Medeniyet medical journal最新文献

Objective: This study aimed to retrospectively examine the cases of individuals who lost their lives as a result of the Kahramanmaraş earthquakes on February 6, 2023, and were brought to the study area designated by the Malatya Forensic Medicine Group Presidency.

Methods: A total of 916 cases were referred for identification to the center designated as the study area by the Malatya Forensic Medicine Group Presidency following the earthquakes on February 6, 2023, and were examined retrospectively. The obtained data were coded and entered into IBM SPSS Version 22. Descriptive statistics and frequency tables were generated, and the data were analyzed.

Results: Among the 916 cases included in the study, 477 (52.1%) were male and 439 (47.9%) were female; 23.2% were under the age of 18, and 13.8% were over the age of 65. The majority (87.9%) were citizens of the Republic of Türkiye. Most injuries were localized to the head and neck region (37.5%). Body integrity was preserved in 88.3% of cases, and signs of decomposition were observed in 77.1%. Fast Technology for the Analysis of Nucleic Acids blood samples was obtained in 39.5% of cases. All bodies were identified through a combination of primary and secondary identification methods and subsequently delivered to their relatives.

Conclusions: In countries facing major disaster risks, forensic medicine units must always be prepared for such events. Postmortem examination and victim identification are multidisciplinary processes that require the coordinated efforts of experts from various fields.

Objective: Accurate sex estimation is a cornerstone in forensic and bioarchaeological investigations. While the pelvis and skull are traditionally used for this purpose, their absence due to taphonomic damage necessitates the use of alternative skeletal elements such as the patellar. This study evaluates the diagnostic potential of patellar morphometry for sex estimation in a Late Roman population.

Methods: The study analyzed 146 adult patellar (70 males, 76 females) recovered from the Karlığın Tepesi Necropolis 3^rd-6^th centuries AD in Malatya, Türkiye. Standard osteological methods were used to determine sex. Three patellar dimensions/length (PL), patellar width (PW), and patellar thickness (PT)-were measured. Intraobserver reliability was assessed via technical error of measurement (TEM), relative TEM (rTEM), and the reliability coefficient (R). Stepwise logistic regression and receiver operating characteristic analyses were conducted to identify the best predictors of sex. Area under the receiver operating characteristic (AUROC) values, cut-off thresholds, and effect sizes were reported.

Results: Statistically significant differences were found between males and females in PL (p=0.001), PW (p<0.001), and PT (p=0.003). The stepwise logistic regression model using PL and PT produced AUROC values of 0.906 in Step 1 and 0.920 in Step 2, with sensitivity and specificity ranging from 82.85% to 94.73%. All intraobserver reliability metrics (TEM, rTEM, R) indicated excellent measurement precision (R=1.000).

Conclusions: Patellar morphometry demonstrates high diagnostic accuracy for sex estimation, particularly when multivariate models are applied. Despite the moderate discriminative power of patella thickness alone, its combination with other parameters enhances overall performance. The study provides the first population-specific discriminant model for sex estimation using the patella in an Anatolian archaeological sample. However, the skewed sex distribution and the possibility of post-depositional changes in ancient skeletal remains should be considered when interpreting results. Additionally, the population-specific nature of the archaeological sample and the lack of external validation on independent datasets limit the generalizability of the model to other contexts.

Bronchiectasis, defined as the permanent dilation of the bronchial wall, is a chronic inflammatory disease with nearly thirty known causes. The most common cause is recurrent and inadequately treated lower respiratory tract infections. Among the rarer causes is alpha-1 antitrypsin (AAT) deficiency, an anti-protease and anti-inflammatory protein deficiency. To date, approximately 500 variants of AAT deficiency have been identified, with the PI*S and PI*Z mutations being the most commonly associated with bronchiectasis. Here, we present a case diagnosed with bronchiectasis secondary to AAT deficiency during an advanced clinical workup, in which the rare Pi*M Palermo mutation was identified. This case is discussed in the context of the existing literature.

