Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: Brucellosis is a prevalent zoonotic disease in developing countries, as well as Türkiye. The objective of this study was to investigate the prevalence of brucellosis in the Hakkari province of Türkiye over a period of 1 year.

Methods: A retrospective cross-sectional study was conducted using serum samples from 12,742 patients in Hakkari's three main hospitals from January to December 2023. Demographic data, results of serological tests, admission time and clinics were collected and recorded. To identify seropositivity for brucellosis, the Rose Bengal Test (RBT) and Standard Tube Agglutination (STA) tests were performed.

Results: Of the samples, 6.6% tested positive for RBT, and 3.2% were confirmed to be seropositive for brucellosis with an STA titer of ≥1/320. The highest prevalence of brucellosis seropositivity was observed in August, with a greater prevalence among women, particularly those aged 25-44. Most patients were admitted to internal medicine clinics, and the highest seroprevalence was observed in infectious disease clinics. Seroprevalence was statistically significant across age, gender, and clinics (p<0.05).

Conclusion: The present study showed that the seroprevalence of brucellosis in Hakkari province was 3.2% in 2023. Brucellosis is still endemic in our province and public health measures are needed to reduce brucellosis transmission. We believe that the results of this study will provide data for epidemiological studies in the region.

Awake thoracic surgery utilizing thoracic epidural anesthesia has shown significant advantages over general anesthesia, especially in patients with comorbidities. This case report presents three cases of critically ill patients who successfully underwent awake thoracic surgery using thoracic epidural anesthesia. The first case involved an 81-year-old male with advanced chronic obstructive pulmonary disease who underwent thoracotomy with decortication for mesothelioma. The second case involved a 73-year-old male with a history of hypertension, coronary artery bypass graft surgery, laryngeal cancer, and permanent tracheostomy who underwent video-assisted thoracic surgery for alung tumor. Finally, the third case involved a 41-year-old female with a history of hypertension, tuberous sclerosis, epilepsy, and interstitial lung disease. All patients were managed with epidural anesthesia and conscious sedation, resulting in perioperative hemodynamic stability and effective pain control without the need for additional opioids. These cases highlight the efficacy and safety of thoracic epidural anesthesia for facilitating pain-free, uneventful thoracic surgeries in high-risk patients, suggesting that thoracic epidural anesthesia is a viable alternative to general anesthesia in selected cases.

Objectives: The aim of this study is to evaluate and compare the minimum 2-year functional outcomes, clinical scores and complications of patients in whom we performed open volar and dorsal ganglion cyst excision.

Methods: Patients were divided into two groups based on cyst location: dorsal and volar. The surgical outcomes were analyzed, encompassing the size and localization of the cyst, wrist ROM (range of motion), VAS (visual analogue scale) for pain, QDASH (quick disability arm shoulder hand) questionnaire, and PRWE (patient rated wrist evaluation) scale. Additionally, complications and recurrence rates were examined.

Results: A total of 53 patients were evaluated in the study, including 34 dorsal ganglion cysts (19 women, 56%) and 19 volar ganglion cysts (15 women, 79%). The mean age of the patients was 34.1 years (range: 18 to 68), and the mean follow-up period was 73.8 months (range: 26 to 136). The surgical duration was longer for volar cysts (p=0.01). For extension, the change in ROM was 3.9±6.3 degrees in volar cysts (p=0.01), whereas in dorsal cysts, this change was measured as 2.0±6.0 degrees (p=0.05). The increase in wrist flexion in the postoperative period was significantly higher in volar ganglion cysts (p<0.01). There were no statistically significant differences between the two groups for QDASH, PRWE, and VAS scores (p>0.05). Recurrence and complication rates were approximately 2-fold higher in volar cysts.

Conclusion: Open surgical excision is a successful treatment method for wrist ganglion cysts based on middle and long-term outcomes, with high patient satisfaction and low recurrence and complication rates.

Objectives: This study aims to determine the prevalence of cold agglutinins (CA) in patients undergoing cardiac surgery in the Turkish population, to draw attention to the importance of preoperative diagnosis, and to increase clinicians' awareness of cold hemagglutinin disease (CHD).

Methods: 4273 patients who underwent elective cardiac surgery between 2012-2022 were examined. All patients were routinely screened for CA. Patients were divided into two groups: 18-49 years old (Group 1) and over 50 years old (Group 2). Prevalence analysis was performed by comparing these age groups and genders.

Results: Among all patients, CA was positive in 390 (9.12%). There was no difference between group 1 and group 2 in all patient groups and women. However, CA was found to be higher in group 2 in men compared to group 1 (n=154 (8.9%) and n=65 (6.6%), respectively), p=0.47). CA was found to be higher in women compared to men (n=171 (10.9%), n=219 (8.07%), respectively), p=0.015).

