Northern clinics of Istanbul最新文献

Objective: Cholestatic diseases are common and classified as benign or malignant based on their etiology. HALP is a unique nutritional immune marker that combines indicators of nutritional status, including hemoglobin and albumin, with immune function markers like lymphocyte and platelet counts. We investigated the HALP score's ability to differentiate between benign and malignant causes in extrahepatic cholestasis patients.

Methods: This research was designed as cross-sectional and retrospective. Between 1 January 2020-1 January 2022, patients diagnosed with extrahepatic cholestasis were included. The diagnoses were confirmed using non-invasive imaging methods, ERCP (endoscopic retrograde cholangiopancreatography), and tissue biopsy results. Based on the type of extrahepatic biliary obstruction, either benign or malignant, the patients were divided into two groups. The HALP score was calculated by multiplying the patient's albumin (g/L), hemoglobin (g/L), and lymphocyte count (/L) and dividing by the platelet count (/L).

Results: In 121 of 216 patients, extrahepatic cholestasis was caused by benign factors, mostly choledocholithiasis, while malignant causes, predominantly pancreatic head cancer, were responsible for extrahepatic cholestasis in 95 patients. The malignant cholestasis group had significantly higher bilirubin levels (p<0.001), lower hemoglobin levels (p=0.005), lower albumin levels (p<0.001), higher lymphocyte counts (p<0.001), and higher platelet levels (p=0.001) compared to the benign cholestasis group. There was no considerable difference in the HALP score between the two groups, as indicated by a p-value of 0.741.

Conclusion: The HALP score could not distinguish between benign and malignant causes of extrahepatic cholestasis.

Objective: Drug utilization studies (DUS), providing insights into various aspects of pharmacoepidemiology from prescribing to medication use, can be conducted through real-world data from health records and survey-based data. In this study, we aimed to describe survey/questionnaire-based DUS conducted in Turkiye.

Methods: We searched online databases for the most frequently used keywords in DUS from January 1993 till May 2023 and identified 180 survey-based DUS conducted in Turkiye. We described DUS by their populations, sociodemographic characteristics, timeframe, setting and provinces, data collection method, medication categories, and article-specific variables were evaluated.

Results: We identified that 68.3% of the DUS were in English and 91.7% were indexed in Web of Science (median 1 [interquartile range: 1-2] citation). We found that 21.7% of the articles (n=39) had pharmacology affiliation. Adults are the target population in 37.8% of the studies and age and gender were not reported in 27.2% and 16.7%, respectively. The response rate was not stated in 55.0%. We determined that 48.3% of the studies were focused on a single medication/medication group. The mean time from data collection to publication was 2.5±1.9 years, and the highest number of articles (10.6%) were published in 2021.

Conclusion: Our systematic review shows that the majority of DUS were listed in well-known international indices, suggesting that our local studies invoke global interest and hold a valuable position in health research. Nevertheless, lack of reporting of methodological characteristics in substantial part of the studies can be considered an important room for improvement of DUS.

Pheochromocytomas are potentially malignant and may manifest with vascular thrombi. We present the treatment of a patient with pheochromocytoma and tumor thrombosis of the renal vein and inferior vena cava. A thirty-eight-year-old male patient was admitted complaining of abdominal pain and headache. High levels of urinary catecholamine were detected. Magnetic resonance imaging revealed left pheochromocytoma with thrombosis of the inferior vena cava and the left renal vein. A left adrenalectomy and a thrombectomy with cavotomy were performed. The pathology results reported a 9.5 cm malignant pheochromocytoma. The patient's symptoms dissipated after the operation and there were no signs of recurrence at the two-month follow-up. Preoperative radiological diagnostic examinations are valuable in the planning of pheochromocytoma surgery. We believe that adrenalectomy and thrombectomy can be performed on pheochromocytoma patients with vascular thrombi with low morbidity.

Dynapenia is a condition characterized by decreased muscle strength and function in older adults that is not due to a specific underlying disease or medical condition. Dynapenia is common among older adults and has significant health effects, including functional impairment, disability, increased risk of falls, hospitalization, and death. Oxidative stress, mitochondrial dysfunction and chronic inflammation are involved in the etiopathophysiology of dynapenia. Diagnosis of dynapenia is based on the evaluation of muscle strength and function using methods such as hand grip strength, timed up and go test and short physical performance battery. Management of dynapenia involves a multifaceted approach that includes exercise, nutrition, pharmacological interventions, management of underlying medical conditions, and fall prevention strategies. With appropriate interventions, older adults with dynapenia can improve muscle strength and function, reduce the risk of falls and disability, and maintain their independence and quality of life.

