Northern clinics of Istanbul最新文献

Objective: Respiratory functions in thalassemia major (TM) patients concerning poor chelation are a frequently researched issue. Our study aims to evaluate the lung functions of our patients with TM in the chronic transfusion program and to correlate them with their age, ferritin levels, and pre-transfusion hemoglobin values.

Methods: Height, weight, pulmonary function test (PFT) results, pre-transfusion hemoglobin levels, and ferritin levels of 97 patients (55 boys and 42 girls) without any underlying cardiac or chronic respiratory disease were recorded. PFT is consisted of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), the ratio of FEV1/FVC to peak expiratory flow (PEF), and forced mid-exhaled flow between 25% and 75% of mid-expiratory flow (MEF_25-75). Data were analyzed with IBM SPSS V25.

Results: Low FVC was observed in 58 patients (60%), and low FEV1 was observed in 26 patients (27.6%). Low PEF was observed in 62 patients (64.5%), and low MEF25-75 was observed in 8 (8.3%). PFT was affected in 75 patients (78.1%). The pattern of involvement was restrictive. Age, height, and ferritin values significantly affected the MEF_25-75 (p<0.05). Age and pre-transfusion hemoglobin values had a significant effect on the FVC test (p<0.05). There was a weak negative correlation between ferritin values and MEF_25-75 (r=-0.221) and a weak positive correlation between pre-transfusion hemoglobin and FVC (r=0.222).

Conclusion: Age and height are the main risk factors affecting FEV1, MEF_25-75, and PEF. Serum ferritin has only an effect on MEF25-75 in our study. The respiratory functions of TM patients were affected in a restrictive pattern.

Objective: Mechanical ventilation (MV) remains the most challenging and important issue in the field of pediatrics. It is a life-saving, invasive procedure that supports the cardiovascular and respiratory systems until the underlying disease is cured. The aim of this study was to evaluate the demographic profile, clinical aspects, indications and complications of MV, and outcome of the children in the pediatric intensive care unit (PICU) of a tertiary hospital in a developing country.

Methods: The demographic profile, clinical aspects, MV indications and complications, and outcomes of pediatric patients (0-18 years of age) who required MV in the Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital PICU from February 2022 to January 2023 were retrospectively reviewed.

Results: A total of 139 patients were analyzed, of whom 79 (56.8%) were males. The median age was 36 months (1-214). Respiratory diseases (38.8%) were the most common indication for MV. We observed a 19.4% mortality rate with a statistically significant association with sepsis (p=0.001). Compared to other diseases, a large number of sepsis patients were found to require a variety of critical care treatment modalities and prolonged respiratory support.

Conclusion: Although MV is an indispensable treatment method in PICUs, it should not be forgotten that it carries the risk of morbidity and mortality in addition to the underlying disease. Therefore, the establishment of experienced teams in PICUs could make an important contribution to the prognosis of the patients.

Objective: Obesity is a global health problem that increases the risk of coronary artery disease (CAD). However in studies, it has been observed that when the disease develops, obese patients have a more favorable prognosis than leaner patients. This is called the "obesity paradox." This study aims to evaluate the effect of obesity assessed with body fat percentage (BFP) and relative fat mass (RFM) besides body mass index (BMI) on infarct size (IS) estimated from peak creatine kinase-MB (CK-MB) levels in patients with non-ST-segment elevation myocardial infarction (NSTEMI).

Methods: Patients with a diagnosis of NSTEMI who underwent coronary angiography between January 2017 and January 2022 were retrospectively evaluated. Patients without available anthropometric data to calculate BMI, BFP, and RFM and serial CK-MB measurements were excluded from the study. BMI was calculated using weight(kg)/(height[m])² formula. Patients were dichotomized as obese (BMI≥30 kg/m²) and non-obese (BMI<30 kg/m²) to compare baseline characteristics. BFP and RFM were calculated from anthropometric data. Linear regression analysis was performed to define predictors of IS.

Results: Final study population consisted of 748 NSTEMI patients (mean age was 59.3±11.2 years, 76.3% were men, 36.1% of the patients were obese). Obese patients were more likely to be female, hypertensive, and diabetic. Smoking was less frequently observed in obese patients. Peak CK-MB levels were similar among groups. Obese patients had higher in-hospital left ventricular ejection fraction, and less severe CAD was observed in coronary angiographies of these patients. Multivariable regression analysis identified diabetes mellitus, systolic blood pressure, white blood cell count, hemoglobin, and BFP (β=-4.8, 95% CI=-8.7; -0.3, p=0.03) as independent predictors of IS.

Conclusion: Higher BFP is associated with smaller IS in NSTEMI patients. These findings support the obesity paradox in this patient group, but further, randomized controlled studies are required.

