E-ISSN: 2822-6771
Volume : 16 Issue : 4 Year : 2025
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COMPREHENSIVE MEDICINE - : 16 (4)
Volume: 16  Issue: 4 - 2024
1. Front Matter

Pages I - III

2. Editorial
Mustafa Kadıhasanoğlu
Page IV

RESEARCH ARTICLE
3. The Effect of Cystoscopy on Patient Anxiety and Pain Scores: Comparison of Two Groups with and without Appointment
Hüseyin Aytaç Ateş, Uğur Yücetaş, Emrah Okucu, Erkan Erkan, Mustafa Kadıhasanoğlu
doi: 10.14744/cm.2024.29981  Pages 213 - 217
INTRODUCTION: To investigate whether there is a difference between the groups with and without an appointment by measuring pain and anxiety scores before and after cystoscopy.
METHODS: Between January and December 2013, 109 patients were randomized into two groups: same-day cystoscopy or scheduled cystoscopy. Pain and anxiety scores were recorded before and after the procedure to compare the effect of scheduling on pain and anxiety.
RESULTS: Of the patients, the mean age was 50±14. Of these patients 26 patients were female and 83 patients were male. Fifty-five patients constituted the group with an appointment, while the remaining 54 patients were in the group without an appointment. Among the patients median age of the group without an appointment was 54±15 and 46±13 for the group with appointment. Median age was higher in the group without an appointment (p=0.006). No gender difference was observed between the groups. Visual Analogue Scale (VAS) scores measured after the procedure were significantly higher in the group with appointment (p=0.014). Also, no statistically significant difference was found between two groups in the State and Trait Anxiety Inventory (STAI) [both State Anxiety (STAI-SA) and Trait Anxiety (STAI-TA)] and Beck Anxiety Inventory (BAI).
DISCUSSION AND CONCLUSION: Although the change in anxiety scores was not significant in the group given an appointment compared to the group not given an appointment, pain scores increased. In order to reduce the pain levels of the patients, it would be an appropriate approach to plan cystoscopy as soon as possible after the indication.

4. Long-term Obstetric and Neonatal Outcome of SARS-CoV-2 Infection During First, Second and Third Trimesters of Pregnancy: Results of 532 Patients and 532 Healthy Controls in a Single Tertiary Center
Emre Yavuz, Niyazi Tuğ, Doğuş Budak, Gül Çavuşoğlu, Ilkyaz Akarsu Başoğlu, Ayşegül Arı, Cemre Şahin, Osman Samet Günkaya, Arzu Bilge Tekin
doi: 10.14744/cm.2024.96967  Pages 218 - 225
INTRODUCTION: After clinical recovery from the SARS-CoV-2 infection, many issues about the long-term effects of the SARS-CoV-2 infection on the body are still to be clarified. The aim of this study is to investigate the obstetric and neonatal outcomes of patients who recovered from SARS-CoV-2 infection during pregnancy.
METHODS: This retrospective cohort study was conducted in a single tertiary hospital with separate SARS-CoV-2 infection (+) and (-) units. Each parameter of 532 confirmed SARS-CoV-2 infected pregnant patients who recovered from the disease and subsequently delivered, and 532 controls between March 2020 and December 2021 were compared. Results were also analyzed according to the trimesters in which SARS-CoV-2 infections were diagnosed.
RESULTS: Mean gestational age at delivery was found to be lower and preterm birth rates were found to be higher significantly in patients who recovered from SARS-CoV-2 during pregnancy compared to those of the controls (p=0.05). Rates of congenital anomalies, in utero fetal demise and comorbidities were not statistically different except for asthma and preeclampsia. APGAR scores and neonatal intensive care unit admission were not significantly different (p>0.05). The clinical severity, lung ultrasound scores, the requirement for oxygen support, and admission rates to the intensive care unit were observed to progressively rise as the pregnancy advanced during the onset of the disease.
DISCUSSION AND CONCLUSION: The patients who recovered from SARS-CoV-2 infection during pregnancy are at higher risk of preterm delivery and preeclampsia. These effects are not related to the clinical severity of the infection. Risks of SGA and congenital anomalies are not increased.

