Medical Bulletin of Sisli Etfal Hospital最新文献

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: This study introduces a novel anatomical closure technique in posterior lumbar interbody fusion (PLIF) surgery utilizing Adjustable Cross-Link (ACL) support to improve hemostasis, minimize drain duration, and enhance postoperative outcomes.

Methods: A retrospective analysis was conducted on 44 patients undergoing single-level PLIF with total laminectomy. Nineteen patients received standard closure (Group 1), while 25 underwent ACL-assisted closure (Group 2). Outcomes, including blood loss, drain usage, and functional recovery, were compared between the groups.

Results: Group 2 demonstrated significantly lower blood loss (p=0.044), reduced drain index (p<0.001), and shorter hospital stays (p<0.05) compared to Group 1. Early-stage visual analogue scale (VAS) for low back pain was also lower in Group 2 (p<0.001). Complication rates were lower in Group 2 (4.0% vs. 10.5%), with no reoperations required. Functional recovery, assessed by ODI scores, showed significant improvements in both groups.

Conclusion: ACL-assisted anatomical closure significantly reduces blood loss, shortens drain duration, and enhances early functional outcomes. Its mechanical stability facilitates better muscle healing and reduces postoperative complications, highlighting its potential as a superior closure method in PLIF surgeries.

Objectives: Ganglion cysts are the most common benign masses of the hand and wrist, frequently requiring surgical intervention due to symptoms such as pain, weakness, or aesthetic concerns. Open excision is a widely used method with varying recurrence rates reported in the literature. However, risk factors contributing to recurrence remain incompletely understood. Our study aims to evaluate the recurrence rates following open excision of wrist ganglion cysts and identify patient-related and surgical factors influencing recurrence.

Methods: Patients who underwent wrist ganglion excision between 2012 and 2024 were identified using the National Healthcare Implementation Communique code 611650. Exclusion criteria included cases without ganglion pathology confirmation, follow-up of less than one year, volar cysts, multiple cysts, first-time surgery for recurrence at the institution, incomplete medical records, and arthroscopic excision. Recurrence rates were calculated, and patient demographics, cyst characteristics, and surgical variables were recorded. Surgical experience was defined as years worked as an orthopedic surgeon. Cyst volume was measured using Magnetic Resonance Imaging data.

Results: A total of 109 patients with dorsal wrist ganglion cysts who underwent surgical excision were retrospectively reviewed. The overall recurrence rate is 11.9%. Ganglion cysts are more commonly observed in women and laborers. Surgical experience and the use of a tourniquet were found to be associated with recurrence (p<0.001 and p=0.019, respectively). Correlation analysis revealed no significant correlation between recurrence and age, follow-up duration, or cyst volume. According to the multivariate regression analysis, the most significant risk factors for recurrence are tourniquet use and surgical experience.

Conclusion: The use of a tourniquet and high surgical experience reduce the recurrence rate after open excision of ganglion cysts.

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.