E-ISSN 2651-3455 (Online) | ISSN 2630-5593 (Print)
The Anatolian Journal of Family Medicine - anatol j fm: 3 (2)
Volume: 3  Issue: 2 - 2020
1.From the Editor
Reşat Dabak
Page I

2.Covid-19 in Children: A Review of the Manifestations and Treatment Options
Olayinka Rasheed Ibrahim, Yetunde T Olasinde
doi: 10.5505/anatoljfm.2020.44127  Pages 86 - 91
The global spread of severe acute respiratory syndrome coronavirus 2, the causative agent of coronavirus disease 2019 with more than a million cases and more than 50.000 deaths as of 4th April 2020 remains a source of concern to humans. The initial impression that children have been less susceptible to the virus when compared with adults has changed recently, with an increasing number of paediatric data becoming more available. The paediatric data have shown a very low mortality rate among the children. The studies in children from China showed the predominance of respiratory and gastrointestinal symptoms; however, few studies outside china reported the absence of gastrointestinal symptoms. Also, the guidelines on the use of specific antiviral and other therapeutic agents in children are limited to few drugs with the use of some of them on compassionate ground. Thus, we have summarized the various clinical manifestations and treatment options of the Covid-19 in childhood since the current outbreak started. This may be of benefits to clinicians and policymakers. Finally, we have also reviewed the various studies on COVID-19 concerning their strength and weakness.

3.Intimate Partner Violence during the COVID-19 Pandemic: An Impending Public Health Crisis in Africa
Brendah Nakyazze
doi: 10.5505/anatoljfm.2020.96967  Pages 92 - 95
With COVID-19 officially declared a global pandemic and changing the social, economic, and political dynamics worldwide, countries are taking different measures to tackle its spread to save lives, which now comes as the number one priority. Different countries are in lockdown with travel restricted and quarantine, self-isolation, and social distancing measures in place. Other than key workers who are allowed to travel for work, people are stuck at home for extended periods of time with access to only their immediate family. Much as these measures have been beneficial in flattening the curve and therefore proved effective in tackling the spread of COVID-19, however, they have, been associated with an increase in the reported cases of Intimate Partner Violence (IPV) across the world, and this poses another public health challenge. With African countries already registering some of the highest global prevalence rates of IPV, it is essential to explore the impact of the COVID-19 measures will have on IPV in Africa.

4.The Effects of Tuberculosis Treatment on Quality of Life, Anxiety and Depression
Fatoş Kurt, Uğur Bilge, Ilhami Ünlüoğlu, Ferdi Köşger, Hülya Özen
doi: 10.5505/anatoljfm.2019.30602  Pages 96 - 100
INTRODUCTION: This study aims to observe the health-related quality of life and depression and anxiety symptoms of newly diagnosed patients who were taking four-drug anti-tuberculosis (anti-TB) therapy during the treatment period.
METHODS: The TB-diagnosed patients who were taking four-drug TB therapy and suitable for this study were followed up during the treatment period in the providence of Eskişehir. The patients were assessed according to the Short From-36 (SF-36) health quality, Beck depression, and Beck anxiety scales at three months and at the end of this study (six months).
RESULTS: Significant improvements were observed in all SF-36 components at the end of this study (p< 0.001). When compared with the beginning and the end of the treatment, there was a statistically significant decrease in Beck depression and anxiety scores (p<0.001).
DISCUSSION AND CONCLUSION: Improvement in the patients’ Beck depression–anxiety and life quality scores without additional psychiatric treatment is an important finding. These scientific outcomes show that, like other chronic diseases, TB may cause psychiatric problems.

