Turkish Journal of Medical Sciences最新文献

Background/aim: The purposes of this study are to determine the frequency of upper extremity overuse syndromes in patients with spinal cord injury (SCI) using manual wheelchairs, to evaluate these syndromes clinically and sonographically, and to identify possible predisposing factors.

Materials and methods: A total of 38 patients with traumatic SCI, aged over 18 years and using manual wheelchairs, were enrolled in this cross-sectional study. The patients were evaluated with clinical and sonographic findings of the wrist, elbow and shoulder joints. Functional capacity, physical ability and upper extremity symptoms, and quality of life were assessed using the functional independence measure, the short form of the disabilities of the arm, shoulder and hand questionnaire, and the 36-item short form (SF-36) health survey, respectively.

Results: While the shoulder joint accounted for the majority of joint pain detected in 23 patients, bursitis was the most common sonographic pathology. As a result of clinical and sonographic evaluations, it was determined that 29 patients had overuse syndrome. The likelihood of developing overuse syndromes increased with longer daily wheelchair use (OR = 1.666; p = 0.048) and high lesion level (OR = 12.01; p = 0.052). It decreased with the SF-36 pain score (OR = 0.943; p = 0.027).

Conclusion: The shoulder joint was the most commonly affected area in terms of pain, sonographic findings, and overuse syndrome. Prolonged daily wheelchair use, thoracic-level lesions, and lower SF-36 pain subscale scores might be determinants of the development of upper extremity overuse syndromes in paraplegic wheelchair users.

Background/aim: This study investigates the role of carbon dioxide (CO₂) angiography, delivered with an automated CO₂ delivery system, in decreasing the amount of iodinated contrast and preventing contrast-induced nephropathy (CIN) in diabetic foot patients who underwent endovascular revascularization.

Materials and methods: A total of 272 diabetic foot patients who underwent endovascular treatment for infrainguinal chronic peripheral arterial disease (PAD) were included in the study. Of these, 64 patients underwent endovascular intervention using CO₂ angiography (study group), while 208 patients underwent endovascular intervention using only contrast media (control group). The rates of CIN and the amount of contrast used during interventions were recorded alongside secondary outcomes, including technical success, complication rates, and complications related to CO₂ usage.

Results: The mean contrast volume used in the CO₂ group was significantly lower than in the control group (24.3 ± 13.3 cc vs 89.4 ± 24.8 cc; p < 0.001). CIN was detected in 41 patients. The incidence of CIN was 17.7% in the control group, while it was significantly lower in the CO₂ group at 6.2% (p = 0.024). In a subgroup of patients with chronic kidney disease stage 3-5, CIN incidence remained significantly lower in the CO₂ group (6.2% vs 38.2%, p < 0.001), and multivariate analysis identified CO₂ use as an independent protective factor (OR: 0.027, 95% CI: 0.005-0.133, p < 0.001). Technical success rates were comparable between the groups (93.7% vs 93.2%; p = 0.892). Pain after CO₂ injection was recorded in 11 patients, and no other adverse effect due to CO₂ usage was observed. There were no major complications, and only minor complications occurred (8%).

Conclusion: CO₂ angiography may play a crucial role in minimizing the risk of CIN in this specific population, who are more vulnerable to this complication and its associated morbidity and mortality. Further multicenter prospective studies are needed to better define the role of CO₂ angiography in high-risk patients.

Background/aim: Several epigenetic alterations are involved in the development of breast cancer. The long noncoding RNA HOTAIR and related RNAs play a role in initiation of breast cancer and are promising targets for diagnostic biomarker and therapeutic studies. In this study, we aimed to investigate HMGA2 associated ceRNA HOTAIR pathway in breast cancer patients.

Materials and methods: Forty breast cancer patients and ten healthy controls were included in this study, and then patients were divided into clinicopathologic groups. After total cell-free RNA isolation, expression levels of target RNAs were analysed by Real-Time PCR. The amount of gene expression was determined according to delta-delta Ct method and change in the expression was determined using the 2^-ΔΔCt method.

Results: HOTAIR expression was significantly higher in the study group (especially in the ER negative group) than in the control group (p value = 0.006). When patients with relapse were compared with those without relapse, HMGA2 expression was significantly higher (p value = 0.048). There was a significant increase in miR-20a-5p expression (p value = 0.002) in the premenopausal group compared to the postmenopausal group, while there was a significant decrease in HMGA2 expression (p value = 0.002). A positive correlation between patient age and HMGA2 and a negative correlation between patient age and miR-20a-5p were found (respectively p value: 0.037 and p value: 0.006). Also, we found a negative correlation between HMGA2 and miR-20a-5p (p value: 0.027, correlation coefficient: -0.350).

