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Volume: 1  Issue: 4 - 2023
1.Front Matter

Pages I - III

2.Measurement of the Knowledge of Pediatric Residents about the Urinary Tract Infection in Children
Emre Leventoğlu, Alperen Kahraman, Bahar Büyükkaragöz
doi: 10.14744/ajh.2023.02996  Pages 97 - 103
INTRODUCTION: Urinary tract infection (UTI) is one of the most common infectious diseases in children. However, although several specific guidelines have been published, the management of UTI has not been standardized. In this study, we evaluated the knowledge of residents about UTI using an online questionnaire. It was aimed to increase the interest and attention of residents on UTI.
METHODS: The questionnaire consisted of 42 multiple-choice and true/false questions prepared through “Google Forms.” The questions were sent to resident physicians working in Ankara province through various “WhatsApp” groups. Participation in the survey was voluntary.
RESULTS: Ninety-three research assistants participated in the survey. The proportion of physicians in the first 2 years of residency training was 29.1%, and in the last year was 54.9%. 25.8% of residents felt competent about UTI. Bladder-bowel dysfunction, vesicoureteral reflux, and obesity were confirmed as risk factors by 98.9% of residents. However, 35.5% of the residents stated that fever is not seen in lower urinary tract infection and 5.4% stated that pyuria is sufficient for the diagnosis of UTI. The use of prophylaxis was thought to prevent renal scarring by 78.5%. Probiotic/prebiotic use was reported to be protective by 40.9%.
DISCUSSION AND CONCLUSION: UTI can be managed differently depending on the level of knowledge and experience of physicians. In addition to correct answers, incorrect/incomplete answers were also noteworthy in our survey. Collaboration among physicians caring for pediatric patients and agreement on common guidelines are thought to provide more appropriate management of pediatric UTIs.

3.Low Body Mass Index Versus Obesity: Which is Worse During Cardiac Surgery?
Kaan Kaya, Murat Koç, Ufuk Mungan, Suleyman Surer, Asım Çağrı Günaydın, Burçin Çayhan Karademir, Haci Ali Kurklu, Ferit Çiçekçioğlu
doi: 10.14744/ajh.2023.36854  Pages 104 - 107
INTRODUCTION: Obesity can cause many diseases and leads to poor prognosis in the course of many diseases. Some researchers report that obesity positively affects cardiac surgery, and they refer to this phenomenon as the “obesity paradox.” Although there are many articles in the literature on obesity, there are no detailed studies on low BMI, especially in cardiac surgery. We wonder whether an extremely low body mass index is a risk factor, similar to obesity, in cardiac surgery patients.
METHODS: We conducted an analysis of the data from 786 patients who underwent elective isolated coronary artery bypass surgery in the last two years. The patients were categorized into four groups based on their BMI: Low BMI (<18.5 kg/m², n=72), Normal BMI (18.5-24.9 kg/m², n=228), Overweight BMI (25.0-29.9 kg/m², n=321), and Obese BMI (≥30.0 kg/m², n=166). Demographic data, co-existing diseases, surgical techniques, cross-clamp times, postoperative bleeding, ICU stay, and extubation times were recorded and compared across the groups. The bleeding index and the transfusion index were calculated and compared.
RESULTS: Although the number of grafts used was the same for all groups, the cross-clamp and total operation times were significantly longer for obese patients. During the postoperative intensive care follow-up, intubation times were also much longer for obese patients. Similarly, the amount of postop-erative drainage was statistically significantly higher in obese patients. On the other hand, it was observed that the “bleeding index” was significantly higher in patients with LBMI (p<0.001). When comparing blood products, it was found that fresh frozen plasma and erythrocyte suspension were used in significantly higher numbers in the OBMI group (p<0.001).
DISCUSSION AND CONCLUSION: Obesity remains an independent risk factor in cardiac surgery. In light of the information obtained in our current study, the bleeding index in patients with low BMI (BMI<18.5 kg/m2) is much higher than in obese patients. Patients with lower BMI require more blood transfusions than obese patients, indicating that low BMI is also a risk factor in cardiac surgery.

4.Organization of Emergency Medical Services After an Earthquake: The Case of Adiyaman, Türkiye
Burak Bekgöz, İshak Şan, Eray Cinar, Ramiz Yazici, Eren Usul, Sukru Yorulmaz, Hakan Güner, Mustafa Uras
doi: 10.14744/ajh.2023.68542  Pages 108 - 113
INTRODUCTION: In this manuscript, we aimed the explanation of health organization of Adıyaman Province after the 5 day of earthquake.
METHODS: The data presented herein were compiled from the experiences of emergency medicine specialists sent to Adıyaman Province by the Ankara Emergency Medical Services (EMS) Adminis-tration. We discuss the personnel and administrative management of Adıyaman Training and Research Hospital, the working system of Adıyaman EMS, patient transport to other provinces by land ambulances and air ambulances, establishment of tent hospitals, medical care point management, and environmental safety.
RESULTS: After the earthquake, a total of 396 patients were transferred from Adıyaman to other provinces by aircraft. The average age of the patients was found 32.8 ± 17.6 years. The most common diagnosis was general body injures. Patients were most frequently transferred to Ankara. The most commonly used aircraft for transportation was the Cargo Aircraft of the Turkish Armed Forces.
DISCUSSION AND CONCLUSION: It should be considered that local administrators are also disaster victims. The fact that teams from other provinces undertake health management in the disaster area will facilitate the process. EMS management in the acute period is particularly important in terms of saving the lives of earthquake victims and preventing disabilities.

