Northern Clinics of Istanbul最新文献

Objective: The aim of this study was to compare the functional and radiological results of lateral, medial, and posterior surgical approaches in pediatric patients undergoing open reduction and internal fixation for supracondylar humerus fractures.

Methods: A total of 86 patients were included in the study. The clinical and radiographic results of the treatment in patients who underwent open reduction and internal fixation with lateral, medial, and posterior approaches were evaluated. Flynn's criteria were used in the evaluation of cosmetic and clinical results. Comparisons were made between the groups in terms of Baumann angle, lateral capitellohumeral angle, and post-operative complications.

Results: There was no statistically significant difference between the three groups in terms of complications. No statistically significant relationship was observed between Flynn's criteria and surgical approaches. When the relationship among post-operative range of motion (ROM) and surgical approach was evaluated, no extension defect was found in any of the patients, but a significant relationship was found between post-operative flexion ROM and surgical approach (p=0.011).

Conclusion: Closed reduction and percutaneous pinning are preferred in cases of pediatric supracondylar humerus fractures. However, when this method cannot be applied, lateral, medial, and posterior approaches are the possible open reduction methods, that can be safely preferred.

Takayasu's arteritis (TA) is a rare chronic granulomatous vasculitis characterized by large-vessel involvement. The aorta and its main branches are most commonly involved. Although pulmonary artery involvement is common, hemoptysis or respiratory findings are rarely seen. Herein, we present a case of TA who developed anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with diffuse alveolar hemorrhage after coronavirus disease 2019 (COVID-19) infection. A 17-year-old female patient with the diagnosis of TA presented with cough, bloody vomiting, and diarrhea. In follow-up, she developed tachypnea and dyspnea and was transferred to the pediatric intensive care unit. The findings on the chest computed tomography were compatible with acute COVID-19 infection, but the SARS-CoV2 reverse transcription-polymerase chain reaction test was negative, but SARS-CoV2 immunoglobulin (Ig) G and IgM antibody tests were positive. The patient was not vaccinated against COVID-19. The bronchoscopy showed bronchial mucosal fragility, bleeding foci, and mucosal bleeding. The broncoalveolar lavage hemosiderin-laden macrophages were seen in the histopathologic examination. The indirect immunofluorescence assay-ANCA test became 3 (+) with myeloperoxidase (MPO)-ANCA of 125 RU/ml (normal: <20). Cyclophosphamide and pulse steroid treatment were started. After immunosuppressive therapy, the patient condition improved and did not have hemoptysis again. The successful response was obtained by applying balloon angioplasty to the patient with bilateral renal artery stenosis. Types of post-COVID vasculitis include thromboembolic events, cutaneous vasculitis, Kawasaki-like vasculitis, myopericarditis, and ANCA-associated vasculitis. It is thought that COVID-19 may impair immune tolerance and trigger autoimmunity with cross-reaction. To the best of our knowledge, the third pediatric case was reported with MPO-ANCA-positive COVID-associated ANCA vasculitis.

Objective: Ankylosing spondylitis (AS) is a rheumatologic disease with severe morbidity and mortality. Many studies in the literature showing that serum antibodies against anti-mutated citrullinated vimentin (anti-MCV ab) can be elevated in rheumatoid arthritis (RA) patients. However, there is little data in the literature about the levels of anti-MCV antibodies in AS patients. We designed the study to evaluate the role of anti-MCV antibody in the diagnosis of AS and to investigate whether it is associated with disease activity parameters.

Methods: There were three separate groups in our study. The number of participants in these groups is 60 patients in the AS group, 60 patients in the RA group, and 50 healthy participants in the control group. The anti-MCV ab levels of the participants were measured by enzyme-like immune assay method. We compared anti-MCV levels between groups. We then evaluated its role in the diagnosis of AS and evaluated its relationship with disease activity parameters.

Results: The anti-MCV antibody levels of both AS (p=0.006) and RA (p>0.001) patients were found to be significantly higher than controls. Anti-MCV antibody was higher than predefined threshold level (20 IU/mL) in 4 of 60 (6.7%) AS patients. Anti-MCV levels are similar in patients with or without a -acceptable symptom state (PASS). There is also no appropriate anti-MCV cutoff level with respect to PASS and a highly sensitive and specific level for diagnosis of AS.

Conclusion: Although AS patients has higher anti-MCV levels than controls, it may have a limited ability to AS diagnosis and to predict severity of the disease.

Anastomosing hemangioma of the liver (AHL) is a very rare condition and limited to a few cases. It is often confused with well-differentiated angiosarcomas and causes overtreatment. In this report, we present a 53-year-old female patient diagnosed with AHL. Since the tumor is rarely seen, it is important to define well the imaging and pathological features for preventing unnecessary surgeries and related morbidities.

