Turkish Journal of Medical Sciences最新文献

Background/aim: Exploratory methods in neuroimaging are gaining increasing attention for revealing functional connectivity structures across the entire brain. This study aims to contribute to the understanding of the functional mechanisms underlying dyslexia, along with the effects of specialized education for dyslexia treatment, by utilizing measures such as regional homogeneity (ReHo), amplitude of low-frequency fluctuations (ALFF), and fractional ALFF (fALFF).

Materials and methods: Resting-state functional magnetic resonance imaging data were collected from three groups of Turkish-speaking children aged 7-12: diagnosed with dyslexia for the first time (Dys, n = 19), children with dyslexia who received specialized education (EDys, n = 20), and healthy controls (HC, n = 27). In the study, brain activation in individuals with dyslexia was examined through resting-state analyses employing the ReHo, ALFF, and fALFF methods.

Results: Significant reductions in ReHo and ALFF values were observed in brain regions associated with phonological processing and visuomotor integration in children with dyslexia. These findings indicate altered neural synchronization related to cognitive deficits in reading and language processing. Compared to HC, children with Dys showed significantly reduced ReHo and ALFF values in the left precuneus and middle frontal gyrus, while those EDys exhibited compensatory increases in calcarine and lingual gyri.

Conclusion: This study provides valuable insights into the resting-state neural connectivity of individuals with dyslexia, highlighting the impact of specialized educational programs in treating dyslexia. Our findings contribute to understanding the altered connectivity foundations of dyslexia compared to healthy children and support the development of educational interventions within this framework.

Background/aim: Acute methanol poisoning (MP) poses a significant public health challenge, with inflammation increasingly recognized as a key factor in its pathophysiology. Identifying accessible and reliable prognostic biomarkers could help enhance clinical outcomes. This study aimed to assess the prognostic value of the systemic immune-inflammation index (SII) and the pan-immune-inflammation value (PIV), measured upon emergency department admission, in predicting in-hospital mortality in patients with acute MP.

Material and methods: This retrospective study included patients diagnosed with acute MP at two tertiary care centers in Ankara, Türkiye: University of Health Sciences Dışkapı Yıldırım Beyazıt Education and Research Hospital (1 January 2015 to 1 October 2022) and Etlik City Hospital (1 October 2022 to 11 March 2025). Demographic, clinical, and laboratory data, along with treatment details and outcomes (discharge or inhospital death), were systematically recorded.

Results: A total of 76 patients were included, of whom 92.1% were male, with a mean age of 49.0 ± 12.4 years. During hospitalization, 48.6% (n = 37) died. Both SII and PIV values at admission were significantly higher in nonsurvivors (p < 0.001 for SII; p = 0.031 for PIV). In multivariate Cox regression analysis, higher SII (HR: 2.44; 95% CI: 1.05-5.67; p = 0.034) and PIV (HR: 2.08; 95% CI: 1.05-4.13; p = 0.030) were independently associated with increased risk of mortality. Receiver operating characteristic (ROC) analysis showed an AUC of 0.750 (95% CI: 0.649-0.865) for SII, with an optimal cutoff of 665.6 (sensitivity: 50%; specificity: 46%), and an AUC of 0.640 (95% CI: 0.519-0.769) for PIV, with an optimal cutoff of 512.5 (sensitivity: 53%; specificity: 47%).

Conclusion: SII and PIV measured at hospital admission may have potential prognostic value in predicting inhospital mortality in patients with acute MP.

Background/aim: To determine the frequency and reasons for appointment nonattendance in a state hospital and a dental health center in a densely populated district of Türkiye, and to identify related factors to guide preventive measures.

Materials and methods: This retrospective cross-sectional study included patients who scheduled appointments at Ankara Etimesgut State Hospital and Etimesgut Oral and Dental Health Center through the Centralized Patient Appointment System (Merkezi Hekim Randevu Sistemi; MHRS) in February 2024. Nonattendees were contacted in March 2024 to determine reasons for nonattendance.

