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The Anatolian Journal of Family Medicine - anatol j fm: 2 (3)
Volume: 2  Issue: 3 - 2019
EDITORIAL COMMENT
1.From the Editor
Yeşim Uncu
Page I

REVIEW
2.Vitamin D Status and Asthma Flare-ups in Children: A Non-systematic Review
Samuel Nkachukwu Uwaezuoke, Adaeze C Ayuk
doi: 10.5505/anatoljfm.2019.48030  Pages 83 - 90
Several non-calcemic actions of vitamin D are well-documented in the literature. Its role in childhood asthma is now an area of on-going research. Studies indicate that the severity of childhood asthma is directly correlated with reduced serum vitamin D levels. This non-systematic review aims to discuss the association of vitamin D status with asthma flare-ups in children. We searched the PubMed database for articles that met the objective of this review. Vitamin D may play a vital role in lung health by inhibiting inflammation, partly by maintaining the regulatory T cells, and by direct induction of innate antimicrobial mechanisms. Vitamin D also inhibits adaptive immunity by delaying the proliferation of T-helper cells. For instance, the neutrophilic asthma phenotype is characterized by neutrophilic inflammation, whose induction is mediated by type 2 T-helper cells. Thus, vitamin D is related to the pathogenesis of asthma based on its ability to block the proliferation of T-helper cells. Predictably, hypovitaminosis D is associated with florid asthma symptoms, asthma flare-ups, decreased lung function, and increased drug usage, as well as severe disease. Several reports have shown a strong relationship between wheezing symptoms/asthma severity in children and low serum 25-hydroxyvitamin D levels. These findings support the use of vitamin D3 supplementation as a potential strategy for reducing disease flare-ups in children.

ORIGINAL RESEARCH
3.Assessment of Knowledge, Attitude and Practice of Tuberculosis Transmission and Prevention Among Tuberculosis Patients at Kuyyu Hospital, North Shoa Zone, Oromia Regional State, Ethiopia
Masresha Leta Ato, Maleda Tefera Sis
doi: 10.5505/anatoljfm.2019.77487  Pages 91 - 97
INTRODUCTION: Tuberculosis is an infectious disease that arises from the bacillus Mycobacterium tuberculosis, which typically affects the lungs (pulmonary Tuberculosis) but may affect other sites as well (extrapulmonary Tuberculosis). This disease is spread through the air when people who are sick with pulmonary Tuberculosis expel bacteria. Tuberculosis continues to be a major public health problem throughout the world, including Ethiopia. In this study, we aim to assess knowledge, attitude, the practice (KAP) of tuberculosis transmission and prevention among patients with Tuberculosis in Kuyyu Hospital, North Shoa Zone, Oromia Region, Ethiopia, 2018 Gregorian Calender.
METHODS: In this study, facility-based cross-sectional quantitative study design was used to assess KAP of Tuberculosis transmission and prevention among Tuberculosis patients in Kuyyu Hospital, North Shoa Zone, Oromia Region, Ethiopia, 2018G.C. The information was collected through an interview using structured questionnaires. The collected data were analyzed by tallying, organizing, and calculating manually using a scientific calculator. Descriptive statistics, such as frequencies and percentages of different variables, were computed as appropriate.
RESULTS: From 108 respondents, 68 (62.9%) were male and 40 (37.1%) were female. Concerning the respondent’s knowledge about TB, out of 108 respondents, 46 (42.6%) of them heard about TB from health institutions at health education programs. Regarding the attitude from a total of 108 respondents, 83 (76.8%) of them agreed that TB transmitted can be by coughing, 5 (4.6%) of them disagreed and 20 (18.6%) of them were neutral. Regarding the practice from a total of 108 respondents, 58 (53.7%) of them responded that they opened windows when they were at home and 50 (46.3%) of them said that they did not open windows when they were at home.
DISCUSSION AND CONCLUSION: To minimize the number of patients who engage in traditional methods of TB transmission and prevention methods, education and training should be given by the hospital in collaboration with other stakeholders, such as Kebele administration, other government offices and international and local NGOs. The hospital and other concerned governmental organizations, non-governmental and community-based organizations should give special attention to patients in providing necessary and basic information in relation to the transmission, prevention and controlling TB.

