Turkish Journal of Medical Sciences最新文献

Background/aim: Individuals with multiple sclerosis (MS) may experience various speech-related issues, including decreased speech rate, increased pauses, and changes in speech rhythms. The purpose of this study was to compare the volumes of speech-related neuroanatomical structures in MS patients with those in a control group.

Materials and methods: The research was conducted in the Neurology and Radiology Departments of Malatya Training and Research Hospital. The records of patients who presented to the Neurology Department between 2019 and 2022 were examined. The study included the magnetic resonance imaging (MRI) findings of 100 individuals, with 50 in the control group and 50 patients with MS, who had applied to the hospital in the specified years. VolBrain is a free system that works automatically over the internet (http://volbrain.upv.es/), enabling the measurement of brain volumes without human interaction. The acquired images were analyzed using the VolBrain program.

Results: As a result of our research, a significant decrease was found in the volume of 18 of 26 speech-related regions in MS patients. It was determined that whole brain volumes decreased in the MS group compared to the control group.

Conclusion: In our study, volume measurements of more speech-related areas were performed, unlike the few related studies previously conducted. We observed significant atrophy findings in the speech-related areas of the frontal, temporal, and parietal lobes of MS patients.

Background/aim: Symptoms of COVID-19 may persist for months. One of the persistent symptoms of COVID-19 is fatigue, which reduces functional status. The relationship between fatigue, functional status, and various other factors has received little attention, which this study aims to address..

Materials and methods: Patients with COVID-19 infection were included in this multicenter cross-sectional study. Age, sex, body mass index (BMI), marital status, smoking status, presence and duration of chronic disease, comorbidity index, regular exercise habits, time since COVID-19 diagnosis, hospitalization status, length of hospital stay, intubation status, home oxygen therapy after discharge, participation in a pulmonary rehabilitation program, presence of dyspnea, presence of cough, presence of sputum, and modified Medical Research Council, Post-COVID Functional Status (PCFS), Fatigue Severity Scale (FSS), and EQ-5D-5L Questionnaire scores were recorded.

Results: We enrolled 1095 patients, including 603 (55%) men and 492 (45%) women with a mean age of 50 ± 14 years. The most common chronic lung disease was COPD (11%) and 266 (29%) patients had nonpulmonary disease. The median time elapsed since COVID-19 diagnosis was 5 months; the hospitalization rate was 47%. The median PCFS grade was 1 (0-4) and the median FSS score was 4.4 (1-7). The PCFS and FSS were positively correlated (r = 0.49, p < 0.01; OR: 1.88, 95% CI: 1.68-2.10). Both functional status and fatigue were associated with quality of life, which was lower in older patients, those with higher BMI, those with systemic disease, those not exercising regularly, and those with more severe COVID-19 infection (defined by dyspnea, pneumonia as indicated by computed tomography, hospitalization, length of stay, ICU admission, intubation, and the need for home oxygen after discharge).

Conclusion: Fatigue may cause poorer functional status regardless of the time since COVID-19 diagnosis. In this study, patients with FSS scores of >4.78 showed moderate to severe functional limitations. It is important to address modifiable patient risk factors and reduce the severity of COVID-19 infection.

Background/aim: Strengthening the muscles of the lumbar region in individuals with neck pain may be protective against future back problems. In addition, telerehabilitation applications, which gained momentum in the literature and clinical practice during the COVID-19 pandemic, are among the applications preferred by patients thanks to their various advantages. This study aimed to compare the effects of telerehabilitation and spinal stabilization exercises applied with face-to-face approaches on the thickness of the transversus abdominis (M.TrA) and lumbar multifidus (M.LM) muscles in patients with nonspecific neck pain.

Materials and methods: The primary outcomes were the thickness of the M.TrA and M.LM. Neck pain intensity and neck disability were secondary outcomes. Muscle thickness was evaluated with an ultrasound device, neck pain intensity was assessed with a visual analog scale, and disability was assessed with the Neck Disability Index. Patients were randomly assigned to the telerehabilitation group (TRG) (n = 13) or the control group (CG) (n = 13). While the TRG did the exercises with live videos and video recordings, the CG did exercises face-to-face in the clinic. Both groups performed the same exercises for 45 minutes per session 3 days a week for 8 weeks.

