Northern Clinics of Istanbul最新文献

Insulin autoimmune syndrome (IAS) is a serious autoimmune disorder that may cause spontaneous hypoglycemia. IAS is characterized by hyperinsulinemia, normal C-peptide levels and positive anti-insulin antibody. The diagnosis is confirmed by demonstrating the presence of macroinsulin complex by polyethylene glycol (PEG) precipitation or gel filtration chromatography. Although some macrohormones like macroprolactin and some macroenzymes such as macroamylase are seen commonly, macroinsulinemia is a rare condition. In this report, we presented an IAS case from laboratory perspective by using three different immunoassays with different performances in eliminating macroinsulin interference. Besides presenting a case with IAS without hypoglycemia we evaluated the contribution of different immunoassays to the diagnosis of this syndrome. Immunoassays have different features, considering the analysis of macroinsulin or bioavailable insulin. In this case, the superiority or handicap of these immunoassays will be discussed in terms of analysis of total or free insulin.

Xanthogranulomatous inflammation is a rare chronic inflammatory reaction. Appendiceal involvement in the pediatric age group is extremely rare. We present a case of xanthogranulomatous appendicitis (XGA) that was detected incidentally during the excision of a residual intraabdominal mass in an 8-year-old male patient who was treated for Burkitt lymphoma. An 8-year-old male patient who had been diagnosed with Burkitt lymphoma underwent abdominal computerized tomography for evaluation after chemotherapy. An approximately 2.5 cm mass in the right lower quadrant of the abdomen was detected, and laparoscopic excision of the mass was planned. During the operation, it was noticed that the appendix (adjacent to the mass) was golden yellow in color and abnormal in appearance, so a synchronous appendectomy was performed. The pathology result of the mass was compatible with Burkitt lymphoma. Microscopic examination of the appendix revealed that the columnar surface epithelium had eroded and been replaced by fibrin and cell debris. Inflammatory cell infiltration rich in foamy histiocytes as well as lymphocytes and sparse neutrophils that form destructive aggregates was observed in all appendiceal layers. The final diagnosis of the appendectomy specimen was compatible with XGA. In very few XGA cases, the appendix is described as bright yellow or golden yellow. The diagnosis is usually made by the pathological examination after surgery. Though the diagnosis was made postoperatively in our case, there is now, for the first time in the literature, a view of the golden yellow color of XGA taken from an intraoperative video clip.

Objective: The aim of this study was to explore the relationship between insight level and clinical and familial psychiatric features of children with obsessive-compulsive disorder (OCD).

Methods: Children's Yale-Brown Obsessive-Compulsive Scale-Symptom Checklist, 11^th item of the Children's Yale-Brown Obsessive-Compulsive Scale, Wechsler Intelligence Scale for Children Revised Form, Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version 1.0, and Structured Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders-IV Axis I Disorders were applied to 92 pediatric OCD patients.

Results: In this study, the prevalence of OCD in the first children of the family was high (41.3%), and low insight was significantly related with concomitant intellectual disability (p=0.003). The level of insight was high in patients with comorbid OCD spectrum disorders (p<0.001). Attention deficit and hyperactivity disorder (ADHD) was the most common psychiatric diagnosis accompanying OCD (19.5%). Among the obsession-compulsion subscales, the symmetry/hoarding was higher in males (p=0.046). OCD patients with a family history of major depressive disorder (MDD) had high ADHD comorbidity rates (p=0.038). In OCD patients, whose family had psychiatric disorders besides MDD and anxiety disorders, the diagnosis rate of intellectual disability was higher than other diagnoses (p<0.001).

Conclusion: The sociodemographic, clinical, and familial features of pediatric OCD patients cannot be adequately clarified if the patient has limited insight. Therefore, the insight of children with OCD should be considered a range or continuity.

Cryptococcal endocarditis is an exceedingly rare entity associated with high mortality and morbidity. Hereby, we present a 37-year-old patient with underlying systemic lupus erythematosus and end-stage renal disease who was diagnosed with cryptococcal endocarditis involving native mitral valve. Her blood culture grew Cryptococcus neoformans. Echocardiography confirmed presence of vegetations and patient underwent mitral valve replacement and received appropriate anti-fungal treatment. Her course was further complicated by sternal wound dehiscence and infection of hemodialysis site as well as atrial flutter. Unfortunately, patient passed 2 weeks after discharge from hospital. C. neoformans is typically known to cause serious central nervous system. However, this pathogen can rarely cause serious infective endocarditis case particularly in immune compromised patients or those with prosthetic valves. Fungal endocarditis is usually treated with a combination of surgery and anti-fungal medications.

Objective: Some anti-cytokine treatments are being used to control the hyperinflammatory condition defined as cytokine storm that develops during COVID-19 infection. In this study, we aim to investigate the effects of anakinra, an IL-1 antagonist, on the clinical status and laboratory values of hospitalized patients with the COVID-19 infection. The aim of the study was to investigate the effects of anakinra, an IL-1 antagonist, on the clinical and laboratory results of hospitalized patients with COVID-19 infection.