4.The Role of Bilirubin in Rheumatoid Arthritis as a Biomarker
Tuba Tülay Koca, Ejder Berk
doi: 10.5505/anatoljfm.2019.29491  Pages 98 - 102
INTRODUCTION: Serum bilirubin (Bb) has an anti-inflammatory biologic effect through its antioxidant component. The present study aims to reveal the importance of serum Bb in Rheumatoid arthritis (RA) as a biomarker.

METHODS: This study was designed as a case-control study. Seventy-five RA patients with age (p=0.31) and gender matched 75 controls were included in this study. Clinical characteristics and laboratory parameters were analyzed retrospectively. Serum direct Bb (DBb), indirect Bb (InBb), total Bb (TBb), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) data were recorded. Disease activity in RA was assessed using the Disease Activity Score 28 (DAS28).

RESULTS: In this study, acute phase reactants, CRP (p<0.01) and ESR (p<0.01) were significantly higher in our study group; DBb was found significantly lower (p<0.01) than the control group. ESR was negatively correlated with DBb, InBb and TBb respectively (p=0.029, r=-0.252; p=0.003; r=- 0.362; p=0.009, r=-0.302). TBb was not correlated with DAS 28 (p=0.08; r=-0.203).
DISCUSSION AND CONCLUSION: We found that DBb was significantly lower in RA patients than the patients in the control group. All Bb parameters were negatively correlated with acute phase reactants and DAS28. As a practical biomarker with anti-oxidative properties, the DBb can be used in clinical follow-up in RA.

5.Evaluation of Mediterranean Type Nutrition Habits with Blood Pressure Regulation and Metabolic Syndrome Parameters in Patients with Hypertension
Elif Fatma Özkan Pehlivanoğlu, Yasemin Sağlan, Hüseyin Balcıoğlu, Pınar Yıldız, Uğur Bilge, İlhami Ünlüoglu
doi: 10.5505/anatoljfm.2019.09719  Pages 103 - 107
INTRODUCTION: Hypertension is a common chronic disease and a global public health problem. There are many studies showing that the Mediterranean diet has an important role in the prevention of cardiovascular diseases. Our aim in this study is to evaluate the dietary habits of patients with hypertension in Eskisehir and the effects of nutrition on metabolic syndrome and blood pressure regulation.
METHODS: In this study, 153 volunteer patients with hypertension who applied to Eskisehir Osmangazi University Medical Faculty Hospital Family Medicine and Internal Diseases Clinics were included. The Mediterranean Diet Adherence Screener was used to evaluate the dietary habits of the patients with hypertension.
RESULTS: While the blood pressure regulation rates of patients using adequate levels of olive oil were found to be higher than the patients who did not consume, the body mass indexes of patients with the Mediterranean diet compliance were significantly lower than the patients without diet adaptation. Similarly, considering waist circumference measurements, the median dimensions of the patients with the Mediterranean diet were significantly lower than the patients without Mediterranean diet.
DISCUSSION AND CONCLUSION: We think that the Mediterranean diet can be regulated as nutrition treatment in the process of protection from cardiovascular diseases and after the formation of the disease by providing appropriate counseling with the specialist branches in a multidisciplinary way, protection can be provided with supportive treatments.

