Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: This research evaluates the accuracy and reliability of ChatGPT's responses to inquiries concerning coronary artery bypass graft (CABG) surgery.

Methods: Between December 1, 2024, and December 15, 2024, two sets of questions were used to assess ChatGPT's performance: (1) a list of frequently asked questions (FAQs) sourced from official cardiovascular surgery websites, professional healthcare platforms, and social media, and (2) a list of scientific questions derived from the 2021 American Association for Thoracic Surgery (AATS) Guidelines for CABG in patients with ischemic cardiomyopathy and heart failure. Responses were evaluated using the modified DISCERN scoring system. To test reproducibility, each question was asked twice on separate computers within the same day. Two experienced cardiovascular surgeons independently scored the responses, and any disagreements were resolved through discussion.

Results: A total of 107 FAQs were assessed, of which 88 met the inclusion criteria. Based on the modified DISCERN scale, 71 responses (80.7%) received a score of 5, while 9 responses (10.2%) were rated as 4. The highest accuracy was observed in the preoperative preparation category, where all responses achieved a perfect score. Regarding scientific questions derived from the AATS Guidelines, 15 out of 20 (75.0%) were answered thoroughly and satisfactorily. The reproducibility rate was 92.0% for FAQs and 90.0% for guideline-based questions.

Conclusion: This study is the first to demonstrate that ChatGPT provides highly accurate and dependable responses regarding CABG surgery, particularly for frequently asked questions. Although performance declines slightly when addressing scientific questions based on guidelines, the reproducibility rate remains high. These findings indicate that AI-driven tools like ChatGPT could play a valuable role in patient education and enhancing public awareness about CABG surgery.

Objectives: Central precocious puberty (CPP) can present as either slowly progressing CPP (SP-CPP) or rapidly progressing CPP (RP-CPP). The speed of progression is critical in determining treatment decisions. This study aims to compare the clinical data between patients who received treatment and those who did not, and to identify factors that may influence the progression in cases of RP-CPP.

Methods: This single-center retrospective observational study includes 406 female patients aged 5-8 years who were followed for CPP at the pediatric endocrinology clinic between 2021 and 2023. The patients were categorized into two groups: those with SP-CPP who did not receive gonadotropin-releasing hormone agonist (GnRHa) treatment (n=252) and those with RP-CPP who did receive GnRHa treatment (n=154). Patients were analyzed according to clinical, laboratory, and radiological findings.

Results: The median age at onset of pubertal signs were 7.2 years (Range 5-8) for the SP-CPP group and 7 (5-8) years for the RP-CPP group (p=0.352). In univariate analysis, Tanner breast stage, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, peak LH levels, and bone age/chronological age ratios were significantly higher in the RP-CPP group. In multivariate logistic regression analysis, Tanner breast stage (p=0.001) and the bone age/chronological age ratio (p<0.001) were found to be a significant parameter, while other variables were not significant (p>0.05).

Conclusion: In this cohort, the bone age/chronological age ratio is a significant parameter for early detection of rapidly progressing precocious puberty cases. It is crucial to classify early puberty cases by evaluating clinical, laboratory, and radiological findings collectively and to make treatment decisions based on individual assessments.

Objectives: Inherited metabolic diseases (IMDs) arise due to deficiencies in enzymes involved in metabolic pathways or other dysfunctions within these pathways, leading to a deficiency of specific end products or the toxic accumulation of intermediate metabolites. These diseases may present at any age with varying clinical courses. With advances in treatment options and increased awareness, IMDs are increasingly being diagnosed and managed in adulthood. This study aims to understand the clinical features and diagnostic processes of patients diagnosed with IMDs during adulthood and to raise awareness regarding these conditions.

Methods: Medical records of adult patients diagnosed with IMDs between June 2022 and June 2024 were retrospectively reviewed. Patients were included if they were diagnosed with an IMD at or above the age of 18. Those diagnosed during childhood but transitioning to adulthood were excluded.