Conclusion: To our knowledge, this study is the first to examine the association of the HMGA2 associated HOTAIR axis with breast cancer in cell-free RNA from peripheral blood of patients. Our findings emphasize the potential of the HMGA2 associated HOTAIR axis as a prognostic biomarker and therapeutic target, especially in ER negative, postmenopausal onset, and relapsed breast cancer.

Background/aim: Floods are the most frequent natural disasters and pose direct and indirect health risks, some well-documented and others poorly understood. Epidemiological studies help bridge these gaps and guide effective public health responses.In September 2023, Storm Daniel caused severe flooding in Libya, damaging infrastructure, including healthcare facilities. The disaster affected 250,000 people, displaced 48,000, and claimed 15,000 lives, making it the second deadliest natural disaster of the year. This study aims to assess the characteristics of flood-affected patients to improve disaster preparedness.

Materials and methods: This descriptive study examined disaster victims who visited three clinics established as part of an international aid initiative after the flood disaster in Libya. Data were collected for visits made between September 13, 2023, and November 24, 2023, and categorized by sex, age group, day of visit, and reason for visit.

Results: A total of 5786 clinic visits were recorded between September 13 and November 24, 2023. Among them, 75.3% were male, and the majority of patients (77.0%) were aged 18-64 years. Most visits (69.8%) occurred within 4-30 days' postdisaster. Acute illnesses and symptoms were the most common reason for visit (55.8%), followed by injuries (22.0%), exacerbations of chronic diseases (13.9%), routine follow-ups (7.9%), and mental health issues (0.4%). The most prevalent subcategory was abrasion/laceration/cuts (18.8%), followed by pain (18.7%) and acute respiratory conditions (17.7%).

Conclusion: This study highlights key findings regarding the healthcare needs of disaster victims following the flood disaster in Libya. The health effects of disasters are influenced by various factors, including sociocultural dynamics. Research into disaster-related health impacts can inform and enhance disaster prevention and management strategies, contributing to improved public health resilience.

Background/aim: One mission of medical faculties is training scientists equipped with the necessary knowledge, skills, and attitudes, who can evaluate the scientific research. The aim was to develop a scale for evaluating the level of scientific competence and activity in research assistants.

Materials and methods: The study is a methodological study, conducted in October 2023-May 2024, with 299 research assistants working at Ankara University Faculty of Medicine. The reliability was assessed by item-total correlation and Cronbach-alpha coefficient; construct validity was assessed by EFA. In EFA, principal component analysis, Varimax rotation were used. KMO and Bartlett test p-value were calculated. Groups with eigenvalues greater than one were determined as factors. The ability of the scale score to determine the level of scientific competence and activity was examined by ROC curve analysis. SPSS 30.0 was used; significance was taken as p < 0.05.

Results: KMO value is 0.945, Bartlett's test p is <0.001. Seven items were removed. As a result of Varimax rotation, four sub-dimensions were determined; factor 1 (fourteen items), factor 2 (eight items), factor 3 (four items), factor 4 (three items). Cronbach's alpha coefficient is 0.960, item-total correlation coefficients are greater than 0.3. The mean score was 91.23 ± 23.10. According to the ROC analysis for participation in at least one publication/project, the cut-off point was 92.

Conclusion: The Scientific Competence and Activity Scale consists of 29 items in 4 subdimensions, it is valid, reliable. To generalize its validity and reliability, it is crucial to test the theoretical structure of the scale in various groups.

Background/aim: The aim of our study was to investigate the effectiveness of lumbar stabilization exercises on serum biomarker levels and clinical outcomes in lumbar disc herniation (LDH) patients with and without neurological deficit.

Materials and methods: 40 patients with neurological deficits (WND) and 34 patients without neurological deficits (WOND) diagnosed with LDH were included in this study. The patients' WND and WOND were randomized into stabilization exercises (SE) and general exercises (GE) groups. Stabilization exercises or general exercises were applied for six weeks. Serum levels of tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-4, beta-endorphin (BE), anandamide (AEA), and 2-arachidonoylglycerol (2-AG) were measured using the enzyme-linked immunosorbent assay. All patients filled out the Visual Analog Scale, Oswestry Disability Index, Beck Depression Inventory, and Beck Anxiety Inventory.

Results: In patients WND and WOND, SE did not show any statistically significant difference in relation to TNF-α, IL-1β, IL-6, IL-4, BE, AEA, and 2-AG (p > 0.05). There were no statistically significant differences between the SE and GE groups in pain intensity and disability outcomes in patients WND (p > 0.05). SE group showed greater reductions in depression and anxiety scores compared to the GE group (p < 0.05). In patients WOND, there were no differences in pain, disability, or depression results between the SE and GE groups (p>0.05), whereas the decrease in anxiety score was greater in the SE group (p < 0.05).

