Turkish Journal of Medical Sciences最新文献

Background/aim: Postoperative sore throat (POST) is a common complication following general anesthesia that significantly affects patient satisfaction, prolongs recovery, and increases treatment costs. This study aimed to evaluate whether the addition of antimicrobial agents to NSAID-based oral sprays could enhance the preventive efficacy against POST.

Materials and methods: In this prospective, randomized, placebo-controlled trial, 105 patients (ASA I-II; age 18-65 years) scheduled for elective ear surgery under general orotracheal anesthesia were enrolled. Patients were randomly allocated into three groups: a placebo group; a flurbiprofen oral spray group; and a group receiving an oral spray containing benzydamine hydrochloride, chlorhexidine digluconate, and cetylpyridinium chloride. The sprays were administered under direct laryngoscopy before intubation and after the final oropharyngeal aspiration. POST severity was assessed using a 10mm Visual Analog Scale (VAS) at 1 h, 6 h, 24 h, and 1 week postoperatively. Patients were also subgrouped based on surgical duration (<120 min vs. ≥120 min).

Results: Both NSAIDbased treatments significantly reduced VAS scores at early postoperative time points compared to the placebo. In subgroup analysis, patients undergoing surgeries lasting less than 120 min exhibited lower VAS scores with both active treatments, while in those with surgeries ≥120 min, significant differences were noted at 1 and 6 h. No significant difference was found between the flurbiprofen spray and the combination spray.

Conclusion: NSAIDcontaining oral sprays effectively reduce the severity of postoperative sore throat. However, the addition of antimicrobial agents does not provide extra analgesic benefit, suggesting that simpler, costeffective NSAID formulations may be preferable in clinical practice.

Background/aim: Hepatitis B virus (HBV) leads to widespread chronic infections that may result in long-term complications such as cirrhosis and hepatocellular carcinoma. The use of sensitive molecular methods for HBV DNA quantitation has provided significant contributions for diagnosis and monitoring of disease. The current study aimed to evaluate the diagnostic performances of a novel DiaRD HBV qPCR kit (novel kit) in comparison with the artus HBV QS-RGQ kit (comparator kit).

Materials and methods: A total of 288 plasma samples-105 HBV DNA-positive and 183 HBV DNA-negative-were tested using both kits. The diagnostic and quantitative results of the novel kit were compared to those of the comparator kit.

Results: The novel kit had very high sensitivity, specificity, and accuracy with rates of >99.9%. Comparative analyses conducted on 105 HBV DNA-positive samples showed no significant differences of ≥ 1 log₁₀ between the novel kit and comparator kit. The median viral load detected by the novel kit was 6.21 × 10⁷ IU/mL (range: 0.9 × 10¹ to 2.98 × 10⁹) as compared to the comparator kit where it was 5.43 × 10⁷ IU/mL (range: 1.00 × 10¹ to 2.87 × 10⁹). The correlation plot demonstrated a strong linear relationship (R² value of 0.9655) between the two kits. Reproducibility testing performed on three different HVB DNA loads showed the overall coefficient of variations <5%. The mean difference between the quantitative results of two kits was -0.03 log IU/mL by Bland-Altman analysis.

Conclusion: The result of the current study indicates that this novel DiaRD HBV qPCR kit can be used in routine diagnosis and monitoring of HBV infections.

Background/aim: Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized not only for its behavioral and cognitive challenges but also for its potential implications in physical health, particularly injury risk. This study aimed to investigate the incidence of extremity fractures among children and adolescents diagnosed with ADHD, and to evaluate the influence of demographic, clinical, and pharmacological variables-including ADHD subtypes and medication types-on fracture risk.

Materials and methods: This retrospective cross-sectional study included 754 children and adolescents aged 6-18 years old who were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders-5 criteria. Data were collected from electronic health records at a tertiary referral hospital. Variables analyzed included age, sex, ADHD subtype, intelligence quotient (IQ) level, pharmacological treatment status (methylphenidate or atomoxetine), comorbid psychiatric and medical conditions, and fracture history confirmed by clinical and radiological evidence. Binary logistic regression analysis was conducted to identify independent predictors of fracture risk.

