Turkish Journal of Medical Sciences最新文献

Background/aim: Thoracic paravertebral block (TPVB) is a well-established procedure for the management of postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). In recent years, there have been studies suggesting that fascial plane blocks may be an alternative to TPVB. The objective of our study was to determine the efficacy of combined deep and superficial serratus anterior block (C-SAPB) as an alternative to TPVB in the management of postoperative analgesia in VATS.

Materials and methods: The patients were divided into two groups: the TPVB group and the C-SAPB group. Both groups were administered the same dose of local anesthetics. Multimodal analgesia was achieved for the groups. The primary outcome measure was visual analog scale (VAS) pain scores recorded within the first 48 h of the postoperative period in each group. The secondary outcomes were analgesic requirement, rescue analgesics, complications rate, and postoperative patient satisfaction.

Results: Thirty patients with C-SAPB and 30 patients with TPVB were analysed. VAS rest and VAS coughing scores were similar between the groups (p > 0.05). Demographic and side effect conditions, total morphine use, additional analgesic needs, vital parameters, block procedure time, and patient satisfaction were also similar between the groups (p > 0.05). Additionally, although block application times were comparable, the time was slightly shorter in C-SAPB.

Conclusion: Similar analgesic efficacy was observed between C-SAPB and TPVB. TPVB maintains its place among the first choices in VATS. The efficacy of C-SAPB is comparable to that of TPVB. While the duration of C-SAPB application is not a significant factor, the brief nature of the procedure and its straightforward administration suggest that it may be an effective method.

Background/aim: Physicians work under high levels of stress due to factors such as excessive workload, emotional factors, and economic variables. This leads to various health problems such as depression, burnout, fatigue, and hopelessness, resulting in decreased interest in a medical career and an increase in career choice regret.

Materials and methods: The study included 300 volunteer resident physicians from Ankara University Medical Faculty Hospital. The data for the research were collected using a survey form prepared by reviewing the literature. The survey consisted of three parts, which questioned the physicians' sociodemographic characteristics and professional choices, including the Depression Anxiety Stress Scale-Short Form (DASS-21) items and the Decision Regret Scale.

Results: Of the physicians, 216 (72.0%) chose the medical faculty due to personal preference. The percentage of those who were not regretful about their career choice was 14.3% (n = 43). Those not regretful about their career choice had fewer years in the profession than the others. According to the categorical assessment of the DASS-21, 73.7% (n = 221) of the physicians had depressive symptoms ranging from mild to severe, 78.7% (n = 236) had anxiety symptoms ranging from mild to severe, and 57.7% (n = 173) had stress symptoms ranging from mild to severe.

Conclusion: Mental health problems such as depression, anxiety, and stress were common among the resident physicians independent of their sociodemographic characteristics, and this was also associated with the level of career regret. Improving working conditions and personal benefits, addressing economic and other issues for physicians, ensuring their well-being, preventing the development of mental health problems, and early screening and rehabilitation for those affected not only have personal benefits but also contribute positively to job satisfaction, strengthen the patient-physician relationship, and have a significant impact on healthcare services.

Background/aim: Menopause is often accompanied by neurological symptoms, including cognitive difficulties, especially with memory and attention. The purpose of the present study was to examine the relationship between the timing of menopause and the cognitive performance of menopausal patients who applied to our neurology clinic with complaints of forgetfulness.

Materials and methods: The data of 538 women who applied to the neurology clinic with complaints of forgetfulness between January 2018 and January 2024 and underwent neuropsychological evaluations were scanned retrospectively. A total of 96 patients who applied to the neurology and menopause clinics were included in the study.

Results: The attention orientation, verbal fluency, memory, and total Addenbrooke's cognitive evaluation battery-revised (ACE-R) test scores were significantly higher in the >50-year-old menopausal group when compared to the other groups (p < 0.001). A statistically significant, negative, and weak relationship was detected between the body mass index (BMI) and memory scores (r = 0.3, p < 0.001). A statistically significant, positive, and weak relationship was detected between the high-density lipoprotein level and verbal fluency score, memory score and ACE-R score (r = 0.3, p < 0.001). A statistically significant, negative, and weak relationship was detected between the BMI and memory scores (r = 0.3, p < 0.001).

Conclusion: The relationship between the cognitive performance of menopausal women and the timing of menopause was examined herein. The ACE-R, attention and orientation, visual, verbal fluency, and memory scores were significantly higher in women ≥50 years of age who entered menopause compared to those <40 years of age and those between 40 and 50 years of age. This study provides evidence that advancing age at menopause is associated with better cognitive performance. This relationship is most evident in the areas of the attention, verbal fluency, memory, and visuospatial domains.

Background/aim: There are insufficient tools to assist in the diagnosis and treatment of vestibular migraine. Hence, the aim of this study was to perform the Turkish adaptation of the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI).

Materials and methods: After the language and content validity was completed, a pilot study was conducted. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to test construct validity, and as a result of the validity analyses, Cronbach's alpha internal consistency coefficient and test-retest analyses were conducted for reliability.

