Northern Clinics of Istanbul最新文献

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.

Objective: Neuropsychiatric assessment is essential part of child and adolescent psychiatry clinic practice, also provides important information about central nervous system dysfunctions. In studies conducted to date, it has been known that both the high frequency of psychiatric comorbidity in epileptic patients and that epilepsy comorbidity is quite common in neurodevelopmental disorders. In fact, considering the high comorbidity of epileptic abnormalities and psychiatric disorders, it has been very important to determine predictors for epileptic abnormalities in a clinical sample of child and adolescent psychiatry. In this retrospective study, we aim to determine possible predictive factors for epileptic abnormalities in a clinical sample of child and adolescent psychiatry according to Weschler Intelligence Scale for Children (WISC-R) results.

Methods: We identified patients who had two or more rotation errors in the block design subtest of WISC-R by retrospectively scanning the system records of 2609 cases who were applied WISC-R with different prediagnoses at Gazi University Child and Adolescent Psychiatry Outpatient Clinic between January 2013 and December 2020 (n=71). After the first step identification, we selected the ones who had a previous electroencephalography (EEG) recording available for our own re-review (n=60).

Results: We found 15% EEG abnormalities and ADHD is the most common diagnosis in both normal and abnormal EEG groups. Due to correlation analysis, there was a positive-mild correlation between presence of EEG abnormality and WISC-R performance (r=0.56) in intellectual disability (ID) group and a positive-strong correlation between presence of EEG abnormality and WISC-R performance-verbal scores (r=0.74) in ID group.

Conclusion: This study has shown that many different abnormal EEG patterns can be found in patients who have rotation errors in the block design test of WISC-R, suggesting diagnoses of ID, and having notable performance-verbal subtests scores difference and rotation errors in the block design subtest of WISC-R should be predicitive factors for epileptic abnormalities.

The World Health Organization has designated carbapenem-resistant Acinetobacter baumannii (CRAB) as a "critical" pathogen on the global priority list of antibiotic-resistant bacteria. This study aims to discuss the molecular epidemiology of CRAB isolates in Turkiye in the last 12 years and the prevalence of gene regions associated with resistance or pathogenesis using a systematic review method. Our study consists of a literature search, determination of eligibility and exclusion criteria, qualitative analysis of studies, data extraction, and statistical analysis. All studies were analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines. The incidence rates of blaOXA-23, blaOXA-23-like, blaOXA-24/40, blaOXA-24/40-like, blaOXA-51, blaOXA-51-like, blaOXA-58, and blaOXA-58-like genes in CRAB strains were 76.4%, 68.6%, 1.2%, 3.4%, 97.0%, 98.6%, 8.4%, and 17.1%, respectively. It was determined that the prevalence of the blaOXA-23 and blaOXA-58 gene regions showed a statistically significant change over the years. Due to the high prevalence of A. baumannii strains carrying the blaOXA-23 variant, it is necessary to follow its geographical distribution and transposon and plasmid movements. Based on available data, molecular surveillance of CRAB strains should be standardized. In addition, sterilization and disinfection processes applied within the scope of an effective struggle against CRAB strains that can remain live on surfaces for a long time should be reviewed frequently.

Terra firma-forme dermatosis (TFFD), also known as Duncan' dirty dermatosis, is a keratinization disorder that is characterized by velvety, dark brown-blackish patches, and plaques and is not associated with systemic diseases. The lesions rarely show a verrucous or reticulate appearance. Especially, in children and adolescents, neck, face, torso, and ankles are the most frequently affected areas. TFFD is a condition that should be suspected in children and adolescents that cannot be cleaned with soap, especially if the neck area looks dirty. In this article, we report 3 cases with a diagnosis of TFFD resembling acanthosis nigricans. TTFD should be included in the differential diagnosis of adolescent cases presenting with hyperpigmented patches and plaques, especially in intertriginous areas such as the neck.