5.The Beliefs of Obese People Towards Obesity
Güzin Zeren Öztürk, Saliha Büşra Aksu, Memet Taşkın Egici
doi: 10.5505/anatoljfm.2020.24633  Pages 101 - 106
INTRODUCTION: Obesity is a multifactorial complex disease that can be prevented. Obesity is a state of weight gain due to environmental factors and malnutrition and is effective in genetic factors, such as other chronic diseases. Obesity is defined as a body mass index (BMI) of 30 kg/m2 or more. In this study, we aim to investigate the knowledge and behavior of obese people about obesity and give them feedback about their weight.
METHODS: This study was conducted with participants who applied to the Family Medicine Clinic for any reason between 01.12.2018-31.12.2018. The questionnaire included questions about socio-demographic factors and their attitudes and knowledge about obesity. The data were collected by doctors using face-to-face interviews.
RESULTS: One hundred thirty two obese were enrolled in the study. Seventy-one (53.8%) of them were women. Seventy-two (54.5%) of them were low educated and 84 (63.6%) of them had low income. Female had higher BMI than men but there was no significant relationship (35.0 (30.0-51.0) kg/m2 vs 34.0 (30.0-48.0) kg/m2, p=0.195). Obesity in family history was positive in 102 (77.3%) of patients. BMI of participants with self-reported low daily exercise levels were significantly higher than those with self-reported high daily exercise levels (p=0.014).
DISCUSSION AND CONCLUSION: Obesity is a long-term and complex problem and it is more than just what people eat. Additional studies are needed to investigate socio-economic, environmental and familial factors to understand its complexity.

6.Determining Emergency Department Nurses’ Competence and Preference Levels for Using Ventrogluteal Site in Administering Intramuscular Injections
Birgül Cerit, Zeynep Emen
doi: 10.5505/anatoljfm.2020.79553  Pages 107 - 115
INTRODUCTION: This study was conducted to investigate emergency service nurses’ competence levels and preferences for using the ventrogluteal site in administering intramuscular injections.

METHODS: This research was designed as a qualitative study. Data for this study were collected from 16 voluntary nurses in a hospital emergency service. Data were collected using a semi-structured interview using the interview form designed by the researchers on April 1-12, 2017. In the analysis of the data, descriptive statistics and content analysis were used.
RESULTS: In this study, 4 (25.0%) nurses preferred the ventrogluteal site to administer intramuscular injections, and in general, they had low competence. Eight (66.8%) of the participating nurses did not utilize ventrogluteal site often due to lack of training or knowledge on the administering intramuscular injections on ventrogluteal site.
DISCUSSION AND CONCLUSION: Nurses’ competences and preference levels for using the ventrogluteal site in administering intramuscular injections were low. Training programs can be organized to meet nurses’ training needs, increase their competences and improve the use of the ventrogluteal site in administering intramuscular injections.

7.Evaluation of HBV and HCV Seroprevalence in Serum Samples of Individuals Diagnosed with Hepatocellular Carcinoma
Ayfer Bakır, Mustafa Güney, Hilal Türkmen Albayrak, Mehmet Tevfik Yavuz
doi: 10.5505/anatoljfm.2020.02419  Pages 116 - 120
INTRODUCTION: According to the data of the World Health Organization, hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related deaths. This study aimed to investigate the importance of hepatitis B virus (HBV) and hepatitis C virus (HCV) in the viral etiology of HCC. In this study, we evaluated HBsAg and anti-HCV test results in serum samples sent with the diagnosis of HCC to Virology Laboratory.

METHODS: This study was planned as a record-based cross-sectional study. The patients with HCC who were analyzed HBsAg and anti-HCV antibody in serum specimens in Virology Laboratory between October 2016 and December 2018. HBsAg and anti-HCV were tested in serum samples with test parameters chemiluminescent micro-particular enzyme immunoassay method by Architect system.
RESULTS: This study included 44 patients with HCC. The median age of the patients diagnosed with HCC was 64.0 (33.0-88.0) years. Thirty-six (81.8%) of the patients were male, and 8 (18.2%) were female. HBsAg seropositivity was found in 13 (29.5%) patients and anti-HCV seropositivity was found in 2 (4.6%). HBsAg seropositivity was found in 2 (25.0%) of female patients and 11 (30.6%) of male patients (p=0.755). Anti-HCV seropositivity was found in 2 (5.6%) male patients (p=0.666). The highest HBsAg rate was 35.3% in the age group of 50-69 years, and the highest anti-HCV rate was 14.3% in the age group of 70-88 years (p=0.415, p=0.407, respectively).
DISCUSSION AND CONCLUSION: As a result, HBsAg seropositivity was found in 29.5%, and anti-HCV seropositivity was found in 4.6% of the patients diagnosed with HCC. HBV still keeps its importance in the etiology of HCC.

