Medical Bulletin of Sisli Etfal Hospital最新文献

Among the agents used for self-defense, O-chlorobenzylidene malononitrile (CS) is the most commonly used substance. It has been suggested that CS use is characterized by rapid onset of action, short duration of action, and minimal side effects. When the clinical situations and case series resulting from exposure to CS were examined, we saw that no cases of exposure during the neonatal period were identified. A male baby born at 40 weeks, weighing 3260 grams, was brought to the emergency room on the 24^th postnatal day with bruising and respiratory distress due to a stranger spraying CS into his mouth. There was a widespread hyperemic erosive lesion in the mouth, tongue exfoliation, and leg ecchymosis. Widespread edema and hyperemia were observed in the vocal cords, and the patient was intubated and followed up. An epithelial defect involving the corneal limbus and conjunctiva was detected in the upper and lower eyelid membranes. Endoscopy revealed a grade 2 burn in the esophagus, and normal pseudomembrane and gastric mucosa in some areas. It was observed that the lesions around the patient's mouth and tongue completely resolved. After discharge, the esophagus-stomach-duodenum radiograph showed no suspicion of obstruction. At the 3rd-month post-discharge check-up, his eye examination was normal, and his stridor and wheezing at rest continued. This case, in which we have shown that CS used for self-defense or riot suppression, seriously threatens the life of a newborn patient for the first time and may perhaps cause permanent morbidities during follow-up, suggests the need to restrict access to such substances.

In recent years, the use of AQUAfilling® filler has become widespread, particularly in breast and gluteal augmentation, which are among the most common aesthetic surgical procedures. Although AQUAfilling® filler is claimed to be biocompatible with human tissue, the number of complications associated with it continues to increase. The invasion of AQUAfilling® filler into the parenchyma, as well as the toxicity and oncogenicity of its main component, polyacrylamide, remain uncertain and require further investigation. In this study, we present three female patients with a history of AQUAfilling® filler injection for breast and gluteal augmentation who experienced long-term major complications. We aim to emphasize the significance of long-term complications of AQUAfilling® filler material and contribute to the reconstruction options in managing these complications.

Argyria can be described as the deposition of silver in the skin taken orally or through direct skin inoculation, causing discoloration of the skin and mucosa. In recent years, the increasing trend of people towards complementary medicine and marketing the colloidal form of silver is causing a resurgence of cases of argyria. Therefore, we aim to report a 16-year-old male patient who applied to our outpatient clinic and highlight this increasing trend by presenting a patient case. In the presented case, discoloration of the skin is much more pronounced on sun-exposed areas as in the literature, with the catalytic effect of sunlight on silver. In order to avoid this permanent situation, the authorities should take measures such as restricting the sale of products containing silver or limiting the silver content of products. Raising awareness is strongly recommended.

Objectives: Parkinson's disease (PD) is a neurodegenerative disorder with both motor and non-motor symptoms, including depression and anxiety, which significantly impact patients' quality of life. The predictors of these psychiatric symptoms remain incompletely understood. This study aims to evaluate the prevalence and potential predictors of depression and anxiety in PD.

Methods: A prospective study was conducted on 99 idiopathic PD patients. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale. A range of clinical and demographic variables, including motor symptoms, sleep disturbances, and quality of life, were analyzed using regression models.

Results: Of the patients, 57.5% had depression, 48.4% had anxiety, and 36.3% had both. Significant predictors of depression included the use of apomorphine, which was associated with lower PHQ-9 scores (p=0.031), and the presence of restless legs syndrome (RLS), which was linked to higher depression scores (p=0.037). For anxiety, younger age was a significant predictor (p=0.007). Both depression and anxiety scores correlated with lower quality of life (p<0.001 for both).

Conclusion: This study highlights the high prevalence of depression and anxiety in PD, with significant predictors including RLS for depression and younger age for anxiety. Apomorphine use appears protective against depression. Both depression and anxiety disrupt quality of life. These findings underscore the importance of routine psychiatric screening and comprehensive management of depression and anxiety in PD, aiming to improve patient outcomes.

Objectives: Isotretinoin-mediated apoptosis is considered the main cause of anti-acne side effects of isotretinoin. The aim of this study is to investigate the effects of oral isotretinoin therapy on the skin and serum levels of forkhead box transcription factor (FoxO)-3, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), p53 and metabolic parameters and examine the relationship between these parameters.

Methods: Sixteen acne vulgaris patients who were administered the appropriate cumulative dose of oral isotretinoin were enrolled in this prospective study.

Results: The decreases in the values of body mass index, waist circumference, systolic blood pressure (BP), CRP, and ferritin from the baseline to the end of the treatment were statistically significant (p=0.028, p=0.029, p=0.008, p=0.046, and p=0.003, respectively). The increases in the levels of serum low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), total cholesterol, gamma-glutamyl transferase (GGT), and FoxO3 from the baseline to the end of the treatment were statistically significant (p=0.001, p=0.004, p<0.001, p=0.010, p=0.007, respectively). In terms of changes from the baseline to the end of the treatment, serum FoxO3 levels were positively correlated with the changes in serum TRAIL levels (r=0.674, p=0.004). The changes in serum FoxO3 levels were positively correlated with the changes in fasting blood glucose levels (r=0.540, p=0.031). The changes in serum TRAIL levels were positively correlated with the changes in the values of systolic BP (r=0.552, p=0.027) and diastolic BP (r=0.511, p=0.043). The changes in serum p53 levels and serum LDL-C levels were also positively correlated (r=0.499, p=0.049).

Conclusion: Isotretinoin therapy caused an increase in skin and serum levels of FoxO3 and TRAIL and a decrease in serum and skin p53 values. However, only the increase in serum FoxO3 levels was statistically significant. The observed reduction in p53 levels implies that the isotretinoin-related side effects may not rely on p53-mediated apoptosis, and it may be considered that its safety profile is better than expected. The correlations between the changes during isotretinoin therapy in metabolic parameters and TRAIL, p53, and FoxO3 values suggest that isotretinoin's metabolic side effects may involve these molecules.

Objectives: Occupational diseases are often underestimated and overlooked among orthopedic surgeons. This study aimed to investigate the prevalence of occupational injuries and their impact on orthopedic surgeons in Türkiye.

Methods: A modified version of the physical discomfort Web-based anonymous survey and the Short Form-36 (SF-36) were sent via email to all members of the Turkish Association of Orthopedics and Traumatology (TOTBID) mailing list. The data were collected and analyzed.

Results: A total of 217 orthopedic surgeons completed the survey. The most common musculoskeletal disorders were low back pain (73%), wrist tendinitis (36%), lateral epicondylitis (29%) and shoulder pain (28%). Additionally, 98% of surgeons had experienced needle stick or sharp instrument injuries at least once, and fewer than one-third of them received special treatment from their institutions. The behavior of not using any protective equipment was found to be associated with the surgeon's age (p=0.03).

Conclusion: This study highlights the high prevalence of occupational health injuries among orthopedic surgeons in Türkiye. The findings of this study may raise awareness among orthopedic surgeons about occupational health injuries and encourage the implementation of prevention strategies, early recognition of these injuries, and timely, definitive interventions.

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.