Results: In the study, in which 289 participants were evaluated, the Kaiser-Meyer-Olkin coefficient was calculated as 0.903. The percentage of variance explained by the EFA was 67.246% and the range of factor load change was 0.433-0.828. The scale structure was tested with CFA and the model was confirmed with adequate goodness of fit index values. The Cronbach's alpha internal consistency coefficient of the scale was 0.931.

Conclusion: The VM-PATHI is a valid and reliable tool for the subjective evaluation of vestibular migraine in Türkiye.

Background/aim: The evolution of sickle cell disease (SCD) is marked by the occurrence of painful episodes linked to the obstruction of microvessels by sickle cells, known as vaso-occlusive crisis (VOC). The aim of this work was to report the practical aspects of the management of acute pain in adults with SCD. Recommendations based on these practices are also provided.

Materials and methods: This prospective, cross-sectional, descriptive, and analytical study was conducted over a four-month period of all sickle cell patients admitted to emergency departments for VOC. The parameters studied were sociodemographic, clinicobiological, therapeutic, and evolutionary.

Results: There were 118 cases of VOC identified, representing a prevalence of 78.14% of sickle cell emergencies. The mean age of the patients was 28.41 years. The SS sickle cell phenotype accounted for 86.61% of the cases. Osteoarticular pain was the reason for admission for 88.39% of the patients; it was located in the lower limbs in 39.08% and in the spine in 27.1%. Pain intensity was moderate in 6.25% of the patients, intense in 31.25%, and unbearable in 55.55%. Multimodal analgesia was the most commonly used treatment method, combining those of levels one and two (74.31%) and levels one and three (8.25%). The mean dose of morphine administered was 17.14 mg when morphine alone was prescribed for titration, 13.57 mg when paracetamol and morphine were combined, and 15.83 mg when nefopam and morphine were combined. Clinical outcome was favorable in 68.87% of the cases.

Conclusion: Wide variability was observed in the modalities of analgesic treatment of sickle cell VOC. These variations reflect different views on the appropriateness of opioids. This study highlights the efficacy of multimodal analgesia in the management of acute pain in patients with SCD, particularly in regard to morphine sparing. Context-specific recommendations will be needed to harmonize practices.

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: The transfusion of blood products is a life-saving clinical practice in patients with bleeding, hemoglobinopathy, and cancer. It was aimed herein to analyze the frequency and types of blood component-related acute transfusion reactions (ATRs) in pediatric patients.

Materials and methods: This retrospective study was conducted at a tertiary care academic pediatric hospital.

Results: During the study period, 30,811 transfusions were administered to 25,448 patients. There were 103 ATRs detected in 81 patients (0.33%; 3.34 reactions per 1000 transfusions, mean age 8.3 ± 5.98 years, 36 females and 45 males). All the reactions were observed within an average of 4 h after the transfusion began. The most common ATRs were allergic reactions (79; 76.6%) and febrile nonhemolytic transfusion reactions (12; 11.6%). All the allergic transfusion reactions occurred within the first hour after the start of the transfusion. Granulocyte concentrates were the blood component associated with the highest ATR rate (2.1%).

Conclusion: Within our hospital, pediatric hematology-oncology wards and the stem cell transplantation unit had the most frequent ATR reports; therefore, when transfusions are carried out, increased attention should be given to these units. Educating health staff about the adverse effects of transfusion therapy should increase the awareness and reporting of ATRs in children.

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: This study aimed to compare the results of Pemberton osteotomy (PO), Salter innominate osteotomy (SO), open reduction (OR), and closed reduction (CR) applied in the treatment of developmental dysplasia of the hip (DDH).

Materials and methods: Included in the study were 101 hips of 82 patients treated at our orthopedic clinic between 2017 and 2023. The patients were evaluated preoperatively, postoperatively, and at the final follow-up. The results were evaluated based on Barret's clinical and Severin's radiological classifications. Those who developed avascular necrosis (AVN) were evaluated based on Bucholz-Ogden's classification.

Results: In terms of the preoperative acetabular angles (AAs), those for hips treated with PO were significantly higher than those of the other three, and those treated with SO were significantly higher than those of the other two (OR and CR) (p < 0.001). There was a significant difference in the final follow-up AAs of those treated with SO and PO compared to those treated with OR and CR (p < 0.001). The best corrections were achieved with PO (average: 27.94 ± 4.89°). There was a significant difference between PO and OR, and PO and CR in terms of the preoperative collodiaphyseal angles (CDAs) (p < 0.05). The greatest decrease was in those treated with PO (average: 22.44 ± 9.45°). AVN developed at various stages in 15 of 79 hips (14.85%) that were treated surgically. While AVN developed at a rate of 22.22% with PO, 18.18% with SO, and 17.85% with OR, no AVN developed in the 22 hips treated with CR.

Conclusion: Understanding normal and abnormal values by age is essential for selecting appropriate treatments. Acetabulum-related surgeries should be planned for patients over 1.5 years of age with an AA above 30°. Early diagnosis and CR treatments yield excellent results and low AVN rates. Various DDH treatments in our clinic have shown low AVN rates, indicating safety and efficacy.