Results: A total of 30,552 appointments were analyzed (1978 dental, 28,574 hospital). The overall nonattendance rate was 9.76%, with significantly higher rates in the dental center (23.8%) compared to the state hospital (2.2%) (p < 0.001). Males had higher nonattendance rates than females (4.04% versus 3.36%, p = 0.002), and the 19-45 age group showed the highest nonattendance (5.63%, p < 0.001). The most common reasons were forgetfulness (20.7%), scheduling conflicts (16.5%), and illness (13.8%).

Conclusion: Appointment nonattendance is influenced by demographics and timing. Comprehensive reminder systems and flexible scheduling policies may effectively reduce nonattendance rates, particularly among young adults, thereby improving patient adherence and healthcare resource utilization.

The vestibular system is one of the three main systems responsible for maintaining balance and posture. Accurate vestibular inputs enable the perception of the head's position and movement in space, and ensure coordination between head movements, eye movements, balance, and posture. Any dysfunction in the peripheral vestibular end organs, the vestibular nerve, or the central vestibular system may lead to vertigo, dizziness, and gait disturbances in individuals. Some syndromes that cause vertigo symptoms can be life threatening. Although peripheral vestibular pathologies are generally benign, they can reduce patients' quality of life, cause falls, and hinder independence. Therefore, the diagnosis and management of vestibular disorders are of great importance. However, due to the complex structure of the vestibular system and the complexity of its symptoms, some vestibular diseases may go undiagnosed or be misdiagnosed. Machine learning (ML), a subfield of artificial intelligence, enables computer systems to learn patterns and relationships from data and make predictions or decisions. The growing capabilities of ML in data processing combined with the needs of healthcare, offer significant opportunities in early diagnosis of diseases, treatment planning, and personalization of healthcare services. The present review provides a general overview of the prediction of vestibular disorders using ML.

Background/aim: Olfaction is necessary for healthy sexual intercourse. Better smell has been associated with a more positive sexual experience.

Materials and methods: In this cross-sectional study, 40 patients diagnosed with a smell disorder and 60 healthy volunteers were included. The participants were divided into 2 groups according to sex. The female group had 19 patients and 25 female controls. The male group had 21 patients and 35 male controls. Sniffin' Sticks tests, the World Health Organization quality of life assessment (WHOQOL), and hospital anxiety and depression scale (HADS) were applied to all participants. In addition, the international index of erectile function (IIEF) was applied to male participants, and the female sexual function index (FSFI) to female participants. The relationship between the Sniffin' Sticks test and the WHOQOL, FSFI, IIEF, and HADS scores in both groups was analyzed statistically.

Results: Hyposmic men scored significantly lower on all IIEF subscales (p < 0.001), while hyposmic women scored significantly lower on all FSFI subscales (p < 0.001).Multivariate logistic regression analysis in men showed 4.9 times lower overall satisfaction (95% CI 1.8-10.1) in hyposmic versus normosmic patients (p = 0.003). Satisfaction was 2.7 times lower (95% CI 1.5-4.8) in hyposmic women compared to normosmic women (p = 0.001).

Conclusions: Both IIEF and FSFI were significantly lower in the hyposmic group. This supports previous research showing that decreased olfactory function is associated with decreased sexual function.

Background/aim: Pulmonary metastasectomy (PM) is a crucial intervention for patients with metastatic sarcomas, particularly among pediatric populations. The timing of PM and its impact on survival outcomes remain a subject of debate in the literature. This study aims to evaluate the impact of PM on survival outcomes.

Materials and methods: This retrospective study included pediatric patients diagnosed with sarcomas who underwent pulmonary metastasectomy. Demographic and clinical characteristics, including age, sex, primary malignancy type, metastasis presence at diagnosis, chemotherapy response, and PM details (e.g., number and laterality of metastatic nodules, time from metastasis detection to surgery) were analyzed. Survival data were assessed using Kaplan-Meier curves and Cox regression analysis, and statistical significance was determined using log-rank tests.