Methods: This study was planned as a retrospective study. The age, gender, and current comorbidities of a total of 66 patients who were treated with anakinra for COVID-19 infection from November 2020 to January 2021 were analyzed. The amount of oxygen demand (L/s), the type of oxygen supplementation, oxygen saturation, radiological findings, WBC count, lymphocyte count, neutrophil count, C-reactive protein, LDH, ferritin, fibrinogen, D-dimer levels were monitored before the treatment, and after the anakinra treatment, newly gathered results were compared. Patients' hospitalization period, oxygen need, and their clinical status at discharge were evaluated. The effects of early anakinra treatment (9 days before and after the onset of symptoms) on the prognosis were evaluated. SPSS version 21.0 provided by IBM Company in the USA, Chicago, IL was used for statistical analysis and p<0.05 was considered significant.

Results: Sixty-six patients were included in the study. There was no significant gender difference in the prognosis of the patients. There was a significant difference in the statistical deterioration in patients with comorbidities (p=0.004). Patients who started the anakinra treatment at an early stage developed less need for intensive care and low mortality ratios (p=0.019). There were significant improvements on the levels of WBC (p=0.045), neutrophils (p=0.016), lymphocyte (p=0.001), LDH (p=0.005), ferritin (p=0.02), and fibrinogen (p=0.01) after the administration of anakinra therapy.

Conclusion: We found that earlier and appropriate use of anakinra therapy in COVID-19 patients with the signs of macrophage activation syndrome reduces the need for oxygen support in patients and contributes to improvement in laboratory results and radiological findings, and most importantly reduces the need for intensive care.

Objective: Rheumatic diseases in children are chronic and multisystemic diseases. In this study, it was aimed to evaluate gastrointestinal endoscopic findings in children diagnosed as autoimmune or autoinflammatory rheumatic diseases consulted with pediatric gastroenterology for gastrointestinal complaints.

Methods: The patients followed up by the Pediatric Rheumatology Department and consulted to the Pediatric Gastroenterology Department due to gastrointestinal complaints were included in the study. File records of the patients were analyzed retrospectively.

Results: A total of 28 patients were included in the study. Twelve of the patients had autoimmune disease (Juvenile idiopathic arthritis [JIA], systemic lupus erythematosus, Sjögren's syndrome, and scleroderma) and the other 16 had autoinflammatory disease (familial Mediterrnean fever, hyper Immunoglobulin D syndrome, undifferantiated systemic autoinflammatory disease, and systemic JIA). Four of the patients with familial Mediterrnean fever also diagnosed as JIA. The mean age of the patients was 11.7±3.5 years. The main gastrointestinal complaints of patients with both autoimmune and autoinflammatory diseases were abdominal pain and diarrhea. Inflammatory bowel disease was found in 33% of those with autoimmune disease and 56% of those with autoinflammatory disease in patients underwent endoscopic evaluation. M694V mutation was present in 62% of the patients with autoinflammatory disease presented with gastrointestinal complaints.

Conclusion: Both autoimmune and autoinflammatory rheumatic diseases can cause gastrointestinal complaints and should be referred to a pediatric gastroenterologist for early diagnosis.

Objective: The aim of this study was to determine normative reference values for major thoracic arterial vasculature in Turkiye and to evaluate differences according to age and gender.

Methods: Low-dose unenhanced chest computerized tomography images acquired with pre-diagnosis of COVID-19 between March and June 2020 were evaluated retrospectively. Patients with known chronic lung parenchymal disease, pleural effusion, pneumothorax, chronic diseases such as diabetes, hypertension, obesity, and chronic heart diseases (coronary artery disease, atherosclerosis, congestive heart failure, valve replacement, and arrhythmia) were excluded from the study. The ascending aorta diameter (AAD), descending aorta diameter (DAD), aortic arch diameter (ARCAD), main pulmonary artery diameter (MPAD), right pulmonary artery diameter (RPAD), and the left pulmonary artery diameter (LPAD) were measured in the same sections by standardized methods. The variability of parameters according to age (<40 years; ≥40 years) and gender (male to female) was evaluated by statistical methods. The Student's t test was used to compare the normal distribution according to the given quantitative age and gender, while the data that did not fit the normal distribution were compared with the Mann-Whitney U test. The conformity of the data to the normal distribution was tested with the Kolmogorov-Smirnov, Shapiro-Wilk test, and graphical examinations.

Results: Totally 777 cases between the ages of 18-96 (43.80±15.98) were included in the study. Among these, 52.8% (n=410) were male and 47.2% (n=367) were female. Mean diameters were 28.52±5.13 mm (12-48 mm in range) for AAD, 30.83±5.25 mm (12-52 mm in range) for ARCAD, DAD 21.27±3.57 mm (11-38 mm in range) for DAD; 23.27±4.03 mm (14-40 mm in range) for MPAD, 17.27±3.19 mm (10-30 mm in range) for RPAD, and 17.62±3.06 mm (10-37 mm in range) for LPAD. Statistically significantly higher values were obtained in all diameters for cases over 40 years of age. Similarly, higher values were obtained in all diameters for males compared to females.