Conclusion: We found that CAs were considerably high in patients undergoing cardiac surgery in the Turkish population. CA is important for cardiac surgery where hypothermia is used, and we believe that this pathology should be routinely screened in the preoperative period. Due to these rates that cannot be ignored, the clinical awareness of the heart team about CHD should be increased.

Intracardiac glomus tumors are very rare neoplasms arising from mesenchymal cells. Solitary glomus tumors are usually benign and mostly seen in the skin of limbs. Still, exceptional cases of noncutaneous visceral glomus tumors have been reported at sites other than the limbs. We present a case of glomangioma that was surgically removed from the right ventricle and briefly pointed to the importance of differential diagnosis of cardiac tumors. A 57-year-old woman was referred to our hospital for dyspnea and recurrent arrhythmia attacks. We performed a three-dimensional transthoracic echocardiogram, and contrast chest CT, which revealed a mass in the right ventricle. She was successfully treated with cardiac surgery. After pathological studies, the tumor was finally diagnosed as benign intracardiac glomangioma.

Objectives: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious hyperinflammatory complication of COVID-19 in which cardiovascular abnormalities are frequently detected. In the context of MIS-C, it remains uncertain which patients will develop cardiac dysfunction and which will experience coronary artery abnormalities (CAAs). To investigate this, patients were categorized into four distinct groups based on the presence or absence of myocardial dysfunction and/or CAAs. We aimed to determine whether there were any differences in demographic, echocardiographic, laboratory results, outcome, and COVID-19 variants between the groups.

Methods: Between July 2020 and August 2022, 135 MIS-C diagnosed patients were divided into 4 groups according to their cardiovascular involvement.

Results: The mean age of the patients was 104 months (9-209 months) and the male/female ratio was 1.45. Thirty-eight percent of the patients had decreased LVEF and 44% had signs of CAAs. Fifty-nine percent (80/135) of the patients were admitted to the pediatric intensive care unit (PICU). Patients admitted to the PICU were older patients with cardiac dysfunction. The severity of cardiac involvement ranged from severe to mild in Group 1, Group 2, Group 3, and Group 4, respectively. Group 1 was older (median age 146 months, p=0.008), albumin was lower (p=0.015) and CRP was higher than Group 4 (p=0.007). PICU admission/stay time and CRP elevation were significant in the groups with decreased LVEF (groups 1 and 2). More MIS-C patients were observed in the alpha wave compared to other waves, but there was no difference in the severity of cardiac involvement (p=0.25). Cardiac dysfunction and improvement in CAAs were observed in patients. The case fatality rate was 1.48%.

Conclusion: D-dimer, CRP, ferritin levels were higher, lymphocyte, platelet and albumin levels were lower in elderly patients with cardiac dysfunction who were followed up in the PICU.

Drug-induced esophagitis (DIE) is a rare condition and doxycycline is responsible for more than 50% of the cases. Most cases can be prevented and treated conservatively. In this case series, four patients with DIE that treated at our center will be presented. Four adolescents, aged 14, 16, 16, and 17 years, presented to the clinic with complaints of dysphagia and odynophagia. All patients had a history of oral doxycycline use for acne vulgaris. Upper GI endoscopy revealed erosions and ulcers in the thoracic esophagus in two cases and in the distal esophagus in the other two cases. All patients were managed conservatively, and follow-up endoscopy showed no development of strictures. DIE should be considered in the differential diagnosis of adolescents presenting with dysphagia and odynophagia. Proper education about medication use can reduce the risk of developing esophagitis.

Objectives: As artificial intelligence (AI) continues to advance, its integration into medical education and clinical decision making has attracted considerable attention. Large language models, such as ChatGPT-4o, Gemini, Bing AI, and DeepSeek, have demonstrated potential in supporting healthcare professionals, particularly in specialty training examinations. However, the extent to which these models can independently match or surpass human performance in specialized medical assessments remains uncertain. This study aimed to systematically compare the performance of these AI models with orthopedic residents in the Specialty Training Development Exams (UEGS) conducted between 2010 and 2021, focusing on their accuracy, depth of explanation, and clinical applicability.

Methods: This retrospective comparative study involved presenting the UEGS questions to ChatGPT-4o, Gemini, Bing AI, and DeepSeek. Orthopedic residents who took the exams during 2010-2021 served as the control group. The responses were evaluated for accuracy, explanatory details, and clinical applicability. Statistical analysis was conducted using SPSS Version 27, with one-way ANOVA and post-hoc tests for performance comparison.