8.Knowledge Levels of Preschool Teachers about Airway Obstruction due to Foreign Body
Hatice Gencer, Ahmet Ergin, Süleyman Utku Uzun
doi: 10.5505/anatoljfm.2020.19480  Pages 121 - 127
INTRODUCTION: This study aims to investigate the knowledge levels of preschool teachers who work in Denizli city center in Turkey about foreign body airway obstruction (FBAO).
METHODS: The population of this cross-sectional study consists of 432 preschool teachers working in primary schools and kindergartens located in Denizli city center. Participants were administered a questionnaire that consisted of 28 questions. For each participant, the knowledge scores about FBAO were calculated. Each participant can score a minimum of 0.0 and maximum of 28.0 points.
RESULTS: For this study, 204 preschool teachers working in 27 schools were selected. The mean age of the participants was 33.5±5.3 years and 185 (98.4%) were female. Twenty-three (12.2%) of the teachers had previously come across airway obstruction due to foreign body. One hundred forty-two (76.3%) of the participants find their knowledge levels insufficient and 151 (80.7%) of them want to get educated. Teachers’ knowledge score about FBAO was 11.6±5.5. Teachers’ knowledge scores who had two and more children and those who get educated before were higher and teachers’ knowledge scores who want additional education were found to be lower (p=0.010, p<0.001 and p<0.001, respectively).
DISCUSSION AND CONCLUSION: The knowledge level of preschool teachers in Turkey about FBAO was low. Teachers were aware of this insufficiency and they were willing to get educated about this issue.

9.Effects of Childbirth Education on Prenatal Adaptation, Prenatal and Maternal Attachment
Nevin Çıtak Bilgin, Bedriye Ak, Fatma Ayhan, Fatma Öztürk Koçyiğit, Songül Yorgun, Mehmet Ata Topçuoğlu
doi: 10.5505/anatoljfm.2020.60352  Pages 128 - 135
INTRODUCTION: Pregnant women’s problems in prenatal adaptation and maternal attachment negatively affect the health of the mother, family and the baby. Childbirth education may increase adaptation to pregnancy by increasing women’s self-confidence and help strengthen the bonds with their babies. This study aimed to investigate the effects of childbirth education on prenatal adaptation, prenatal and maternal attachment.
METHODS: This study was with pre/post-education, semi-experimental and prospective design. Research data were collected using the Participant Identification Form, Prenatal Self Evaluation Questionnaire, Prenatal Attachment Inventory and Maternal Attachment Inventory.
RESULTS: A total of 173 women, 90 (52.0%) in the education group and 83 (48.0%) in the control group, participated in the study. The prenatal and prenatal attachment adaptation levels of the control and education group were found to be similar before this study (p=0.770 and p=0.277, respectively). Pregnant women’s prenatal adaptation increased after education and between-group differences were significant (p<0.001). Prenatal attachment level also increased in the education group after education (p<0.001). However, prenatal and maternal attachment levels were similar between groups (p=0.171 and p=0.763, respectively).
DISCUSSION AND CONCLUSION: It was identified that childbirth education increased prenatal adaptation but did not affect prenatal and maternal attachment. Childbirth education routinely provided as a part of antenatal care by health professionals ensures awareness in parenting by increasing prenatal adaptation.

