Northern Clinics of Istanbul最新文献

Objective: Previous studies showed that vitamin B12 deficiency anemia causes a false increase in glycosylated hemoglobin (HbA1c) and that HbA1c decreases with B12 treatment. However, no study has been conducted on how much an increase in hemoglobin (Hgb) level causes a decrease in HbA1c level after treatment.

Methods: The study included 37 patients who were not diagnosed with diabetes, did not use anti-diabetic drugs, were pre-diabetic according to HbA1c level, and were diagnosed with vitamin B12 deficiency anemia in the patient group and 40 healthy volunteers of similar age and gender characteristics in the control group. The patient group was given 1 mg/day of cyanocobalamin (vitamin B12) orally for 3 months. Patients' Hgb, mean corpuscular volume, fasting plasma glucose, HbA1c, and vitamin B12 values were compared at the beginning and at the end of the 3^rd month.

Results: In the patient group, it was determined that 0.94 mg/dL increase in Hgb after vitamin B12 treatment caused a 0.24 decrease in HbA1c (%). The initial HbA1c of the patient group was 6.01±0.20 and the 3^rd-month HbA1c was 5.77±0.33; the initial and 3^rd-month Hgb values were 11.31±0.28 and 12.26±0.33, respectively; the initial and 3^rd-month vitamin B12 (ng/L) levels were 112.43±7.18 and 408.48±119.61, respectively; and there was a significant difference between the initial and 3^rd-month values (p<0.001, p<0.001, p<0.001, respectively). Moreover, 35% of the patients in the patient group had no diagnosis of prediabetes according to the HbA1c level at the end of the 3^rd month.

Conclusion: Elimination of vitamin B12 deficiency anemia before making a diagnosis or treatment decision according to HbA1c level will prevent patients from misdiagnosis of diabetes and unnecessary treatment changes in diabetic patients.

Objective: During the COVID-19 pandemic, health-care services for diseases other than COVID-19 were interrupted, and patient referrals to health institutions were postponed due to their fear of being infected with COVID-19. Under this situation, we conducted this study to evaluate the clinical and laboratory findings of COVID-19 in patients with Type 1 Diabetes Mellitus (T1DM) hospitalized in our pediatric intensive care unit (PICU) with the diagnosis of diabetic ketoacidosis (DKA) during the pandemic period, and the impact of the pandemic on these findings.

Methods: We retrospectively evaluated 55 children aged from 1 month to 18 years old, diagnosed with DKA, and followed up at Istanbul Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital PICU between April 2020 and December 2021.

Results: A total of 55 patients with DKA as a complication of T1DM were admitted to the PICU during the COVID-19 pandemic. While there was no significant difference in pH and HCO₃ values between those with newly diagnosed T1DM and those with previously-diagnosed T1DM, the HbA1c ratio of newly diagnosed DMs was significantly higher. Of the 55 patients, 4 were COVID-19 PCR positive, and two patients had COVID-19 antibody positivity. When COVID-19 positive patients were compared with negative patients, no significant difference was found between the hospital stay, glucose, HbA1c, lactate, pH, and HCO₃ values.

Conclusion: Higher HbA1c levels of newly diagnosed patients presenting with DKA may be associated with delayed admission to the health institutions due to COVID-19 and the length of insulin-free periods compared to pre-diagnosed patients with T1DM. In conclusion, our results, emphasize the importance of physician's and family's awareness of the symptoms of diabetes in terms of early diagnosis and prevention of DKA during public health measures due to COVID-19.

Objective: No studies of thyroid-related hormone levels have been conducted in patients with hypochondriasis to date. The aim of this study is to examine thyroid-related hormones in patients with hypochondriasis.

Methods: Sixty patients with hypochondriasis and 138 healthy controls were included in this study. Patients with hypochondriasis who applied to the psychiatry outpatient clinic and met the study criteria and healthy controls were determined by chart analysis.

Results: According to the results of the comparisons, TSH, fT3, and fT4 levels did not show a statistically significant difference between hypochondriasis patients and healthy controls.

Conclusion: Thyroid hormone levels are not associated with hypochondriasis.

Objective: The aim of our study is to determine the risk of coinfection with COVID-19 due to the high prevalence of viral agents in Istanbul in autumn (September, October, and November) and winter (December and January) and to investigate the effects of age, gender, season and clinical features on the development of coinfection with COVID-19.

