Medical Bulletin of Sisli Etfal Hospital最新文献

Objective: Coronavirus disease 2019 (COVID-19) is considered to deteriorate endothelial function through hyperinflammation. We aimed to investigate microvascular dysfunction using the angiographic parameters thrombolysis in myocardial infarction frame count (TFC) and myocardial blush grade (MBG), in COVID-19 patients with acute coronary syndrome (ACS).

Methods: One hundred and sixty-five patients presented with ACS (62.4% ST elevated myocardial infarction) and underwent percutaneous coronary intervention between March 1 and June 30, 2020, were enrolled in the study. The polymerase chain reaction test was performed in case of suggestive symptoms or typical computerized tomography findings.

Results: Twenty-six patients (15.7%) were tested positive for COVID-19. Significantly higher values were observed in TFC in patients with COVID-19 (p<0.001), whereas COVID-19 patients had significantly lower MBGs (Grade 0 and 1) (p<0.001). Peak troponin-I value was also higher in the COVID-19 group (27335 vs. 15959 ng/dL, p=0.006). Mortality risk was higher in COVID-19 patients (38.4% vs. 7.2%, p<0.001). TFC and ejection fraction may predict in-hospital mortality among COVID-19 patients with ACS according to logistic regression results. In correlation analysis, TFC correlated positively with C-reactive protein (r=0.340, p<0.001) and peak troponin-I value (r=0.369, p<0.001).

Conclusion: COVID-19 is associated with slow coronary flow and microvascular impairment in ACS.

Objectives: Lateral lymph node metastasis (LLNM) in papillary thyroid cancer (PTC) determines the extent of surgery to be performed and the prognosis of the disease. In this study, we aimed to evaluate the clinicopathological risk factors affecting the development of LLNM.

Methods: We retrospectively evaluated the demographic and clinicopathological data of 346 cases with PTC who were operated in our clinic between May 2012 and September 2020. The patients were divided into 2 groups as patients with LLNM (Group 1) and without LLNM (Group 2).

Results: Thirty-six (10.4%) patients out of 346 patients with PTC had LLNM. A statistically significant difference was found between Group 1 and Group 2 regarding the male gender (M/F: 38.9% vs. 21.6%; p=0.020), tumor size (2.30±1.99 cm vs. 1.31±1.40 cm; p=0.000), lymphovascular invasion (69.4 vs. 20.6%; p=0.000), multicentricity (69.4% vs. 35.5%; p=0.000), multifocality (p=0.000), aggressive variant (22.2% vs. 9.4%; p=0.000), extrathyroidal extension (50% vs. 16.1% p=0.000), central lymph node metastasis (CLNM) rates (75% vs. 6.5%; p=0.000), and ≥3 cm lymph node metastasis (48.5% vs. 0%, p=0.000), distant metastasis (2.1% vs. 0%, p=0.000), respectively. Multivariance analysis determined the presence of CLNM as an independent risk factor for the development of LLNM.

Conclusion: The presence of CLNM in patients with PTC was determined as an independent risk factor for the development of LLNM. Although there has been increasing debate about prophylactic central neck dissection (pCND) in LLNM, pCND should still be considered in these patients as the rate of CLNM is high in patients with LLNM. CLNM might be a reference for surgeons to determine the extent of surgery. In addition, the presence of CLNM is important for close follow-up for the early detection of LLNM recurrence.

Objective: Hirsutism affects 5-15% of women of reproductive age. Health-related quality of life (HQOL) is a multidimensional assessment of well-being that considers the physical, social, and emotional aspects associated with a specific disease. The aim of this study is to evaluate HQOL in patients diagnosed with idiopathic hirsutism (IH) and compare it with patients diagnosed with polycystic ovary syndrome (PCOS).

