Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: Breastfeeding is accepted to be the optimum nutrition for term and preterm newborns. The objective of our study was to investigate the rates of exclusive breastfeeding (EBF) at discharge among infants less than 34 weeks of gestation (GWs), followed up in neonatal intensive care unit (NICU) and to analyze the factors influencing EBF practices at discharge and 6th months of age.

Methods: In this study, we retrospectively evaluated the medical records of neonates <34 GWs admitted to NICU within the first postnatal 24 hours of life between January 2022 and June 2023. The maternal and neonatal demographic data and the related medical and nutritional factors, morbidities were recorded. Data regarding the duration of exclusive breastfeeding, and the maintenance of breastfeeding were retrieved from the follow-up records of the high-risk newborn outpatient clinic post-discharge. The rate of breastfeeding at discharge and the factors influencing breastfeeding practices were analyzed.

Results: The study cohort comprised 114 neonates, of whom 44.8% were female and 55.2% were male. The mean gestational age was 29.8±2.6 weeks and the mean birth weight was 1365±474 grams. The exclusive breastfeeding rate was 57.8% at discharge and declined to 45.6% at six months. The mean duration of breastfeeding was 15.7±6.5 months. Maternal ethnicity and the language barrier were found to be statistically significantly associated with exclusive breastfeeding at discharge, respectively (p=0.04, p=0.05). Infants who were exclusively breastfed at six months had significantly higher gestational age and shorter duration of hospital stay, respectively (p=0.029, p=0.02). Exclusive breastfeeding at six months was statistically significantly associated with a reduced incidence of extrauterine growth retardation (EUGR) (p=0.04). Among exclusively breastfed infants at discharge, 96.9% (n=64) received breast milk as their first feed, significantly more than mixed-fed infants (p=0.005). Time to reach full enteral feeding was also statistically significantly shorter in the exclusively breastfed group (p=0.017). Infants with a shorter duration of feeding via orogastric/nasogastric tube had a significantly higher rate of exclusive breastfeeding at six months compared to the mixed-fed group (p=0.043).

Conclusion: To improve exclusive breastfeeding rates at discharge and six months postnatally, and to reduce the incidence of EUGR, feeding preterm infants with their mother's own milk from birth should be actively promoted. In addition, comprehensive and consistent maternal support should be provided in the NICU to facilitate both the initiation and continuation of breastfeeding under all circumstances from birth.

Objectives: Family physicians (FPs) are directly responsible for the care of people with epilepsy. However, their education about epilepsy may be inadequate or lacking. The aim of this study was to assess the basic knowledge and self-efficacy levels regarding epilepsy among FPs and to identify their educational needs in managing epilepsy.

Methods: The sample for this pre-test-intervention-post-test study consisted of 60 FPs. FPs attended a four-hour training on epilepsy management. The effectiveness of the training was assessed with the Epilepsy Knowledge and Self-Efficacy (EKSE) scale before and after the training. In addition, a survey was conducted to determine the problems encountered in the follow-up of epilepsy patients and their training needs.

Results: 60 physicians participated in the study [37 males (61.7%), mean age 37.97±8.92 years and professional duration 80.48±70.59 months]. While the total EKSE score of FPs was 90.23±10.97 before the training, it increased to 112.3±15.26 points after the training (p<0.001). After the training, significant score increases were observed in all subcomponents of the EKSE compared to before the training. After the training, there was a significant improvement in the physicians' ability to recognize diseases accompanying epilepsy, to have sufficient knowledge about antiseizure medications, and to follow up patients with epilepsy compared to before the training (p<0.001, p=0.001, and p=0.002, respectively).

Conclusion: This study demonstrated that FPs have need for education regarding epilepsy management and that the education provided has a positive impact.

The guidelines for the management of thyroid nodules and differentiated thyroid cancer were first published by the American Thyroid Association in 1996 and subsequently updated in 2006, 2009, and 2015. In light of advances in technology and the accumulation of new scientific evidence, the guidelines were revised once again in 2025. The most notable change in the 2025 version is the exclusion of thyroid nodules, with the focus placed solely on differentiated thyroid cancer. This review aims to provide an overview of the major recommendation level changes introduced in the 2025 ATA guidelines compared with the previous version. This part specifically addresses the updates regarding the diagnosis and surgical management of differentiated thyroid cancer.

Objectives: We analyses separate age groups for in-hospital COVID pediatric patients clinical symptoms, lab tests, and treatment efforts. We also wanted to see if having another illness or a patient's nutritional condition could change the way the disease unfolds.

