Turkish Journal of Medical Sciences最新文献

The heart, as the main part of the circulatory system, is one of the organs frequently affected by hematological diseases. Cardiac problems may develop during the course and treatment of benign and malignant hematological diseases. This review study was conducted based on recent information from the literature and manifestations of cardiac involvement in hematology were summarized. Determining appropriate cardiac approaches in cases of hematological diseases with relevant knowledge and experience regarding the development of cardiac involvement in pathophysiological conditions has an important role in the diagnosis and treatment processes of patients. This review provides relevant information about hematological diseases and the heart, and key points that will help in the diagnosis and treatment process are presented.

Background/aim: Cesarean section (CS) is a widely performed operation worldwide but data about uterine closure are lacking. We aimed to evaluate scar niches and compare single-layer and double-layer uterine closure at 6 months following CS.

Materials and methods: This prospective randomized trial assessed 56 women undergoing single- or double-layer uterine closure. None of the patients had previous uterine surgery and all CS cases were elective. Transvaginal ultrasound was performed 6 months after CS to assess the uterine scars by measuring the width, depth, and length of the scar niche and residual myometrial thickness. An experienced sonographer was blinded to the uterine closure technique and the ultrasounds were conducted by practitioners unaware of the technique in the postoperative follow-up appointments.

Results: Twenty-eight women were assigned to the single-layer closure group (Group 1) and 28 were assigned to the double-layer closure group (Group 2). The demographic and clinical characteristics of patients and the width, depth and diameter of the niche were similar between the groups, as was residual myometrial thickness. There was no difference in uterine scar volume under the incision between the two groups. The duration of surgery was approximately 5 min longer (p = 0.048) and hemoglobin decrease was about 0.5 g/dL less (p = 0.039) in the double-layer group compared to the single-layer group. Postmenstrual spotting rates were similar between the groups. Group 1 had two and Group 2 had one spontaneous pregnancy within 6 months after CS.

Conclusion: The single- and double-layer closure techniques do not produce different impacts on CS niche features at 6 months after delivery. Ultrasound might be an important noninvasive diagnostic tool for understanding CS scar remodeling.

Background/aim: The transition from pediatric to adult-oriented care for individuals with juvenile-onset systemic lupus erythematosus (SLE) poses significant challenges. This study aimed to assess the outcomes of transitioning patients with juvenile-onset SLE from pediatric to adult-oriented care.

Materials and methods: Patients with juvenile-onset SLE were included in the study. They were transferred in face-to-face meetings where at least one pediatric rheumatologist and one adult rheumatologist were present (transition time: October-December 2020).

Results: The median (25th-75th percentile) age at diagnosis and the time of the first examination in an adult-oriented rheumatology department of the included 65 SLE patients were 14.3 (10.9-15.1) years and 19.2 (18.5-20.4) years, respectively (female/male ratio: 7.1). There was no difference in clinical findings related to SLE between the last pediatric care visit and the last adult-oriented care visit other than constitutional symptoms being more prevalent in adult-oriented care (p = 0.039). There was a higher rate of low medication adherence in the post- than pretransition period (p = 0.003). The number of patients admitted to the emergency department during follow-up in adult-oriented care was higher (p = 0.009). Additionally, patients were more likely to miss at least one scheduled appointment in the post- than pretransition period (p = 0.002).

Conclusion: We observed that patients with juvenile-onset SLE had more constitutional symptoms, lower medication compliance, higher rates of emergency department visits, and more missed appointments in the posttransition period despite a face-to-face structured transition process. We hope that future studies will offer solutions to the problems in transitional care.

Neurological disorders encompass a complex and heterogeneous spectrum of diseases affecting the brain, spinal cord, and peripheral nervous system, each presenting unique challenges that extend well beyond primary neurological symptoms. These disorders profoundly impact cardiovascular health, prompting an intensified exploration into the intricate interconnections between the neurological and cardiovascular systems. This review synthesizes current insights and research on cardiovascular comorbidities associated with major neurological conditions, including stroke, epilepsy, Parkinson's disease, multiple sclerosis, and Alzheimer's disease. The cardiovascular sequelae of these neurological disorders are multifactorial. For instance, strokes not only predispose individuals to arrhythmia and heart failure but also exacerbate preexisting cardiovascular risk factors. Similarly, epilepsy is associated with autonomic dysregulation and an elevated risk of sudden cardiac death, underscoring the necessity for vigilant cardiac monitoring in affected individuals. Parkinson's disease manifests with orthostatic hypotension and cardiac sympathetic denervation, significantly contributing to morbidity. Additionally, multiple sclerosis and Alzheimer's disease exhibit cardiovascular autonomic dysfunction and heightened cardiovascular risk, underscoring the need for proactive management strategies. Mechanistically, these conditions disrupt autonomic nervous system regulation, induce chronic inflammation, and may share genetic susceptibilities, each contributing to cardiovascular pathology. Effective management of these complexities requires an integrative approach that includes risk factor modification, pharmacotherapy, lifestyle interventions, and comprehensive patient education. Future research directions include identifying novel therapeutic targets, conducting large-scale clinical trials, and investigating genetic biomarkers to individualize treatment strategies. By addressing the multifaceted interactions between neurological disorders and cardiovascular health, healthcare providers can optimize patient care, reducing cardiovascular morbidity and mortality in this vulnerable population.