Results: At the end of the treatment, the thicknesses of the M.TrA and M.LM were increased and neck pain intensity and neck disability were decreased in both groups (p < 0.05). The groups were similar in terms of these variables (p > 0.05).

Conclusion: Telerehabilitation and face-to-face spinal stabilization exercises are both beneficial for spinal muscle architecture and clinical variables as a preventive measure against future lower back problems in individuals with neck pain.

Background/aim: Tandem mass spectrometry is helpful in diagnosing amino acid metabolism disorders, organic acidemias, and fatty acid oxidation disorders and can provide rapid and accurate diagnosis for inborn errors of metabolism. The aim of this study was to predict inborn errors of metabolism in children with the help of artificial neural networks using tandem mass spectrometry data.

Materials and methods: Forty-seven and 13 parameters of tandem mass spectrometry datasets obtained from 2938 different patients were respectively taken into account to train and test the artificial neural networks. Different artificial neural network models were established to obtain better prediction performances. The obtained results were compared with each other for fair comparisons.

Results: The best results were obtained by using the rectified linear unit activation function. One, two, and three hidden layers were considered for artificial neural network models established with both 47 and 13 parameters. The sensitivity of model B2 for definitive inherited metabolic disorders was found to be 80%. The accuracy rates of model A3 and model B2 are 99.3% and 99.2%, respectively. The area under the curve value of model A3 was 0.87, while that of model B2 was 0.90.

Conclusion: The results showed that the proposed artificial neural networks are capable of predicting inborn errors of metabolism very accurately. Therefore, developing new technologies to identify and predict inborn errors of metabolism will be very useful.

Background/aim: Early detection and prognosis of sepsis in critically ill children is crucial. The aim of this research was to investigate the prognostic ability of pancreatic stone protein (PSP) in validating sepsis and predicting mortality in a prospective observational study.

Materials and methods: In a single-center study, pediatric intensive care unit patients were divided into cohorts of confirmed and suspected sepsis, as well as survivors and nonsurvivors. Patients with positive blood culture growth were considered to have confirmed sepsis, while their negative counterparts were considered to have suspected sepsis. Comparisons were made between complete blood counts, laboratory parameters, mortality indices, and C-reactive protein (CRP), procalcitonin (PCT), and PSP levels. The correlations between PSP and alternative inflammatory markers and mortality indices were then analyzed. The diagnostic and prognostic applicability of PSP for sepsis confirmation and mortality prediction was assessed using receiver operating characteristic curve analysis.

Results: PSP levels were significantly elevated in patients with confirmed sepsis and within the nonsurvivor segment. In confirming sepsis and predicting mortality, PSP outperformed CRP and PCT in terms of sensitivity. It had sensitivity of 95% in diagnosing sepsis at a cut-off level of 50 ng/L, with an area under the curve (AUC) of 0.67 (95% CI: 0.52-0.81), and sensitivity of 92% in predicting mortality, with an AUC of 0.71 (95% CI: 0.56-0.83). In addition, PSP showed significant correlations with CRP, PCT, and mortality scores.

Conclusion: PSP is emerging as a highly sensitive marker for confirming sepsis and predicting mortality in critically ill pediatric patients. Incorporating the PSP biomarker into routine clinical practice could potentially improve the management of pediatric sepsis.

Background/aim: We aimed to determine the genetic risk factors in patients aged 45 years and below with a history of early myocardial infarction (MI), compared to individuals over 60 years of age with no history of MI.

Materials and methods: In this study, we selected different age groups to more clearly distinguish genetic differences. Accordingly, we compared individuals who had experienced MI at an early age with those who were older and had not experienced any cardiovascular events. The patient group consisted of 99 volunteers under the age of 45 with a history of MI, while the control group included 99 volunteers aged 60 and over without a history of MI. MTHFR (C677T, A1298C), Factor V Leiden (G1691A), Prothrombin (G20210A), PAI (4G/5G), Factor XIII (V34L), APOA1 (rs670, rs1799837, rs5069), and APOB were studied using blood samples taken from the patients.