Results: The overall incidence of extremity fractures was 15%, with 69% occurring in the upper extremities. Children using ADHD medication had significantly lower fracture rates (9.7%) compared to untreated peers (32.6%, p < 0.001). Logistic regression showed that both methylphenidate (OR = 0.396) and atomoxetine (OR = 0.138) were associated with reduced fracture risk. The inattentive subtype also showed a protective effect. Other factors, such as age, sex, IQ, and comorbidities, were not significantly associated with fracture incidence.

Conclusions: This study highlights a notable reduction in extremity fracture risk among children with ADHD receiving pharmacological treatment, suggesting a possible protective role of stimulant and nonstimulant medications. Subtype-specific risk profiles further emphasize the importance of personalized approaches in ADHD management strategies.

Background/aim: Microplastics (MPs) are a growing concern due to their pervasive environmental presence and their potential impact on environmental and human exposure. Given evidence of systemic MP presence in human tissues and fluids, and the ear canal's environmental exposure, this novel study aimed to identify these particles in human cerumen. Cerumen was collected from the proximal ear canal to minimize potential airborne contamination.

Materials and methods: Cerumen samples were prospectively collected from 12 adult patients (23 patient-derived samples) and three control water samples, following ethical approval and consent. Samples were extracted using sterile instruments, stored in glass, diluted, and filtered through 0.22 μm cellulosic membranes. Microplastics were identified and measured morphologically using a 10× laboratory microscope with digital image processing; however, chemical confirmation of polymer type was beyond the scope of this initial study. Descriptive statistics were employed for analysis.

Results: Among the 12 adult patients (23 patient-derived samples), microplastic particles were detected in 10 (83.3%, patient level detection rate). A cumulative total of 31 individual MPs were identified across the 23 patient-derived cerumen samples analyzed (comprising 29 detected and two instances of zero particle detection), ranging significantly in size from 16 μm to 930 μm and displaying various colors. Water control samples contained seven particles (3-46 μm), showing a clear size disparity from cerumen-borne particles.

Conclusion: This study provides solid evidence of microplastic presence in human cerumen, suggesting a novel potential route of elimination from the human body. The high detection rate among patients and distinct characteristics of cerumen-borne MPs compared to controls imply genuine human accumulation rather than procedural contamination. Cerumen highlights a promising potential noninvasive bioindicator for assessing microplastic exposure. Further research in larger populations is essential to confirm these findings, elucidate mechanisms, identify polymer types, and explore potential health implications.

Background/aim: Serratia marcescens which is a nosocomial pathogen, is naturally resistant to a wide spectrum of antibiotics, which makes the management of infections difficult. The aim of this study was to determine the in vitro susceptibilities of S. marcescens to ceftriaxone, ceftazidime, meropenem, amikacin, gentamicin, ciprofloxacin, and to compare the metabolic profiles of meropenem-resistant isolates under basal conditions and after exposure to sublethal concentrations of meropenem.

Materials and methods: A total of 84 S. marcescens isolates were included from various samples. Genes for meropenem resistance were determined by polymerase chain reaction (PCR). Genetic similarities among isolates of S. marcescens were investigated by pulsed-field gel electrophoresis (PFGE). MIC changes of meropenem were investigated in the presence of the resistance-nodulation-cell division (RND) type pump inhibitor phenylalanyl-arginyl-β-naphthylamide (PAβN) and proton ionophore (uncoupler) carbonyl cyanide m-chlorophenylhydrazone (CCCP). A GC/MS-based metabolomics approach was implemented to determine the differentiation of metabolome structure. We examined the adaptive responses of isolates, characterized by resistance or susceptibility, under conditions of meropenem-induced stress.

Results: The highest resistance rate was observed for ceftriaxone (27.6%). Amikacin was the most effective drug, with a resistance rate of 6.9%. Overall, 10 (11.9%) isolates were resistant to meropenem. Genotyping of β-lactamase genes revealed that bla _OXA-48 was present in one isolate. In total, efflux pump activity was detected in four isolates. The GC/MS-based metabolomics analysis revealed alterations in nucleotide and pyrimidine metabolism, as well as in ATP-binding cassette (ABC) transporter pathways, between the meropenem-susceptible and meropenem-resistant groups.