Background/aim: Syndesmophyte formation appears to be site-specific in ankylosing spondylitis (AS) and new bone formation seems to occur in regions of microtrauma that are prone to tensile forces. Pelvic and spinal parameters are unique for each individual. Pelvic tilt and sacral slope are important anatomical features that compensate in harmony in keeping the sagittal balance. After puberty, the sacral slope shapes the lumbar lordosis, whereas the pelvic incidence has an individual constant value. This study aimed to analyze the properties of pelvic parameters in AS patients with and without syndesmophyte formation in the spine after 15 years of disease duration.

Materials and methods: Whole-spine radiographs and clinical data of 104 AS patients were analyzed according to radiographic damage in the spine. AS patients were grouped as those with and without syndesmophytes. Patients with complete bridging in at least one vertebral unit were excluded. Sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis were measured.

Results: The mean disease duration was 14.5 years and 60% of the AS patients were male. The groups were similar in terms of age, sex distribution, and disease duration. Although numerically higher in patients with syndesmophytes, the mean pelvic incidence of AS patients was not significantly different between groups (55.2 ± 13.6 vs. 57.2 ± 15.4). The sacral slope was higher in patients with lumbar syndesmophytes (p < 0.005).

Conclusion: The sacral slope was significantly higher in patients with syndesmophytes, which in turn resulted in increased lumbar lordosis. Our results imply that the individual shape of the spine affects the distribution of weight and tensile forces in AS, and some patients are possibly more prone to new bone formation due to altered repetitive microtrauma in the general genetic background of AS. Prospective studies addressing this cross-sectional observation may contribute to the development of new treatment strategies addressing mechanical load and may aid in decreasing the management costs of AS with the present biological therapies targeting new bone formation.

Background/aim: In Türkiye, the recommendations for screening for retinopathy of prematurity (ROP) were updated in 2021. We aimed to present detailed data on the infants included in the screening program according to the new criteria and evaluate whether these changes are of benefit in detecting severe ROP.

Materials and methods: Our hospital's medical records of infants screened for ROP between July 2019 and July 2021 or between August 2021 and August 2023 were retrospectively examined. Gestational age (GA), birth weight, the sex of the infant, whether there was multiple pregnancy, ROP examination results, the most advanced ROP level and time, and ROP treatment needs and times were recorded. Cohort data from these two time periods before and after the update were compared.

Results: Three hundred and fifty-seven infants screened before the updating of the guidelines and 336 infants screened after the update were included in the analysis. Between August 2021 and August 2023, more cases of ROP were detected (19.3% and 21.4% for the two cohorts, respectively), while a lower rate of treatment was required (3.9% and 2.1% for the cohorts, respectively). One of the infants treated after the update was included in the screening based on the new GA criterion. In both cohorts, no infant needed treatment before 32 weeks of postmenstrual age regardless of agreement with GA at birth.

Conclusion: In this study, one infant in need of treatment who was not included in the screening program according to the previous criteria was identified. The data we obtained support the necessity of increasing the upper limit for GA. Additionally, the 31st week seems safe for the beginning of examinations in extremely premature infants.

Background/aim: Congenital anomalies of the kidney and urinary tract (CAKUT) are characterized by renal developmental disorders in the embryonic period. STAT3 is a member of the STAT protein family. The members of this protein family play roles in various cellular mechanisms, such as the early stages of embryonic development, kidney development, and renal diseases. This study aims to determine the frequency of STAT3 rs1053004, rs744166, rs3816769, and rs4796793 polymorphisms in individuals with CAKUT.

Materials and methods: Two of four polymorphisms, rs744166 (c.-1-13666T>C, NM_001369512.1) and rs4796793 ( c.-1915C>G, NM_001369512.1), were analyzed by a polymerase chain reaction (PCR) and the restriction fragment length polymorphism method. Two other polymorphisms, rs1053004 (c.*1671C>T, NM_001369512.1) and rs3816769 (c.273+314A>G, NM_001369512.1), were analyzed using real-time PCR-melting curve analysis.

