Acta Medica Ruha

COVID-19-Associated Pneumothorax: Radiological Insights and Inflammatory Markers

2025-03-10T22:16:46+03:00

Dear Editor,

I read with interest the article by Kılıç et al. (1). “Retrospective Analysis of Spontaneous Pneumothorax Cases Associated with COVID-19'' was published in the 3/2024 issue of the journal. Congratulations to the authors for this article.

Recent literature indeed confirms a link between COVID-19 infection and spontaneous pneumothorax, although it remains a rare occurrence. Several studies have reported that spontaneous pneumothorax occurs in roughly 1% of hospitalized COVID-19 patients, rising to about 3% among those with COVID-19 pneumonia, and up to 6% in patients requiring mechanical ventilation (2). These figures underscore that while the complication is infrequent overall, certain high-risk subsets (such as critically ill or ventilated patients) experience it more commonly. Thus, clinicians should be vigilant for spontaneous pneumothorax in COVID-19, especially in those with severe pulmonary involvement.

Kılıç et al. retrospectively analyzed 31 COVID-19 patients who developed spontaneous pneumothorax, providing valuable insight into their clinical outcomes. Consistent with other reports, the authors found a high mortality rate among these patients – 11 out of 31 (35%) in-hospital mortality in their series. This figure is in line with prior cohort studies which have reported mortality ranging from roughly 27% up to over 50% in COVID-19 patients with pneumothorax (2,3). One of the study’s strengths is its use of CO-RADS scoring. Notably, 63.6% of fatal cases were classified as CO-RADS-5, whereas only 20% of discharged patients fell into this category. This supports previous studies reporting an association between high CO-RADS scores and increased mortality in COVID-19 (4). However, the study did not provide details on specific radiological findings that may contribute to pneumothorax development, such as bulla formation, cavitation, and air trapping. Conversely, Ershadi et al. identified bulla presence as a significant prognostic factor (2).

Kılıç et al. also report significantly divergent levels of hemoglobin, platelet count, INR, and D-dimer between the discharged patients and those who died (1). This observation is an important contribution, as it suggests that more severe systemic inflammation and coagulopathy may accompany or predispose to poor outcomes in COVID-19 patients with pneumothorax. Nonetheless, gender and the Charlson Comorbidity Index, both identified in previous studies as risk factors for COVID-19-related pneumothorax (5,6), were not analyzed in the study by Kılıç et al. Among inflammatory markers, the Systemic Immune-Inflammation Index (SII) is considered superior to PLR and NLR in assessing disease severity and mortality risk in COVID-19 and other inflammatory disorders (7).

In conclusion, COVID-19-induced widespread lung damage can predispose patients to pneumothorax, a complication associated with high mortality rates. Therefore, in cases of sudden clinical deterioration in COVID-19 patients, the possibility of pneumothorax should be carefully considered, and radiological evaluations and anticoagulation interventions should be promptly initiated. Moreover, the use of more comprehensive anticoagulation and inflammatory indices such as SII may aid in identifying high-risk patient groups and optimizing treatment strategies.

Pyelolithotomy In Pelvic Ectopıic Kidney: Case Report

2025-01-14T10:43:38+03:00

Introduction: Urinary system stone diseases are among the most common diseases in urology practice. Treatment methods are decided according to the size, location and number of the stone, but in rare diseases such as ectopic pelvic kidney, the decision must be made according to the kidney structure, vessels and stone. In this case report, the pyelolithotomy performed on the 29 mm stone of the patient with pelvic etopic kidney was tried to be explained in the light of the literature.

Case: A thirty-two-year-old male patient was diagnosed with a 29 mm stone in the right pelvic kidney and renal pelvis as a result of the examinations performed at the hospital where he complained of abdominal pain. With the subsequent examinations and preparations, the patient underwent a pyelolithotomy operation modified with appropriate steps for the pelvic kidney.

Discussion and Conclusion: ESWL, PNL, RIRS, laparoscopic surgery techniques can be applied in pelvic ectopic kidney. Studies have reported the success of ESWL as 54-81%, the success of PNL as 80%, and the success of laparoscopic and robotic surgeries as 80-100%. Although the success of minimally invasive methods is high, the stone burden is below two centimeters in most of these studies. Although open surgery seems to be the last choice, in this anomaly where the surgical technique is not fully determined and the approach is case-specific, open surgery should be considered and the technical approach and dissection steps should be determined.