5.Nt-proBNP in Pediatric Cardiac Surgery: A Correlation Study with the Postoperative Course and Morbidity
Murat Koç, Sercan Tak, Tolga Baş, Kaan Kaya, Ali Bolat, Ali Kutsal
doi: 10.14744/ajh.2023.92400  Pages 114 - 117
INTRODUCTION: B-type natriuretic peptides, synthesized by cardiac myocytes in response to increased ventricular wall stress, are secreted as prohormones and cleaved into biologically active hormone (BNP) and the inactive N-terminal fragment, known as Nt-proBNP. They possess diuretic, natriuretic, and vasodilatory effects. Recently, B-type natriuretic peptides have been identified as valuable param-eters in detecting acute and chronic left ventricular dysfunction. This study aims to investigate the relationship between preoperative and postoperative Nt-proBNP levels, the postoperative course, and morbidity in congenital cardiac surgery patients.
METHODS: Thirty-one patients, aged between 3 months and 16 years, undergoing open-heart surgery with cardiopulmonary bypass due to congenital heart disease, were examined. The patients had left-to-right shunt lesions or stenosis in the ventricular outflow tract. Patients were divided into two groups based on the need for high-dose (>5mcg/kg/min) inotropic therapy during the postoperative period: those requiring high-dose inotropic support and those requiring low-dose or no inotropic support. Nt-proBNP levels were measured preoperatively (T0), at 2 hours postoperatively (T1), and 24 hours postoperatively (T2). Additionally, postoperative inotropic support, cardiopulmonary bypass, cross-clamp, and mechanical ventilation durations were recorded.
RESULTS: There was a statistically significant difference in cross-clamp durations between the groups. Statistically significant differences were also observed in the duration of inotropic therapy, mechanical ventilation, and length of stay in the intensive care unit. Our study revealed a correlation between the dose and duration of inotropic therapy administered during the postoperative period and Nt-proBNP levels, with patients requiring high-dose inotropic support showing a mean serum level of 1009.10±1345.43 pg/ml. This finding suggests an association between elevated Nt-proBNP levels and increased postoperative inotropic requirements.
DISCUSSION AND CONCLUSION: In the context of adult heart illnesses and cardiac surgery, serum Nt-proBNP levels are a biochemical marker that can effectively assess low functional capability and prognosis. Elevated levels of preoperative serum Nt-proBNP in individuals having cardiac surgery for congenital heart abnormali-ties offer crucial insights into myocardial function and the efficacy of medicinal interventions.

6.Wilms Tumor Mimicking Renal Pelvis Hematoma in a Post-Traumatic Pediatric Patient: Case Report
Nilüfer Özlem Tuncer, Mehmet Can Pençe, Nilüfer Arda, Berna Ucan, Melahat Melek Oguz, Cigdem Uner
doi: 10.14744/ajh.2023.24633  Pages 118 - 121
Wilms’ tumor (WT) is the most common renal tumor of childhood. Children with WT may present with a large, painless, abdominal mass and usually no constitutional symptoms. In our case, there were neither symptoms nor any physical examination findings that would lead us to WT. Herein, we report a 4-year-old male who presented to our clinic with concern for a traumatic lesion in abdomen. He was asymptomatic and had a small bruise on left upper quadrant. Ultrasound revealed a heterogeneous lesion which fills the renal pelvis. Renal pelvis hematoma and space-occupying lesions originating from the collecting system epithelium was considered as differential diagnoses. After kidney biopsy, the diagnosis of WT was confirmed. We present this case of WT to keep it in mind in the differential diagnosis of renal pelvis hematoma in a pediatric post-traumatic patient. We emphasise the impor-tance of using multimodal approaches to make the correct diagnosis.

7.Mönckeberg's Medial Sclerosis of the Thyroid: An Unusual Case Presentation
Şükran Çavdar, Mehmet Burkay Karakulak, Hikmet Erhan Güven, Melih Akıncı
doi: 10.14744/ajh.2023.76476  Pages 122 - 124
Mönckeberg sclerosis (MS) is an idiopathic and non-inflammatory vascular disease. It is characterized by calcification of the medium layer of muscle arteries. In contrast to atherosclerosis, MS does not cause narrowing of the vessel wall. In this study, we present a rare case who underwent total thyroid-ectomy due to Graves› Disease, and whose histopathological examination revealed the diagnosis of Mönckeberg Medial Sclerosis.

8.A Very Rare Cause of Bicytopenia; The Use of Vitex Acnu Castus
Merih Reis Aras, Murat Albayrak, Fatma Yılmaz, Senem Maral, Pınar Tığlıoğlu, Mesut Tığlıoğlu, Hacer Berna Afacan Öztürk, Ahmet Kürşad Güneş
doi: 10.14744/ajh.2023.76486  Pages 125 - 127
Vitex Agnu Castus dry extract BNO 1095 is used in many indications, mainly premenstrual syndrome. Nausea, headache,acne, etc. are the main side effects. The use of BNO 1095 was learned from the history of a 27-year-old female patient who was examined for bicytopenia etiology. Serological tests results were within normal limits and the bone marrow biopsy clonality result suggested that this might be related to non-neoplastic autoimmune processes. The response to methylprednisolone treatment was accepted as a finding supporting this result. Although there are many reasons in the etiology of bicytopenia, the use of herbal medicine should always be considered. This is the first case in the literature demostrating that this herbal medicine causes bicytopenia.