Medical Bulletin of Sisli Etfal Hospital最新文献

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.

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.