Balkan Medical Journal最新文献

Background: Although several surgical landmarks have been proposed to localize the recurrent laryngeal nerve (RLN), there is still no reliable landmark.

Aims: To validate the reliability of a novel reference point at the intersection of the inferior border of the cricopharyngeal muscle and the inferior cornu of thyroid cartilage for locating the RLN.

Study design: Cadaver dissection study in the academic department of otolaryngology-head and neck surgery.

Methods: Sixty-four RLNs in cadavers were assessed, and measurements of different surgical landmarks in conjunction with the proposed surgical landmark were obtained. Descriptive statistics, Pearson’s chi-squared test, and Student’s t-test were performed to analyze the data using GraphPad Prism (version 9.4.1; Dotmatics, Boston, Massachusetts, USA).

Results: The average distance from the proposed landmark to the RLN was 2.3 ± 0.85 mm. The RLN was located just posterior to the reference point in 95.31% of the cadavers. The RLN passed under the inferior constrictor muscle in 90.63% of the cadavers. There was no statistically significant difference between right- and left-sided RLNs in terms of their relation with the reference point.

Conclusion: The proposed reference point can be used as a reliable landmark to locate the RLN. This reference point may help surgeons during difficult thyroidectomy surgeries by providing an additional anatomical landmark.

Atopic dermatitis (AD) is a chronic inflammatory condition that significantly affects the quality of life of both patients and their families or caregivers. Recently, treatment for moderate-to-severe AD were limited to conventional immunosuppressive therapies. However, currently, with the approval of biologic treatments and oral small molecules in the past decade, the effective and safe management of patients with AD is possible. Despite these advancements, challenges and unmet needs in clinical practice remain. This includes patients who do not respond well to or cannot tolerate existing treatment options and inadequate therapies that can modify the disease course. This review aimed to provide an overview of the current treatment approach for AD, highlight the current challenges in treatment, and discuss the rationale for novel treatment options and emerging evidence on systemic treatment options for AD.

Background: Premature rupture of membranes (PROM) is defined as the leakage of amniotic fluid before the onset of labor and delivery contractions. Some studies found that women who experienced PROM had significantly lower vitamin C blood levels than those who did not, while others found no significant differences. Previous systematic reviews and meta-analyses on the efficacy of vitamin C in the prevention of PROM had conflicting results.

Aims: Conduct a systematic review and meta-analysis to determine if there was a significant difference in vitamin C blood levels in women who had PROM versus the control group who did not and to determine if vitamin C supplements could help prevent it.

Study design: Systematic review and meta-analysis.

Methods: We registered our protocol with PROSPERO (CRD42022371644). We searched PubMed/MEDLINE, Web of Science, and Scopus through February 15, 2024. Additionally, backward and forward citation searches were conducted. Studies were selected based on predetermined inclusion and exclusion criteria. Meta-Essentials: Workbooks for Meta-Analysis (version 1.5) was used for analysis.

Results: Twenty-five studies (26 reports) met all eligibility criteria, with 18 studies (18 reports) assessing vitamin C levels and seven studies (eight reports) evaluating efficacy. Women with PROM, whether preterm or term, had significantly lower vitamin C levels [Hedges’ g, -1.48; 95% confidence interval (CI): -2.82, -0.14; p = 0.020; I² = 94.08%) and specifically preterm PROM after removing the outlying study [Hedges’ g, -1.29; 95% CI: -1.85, -0.73; p < 0.001; I² = 87.35%). Vitamin C supplementation significantly reduced the risk of preterm or term PROM [risk ratio (RR), 0.57; 95% CI: 0.39, 0.81; p < 0.001; I² = 12.17%), particularly for preterm PROM (RR, 0.67; 95% CI: 0.45, 0.99; p = 0.001; I² = 0.00%). There were no significant differences in vitamin C levels between women with term PROM and controls, and there were no differences in the risk of developing term PROM between women taking vitamin C supplements and controls. Results were not robust in all sensitivity analyses.