Results: A total of 29 patients (51.7% male, 48.3% female) were included, with 55.2% presenting with metastasis at diagnosis. Overall, 47 surgical procedures were performed. The 5-year survival rate following PM was significantly higher for patients who underwent surgery within 30 days of metastasis detection (75.26%) compared to those who had surgery later (35.88%, p = 0.031). In univariate analysis, both 5-year survival after nodule detection and 5-year survival after metastasectomy were better in patients who underwent PM within the first 30 days (p = 0.022 and p = 0.039, respectively). Additionally, the number of metastatic nodules (< 10 versus ≥ 10) and the number of nodules per operation (< 3 versus ≥ 3) were significant factors influencing survival. Patients with fewer metastatic nodules exhibited better 5-year survival rates. The survival outcomes were comparable across different sarcoma subtypes, including osteosarcoma, Ewing sarcoma, and synovial sarcoma.

Conclusion: Our study suggests that early pulmonary metastasectomy, performed within 30 days of metastasis detection, improves 5-year survival in pediatric sarcoma patients. The number of metastatic nodules and the timing of surgery are critical factors in determining survival outcomes. These findings highlight the importance of timely surgical intervention and careful evaluation of metastasis extent in optimizing patient prognosis.

Background/aim: The child oral and motor proficiency scale (ChOMPS) is a parent-reported assessment that evaluates a child's eating and drinking skills within the framework of all related motor functions. It has been found to be useful in research studies and recommended in reviews. The purpose of this study was to perform the translation and cultural adaptation of the English version of the ChOMPS to Turkish and conduct psychometric testing of the ChOMPS-Turkish version, including reliability and validity.

Materials and methods: This study was conducted with 185 children. Cronbach's α, corrected item-to-total correlations, coefficient of variation, and Cronbach's α when one item was deleted were used to assess internal consistency. In addition, test-retest reliability was assessed. The functional oral intake scale (FOIS) and pediatric eating assessment tool-10 (Pedi-EAT-10) scales were used for convergent validity. Moreover, Pedi-EAT-10 score was used to perform the receiver operating characteristic (ROC) curve analysis and the sensitivity and specificity of ChOMPS-Turkish version were calculated.

Results: It was found that the ChOMPS-Turkish version demonstrated acceptable validity and reliability. Cronbach's α levels were excellent (0.969 and 0.973), and test-retest reliability demonstrated very high agreement (0.997-0.999; p < 0.001). Significant good-to-excellent correlations were found between the validation scales. In addition, the total ChOMPS-Turkish version score for dysphagia risk as estimated using Pedi-EAT-10 had 94.74% sensitivity and 80.28% specificity.

Conclusion: The ChOMPS-Turkish version demonstrates strong evidence of validity and reliability for use in clinical practice and research.

Background/aim: Patients with multiple sclerosis (MS) may present with a rapidly disabling clinical course in the first few years of disease. It is imperative to find biomarkers to predict patients with aggressive MS (AMS) and have an opportunity to prevent disability accumulation through appropriate treatment strategies. Our aim was to explore the prognostic value of neurofilament light chain (NFL) and brain-derived neurotrophic factor (BDNF) levels in cerebrospinal fluid (CSF) obtained in the early stages of MS.

Materials and methods: Relapsing-remitting multiple sclerosis (RRMS) patients presenting with first-time attacks were screened, of which 26 fulfilled AMS criteria in the 3-year follow-up period. In addition, 27 age/sex-matched RRMS patients without AMS (non-AMS) were included. Baseline NFL and BDNF levels were measured in CSF obtained during the remission period following the first MS attack. Disease activity was monitored for 3 years by periodic expanded disability status scale (EDSS), cranial-spinal MRI assessments, and no evidence of disease activity (NEDA)-3 was determined.

Results: AMS patients showed significantly higher attack numbers, EDSS scores, MRI lesions, and baseline NFL levels compared to non-AMS patients. Baseline BDNF levels were significantly lower than in non-AMS patients. NFL/BDNF levels were correlated with number of attacks and/or EDSS scores at the third year follow-up. Patients with NEDA-3 showed significantly lower baseline NFL and higher BDNF levels than those without NEDA-3. Receiver operating characteristic curve analysis showed the highest specificity for CSF BDNF measurements in predicting AMS conversion.