Methods: This cross-sectional observational study was performed on 183 female individuals, consisting of 51 patients diagnosed with idiopathic hirsutism, 76 patients diagnosed with PCOS, and 56 healthy volunteers. Participants with a history of neuropsychiatric disorders, under 18 and over 45 years of age, during pregnancy and lactation, with any chronic disease that could interfere with diagnostic laboratory tests, and who had previously been treated for IH or PCOS were excluded from the study. Demographic, anthropometric, laboratory, and clinical data on the cases were recorded. The Short Form-36 (SF-36) questionnaire, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) were administered in a face-to-face interview by related authors involved in the study.

Results: The mean age, level of education, lifestyle, and marital status of all three groups were similar. There were no significant differences in body mass index (BMI) or waist circumference between the groups. Mean modified Ferriman-Gallwey (mFG) scores were similar in the IH and PCOS groups. In the IH patients, the general health and mental health domains of the SF-36 questionnaire scores were significantly lower than in the control group (p<0.001 and p=0.026, respectively). When the SF-36 questionnaire scores were compared between the IH and PCOS groups, the general health and role emotional domains were significantly lower in the PCOS group (p=0.013 and p<0.001, respectively), and the other domains were similar. All SF-36 questionnaire domains were significantly and negatively correlated with BMI and waist circumference measurements in IH patients. Both BDI and BAI scores were significantly and positively correlated with BMI (r=0.348, p<0.001, and r=0.162, p=0.012, respectively) and waist circumference (r=0.326, p<0.001, and r=0.344, p<0.001, respectively). Six out of eight domains of the SF-36 QOL scores were significantly and negatively correlated with the mFG scores.

Conclusion: Patients diagnosed with IH have impaired HQOL, similar to patients diagnosed with PCOS. Improving HQOL should be a goal when deciding on a management approach for hirsutism, which is one of the most common reasons for referral to endocrinology and dermatology outpatient clinics.

Objectives: We aimed to evaluate the effectiveness of the additive transurethral anesthetic agent to transrectal anesthetic agent.

Methods: Transrectal ultrasound-guided 12 core prostate biopsy planned, 237 patients included in our study. The patients randomly divided into two groups. Group 1 (n=113): Only transrectal 2% lidocaine, Group 2 (n=124): Transrectal + Transurethral(Sandwiches) lidocaine gel given to the patients 10 min before the procedure as anesthesia. Immediately after the biopsy, the patient questioned about the level of pain he felt during the needle entry. The evaluation measured by the VAS score. Immediately after biopsy satisfaction rate with the procedure and if rebiopsy was required, acceptance was scored between 1 and 4. The two groups compared statistically.

Results: The mean VAS score of Group 1 and Group 2 was 4.88±1.89 and 3.77±1.83, respectively. The pain level of Group 2 was lower than Group 1' pain level. The difference between the two groups was considered statistically significant (p<0.001). The patient satisfaction rates of Group 1 and Group 2 found to be 2.45±0.71 and 2.78±0.66, and the acceptance rate of rebiopsy was 2.81±0.69 and 3.02±0.51, respectively. The patient satisfaction rate and acceptance rate of the rebiopsy of Group 2 were higher than Group 1. Patient satisfaction level (p<0.001) and rebiopsy acceptance rate (p=0.014) between the two groups found to be statistically significant.

Conclusion: In the TRUS-guided prostate biopsies, sandwich anesthesia is a cheap, convenient, tolerable, and effective method.

Objectives: The transmission of severe acute respiratory syndrome coronavirus-2 occurs primarily through droplets, which highlights the importance of protecting the oral, nasal, and conjunctival mucosas using personal protective equipment (PPE). The use of PPE can lead to communication difficulties between healthcare workers and patients. This study aimed to investigate changes in the acoustic parameters of speech sounds when different types of PPE are used.