Methods: Between July 2020 and September 2021, 90 pediatric patients (aged 1 month-18 years) with positive PCR and/or antibody tests who were hospitalised in our hospital were included in the study. Patients were classified according to age groups (0-2, 2-5, 5-12, >12 years), disease severity and presence of comorbidities. Demographic characteristics, clinical findings, laboratory parameters and radiological imaging were evaluated.

Results: The disease had a mild course in 73.3% of the patients with a mean age of 87 months. In the youngest age group (0-2 years), fever (53.3%) and respiratory distress (26.7%) were more common and hospital stay was longer (median 7 days). Comorbidity rate (47.4%) was significantly higher in the moderate to severe disease group (p<0.001). The rates of elevated CRP (54.5%) and pathological chest radiography (36.4%) were higher in obese children. Recovery time was significantly longer in comorbid patients (7.3±2.4 days).

Conclusion: Our study suggests that COVID-19 does not affect all children in the same way-it appears to vary notably with age. In our observations, younger children and those with existing health conditions seem to require a bit more care and close monitoring to ensure the best outcomes.

Objectives: Influenza is an infectious disease that primarily affects the respiratory system. It can cause high morbidity and mortality, especially in people with risk factors. This study aimed to epidemiologically analyze influenza PCR-positive patients in the 2014-2015 influenza season and to identify risk factors associated with disease severity and fatality.

Methods: Within the scope of national influenza surveillance program, clinical samples from patients with influenza-like illness (ILI) symptoms are sent to the Turkish Public Health Institution, National Influenza Center for testing, accompanied by case information forms. A retrospective analysis was conducted on the case information forms of patients who tested positive for influenza via PCR during the 2014-2015 influenza season. Demographic data were analyzed, and the presence of risk factors associated with fatality was investigated through further analysis.

Results: A total of 1330 patients were included in the study. 684 (51.4%) of the patients were female. The median age was 42.8 years (IQR: 23-61). Among the patients, 154 (11.9%) died. The median age of deceased patients was 60.2 years (IQR: 39.8-75). Being over 65 years old in deceased patients is 3.4 times more likely compared to survived patients [OR=3.4 (95% CI=2.4-4.9)]. Additionally, deceased patients were 4.8 times more likely to have Influenza A (H1N1) compared to survivors [OR=4.8 (95% CI=3.2-7.2)], and the presence of chronic diseases in deceased patients was also 3.4 times higher than in those who survived [OR=3.4 (95% CI=2.3-5.1)].

Conclusion: Infection with H1N1, being elderly and presence of chronic diseases were found to be associated with increased fatality. To mitigate morbidity and mortality, it is crucial to vaccinate individuals with chronic diseases and the elderly, educate them about contact precautions, and encourage prompt healthcare seeking when symptoms appear.

Objectives: Clinicians are uncertain about the nutrition of patients diagnosed with hypoxic-ischemic encephalopathy due to the risk of necrotizing enterocolitis and feeding intolerance. The nutritional protocols of these patients are still unclear. We aimed to investigate the time of starting nutrition and related conditions in these patients receiving therapeutic hypothermia (TH) treatment.

Methods: This retrospective single-center study evaluated patients hospitalized at our unit and receiving TH between January 2022 and June 2023. Those who started nutrition during TH and after TH were defined as the early enteral nutrition (EEN) and late enteral nutrition (LEN) groups, respectively. Analyses were performed between the two groups.

Results: Our study evaluated 91 patients, of whom 40 were in the EEN group and 51 were in the LEN group. The reaching birth weight time in the LEN group was delayed (10 [5-22] vs. 7.5 [5-25] days, respectively, p<0.001), the transition time to full enteral nutrition was longer (10 [6-20] vs. 7 [5-18] days, respectively, p<0.001), and the hospitalization time was longer (13 [8-43] vs. 9 [7-35] days, respectively, p<0.001) compared with those of the EEN group.

Conclusion: TH is not an obstacle to starting nutrition. Starting nutrition in these patients at an early stage does not increase nutritional complications and shortens their discharge time.

Objectives: This study aimed to assess the predictive value of the Diastolic Deceleration Area (DDA), a novel Doppler ultrasound parameter, in detecting adverse neonatal outcomes in fetuses with late-onset fetal growth restriction (FGR). While Doppler parameters such as cerebroplacental ratio (CPR), umbilicocerebral ratio (UCR), and cerebralplacentaluterine ratio (CPUR) are commonly used for fetal monitoring, their predictive power varies. Given the importance of cerebral blood flow redistribution in fetal adaptation to hypoxia, we investigated whether DDA could serve as a reliable indicator of fetal distress and adverse perinatal outcomes.

