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: In the early years of defining Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), its prevalence among homosexual men gave rise to prejudices, the development of immunodeficiency, and lethal infections, causing fear and panic in society. Unethical approaches hindered patients from accessing healthcare services, creating substantial barriers from diagnosis to treatment in the fight against HIV/AIDS. This study aimed to explore the diagnostic significance of an ethical approach toward HIV-positive patients, guided by demographic data.

Methods: Demographic patient characteristics and stigmatization during HIV testing were assessed using a 47-question questionnaire. The research commenced on 01/05/2019 and concluded on 01/05/2020, with questionnaires administered online during the COVID-19 pandemic. Statistical analysis employed the SPSS 21.0 (Armonk, New York: IBM Corp.) package, cross-tabulating survey questions and comparing answers using the Chi-square test. Additionally, multivariate logistic regression analysis was conducted to identify factors associated with perceptions of ethical violations.

Results: The study included 121 participants, with 91% identifying as male, 3% as female, 1.7% stating another gender identity, 2.5% declining to specify, and 1.7% not responding to the question. Participant ages ranged from 19 to 66 years, with a mean of 37.9±10.5. Prior to HIV testing, written consent was obtained from 62.8% of patients, while 37.2% declined to provide consent. Among those who consented, 31.4% reported feeling insufficiently informed about the procedure. During result disclosure, 25.6% found the approach impolite, with abrupt and insufficient information. Additionally, 24% noted the presence of a third person during disclosure, while 25.6% reported breaches of patient confidentiality. Logistic regression analysis revealed that age was the only statistically significant factor associated with perceived ethical violations (p=0.010).

Conclusion: This study highlights critical ethical deficiencies in Türkiye's HIV testing procedures, with 31.4% of patients reporting inadequate consent and 25.6% experiencing unprofessional result disclosure. These findings underscore the urgent need for patient-centered protocols to ensure ethical standards and reduce stigma.

Objectives: Psoriasis is a chronic inflammatory papulosquamous skin disease whose psychological and interpersonal effects are underrecognized. This study aimed to evaluate dyadic adjustment and sexual functioning in patients with psoriasis and their spouses, in comparison with healthy controls.

Methods: The study included three groups: psoriasis patients (n=47), their spouses (n=40), and healthy controls (HC) (n=42). The Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) were administered to the patient group, while the Family Dermatology Life Quality Index (FDLQI) was administered to the spouse group. The Short Form-12 Health Survey (SF-12), the Dyadic Adjustment Scale-Revised (RDAS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Arizona Sexual Experiences Scale (ASEX) were administered to all three groups.

Results: Sexual dysfunction was observed in 83% of patients, 65% of spouses, and 50% of healthy controls. RDAS total and subscale scores (consensus, cohesion, satisfaction) were significantly lower in patients and spouses compared with healthy controls (p<0.001). Patients had significantly higher BDI scores than both spouses (p=0.016) and controls (p=0.002), and significantly lower physical and mental SF-12 scores. In spouses, FDLQI scores positively correlated with BDI (r=0.369, p=0.021) and negatively with SF-12 mental scores (r=-0.505, p=0.001). Regression analysis revealed that depressive symptoms (p=0.004) and disease duration (p=0.049) significantly predicted sexual dysfunction.

Conclusion: Psoriasis exerts a substantial psychosocial burden not only on patients but also on their spouses. Addressing relational and sexual well-being in clinical care may improve overall quality of life for affected couples.

Objectives: The objective of this study is to examine the association between nutritional status and the incidence of fractures in elderly patients with osteoporosis, while also evaluating other clinical, anthropometric, and biochemical factors related to these outcomes.

Methods: Geriatric patients diagnosed with osteoporosis who presented to the outpatient clinic were included from January 2016 to December 2019. In addition to demographic, clinical, anthropometric, and laboratory data, we examined bone mineral density (via DEXA), nutritional status, sarcopenia assessment, and the presence and types of fractures. Nutritional status was assessed using multiple validated tools, including the Geriatric Nutritional Risk Index (GNRI).

Results: A total of 181 patients (79% females) with a mean age of 78.12±6.65 years were included in the study. The fracture incidence recorded during follow-up was 40.88% (n=74). The mean age of the fracture group was significantly higher than that of the non-fracture group. GNRI, with a cut-off value of ≤100.6, significantly distinguished patients without fracture. Sarcopenia was present in 57.46% of patients, with no significant difference between fracture and non-fracture groups (p=0.642). Multivariable logistic regression indicated that older age (OR: 1.090, 95% CI: 1.022-1.162, p=0.009), fewer medications (OR: 0.868, 95% CI: 0.791-0.953, p=0.003), and low DEXA vertebra T-score (OR: 0.436, 95% CI: 0.285-0.668, p<0.001) were independently associated with fracture likelihood.

Conclusion: Malnutrition is correlated with increased fracture risk among older adults with osteoporosis, whereas sarcopenia prevalence was high but not independently associated with fractures.

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: This study aimed to evaluate the awareness, knowledge, and attitudes of parents regarding retinopathy of prematurity (ROP) and its follow-up in a tertiary referral center.

Methods: In this cross-sectional survey conducted at a single ROP center in Turkey from March to August 2025, 608 parents of infants born at <34 weeks' gestation and/or ≤1700 g birth weight, and those of infants with higher gestational age or birth weight who required cardiopulmonary support, completed a validated 15-item questionnaire during their infant's first ROP examination. A structured questionnaire, including sociodemographic data, knowledge about ROP, its consequences, treatment options, and adherence to follow-up, was administered. Associations between parental education level and ROP awareness were analyzed.

Results: Among 608 parents (59% mothers, 41% fathers; mean age 29.7±3.2 years), only 16.6% recognized that ROP screening differs from a routine eye exam. Overall, 81% were unaware of ROP, and 86% did not know it could cause blindness. Only 14% had received information about ROP, mainly from physicians (63.5%) or the internet (34.1%). While 71% were unsure about treatability and 37% acknowledged the importance of follow-up, 90% reported willingness to attend recommended visits. Higher educational level was significantly associated with ROP awareness (p<0.001), with university-educated parents showing the greatest knowledge (p<0.05).

Conclusion: Parental knowledge regarding ROP examinations was generally found to be low. A higher level of knowledge about ROP was observed among university graduates. Efforts to improve adherence to ROP follow-up should include systematic training programs for healthcare professionals, structured guidance for parents, and the widespread implementation of educational materials. In this context, integrating targeted educational interventions into routine care may contribute to long-term success in ROP management.

Objectives: Reconstruction of lower extremity soft tissue defects, which may occur due to various reasons, is challenging. Although different methods have been described in lower extremity reconstruction, the peroneal artery perforator flap has unique advantages. This study aims to present the use of the peroneal artery perforator flap, which is gaining popularity day by day, to treat crus defects.

Methods: Twelve patients with middle or distal third crus defects who underwent reconstruction with peroneal artery perforator flaps were included in the study. The patients were evaluated according to age, gender, etiology, complications, defect area, and defect and flap size. The etiology included chronic wounds in one patient, trauma in six, and tumors in five. Among the patients diagnosed with tumors, two had squamous cell carcinoma, two had malignant melanoma, and one had dermatofibrosarcoma protuberans.

Results: The average age of the patients was 45.9 years. Four of the patients were female, and eight were male. Nine of the defects were located in the middle third of the crus, and three were distal. The flaps ranged in size from 78 to 210 cm². Venous insufficiency was observed in two flaps, and partial necrosis developed distally in one of them. All flaps survived.

Conclusion: The peroneal artery perforator flap is a versatile option that can be used in the middle and distal parts of the crus.