Predictive Power of Self-Efficacy on the Fear of Childbirth in Pregnant Women: Underlying Mechanisms of Social Support as a Mediator and the COVID-19 Fear as a Moderator.

BACKGROUND: Fear of childbirth (FOC) is a common problem associated with psycho-social factors in pregnant women. OBJECTIVES: This study aimed to determine the mediator of social support and the moderator role of fear of coronavirus disease 2019 (COVID-19) in the relationship between self-efficacy and FOC in pregnant women. MATERIALS AND METHODS: This descriptive and cross-sectional study was conducted with 422 pregnant women registered in 18 family health centers. Data were collected with the introductory information form, the Wijma Delivery Expectancy/Experience Questionnaire-A, the Childbirth Self-Efficacy Inventory, the Multidimensional Scale of Perceived Social Support, and the Fear of COVID19 Scale. The SPSS 22 package program and Hayes's process macro 3.2 were used in the analysis of the data. RESULTS: Findings showed that 19.9% of the pregnant women experienced severe FOC. Self-efficacy and social support negatively predicted FOC, while fear of COVID-19 predicted it positively. Perceived social support moderately mediated the relationship between FOC and self-efficacy. Fear of COVID-19 was found to be a marginally effective moderator in the relationship between self-efficacy and FOC. This indicates that as self-efficacy increases in pregnant women with low fear of COVID-19, the FOC is experienced less. CONCLUSION: In the relationship between self-efficacy and FOC, social support is a key factor in reducing FOC. To reduce the FOC, the social support of pregnant women should be strengthened, and the fear associated with acute crisis periods such as pandemics should be reduced with some preventive measures.

Troponin-T value as a prognostic marker in neonates diagnosed with neonatal encephalopathy and receiving hypothermia treatment.

OBJECTIVE: The aim of this study was to investigate the effect of Troponin-T levels on the prognosis of neonatal encephalopathy (NE). PATIENTS AND METHODS: The study included one hundred and eleven newborns diagnosed with NE and receiving hypothermia treatment. The cases were separated into 2 groups according to the SARNAT classification as Stage 2 or Stage 3. The groups were compared in respect of anthropometric characteristics, APGAR scores, and biochemical parameters. The cases were also separated into 3 groups according to the Troponin-T levels and were compared with respect to the clinical course. RESULTS: The serum Troponin-T (p=0.012), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (p<0.0001), and lactate levels (p=0.04) in the Sarnat Stage 3 group were statistically significantly higher than in the Sarnat stage 2 group. A significant positive correlation was determined between the Troponin-T level and the total duration of respiratory support (r=0.20, p=0.03). A significant positive correlation was determined between the ALT/AST ratio and the length of stay in hospital (r=0.29, p=0.001), duration of intubation (r=0.32, p=0.01), and total duration of respiratory support (r=0.36, p<0.001). A statistically significant difference was determined in mortality rates between the 3 subgroups of Troponin-T levels; Group 1: 2.8%, Group 2:5.4%, and Group 3: 15.8%. (p=0.04, χ²=4.74). A cut-off value of 164 ng/L for Troponin-T was determined to predict mortality with 77% sensitivity and 67% specificity (AUC=0.73, p=0.023). When the groups were compared according to Troponin-T level, a statistically significant difference was determined in respect of length of stay in hospital (p=0.03, χ²=6.95) and total duration of oxygen support (p=0.01, χ²=9.12). CONCLUSIONS: The serum Troponin-T level can be evaluated as a prognostic marker in cases followed up with a diagnosis of NE and receiving hypothermia treatment. There is a need for further prospective studies with larger samples on this subject.

Factors predicting iliac metastasis and overall survival in malignant melanoma of the lower extremities.