10.Evaluation of Toxoplasma gondii, Rubella virus and Cytomegalovirus Infections
Hilal Türkmen Albayrak, Ayfer Bakır, Mustafa Güney, Mehmet Tevfık Yavuz
doi: 10.5505/anatoljfm.2020.22932  Pages 136 - 140
INTRODUCTION: Primary infection agents occurring during pregnancy and causing congenital anomalies are Toxoplasma gondii (T.gondii), rubella virus and cytomegalovirus (CMV). It was revealed that these agents infected the fetus by crossing the placenta and increased the rate of fetal morbidity and mortality. This study aimed to investigate the relationship between seroprevalences of T. gondii, rubella virus and CMV antibodies.
METHODS: The results were retrospectively evaluated. Pregnant women’s serum samples sent to the Medical Microbiology Laboratory of Ankara Gülhane Training and Research Hospital between January 2018 and December 2018 were included in this study. T. gondii, rubella virus and CMV IgM and IgG antibodies were analysed using the chemiluminescent immunoassay method.
RESULTS: In this study, the results of 647 pregnant patients were retrospectively analysed. The median age of the attendants was 28.0 (18.0-49.0) years. IgM positivities for T. gondii, rubella virus and CMV were found as 3 (0.6%), 3 (0.5%) and 61 (15.0%) respectively and IgG positivities were 66 (13.8%), 529 (91.7%) and 394 (99.3%), respectively.
DISCUSSION AND CONCLUSION: In this study, the results were consistent with the findings obtained in the regional studies. Seroprevalence studies in pregnant women will be guide for the necessity of prenatal screening tests. Therefore, the findings suggest that pregnant women and women of childbearing age should be investigated concerning T. gondii, the rubella virus and CMV antibodies.

11.Factors Affecting Access to Health Care Services for Syrians in Turkey
Hande Bahadir, Reyhan Uçku
doi: 10.5505/anatoljfm.2020.19483  Pages 141 - 149
INTRODUCTION: This study was conducted to find out about the access of Syrians residing in a neighborhood densely populated by Syrians in Izmir to therapeutic health care services and to identify the factors affecting their access.
METHODS: The dependent variable of this cross-sectional study is the status of Syrians' access to therapeutic health care services. The independent variables of this study include age, gender, educational background, marital status, working status, perceived economic status, registration status, whether speaking Turkish, presence of language barrier, time of residence in Turkey and Izmir, type of housing, presence of heating, number of individuals, family, rooms and individuals per room in the housing. The population of this study was composed of all Syrians residing in the neighborhood between September and October 2015.
RESULTS: In this study, 556 Syrian individuals were interviewed in 97 households. It was found that 132 (56.9%) of the 232 individuals who needed access to health care services could not access them. The increase in the number of people sharing housing and presence of language barriers had a negative impact on access to health care (p=0.029 and p=0.001, respectively).
DISCUSSION AND CONCLUSION: Immigrant polyclinics that provide primary health care should be generalized to prevent the language barrier from being an obstacle in access to health care.

12.The Immunization Status Evaluation of the Children Hospitalized
Burcu Doğan, Yasemin Akın
doi: 10.5505/anatoljfm.2020.74936  Pages 150 - 157
INTRODUCTION: In our study, we aimed to identify the vaccination rates in hospitalized children by analyzing their immunization records and the factors that affect vaccination status.
METHODS: In our study, we have analyzed cases 3-48 months of age old who were hospitalized between 2006-2008 in Kartal Dr. Lütfi Kırdar Training and Research Hospital, Pediatric Health and Diseases Clinics. The immunization registration forms saved by the parents were inspected and saved in the questionnaire sheets.
RESULTS: The study group included 218 (43.4%) female and 284 (56.6%) male, total 502 cases while mean birth weight of the children was 3067.0±690.3 grams. Mean duration of exclusive breastfeeding was found 3.5 (1.0-20.0) months. Vaccination rate analysis of the 502 cases, 379 (75.5%) cases was fully vaccinated, whereas 123 (24.5%) cases children received incomplete vaccination.
DISCUSSION AND CONCLUSION: We have encountered inadequate childhood vaccination rates in hospitalized children.