Conclusion: Our results demonstrate that no effect of lumbar stabilization exercise is seen on circulating levels of TNF-α, IL-1β, IL-6, IL-4, BE, AEA, and 2-AG. Further exercise trials are needed to investigate what type, duration, and intensity of exercise is relevant for biomarkers that may play a role in the immune process.

Background/aim: We aimed to evaluate the effectiveness of distal versus proximal greater occipital nerve (GON) pulsed radiofrequency (PRF) treatments in patients with episodic or chronic migraine.

Materials and methods: In this prospective, randomized controlled study, sixty participants were randomized to either distal GON PRF (n = 30) or proximal GON PRF (n = 30). Migraine related assessments were conducted at the baseline and at the first, second, and third month.

Results: Baseline characteristics indicated a higher migraine burden in the proximal group, including increased monthly headache frequency (15.0 vs. 9.5 attacks, p = 0.007). Both groups experienced significant reductions in headache duration, severity and frequency over three months (Friedman test, p < 0.001). Notably, the proximal group experienced greater reductions in severe headache frequency at all time points (1st month: p = 0.004; 3rd month: p = 0.022) and total headache days by the third month (14.0 vs. 9.5 days, p = 0.039). The distal group exhibited some advantages in reducing headache severity (VAS), showing a trend toward improvement in the second month (p = 0.055) and achieving statistical significance by the third month (p = 0.011). No unexpected adverse effects were observed in either group.

Conclusion: Both treatments were well-tolerated, with minimal adverse effects. Our findings indicate that both proximal and distal approaches are safe and effective for migraine management. The proximal approach might offer slightly superior outcomes for patients experiencing severe and frequent migraine attacks.

Background/aim: Injection neuropathy (IN) is a rare but preventable form of iatrogenic nerve injury, particularly affecting the sciatic nerve when intramuscular injections are administered incorrectly. While IN is uncommon in high-income countries, it remains a significant public health issue in Türkiye, especially in pediatric populations. The aim of this study is to evaluate pediatric IN cases referred to the Council of Forensic Medicine and highlight medicolegal aspects to inform clinical and legal preventive strategies.

Materials and methods: We retrospectively analyzed 67 pediatric cases (age range: 1-17 years; mean age: 10.5 years; 57 boys, 10 girls) referred to the Council of Forensic Medicine between January 01/01/2015 and January 01/01/2023, due to suspected injection-related sciatic neuropathy. Demographic data, clinical findings, suspected drugs, injection sites, and medicolegal conclusions were reviewed using descriptive statistics.

Results: Sciatic nerve involvement was confirmed in 64 cases. The most frequently implicated drug was diclofenac sodium (n = 38), followed by sulbactam-ampicillin and clindamycin. In 59 cases, complications were identified; 2 cases were classified as malpractice due to incorrect site or technique. Six cases could not be evaluated due to insufficient medical documentation.

Conclusion: Intramuscular injections, especially in pediatric patients, should not be considered routine procedures. Given the potential for severe complications, oral alternatives should be prioritized. When unavoidable, injections must be performed by qualified professionals considering patient age, muscle mass, and anatomical safety. This study underscores the medicolegal importance of accurate technique and documentation to prevent lifelong disability and litigation.

Background/aim: Unilateral atrophic kidney (UAK) could be related to many etiologies that can cause chronic kidney disease in adults. There is limited data on the long-term outcome of adults with UAK in the literature.

Materials and methods: This study included 199 adult patients with UAK. The etiology, baseline clinical/laboratory, and radiological findings were evaluated. Composite primary outcomes (CPO) (chronic kidney disease stage 5 or doubling of serum creatinine) and secondary outcomes (new-onset proteinuria (>0.5 g/day or g/g) or >50% increase in proteinuria level according to baseline, mortality, and nephrectomy requirement during follow-up) were evaluated in 166 patients with at least 3 months of follow-up.

Results: Of 199 patients, 57.3% were female. The mean age at presentation was 44.4 years. Right and left kidney atrophy rates were 51.8% and 48.2%, respectively. Among the known etiologies, the most common was chronic pyelonephritis (17.1%, n = 34). Of 166 patients, 19 had a CPO. Patients with CPO had higher rates of hypertension (p = 0.033), proteinuria (p < 0.001), and renal artery stenosis. Baseline systolic blood pressure (p = 0.004) and serum creatinine (p < 0.001) were higher, and baseline eGFR (p < 0.001) and serum albumin (p = 0.001) were lower in these patients than in patients without CPO. Multivariate logistic regression analysis showed that baseline creatinine (p < 0.001), serum albumin (p = 0.034), and renal artery stenosis (p = 0.015) were independent risk factors for CPO.

Conclusion: Higher baseline serum creatinine and lower serum albumin levels were associated with poor renal prognosis in adult patients with UAK. Also, UAK due to renal artery stenosis might be associated with worse outcomes than UAK related to other etiologies.