E-ISSN 2651-3455 (Online) | ISSN 2630-5593 (Print)
The Anatolian Journal of Family Medicine - anatol j fm: 5 (2)
Volume: 5  Issue: 2 - 2022
1.Front Matter 2022-2

Pages I - VII

2.From the Editor
Mustafa Reşat Dabak
Page VIII

REVIEW
3.Allergic Rhinitis in Children
Nevin Cambaz Kurt, Burak Ölmez
doi: 10.5505/anatoljfm.2021.39200  Pages 68 - 72
Allergic rhinitis is one of the most common chronic diseases in all age groups. It is an IgE-mediated allergic inflammation of the nasal airways and is characterized by sneezing, swelling, and inflammation of the nasal mucosa as well as itchy and watery eyes. Laboratory tests used in the diagnosis of allergic rhinitis include allergy skin tests, specific IgE measurements, and imaging studies. The management of allergic rhinitis consists of environmental control, pharmacologic management, and immunotherapy.

4.Ethical Issues in Pediatrics Practice
Hüseyin Dağ, Hüseyin Dağ, Hakan Ertin
doi: 10.5505/anatoljfm.2021.03064  Pages 73 - 78
It is widely accepted that children are not simply “small adults,” and pediatric medicine has been developed as a completely separate branch of medicine. Pediatric medicine involves many of the same ethical issues pertinent to adult medicine, but will also attract a range of ethical issues and, indeed, ethical controversies specific to dealing with children. Although some ethical problems in pediatrics have gained a legal basis over time, some problems continue to be discussed. It is important for pediatricians to be aware of the ethical issues they may encounter and seek medical ethics consultation regarding a contradictory situation when necessary, taking into account the legal regulations of their countries.

ORIGINAL RESEARCH
5.Aspirin Use in Patients Aged 80 years and over in Turkey: Snapshot of Results from the ASSOS Study
Kadriye Memiç Sancar, Oğuzhan Çelik, Cem Çil, Özcan Başaran, Erkan Demirci, Veysel Ozan Tanık, Mucahit Yetim, Osman Karaarslan, Lütfü Bekar, Tolga Doğan, Mubariz Murat Resulzade, Çağlar Kaya, Volkan Doğan, Murat Biteker
doi: 10.5505/anatoljfm.2022.26566  Pages 79 - 84
INTRODUCTION: Acetylsalicylic acid (aspirin) is commonly used with various indications, especially in the elderly population. This study aims to evaluate the prevalence of polypharmacy and aspirin use in patients aged ≥80 years.
METHODS: The ASSOS trial is a cross-sectional, national registry study. This nonrandomized study was conducted by 30 cardiologists in 14 cities on the elderly (over the age of 80 years) who used aspirin (80–325 mg). Polypharmacy is described as an intake of five or more medicines daily.
RESULTS: A total of 309 patients were included in the study, and 146 (47.2%) of them were females. Aspirin treatment for primary prevention (PP) was reported to be given to 101 (32.7%) patients, and polypharmacy was detected in 198 (64.1%) patients. Major gastrointestinal bleeding was reported in 7 (3.5%) patients in the polypharmacy group and 0 (0.0%) patients in the without polypharmacy group (p=0.043). Minor bleeding was reported in 58 (29.3%) patients in the polypharmacy group and in 8 (7.2%) patients in the group without polypharmacy (p<0.001).
DISCUSSION AND CONCLUSION: Aspirin was reported to be used commonly among patients aged ≥80 years for PP although the current guidelines do not recommend aspirin for PP in Turkey. Polypharmacy is still critical in the very elderly population and should be carefully considered in terms of complications.