A Rare Complication: Removing the Guide Wire Pieces Remaining in the Calyx After Nephrostomy by Retrograde Ureterorenoscopy

2025-01-14T14:27:18+03:00

Introduction: Ureterorenoscopy is a frequently applied technique in stone surgery, and its complications are rare with the development of endoscopic materials. In cases where progress cannot be made through the ureter, antegrade interventions or a catheter must be inserted. In this case, we tried to explain the management and removal of the guidewire pieces that could not be performed with URS and remained in the calyx during the insertion of the nephrostomy catheter.

Case: In a 64-year-old patient who applied to the external center with the complaint of left flank pain, a left ureteral stone was detected, then URS was performed and the stone could not be reached due to proximal ureteral cyst. Subsequently, a nephrostomy catheter was inserted. The patient then underwent flexible URS and guidewire fragments were seen. An annual DJ catheter was applied and then the patient was passed through the dilated ureter with a rigid URS and the existing guyite pieces were removed.

Discussion and Conclusion: Ureteric strictures are rare complications with a rate of 9% and improvements. It usually does not require additional intervention, but rare and challenging situations may occur, as in our case. Complications such as failure to enter the collecting system, bleeding, and infection may also occur during percutaneous nephrostomy. In this type of URS cases, the limits of endoscopic interventions should be taken into consideration and contrast-enhanced images revealing the anatomy should be taken.

Urge Urinary Incontinence: Case Report

2024-12-31T21:37:39+03:00

Urge incontinence is one of the most common types of incontinence in women. Urge incontinence is described as a sudden feeling of urge to urinate and a strong urge to urinate. It usually occurs due to overactivity of the detrusor muscle. The associated risk factors such as age, frequent urination, obesity and mode of delivery were found to be compatible with the literature. The aim of this case report is to present the current status, risk factors and causes of urge incontinence in an explanatory manner.

Trends and Determinants of Alcohol Consumption in Turkey

2024-12-08T16:56:27+03:00

Introduction: This study explores the trends and underlying factors influencing alcohol consumption in Turkey, using data from the Turkish Health Survey (TÜİK) for the years 2010 and 2022.

Objective: The analysis focuses on the distribution of alcohol use by gender, age group, and the reasons behind the initiation of alcohol consumption.

Method: Data for this study were sourced from the Turkish Health Survey (TÜİK), which provides detailed statistics on alcohol consumption behavior among individuals aged 15 and above. The survey includes information on the prevalence of alcohol use, categorized by sex and age group, as well as the reasons individuals report for starting alcohol use.The analysis focuses on two main time periods: 2010 and 2022, to examine the trends and changes over the last decade.

Results: Findings indicate a slight decline in overall alcohol use between 2010 and 2022, with notable differences by gender and age. Furthermore, various socio-cultural factors, including peer influence, curiosity, and the desire for fun, are highlighted as significant drivers of alcohol consumption.

Conclusion: While alcohol use has slightly decreased over the last decade, gender and age disparities persist. The shift in reasons for starting to use alcohol from curiosity and peer influence to entertainment points to changing social dynamic. Policymakers and public health professionals must continue to monitor these trends to develop effective strategies aimed at reducing harmful alcohol consumption across various demographic groups.

Evaluation of the Effectiveness of Child Emergency Disaster Plan Training in Nursing Students

2025-01-03T11:19:07+03:00

Introduction: Children are one of the groups most affected by disasters. Health professionals have an important role to play in the protection and development of children's health in disasters. It is important and necessary to support nurses and nurse candidates, who are a numerically strong group among health professionals, with training in emergency management of children in disasters to reduce the risks that may occur.

Objective: This study was conducted to evaluate the effectiveness of paediatric emergency disaster plan training for nursing students.

Method: This study was conducted as a qualitative study with 40 students studying in the nursing department of a university who participated in the child emergency disaster plan training. An introductory information form and a semi-structured interview form were used to collect the study data.

