Northern Clinics of Istanbul最新文献

Objective: Coronavirus disease-19 (COVID-19) is a multisystemic disease that can cause severe illness and mortality by exacerbating symptoms such as thrombosis, fibrinolysis, and inflammation. Plasminogen activator inhibitor-1 (PAI-1) plays an important role in regulating fibrinolysis and may cause thrombotic events to develop. The goal of this study is to examine the relationship between PAI-1 levels and disease severity and mortality in relation to COVID-19.

Methods: A total of 71 hospitalized patients were diagnosed with COVID-19 using real time-polymerase chain reaction tests. Each patient underwent chest computerized tomography (CT). Data from an additional 20 volunteers without COVID-19 were included in this single-center study. Each patient's PAI-1 data were collected at admission, and the CT severity score (CT-SS) was then calculated for each patient.

Results: The patients were categorized into the control group (n=20), the survivor group (n=47), and the non-survivor group (n=24). In the non-survivor group, the mean age was 75.3±13.8, which is higher than in the survivor group (61.7±16.9) and in the control group (59.5±11.2), (p=0.001). When the PAI-1 levels were compared between each group, the non-survivor group showed the highest levels, followed by the survivor group and then the control group (p<0.001). Logistic regression analysis revealed that age, PAI-1, and disease severity independently predicted COVID-19 mortality rates. In this study, it was observed that PAI-1 levels with >10.2 ng/mL had 83% sensitivity and an 83% specificity rate when used to predict mortality after COVID-19. Then, patients were divided into severe (n=33) and non-severe (n=38) groups according to disease severity levels. The PAI-1 levels found were higher in the severe group (p<0.001) than in the non-severe group. In the regression analysis that followed, high sensitive troponin I and PAI-1 were found to indicate disease severity levels. The CT-SS was estimated as significantly higher in the non-survivor group compared to the survivor group (p<0.001). When comparing CT-SS between the severe group and the non-severe group, this was significantly higher in the severe group (p<0.001). In addition, a strong statistically significant positive correlation was found between CT-SS and PAI-1 levels (r: 0.838, p<0.001).

Conclusion: Anticipating poor clinical outcomes in relation to COVID-19 is crucial. This study showed that PAI-1 levels could independently predict disease severity and mortality rates for patients with COVID-19.

Objective: The Fourth National Audit Project revealed that severe airway complications occur in the frequency of 1/22,000. Various rescue techniques were recommended in difficult airway guidelines. This study aims to evaluate the rescue techniques following failed direct laryngoscopy and analyze the success rates and potential complications during difficult airway management.

Methods: This was a multicenter and prospective observational study carried out in four referral centers. Four academic university hospitals using fiberoptic bronchoscopy and videolaryngoscopy in their daily practice were included in the study. Patients undergoing general anesthesia with anticipated or unanticipated difficult intubation were enrolled. The preferred rescue technique and the attempts for both direct and indirect laryngoscopies were recorded.

Results: At the mean age of 46.58±21.19 years, 92 patients were analyzed. The most common rescue technique was videolaryngoscopy following failed direct laryngoscopy. Glidescope was the most preferred videolaryngoscope. Anesthesia residents performed most of the first tracheal intubation attempts, whereas anesthesia specialists performed the second attempts at all centers. The experience of the first performer as a resident was significantly higher in the anticipated difficult airway group (4.0±5.5 years) (p=0.045). The number of attempts with the first rescue technique was 2.0±2.0 and 1.0±1.0 in the unanticipated difficult airway and anticipated difficult airway groups, respectively (p=0.004).

Conclusion: Videolaryngoscopy was a more commonly preferred technique for both anticipated and unanticipated difficult intubations. Glidescope was the most used rescue device in difficult intubations after failed direct laryngoscopy, with a high success rate.

Objective: The aim of present study is to compare ventricular and supraventricular arrhythmia incidences in subjects with and without mitral valve prolapse (MVP) syndrome and to examine if an association exists between ventricular arrhythmias and repolarization parameters in patients with MVP syndrome.

Methods: This cross-sectional study involved 41 subjects with MVP Syndrome and 41 subjects with palpitation but without MVP (control group). All subjects were subjected to lead-electrocardiogram, transthoracic echocardiography, and 24-h Holter monitoring to identify repolarization abnormalities, structural abnormalities, and supraventricular and ventricular arrhythmias. The QRS width, QTC interval, and Tpeak-Tend intervals were measured for each participant.

Results: The number of subjects who had premature ventricular contractions (PVCs), couplets, and non-sustained ventricular tachycardia (NSVTs) was significantly higher in the MVP group compared to the control group. Left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) and left atrial diameter were also significantly higher in the MVP group than the control group. QRS width and Tpeak-Tend interval were also significantly higher in subjects with MVP than the controls. Correlation analysis showed a positive correlation between the severity of mitral regurgitation (MR) and the number of PVCs and couplets, while there was a significant correlation between left atrium (LA) diameter and the number of the PVCs and NSVTs.

