Turkish Journal of Medical Sciences最新文献

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: 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: The relation between the demographic characteristics of individuals and their health-seeking behaviors was presented and the effects of health cognitions, healthy lifestyle behaviors, and coronavirus fear levels on health-seeking behaviors during the COVID-19 pandemic were examined.

Materials and methods: This descriptive survey study was conducted in the Tuzla District of İstanbul, Türkiye, between March and June 2021.

Results: From analysis of the 391 participants, 60.0% were females, 27.1% were between 31 and 40 years of age, 47.0% were healthcare professionals, and the perceived socioeconomic status of 50.9% was above average. According to the results, the women exhibited more health-seeking behavior than the men (p < 0.05). While the young participants showed more online health-seeking behavior (p < 0.05), the older ones showed greater health responsibility (p < 0.05). The participants with a high level of education exhibited traditional health-seeking behavior (p < 0.05) more than the others, and below-low socioeconomic status increased the COVID-19 fear level 1.94 times (95.0% CI: 1.08-3.48). The Health-Seeking Behavior Scale (HSBS) score was related to the Health Cognitions Questionnaire (HCQ) (p < 0.0001) and the Healthy Lifestyle Behaviors Scale-II (HLBS-II) scores (p = 0.002; Table 3). While the HSBS score was positively associated with an increase in the HCQ score and HLBS-II score (p < 0.05), the HSBS score was not significantly related to the Fear of COVID-19 Scale score (p > 0.05).

Conclusion: While fear of COVID-19 was not significantly influential, health cognitions and healthy lifestyle behaviors were the main factors that led to health-seeking behavior during the COVID-19 pandemic.

Background/aim: Migraine is a prevalent neurological disorder that can lead to disability in children and adolescents. It is frequently accompanied by psychiatric comorbidities, both internalizing and externalizing disorders. While the relationship between migraine and internalizing disorders has been studied, there is limited research on the link between migraine and attention deficit hyperactivity disorder (ADHD).

Materials and methods: A total of 280 pediatric headache patients, 107 with externalizing (ADHD) and 173 with internalizing disorders (depression and/or anxiety), were included. The dataset was composed using the Turkish headache database, Mersin Branch. Pain characteristics, associated symptoms, and accompanying comorbidities were evaluated retrospectively.

Results: Two hundred four patients were followed up with episodic migraine (EM) and 76 patients with chronic migraine (CM). One hundred forty-six boys and 134 girls were evaluated, and internalizing disorders were more common in the girls (p < 0.001). It was a much more prominent accompaniment in chronic migraine internalizing disorders (p = 0.038). EM, on the other hand, was more frequent in ADHD. Pain intensity and frequency were greater in those with internalizing disorders (p = 0.007), while photophobia was more prevalent in those with ADHD (OR; 0.555, p = 0.044). Moreover, we observed that individuals with internalizing disorders were predominantly female (p = 0.003) and had a higher mean age (p < 0.001) than those with externalizing disorders.

Conclusion: Internalizing disorders seem to be a risk factor for migraine chronification in pediatric migraine. ADHD is a prototypic externalizing disorder more associated with EM. This outcome provides an opportunity to follow our patients in terms of prognosis and offers us the chance for a better evaluation. Identifying factors that contribute to the chronicity of migraine may lead to better management and reduced disability for migraine sufferers.

Background/aim: The comparative risk of gastrointestinal bleeding (GIB) among users of direct-acting oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) is a topic of ongoing debate. This study leverages a comprehensive national health database to evaluate the incidence of GIB, associated risk factors, and postbleeding management strategies among anticoagulated patients.

Materials and methods: Utilizing the Turkish Ministry of Health's e-Nabız system, we conducted a retrospective analysis of patients treated with DOACs and warfarin from January 2017 to July 2023. GIB events were identified using ICD codes, and comorbidities, prior medication use, interventions, and mortality rates were analyzed. Drug survival and patterns of changes following GIB were also evaluated.

Results: Among 102,545 patients with a GIB event during anticoagulant treatment, DOAC users were older with a higher prevalence of comorbidities, except for chronic obstructive lung disease, compared to VKA users. GIB-related mortality was 0.6% in the DOAC group and 0.4% in the VKA group at admission after the GIB (p < 0.01). In all drug groups, approximately half of the patients discontinued anticoagulation due to GIB after 3 months, the rate being highest with apixaban (61.9%). In patients who continued anticoagulation, the anticoagulant prior to GIB remained the most common agent in all groups, with rivaroxaban having the highest retention rate (40.7%).

Conclusion: This nationwide study indicates a higher frequency of GIB in DOAC users versus VKA users, with age and comorbidities potentially contributing to this trend. Mortality rates were comparable to the previous literature but warrant further investigation. The significant rate of discontinuation following GIB raises concerns about ongoing anticoagulation management. These findings underscore the need for cautious case management.