Results: The mean age of the nursing students who participated in our study was 22.5±0.7 years and 66.6% of them were female. It was found that 92.5% of the students had not received any training on disaster and emergency management in children and 77.5% of them had no information on disaster and emergency plans for children in hospitals. As a result of the analysis of the data, 5 themes were identified: creating a special disaster management plan for children, organising children's emergency services, ensuring and protecting the safety of children, managing orphaned children and providing coordination.

Conclusion: In this study, it was found that the level of knowledge and awareness of nursing students about emergency disaster management for children was inadequate. However, it was found that the training received by the students helped them to become aware of critical issues such as disaster emergency planning for children, organisation of emergency services and management of orphaned children

Evaluation of Physiotherapy and Rehabilitation Undergraduate Students’ of Clinical Practice Skills

2025-01-05T16:51:18+03:00

Introduction: Clinical practice courses in physiotherapy are very important for training clinically competent physiotherapists. The quality of students' clinical skills training can be enhanced by rigorously monitoring and assessing their performance in these environments.

Objective: To evaluate the observations and practices in the course forms used in the clinical practice education of physiotherapy students.

Methods: In this descriptive study, the clinical practice education of fourth-year physiotherapy students was evaluated with forms filled out by 170 students in the 2022-2023 academic year.

Results: Students achieved the minimum number of observations and applications specified in the forms for each application. The observations, evaluations and applications made by the students in clinical practice are as follows: It was found that there were exercise applications with 10.37%, electrotherapy applications with 9.49% and some evaluation methods (pain, joint range of motion and muscle strength) with 5.4%. On the other hand, there was limited participation in some neonatal assessments/applications and some specific electrotherapy (biofeedback, iontophoresis and hydrotherapy) approaches. Students mostly participated in exercises for general physiotherapy and neurological rehabilitation units. The students used electrotherapy methods mainly in pediatric and orthopedic therapies.

Conclusion: The clinical practice forms tried for the first time in this study made a limited contribution to monitoring the clinical practice performance of students. Forms have the potential to provide feedback to students and educators in areas such as planning and supervision. Ensuring that students are involved in the development of the forms and getting their views can be useful.

Maternal Ambivalence and Related Factors: The Case of Şanlıurfa

2025-02-14T12:02:06+03:00

Introduction: Maternal ambivalence refers to both positive and negative emotions associated with mothering. It is an essential factor that may affect maternal and infant health.

Objective: This study aimed to determine maternal ambivalence and related factors among women living in Şanlıurfa province.

Method: The population of this descriptive study consisted of pregnant women over 18 and mothers with children in the 0-2 age group. The sample size was calculated as 172 people according to the values obtained from the pilot study. The data were collected by face-to-face interviews between October and December 2024 using a personal information form, the Maternal Ambivalence Scale (MAS) and the Psychological Distress Scale (PDS). In evaluating the data, percentage, mean, and standard deviation from descriptive statistics, t-test, one way ANOVA test and Pearson Correlation analysis from univariate analysis were used.

Results: In the study, the mean age of the women was 26.3±5.4 years, and 60.4% had primary education or less. 20.9% of the women stated that they did not receive any spousal support during pregnancy, labour and postpartum periods. The mean MAS score was 29.8±0.2, and the mean PDS score was 38.7±0.4. Maternal ambivalence was higher in women without spousal support, and maternal ambivalence decreased as psychological distress increased (p<0.05).

Conclusion: As a result of this study, it was determined that women in Şanlıurfa have a moderate level of maternal ambivalence and that spousal support and psychological distress are factors affecting maternal ambivalence.

Nurses' Caring Behaviour And Identification Of Influencing Factors: The Case Of A Public Hospital

2025-03-08T23:27:13+03:00

Introduction: Caring behavior aims to provide care in accordance with the needs of patients by taking an approach to improve their health status and is a concept directly related to the performance of nurses. The fact that patients' health outcomes are related to nurses' caring behaviors shows that it is imperative to focus on care in nursing practice.

Objective: The study was conducted to determine nurses' perceptions of quality of care and the factors affecting these perceptions.

Method: It is a descriptive study. It was conducted with nurses working in a public hospital between February 10 and February 20, 2025. There were 279 nurses in the sample of the study. Data were collected using the Socio-demographic Information Form and the Caring Behaviors Scale-24 form. Descriptive statistics, t-test, one-way variance test (ANOVA) and Kruskal Wallis analysis were applied to analyze the data.