13.An Effective Method for Diagnosing Appendicitis in Children: Appendicitis Scoring System
Yusuf Atakan Baltrak, Seniha Esin Söğüt, Onursal Varlıklı
doi: 10.5505/anatoljfm.2020.04695  Pages 158 - 162
INTRODUCTION: This study aims to examine the diagnostic values of physical examination, laboratory and imaging methods of pediatric patients, who were hospitalized, followed up and operated in the pediatric surgery clinic of our hospital with the diagnosis of acute appendicitis, to investigate a simple and useful scoring system that can be formed from those with the highest diagnostic value, and to compare scoring systems concerning their effectiveness in diagnosing appendicitis and reducing negative appendectomy rates.
METHODS: The study group consisted of patients hospitalized and treated at the pediatric surgery clinic with a preliminary diagnosis of acute appendicitis between January 2016 and January 2019. The cases were divided into two different groups as appendicitis group (AG) and non-appendicitis group (NAG). Alvarado Appendicitis Score (AAS), Pediatric Appendicitis Score (PAS) and Tzanakis Appendicitis Score (TAS) of the patients were calculated retrospectively in both groups.
RESULTS: The difference between the PAS, AAS and TAS of AG and NAG was statistically significant (p=0.042, p=0.021 and p=0.021, respectively). The rate of neutrophil-to-lymphocyte ratio of >3.5 in 53 (77.9%) of the AG group and 33 (63.4%) of NAG was higher than 3.5 (p=0.030).
DISCUSSION AND CONCLUSION: This study has shown that appendicitis scoring methods are as effective as imaging techniques in the diagnosis of appendicitis, which is the most common cause of surgical abdominal pain in children admitting to emergency care units due to abdominal pain, as well as in reducing the negative appendectomy rates.

14.Financial Burden of Unnecessary Test Request for Thyroid Tests in Public Health Laboratory: To What Extent the Algorithms are Used?
Durmuş Ayan
doi: 10.5505/anatoljfm.2019.82997  Pages 163 - 166
INTRODUCTION: In this study, we aimed to investigate the financial burden of not performing thyroid function tests (TFT) according to the algorithms in diagnosis and treatment guidelines.
METHODS: The TFT results of 61.422 patients whose testing was requested between 01.01.2018-31.12.2018 in Amasya Public Health Laboratory were analyzed retrospectively. The results of the patients were grouped according to the diagnoses specified in the diagnosis and treatment guidelines (euthyroid, hyperthyroid and hypothyroid). In addition, patients were grouped according to the type of test request (group 1: Thyroid stimulating hormone (TSH), group 2: TSH and free triiodotyronine (fT3), group 3: TSH and free throxine (fT4), group 4: TSH, fT4 and fT3).
RESULTS: Among these patient results, the number of patients who received TSH only in the first step, in line with the algorithms, was 12.522 (20.2%). The number of the patients from whom TSH and fT3 were requested together was identified as 703 (1.1%), fT4 and TSH together as 6343 patients (11.2%) and all three tests (TSH, fT4 and fT3) as 41.854 (67.5%). The total cost of the test requests was calculated as 388.426 Turkish Liras per annum, which was repaid to institutions in accordance with the principles of Health Practice Communiqué.
DISCUSSION AND CONCLUSION: According to the results we obtained, it was found that the algorithms related to the request of thyroid tests were not followed, and the financial implications of this situation were high. We believe that the inclusion of applications, such as reflex testing in laboratory automation and planning of training for algorithms, will reduce improper test requests and unnecessary financial burden.