Objective: This study aimed to investigate antinuclear antibody (ANA) staining patterns and titers in patients with juvenile idiopathic arthritis (JIA)-associated uveitis, idiopathic uveitis, and JIA without uveitis, in order to identify serologic profiles that may contribute to disease pathogenesis and guide clinical decision-making.

Methods: We analyzed patients with JIA and/or uveitis at our tertiary center with ANA titers ≥1/100. Patients were grouped as JIA-associated uveitis, JIA without uveitis, and idiopathic uveitis. Diagnoses followed International League of Associations for Rheumatology and standardization of uveitis nomenclature criteria. ANA testing was performed by indirect immunofluorescence on HEp-2 cells, and patterns and titers were evaluated per International Consensus on ANA Patterns guidelines. ANA profiles were compared across patient groups and JIA subtypes.

Results: Ninety-one patients were included: 21 (23%) with idiopathic uveitis, 12 (13.1%) with JIA-associated uveitis, and 58 (63.7%) with JIA without uveitis. The AC-1 pattern was present in all uveitis patients. The most common ANA patterns in JIA were AC-1 (65.7%), AC-4/5 (21.4%), and AC-2 (10%). ANA profiles differed across JIA subtypes (p<0.001), with AC-1 dominant in oligoarticular JIA (74.5%) and AC-4/5 in enthesitis-related arthritis (50%).

Conclusions: Our findings show that ANA pattern differences in JIA subtypes may provide significant clues regarding disease pathogenesis and clinical prediction. In particular, the prominence of the AC-1 pattern in JIA-associated uveitis may suggest a potential biomarker for the early identification of uveitis risk, which should be further explored in larger prospective studies.

Salivary gland tumors (SGTs) pose considerable diagnostic and treatment challenges due to their heterogeneous nature, diverse histogenesis, and unpredictable clinical outcomes. Benign tumors exhibit a known recurrence rate, whereas malignant tumors are associated with a poor prognosis and a low recovery rate. Nonetheless, despite the growing body of research, there is insufficient evidence to establish a link between SGTs, human papilloma virus (HPV) infection, and the hypermethylation of tumor suppressor genes. The aim of this study is to elucidate the relationship between DNA hypermethylation and HPV in SGTs, elucidate the role of DNA hypermethylation in HPV-associated SGTs, thereby offering insights into novel diagnostic, and prognostic markers. As epigenetic alterations significantly contribute to the development of carcinogenesis, addressing these epigenetic alterations may help in early treatment plans and early detection of SGTs.

Objective: Transient Tachypnea of the Newborn (TTN) is a common cause of respiratory distress in term infants, associated with delayed pulmonary fluid clearance resulting from dysfunction of the epithelial sodium channel. Although generally self-limiting, TTN may increase early childhood wheezing and asthma risk. This study aimed to assess the incidence and characteristics of acute bronchiolitis in TTN infants compared to those in healthy controls within a large birth cohort.

Methods: We conducted a population-based cohort study that included all live births in Istanbul from January 2016 to December 2018, utilizing the Turkish Ministry of Health's e-Nabız database. Infants diagnosed with isolated TTN (International Classification of Diseases [ICD]-10 P22.1) formed the study group. A randomly selected control group of healthy infants without respiratory diagnoses was included in the study. Both groups were followed for two years to identify episodes of acute bronchiolitis (ICD-10 J21*), excluding cases within the first month of life. The data collected included bronchiolitis incidence, recurrence, age at the time of the episode, and hospitalizations.

Results: Among 1,002,261 live births, 14,389 TTN infants and 14,500 controls were analyzed. Acute bronchiolitis occurred in 42.4% of TTN infants and 35.8% of controls (p<0.001). TTN infants had higher rates of single episodes, while controls experienced more recurrent episodes (p<0.001). Hospitalization was more frequent in the control group (p<0.001), with single hospitalizations predominating in the TTN group and multiple hospitalizations in the control group. The first episodes in TTN infants mainly occurred between 1-6 months, with controls showing more episodes early but fewer later (p<0.001). Recurrence was correlated with an earlier age of the first episode in both groups (p<0.001).