Results: The mean total score and sub-dimension total scores of the “Caring Behaviors Scale-24” of the nurses participating in the study were as follows: Assurance sub-dimension mean score 5.30±0.68, Knowledge-Skill sub-dimension mean score 5.55±0.64, Respectfulness sub-dimension mean score 5.28±0.73, Commitment sub-dimension mean score 5.15±0.81, and scale total mean score 5.32±0.66, respectively. In the study, a statistically significant difference was found between the total score of the nursing behaviors scale and professional experience, liking the nursing profession, average weekly working hours, the time allocated to patient care in the 8-hour shift, finding the nursing care provided in the unit where they worked adequate and satisfaction with the nursing care provided (p<0.05).

Conclusion: It was found that nurses' perceptions of quality of care were higher, nurses with 11 years or more of professional experience, those who love the nursing profession, those with an average weekly working time of 40 hours, those who spent two hours or more on patient care in an eight-hour shift, those who found nursing care adequate in the unit where they worked, and those who were satisfied with the nursing care provided had higher total scores on the care behaviors scale. In line with these results, it is recommended to organize trainings that will strengthen nurses' bonding with the patient, empathy, and support for the patient and to create positive working environments in order to increase the quality of care.

The Role of Gut Microbiota and Probiotics-Prebiotics in the Treatment of Cardiovascular Diseases

2025-03-11T00:43:00+03:00

Cardiovascular diseases (CVD), a major cause of morbidity and mortality worldwide, are among the most well-known and extensively studied diseases. The onset and progression of CVD are associated with multiple risk factors, among which the gut microbiota has gained significant attention over the past two decades. The microbial community colonizing the gut, referred to as the gut microbiota, plays a crucial role in human health. In particular, gut dysbiosis is directly linked to various acute and chronic dysfunctions of the host's cardiovascular system. Previous studies have demonstrated a strong association between CVD pathogenesis, gut microbiota imbalance, and inflammatory responses. Probiotics and prebiotics, which provide various health benefits to the host, have emerged as promising therapeutic interventions for many diseases. These two types of dietary supplements have the potential to reduce cardiovascular disease risks by improving the levels of cardiovascular markers such as total and low-density lipoprotein (LDL) cholesterol, high-sensitivity C-reactive protein (hs-CRP), and specific cytokines related to the inflammatory response. This review discusses the protective effects of probiotics and prebiotics in balancing structural and functional changes in the gut microbiota and maintaining immune homeostasis.

The Role of Nurses as Guides in Inflammatory Bowel Diseases

2025-03-01T02:21:47+03:00

Inflammatory Bowel Diseases are a group of chronic and recurrent inflammatory disorders affecting the gastrointestinal system, with unknown etiology. Crohn's Disease and Ulcerative Colitis are the most common subtypes, associated with physical symptoms and psychosocial issues that negatively impact the quality of life. The management of Inflammatory Bowel Diseases requires a multidisciplinary approach, and the guiding role of nurses is critical for symptom management, treatment adherence, and enhancing patients' quality of life.

Nurses actively participate in symptom management, nutritional counseling, psychosocial support, and patient education, creating individualized care plans tailored to patients' needs. Specifically, nutritional management, psychosocial support, and educational strategies help alleviate symptoms and improve treatment adherence. Additionally, the utilization of health technologies, such as mobile health applications and tele-health services, facilitates patient follow-up and enhances treatment processes.

Psychosocial support services assist patients in managing stress, depression, and anxiety, thereby positively impacting their quality of life. Moreover, support groups and counseling services reduce social isolation and strengthen psychological resilience. Nurses play a crucial role in patient education and raising public awareness, which helps reduce social stigma and improves patients' compliance with treatment.

This review highlights the importance of nursing guidance in the management of Inflammatory Bowel Diseases and provides a guiding perspective for future research. Multidisciplinary teamwork, individualized care plans, and the integration of digital health applications are effective strategies for improving the quality of life of Inflammatory Bowel Diseases patients. In this context, strengthening the educational and counseling roles of nurses is essential for effective Inflammatory Bowel Diseases management.