15.Evaluation of Metabolic Syndrome Prevalence and Parameters in Patients with Fibromyalgia
Tahir Darçın, Hamide Kart Köseoğlu
doi: 10.5505/anatoljfm.2020.41636  Pages 167 - 172
INTRODUCTION: We aimed to evaluate the metabolic syndrome (MetS) parameters in patients with fibromyalgia syndrome.
METHODS: Age, weight, height, body mass index, waist and hip circumferences, and blood pressure were recorded. Laboratory parameters included fasting blood glucose and insulin, high-density lipoprotein, and triglyceride, HOMA-IR.
RESULTS: Thirty-five female patients aged 20-64 years with fibromyalgia and 29 age-matched healthy controls were included in this case-control study. Although MetS was more prevalent in fibromyalgia patients than the control group, the difference did not reach a statistically significant level [7 (20.0%) vs. 5 (17.2%), p=0.770]. The prevalence of high waist circumference was significantly higher in the fibromyalgia group than the control group [23 (65.7%) vs. 6 (20.7%), p<0.001]. High blood pressure was also more prevalent in fibromyalgia group [10 (28.6%) vs. 1 (3.4%), p=0.009]. Insulin resistance and dyslipidemia prevalence did not show a significant difference between groups (p=0.830 and p=0.250, respectively).
DISCUSSION AND CONCLUSION: Although statistically insignificant, metabolic prevalence increases in patients with fibromyalgia, while some MetS parameters, including waist circumference, and systolic and diastolic blood pressures, were significantly higher in fibromyalgia. Therefore, fibromyalgia patients may be under greater risk of MetS than the general population. For a definitive conclusion on the MetS and fibromyalgia, further large-scale studies are needed.

16.A Clinical View on the COVID-19 Racial Disparity in the United States and the United Kingdom
Ernest Herbert, Dominique Fournier
doi: 10.5505/anatoljfm.2020.84756  Pages 173 - 178
COVID-19 that was originating from Wuhan in China has then evolved into various variants, which are specific to regions. Interestingly, COVID-19 highlights that the first strain travelled majorly to the Western Region and was possibly transforming during endemic transmission. There are approximately 93 mutations acquired by the novel virus, and the multiple strains are now grouped into three different clusters. This outbreak has led to a global pandemic never seen for more than a century. This viewpoint is focused on mutation hotspots, case fatalities in most affected nations, impacts of a cytokine storm, and influencing factors that may have amplified the pandemic, to culminate with a racial disparity in both the United States and the United Kingdom Leadership at the highest level of government is important to quickly averting the worst outcome of this pandemic as evident from other countries. Science is the key toresolving many problems; however, that may be professionally used by society and governments as to tackle the difficulty and challenges posed by COVID-19.

17.Implementing Nationwide Preparedness and Response Action plan for the Containment of the Corona Virus Disease 2019 Pandemic
Saurabh Shrivastava, Prateek Shrivastava
doi: 10.5505/anatoljfm.2020.25238  Pages 179 - 180
The ongoing global Corona Virus Disease-2019 (COVID-19) outbreak has become one of the biggest public health concerns of infectious origin affecting the entire world. Acknowledging the magnitude of the disease, rapid rise in the number of cases and geographical distribution, it is the need of the hour to strengthen preparedness activities and response action plan. In these emergency times, it is important to realize that not the health sector alone cannot make a difference unless other concerned sectors join hands together and work in a concerted and coordinated manner. The planned measures should also simultaneously target the strengthening of the case detection, prompt isolation, contact tracing, facilities for quarantine, and provision of appropriate care to the confirmed cases of the disease. In conclusion, the COVID-19 pandemic is increasing at a rapid pace with each day and this clearly highlights the fact that the preparedness and response activities need to be strengthened immensely. However, the success of the implemented measures and the eventual magnitude of the disease will be determined by the adoption of a multi-sectoral approach.

18.Conducting a COVID-19 Risk Assessment to Implement Evidence-based Decisions for Enabling Closure or Reopening of Schools
Saurabh Shrivastava, Prateek Shrivastava
doi: 10.5505/anatoljfm.2020.69672  Pages 181 - 182
The Corona Virus Disease 2019 pandemic has compelled public health authorities to implement a wide range of public health and social measures to reduce the caseload and the spread of the novel viral infection. Owing to the implementation of various measures, some of the affected nations have demonstrated a decline in the incidence of the caseload, and it is the responsibility of the public health authorities to modify the implemented public health and social measures based on the epidemiological distribution and determinants. The decision should be based on the risk assessment which in itself is determined by the level of understanding about the disease transmission in children, local transmission pattern, and the readiness of the schools to reduce the possibility of emergence or appropriate management of an outbreak. In conclusion, as the epidemiological distribution of the disease is changing, it becomes vital for the public health authorities and school authorities to take specific steps on the closure or reopening of schools. However, regardless of any other factor, our interest should be to safeguard the well-being of staff and school children.