Conclusion: Subjects with MVP experience ventricular arrhythmias more often including PVCs, couplets, and NSVTs compared to subjects without MVP. LVESD, LVEDD, LA diameter, QRS width, and Tpeak-Tend interval were increased in MVP subjects than those without MVP. There is an association between the severity of the MR and the frequency of the PVCs, couplets, or NSVTs.

Objective: Hashimoto's thyroiditis (HT) was described many years ago, but the etiopathogenesis remains unclear. Mannose-binding lectin (MBL) initiates complement activation in the lectin pathway. We determined MBL levels in children with HT and the associations thereof with thyroid hormone and thyroid autoantibody levels.

Methods: Thirty-nine patients with HT and 41 controls were enrolled from the pediatric outpatient clinics. Subjects were grouped according to their thyroid functions: Euthyroid, marked hypothyroidism and clinical/subclinical hyperthyroidism. MBL levels were compared among these groups. Serum MBL levels of the subjects were determined using MBL Human ELISA kit.

Results: Serum MBL levels were studied in serum samples from the 80 subjects (48 (60.0%) females). MBL levels in HT and control groups were 50.787±34.718 and 50.593±44.28 ng/ml (p=0,983), respectively. In HT group, there was no significant difference in MBL levels between thyroid function groups (p=0.869). In addition, gender was not detected as a factor for serum MBL levels. Also we found negative correlation between WBC and serum MBL levels (r=-0.532; p=0.050). Otherwise there was no correlation between TSH, anti-TPO and anti-TG with serum MBL levels.

Conclusion: MBL levels did not decrease in HT patients. Further research is needed to elucidate more fully any role for MBL in the development of autoimmune thyroid disease.

Objective: Pilonidal sinus disease (PSD) is a common disorder in the sacrococcygeal region and has a lower incidence in female as compared with male patients. The aim of this study is to evaluate clinical, hematological, biochemical, and hormonal parameters in women with PSD, and to determine whether the disease plays a major role in abnormalities of clinical and laboratory findings. This study also brings to the forefront the issue of the association between PSD and polycystic ovary syndrome (PCOS).

Methods: The prospective single-center study included women with PSD, and an equal number of healthy women enrolled in the control group (50 women in each arm of the study). Medical history was taken from every patient, and blood tests were performed on all participants. Ultrasound imaging was performed to evaluate the ovaries.

Results: Both groups were matched for age (p=0.124). The prevalence of obesity and dyslipidemia was significantly higher in women with PSD compared to controls (p=0.046, p=0.008, respectively). The right ovary volume was significantly higher in the study group than the control group (p=0.028). The study group had also significantly higher mean levels of neutrophil, C-peptide, and thyroid stimulating hormone (p=0.047, p=0.031, and p=0.048, respectively). The prevalence of PCOS was higher in patients with PSD, but the difference failed to reach statistical significance (32 vs. 22%, p=0.26).

Conclusion: Based on the findings of our study, some clinical and blood parameters differed significantly between women with and without PSD. Although the present study revealed that the prevalence of PCOS was not significantly different in women with or without PSD, more comprehensive and prospective studies are required.

Objective: In this study, we aimed to determine the continuing pain during the post-COVID-19 period the frequency of neuropathic pain in these patients, and the factors affecting the frequency.

Methods: A total of 209 participants were included in the study who had COVID-19 disease (PCR-positive) aged 18-75 years. The demographic characteristics and COVID-19 severity data were recorded by questioning the patients. The musculoskeletal pain was also assessed using Visual Analog Scale (VAS) and the extended Nordic musculoskeletal system questionnaire (NMQ-E). In addition, the neuropathic components of pain were evaluated using the Leeds Assessment of neuropathic symptoms and Signs (LANSS) pain scale and the Pain-DETECT questionnaire (PDQ).

Results: The mean time elapsed since COVID-19 was 5.76±2.95 months (min, 1; max, 12). Six patients (2.9%) had neuropathic pain according to the LANSS score, and 12 patients (5.7%) according to the PDQ score. The NMQ-E indicated that the most pain was detected in the back (20.1%), low back (15.3%), and knee (11.5%) regions during the post-COVID-19 period. According to both neuropathic pain scales; low back pain (p=0.001/0.001) and knee pain (p=0.001/0.01) were more common in patients with PDQ/LANSS neuropathic pain. Logistic regression analysis showed that there were significant associations between neuropathic pain and acute COVID-19 VAS score.

Conclusion: This study demonstrated that musculoskeletal pain was prominent mostly in the back, low back, and knee during the post-COVID-19 period. The incidence of neuropathic pain was 2.9%-5.7% depending on the evaluation parameters. Neuropathic pain is a finding that should be considered during the post-COVID-19 period.