Conclusion: Baseline NFL and BDNF levels effectively predict the development of AMS emerging early in the course of MS. Combined use of these molecular markers with MRI results may enable early diagnosis and appropriate therapeutic intervention of AMS.

Background/aim: Upper extremity venous thrombosis (UEVT), encompassing upper extremity deep vein thrombosis (UEDVT) and superficial vein thrombosis (UESVT), is increasingly recognized due to invasive procedures and advanced diagnostics. This study characterizes the 5-year outcomes and etiological factors of UEVT in a large cohort.

Materials and methods: We conducted a retrospective cohort study of 304 consecutive adult patients with acute UEVT (2019-2025) at a tertiary care center in Türkiye. Demographics, medical history, thrombosis characteristics, treatments, and outcomes-including thrombosis resolution, pulmonary embolism, and mortality-were analyzed. Statistical analyses were performed using chi-square tests, multivariate logistic regression, and random forest models.

Results: Among the 304 patients, 4 (1.32%) had primary UEDVT, 115 (37.8%) had secondary UEDVT, 112 (36.8%) had nonfistula UESVT, and 73 (24.0%) had fistula-related UESVT. UEDVT was associated with malignancy (38.3%, n = 44), central venous catheters (25.2%, n = 29), rheumatologic disorders (n = 15), and coagulopathies (n = 10). Nonfistula UESVT was linked to local factors (e.g., IV contrast, n = 14; IV drug use, n = 12), with no pulmonary embolism (PE) or mortality. Fistula-related UESVT had a 1.4% PE and mortality rate. UEDVT showed higher PE (29.6% vs. 1.1%, p < 0.001) and mortality (23.5% vs. 0.5%, p < 0.001) than UESVT. Multivariate analysis identified UEDVT (OR = 36.50, 95% CI: 8.58%-155.31%), cancer (OR = 2.80), and heart failure (OR = 3.15) as PE predictors, while UEDVT (OR = 58.76), cancer (OR = 9.50), and age (OR = 1.05) were predictors of mortality (all p < 0.05).

Conclusions: UEDVT, driven by systemic factors, carries a higher risk of PE and mortality than UESVT, influenced by local factors. Thorough etiological evaluation and tailored interventions (e.g., catheter removal, multidisciplinary management) are critical to mitigate complications.

Background/aim: This study aimed to comprehensively analyze the distribution of ABO and Rh blood groups, as well as demographic characteristics and regional variations, using data from 9.5 million blood donors across Türkiye.

Materials and methods: In this multicenter, retrospective, cross-sectional study, data were collected from 9,587,592 healthy, voluntary donors who donated to the Turkish Red Crescent between 1998 and 2021. Donors met the criteria of being 18-70 years old, weighing over 50 kg, with hemoglobin levels above 13.5 g/dL for males and 12.5 g/dL for females. The data were evaluated based on age, sex, education level, and geographic region.

Results: The ABO blood group distribution was determined as follows: A (42.1%), O (34.0%), B (16.4%), and AB (7.5%). When analyzed together with the Rh factor, A Rh (+) was the most common (37.1%), while AB Rh (-) was the least common (0.9%). Regional analyses showed that A Rh (+) was highest in the Black Sea Region, whereas the Aegean Region had a notably high AB Rh (+) rate. The Marmara Region had the highest total number of donors, while Eastern Anatolia had the highest donation rate relative to its population. Demographically, 82.0% of donors were male; the 18-34 age group represented the most active segment (50.5%), and high school graduates had the highest donation rate (31.2%).

Conclusion: This study provides a detailed profile of Türkiye's blood donors, filling a gap in national blood group data. The findings support optimizing transfusion services, improving blood supply management, and refining donor recruitment strategies. Regional and demographic disparities highlight the need for targeted awareness campaigns. Addressing sex imbalances and increasing participation from underrepresented groups can enhance sustainability. Additionally, these findings contribute valuable data for clinical applications, epidemiological studies, and future healthcare policy development.