Conclusions: TTN infants experience more bronchiolitis episodes early in life, though recurrent episodes are more common among healthy controls. Further studies are warranted to investigate the relationship between TTN and the development of wheezing and asthma.

Objective: Central nervous system (CNS) infections remain a significant cause of morbidity and mortality in children. This study aimed to evaluate the impact of cerebrospinal fluid (CSF), multiplex polymerase chain reaction (PCR) panel results on clinical decision-making and patient management in children who underwent lumbar puncture (LP) with a preliminary diagnosis of meningitis/meningoencephalitis.

Methods: Patients aged 1 month to 18 years who underwent LP for suspected CNS infection in our pediatric emergency or intensive care units between 2018 and 2023, and who had a CSF multiplex PCR meningitis/encephalitis panel performed, were retrospectively evaluated in terms of demographics, clinical presentation, laboratory parameters, and treatments. Patients younger than 1 month or older than 18 years, those who underwent LP for non-infectious indications, and those with ventriculoperitoneal shunts were excluded. Data were analyzed using SPSS version 24.

Results: The median age of the 144 patients was 2.7 (6.7) years, and 93 (64.6%) were male. At least one pathogen was detected by multiplex PCR in 35 patients (24.3%). Of these, 22 had viral agents (enterovirus in 9, HSV-1 in 4, HHV-8 in 2, HHV-7 in 2, VZV in 2, CMV in 2, and HHV-6 in 1), 11 had bacterial agents [Streptococcus pneumoniae (S. pneumoniae) in 7, Neisseria meningitidis in 3, and Haemophilus influenzae type b (Hib) in 1], and 2 had multiple agents (S. pneumoniae + Hib + HHV-6 in one case; enterovirus + HHV-6 in one case). No significant clinical differences were observed between viral and bacterial infections. In 51 patients (35.4%), treatment was modified based on PCR results, most often by discontinuing acyclovir (22.1%), antibiotics (7.6%), or both (3.5%).

Conclusions: In approximately one-third of cases, unnecessary antiviral or antibiotic treatments were discontinued based on PCR results, demonstrating the utility of molecular diagnostics in guiding clinical management. Especially in patients who had received antibiotics prior to LP, early pathogen detection via PCR may help reduce treatment costs, complications, and length of hospital stay.

Objective: Despite the established efficacy of statins in reducing major cardiovascular events and mortality, rates of statin persistence remain low. This study aimed to assess short- and long-term statin persistence rates and identify factors influencing persistence in patients initiating statin therapy.

Methods: A retrospective, observational, clinical study was conducted, enrolling a consecutive total of 903 patients aged 18 years and older (692 female, 211 male, mean age: 60.74 ± 11.70 years) who had initiated statin therapy between January 1, 2016, and January 1, 2017. Short-term (2018) and long-term (2023) statin persistence statuses were determined. Groups persisting and non-persisting with statin therapy were compared for demographic characteristics; presence of cardiometabolic diseases such as diabetes mellitus (DM), coronary artery disease (CAD), and hypertension (HT); statin therapy intensities; and indications for statin initiation (primary or secondary prevention) for both time periods.

Results: The study included 903 patients with a mean age of 60.7±11.7 years and a female predominance of 76.6%. In 2018, 498 (55.1%) patients continued statin therapy, while 405 (44.9%) discontinued. In 2023, excluding 36 cases with death (18 cases were among those continuing statin treatment, and 18 cases were who did not continue). Four hundred and forty-eight (51.7%) patients persisted with statin therapy, while 419 (48.3%) discontinued. Statin non-persistence was more frequent in patients initiated on statins for primary prevention (p<0.01) and more frequent in those under 45 years old (p=0.028 and p=0.036, respectively), while it was less common in patients with HT, DM, and CAD (all p<0.01).

Conclusions: The study reveals the low and declining rates of statin persistence in patients initiating statin therapy, both in the short and long term. Furthermore, persistence rates are lower in younger patients and those initiated on statins for primary prevention compared to those with established cardiovascular risk factors.