Medical Bulletin of Sisli Etfal Hospital最新文献

Objectives: Hypoxic-ischemic encephalopathy (HIE) continues to be a predominant cause of morbidity and mortality in neonates. Therapeutic hypothermia (TH) is the only method with proven neuroprotective effects, and the aim of this study was to evaluate the short-term results of patients treated with TH.

Methods: Demographic, clinical characteristics, laboratory and aEEG results of patients who received TH treatment with a diagnosis of Stage II or Stage III HIE according to modified Sarnat staging in the Neonatal Intensive Care Unit were analyzed retrospectively.

Results: A total of 101 patients were included in the study. The mean gestational age of the patients was 38.8±1.5 weeks, the mean birth weight was 3215±499.5 g, and 40.6% were female. According to the modified Sarnat staging, 50.5% of the patients were evaluated as Stage II, and the others as Stage III HIE. The most common peripartum risk factors were meconium delivery (25.7%) and prolonged or difficult labor (20.7%). Mortality rates in patients with Stage II and Stage III HIE were 5.9% and 26%, respectively. In one of the patients who died, the 6th-hour aEEG background activity was moderately abnormal, and in 15 patients there was a severely abnormal voltage pattern. Acute kidney injury was found to be the most effective factor in mortality.

Conclusion: In our study, it was concluded that the mortality rate of newborns diagnosed with Stage III HIE was higher, the biggest impact factor on mortality was acute kidney injury, and 6th-hour voltage activity in aEEG monitoring was useful in predicting prognosis.

Objectives: Streptococcus anginosus group (SAG), also known as the Streptococcus milleri group, consists of Streptococcus anginosus, Streptococcus intermedius and Streptococcus constellatus. Skin and soft tissue infections, intra-abdominal infections, skeletal infections and ear-nose-throat (ENT) and cervical infections are the most common presentations. This study aimed to evaluate SAG infections in children.

Methods: A retrospective review was conducted on patients aged 0-18 years who had cultures positive for S. anginosus, S. intermedius, or S. constellatus between January 1, 2019, and March 1, 2024.

Results: SAG bacteria were cultured in 113 patients. SAG was identified as the causative agent of infection in 93 patients. Of a total of 93 patients, 39 were female (41.9%) and 54 were male (58.1%). The median age of the patients at the time of diagnosis was 14 years (IQR: 9-17). Among these, S. constellatus was found in 46 patients (49.5%), S. anginosus in 36 patients (38.7%), and S. intermedius in 11 patients (11.8%). The infections presented primarily as skin and soft tissue infections (63 patients), head and neck infections (23 patients), and intra-abdominal abscesses (7 patients). Additionally, two patients had concomitant bacteremia. Predisposing factors for the development of infection were identified in 52 patients (55.3%). Surgical drainage was required for 70 patients (74.4%).

Conclusion: Streptococcus constellatus was the most frequently isolated species among the SAG, followed by S. anginosus and S. intermedius. The most common site of infection was skin and soft tissue, with a significant proportion of patients requiring surgical drainage. The overall incidence of bacteremia was low. S. intermedius was more frequently isolated from deep tissue infections.

Objectives: To assess the efficacy of endovascular treatment and clinical outcomes in individuals with symptomatic intracranial stenosis who had not responded adequately to medical intervention.

Methods: The study included 32 patients who received endovascular treatment due to high-grade (70%-99% severity) intracranial atherosclerotic stenosis from December 2021 to December 2023. The patients had not experienced any acute ischemic or hemorrhagic infarction within the last three weeks, had a Modified Rankin Scale score of ≤3 at baseline, and developed a transient ischemic attack or non-disabling stroke despite having received the best medical treatment. Technical and clinical success, mortality, and complication rates were recorded.