Objective: General or single-shut spinal anesthesia (SA) is applied for cesarean section and both methods of anesthesia have different effects on the mother and newborn. This retrospective study, in which 1-year data were analyzed, was aimed to examine the effects of general or SA on maternal and neonatal outcomes.

Methods: Anesthesia technique, mother's age, gestational age, number of pregnancies, previous cesarean delivery number, maternal complications, and indications for cesarean delivery were analyzed in 883 cesarean deliveries. In addition, weight and Apgar scores of newborn and umbilical cord blood gas values were examined.

Results: Neonatal intensive care need was higher in the general anesthesia (GA) group, Apgar scores were higher in the SA group, but neonatal mortality was similar. The umbilical cord Ph and lactate were lower; PCO₂ values were higher in the GA group. Neonatal weight, mother's age, gestational age, and Apgar scores were predictive for neonatal mortality, but anesthesia technique was not.

Conclusion: While umbilical cord blood gas values were less affected and the need for neonatal intensive care was lower with SA, we believe that both anesthesia methods can be used safely for mother and neonatal in cesarean anesthesia considering maternal and neonatal morbidity and mortality.

Objective: The high prevalence of vitamin D deficiency in the population causes physicians to request more vitamin D tests and increases laboratory costs. It is aimed at investigating the demanded numbers and cost analyzes of 25-hydroxyvitamin D (25(OH)D) tests with the big data obtained from the national information health system of the Turkish Ministry of Health.

Methods: Between 2017 and 2018, all inpatient and outpatient tests and 25(OH)D tests in all medical biochemistry laboratories in Turkiye were determined based on department and institution type. The cost amount, distribution among health institutions, and test request rates were calculated. In both years, the top ten most expensive tests, according to health institutions, were evaluated.

Results: The total number of medical biochemistry tests performed in 2017 and 2018 was 1.424.948.155 and 1.713.134.326, respectively. The number of 25 (OH)D tests analyzed in the same years was 8.698.393 and 13.919.127, respectively. When the data of the 2 years are compared, the consumption of 25 (OH)D tests increased by 37% in General hospital laboratories, whereas it increased by 115.09% in primary health laboratories. When all health institutions were evaluated, the increase rate in 25 (OH)D test demand was 60%, while the cost increase rate was 23%.

Conclusion: This report showed that the demands for 25(OH)D testing are increasing steeply, especially in primary health-care facilities. In this direction, laboratory information system test demand restrictions in accordance with national and international guidelines are important issues for policymakers.

Objective: The hematocrit (Hct) to hemoglobin (Hb) ratio, generally at 3.0 in healthy individuals, can vary in certain disease states. An emerging area of interest is the potential influence of triglyceride concentrations on this ratio and hemoglobin A1C (HbA1c) levels. This study aimed to identify the changes in HbA1c and the Hct/Hb ratio as triglyceride concentration increases.

Methods: This research involved an extensive analysis of 35,656,613 laboratory samples taken between January 2015 and December 2022 in Türkiye, including the respective triglyceride, Hb, Hct, and HbA1c results. The laboratory test results were obtained from the national health database of the Turkish Ministry of Health. The triglyceride levels were divided into 24 groups, each incremented by 100 mg/dL from a range of 0-3099 mg/dL. Mean and standard deviation values of Hb and Hct were calculated for each group, and the Hct/Hb ratio was graphically represented.

Results: The average HbA1c values ranged between 4.37±0.85 and 7.76±3.19 across the groups, Hb averages ranged from 9.75±1.7 to 14.03±2.21, Hct averages from 27.35±4.97 to 38.86±5.66, and Hct/Hb ratios varied between 2.77 and 3.03. The overall average for all samples was identified as 5.15±0.13 for HbA1c, 38.48±5.13 for Hct, 12.73±1.65 for Hb, and 3.02 for the Hct/Hb ratio.

Conclusion: It was observed that the Hct/Hb ratio gradually decreased as triglyceride levels increased. Evaluating anemia based on Hb concentration in individuals with hypertriglyceridemia might be misleading. It is recommended to use a correction factor based on triglyceride level.

Objective: This article aimed to study two different parameters of basal cell carcinoma (BCC): First, to analyze the expression of antihuman epithelial antigen (Ber-EP4) on the primary and recurrent BCCs on the head, neck, and other body parts and second, to find Ber-EP4's staining pattern and staining intensities correlation between histological type, demographic data, tumor, and its prognostic parameters.

Methods: We evaluated the Ber-EP4 staining patterns of 201 patients diagnosed with BCC. We analyzed the possible correlation between the tumor's prognostic parameters and the Ber-EP4 staining intensity and its pattern (peripheral, superficial, or diffused).