Conclusion: Understanding the metabolic profiles of S. marcescens could facilitate the development of novel diagnostic approaches and antimicrobial strategies in the ongoing global effort to combat meropenem-resistant S. marcescens.

Background/aim: The literature shows a link between hyperoxemia and poor outcomes, whereas this association remains unclear in hospital wards. This study aims to determine the incidence of hyperoxemia in hospital wards and its risk factors.

Materials and methods: Patients aged ≥ 18 years who underwent an evaluation by an intensivist between 1 January 2020 and 31 December 2020, while receiving treatment in hospital wards, were included in the study following ethics committee approval. Patients with hypoxemia (partial pressure of oxygen [PaO₂] < 60 mmHg), a condition related to Coronavirus disease 2019, a hospital stay < 1 day, or missing data were excluded. Patients were divided into two groups: normoxemia (60 mmHg ≤ PaO₂ < 120 mmHg) and hyperoxemia.

Results: The incidence of hyperoxemia was 42.2%. Patients with hyperoxemia had longer hospital stays and higher intensive care unit admission rates than those with normoxemia. Partial pressure of carbon dioxide < 30 mmHg (OR, 1.61; 95% CI, 1.16-2.25; p = 0.005), hemoglobin ≤ 10.3 g/dL (OR, 1.33; 95% CI, 1.01-1.75; p = 0.044), positive pressure ventilation (OR, 1.73; 95% CI, 1.09-2.74; p = 0.021), fraction of inspired oxygen ≥ 50% (OR, 1.71; 95% CI, 1.10-2.65; p = 0.018), type IV respiratory failure (OR, 1.62; 95% CI, 1.05-2.51; p = 0.030), and receiving treatment on surgical units (OR, 1.47; 95% CI, 1.02-2.12; p = 0.038) were independently associated with hyperoxemia. Charlson comorbidity index > 6 (OR, 0.64; 95% CI, 0.49-0.85; p = 0.002), and chronic obstructive pulmonary disease exacerbation (OR, 0.51; 95% CI, 0.29-0.89; p = 0.017) were independently associated with normoxemia.

Conclusion: Monitoring potentially critically ill patients receiving oxygen therapy in wards is essential to mitigate hyperoxemia and optimize the use of healthcare resources. Further research could focus on developing strategies to accomplish this objective.

Background/aim: Teachers play an essential role in the early identification of autism spectrum disorder (ASD) and associated difficulties in children. Increasing teachers' knowledge of ASD can be helpful in identifying these children and making the necessary referrals. This study aimed to assess teachers' knowledge and awareness of ASD and the factors affecting them.

Materials and methods: This is a cross-sectional study conducted among school counsellors. A total of 171 school counsellors were contacted; school visits were arranged by prior appointment, and the purpose of the study was explained. Data were collected using a questionnaire prepared by the researchers and the autism awareness scale (AAS).

Results: Most teachers had heard of the concept of ASD, but the concept of shadow teaching was less familiar. Women and those with lower perceived income levels had statistically significantly higher scores on the ASD awareness scale. Participants who had received ASD-related training or had individuals diagnosed with ASD in their environment had higher ASD scores. Women had statistically significantly higher scores than men in the subdimensions of "causes of autism", "friendship relationships in autism", and "basic elements in the intervention process in autism".

Conclusion: This study shows that sex and previous contact with individuals diagnosed with ASD may contribute to intervention processes beyond autism identification. In particular, teachers need to be aware of early identification and referral to intervention programs in schools with pupils diagnosed with ASD. Teachers are likely to come into contact with individuals diagnosed with ASD in a variety of settings. It is, therefore, vital that they have sufficient knowledge and awareness of autism to be able to interact effectively with individuals diagnosed with ASD.

Background/aim: The primary aim of this study was to compare the thickness and stiffness of the plantar fascia (PF) and Achilles tendon (AT) between healthy volunteers and patients with type 2 diabetes mellitus (T2DM). A secondary objective was to explore the correlations between the thickness and stiffness of the PF and AT and diabetes duration (in months) and hemoglobin A1c (HbA1c) levels in T2DM patients without peripheral neuropathy or foot ulcers, with peripheral neuropathy, or with foot ulcers.