5. A Comprehensive Review of the Last 50 Years of Research on Thoracic Outlet Syndrome: A Bibliometric Analysis
Elif Özyiğit, Mert Zure, Fatih Bağcıer
doi: 10.14744/cm.2024.52207  Pages 226 - 231
INTRODUCTION: Numerous articles on Thoracic Outlet Syndrome (TOS) have been written by multiple generations of committed researchers worldwide. Knowing the present state of TOS research output requires performing a bibliometric examination of the literature. This study aims to identify the top 50 cited articles published over the previous 50 years on thoracic outlet syndrome.
METHODS: A title-specific search was executed in March 2024 on the Web of Science database, using "thoracic outlet syndrome" as the primary search term. The selected timespan for the search extended from 1975 to 2024. The top 50 most-cited articles were reviewed for the analysis.
RESULTS: The articles received a mean citation of 81.26±32.97 per article. The top 10 articles were published between the years 1982 and 2016. The top 5 journals with the most publications were Journal of Vascular Surgery, Annals of Vascular Surgery, Muscle & Nerve, Archives of Surgery, and American Journal of Roentgenology, respectively. Machleder HI and Sanders RJ were the most productive authors in the field with 5 and 4 papers respectively. Most of the publications (25) concentrated on the surgical management of the syndrome, along with 5 studies focusing on imaging and radiological aspects, 3 on rehabilitation, and 1 on social issues regarding the syndrome.
DISCUSSION AND CONCLUSION: It is foreseeable that TOS will continue to be a focal point of future research. This study serves as a valuable resource for researchers to identify potential collaborators and partner institutions, thereby contributing to the advancement of further research in the field.

6. Effect of Prophylactic Tranexamic Acid Use on the Amount of Bleeding in Previous Cesarean Deliveries
Hale Çetin Arslan, Kadir Arslan, Mustafa Göksu, Burak Demirdelen, Pakize Özge Karkın
doi: 10.14744/cm.2024.54154  Pages 232 - 237
INTRODUCTION: This study aimed to evaluate the effect of prophylactically administered tranexamic acid (TXA) on the amount of perioperative bleeding in previous cesarean deliveries.
METHODS: Patients who underwent previous cesarean section between January 2022 and January 2023 in our hospital, a tertiary care center, were retrospectively screened. Patients who received 1 g of TXA intravenously 10 minutes before the incision during previous cesarean delivery were defined as the study group, and patients who did not receive it were defined as the control group. The patients' demographic findings, clinical characteristics, preoperative and postoperative 24th-hour hemogram levels, uterotonic and blood transfusion needs, and side effect profiles were compared between the two groups.
RESULTS: A total of 203 cases were included: 103 cases in the study group and 100 cases in the control group. There were no significant differences between the groups in terms of demographic characteristics, operation duration, and clinical outcomes such as fetal macrosomia. The groups' preoperative hemoglobin levels were similar, but postoperative hemoglobin levels were significantly higher in the study group (p=0.015). Estimated blood loss and transfusion needs were also significantly lower in the study group (p=0.003, p=0.03, respectively). No thromboembolic events were observed in any patient.
DISCUSSION AND CONCLUSION: Our study determined that TXA applied prophylactically in previous cesarean section operations reduced perioperative bleeding and the need for blood transfusion. Its use will be advantageous to clinicians, especially in cases where resources are limited or in anemic patients, as it reduces the need for banked blood.

7. The Role of Lymphoscintigraphy in Lower Extremity Peripheral Edema
Seçkin Bilgiç, Tuğba Şahbaz
doi: 10.14744/cm.2024.52523  Pages 238 - 243
INTRODUCTION: Lower extremity edema (LEE) can arise from various conditions such as venous insufficiency, lymphedema, and systemic diseases, making its diagnosis challenging. Lymphoscintigraphy has become an essential tool in accurately diagnosing lymphedema by visualizing lymphatic function and identifying abnormalities.
METHODS: In this retrospective study, we evaluated 66 patients with suspected lymphedema who underwent lymphoscintigraphy between January 2023 and April 2024. Patient demographic data, including age, gender, and body mass index (BMI), were collected, and the lymphoscintigraphy results were reviewed to assess lymphatic dysfunction. Lymphoscintigraphy findings were classified using the Lee Bergan and Chang classification systems, and statistical comparisons were made between patients with and without lymphedema.
RESULTS: Of the 66 patients, 55 were diagnosed with lymphedema, with a higher prevalence in females (80%). Lymphedema was bilateral in 40% of the cases. No significant differences were found in age, gender, or BMI between patients with and without lymphedema. Lymphoscintigraphy detected inguinal lymph node pathology in 55 (83%), popliteal lymph node pathology in 49 (74%), main lymphatic duct pathology in 54 (82%), collateral duct pathology in 49 (74%), and dermal-backflow pathology in 48 (73%) of the patients. Most patients were classified as moderate-stage (G2, P2) lymphedema.
DISCUSSION AND CONCLUSION: In conclusion, lymphoscintigraphy demonstrated high diagnostic efficacy, confirming lymphedema in the majority of cases. It not only facilitated early diagnosis but also provided valuable insights into disease staging, enabling more targeted interventions. This study supports the role of lymphoscintigraphy as a critical tool in the management of lymphedema, offering comprehensive information that aids in both diagnosis and treatment planning.