Results: Twenty patients, aged 19-72 years (11 males, 9 females), were diagnosed with IMDs. The mean age of symptom onset was 30 years (range: 15-70 years), and the mean age of diagnosis was 37 years (range: 18-72 years). Diagnoses included Fabry disease (n=10, 20%), familial hypobetalipoproteinemia (FHBL) (n=3, 15%), and alkaptonuria (AKU) (n=2, 10%). Other diagnoses included Gaucher disease, Niemann-Pick disease type B, glycogen storage disease type IIIa (GSD IIIa), glycogen storage disease type XV (GSD XV), and cerebrotendinous xanthomatosis (CTX). Sixty-five percent of patients were identified via family screening, while 35% were diagnosed based on clinical findings supported by biochemical tests. Misdiagnoses before definitive IMD diagnosis included osteoarthritis, psoriatic arthritis, renal failure, heart failure, proteinuria, interstitial lung disease, hepatosteatosis, and nephrolithiasis. Disease-specific treatments were initiated and follow-ups were conducted.

Conclusion: Chronic and mild phenotypes of certain IMDs may pose diagnostic challenges. Increased awareness among healthcare professionals and further studies focusing on differential diagnoses are critical to improving the detection and management of IMDs.

Objectives: To compare the outcomes of the patients with primary spontaneous pneumothorax (PSP) treated by immediate video-assisted thoracoscopic surgery (VATS) and chest tube placement in the first episode.

Methods: Fifty patients aged between 18 and 40 years with PSP were grouped regarding the treatment modalities as G1 (patients undergoing chest tube placement, n=25) and G2 (patients undergoing immediate VATS, n=25). VATS procedure consisted of apical blebectomy and partial pleurectomy. Early outcomes (chest tube and hospital duration, and in-hospital complications) and late outcomes (recurrence rate after 10 years) were compared.

Results: In G2, the mean duration of surgery was 40.3±14.5 min. No conversion to thoracotomy was required. The rate of complication was insignificantly higher in G1 (p>0.05). Prolonged air leak was significantly common in G1 (p=0.03). In G2, the duration of chest tube and hospital stay were significantly lower (p=0.03 and p=0.05, respectively). After a follow-up of 10 years, a significantly higher recurrence rate was recorded in G1 (p=0.02). Recurrence was insignificantly higher in smokers (p>0.05), and mostly detected in older patients (p=0.03).

Conclusion: Immediate VATS in the first episode of PSP is an effective treatment to prevent recurrence in patients with PSP. VATS is safe with a lower rate of morbidity, and lower durations of chest tube and hospital stay compared to chest tube treatment.

Objectives: The role of bone grafting in the surgical treatment of displaced intra-articular calcaneal fractures (DIACFs) remains controversial. Although bone grafts are commonly used to restore joint congruity and support anatomical reduction, recent evidence favors minimally invasive approaches that may eliminate the need for routine grafting. This study aimed to evaluate the impact of bone graft use on radiological parameters and functional outcomes in Sanders Type II, III, and IV calcaneal fractures treated surgically.

Methods: This retrospective cohort study included 115 patients who underwent open reduction and internal fixation (ORIF) for DIACFs between 2016 and 2022. Fractures were classified using the Sanders classification and subgrouped as grafted (+) or non-grafted (-). Böhler and Gissane angles and calcaneal height were measured at four time points. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Intergroup and intragroup comparisons were made using appropriate statistical methods.

Results: Of the 115 patients, 38 had Type II, 43 had Type III, and 34 had Type IV fractures. Demographics and follow-up durations were comparable across groups (p>0.05). Both grafted and non-grafted groups demonstrated significant postoperative improvements in radiological parameters (p<0.05), which gradually declined over time. No statistically significant intergroup differences were observed at any time point (p>0.05). AOFAS scores and superficial wound infection rates were also similar.

Conclusion: Bone grafting did not yield superior radiological or functional outcomes in Sanders Type II, III and IV DIACFs treated with ORIF. These findings support a selective approach to grafting, especially in cases with significant comminution or bone loss, and align with current trends favoring biologically friendly and minimally invasive techniques.