6.Social Determinants of Health Affect Postneonatal Infant Mortality: A Case–Control Field Study
Binali Çatak, Can Öner, Hayrunnisa Bekis Bozkurt
doi: 10.5505/anatoljfm.2022.97759  Pages 85 - 91
INTRODUCTION: Postneonatal infant deaths are mainly associated with environmental and socioeconomic causes that are preventable. The aim of this study was to identify the sociodemographic risk factors for postneonatal infant death.
METHODS: This is a case–control study. The case group consisted of mothers residing in Bursa who lost their babies in the postneonatal period (n=113). The control group included mothers living in Bursa whose children were of age 12–24 months. The control group received health services from the same family physician as the case group and gave birth in the same month. No sample was selected from the case group, and all data were collected by a questionnaire using the face-to-face technique.
RESULTS: This case–control study was conducted with 101 (34.1%) cases and 195 (65.9%) controls. The analyses of the model, which included all variables significant in binary analyses, showed that the infant mortality rate was higher in those residing in Bursa for less than 10 years (OR=4.211, 95%CI=2.202–8.023, p=0.001); was higher in those who were related to their spouses (OR=2.232, 95%CI=1.112–4.632, p=0.001); was higher in those who had 3 or more pregnancies (OR=3.814, 95%CI=2.001–7.275, p=0.001); was higher in male babies (OR=2.201, 95%CI=1.204–4.001, p=0.001), and was higher in those with a birth weight of ≤2.500 g (OR=6.881, 95%CI=2.811–16.901, p=0.001).
DISCUSSION AND CONCLUSION: The medical history of the patients should be evaluated, and the patients with high risk should follow more closely and frequently to reduce postneonatal infant mortality.

7.Cutoff Value of Metabolic Score for Visceral Fat in Patients with Nonalcoholic Fatty Liver Disease
Şevin Demir
doi: 10.5505/anatoljfm.2022.27147  Pages 92 - 97
INTRODUCTION: This study aimed to determine the cutoff values of a novel adiposity index and the metabolic score for visceral fat (METS-VF) for nonalcoholic fatty liver disease (NAFLD) and its related factors.
METHODS: A total of 1603 individuals participated in our checkup program and were retrospectively evaluated between June 2020 and January 2022. Patients who were less than 18 years of age and those with malignancies, hepatitis, HIV, insulin-dependent diabetes mellitus (DM), corticosteroid, parenteral nutrition, or alcohol use were excluded from the study. As a result, 1034 (64.5%) subjects were included in the study. Anthropometric and biochemical values in patient files were used to calculate indexes. Ultrasonography was used for the diagnosis of hepatic steatosis.
RESULTS: Among the 1034 participants, 611 (59.1%) were females. The mean age was 48.7±12.9 years. Metabolic syndrome, DM, and hypertension were identified in 331 (50.5%), 96 (14.7%), and 179 (27.3%) patients with NAFLD, respectively, and in 47 (12.4%), 11 (12.4%), 34 (9.0%) patients without NAFLD (p<0.001, p<0.001, p<0.001, respectively). METS-VF cutoff value was 6.43 regardless of gender (sensitivity: 85.1%, specificity: 66.9%, AUC=0.836, p<0.001). When the genders were examined separately, the cutoff value was 6.41 for females (sensitivity: 78.2%, specificity: 82.8%, AUC=0.872, p<0.001) and the cutoff value was 6.91 for males (sensitivity: 79.6%, specificity: 67.9%, AUC=0.813, p<0.001).
DISCUSSION AND CONCLUSION: The cutoff values of METS-VF in patients with NAFLD were found to be 6.41 in females and 6.91 in males.

8.Evaluation of the Relationship between Neck Circumference and Metabolic Parameters in Women with Insulin Resistance
Zehra Margot Çelik, Mehmet Sargın, Havva Gonca Tamer, Fatma Esra Güneş
doi: 10.5505/anatoljfm.2022.48344  Pages 98 - 103
INTRODUCTION: The aim of this study was to evaluate the relationship between neck circumference (NC), other anthropometric measurements, and metabolic parameters in women with insulin resistance (IR).
METHODS: This study is a descriptive study carried out with volunteer female patients with IR who applied to the obesity outpatient clinic at a tertiary hospital. Patients with homeostasis model assessment of insulin resistance (HOMA-IR) ≥2.5 were included. A demographic questionnaire was applied, and anthropometric measurements, such as height, weight, body fat mass, body muscle mass, NC, waist circumference (WC), hip circumference, and middle-upper arm circumference, and body mass index (BMI), were all carried out by the researchers. Metabolic parameters were obtained from the patients’ files after the necessary permission had been received.
RESULTS: A total of 105 patients were included in this study. The mean NC was found to be 37.2±3.1 cm. NC showed a moderately positive correlation with BMI, WC, and body muscle mass (kg) (r=0.568, p<0.001; r=0.572, p<0.001; and r=0.589, p<0.001, respectively). It was also found that NC correlated positively with C-peptide, HOMA-IR, and triglyceride (r=0.194 p=0.048; r=0.199 p=0.043; and r=0.201, p=0.040, respectively). An association was found between NC and HOMA-IR after adjusting for age, triglyceride, total cholesterol, high density lipoprotein cholesterol, and low-density lipoprotein cholesterol with multiple linear regression analysis (p=0.027).
DISCUSSION AND CONCLUSION: In conclusion, the NC of women with IR has a correlation with other anthropometric measurements as well as some metabolic parameters. When consulting IR patients, all anthropometric measurements should be recorded, including NC.

