Acta Medica Ruha
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Trends and Determinants of Alcohol Consumption in Turkey: Research Article
No full textIntroduction: 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
COVID-19-Associated Pneumothorax: Radiological Insights and Inflammatory Markers: Letter to the Editor
No full textDear 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
The Role of Gut Microbiota and Probiotics-Prebiotics in the Treatment of Cardiovascular Diseases: Review Article
No full textCardiovascular 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
Educational Quality of YouTube Videos on Endoscopic Submucosal Dissection: A LAP-VEGaS-Based Analysis: Research Article
No full textIntroduction: Endoscopic submucosal dissection (ESD) is a technically demanding procedure that requires advanced training, yet the educational quality and reliability of related YouTube content remain uncertain.
Objective: This study aimed to evaluate the educational quality of YouTube videos related to ESD using the LAP-VEGaS scoring system and to examine their association with viewer engagement metrics.
Methods: A cross-sectional study was conducted in November 2025 by searching YouTube with the keyword “endoscopic submucosal dissection,” yielding 26 eligible videos after applying predefined criteria. For each video, basic characteristics (upload date, duration, views, likes, dislikes, comments) and viewer interaction metrics (like rate, view rate, Video Power Index) were recorded. Two independent reviewers assessed educational quality using the nine-item LAP-VEGaS scoring system, classifying videos as high quality (HQ, ≥9 points) or low quality (LQ, <9 points). Statistical analyses were performed using SPSS 26.0, with p < 0.05 considered significant.
Results: Of the 26 analyzed videos, 13 (50%) were classified as HQ. HQ videos had significantly higher LAP-VEGaS scores than LQ videos (13.61 ± 1.98 vs. 4.15 ± 1.77, p < 0.001). HQ videos tended to be longer than LQ videos (1,262 ± 748 s vs. 1,028 ± 1,239 s, p = 0.064). The view ratio was significantly higher in LQ videos (p = 0.043). No significant differences were found between groups regarding total views, like ratio, or VPI.
Conclusion: The educational quality of ESD-related YouTube videos is inconsistent and often inadequate, underscoring the need for peer-reviewed, structured content to provide more reliable educational resources
Evaluation of the Effectiveness of Child Emergency Disaster Plan Training in Nursing Students: Research Article
No full textIntroduction: 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 childrenIntroduction: 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 childre
A Rare Complication: Removing the Guide Wire Pieces Remaining in the Calyx After Nephrostomy by Retrograde Ureterorenoscopy: Case Report
Get PDFIntroduction: 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.Giriş: Üreterorenoskopi, taş cerrahisinde sıkılıkla uygulanan bir teknik olup endoskopik malzemlerin gelişmesiyle komplikasyonları nadir görülmektedir. Üreterden ilerlenemediği durumlarda ise antegrade girişimler yada kateter takılması gerekmektedir. Bu olgumuzda URS yapılamayan ve sonrasında nefrostomi kateteri takılması sırasında kaliks içinde kalan kılavuz tel parçalarının yönetimi ve çıkarılması aktarılmaya çalışılmıştır.
Olgu: Sol yan ağrısı şikayeti ile dış merekeze başvuran 64 yaşındaki hastada, sol üreter taşı tespit edilmiş, sonrasında URS yapılmış ve proksimal üreter kingi nedeniyle taşa ulaşılamamış. Akabinde nefrostomi katateri takılmış. Hastaya daha sonra fleksible URS yapılmış ve kılavuz tel parçaları görülmüştür. Yıllık dj kateteriuygulanmış ve sonrasında hastaya dilate olan üreterden rijid URS ile geçilerek mevcut guyt parçaları çıkarılmıştır.
Tartışma ve sonuç: Üreter darlıkları %9 oranında görülmesi ile ve gelişmelerle birlikte nadir rastlanan komplikasyonlardandır. Genellikle ek girişim gerektirmez ancak olgumuzda olduğu gibi nadir ve zorlu durumlar görülebilmektedir. Perkütan nefrostomi açılmasında da toplayıcı sisteme girememe, kanama, enfeksiyon gibi komplikasyonlar görülebilmektedir. Bu tipte URS vakalarında endoskopik girişimlerin sınırları göz önünde bulundurulmalı ve mutlaka anatomiyi ortaya koyan kontrastlı görüntüler alınmalıdır.
 
Maternal Ambivalence and Related Factors: The Case of Şanlıurfa: Research Article
No full textIntroduction: 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: Research Article
No full textIntroduction: 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
Social Pressures Against Breastfeeding Women During Breastfeeding: Breastfeeding Bullying: Research Article
No full textIntroduction: Studies on mothers' breastfeeding experiences report that they perceive pressure to breastfeed. Mothers who feel pressured to breastfeed may see themselves as bad parents and feel guilty, ashamed, and embarrassed when they do not breastfeed.
Objektive: In this study, we aimed to investigate the frequency and nature of social pressure towards breastfeeding from the immediate environment of breastfeeding women.
Method: The study is cross-sectional. The population of the study consisted of mothers with infants aged 0-24 months who were registered to Family Health Centers (FHC) in Haliliye district of Şanlıurfa province. Five FHCs were selected using simple random sampling method. After the pilot study, the sample size was calculated as 311. 'Questionnaire on social pressure towards breastfeeding' was used as a data collection tool.
Results: 66.9% of mothers were exposed to social pressure during breastfeeding. Women with higher education level, who were employed, and who had 2 or less children were exposed to more social pressure (p=0.01, p=0.01 and p=0.01, respectively). In the logistic regression model, high school education and above increases the social pressure experienced during breastfeeding by 5.8 times and the number of children with 2 or less children by 1.7 times. 47.27% of the participants stated that they were subjected to social pressure by their mother-in-law, 29.90% by their husbands, 17.04% by their neighbors and 17.04% by their friends.