Results: Our research indicates that individuals with the TT allele for rs1053004 single nucleotide polymorphism have a 1.23 times greater disease risk than those with the CC allele. Those with the CC allele for rs3816769 have a 1.41 times greater risk of disease than those with the TT allele. These findings suggest a potential genetic predisposition to CAKUT. Furthermore, the research identified significant connections between rare haplotypes and CAKUT (p = 0.041). The CCTC haplotype for rs744166, rs4796793, rs1053004, and rs3816769 polymorphism was exclusively present in the CAKUT group, while the CGTT haplotype for the same polymorphisms was only detected in the control group.

Conclusion: The presence of rare haplotypes for the rs1053004, rs3816769, rs4796793, and rs744166 polymorphisms may significantly affect the onset or prevention of CAKUT. These findings could potentially have important clinical implications, providing a deeper understanding of the genetic basis of CAKUT and potentially influencing future diagnostic and treatment strategies.

Background/aim: Functional asymmetry in the upper extremities may occur in infants with neuromotor problems due to neurodevelopmental or musculoskeletal disorders. The aim of this study was to investigate the validity and reliability of the Turkish version of the Infant Motor Activity Log (IMAL-T), which assesses the frequency (how often) and quality (how well) of the affected arm usage during activities in infants with functional asymmetry in the upper extremities.

Materials and methods: The IMAL-T was administered face-to-face to the parents of 102 infants [60 infants at high risk of developing cerebral palsy (CP) and 42 infants with brachial plexus birth injury (BPBI)], aged 6-24 months, with functional asymmetry in the upper extremities. One week later, the IMAL-T was administered again to 22 parents to determine the test-retest reliability. Cronbach's alpha and the intraclass correlation coefficient (ICC) were used to determine the internal consistency and test-retest reliability. Discriminant validity was assessed using the manual ability level (Mini Manual Ability Classification System) and the nerve injury type was evaluated using the independent samples t test. For concurrent validity, the relationship between the IMAL-T and the Pediatric Evaluation of Disability Inventory (PEDI) self-care was examined using Spearman's correlation coefficient.

Results: Internal consistency (Cronbach's alpha ≥ 0.91) and test-retest reliability (ICC ≥ 0.93) of the IMAL-T were adequate. The IMAL-T scores differed according to the mini-MACS and nerve injury type (p < 0.05). Moderate to strong (CP, r ≥ 0.706, p < 0.001; BPBI, r ≥ 0.579, p < 0.001) correlation coefficients were found between the IMAL-T and PEDI self-care scores.

Conclusion: The IMAL-T is a reliable and valid parent-reported outcome measure that indicates the frequency and quality of the affected arm use during age-appropriate real-life activity in infants aged 6-24 months with upper extremity functional asymmetry due to neuromotor problems. The IMAL-T can be used in early intervention to assess upper extremity functional asymmetry in Turkish infants.

Background/aim: Sarcoidosis is a multisystem disorder that affects many organs, including the kidneys. This single-center retrospective study investigated the clinical, pathological, and laboratory findings of patients with kidney sarcoidosis who were treated with immunosuppressives.

Materials and methods: Twenty-three patients with biopsy-confirmed kidney sarcoidosis were included. Demographic, clinical, pathological, and laboratory findings, in addition to the treatments and outcomes of 20 patients with at least one month of follow-up were evaluated.

Results: The median age of the patients at the time of biopsy was 47 years (60.9% were female). The median baseline estimated glomerular filtration rate (eGFR) and proteinuria were 21.5 mL/min and 1 g/g or g/day, respectively. Nineteen of the 23 patients were diagnosed with nonglomerular disease (four had glomerular diseases). Extrarenal sarcoidosis was present in 86.7% of the patients. Granulomatous interstitial nephritis (56.5 %) and nephrosclerosis with intratubular calcific casts (17.4 %) were the two most common diagnoses. All the patients initially received 1 mg/kg/day steroids for kidney involvement. Although no statistical difference was observed in kidney function during the follow-up, steroids improved the eGFR in the first month compared with baseline in patients with nonglomerular diseases (p = 0.049). Eventually, 45% of the patients developed end-stage kidney disease, and 45% of cohort had a treatment response. Patients with higher baseline calcium levels (p = 0.03) and lower degrees of interstitial fibrosis/tubular atrophy (p = 0.043) had better kidney outcomes. Moreover, none of the patients with sarcoidosis-related secondary glomerular disease had a treatment response (p = 0.043).

Conclusions: Hypercalcemia and lower interstitial fibrosis and tubular atrophy rates might be associated with better outcomes in sarcoidosis-related kidney involvement under immunosuppressive treatment. Moreover, late diagnosis, irregular follow-up, and glomerular disorders could be poor prognostic factors.