediatric COVID-19 case presenting with isolated acute pancreatitis without any other risk factors is presented. SARS-CoV-2 should be considered when investigating the etiology of acute pancreatitis.

14.Tumor D’emblee Variant of Mycosis Fungoides
Manoj Kumar Nayak, Aditi Dhanta, Naveen Kumar Kansal, Ashok Singh, Prashant Durgapal
doi: 10.5505/anatoljfm.2021.88942  Pages 62 - 65
Mycosis fungoides (MF) is a rare lymphoid malignancy and accounts for about 2% of new cases of non-Hodgkin’s lymphoma. MF is known to have extensive clinical variability, usually progressing from patch stage to plaque, nodules, tumors, and generalized erythroderma. In this report, the rare presentation of sudden onset of tumor stage of MF (i.e., MF d’emblee variant) is presented.

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