Material and methods: A total of 289 participants, including 117 healthy volunteers (Group A) and 172 T2DM patients (59.5%), matched for age, sex, and body mass index, were included. The T2DM cohort was stratified into three subgroups: Group B (without peripheral neuropathy or foot ulcers), Group C (with peripheral neuropathy), and Group D (with foot ulcers). Ultrasonography (USG) and shear wave elastography (SWE) were used to assess PF and AT properties, and correlations with diabetes duration and HbA1c levels were analyzed.

Results: T2DM patients exhibited significantly greater PF and AT thickness, and lower stiffness compared to healthy controls (p < 0.001). Among subgroups, Group D had the greatest PF and AT thickness and the lowest stiffness, followed by Group C and then Group B (p < 0.001 for all comparisons). Positive correlations were observed between diabetes duration, HbA1c levels, and tendon thickness, while negative correlations were identified with stiffness (p < 0.001 for all).

Conclusion: USG and SWE revealed significant alterations in PF and AT properties in T2DM patients compared to healthy individuals, with these changes correlating with diabetes severity and duration.

Background/aim: Existing treadmill-based VO₂ prediction models may not accurately estimate submaximal VO₂ in patients with coronary artery disease (CAD), as they are often derived from healthy populations. This study aimed to develop and validate a submaximal VO₂ prediction model derived from healthy individuals and tested for generalizability in CAD patients by incorporating clinically relevant parameters.

Materials and methods: A retrospective analysis was conducted with 101 participants (54 healthy, 47 CAD patients) undergoing cardiopulmonary exercise testing using the modified Bruce protocol. To better represent the submaximal VO₂ reached during exercise, the average VO₂ in the last minute of each stage was used. The model was developed using data from healthy individuals and subsequently validated in the CAD cohort. A linear mixed-effects model was employed to predict VO₂ based on speed, grade, and other confounders, including peak VO₂, body weight, and body mass index (BMI). The model's performance was evaluated and compared with previously published equations using Bland-Altman plots, mean absolute error (MAE), root mean square error (RMSE), and Lin's concordance correlation coefficient (CCC).

Results: The final model, including speed, grade, and peak VO₂, achieved an R² of 0.83 (95% CI: 0.79, 0.86; f² = 4.88). For CAD patients, the predicted-actual VO₂ difference was -0.05 ± 1.8 mL/kg/min, with MAE and RMSE values of 1.4 and 1.8 mL/kg/min, respectively. The model outperformed reference equations, achieving the highest accuracy (CCC = 0.923) and minimal bias. Incorporating peak VO₂ effectively accounted for exercise response differences between healthy individuals and CAD patients.

Conclusion: A submaximal VO₂ estimation model derived from healthy individuals and validated in CAD patients demonstrated high accuracy. Incorporating peak VO₂ effectively bridged physiological differences, supporting individualized exercise prescriptions in cardiac rehabilitation. However, larger prospective cohorts are warranted to confirm external validity.

Background/aim: Acute kidney injury (AKI) is a major clinical issue, frequently resulting from ischemia-reperfusion (I/R) injury. Sinapic acid (SA), a natural phenolic molecule included in numerous plant-based foods, exhibits antiapoptotic, antioxidant, and antiinflammatory properties. This study aimed to investigate the renoprotective effects of SA in an I/R-induced acute kidney injury (AKI) model.

Materials and methods: Sprague-Dawley male rats (n = 32) were randomly assigned to four groups: sham, I/R, SA 20 mg/kg, and SA 40 mg/kg. SA was administered intraperitoneally before reperfusion. Renal tissues were examined using biochemical, histopathological, and immunohistochemical methods, focusing on oxidative stress, cytokine expression, and apoptosis markers.

Results: I/R induced significant oxidative stress, elevated proinflammatory cytokines, and tubular damage. Treatment with SA, particularly at 40 mg/kg, significantly improved antioxidant defenses, reduced inflammatory cytokine levels, and attenuated tubular necrosis and apoptosis, as confirmed by decreased caspase-3 and HAVCR1 (also known as KIM-1) expression.

Conclusion: SA significantly ameliorated renal I/R injury by modulating apoptosis, inflammation, and oxidative stress. These findings support the therapeutic efficacy of SA in AKI and highlight the need for further translational research.