Results: All AI models outperformed orthopedic residents in terms of accuracy. Bing AI demonstrated the highest accuracy rates (64.0% to 93.0%), followed by Gemini (66.0% to 87.0%) and DeepSeek (63.5% to 81.0%). ChatGPT-4o showed the lowest accuracy among AI models (51.0% to 59.5%). Orthopedic residents consistently had the lowest accuracy (43.95% to 53.45%). Bing AI, Gemini, and DeepSeek showed knowledge levels equivalent to over 5 years of medical experience, while ChatGPT-4o ranged from to 2-5 years.

Conclusion: This study showed that AI models, especially Bing AI and Gemini, perform at a high level in orthopedic specialty examinations and have potential as educational support tools. However, the lower accuracy of ChatGPT-4o reduced its suitability for assessment. Despite these limitations, AI shows promise in medical education. Future research should focus on improving the reliability, incorporating visual data interpretation, and exploring clinical integration.

Objectives: Chronic spontaneous urticaria (CSU) is characterized by recurrent wheals and/or angioedema lasting more than 6 weeks. The disease is marked by unpredictable, severe itching attacks, significantly impacting patients' quality of life and often prompting them to seek medical treatment. This study aimed to evaluate the efficacy of omalizumab in patients with CSU and identify the factors that determine its effectiveness.

Methods: This retrospective descriptive study analyzed registered data of 159 patients with CSU who received omalizumab at a tertiary dermatology clinic. The study recorded patient demographics, allergic conditions, omalizumab dosage, treatment response time, efficacy, duration of use, and additional medications. It also included assessments of total IgE levels.

Results: Of 159 patients with CSU, 112 (70.4%) were females, and 42 (29.6%) were males with a median age of 43 years (IQR = 20). Among the patients, 156 (98.1%) received a 300 mg dose of omalizumab, while 3 (1.9%) received 450 mg. Additionally, 41 (25.8%) required antihistamines and corticosteroids in addition to omalizumab, while 118 (74.2%) were treated with omalizumab alone. The median response time was 3 months, with 116 (73%) showing complete responses and 39 (24.5%) showing partial responses. Four patients (2.5%) showed no response. When patients were categorized into two groups-those receiving only omalizumab and those on combination therapy, the median response time to omalizumab was statistically significantly longer in the combination therapy group (mean=2.53±0.76, median=3, IQR=1 vs. mean=3.49±1.63, median=3, IQR=0). When patients were categorized into two groups based on a total IgE cut-off value of 20 IU/ml, the group with IgE levels greater than 20 had a significantly higher proportion of full responders.

Conclusion: The majority of patients with CSU in this study responded well to omalizumab, with a significant proportion achieving complete responses. Additionally, higher IgE levels (>20 IU/ml) were associated with a greater likelihood of full response to treatment. These findings suggest that omalizumab is an effective agent for CSU, with the possibility of enhanced response in patients with elevated IgE levels.

Objectives: Epicardial fatty tissue volume (EFV) is regarded as an important parameter in the evaluation of coronary artery disease (CAD). The aim of our study was to investigate the prognostic value of EFV measurements related to age, gender, coronary artery calcium score (CCS) and CAD severity through coronary computed tomography angiography (CCTA).

Methods: We retrospectively evaluated a total of consecutive 688 patients who were either asymptomatic but had a positive family history or had typical or atypical symptoms suggesting the presence of CAD. They all underwent CCTA examination with multiplanar reformat (MPR), maximal intensity projection (MIP), and myocardial three-dimensional (3D) volume rendering (VRT) images were obtained. We calculated CCS, coronary artery plaque stenosis degrees, the number of main coronary arteries involved and the EFVs for each patient. Finally, the relationship between the EFVs and all other parameters was analyzed by performing the Pearson and Spearman correlation analysis.

Results: We found a statistically significant difference between the genders of the patients where males presented higher EFVs than females (p=0.001, p<0.01). The correlation between the presence of CAD and the number of main vessels involved with EFVs was also statistically significantly higher in the analysis performed with the student t-test (p=0.001, p<0.01). There was a statistically significant but weak positive correlation between the ages of the patients (r=0.271, p=0.001, p<0.01), calculated total CCSs (r=0.149, p=0.001, p<0.01) and the degree of vessel stenosis determined based on coronary artery disease reporting and data system (CAD RADS) (r=0.347, p=0.001, p<0.01) and their EFV measurements.

Conclusion: We assume that the quantification of EFV performed by the CCTA technique is a potential novel method and hence, can guide clinicians in predicting the presence and severity of CAD.