Turkish Journal of Medical Sciences最新文献

Background/aim: Video pediatric gait, arms, leg, and spine (v-pGALS) is a virtual application of the pediatric gait, arms, leg, and spine (pGALS) examination performed by video. We aimed to verify the applicability, validity, and accuracy of the Turkish translation of v-pGALS in a large pediatric patient cohort.

Materials and methods: Children aged 4-18 years seen between May and June 2022 were included. A hands-on physical examination and v-pGALS were performed. Demographics, active symptoms, physical examination findings, diagnosis, and v-pGALS findings were recorded. The acceptability of v-pGALS, in terms of additional distress and duration, was measured by the parent/patient using a visual analog scale (VAS).

Results: 102 patients (median age 12.41 years) were included. Juvenile idiopathic arthritis (JIA) was the most common diagnosis. The median duration of v-pGALS was 7 min. An abnormal v-pGALS was identified in 25 patients while the hands-on physical examination was abnormal in 27 patients. Scoliosis and pes planus were missed in v-pGALS. Both children and parents gave a median VAS score of 0 for additional discomfort and duration. That is, the duration of v-pGALS was acceptable for ≥98% of the patients/parents, and ≥98% mentioned that it caused little/no discomfort. The sensitivity and specificity of v-pGALS were 92.6% and 100%, respectively, for the detection of musculoskeletal (MSK) abnormalities.

Conclusion: The v-pGALS is an applicable, accurate, and practical tool for evaluating MSK problems in children. The Turkish translation was also conveniently acceptable.

Background/aim: This study explored the correlation between maternal muscle mass and strength and the mode of delivery in childbirth. Specifically, it focused on full-term nulliparous pregnant women, analyzing ultrasonographic measurements of the quadriceps femoris muscle together with serum myostatin levels and muscle strength as determined by a handgrip test. The aim was to discern whether these factors could influence the likelihood of delivering vaginally or via cesarean section.

Materials and methods: This study included 86 healthy nulliparous women at term, categorizing them into two groups based on their mode of delivery: vaginal delivery (58 women, Group 1) and cesarean section (28 women, Group 2). Comparative analyses of demographic information, delivery characteristics, ultrasonographic measurements of the quadriceps femoris, limb circumferences, handgrip strength, and serum myostatin concentrations were conducted.

Results: The findings revealed that women in Group 1 had less gestational weight gain but greater handgrip strength compared to Group 2. Additionally, women who underwent cesarean section due to nonprogressive labor had greater arm and calf circumferences relative to those who had vaginal deliveries.

Conclusion: The data of this study suggest a trend whereby lower maternal muscle strength and mass are associated with a decreased likelihood of vaginal delivery in pregnant women.

Background/aim: WW domain-containing oxidoreductase (WWOX) loss frequently occurs in triple-negative breast cancer (TNBC). WWOX loss enhances cisplatin resistance in TNBC patients. Although WWOX loss has an effect on the selection of a DNA repair pathway that contributes to enhanced mutagenesis, the downstream expression changes in resistant cancer cells have not been fully explored. This study aimed to investigate the potential role of microRNAs (miRNAs) in the regulation of cisplatin resistance in WWOX-deficient TNBC cells.

Materials and methods: Transient transfections were performed to overexpress WWOX in MDA-MB-231 cells. WWOX-overexpressing MDA-MB-231 cells were determined by western blot. Expression profiling of the miRNA was assessed via real-time polymerase chain reaction.

Results: miRNA expression profiling of WWOX-deficient and -sufficient MDA-MB-231 cells revealed that miR-182 upregulation and miR-214 downregulation were markedly positively associated with cisplatin resistance of WWOX-deficient MDA-MB-231 cells. An elevated expression of miR-182 and decreased expression of miR-214 may contribute to cisplatin resistance in WWOX-absent MDA-MB-231 cells by signaling pathway dysregulation of DNA repair/apoptosis/ protein kinase B (AKT).

Conclusion: The results emphasize that WWOX deficiency promotes resistance to cisplatin in TNBC cells and the possible predicting biomarker of WWOX for resistance to cisplatin.

Background/aim: The sacroiliac joint (SIJ) is a frequently overlooked source of lower back pain (LBP). Recently, it has gained recognition as a significant pain generator, prompting increased interest in surgeries targeting this area. Traditionally, open SIJ fusion was used to stabilize pelvic and sacral fractures, and then it was adapted for use in pain management until the development of minimally invasive surgery (MIS). Revolutionizing the field, MIS offers fast and effective pain relief with significantly less risk of postsurgical adverse events, thereby gaining increased attention among surgeons. This review aims to highlight the current advancements in the literature regarding MIS SIJ fusion.

Conclusion: The current literature demonstrates the superiority of MIS over open surgery with satisfactory patient outcomes and significantly lower complication rates. With the advancement in navigation and the inclusion of robotic assistance, MIS SIJ fusion is expected to become more ergonomically feasible for surgeons and shorten the learning curve for new trainees worldwide.

Background/aim: Hyoscine-N-butylbromide (HBB) is an anticholinergic agent widely used to treat pain caused by spasms in the gastrointestinal and urogenital systems. The aim of this study was to compare the efficacy of HBB with a placebo in treating abdominal cramping pain caused by acute gastroenteritis in the emergency department (ED).