Results: Of the 32 patients included in the study, 62.5% (n=20) were male, and the mean age was 66.4±10.09 years. Stenting was performed on the intracranial internal carotid artery in 43.8% (n=14) of the patients, the intradural vertebral artery in 37.5% (n=12), the middle cerebral artery in 12.5% (n=4), and the basilar artery in 6.3% (n=2). The technical success rate was 100%, and the clinical success rate was 87.5%. The mean degree of stenosis before the procedure was 91.7±6.3%, and the degree of residual stenosis after the procedure was 22.1±4.7%. The Neuroform Atlas® stent system was used in 18 cases (56.3%), Credo® stents in eight (25%), coronary balloon-expandable stents in four (12.5%), and the LVIS® stent system in two (6.3%). Twenty-eight (87.5%) patients did not have any symptoms in the first 30 days, while two (6.2%) patients had an ischemic stroke, one (3.1%) patient had a hemorrhagic stroke, and one (3.1%) died.

Conclusion: Endovascular treatment in carefully selected patients, a tailored selection of treatment subtypes, and an experienced multidisciplinary team overseeing the patient before, during, and after the procedure have the potential to provide safe and effective treatment for patients with symptomatic intracranial atherosclerotic stenosis.

Inguinal masses have a large variety of causes, ranging from inguinal hernias to soft tissue sarcomas. One of the less prevalent causes is vascular origin. Venous aneurysms, unlike their arterial counterparts, are seen seldomly and experience in management of these cases is scarce. A 32-year-old male patient was referred to our clinic due to an enlarging left inguinal mass with a preliminary diagnosis of inguinal hernia. Doppler ultrasonography revealed an eight cm in diameter aneurysmatic Great Saphenous Vein segment located just below the inguinal ligament. Dilated segment was excised without complete resection. Removal of the dilated segment and performing complete venous resection depending on venous valvular failure constitutes surgical repair of Great Saphenous Vein aneurysms. Surgical approach should be primarily selected if Great Saphenous Vein aneurysm is detected due to its debilitating nature and possible rupture.

Objectives: Adipsin and leptin are adipokines that link adipose tissue dysfunction and increased fat accumulation to obesity-related metabolic disorders. This study aimed to assess the effects of sitagliptin/metformin versus metformin monotherapy on the levels of adipsin, leptin, and lipid profile in type 2 diabetic patients.

Methods: This comparative case-control study included 120 participants divided into four groups: healthy participants, newly diagnosed type 2 diabetic patients, metformin-treated patients, and sitagliptin/metformin-treated patients.

Results: Newly diagnosed type 2 diabetic patients revealed significantly lower adipsin levels, with concomitant higher leptin levels compared to the healthy control group. Adipsin levels were significantly higher and leptin levels were significantly lower in both drug-treated patients compared to newly diagnosed group. Compared to healthy control, there were significantly higher levels of hemoglobin A1c (HbA1c), fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), and atherogenic index (AI) in the newly diagnosed patients, with significantly lower high-density lipoprotein (HDL) levels. Interestingly, in both treated groups, HbA1c, FBG, TC, TG, VLDL, and AI were significantly decreased compared to newly diagnosed patients. Concomitantly, there are significantly higher levels of HDL in drug-treated group compared to untreated patients.

Conclusion: Adipsin is low and leptin is high in diabetic patients which support its possible use as a biomarker for type 2 diabetes. Accordingly, the modification of these adipokines, via the use of drug therapy, has advantageous effects on the cardiovascular system in diabetic patients. Specifically, sitagliptin/metformin regulates adipsin, leptin, and lipid profile to a greater extent than metformin.

Chromosome 15q26 deletion is a rare condition that causes short stature and is associated with intrauterine growth restriction (IUGR), failure to thrive, congenital heart disease and many congenital malformations. The insulin growth factor receptor (IGF-1R) on chromosome 15 has many important roles, especially in growth regulation. Our case is an 18-month-old small for gestational age girl who presented with severe short stature, microcephaly and minor dysmorphic features. Chromosome microarray revealed 15q26 deletion including the IGF1R gene. Recombinant growth hormone (rGH) has been used in patients with IGF-1R defects with variable treatment responses. The reason for rGH unresponsiveness in some patients with terminal chromosome 15q deletion is still unclear. Herein we discuss the use of rGH in a patient with heterozygous IGF1R deletion and emphasize the need for further follow-up regarding other endocrine disorders.