6.Evaluation of Vaccine-Preventable Diseases, HIV and HCV Antibody Levels in Residents
Ahmet Ayrancı, Kamile Marakoğlu, Duygu Fındık, Muhammet Kızmaz, Hatice Türk Dağı
doi: 10.5505/anatoljfm.2019.00710  Pages 108 - 118
INTRODUCTION: In our study, we aimed to evaluate the vaccine-preventable diseases and viral serology status of residents to prevent all the potential risks.
METHODS: Referring to this study list dated 11/01/2014, 203 residents working in Selcuk University Faculty of Medicine were included in this study from the Department of Internal Medicine, Department of Surgical Medi-cal Sciences and Department of Basic Medical Sciences. A questionnaire that consisted of 27 questions was administered using the face to face interview method. Anti-HAV IgG anti-HBs, HBsAg, anti-HCV and anti-HCV levels were measured by COBAS/E- 601 device with ELISA method. Measles IgG, rubella IgG, mumps IgG were measured by VIDAS device with ELFA method at Selcuk University Faculty of Medicine Department of Microbi-ology laboratory. SPSS for Windows 21.0 statistical software was used in the analysis of all the data.
RESULTS: In this study, all of the residents’ HBsAg (n=203, 100%), anti-HCV and anti-HIV levels were normal and 9 (4.4%) of the residents were no immune to mumps. Of the residents; 3 (1.5%) were no immune to rubella. Of the residents; 21 (10.3%) were no immune to measles. Of the residents; 52 (25.6%) were no immune to hepatitis A. Anti-HBs antibody levels were measured range to 0.0-9.9 mIU/mL as 13 (6.4%) of the residents and ≥10 mIU/mL as 190 (93.6%). Of the residents; 13 (6.4%) were no immune to varicella. Vaccine declaration of the residents and their serology results compared by Kapaa test and the findings showed that low or negligible compliance for hepatitis B (ĸ=0.153 p=0.022) and found low intermediate compliance for hepatitis A (ĸ=0.217 p<0.001). There was no compliance vaccine declaration of the residents and their serology results for measles, rubella, mumps and varicella (p>0.05).
DISCUSSION AND CONCLUSION: As a result, increasing compliance with the residents for safeguard measures, assessment of se-rological status before beginning the work, and then, the vaccine for the seronegative disease and in-house training to increase vaccine awareness are necessary.

7.Our Positive and Negative Deductions regarding the Results of Tumor Prostheses after Resection of Primary and Metastatic Tumors of the Proximal Humerus
Ertuğrul Allahverdi, Yusuf Yıldız
doi: 10.5505/anatoljfm.2019.07279  Pages 119 - 125
INTRODUCTION: The aim of modular tumor prostheses for primary and metastatic tumors of the proximal humerus is to provide the maximum possible physical, psychological and social activity despite the wide resection areas. The present study aims to show the suitability of modular tumor prostheses of the shoulder joint in the early period without considering the postoperative life expectancy in patients diagnosed with a malignant tumor of the proximal humerus.
METHODS: In this study, a total of 53 patients were evaluated retrospectively. Our patients consisted of 32 female and 21 male patients who were diagnosed and underwent surgery at our Orthopedics and Traumatology clinics between 1980 and 2003. The 14 patients we had personally followed-up at our clinic were included in Group A, while the 39 patients who were evaluated using the data in the archives were included in Group B. The mean age of the patients was 57 years in Group A and 39 years in group B. Modular tumor prostheses were mostly used for the 53 patients in total in Group A and B, but a few patients received a tumor prosthesis made of Polyacetalharz or an isoelastic tumor prosthesis.
RESULTS: There was no sign of postoperative metastasis or local residual tumor in any of the 14 patients in Group A. Seven patients had no pain and five patients had only mild pain. None of the patients required opioids. Postoperative cranial subluxation was seen in ten patients after a mean duration of 34.5 months. Resurgery was performed only in four of 14 patients in group A. Multiple bones, or visceral/pulmonary metastases were found at the same time as the initial diagnosis in Group B patients, and these subjects died within a mean postoperative duration of six months. Nine of the 39 patients underwent resurgery. There were six patients with no pain in Group B. There was no recorded data related to pain in 25 patients. The movement limitation was significant in 13 patients and mild in two patients.
DISCUSSION AND CONCLUSION: The findings suggest that it was possible to achieve a good level of movement capacity and muscle strength although limited due to the refixation of the muscles and tendons protected during the wide intraoperative resections with modular tumor resection prosthesis implantation, despite some tolerable pain in the early period, when the results were compared with other treatment options, such as arthrodesis or amputation. It is encouraging that the elbow, forearm and hand functions were fully protected in all patients and good quality of life was ensured considering the cosmetic results, patient psychology and daily social activities.