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: Zinc is a structural component of some enzymes. The aim of this study was to evaluate the potential associations between serum zinc and oxidative stress levels and periodontal inflamed surface area (PISA).

Materials and methods: This study included 90 patients divided into three groups: a periodontitis group (P; n = 30), a gingivitis group (G; n = 30), and a periodontal health group (PH; n = 30). Periodontal parameters were recorded and PISA values were calculated. Serum total antioxidant status (TAS), total oxidant status (TOS), and zinc levels were examined biochemically. Oxidative stress index (OSI) levels were calculated.

Results: All clinical periodontal parameters, periodontal epithelium surface area, and PISA values were lower in the PH group than the P and G groups (p < 0.05). Serum zinc and TAS values were higher in the PH group than the P and G groups (p < 0.05). Serum TOS and OSI values were lower in the PH group than the G and P groups (p < 0.05). Serum OSI levels were lower in the G group than the P group (p < 0.05). PISA was associated with serum zinc (β = -28.96, 95% CI = (-38.95, -18.98), p < 0.001) and OSI (β = 89.84, 95% CI = (20.63, 159.05), p = 0.011) levels in the multivariate generalized linear model.

Conclusion: PISA values were associated with decreasing serum zinc and TAS and increased TOS and OSI levels. Zinc deficiency can be associated with the severity of periodontal disease and higher oxidative stress levels.

Background/aim: Innate-like T lymphocytes are a recently defined group of T cells comprising mainly mucosa-associated invariant T (MAIT) cells. The relationship between MAIT cells and childhood asthma is controversial. In this study, we aimed to determine the role of MAIT cells in patients with allergic asthma (AA) and nonallergic asthma (NAA). This is the first study to compare the ratios of these cells in patients with AA and NAA.

Materials and methods: The study included children aged 6-18 years with AA (n = 41) or NAA (n = 30) and healthy control subjects (n = 36). The control group consisted of children who presented to the outpatient clinic without chronic disease, malnutrition, or acute or chronic infection. The proportions of MAIT, TH17, MAIT-17, and Th17-17 cells were investigated by flow cytometry and compared among the AA, NAA, and control groups.

Results: When the AA and NAA patient groups were compared, the mean MAIT cell ratio was significantly lower in NAA patients (median: 0.45, p < 0.05). MAIT cell ratios were also substantially lower in NAA patients compared to the control group (mean: 0.504, p < 0.05). TH17, MAIT-17, and TH17-17 cell values were not statistically significant among the groups.

Conclusion: Our study found that MAIT cell ratios were lower in the NAA patient group compared to the control group and AA patients. It has been predicted that MAIT cell depletion may have a role in the development of NAA. Our study is the first on this subject in the literature and further studies are needed.

Background/aim: The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram was developed to predict survivorship in gastric cancer patients undergoing R0 resection. This study aimed to evaluate the predictive power of this nomogram in the Turkish patient population.

Materials and methods: Gastric cancer patients over 18 years of age who were admitted to our clinic between 2000 and 2019 and underwent primary curative surgery and R0 resection were included in the study. The 5- and 9-year overall survival (OS) rates of 489 patients were analyzed. Real-life survival rates and those calculated using the MSKCC tool were compared in all the patients and subgroups. The relationship between the variables and survival were analyzed.

Results: The 5-year median observed OS rate for all the patients was 51.7%, while the 5-year median OS rate calculated using the MSKCC tool was 48.5%. The difference between the expected and observed survival rates was 3.2%. The rates were similar and there was no statistically significant difference (p = 0.31). The 9-year median observed OS rate for all the patients was 41.4%, while the 5-year median OS rate calculated using the MSKCC tool was 41%. The difference between the expected and observed survival rates was 0.4%. The rates were similar and there was no statistically significant difference (p = 0.9).

Conclusion: The 5- and 9-year survival rates estimated using the MSKCC tool were correlated with the 5- and 9-year survival rates in the real-life data. Hence, the use of the MSKCC prognostic tool in clinical practice should be expanded.

Background/aim: Increasing international migration poses unique challenges, especially regarding health outcomes and behaviors such as substance use. This study aims to identify risk factors influencing substance use among Turkish-origin immigrants in Germany.

Materials and methods: Data were obtained from the STEPS survey conducted by the Presidency for Turks Abroad and Related Communities (YTB) in 2021 in Germany. A total of 1157 participants were selected through a quota sampling method. Data analysis involved descriptive statistics and logistic regression utilizing IBM SPSS Statistics 21.

Results: The study found a significant association between substance use and variables such as generation status, age, and sex. Third-generation immigrants showed a higher propensity for substance use compared to the first and second generations. Significant relationships were also observed between substance use and other risk behaviors such as tobacco and alcohol consumption.

Conclusion: Substance use among Turkish-origin immigrants in Germany is influenced by generational status, with younger and third-generation individuals being at higher risk. Additionally, tobacco and alcohol use are strong predictors of substance use, highlighting the need for targeted interventions, especially for young migrants.