Conclusion: It is common for women to experience social pressure to breastfeed during breastfeeding. The actors of this pressure experienced by women are mostly mothers-in-law and husbands. Identifying and raising awareness of the social pressures women experience towards breastfeeding can improve breastfeeding success and duration
Vancomycin-Induced Immune Thrombocytopenia in an Older Patient in the Intensive Care Unit: A Case Report: Letter to the Editor
No full textTo the Editor,
Thrombocytopenia is a frequent finding in patients treated in intensive care units, and determining its exact cause is essential for proper management. Among many possible etiologies, drug-related immune thrombocytopenia (DITP) is uncommon but clinically relevant. The disorder occurs when drug-dependent antibodies react with platelet surface glycoproteins, mainly GPIb/IX/V or GPIIb/IIIa, leading to immune-mediated destruction of platelets. Early recognition and discontinuation of the suspected medication are crucial to avoid potentially severe bleeding events (1-4).
Vancomycin is a glycopeptide antibiotic that inhibits bacterial cell wall synthesis and is used to treat gram-positive infections, particularly methicillin-resistant Staphylococcus aureus (5). In rare cases, vancomycin may trigger immune-mediated thrombocytopenia through a quinine-like mechanism. The drug can promote the formation of drug-dependent antibodies that bind to platelet glycoproteins such as GPIIb/IIIa, leading to immune destruction and platelet clearance (2, 6). In this letter, we describe a patient with septic shock who developed vancomycin-associated immune thrombocytopenia during intensive care treatment.
A 65-year-old woman with a history of ischemic cerebrovascular disease was admitted to the intensive care unit (ICU) due to fever and deterioration in her general condition. She was immobilized and had chronic comorbidities including diabetes mellitus, hypertension, and recent ischemic stroke. On admission, she fulfilled the criteria for septic shock secondary to a urinary tract infection, with an increase of more than two points in the Sequential Organ Failure Assessment (SOFA) score, hypotension requiring vasopressor support, and lactate levels exceeding 2 mmol/L. She was started on intravenous hydration, empiric broad-spectrum antibiotics (meropenem and vancomycin), vasopressors, and corticosteroids.
Initial laboratory tests revealed leukocytosis, elevated inflammatory markers (CRP and procalcitonin), increased urea and creatinine levels consistent with acute kidney injury, and a platelet count of 129×10³/µL. Coagulation tests (INR and aPTT) and liver enzymes were within normal limits, while lactate was elevated. The peripheral smear confirmed the platelet count (approximately 120×10³/µL) and ruled out platelet clumping. During follow-up, infection markers regressed, renal function normalized, and vasopressor requirements decreased. However, the platelet count continued to decline despite overall clinical improvement.
Over the next several days, the patient’s platelet values fell progressively, reaching below 20×10³/µL. A pooled platelet transfusion was administered, but the post-transfusion count did not show a meaningful increase. The patient’s clinical course and laboratory data suggested isolated thrombocytopenia without signs of disseminated intravascular coagulation (DIC), as fibrinogen, D-dimer, and coagulation parameters remained within normal limits. Serum lactate dehydrogenase (LDH) was 214 U/L (135–214 U/L), total and indirect bilirubin levels were 0.4 and 0.1 mg/dL respectively (reference: 0.1–1.2 mg/dL and 0–0.5 mg/dL), and no schistocytes were observed in the peripheral smear, excluding hemolysis. The absence of renal deterioration or microangiopathic findings ruled out thrombotic microangiopathies such as hemolytic uremic syndrome (HUS), atypical HUS, and thrombotic thrombocytopenic purpura.
Since meropenem was considered more likely to cause thrombocytopenia, it was discontinued after Staphylococcus hominis was isolated, while vancomycin therapy was continued. Despite infection resolution, the platelet count failed to recover, excluding sepsis-related thrombocytopenia. The temporal relationship between vancomycin exposure and platelet decline, along with the absence of other etiologies, strongly suggested vancomycin-induced immune thrombocytopenia. The patient had not received heparin or low-molecular-weight heparin, excluding heparin-induced thrombocytopenia.
Given the possibility of immune-mediated thrombocytopenia, corticosteroid therapy was intensified to prednisolone 1 mg/kg/day. Despite three days of treatment, there was no platelet recovery, and intravenous immunoglobulin (IVIG) was initiated at 1 g/kg/day for two consecutive days. Vancomycin therapy was discontinued concurrently. Following drug withdrawal and IVIG administration, the platelet count increased markedly, reaching normal levels within two weeks. As the platelet count normalized and infection markers stabilized, corticosteroid therapy was gradually tapered and discontinued. The patient was discharged from the ICU.
Vancomycin-associated thrombocytopenia is an uncommon but clinically important adverse reaction that has been reported only in a limited number of cases (7). Literature data emphasize the importance of recognizing the condition early, promptly discontinuing the causative drug, and initiating appropriate therapeutic interventions, including corticosteroids, IVIG, and platelet transfusions when active bleeding is suspected (1). In our case, corticosteroid treatment had already been started for septic shock, but platelet recovery occurred only after IVIG administration. This observation suggests that, in critically ill patients receiving corticosteroids for septic shock, IVIG can be prioritized as a first-line option for drug-induced immune thrombocytopenia, avoiding unnecessary escalation of steroid therapy and potential adverse effects.
Sincerely