Conclusion: Women with PROM, particularly those who developed it preterm, appear to have significantly lower vitamin C levels, and vitamin C supplementation appears to be effective in reducing the risk of PROM, particularly preterm PROM. More high-quality studies with low risk of bias, more homogenous, and larger samples are needed to confirm these findings.

Background: Type 1 diabetes is one of the most common chronic diseases in children. Wearable technology (insulin pumps and continuous glucose monitoring devices) that makes diabetes management relatively simple, in addition to education and follow-ups, enhances the quality of life and health of individuals with diabetes.

Aims: To evaluate the impact of wearable technology on metabolic management and the quality of life in children and adolescents with type 1 diabetes.

Study design: Systematic review and meta-analysis.

Methods: The Preferred Reporting System for Systematic Reviews and Meta-Analyses was used to conduct a systematic review and meta-analysis. PubMed, Web of Science, MEDLINE, Cochrane Library, EBSCO, Ulakbim and Google Scholar were searched in July 2022 and July 2023 using predetermined keywords. The methodological quality of the studies was evaluated using the Joanna Briggs Institute’s Critical Appraisal Checklists for randomized controlled experimental and cross-sectional studies. The meta-analysis method was used to pool the data.

Results: Eleven studies published between 2011 and 2022 were included. The total sample size of the included studies was 1,853. The meta-analysis revealed that the decrease in hemoglobin A1C (HbA1c) level in those using wearable technology was statistically significant [mean difference (MD): -0.33, Z = 2.54, p = 0.01]. However, the technology had no effect on the quality of life [standardized mean difference (SMD): 0.44, Z = 1.72, p = 0.09]. The subgroup analyses revealed that the decrease in the HbA1c level occurred in the cross-sectional studies (MD: -0.49, Z = 2.54, p = 0.01) and the 12-19 (MD = 0.59, Z = 4.40, p < 0.001) and 4-18 age groups (MD: -0.31, Z = 2.56, p = 0.01). The subgroup analyses regarding the quality of life revealed that there was no difference according to the research design. However, the quality of life was higher in the wearable technology group than in the control group in the 8-12 and 4-18 age groups (SMD: 1.32, Z = 2.31, p = 0.02 and SMD: 1.00, Z = 5.76, p < 0.001, respectively).

Conclusion: Wearable technology effectively reduces the HbA1c levels in children and adolescents with type 1 diabetes in some age groups. However, it does not affect the quality of life.

Background: Breast cancer is the leading cause of cancer-related mortality in women in Türkiye.

Aims: Explore the trends in female breast cancer mortality rates and the associated modifiable factors in Türkiye between 1990 and 2019.

Study design: Epidemiological descriptive analysis.

Methods: The database of the Global Burden of Disease study was used to obtain data regarding breast cancer-related mortality and modifiable (behavioral and metabolic) risk factors among women in Türkiye from 1990 to 2019. The average annual percentage change (AAPC) for female breast cancer mortality rates was computed using the Joinpoint regression method.

Results: From 1990 to 2009, the breast cancer mortality rates in Türkiye tended to increase [from 12.26/105 in 1990 to 12.65/105 in 2019; AAPC=0.1 "95% confidence interval (CI): 0.1-0.1"]. In terms of breast cancer mortality attributed to modifiable factors, a 3% increase was observed from 1990 (20.4%) to 2019 (23.1%), the highest contributor being high body mass index (3.19% in 1990 to 5.87% in 2019; AAPC=1.5; 95% CI: 1.3-1.5), followed by high fasting plasma glucose (5.01% in 1990 to 7.72% in 2019; AAPC=1.4; 95% CI: 1.3-1.5).

Conclusion: The proportion of breast cancer-related deaths attributed to metabolic factors has been increasing in Türkiye from 1990 to 2019. Therefore, health policies aimed at managing metabolic factors in women are warranted to reduce breast cancer-related mortality in Türkiye.