8.Cost-Effectiveness of Closed Incison Negative Pressure Wound Therapy for Reducing Surgical Site Infections
Gaye Çelikcan, Menekşe Kastamoni, Ramazan Kahveci
doi: 10.5505/anatoljfm.2019.99609  Pages 126 - 131
INTRODUCTION: Current preventive measures for the prevention of surgical site infections (SSI) are still not sufficient. We aimed to investigate the cost-effectiveness of negative pressure wound therapy (NPWT) on closed incisions in reducing SSI by reviewing local data or available data and values.
METHODS: We suggested a complication cost model for 100 patients, one-fourth of which were presumed as high-risk patients. In high-risk patients, the cost of negative pressure wound therapy (PrevenaTM) was added to the complication cost. The control group was another hypothetical group of patients, and the SSI cost was also calculated. The cost of negative pressure wound therapy (PrevenaTM) in this calculation was the actual raised price of the therapy system in Turkey in the beginning of 2019.
RESULTS: There was an additional 11.953 USD cost for the SSI in 100 amputation patients when standard care was performed. If we apply negative pressure wound therapy (PrevenaTM) in 25 patients who would be considered as high risk, the additional cost would be 11.361 USD. In the case of median sternotomy, the cost of SSI burden was 27.889 USD for standard care, and the cost burden including negative pressure wound therapy (PrevenaTM) cost for high-risk patients was calculated as 11.281 USD. In the laparotomy group, the cost burden of SSI in standard care was 165.105 USD, and negative pressure wound therapy (PrevenaTM) group had 96.767 USD.
DISCUSSION AND CONCLUSION: Applying negative pressure wound therapy (PrevenaTM) in high-risk patients, as recommended in World Health Organization guideline in different surgery types, demonstrates cost benefit. The cost benefit of PrevenaTM was more apparent in median sternotomy and laparotomy compared to amputation. Negative pressure wound therapy (PrevenaTM) can be a good choice in high-risk patients in cost perspective. Further studies would be needed to confirm the cost-effectiveness of negative pressure wound therapy (PrevenaTM) in different types of surgeries.

CASE REPORT
9.Unstoppable Baby Crying: Is it Only Gas Pain or not?
Abdussamed Vural
doi: 10.5505/anatoljfm.2019.66376  Pages 132 - 133
Hair-thread tourniquet syndrome (HTTS) is a rare but well-documented clinical condition results in significant injury as hair or thread wraps around a digit, causes tissue swelling, pain, or possible tissue ischemia. If untreated, HTTS may result in serious events, such as amputation of the organ. In this case report, we aimed to raise awareness that the hair-thread tourniquet syndrome is a clinical situation that can be easily misinterpreted as gas colic especially by family physicians, pediatricians and emergency physicians to whom families first applied.

10.Primary Leiomyosarcoma of the Breast with Unusual Metastasis
Malek Bouhani, Saida Sakhri, Olfa Jaidane, Salma Kammoun, Riadh Chargui, Khaled Rahal
doi: 10.5505/anatoljfm.2019.75047  Pages 134 - 136
Primary leiomyosarcomas of the breast are extremely rare tumors, with unpredictable biological behavior. The main treatment consists of wide resection or mastectomy. Local recurrence is late; the distant metastasis spreads via the hematogenous route to lungs and liver; however, bone metastasis is rarely reported. Here, we present a case of primary leiomyosarcoma of the breast, diagnosed in the postmenopausal female. She underwent a wide resection with free margins. The patient rapidly, presented an unusual aggressive behavior of leiomyosarcoma, with a local recurrence in axillary lymph node and an exceptional distant metastasis in bones.

LETTER TO THE EDITOR
11.25 Years of Experience as the First Family Medicine Specialist in Academic Life
İlhami Ünlüoğlu
doi: 10.5505/anatoljfm.2019.37029  Pages 137 - 138
Abstract | Full Text PDF

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