Pheochromocytoma is a rare tumor originating from the adrenal gland, characterized by the secretion of catecholamines. Due to the risk of hypertensive crises associated with catecholamine release, surgical procedures in pheochromocytoma patients are risky. In this case report, laparoscopic appendectomy for acute appendicitis in a patient who has pheochromocytoma will be presented. A 49-year-old female patient presented with abdominal pain. Physical examination showed guarding and rebound in the right lower quadrant. The patient, who had leukocytosis in the investigations, showed signs of acute appendicitis and a 5 cm right adrenal mass on the abdominal computed tomography. A previous abdominal magnetic resonance imaging by the endocrinology department six months ago revealed a 39x32 mm mass in the right adrenal gland and elevated urinary catecholamine levels. It was learned that the patient had not attended follow-up appointments during this period. The patient was consulted by endocrinology and an emergency laparoscopic appendectomy was performed. The patient, discharged on the 2nd day after surgery, did not experience any complications. The patient was referred to endocrinology, and preoperative preparations for pheochromocytoma surgery were initiated. In cases of emergency in patients diagnosed with pheochromocytoma emergency surgery can be performed with appropriate preoperative preparation.

Objectives: Nonsmall cell lung cancer (NSCLC) accounts for about 85% of all lung cancers. Asymmetric dimethylarginine (ADMA) is an emerging molecule that is highlighted in carcinogenesis and tumor progression in lung cancer. Since elevated concentrations of ADMA are observed in lung cancer patients, we aimed to explore its associations with inflammation markers and established prognostic indices.

Methods: 78 newly diagnosed non-small cell lung cancer patients who were presented with brain metastases at the initial admission and 41 Stage 1 patients with NSCLC were included in the study. ADMA concentrations among the groups were correlated. Further, the relationship between ADMA levels and the other inflammatory markers was analyzed.

Results: ADMA levels were significantly higher in the group of NSCLC patients with brain metastases than in the Stage 1 patients control group (p<0.001). A significant negative correlation was found between ADMA levels and BMI, albumin and hemoglobin (p<0.001), whereas it was positively correlated with platelet, WBC, neutrophil-to-lymphocyte ratio, RDW, RDW/albumin ratio, LDH, CRP, fibrinogen, platelet, and CRP/albumin ratio (p<0.001).

Conclusion: Increased circulating concentrations of ADMA were significantly correlated with higher NLR, CRP and LDH; which were accepted as indicators of poor prognosis in NSCLC patients. ADMA might contribute to tumor growth and dissemination via systemic inflammatory pathways.

Objectives: Inflammatory bowel disease (IBD) in children is a chronic condition that affects the psychosocial status and physical activities of children and their parents. This study aimed to investigate the impact of IBD on the quality of life of adolescents and their families and the variability of behavioral and emotional adjustment issues compared to a healthy control group.

Methods: This study was designed as a prospective controlled study. A total of 159 cases were included, consisting of 84 IBD patients aged between 8-17 years and 75 healthy control subjects. All children and their parents included in the study were administered the Pediatric Quality of Life Inventory (PedsQL) and the Strengths and Difficulties Questionnaire (SDQ) for adolescents and parents.

Results: The median ages of the IBD children and the control group were 13.5 and 13, respectively. Of all 154 cases, 87 were female and 72 were male. Among the patients diagnosed with IBD, 39 had Crohn's disease, 37 had ulcerative colitis, and 8 had indeterminate colitis. It was observed that both the PedsQL and SDQ scores of children and parents with IBD were statistically significantly lower in both physical and psychosocial scoring (p=0.01 and p<0.001, respectively). A weak but statistically significant correlation was observed between the PedsQL and SDQ results applied to parents (rho=-0.214, p=0.007) and children (rho=-0.208, p=0.008).

Conclusion: The lower PedsQL and SDQ scores in children with IBD and their parents suggest that IBD negatively affects psychosocial, physical, and behavioral adaptations in children.