Objective: Oral Lichen Planus (OLP) is an immune system disease and its cause has not been fully determined yet. Oral Lichenoid Contact Lesions (OLCL) is an allergic condition known to develop because of dental materials. It is considered that some infectious agents (e.g., Epstein-Barr virus (EBV)) play roles in the etiology of OLP and OLCL. The purpose of the present study was to investigate the presence of EBV in different clinical samples of patients who had OLP and OLCL, to show its relationship with OLCL, and to determine its role in etiopathogenesis in these patients.

Methods: Twenty (20) OLCL, twenty-three (23) OLP, and twenty (20) healthy volunteers who applied to Istanbul University Faculty of Dentistry, Oral and Maxillofacial Surgery were included in the study, regardless of gender. Biopsy samples were taken from patients who had a 5mm punch, including the mucosa containing the lesion along with saliva and blood samples, and all clinical samples were sent to the Department of Medical Microbiology Laboratory under appropriate storage conditions. After the isolation of the DNA from clinical samples, EBV DNA was analyzed on the Light Cycler 480 II device by using Real-time PCR (RT-PCR) tests. The evaluation of the statistical data of the results was made by using the SPSS program.

Results: When the data were evaluated, EBV DNA positivity was detected in 13.04% of the patients who had OLP, 10% of the patients who had OLCL, and 5% of the individuals in the Control Group. In saliva samples, EBV DNA was found positive in 21.74% of individuals with OLP, 15% of individuals with OLCL, and 10% of individuals in the Control Group. In the biopsy samples, EBV DNA was detected positive in 21.74% of the OLP patients, 15% of the OLCL patients, and 10% of the Control Group individuals.

Conclusion: Based on the findings of the present study, no significant differences were observed in the presence of EBV DNA or the quantitative viral load between patients with OLP, OLCL, and the Control Group. However, the quantitative EBV DNA results varied depending on the type of clinical sample selected. We believe that comprehensive studies that will include a larger number of samples must be conducted to determine the role of EBV in OLP and OLCL.

Objective: Patient satisfaction refers to the degree to which patients' expectations from health care services are met and is a critical indicator used to measure the overall quality of this service. This study aims to analyze overall patient satisfaction and regarding factors in our country, providing valuable insights for policymakers, clinicians, and researchers who aim to improve the quality of health care services and patient outcomes. Furthermore, as a nationwide assessment, this study reveals the potential of big data analytics in health services.

Methods: Integrated e-Pulse and Health Statistics and Causal Analysis (SINA) systems were used to gather satisfaction scores given by patients after any health care service obtained for overall health care service, physician, personnel other than physician, sanitization (from 0 to 100). The data were processed and analyzed using libraries Pandas and NumPy in the Python programming language.

Results: A total of 37.674.978 scores were given by a total of 11.421.857 patients regarding health care service they obtained involving ratings of 207.339 physicians, between the years of 2016 and 2023. Mean health care rating was 80.4 over 100, mean physician rating was 82, mean rating for personnel other than physicians was 78.4 and mean rating for sanitization was 77.7. When the top 15 most scored facilities were investigated, overall point was highest for Family Medicine centers (94.62) and lowest for Women's Health and Pediatric Diseases hospitals. When rate of 100 points given for each clinic after an admission was investigated, it was lowest for emergency medicine, pediatric emergency medicine, dentistry, endodontia, dermatology and pandemic clinics, and highest for oncology, radiation oncology and family medicine clinics. Waiting time to admission and length of hospital stay seemed to be important factors for patient satisfaction.

Conclusion: This is the largest study regarding patient satisfaction in Turkiye and was conducted by the foremost health care provider, the Ministry of Health. This limited data may provide implications to be assessed to keep the positive trend in our country in patient satisfaction and future analyses evaluating infinite potential factors to hasten the progress of health care in our country.

Objective: Macroprolactinemia is a well-described endocrine disorder, with its results leading to unnecessary tests and overtreatment. However, routine macroprolactin screening is not performed in many laboratories. Routinely used prolactin assays can result in false diagnosis of hyperprolactinemia in patients with no signs and symptoms related to hyperprolactinemia and clinicians should be aware of macroprolactinemia frequency encountered with the method in use. In this study, it was aimed to examine the frequency of macroprolactinemia among patients with hyperprolactinemia.