8. Predictors and Influential Factors of Prolonged Stay in the Postoperative Surgical Intensive Care Unit
Kadir Arslan, Ramazan Ahmet Altunbay, Ayça Sultan Şahin
doi: 10.14744/cm.2024.72792  Pages 244 - 251
INTRODUCTION: Prolonged stays in the surgical intensive care unit (SICU) lead to increased costs of care, mortality, and delays in elective operations. This study investigates the factors and predictors of prolonged stays in the SICU.
METHODS: Patients who were followed up in the SICU after the operation between June 2021 and June 2022 were evaluated retrospectively. Patients were classified into a non-prolonged group (<7 days) and a prolonged group (≥7 days) according to the duration of stay in the SICU. The patient's clinical characteristics, comorbidities, anesthesia type, anesthesia- and surgery-related complications were compared between the groups.
RESULTS: The study included 516 patients. Emergency surgery was performed on 37.2% of the patients (n=192). The emergency surgery, intracranial surgery, and surgery duration were significantly higher in the prolonged group (p<0.001, p=0.008, and p<0.001). In addition, the need for mechanical ventilation (Mv), renal replacement therapy (RRT), and sepsis on admission to the SICU was found to be significantly higher (p<0.001 for all). The mean hemoglobin and median albumin levels of patients in the prolonged group upon admission to the SICU were significantly lower (p=0.004 and p<0.001, respectively). At the same time, median GCS scores at admission to SICU were significantly lower, and APACHE-II scores were significantly higher in the prolonged group (p<0.001).
DISCUSSION AND CONCLUSION: Emergency surgery, intracranial surgery, surgery lasting more than 2 hours, sepsis on admission, MV and RRT requirements, and low hemoglobin and albumin levels are risk factors for prolonged stay. GCS (<11.5) and APACHE-II (>12.5) scores help predict prolonged stay.

9. Comparison of Effectiveness of Ultrasound Guided Costoclavicular Block Versus Shoulder Block for Postoperative Analgesia in Shoulder Arthroscopy Cases
Blerta Krasniqi, Volkan Özen
doi: 10.14744/cm.2024.06078  Pages 252 - 259
INTRODUCTION: Our primary objective was to compare the effectiveness of ultrasound (US)-guided costoclavicular (CCB) and shoulder block (ShB) for postoperative analgesia in patients undergoing shoulder arthroscopy using the Numeric Rating Scale (NRS) pain score. Our secondary objective was to evaluate the timing of the first analgesia, the total amount of analgesia administered, and the postoperative complications associated with the blocks.
METHODS: Our prospective observational study included patients between the ages of 18-65 years, who underwent unilateral shoulder arthroscopy, who did not have any disease that would cause limitation of cooperation, who were not allergic to local anesthetic (LA), who were American Society of Anesthesiologists (ASA) I-III, who did not have coagulopathy, and who agreed to participate in the study by signing the consent form. The patient’s pain was assessed and recorded by a blind anesthesiologist using NRS at the 30th minute, 1st, 2nd, 4th, 6th, 12th, and 24th hours postoperatively in the ward where the patients were located.
RESULTS: A total of 26 patients were included, 13 receiving the CCB (Group CCB) and 13 receiving the ShB (Group ShB). The mean age of the patients, education level, gender, ASA score, NRS score, intraoperative duration, postoperative first analgesic requirement time, total analgesic amount, and postoperative complications did not show statistically significant differences between the groups. Block failure was not seen in any patients.
DISCUSSION AND CONCLUSION: This prospective observational study shows that both US-guided CCB and ShB effectively provided similar successful postoperative analgesia in shoulder arthroscopy surgery.