Methods: This prospective case-control study was conducted between January 2024 and July 2024, including 90 pregnant women: 45 diagnosed with late-onset FGR and 45 gestational age-matched healthy controls. Doppler ultrasound measurements, including umbilical artery, uterine artery, middle cerebral artery Doppler indices, CPR, UCR, CPUR, and DDA, were performed. The primary outcome was the prediction of adverse neonatal events, such as neonatal intensive care unit (NICU) admission, neonatal sepsis, respiratory distress, low APGAR scores, and low cord blood pH. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive ability of the Doppler indices.

Results: DDA values were significantly higher in the FGR group compared to controls (p<0.001). At a cut-off value of >7.23, DDA demonstrated 50% sensitivity and 88% specificity, making it the most specific Doppler parameter for predicting adverse neonatal outcomes. In comparison, CPR (cut-off ≤2.11), UCR (cut-off >0.46) and CPUR (cut-off ≤1.36) had higher sensitivity (96%, 96%, 54%) but lower specificity (32%, 31% and 85% respectively).

Conclusion: DDA is a promising Doppler parameter for identifying fetuses at risk in late-onset FGR. Its high specificity suggests it could be a valuable supplementary tool alongside traditional Doppler indices for better risk assessment and clinical decision-making. Further studies are needed to validate its role in perinatal care.

Objectives: This study aimed to compare the expression of midkine (MK) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and non-diabetic individuals, elucidating its potential role in the pathogenesis of the disease.

Methods: This prospective cross-sectional study included three groups of patients who underwent pars plana vitrectomy (PPV) surgery. The first group (control) consisted of patients who underwent PPV for epiretinal membrane and macular hole and did not have diabetes mellitus (DM). The second group included patients who underwent PPV for vitreous hemorrhage (VH) and tractional retinal detachment (TRD) secondary to PDR without prior anti-VEGF treatment (No preoperative anti-VEGF application: NPa-VEGF). The third group comprised patients who underwent PPV for VH and TRD secondary to PDR and received a preoperative anti-VEGF injection one week before surgery (preoperative anti-VEGF application: Pa-VEGF). Vitreous samples were collected intraoperatively, and the concentrations of MK, interleukin (IL)-6, and IL-8 were measured using specific Enzyme-Linked Immunosorbent Assay (ELISA) kits.

Results: The study included a total of 49 eyes from 49 patients undergoing PPV. The concentrations of IL-6 and IL-8 in vitreous samples from the NPa-VEGF group (n=15) and the Pa-VEGF group (n=14) were not significantly different compared to the control group (n=20) (p>0.05). However, the vitreous fluid of patients in the NPa-VEGF group exhibited significantly higher MK concentrations compared to the control group (p<0.007). Similarly, MK concentrations were significantly elevated in the Pa-VEGF group compared to the control group (p<0.046). No significant difference in MK levels was detected between the NPa-VEGF and Pa-VEGF groups (p>0.05).

Conclusion: These findings suggest that increased MK expression in the vitreous may be associated with the pathogenesis of PDR. Further studies are warranted to elucidate the precise mechanisms underlying this association and to explore the potential of MK as a therapeutic target for PDR management.

Congenital hyperinsulinism (HI) is the leading cause of persistent hypoglycemia in infants and children. Focal pancreatic lesions account for 30-40% of cases with congenital HI. With early diagnosis, these patients can be treated by resection of the lesion, making long-term medical care unnecessary. In this case, a 5-day-old newborn boy presented with convulsion due to severe and persistent hypoglycemia at his hospitalization in neonatal intensive care unit. Laboratory studies revealed very low levels of ketone bodies with inappropriately normal insulin levels during hypoglycemia. The patient was unresponsive to diazoxide treatment. The molecular genetic analysis revealed a heterozygous pathogenic variant in the ABCC8 gene. 18F-DOPA-PET/CT scan showed increased uptake of 18F-DOPA consistent with focal lesion at the tail of the pancreas. A focal pancreatectomy operation was performed when he was three months old. Histopathological evaluation confirmed focal endocrine cell hyperplasia. Hypoglycemia did not recur after the operation. CHI patients with ABCC8 / KCNJ11 mutation are not easy to manage with pharmacotheraphy. In the case of an identifiable focal lesion associated with CHI, surgery is the most preferred option. In focal CHI, as in our case, the lesion may not be visually evident and requires a surgeon experienced in CHI.