9.Relationship between Technology Use and Eating Behavior
Ecem Gökbike Ersen, Ayşe Güliz Dirimen Arıkan
doi: 10.5505/anatoljfm.2021.82584  Pages 104 - 109
INTRODUCTION: The aim of this study was aimed to investigate the relationship between the use of technological devices and eating behavior.
METHODS: The study sample consisted of participants who applied to the Nutrition and Diet Policlinic in a private medical center in Istanbul between March and April 2019. The data were obtained using the data collection form, Eating attitude test, and Technology addiction scale.
RESULTS: There were 206 participants in this study. While the frequency of technology addiction in females was 125 (65.4%), it was 66 (34.6%) in males (p=0.010). It was found that 69 (36.1%) people who were technology addicts had impaired eating behavior, and 122 (63.9%) people had normal eating behavior (p=0.828).
DISCUSSION AND CONCLUSION: As a result, there was no statistical difference between the normal and eating disorder groups with respect to their technology use. On the other hand, technology addiction and eating disorder were more common among women. From these results, it was concluded that it would be useful to plan initiatives against technology addiction, especially for women.

10.Frequency of Human Papillomavirus Vaccination and Knowledge Levels of Women between 15 and 49 Years: A Cross-sectional Study
Muhammet Kızmaz, Mehmet Emre Ay, Ezgi Döner, Funda Gökgöz Durmaz, Burcu Kumtepe Kurt
doi: 10.5505/anatoljfm.2022.55477  Pages 110 - 116
INTRODUCTION: This study aimed to determine the frequency of vaccination with the human papillomavirus (HPV) vaccine among women aged 15–49 years and their knowledge levels.
METHODS: This cross-sectional study was conducted on female patients aged 15–49 years who applied to a rural state hospital, family medicine outpatient clinic, between December 15, 2019, and March 1, 2020. A questionnaire about HPV vaccination was filled out through a face to-face interview. Patients who did not agree to participate in the study, who had a hysterectomy, and those diagnosed with cervical malignancy or premalignancy were excluded.
RESULTS: The mean age of 409 female participants was 30.0±9.1 years. None of the women who participated in this study had the HPV vaccine. The number of those who heard about the HPV vaccine was 164 (40.1%). After brief information about the HPV vaccine, 269 (65.8%) participants wanted to have the HPV vaccine.
DISCUSSION AND CONCLUSION: It was determined that the frequency of HPV vaccination and the knowledge levels about the HPV vaccine are low.

11.Effect of Nutritional Status and Muscle Strength on Mortality of the Palliative Care Patients
Yasin Güçlü, Hakan Demirci, Gökhan Ocakoğlu, Özge Aydın Güçlü
doi: 10.5505/anatoljfm.2022.94914  Pages 117 - 122
INTRODUCTION: This study aimed to evaluate the association of nutritional status and muscle strength measurement results of the patients in the palliative care unit during their 6-month survival.
METHODS: In this prospective observational study, the effects of nutritional status on mortality were evaluated during the 6-month follow-up of patients hospitalized in the palliative care units of Bursa State Hospitals between January 2018 and April 2018. Their handgrip strength was measured by a hand dynamometer, and their subcutaneous adipose tissue was measured by skin-fold calipers. Mini Nutritional Assessment was used to evaluate the sociodemographic characteristics and nutritional status of the patients.
RESULTS: A total of 211 patients aged 73.3±14.6 years treated in the palliative clinic were included in the study, of which 112 (53.1%) were males. The frequency of malnutrition at the beginning of follow-up was 75 (78.1%) in the living group and 108 (93.9%) in the dead group (p=0.001). During the 6-month follow-up period, 115 (54.5%) cases died. The frequency of malnutrition after 6 months was observed in 175 (82.9%) of the entire patients. The average muscle strength of the right and left arms was found to be significantly higher in alive patients than in dead patients [5.0 (0.0–21.8) kg vs 0.0 (0.0–10.0), p=0.001].
DISCUSSION AND CONCLUSION: Nutritional status and muscle strength may be important in palliative care patients’ survival. It would be appropriate to promote a balanced diet and physical activity to patients before the need for palliative care develops.