10. Comparison of Lumbar Erector Spinae Plane Block and Modified Thoracolumbar Interfascial Plane Block in Single Level Lumbar Discectomy
Engin Ihsan Turan, Semih Çelik, Selbiye Keçi Karagülle, Emirhan Kahraman, Semra Işık, Ayça Sultan Şahin
doi: 10.14744/cm.2024.39306  Pages 260 - 266
INTRODUCTION: Lumbar disc herniation significantly impacts daily life, affecting 2-3% of the population. This condition is a major cause of low back pain, leading to motor weakness and acute pain. While most cases are treated non-surgically, 15% require surgery. Postoperative pain management is crucial, and recent advancements in regional anesthesia have introduced blocks like the Erector Spinae Plane (ESP) block and Modified Thoracolumbar Interfascial Plane (m-TLIP) block. This study compares the analgesic efficacy of these blocks in single-level lumbar discectomy.
METHODS: This study included 52 patients who underwent lumbar discectomy between March 2021 and March 2022 at Istanbul Health Science University Kanuni Sultan Suleyman Hospital. Patients were randomized to receive either the ESP or m-TLIP block. General anesthesia was administered, and blocks were performed preoperatively. Visual Analogue Scale (VAS) scores were recorded postoperatively at 15 minutes, 4 hours, and 12 hours. Statistical analyses were conducted using IBM® SPSS® 20 and GraphPad 8.3.0 software.
RESULTS: No significant difference was found in VAS scores between the ESP and m-TLIP blocks at any time point (p>0.05). Both blocks showed low pain scores and reduced opioid consumption. No patients experienced postoperative nausea and vomiting (PONV).
DISCUSSION AND CONCLUSION: Both ESP and m-TLIP blocks effectively reduce postoperative pain and opioid consumption in lumbar discectomy patients, providing similar analgesic efficacy. These blocks can be safely used as part of multimodal analgesia strategies for postoperative pain management. Further studies are needed to evaluate long-term outcomes and patient satisfaction.

11. Childhood-onset Systemic Lupus Erythematosus: A Tertiary Pediatric Rheumatology Center Experience
Özlem Akgün, Gülşah Kavrul Kayaalp, Fatma Gül Demirkan, Selen Duygu Arık, Nuray Aktay Ayaz
doi: 10.14744/cm.2024.94840  Pages 267 - 274
INTRODUCTION: This study aimed to reveal the clinical findings, treatment options, organ involvement and severity of childhood-onset systemic lupus erythematosus (cSLE) patients followed in a tertiary pediatric rheumatology center and to better understand this disease.
METHODS: Thirty-seven patients with cSLE diagnosed according to the classification criteria between 2019 and 2024 were included in the study.
RESULTS: The median age at the diagnosis was 13.8 (IQR: 10.6-16.1) years. The most common finding was acute/subacute lupus rash in 62.2% of the patients, while other common findings included alopecia, photosensitivity, and arthritis, with a prevalence rate of 54.1%. Sixteen (43.2%) patients had renal involvement. Fifteen (40.5%) of them had biopsy-proven lupus nephritis. Twenty percent of the patients had class 1, 13.3% class 2, 13.3% class 3, 40% class 4, and 20% class 5 nephritis. The two most commonly used agents were hydroxychloroquine (97.3%) and mycophenolate mofetil (51.4%). The rate of steroid use was 81%. The proportion of patients receiving pulse methylprednisolone was 32.4%. The median baseline Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score for participants was 9.5 (IQR: 6-15.5), while the median final visit SLEDAI-2K score was 2 (IQR: 0-2). There was a difference between the last visit and baseline SLEDAI-2K scores (p<0.001).
DISCUSSION AND CONCLUSION: This article presents a comprehensive analysis of clinical and laboratory findings, disease activity scores, and disease damage indices of children with cSLE in a tertiary referral center. Additionally, the patient's last visit growth parameters are included in the study for a more holistic view of the patient's condition.