Conclusion: The diameters of all thoracic main vascular structures are larger in men than in women and increase with age.

Objective: The aim of the study was to investigate the relationship between peripartum depression and social support, marital satisfaction, and self-differentiation.

Methods: This cross-sectional study was conducted on postpartum women from December 28, 2021, and March 31, 2022. Postpartum women were evaluated using a questionnaire consisting of sections assessing sociodemographic characteristics, obstetric history, and psychometric instruments: Edinburgh Postpartum Depression Scale (EPDS), Marital Disaffection Scale (MDS), Multidimensional Scale of Perceived Social Support (MSPSS), and Differentiation of Self Inventory (DSI).

Results: A total of 425 mothers were included in the study. Of those, 140 (32.9%) mothers scored ≥13 points on EPDS, and 285 (67.1%) mothers scored ≤12 points. Mothers who scored ≥13 on the EPDS were found to have significantly higher scores for marital dissatisfaction. Total scores of family support, friend support, emotional cutoff, fusion with others, and differentiation of self were higher in mothers who scored ≤12 points on the EPDS. There was no significant difference between the two groups in terms of significance with others, emotional reactivity and I position.

Conclusion: This study found that marital satisfaction is important in the development of perinatal depression both directly and through family support and emotional cuttoff. In addition, mothers with family support, friend support, and self-differentiation had comparatively lower EPDS scores, while mothers with marital dissatisfaction had higher EPDS scores.

Objective: The main purpose of treatment and management in chronic mental disorders is to improve the quality of life (QOL). Hopelessness indicates a significant cognitive vulnerability that is associated with suicide risk. It is important for clinicians to have information about their patients' life satisfaction and spirituality. This study was conducted to determine hopelessness and life satisfaction in patients who received service from a community mental health center (CMHC).

Methods: This cross-sectional study was conducted with patients diagnosed with psychosis (n=66) and bipolar disorder (n=24) according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria, at a community mental health center serving in a hospital located in eastern Turkiye. Data was collected by a psychiatrist between January and May 2019 with face-to-face interviews, using a questionnaire, Beck Hopelessness Scale (BHS) and Satisfaction with Life Scale (SWLS).

Results: In the study, it was found that the mean BHS and SWLS scores of the patients did not differ significantly between the diagnosis groups (p>0.05). A moderately negative correlation was found between the patients' mean BHS and SWLS scores (rs=-0.450, p<0.001). In addition, it was determined that the hopelessness level of the secondary school graduates was low (p<0.05), the mean BHS score increased as the age and time from diagnosis of the patients increased (p<0.001), and there was a low negative correlation between the time from diagnosis and the mean SWLS score (rs: -0.208; p<0.05).

Conclusion: In this study, it was found that the hopelessness level of the patients was low, their life satisfaction was moderate, and as the hopelessness level increased, their life satisfaction decreased. In addition, it was determined that the hopelessness and life satisfaction levels of the patients did not differ by to the diagnosis groups. It is extremely important for mental health professionals to consider aspects such as hope and life satisfaction, which are key in the recovery of patients.

Objective: Strabismus, defined as the misalignment of the eyes, is a common disorder that is usually diagnosed in childhood. Strabismus is an important health problem with both functional and psychosocial effects on children. In this study, we aimed to determine the clinical features and risk factors of patients diagnosed with strabismus and followed up in our clinic.

Methods: The data of pediatric patients who were followed up in our strabismus clinic between February 2016 and September 2022 were retrospectively reviewed. The patients' detailed ophthalmological and strabismus examination findings and anamnesis findings concerning the etiology of strabismus were recorded.

Results: A total of 391 patients were enrolled in the study. The mean age of the patients was 8.66±4.7 years. Of the patients, 207 (52.9%) had esotropia, 172 (43.99%) had exotropia, and 12 (3.07%) had vertical deviation, with the mean ages of these groups being calculated as (7.27±4.1), (10.45±4.8), and (7.16±4.7) years, respectively. Amblyopia was present in 54 (26.09%) of the 207 esotropia cases, 27 (15.70%) of the 172 exotropia cases. Esotropia is more likely than exotropia to be related to amblyopia, according to our research. Of all the patients, 97 (24.81%) had a family history of strabismus, 38 (9.7%) had a history of preterm birth, 39 (10.0%) had a history of neonatal care unit stay, 38 (9.7%) had epilepsy, 4 (1%) had a history of trauma, and 14 (3.6%) had an additional eye disease.

Conclusion: Detection of risk factors such as family history, preterm birth, length of stay in the neonatal care unit and epilepsy that may be associated with strabismus can help identify high-risk children for early diagnosis and treatment.