CASE REPORT
12.A 27-Year-Old Case with Bilateral Breast Cancer
Deniz Esin Tekcan Şanlı, Emel Özveri, Emel Ure, Yasemin Kayadibi, Düzgün Yıldırım
doi: 10.5505/anatoljfm.2021.64326  Pages 123 - 125
Breast cancer is the most common cancer in women. Its incidence is increasing day by day, and the frequency of its occurrence in the reproductive periods at earlier ages has also increased. Although there is a significant increase in the number of cases diagnosed at an early age with the widespread use of screening programs, there is no standard screening program under the age of 40 years. It is possible to reduce mortality and morbidity rates due to breast cancers in the reproductive period through early screening programs, especially in patients with a family history of breast cancer or in the high-risk group. In this case report, a 27-year-old female patient, who had a family history of breast and ovarian cancer, with a diagnosis of bilateral invasive ductal carcinoma was evaluated with clinical, radiological, and surgical features.

13.Diagnostic Dilemma in a Primary Care Setting: Postpartum Suprapubic Pain
Shahrul Hisham Sulaiman, Khasnur Abd Malek
doi: 10.5505/anatoljfm.2021.29200  Pages 126 - 128
Osteitis pubis is a rarely reported condition in postpartum following a normal, uncomplicated vaginal delivery. A detailed history and physical examination including the institution of appropriate management and specific diagnostic tests are needed. Suprapubic pain is a common presentation in the postpartum period, and therefore many primary care doctors may not consider the pain as a serious complication. It is crucial that primary care physicians are aware of this illness and proactively manage this condition. Unresolved, prolonged pain might create unnecessary anxiety and frustrations for both the mother and the physician. The case here has been highlighted to address the diagnostic dilemma and to increase the likelihood of a precise diagnosis, particularly in the primary care setting. In this study, a 31-year-old female patient who had been to the local community clinic many times with complaints of suprapubic pain that had persisted for 3 months since the second birth was presented. Physical examination revealed marked tenderness over the symphysis pubis with no other significant findings. Radiological images showed evidence of osteitis pubis. The patient was treated conservatively but objectively with rest, nonsteroidal anti inflammatory drugs, and physical therapy. The condition of the patient improved with time, and the patient returned to normal daily life after 2 months. This case emphasized the importance of recognizing and making an accurate diagnosis of postpartum pubic pain in a primary care setting and instituting a proper treatment regime early and strictly.

14.Spontaneous Pregnancy and Live Birth after Fertility-Sparing Treatment for a Yolk Sac Tumor: A Case Report
Begüm Ertan, Eyüphan Özgözen, Orkun İlgen, Süreyya Sarıdaş Demir, Erkan Çağlıyan
doi: 10.5505/anatoljfm.2022.86570  Pages 129 - 131
A 17-year-old female adolescent presented to the gynecology department and was diagnosed with a yolk sac tumor (YST). The patient received neoadjuvant chemotherapy followed by fertility-sparing surgery and then adjuvant chemotherapy. The patient, who was married 6 years after the diagnosis of YST (endodermal sinus tumor) and who wanted pregnancy became pregnant spontaneously in 2020 and had a healthy, term, vaginal delivery in 2021 (birth weight 3040 g, Apgar score of 8–9). There were no complications during her pregnancy. There are not enough studies about the management of such patients during pregnancy. The increase in this and similar case reports will shed light on the approach and management of these patients. It is possible to achieve spontaneous pregnancy and healthy vaginal delivery after fertility sparing surgery for the YST.

SCIENTIFIC LETTER
15.COVID-19 Pandemic and Impact on Coverage of HIV Screening for Risk Groups
Beuy Joob, Viroj Wiwanitkit
doi: 10.5505/anatoljfm.2022.81894  Pages 132 - 133
COVID-19 pandemic and impact on coverage of HIV screening for risk groups

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