Methods: A cross-sectional study was conducted, enrolling 18 healthy male and female participants. They were instructed to produce a sustained [ɑː] vowel for at least 3 s to estimate voice quality. In addition, all Turkish vowels were produced for a minimum of 200 ms. Finally, three Turkish fricative consonants ([f], [s], and [ʃ]) were produced in a consonant/vowel/consonant format with different vowel contexts within a carrier sentence. Recordings were repeated under the following conditions: no PPE, surgical mask, N99 mask, face shield, surgical mask + face shield, and N99 mask + face shield. All recordings were subjected to analysis.

Results: Frequency perturbation parameters did not show significant differences. However, in males, all vowels except [u] in the first formant (F1), except [ɔ] and [u] in the second formant (F2), except [ɛ] and [ɔ] in the third formant (F3), and only [i] in the fourth formant (F4) were significant. In females, all vowels except [i] in F1, except [u] in F2, all vowels in F3, and except [u] and [ɯ] in F4 were significant. Spectral moment values exhibited significance in both groups.

Conclusion: The use of different types of PPE resulted in variations in speech acoustic features. These findings may be attributed to the filtering effects of PPE on specific frequencies and the potential chamber effect in front of the face. Understanding the impact of PPE on speech acoustics contributes to addressing communication challenges in healthcare settings.

Objectives: The aim of this study is to examine the kidney morphology and somatotype components of adult patients with early-stage chronic kidney disease (CKD).

Methods: The sample consisted of 46 individuals with early-stage CKD (26 men and 20 women, mean age=45.92±16.53 years). The pathological subjects were compared with a control group consisting of 46 healthy subjects (28 men and 18 women, mean age=41.96±11.48 years). The Heath-Carter method was used to determine somatotype components. Abdominal computed tomography (CT) of patients with Stage 2 CKD and healthy volunteers taken within the past 3 months was scanned to determine kidney morphology. Kidney measurements were performed on CTs (length, width, depth, and volume of kidney).

Results: Kidney patients (mean somatotype: 6.33-5.37-0.6) were less ectomorphic and more endomorphic than the controls (mean somatotype: 4.35-4.40-3.02). Moderate effect size (ES) was found in endomorphy (ES=0.87; p=0.035) and ectomorphy (ES=1.08; p=0.012) between groups. No significant difference was observed in the kidney morphology (ES=0.04-0.19; p>0.05).

Conclusion: In the early-stage CKD, kidney morphology may not be the distinguishing factor. On the other hand, patients differed significantly in terms of endomorph components. Being overweight can also be one of the negative findings for kidney disease. Somatotype classification could be a suitable tool for monitoring kidney disease.

Objectives: The purpose of the study was to evaluate cochlea dimensions by the multiplanar reconstruction of high-resolution computed tomography that could be useful in diagnosing incomplete partition (IP) malformations.

Methods: This study included 32 patients with 64 side cochleae diagnosed with IP defect and 38 cochleae as the control without any defect. Basal turn length (BL), cochlear height (CH), Mid-apical length (MAL), Mid-apical height, Cochlear length (A), and Cochlear width (B) were measured on reformat images.

Results: Twenty cochleae of these patients have been diagnosed with IP type I, 34 with IP type II, and 10 with IP type III. The MAL values are shorter than the control group in IP types I and III (p<0.001, p<0.001). BL values are shorter in IP type III cases (p<0.001). In IP II cases, BL and MAL values overlapped with the control group. CH did not differ significantly from the control group in any IP type. A and B values were significantly lower than the control group for IP I and III (p<0.01). There is a positive correlation between A and B values for all IP types (p<0.01).

Conclusion: Quantitative data about differences in the size and shape of the cochlea in IP cases would help differentiate them from the normal cochlea. Since A and B values showed a positive correlation, it is suggested that A and B values can be used to estimate CDL for IP types.

Objectives: Behcet's disease (BD) is characterized by systemic vasculitis with inflammation that can affect various body organs. In BD, vasculitis primarily manifests with venous involvement, distinguishing it from other forms of systemic vasculitis.

Methods: We retrospectively analyzed the demographic and clinical characteristics of 147 patients diagnosed with vascular BD in our center.