Results: In the logistic regression analysis of thrombophilia markers and gene polymorphisms in the patient and control groups, no statistically significant increase was observed in markers other than APOA1 rs5069 gene polymorphism. APOA1 rs5069 gene polymorphism was found to be higher in the patient group than those without this polymorphism. The frequencies of homozygous MTHFR (C677T, A1298C) and heterozygous Factor XIII V34L were higher in the patient cohort compared to the controls.

Conclusion: In our study, we found that prothrombotic gene variants and APOA1 rs5069 polymorphism were statistically significantly associated with coronary artery disease. Thus, prothrombotic gene variants and APOA1 rs5069 polymorphism may serve as predictors of early myocardial infarctions. Individuals with early family histories of coronary artery disease could be screened for these mutations.

Background/aim: Injury is an important public health problem in the pediatric age group and one of the leading global causes of morbidity and mortality. The fact that pediatric trauma has a significant impact on patients, families, and countries shows the need for a better understanding of this phenomenon. This study investigates the demographic characteristics, reasons for admission to the hospital, and diagnoses of pediatric trauma patients who received prehospital emergency health services.

Materials and methods: This study was designed as a retrospective observational study and included all patients under the age of 18 who received emergency healthcare due to trauma and were registered in the Emergency Health Automation System after a call was placed to the emergency call center between 1 January 2018 and 31 December 2022. Information such as the reason for calling an ambulance, ICD-10 diagnosis codes, mechanism of injury, time of arrival at the scene, transport duration from the scene to the hospital, and reasons for interfacility transfers were collected for all patients.

Results: A total of 37,420 patients were included in the analysis. Seventeen patients were found dead at the scene of the trauma and 35 patients experienced cardiac arrest on the way to the hospital from the scene. The difference between age groups in terms of time from arrival at the scene to arrival at the hospital was statistically significant (p < 0.001). Falls were the most common cause of trauma in all age groups, followed by traffic accidents. Patients requiring a specialist and transferred primarily for fall-related injuries were in direct proportion to the total number of cases (65.0%, n = 1838), followed by cases of traffic accidents and sports injuries. Most of the secondary transports were made to a training and research hospital or state hospital.

Conclusion: Targeted preventive measures and community education should address the specific causes of trauma that are more prevalent in certain age groups. Early identification of special patient groups that typically require secondary transport can reduce mortality and morbidity related to trauma by facilitating direct transfers to appropriate hospitals.

Background/aim: This study aimed to examine the relationships between severity of stenosis, pain, functional limitation, disability, and quality of life in patients with cervical spondylotic radiculopathy.

Materials and methods: Patients (45 female, 19 male) with radiculopathy due to spondylotic changes in the cervical spine were included in this study. Stenosis severity (thecal sac cross-sectional area (CSA)), numbness, neck and arm pain severity, functional limitation (Cervical Radiculopathy Impact Scale), disability, and quality of life (EQ-5D-3L General Quality of Life Scale) were evaluated. The study was registered at ClinicalTrials.gov as NCT06001359.

Results: According to CSA values, 28 (43.75%) patients had severe stenosis and 36 (56.25%) had moderate stenosis, and the average CSA was 81.65 ± 10.08 mm². Positive correlations were found between both neck and arm pain and neck disability (r = 0.597, r = 0.359), and negative correlations were found for the General Quality of Life Scale index score and EQ-5D-3L visual analog scale (r = -0.787, r = -0.518). There were significant positive correlations between Cervical Radiculopathy Impact Scale subscales and severity of stenosis, neck and arm pain, numbness, and disability (p < 0.05 for all). A significant negative correlation was observed between Cervical Radiculopathy Impact Scale subscales and quality of life (p < 0.01). Stenosis severity was correlated with pain, neck disability, and quality of life (p < 0.01 for all).

Conclusion: There are direct relationships between cervical spondylotic radiculopathy and neck and arm pain, numbness, disability, and quality of life. Additionally, an increase in the severity of cervical stenosis is associated with an increase in pain and disability.