Methods: In the routine studies of our hospital, COVID-19, reverse transcriptase polymerase chain reaction (RTA kit, Turkiye) and Multiplex PCR Bio-Fire (Bio Merieux Company, France) methods were studied from the nasopharyngeal swab sample and the data were recorded. A total of 400 people with a mean age (7.91±17.80) were included in the study by retrospective scanning.

Results: Considering the virus distribution, Respiratory syncytial virus (RSV), COVID-19, rhino/entero virus did not show a significant difference in autumn and winter, while H. metapneumovirus, adeno virus, influenza A significantly higher rates were observed in winter months. Parainfluenza (1, 2, 3, 4) and Corona OC43 were detected at a higher rate in autumn compared to other viruses. Double and triple coinfection rates with other viral agents were high for 2 years and younger.

Conclusion: The risk of coinfection of COVID-19 with influenza A, RSV, parainfluenza, and rhino/entero virus was found to be higher than other viral agents. Especially in winter, the risk of coinfection with influenza A and COVID-19 increases. In terms of treatment management, coinfection should be investigated in risky patients and influenza a vaccine should be offered to risky groups.

Objective: The purpose of this study was to evaluate the relationship of IL28B rs12979860 and rs8099917 polymorphisms with the clinical, histological, and virological outcomes of patients with chronic hepatitis B (CHB) also the treatment responses of patients who received Nucleos(t)ide analogs (NAs) therapy.

Methods: This study included 152 CHB patients who were underwent liver parenchymal biopsy. The IL28B rs12979860 and rs8099917 polymorphism were genotyped using the TaqMan assay.

Results: The IL28B rs12979860 CC and IL28B rs8099917 TT were identified as the genotypes with the highest frequency in all patients. On the other hand, IL28B rs12979860 TT and IL28B rs8099917 GG were the genotypes with the lowest frequency. The frequency of IL28B rs8099917 TG genotype was significantly different between patients with hepatitis B, who has histologically defined liver cirrhosis and no-fibrosis (p=0.02). In addition, a statistically significant correlation was found between the presence of IL28B rs8099917 G allele and virological unresponsiveness to NAs treatments in CHB patients (p=0.028).

Conclusion: The presence of the IL28B rs8099917 G allele in CHB patients might be associated with the risk of developing cirrhosis and virological unresponsiveness to NAs treatments.

Objective: This study aimed to compare the attention levels, of Turkish children and adolescents with Attention Deficit/ Hyperactivity Disorder (ADHD) in on-line education classes with healthy controls.

Methods: This study is a cross-sectional, internet-based, case-control study that recruited 6-18 years old patients diagnosed with ADHD and receving treatment and healthy controls from eight centers. The measurements used in the study were prepared in the google survey and delivered to the participants via Whatsapp application.

Results: Within the study period, 510 children with ADHD and 893 controls were enrolled. Parent- rated attention decreased significantly in both groups during on-line education classes due to COVID-19 outbreak (p<0.001; for each). Children and adolescents with ADHD had significantly elevated bedtime resistance, problems in family functioning difficulties than control children according to parental reports (p=0.003; p<0.001; p<0.001, respectively). Furthermore, bedtime resistance and comorbidity significantly predicted attention levels in on-line education.

Conclusion: Our findings may underline the need to augment student engagement in on-line education both for children without attention problems and those with ADHD. Interventions shown to be effective in the management of sleep difficulties in children as well as parent management interventions should continue during on-line education.

Objective: Abducens nerve paralysis is the most common ocular motor neuropathy. In this article, we aimed to compare the causes of isolated abducens nerve palsy in terms of demographic, clinical features, and prognosis.

Methods: Thirty-six isolated abducens nerve palsy patients were prospectively enrolled in the study. The demographic, clinical features, and prognosis compared in two etiological groups as microvascular and other causes.

Results: The most common etiology was microvascular, which was seen in 16/36 (44.4%) patients. Mean clinical recovery time was 2.5±1.3 months (range, 10 days-6 months). When etiological groups were compared as microvascular and other causes, the mean age of the microvascular group was significantly higher (62.8±13.3 vs. 44.5±16.4, p=0.001). Diabetes mellitus was seen significantly higher in the microvascular group than other causes group (p=0.001), but no significant difference was observed in terms of other atherosclerotic risk factors (p>0.05). The fasting blood glucose and hemoglobin A1c value were significantly higher in the microvascular group (p=0.02 and p=0.02, respectively). There was no significant difference in terms of clinical improvement and clinical recovery times between groups (p>0.05).

Conclusion: There is no difference between microvascular group and other causes in terms of clinical outcome, while the mean age and presence of diabetes were higher in the microvascular group. The presence of diabetes should be questioned in cases with isolated abducens nerve palsy.