BACKGROUND: To analyse the patient-related, disease-related and treatment-related factors in a group of melanoma patients to assess their impact on iliac metastasis and on overall survival. METHODS: Medical records of thirty-nine patients with lower extremity malignant melanoma were retrospectively reviewed to confirm all of the clinical data. Age and gender were recorded as patient-related factors. Tumor location, size, histology, ulceration status, and TNM stage, Breslow thickness, Clark level, presence of inguinal LN metastases, and locoregional metastases (local recurrences, in transit metastases and regional LN metastases) were evaluated as disease-related factors. Type of surgery (en block excision of primary tumor, en block excision of primary tumor and inguinal lymph node dissection, en block excision of primary tumor and ilioinguinal lymph node dissection) and postoperative chemotherapy were taken into account as treatment-related factors. RESULTS: The presence of inguinal lymph node metastases was significantly associated with iliac metastasis (p = 0.015). Tumor size (p = 0.046), tumor TNM stage (p = 0.009), Breslow thickness (p = 0.033), Clark level (p = 0.029), presence of in transit metastases (p = 0.010) and postoperative chemotherapy (p = 0.002) has been related to impaired overall survival rate. CONCLUSIONS: Therapeutic lymph node dissection appears to carry a small but definite therapeutic benefit. Selection of appropriate patients for the more extensive procedure would be ideal, but at present there are no well proven selection criteria. The authors advocate therapeutic dissection when the inguinal lymph nodes are involved.

The assessment of urinary function following extended lymph node dissection for colorectal cancer.

AIMS: The aim of the current study is to demonstrate whether the effects of extended systematic lymph-node dissection (ESLND) on urinary dysfunctions differ from those of curative radical surgery (CRS) only for rectal cancer. METHODS: We present data about our patients who underwent rectal resection for rectal cancer over 5 years. One hundred and seventy patients with rectal cancer were reviewed with respect to surgical procedures and post-operative urinary problems. RESULTS: We performed CRS on 146 patients and CRS+ESLND on 24 patients, and analysed the incidence of post-operative urinary dysfunction in both groups. Urinary incontinence rates were 39 and 58%, urinary retention rates were 4 and 16%, for the patients from CRS group and CRS+ESLND group, respectively. CONCLUSIONS: We conclude that the addition of ESLND to CRS does not increase the frequency of post-operative urinary dysfunction, apart from an increased risk of urinary retention.

Surgical treatment of advanced alveolar hydatid disease of the liver: a report of five cases.

We report herein the cases of five patients with alveolar hydatid disease (AHD) of the liver who were diagnosed and underwent surgery at the Department of Surgery of Ankara University between 1989 and 1994. In all five patients, the final diagnosis was established by frozen section of the lesion during laparotomy. Lesions of AHD were found only in the liver. Hepatic resections including right lobectomy and segmentectomy were performed in three patients while palliative procedures were carried out in the remaining two patients with unresectable disease. There was no operative mortality, and only one late death occurred 3 years after the hepatic resection. In this paper, we present the clinical and operative findings of these five patients and their outcomes, followed by a review of the surgical treatment of AHD.

Value of high-resolution intraoperative ultrasonography in the determination of limits of horizontal tumor spread during surgery for gastric malignancy.

Determination of the resection margins during surgery for gastric malignancy is a subject of controversy because accurate detection of horizontal limits of tumor spread is difficult by current methods. In this study, we investigated the value of intraoperative-ultrasonography (IUS) in the detection of proximal and distal limits of horizontal tumor spread (HTS) in 19 gastric adenocarcinoma (Group I) and five gastric lymphoma (Group II) patients. After sonographic and clinical limits of HTS were marked, resections were carried out 2 cm away from the IUS limits, and biopsies from IUS limits and resection margins were obtained. Then, the gap between IUS and clinical limits were recorded and compared with results of pathology. In both groups, the distance from clinical to IUS limits ranged from 0 cm to 3 cm and IUS limits were never inside the clinical limits. In Group I, results of sonographic proximal limit detection were satisfactory in all patients excluding recurrent cases (n:2) and a patient with early gastric cancer. Sonographic accuracy of distal limit detection was 68%. In Group I, only one resection margin (distal) was found to be infiltrated with cancer. In Group II, the success rate of IUS-guided HTS detection was 40%. IUS seems to be a valuable method for determining the extent of HTS during operation for gastric adenocarcinomas, especially so for the most problematic proximal limits. In recurrent cancers and lymphomas, however, results of IUS may be frequently misleading. IUS can be advocated as a routine procedure to determine the tumor limits and thus the resection margins during surgery for primary gastric adenocarcinomas.