Methods: Prolactin analyses were performed on Roche Cobas^® e801 immunoanalyzer using the Elecsys Prolactin II electrochemiluminesence immunoassay (Roche Diagnostics, Mannheim, Germany). Samples were provided from 14 different hospitals in total and evaluated with the same method in a single central laboratory. In order to precipitate the samples for macroprolactin analysis, polyethylene glycol (PEG) 6000 was used.

Results: In this study, we evaluated 1100 patients with hyperprolactinemia and determined the frequency of macroprolactinemia to be 9.6% (recovery cut-off value <40%), while 8.5% of the patients were in the gray zone (recovery cut-off value 40% to <60%).

Conclusion: Laboratories should consider regularly screening for macroprolactinemia in all hyperprolactinemic samples and collaborate with clinicians to raise awareness about the prevalence of this condition.

Objective: Coronavirus Disease 2019 (COVID-19) has affected every aspect of human life and all health care systems globally. The aim of this study was to investigate the effect of COVID-19 pandemic on the frequency, presentation and surgical outcomes of complicated appendicitis.

Methods: Patients who underwent appendectomy for acute appendicitis one year before and one year after the declaration of the pandemic were investigated. Demographics and diagnostic findings as well as surgical and histopathological outcomes were recorded and statistically analyzed.

Results: The study group of 409 patients was composed of 241 cases in the pre-pandemic group and 168 cases in the pandemic group revealing that the weekly total number of appendectomies decreased during the pandemic [pre-pandemic, median (IQR): 5 (3-6); pandemic, median (IQR): 3 (2-5); p=0.005]. The pandemic group was significantly associated with a longer time from emergency department admission to hospitalization, increased mean blood C-reactive protein levels and increased rate of postoperative complications (p=0.024, p=0.038 and p=0.004, respectively). Most importantly, pathological examinations revealed a higher number of complicated appendicitis cases in the pandemic group when compared to the pre-pandemic group [26 (15.5%) vs. 19 (7.9%), respectively] which corresponded to a 2.1-fold higher risk of being diagnosed with complicated appendicitis during the pandemic [OR: 2.1 (95% CI: 1.1-4.1), p=0.024].

Conclusion: While fewer appendectomies were performed during the pandemic, the incidence of complicated appendicitis and postoperative complications increased considerably.

As in many surgical branches, minimally invasive methods are becoming increasingly prominent in hepatobiliary surgery. Nowadays, robotic and laparoscopic methods are among the hot topics in the current literature. Both laparoscopic and robotic surgery have better short-term results than open surgery in terms of the blood loss, need for blood transfusion, length of intensive care unit and hospital stay, and postoperative major complication rate. In addition to cosmetic benefits, minimally invasive methods have similar results to open surgery in terms of oncologic outcomes. Minimally invasive techniques for hepatocellular carcinoma, colorectal cancer liver metastasis and cholangiocarcinoma, which are the most common indications for surgery, also for donor and recipient surgeries in organ transplantation, can be safely applied in high-volume centers and by experienced surgeons. The use of robotic surgery is increasing especially in major hepatectomy operations. The main advantages of robotic surgery over laparoscopic surgery are less bleeding, less conversion rate and a shorter learning curve. However, there is a need for studies investigating the cost-effectiveness of robotic surgery, the production of devices such as robotic ultrasonographic dissectors, and the establishment of structured minimally invasive hepatobiliary surgery training programs. The aim of this review is to evaluate the recent findings and current evidence on minimally invasive hepatobiliary surgery.

Objective: This study aims to evaluate the nutritional status of patients with stage 3 and 4 diabetic nephropathy (DN; DN-3 and DN-4) and to explain the effect of DN stages on the prognosis of protein-energy wasting (PEW).

Methods: Data from demographic characteristics, anthropometric measurements, biochemical findings, food consumption records, and the Subjective Global Assessment (SGA) screening tool of 49 patients (25 DN-3; 24 DN-4) who were followed at the nephrology department were collected. The criteria of the International Society of Renal Nutrition and Metabolism (ISRNM) were used to determine PEW.

Results: 56% of DN-3 and 66.7% of DN-4 have been diagnosed with diabetes for over 15 years. The groups differed in total body weight, body-muscle weight, creatinine, microalbuminuria, and eGFR values (p<0.05). Protein (g/kg) intake was only different between the groups (p<0.05). 18.4% of patients had SGA-B score, and 26.5% had PEW.

Conclusion: Our study provides a general impression about the presence of PEW in DN patients not receiving dialysis in Turkiye. In patients with DN-3 and DN-4, daily energy and macronutrient intakes are adequate by recommendation. According to ISRNM criteria, the prevalence of PEW increased with advancing disease stage. PEW was observed to be more effective than SGA in assessing malnutrition.