Objective: The aim of this study was to reveal the relationship between hemodialysis (HD) adequacy and dialysis symptom index (DSI) in patients with end-stage kidney disease (ESKD).

Methods: This prospective study included 92 ESKD patients who underwent HD three times a week. Data including sex, age, education status, marital status, economic status, employment status, dependency status, type of vascular access, and duration of HD were recorded. Biochemical and hematological analyses were carried out. Dialysis adequacy was assessed based on clinical and biochemical analysis. The DSI was used to evaluate the emotional and physical symptoms of HD patients.

Results: Of the patients, 55 were males and 37 were females, with a mean age of 59.95±14.9 years. The median duration of HD was 60.0 months (interquartile range: 20.8-103.5). The mean DSI score was 54.35±26.0, with a significantly higher score in female patients (p<0.001). There was a significant correlation between DSI and increasing age (p<0.05). The single pool Kt/V (spKt/V) ratio of HD patients with AVF access was significantly higher, and the mean DSI was significantly lower than that of those receiving HD with a central venous catheter (p<0.001). The mean DSI score was significantly higher in patients with a spKt/V ratio of <1.2 than those with a spKt/V ratio of ≥1.2 (p<0.001). In multivariate regression analysis using biochemical parameters, the spKt/V ratio was a significant and independent predictor of DSI scores (R²=0.64, p<0.001). In addition, a significant and independent relationship was found between DSI and gender, age, and economic status in the regression analysis (R²=0.36, p<0.001).

Conclusion: Dialysis adequacy is an independent predictor of DSI. If an adequate dialysis dose is ensured to be delivered, symptom burden may dramatically decrease.

Objective: This study was designed to investigate the traumatic stress levels, participants demonstrating higher than post-traumatic stress disorder (PTSD) cutoff, thus PTSD possibility, levels, and related factors of patients who felt the need to apply to the outpatient clinic for the 1st time during the first period of the outbreak of the pandemic as a traumatic event, when many psychiatry outpatient clinics were mostly closed to face-to-face admissions. In our research, we targeted three objectives. First, we evaluated PTSD as indicated with measure cutoff points and post-traumatic stress symptom (PTSS) rates among the individuals who were admitted to an outpatient psychiatric clinic for the 1st time, 3 months after the first COVID-19 case was reported in Turkiye. Second, we investigated the relationship between PTSS and PTSD cutoff with anxiety, stress, depression, hopelessness, fear of COVID-19, and disability levels. Third, we aimed to explore the sociodemographic data and risk factors related to PTSD cutoff and PTSS controlling levels of disability, hopelessness, fear of COVID-19, anxiety, depression, and stress.

Methods: For our study, a total number of 85 cases were recruited. Post-traumatic Stress Diagnostic Scale (PDS), Beck Hopelessness Scale (BHS), Depression, Anxiety, and Stress Scale (DASS-21), Sheehan Disability Scale (SDS), and Fear of COVID-19 Scale (FCS) were administered to each patient.

Results: The rates of possible PTSD and PTSSs were found to be 25.9% and 88.2%. The majority of participants were women (65.9%) who have been presenting complaints with anxiety symptoms (60.1%) and social media users (74.1%). The mean DASS-21 all subscales (anxiety, depression, and stress) (p<0.01), BHS (p<0.01), FCS (p=0.03), and SDS family life/home responsibilities subscale (p<0.01) scores of PTSD cutoff subgroup (n=22) were higher than non-PTSD group (n=63). We observed significant positive correlations between the FCS scores and DASS-21 anxiety subscale (p<0.01), SDS family life/home responsibilities and social life/leisure activities subscales (p<0.05), and PDS symptom severity subscale (p<0.01) scores.

Conclusion: These results demonstrate that a COVID-19 pandemic is a traumatic life event that causes high rates of possible PTSD, PTSS, anxiety, depression, hopelessness, and disability and leads to admissions to psychiatric outpatient clinics.

Objective: Reoperative thyroid surgery is technically difficult process with increased complications due to the adhesions and fibrosis caused by the previous surgery. In this experimental animal model, we planned to investigate the effect of Contracttubex^TM, a mixture of Extractum cepae, Heparin sodium and Allantoin, on adhesion and fibrosis after neck surgery (thyroidectomy).