12. Incidence of Life-threatening Diseases in Children Referred to the Pediatric Hematology and Oncology Polyclinic
Özlem Terzi, Hasan Tunç Şarman, Tuğçe Aras Çöl, Tugay Çatı, Ecem Bengisu Dervişoğlu, Hüseyin Onur Güzel, Ahmet Kara, Arzu Kapdan
doi: 10.14744/cm.2024.62533  Pages 275 - 280
INTRODUCTION: Direct referral of patients to pediatric hematology and oncology outpatient clinics without questioning their complaints, investigating the etiology, and following up causes concern in patients and families and increases the burden on oncology outpatient clinics. However, very few of these children have conditions that cannot be diagnosed and managed by pediatricians, and even fewer are diagnosed with life-threatening conditions. In this study, we examined the diagnoses of patients admitted to the pediatric hematology and oncology outpatient clinic, the rate of life-threatening diseases, and the need for referral.
METHODS: We retrospectively reviewed the records of patients referred or consulted by pediatricians to the Pediatric Hematology and Oncology Outpatient Clinic over a one year period.
RESULTS: Among the 4210 patients included in the study, the most common diagnosis was anemia, followed by lymphadenopathy, bleeding disorders, and infantile hemangioma. Of these patients, 0.95% (n=40) were diagnosed with life-threatening diseases. Only 0.07% of the patients died during the follow-up period.
DISCUSSION AND CONCLUSION: This very low life-threatening diseases and mortality for a reference center suggests that patients are referred to pediatric hematology and oncology outpatient clinics without comprehensive evaluation in primary and secondary health care centers.

13. Doppler Ultrasound Vascularity Patterns in Morpho-radiological and Pathological Evaluation of Thyroid Nodules
Abdullah Yakupoğlu, Murat Dökdök, Adnan Aras, Olgun Duran
doi: 10.14744/cm.2024.36036  Pages 281 - 286
INTRODUCTION: We aimed to evaluate Doppler ultrasound (US) vascularity patterns compared to morphological, radiological, and pathological thyroid nodule features to predict malignancy.
METHODS: A total of 257 thyroid nodules (173 in women and 84 in men) were examined. The blood supply patterns of the nodules were categorized with color Doppler US. as (-); no vascularity (+); intranodular microvascular punctuate, (++); rod, or fine branching peripheral, (+++); intense intranodular and peripheral vascular blood supply.
RESULTS: The data indicated a tendency for higher TI-RADS categories to exhibit higher Bethesda results, which are indicative of a higher risk of malignancy. TI-RADS 5 had the highest percentage in Beth-6. A statistically significant difference was found between vascularity and nodule diameter. Among those nodules with (+) and (++) vascularity, the percentage of nodule diameters between 11 mm and 20 mm was the highest, while among those with (+++), the percentage of those >20 mm was the highest. The data indicated that even nodules with low vascularization (negative) could belong to higher TI-RADS categories. TI-RADS 5 nodules were evident in intranodular vascularity group. The percentage of those in the Bethesda 2 group according to vascularity was the highest. Bethesda 6 nodules had prominent intranodular vascularity among others. A statistically significant difference was found in all groups compared to vascularity (p<0.05).
DISCUSSION AND CONCLUSION: Along with other radiological findings, using Dopper US vascularity patterns in some nodule groups might elaborate the algorithm in predicting malignancy. This can accurately translate into better management planning, whether conservative, surgery, or invasive.

REVIEW
14. Comprehensive Current Overview of Pelvic Congestion Syndrome: Symptoms, Pathogenesis, Diagnosis, Treatment
Ümmihan Topal
doi: 10.14744/cm.2024.37928  Pages 287 - 294
Pelvic congestion syndrome (PCS), which is one of the most common causes of chronic pelvic pain (CPP), is a frequently encountered disease in women that generally receives inadequate diagnosis. It is commonly seen in multiparous women. PCS is defined by CPP persisting for at least six months without evidence of inflammatory disease. Patients with complaints of CPP may be associated with PCS in 30% of cases; however, diagnosing it can be challenging due to overlap with other causes of CPP in the pelvic region. Therefore, exclusion of other causes of CPP is necessary. Recent studies indicate a trend towards preferring endovascular treatment over surgical intervention due to its high success rate and low complication risk. The strong evidence about the diagnosis and treatment of PCS is still incomplete. There are few randomized controlled trials available. It should be discussed and evaluated in a multidisciplinary setting involving gynecologists, GI specialists, pain management experts, physical therapists, and interventional radiologists. The aim of this review is to comprehensively examine current information on the symptoms, pathogenesis, diagnosis, and treatment of PCS.