19.Overcoming the Existing Challenges in the Eastern Mediterranean Region in the Fight Against COVID-19
Saurabh Shrivastava, Prateek Shrivastava
doi: 10.5505/anatoljfm.2020.07269  Pages 183 - 185
The cases of Corona Virus Disease-2019 (COVID-19) have been reported across all the regions of the world, with the European region and the American region being the most affected. Even though the current estimates pertaining to the outbreak in the Eastern Mediterranean appear significantly less in comparison to the global scenario, but we still have to acknowledge COVID-19 as a major cause of public health concern in the region. This is predominantly because most of the recently affected nations have been experiencing one or the other form of humanitarian emergencies resulting due to wars or conflicts. The presence of all these factors has significantly affected the various prevention and control dimensions, and the delay has been reported in the detection of cases, their isolation and contact tracing. In conclusion, in the fight against COVID-19 pandemic in the Eastern Mediterranean region, many strengthening and capacity building activities need to be carried out. It is the responsibility of the political leaders to acknowledge the prevailing vulnerabilities and accept a ceasefire and work together to reduce the risk of COVID-19 within their settings.

20.Severe Epistaxis Presenting with Deep Anemia: A Case Report
Serdar Özdemir, Abdullah Algın, Hatice Şeyma Akça
doi: 10.5505/anatoljfm.2020.48568  Pages 186 - 187
Epistaxis is the most common nasal emergency. In this case report, we aimed to present a patient who presented to the emergency department with epistaxis-related deep anemia in the light of the literature. A 73-year-old male patient applied to the emergency service with nasal bleeding since yesterday despite the nasal tampon. He had epistaxis for three days. The pulse of the patient was 97 beats/min, rhythmic and blood pressure was 90/61 mmHg. The nasal septum was cauterized. Tampon was placed in the right nasal passage again. Bleeding started again after two hours. The laboratory results were hemoglobin 6.7 g/dl and hematocrit 21.5%. On the second day of the hospitalization, the patient was operated due to nasal bleeding. The sphenopalatine artery was endoscopically ligated. The patient was discharged without any complications. Although epistaxis is often self-limited, it can be life-threatening in rare cases. Physicians should keep in mind that surgical treatment may be necessary in the treatment of epistaxis.

21.Is it Possible to Suffer from Simultaneous Contralateral Knee and Elbow Dislocation after Falling down? A Case Report
Mustafa Enes Demirel, Hassan Salad
doi: 10.5505/anatoljfm.2020.84803  Pages 188 - 190
Isolated knee and elbow dislocations due to falls are frequently observed. However, dislocation of the knees and elbows accompanied by that of other joints are less common. Ipsilateral dislocations have been reported in the literature, although less frequently. When properly evaluated and diagnosed, most fallen and sport-related dislocation can be reduced and initially managed at the game and reducing weight to prevent excessive weight gain and obesity, which can be a risk factor of fallen related dislocations and fractures, particularly female. There is little information available regarding isolated knee–elbow dislocation in normal population and athletes, slips and falls that result in elbow–knee dislocation injuries occur when the bones in joints are forced out of alignment. Complications that result from dislocations include accumulation of scar tissue that restricts the ability to move the joint and increased tendency for repeated dislocations. In addition to the surgical treatment, medical treatment, physical therapy and weight loss may help to heal dislocations. Here, we report a case of contralateral knee–elbow dislocation for the first time in the literature.

22.Scores Used in Sore Throat
Serdar Özdemir
doi: 10.5505/anatoljfm.2020.41736  Pages 191 - 192
Abstract | Full Text PDF

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