Methods: The current study is an experimental animal model of post-thyroidectomy adhesion. Twelve Wistar-Albino male rats in two groups were used. Under sterile conditions, a midline incision on the neck was made. The anterior thyroid muscles were separated and the thyroid lodge was reached. As a minor interventional procedure, a sponge was applied to the thyroid tissue, and then a combination of 1 g Extractum capae, heparin, sodium, and allantoin was applied to the dissection site in the drug group. Rats in both groups were sacrificed on 30^th day. Cervical regions were dissected and evaluated for macroscopic adhesion. Tissue samples were taken for microscopic evaluation for fibrosis and inflammation.

Results: In the experimental group in which Contractubex^TM was applied, inflammation was not detected in five (83.3%) of six rats while no inflammation was detected in four (66.7%) of six rats in the control group (p=0.505). Considering the fibrosis score, mild or moderate fibrosis was detected in four (66.7%) of six rats in the control group, while fibrosis was found in only two (33.3%) rats in the experimental group (p=0.264). When macroscopic adhesion was evaluated, two (33.3%) rats of the control group subjects were Grade 4, and one (16.7%) was Grade 3. No rats in the experimental group were Grade 4 (p=0.392).

Conclusion: Contractubex^TM seems to be effective in preventing adhesions and fibrosis after thyroidectomy and neck surgery, but further research is needed for use in human studies.

Objective: Hemodialysis (HD) patients are a population at high risk for exposure to the severe respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Undiagnosed mild or asymptomatic SARS-CoV-2 infection in HD patients can make these patients a potential source of infection. In our study, we aimed to evaluate the entire spectrum of SARS-CoV-2 infection with the IgM and IgG rapid antibody kit in HD patients and healthcare providers working in HD unit.

Methods: 633 HD patients and 134 health workers from all dialysis centers (three private and three public) in Eskisehir were included in the study. Blood samples obtained from participants were allowed to clot for 30 min at room temperature at 15°C using a serum separator tube. Then it was centrifuged at 1000 g at 2-8°C for 15 min. The supernatant was collected and the samples were stored at -20°C until use. Serum samples stored at the end of the study were studied with the A.B.T.™ Biotechnology COVID-19 Rapid IgG-IgM Diagnostic Test. Routine examination was measured by standard methods. All participants were evaluated by serological analysis of IgG and IgM antibodies against the SARS-CoV-2 recombinant antigen.

Results: Two symptomatic HD patients (0.27%) were diagnosed with SARS-CoV-2 infection by real-time reverse-transcription-polymerase-chain - reaction test and chest tomography. In 15 (2.36%) of 633 asymptomatic patients, antibody was positive against the SARS-CoV recombinant antigen (IgG in 13, both IgG and IgM in 2), while no antibodies were detected in 134 health workers.

Conclusion: We have shown that most HD patients with SARS-CoV-2 experience the disease asymptomatically, and that antibody testing plays an important role in identifying patients with asymptomatic infection.

Objective: Vaccination is the primary way to mitigate the COVID-19 pandemic. Vaccine hesitancy and refusal are one of the most important challenges against to reach herd immunity. The aim of this study is to examine the reasons for not getting vaccinated and the attitudes toward vaccines by people in Turkiye, who were not vaccinated, even though a COVID-19 vaccine was available for them.

Methods: This cross-sectional study is conducted in Eyupsultan district of Istanbul. The study population is 12,540. A questionnaire consisted of three sections as sociodemographic characteristics, attitudes toward COVID-19 vaccines, and Vaccination Attitudes Examination (VAX) scale was used. Among the sample size, participation rate is 69.4%.

Results: About 50.2% of the participants (n=259) are male, 80.3% are married, 13.1% are university graduates, and 44.0% are working in a job. About 32.8% of the participants have COVID-19 history. About 34.4% of the participants stated that they would be vaccinated against COVID-19. Although those who define themselves as vaccine refuser are 5.4%, those who still refuse to be vaccinated for COVID-19 are 20.1%. In addition to this, those who are hesitant about COVID-19 vaccines are 45.6%. The most frequently preferred vaccine is comirnaty (41.7%). About 13.1% of the participants stated that "if we had a domestic COVID-19 vaccine, I would have it." The most common sources of information about vaccines are television with 78.4%, and health workers are in the last place with 14.7%. "Concerns about side effects" are the most frequently cited (85.9%) reason for not vaccinating. The mean score of the VAX scale is 42.34±10.93, and the "mistrust of vaccine benefit" is higher among primary school graduates than other educational status groups (p=0.001).

Conclusion: Anti-vaccination attitudes have increased with the COVID-19 vaccines during pandemic. Our study is valuable in terms of examining the reasons of individuals who have not gotten vaccinated even though they had no access problems. Prominent concerns of the population should be approached seriously. Otherwise, vaccine hesitancy can be a decisive factor that would prevent the success of the struggle against pandemic.