Objective: Errors in the laboratory process often occur in the preanalytical phase (PA). The study aims to calculate the direct cost elements of PA errors, including material, logistics, transfer, personnel workforce, and medical waste.

Methods: Medical laboratory PA phase errors were retrospectively reviewed using the Laboratory Information Management System. We evaluated the whole 2019 laboratory data of the 836-bed Health Sciences University Umraniye Training and Research Hospital (UTRH). We assessed the direct cost elements of PA errors, such as those related to material, logistics, transfer, human resources, and waste. We performed the procedure for both samples analyzed in the hospital and transferred to the central laboratory.

Results: We analyzed 1,939,650 patient samples and 46,534,532 parameters studied in 2019 for UTRH. The rates for rejected tests and rejected samples (tube) for UTRH were noted as 0.32% and 1.7%, respectively. The total direct cost for PA errors was TRY 438,284.51 (68,918.07 euros) for 32,783 patient samples and 147,893 tests. We calculated the total cost for PA test errors detected in the hospital as TRY 390,238.06, while the total cost for PA test errors detected in the central laboratory was TRY 48,046.45. 89% of the total cost was for PA errors detected in the hospital, and 11% was for the errors detected in the central laboratory. The 2019 direct PA error cost we calculated based on our hospital's data was 0.153% of the 2019 hospital operating cost. We calculated the direct cost per rejected sample as TRY 13.37 (2.1 Euro).

Conclusion: Providing reliable laboratory service with the least possible financial loss is one of the main goals in terms of laboratory medicine. In achieving this goal, the prevention of error costs is a priority. The direct cost elements for the PA phase, where laboratory errors are concentrated, can be easily identified. The amount of PA phase error direct cost will attract the attention of health policy decision-makers and field professionals and inspire further research. Therefore, we tried to determine a threshold cost regarding interventions and practices required to prevent PA phase errors.

Magnetic resonance imaging (MRI) is a technique useful for the diagnosis of cartilage damage due to high sensitivity to identify subchondral bone abnormalities and full-thickness cartilage lesions. The lack of a study on knee cartilage changes over time in patients with osteoarthritis (OA) by MRI technique led us to investigate the accuracy of MRI in identifying knee cartilage changes over time in patients with OA in a systematic review. In the present systematic review, started from the beginning of 2020 in one of the University Hospitals in Iran, the databases of CINAHL, Ovid, Elsevier, Scopus, PubMed, Science Direct, and Web of Science were searched using the keywords MRI, OA, Cartilage Lesion, Imaging Techniques. A total of 169 articles were retrieved in the initial search, and after reviewing the titles, abstracts, and full-texts, finally, seven were enrolled in the systematic review. Review of the selected papers showed that a total of 1091 subjects were studied, of which 355 were males. The results of all the studies, except one, indicated the high accuracy of MRI to identify knee cartilage changes over time. MRI technique can show cartilage changes with high accuracy in patients with knee OA over time. We proved the potential of MRI to identify articular cartilage injuries in patients with OA and its importance to the evaluation of articular cartilage lesions along with other available techniques.

Objective: Intratracheal (IT) and intravenous (IV) lignocaine suppress airway reflex and hemodynamic response during extubation, but studies regarding this are sparse. The primary aim was to compare the effect of IT and IV lignocaine on attenuation of airway reflex to endotracheal extubation and the secondary aim was to compare the hemodynamic responses to extubation, using lignocaine by the two different routes.

Methods: Seventy-five female patients with comparable age, body mass index, and American Society of Anesthesiologists Physical Status undergoing carcinoma breast surgery were randomized into three groups. Group A received 2% lignocaine 3 mg/kg intratracheally 5 min and Group B received 2% lignocaine 1.5 mg/kg intravenously 3 min before extubation. Group C was control group. The airway and hemodynamic responses were noted in terms of episodes of cough during emergence and extubation. Categorical variables assessed using Fisher's exact test and continuous variables assessed using one-way analysis of variance.

Results: Cough suppression was present in Groups A and B, with better results observed with IT than with IV lignocaine. In the control group, Grade III cough reflex was present predominantly. There was a statistically significant difference (p<0.001) in blood pressure and heart rate between Group A versus Group C and in Group B versus Group C, but not between Group A and Group B.

Conclusion: IT lignocaine administered before extubation significantly attenuates post-extubation cough reflex than IV lignocaine. Both IT and IV lignocaine can effectively attenuate the airway and hemodynamic response to extubation.