Objective: Our aim was to determine whether serum C-X-C motif chemokine 5 (CXCL5) may serve as a diagnostic biomarker for relapsing-remitting multiple sclerosis (RRMS) as well as a marker that can be used to predict treatment response.

Methods: CXCL5 levels were measured by ELISA in sera of 20 RRMS patients under fingolimod treatment, 10 neuromyelitis optica spectrum disorder (NMOSD) patients, 15 RRMS patients presenting predominantly with spinal cord and optic nerve attacks (MS-SCON), and 14 healthy controls.

Results: Fingolimod treatment significantly reduced CXCL5 levels. CXCL5 levels were comparable among NMOSD and MS-SCON patients.

Conclusion: Fingolimod might regulate the innate immune system. Serum CXCL5 measurement does not differentiate between RRMS and NMOSD.

Objective: Seborrheic dermatitis (SD) is a chronic, recurrent inflammatory skin disease characterized by clinically scaly patches. It is known that skin diseases with chronic inflammation are associated with comorbid conditions such as metabolic syndrome, obesity, cardiovascular diseases (CVD) and diabetes. In recent years, there are studies investigating the relationship of SD with metabolic syndrome, hypertension, obesity and nutritional factors. However, there is no study evaluating body composition parameters in SD patients. In the light of this information, it was aimed to evaluate the relationship between SD and body composition parameters.

Methods: The study was conducted on a total of 78 participants, including 39 SD patients over the age of 18 and 39 age- and gender-matched control patients, who applied to the University Faculty of Medicine Dermatology outpatient clinic. Body composition parameters were measured for each participant with the Tanita MC 580 Body Analyzer. In addition, SD area severity ındex (SDASI) was calculated in the SD patient group. These parameters were compared between the case and control groups.

Results: There was no significant difference concerning height (p=0.208), weight (p=0.309), body mass index (p=0.762), fat mass (p=0.092), metabolic age (p=0.916), body density (p=0.180), mineral (p=0.699), visceral adiposity (p=0.401), protein (p=0.665), and other body composition parameters, between the case and control groups. There was only positive correlation between SDASI and height (p=0.026) and protein (0.016) value.

Conclusion: SD may be associated with obesity, metabolic syndrome, insulin resistance, and CVD, but the results are unclear and further studies are needed.

Objective: The aim of this study is to determine the level of compliance with treatment and achieving metabolic goals in type 2 diabetes mellitus (T2DM) patients who are remotely monitored with mobile health (mHealth) technologies during the pandemic.

Methods: A total number of 86 patients were included in the study. Data from two periods were used: from 1 month before the date when the first COVID-19 case in Turkiye was reported on March 11, 2020 (Febraury 10, 2020-March 31, 2020) and from the pandemic was severe between April 01, 2020 and May 31, 2020. Participants' mean blood glucose, step count, blood pressure, body weight, and diet compliance levels were evaluated.

Results: When the blood sugar, blood pressure, and weight averages of the patients were compared between the pre-pandemic period and the pandemic months separately, no significant difference was observed. However, it was observed that the number of steps decreased significantly compared to the period before the pandemic (p<0.05). It was determined that 88% of the participants were able to access health services without applying to the hospital.

Conclusion: In this study, we showed that patients with T2DM who were followed up with mHealth technologies provided the necessary metabolic control and compliance with the treatment during the pandemic.

Objective: Cardiovascular magnetic resonance imaging (MRI) is a widely accepted reference imaging technique in routine cardiology clinics in many centers due to its advantages in providing preferable functional, morphologic information. However, there is little information about national experience in clinical application and findings of cardiovascular MRI. The objective of this study was to demonstrate the clinical and demographic characteristics of patients admitted to our cardiac imaging department.

Methods: A total of 500 cardiovascular MRI examinations performed between 2016 and 2019 were enrolled in this retrospective study. Clinical indications, demographic, and cardiovascular MRI findings of the patients were retrospectively evaluated.

Results: Five hundred patients (M/F=301/199) were included in this retrospective, single center study. The majority of the examinations were performed for the assessment of congenital heart disease (n=254, 50.8%). The other indications were for myocardial disease (n=160, 32%), cardiac mass (n=44, 8.8%), valvular heart disease (n=20, 4%), magnetic resonance angiography (n=12, 2.4% for aorta and pulmonary artery [n=9, 1.8%] and for coronary arteries [n=3, 0.6%]), and vasculitis (n=7, 1.7%), pericardial disease (n=3, 0.6%). Minor complication was seen during the contrast agent injection in three patients (0.06%).

Conclusion: Cardiovascular MRI is a reliable and accurate imaging tool in identifying the various cardiac pathology with widely accepted use in the clinical area. Our single-center experience of 500 cases demonstrates the varieties of clinical indications in daily practice that may contribute to the national data pool.