Objectives: Mechanical thrombectomy (MT) has revolutionized stroke care over the past decade. Thus, we aimed to assess whether presenting during off-hours affects workflow times, clinical outcomes, and mortality of patients with acute ischemic stroke (AIS) undergoing MT at our center and, if there is an impact, to identify areas for improvement in the treatment of acute stroke.

Methods: A total of 263 consecutive patients who underwent MT between January 2020 and April 2023 were included in the study. The patients were categorized into two groups: those who presented during on-hours (Group 1) and those who presented during off-hours (Group 2).

Results: Among the 263 patients enrolled in the study (131 men and 132 women; mean age: 69.49±12.22 years; age range: 25-95 years), 74 (28.14%) were admitted to the hospital during on-hours, and 189 (71.86%) were admitted during off-hours. Of these patients, 30 (40.54%) and 68 (35.98%) from Groups 1 and 2, respectively, had good outcomes in the third month. The groups showed similar demographics, treatment-related characteristics, and outcomes, with no significant differences detected. The only notable difference was that the percentage of Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) was notably greater in the off-hours group (p=0.044).

Conclusion: The results indicate that MT performed on patients presenting during off-hours yielded similar workflow times, successful recanalization, and clinical outcomes to MT performed on patients presenting during on-hours.

Objectives: This study aimed to evaluate the therapeutic plasma exchange (TPE) procedures performed in our pediatric intensive care unit (PICU) and to review the relevant literature.

Methods: This retrospective study was conducted between 2020 and 2024. Forty-nine patients who received TPE at any point during their PICU stay were included. The groups were categorized as survivors and non-survivors.

Results: Of the 49 cases, 71.4% were male, with a median age of 54 months (range 20-135 months). A total of 274 TPE sessions were performed. The three most common indications for TPE were sepsis, trauma induced multiple organ dysfunction syndrome/disseminated intravascular coagulation, and neurological diseases. The non-survivor group had higher rates of chronic illness (p<0.001), pediatric risk of mortality score III, and pre- and post-procedure vasoactive inotropic scores (p=0.005, p<0.001, and p<0.001, respectively). The use of invasive mechanical ventilation and continuous renal replacement therapy (p=0.005, p<0.001, respectively), as well as TPE in cases with sepsis (p<0.001), were more frequent in non-survivors. The most common complication during the procedures was hypotension (9.9%).

Conclusion: Sepsis remains the most frequent indication for TPE in PICUs. Although the most common complication of TPE in our study was hypotension, there were no life-threatening complications, suggesting it is a safe treatment modality.

Objectives: The aim of this study is to evaluate whether the presence of other HPV genotypes in addition to HPV16 infection has a negative effect on pathological outcomes.

Methods: This retrospective study was conducted using data from patients followed up at the Gynaecological Oncology Clinic of Antalya Training and Research Hospital between 2017 and 2025. Patients who were HPV16-positive and also carried other genotypes in addition to HPV16 were included in the study. HPV genotyping was performed using the Hybrid Capture 2 and CLART Genomica systems.

Results: Of the total 2,700 HPV (Human Papillomavirus) -positive women, 524 were HPV16-positive only, while 358 were positive for HPV16 along with other genotypes. Histopathological results, including CIN 2/3, HSIL, and invasive cancer, did not show significant differences between the two groups (p>0.05). However, abnormal colposcopy findings were statistically more prevalent in the co-infection group (p=0.037). Cigarette smoking was associated with a 1.27-fold increased risk for co-infection (p=0.026).

Conclusion: The findings of this study indicate that HPV16 is the primary determinant in the development of high-grade cervical pathology, and the presence of other high-risk HPV types does not significantly worsen histopathological outcomes. The results support the importance of a risk-based approach in cervical cancer screening processes and emphasize the need to prioritise early diagnosis and preventive interventions in HPV16-positive individuals.