Results: Vascular BD cases accounted for 25.0% (147 out of 589) of all BD patients. A statistically significant correlation was found between gender and vascular involvement that was seen predominantly in males (76.9%). In 71 patients, a vascular event developed during follow-up for BD, while in 76 patients the disease was diagnosed after the occurrence of a vascular event (51.7%). The most common vascular event was deep vein thrombosis in the lower extremities (69.4%). Arterial involvement was primarily observed in the pulmonary arteries (12.9%). Patients with lower extremity deep vein thrombosis tended to be younger, while those with pulmonary artery involvement were typically older. Overall, veins were affected 4.5 times more frequently than arteries.

Conclusion: The prevalent type of venous involvement was deep vein thrombosis in the lower extremities. Thrombotic events in BD cannot be solely attributed to abnormalities in thrombotic factors. The treatment of thrombotic events in BD remains contentious, with anticoagulant efficacy being debated and immunosuppressive therapy representing the primary treatment approach. Behcet's disease should be considered when a young male patient presents with an arterial or venous vascular event, especially if it is recurrent.

Objectives: Necrotizing fasciitis (NF) requires surgical intervention and has high morbidity and mortality. Furthermore, it can be confusing with some skin diseases such as cellulitis. We investigated the roles of clinical and laboratory parameters at the time of admission to the hospital in the differential diagnosis of NF and cellulitis patients.

Methods: Patients with cellulitis and NF located between the nipple level and the knee between January 2018 and January 2021 were included in our retrospective study. The fever, history, complete blood count results, blood biochemistry, C-reactive protein and procalcitonin values of the patients at the time of admission to the emergency department, length of hospital stay, mortality rates, and laboratory risk indicator for necrotizing fasciitis (LRINEC) scores were recorded and evaluated whether there was a difference in both patient groups.

Results: A total of 55 patients, including 26 patients in the NF group and 29 patients in the cellulite group, were included in the study. It was observed that patients with NF applied to the hospital statistically earlier, had higher leukocyte, platelet and neutrophil levels, had longer hospital stays and had higher mortality numbers.

Conclusion: In high leukocyte, platelet, and neutrophil levels in the case of cellulitis patients, the clinician should follow the patient's clinic course closely and keep NF in mind.

Thyroid nodules are common and the prevalence varies between 4 and 7% by palpation and 19-68% by high-resolution USG. Most thyroid nodules are benign, and the malignancy rate varies between 7 and 15% of patients. Thyroid nodules are detected incidentally during clinical examination or, more often, during imaging studies performed for another reason. All detected thyroid nodules should be evaluated clinically. The main test in evaluating thyroid function is thyroid stimulating hormone (TSH). If the serum TSH level is below the normal reference range, a radionuclide thyroid scan should be performed to determine whether the nodule is hyperfunctioning. If the serum TSH level is normal or high, ultrasonography (US) should be performed to evaluate the nodule. US is the most sensitive imaging method in the evaluation of thyroid nodules. Computed tomography (CT) and magnetic resonance imaging are not routinely used in the initial evaluation of thyroid nodules. There are many risk classification systems according to the USG characteristics of thyroid nodules, and the most widely used in clinical practice are the American Thyroid Association guideline and the American College of Radiology Thyroid Imaging Reporting and Data System. Fine needle aspiration biopsy (FNAB) is the gold standard method in the evaluation of nodules with indication according to USG risk class. In the cytological evaluation of FNAB, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the most frequently applied cytological classification. TBSRTC is a simplified, 6-category reporting system and was updated in 2023. The application of molecular tests to FNAB specimens, especially those diagnosed with Bethesda III and IV, is increasing to reduce the need for diagnostic surgery. Especially in Bethesda III and IV nodules, different methods are applied in the treatment of nodules according to the malignancy risk of each category, these are follow-up, surgical treatment, radioactive iodine treatment, and non-surgical ablation methods.