Materials and methods: This was a prospective, double-blind, placebo-controlled, randomized trial conducted in a single-center academic ED from September to November 2021. Patients aged 18-65 years with acute gastroenteritis symptoms were included. The study compared the efficacy of intravenous HBB (20 mg) to a placebo. The primary outcome was the absolute change in pain score at 30 min after treatment, with secondary outcomes including pain relief at 60 min, adverse events, and the need for rescue analgesics.

Results: Fifty patients were randomized (25 in each group). There was no significant difference in 30-min and 60-min pain scores between the groups. At 60 min, pain reduction and the need for rescue analgesia were similar in both groups. Changes in pain scores from admission to 30 and 60 min did not significantly differ between the groups.

Conclusion: Intravenous HBB did not show a statistically or clinically significant difference in pain reduction compared to a placebo in patients with acute gastroenteritis and cramping abdominal pain in the ED.

Background/aim: The p53 protein, a crucial tumor suppressor, governs cell cycle regulation and apoptosis. Similarly, p63, a member of the p53 family, exhibits traits of both tumor suppression and oncogenic behavior through its isoforms. However, the functional impact of ΔNp63β, an isoform of the p63 protein, on human glioma cancer cells like T98G cells remains poorly understood, representing the novelty of this study in the current literature.

Materials and methods: Employing the pRetroX-Tet-On vector system, the apoptotic effects of ΔNp63β on T98G cell lines was investigated and its influence on the cell cycle was assessed. Initially, an rtTA-expressing vector, a component of the pRetroX-Tet-On system, was established in the T98G cell lines. Subsequently, the ΔNp63β cDNA was cloned into the Retropur Tight retroviral vector and transfected into T98G cells containing the pRetroX-Tet-On system for functional analysis. The gene expression and cell cycle regulation were evaluated through reverse-transcription polymerase chain reaction and flow cytometry, determining protein translation via western blotting. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and β-galactosidase cell staining were employed to assess the cytotoxicity and senescence of ΔNp63β, respectively.

Results: The overexpression of ΔNp63β in the T98G cells correlated with increased cell viability and altered cell cycle regulation, notably upregulating the p21 expression independent of p53. Caspase-3/7 activity analyses showed no changes in the apoptotic genes but revealed an increase in antiapoptotic gene expression. Surprisingly, cell death in the ΔNp63β-overexpressing T98G cells did not occur through apoptosis as anticipated. Instead, it resulted from the cytotoxic effects of the ΔNp63β protein.

Conclusion: Δp63β increased the p21 levels, induced cell death, and caused cell cycle arrest at the G1 phase, while exhibiting antiapoptotic properties and promoting senescence. Unexpectedly, overexpression of Δp63β in T98G cells led to significant cell death, potentially through necrosis rather than apoptosis, suggesting a complex role for Δp63β in cell cycle regulation and tumor suppression.

Background/aim: Fall risk assessment is crucial for older adults because falls are associated with morbidity and mortality. This study investigated the relationship of gait speed (GS) and handgrip strength (HGS) with falls and assessed whether cognition mediates this causality.

Materials and methods: The study was conducted in a tertiary referral geriatric outpatient clinic. The physical performance of participants was evaluated by GS and HGS. All falls in the previous year were noted and factors associated with falls were analyzed using multivariate regression analysis.

Results: A total of 1018 older adults with a mean age of 78.8 ± 7.2 years, 64.2% of whom were female, were stratified into two groups: those who were cognitively impaired (n = 331) and those who were cognitively healthy (n = 660). In the study population, 22.8% (n = 226) had a history of falls in the previous year. The rates of low GS and HGS were 29.1% and 80.6%, respectively. After adjusting for confounding factors, low GS (OR = 2.01, 95% CI: 1.10-3.77, p = 0.019), low HGS (OR = 3.57, 95% CI: 1.10-11.35, p = 0.038), and low GS plus low HGS (OR = 4.52, 95% CI: 1.14-15.78, p = 0.024) in the cognitively impaired group and low GS (OR = 2.13, 95% CI: 1.39-3.52, p = 0.003) in the cognitively healthy group were independently associated with falls.

Conclusion: GS is an efficient and practical assessment tool for identifying older adults at risk of falls regardless of their cognitive status.

Background/aim: Despite Türkiye's relatively young population, there is an emerging trend of earlier diagnoses of chronic diseases, including heart failure (HF). This study aims to shed light on survival rates, potential influences of guideline-directed therapies, and sex-based differences necessitating personalized management in HF.

Materials and methods: We conducted a nationwide retrospective cohort analysis of 2,722,151 patients with HF using deidentified data from the Turkish Ministry of Health's national electronic database. That cohort included 2,701,099 adult patients with HF. Adult patients were divided into two groups based on their outcomes as those who were deceased and those who survived and were then compared. Multivariate regression analysis was conducted to identify variables predicting mortality. The patients' hospital admissions and length of hospital stay were analyzed based on survival status and age.

Results: Out of 2,722,151 HF patients, the overall mortality rate was 33.7%, with a difference observed according to sex (32.5% in female patients, 35.0% in male patients). Survival rates at 1, 5, and 7 years after the HF diagnosis were detailed. Deceased HF patients had more comorbidities, higher natriuretic peptides, and lower glomerular filtration rates. Hospitalization patterns varied, with 41% experiencing no hospitalization. The average length of hospital stay in 2022 was 6 days, with sex- and age-specific disparities.

Conclusion: The survival rate of HF in Türkiye is similar to world data. The survival of female patients is better than that of male patients. Increased survival rates can likely be attributed to the widespread use of guideline-directed therapies. Finally, high healthcare utilization is observed, especially in emergency situations.

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.