Results: In 199 out of the 201 cases, staining was observed. Two cases were unstained. In 25.6% (n=51) of the cases with staining, the staining was weak, on the 25.6% (n=51), it was moderate, and on the 48.8% (n=97), it was severe. The staining pattern was 31.2% (n=62) peripheral, 4.0% (n=8) superficial, 54.7% (n=109) diffuse, and 10.1% (n=20) peripheral and superficial.

Conclusion: Ber-EP4 is the only antibody commonly used for BCC diagnosis; the existence of different staining intensities and patterns in BCC tumor cells in routine dermatopathology practice limit the pathologists. The studies investigating Ber-EP4 staining in BCCs were conducted with very small numbers of cases. In these studies, even the presence of staining in the focal area was considered to be a positive acceptance criterion; the staining intensity and pattern were not evaluated. Therefore, our study is the first study with a high number of cases and the first to include an evaluation of Ber-EP4 staining's intensity and localization.

Objective: The popularity of intravenous immunoglobulin (IVIG) therapy in Acute Respiratory Distress Syndrome (CARDS) secondary to COVID-19 infection is increasing day by day. In this study, we aimed to retrospectively evaluate the possible cardiac effects in our CARDS patients treated with IVIG.

Methods: Demographic and clinical characteristics, mortality, sequential electrocardiography (ECG), echocardiography, cardiac markers, and other laboratory parameters of CARDS patients who received IVIG treatment were recorded.

Results: The mean age of the patients was 68.7±13.6%, and 70.5% were female. The mean number of days of hospitalization in the intensive care unit was 18.2±9.7, and the mortality rate was recorded as 35.2%. No pathological rhythm or ischemic change was observed in sequential ECG follow-ups. However, in consecutive ECO follow-ups, the sPAP values at the treatment end were numerically lower, although not statistically significant.

Conclusion: Our study suggests that IVIG therapy may be used safely in COVID-19 patients with cardiovascular side effects. However, due to the high risk of coagulopathy in these patients, the use of IVIG therapy in COVID-19 infection should be monitored with close monitoring, as it may increase the potential for cardiovascular risk. Furthermore, monitoring cardiac parameters are also essential as it may predict high cardiovascular risk in patients. For this reason, patients need lower infusion rates, steroid combination, adequate hydration, and effective anticoagulation therapy to avoid these side effects.

Objective: Although eyelid involvement is rare in cutaneous leishmaniasis (CL), it can cause severe ocular complications if the diagnosis is delayed and not treated. Our purpose in this study is to examine the clinical characteristics, diagnosis, and treatment methods as well as accompanying ocular complications in patients with CL diagnosis and eyelid involvement.

Methods: In this retrospective study, the clinical characteristics, diagnosis, and treatment methods of the disease as well as accompanying ocular complications were examined for 18 patients with CL diagnosis and eyelid involvement between May 2018 and October 2022 in our Dermatology and venereal diseases clinic.

Results: 10 (55%) of the patients were male and 8 (45%) were female. Unilateral lower eyelid involvement was most common (9 patients [50%]). Chalazion-like lesions (8 patients [45%]) were observed most commonly. All patients were diagnosed with CL by direct microscopic examination and were given systemic meglumine antimonate treatment. No ocular complications were observed in any of the patients.

Conclusion: It should be kept in mind that eyelid involvement may occur in CL, and ophthalmological examinations of these cases should be performed and treatment should be initiated in the early period to prevent possible ocular complications.

Objective: Anaphylaxis is an acute, life-threatening systemic hypersensitivity reaction. We aimed to evaluate the demographic and clinical characteristics of patients presenting with anaphylaxis, as well as triggers and risk factors, and to determine the rate of adrenaline auto-injector (AAI) usage.

Methods: The study was planned in the pediatric allergy outpatient clinic over a 1-year period. The data of children diagnosed with anaphylaxis were evaluated retrospectively; demographic characteristics, causes of anaphylaxis, and treatment modalities were recorded in the created study form.

Results: Eighty children (29 females) with a median age of 6.5 years (range: 1 month-17 years) were evaluated. The most common triggers were foods under 2 years of age (73%), and drugs (70%) above 2 years of age. Nearly half of the anaphylaxis episodes (n=41, 51.3%) occurred at home. Cutaneous and respiratory symptoms were the most commonly reported complaints (98.8%). The median age of the patients at the first attack with severe anaphylaxis (n=29, 36.3%) was significantly higher than the rest (p:0.007). The age at onset of the reaction (p:0.006) and occurrence of the reaction in hospital conditions (p<0.001) were determined to be significant risk factors for severe anaphylaxis. Most of them received antihistamines (95.7%) and corticosteroids (91.3%), while 78.3% received adrenaline. Only 9.5% of patients with recurrent episodes of anaphylaxis used AAIs.

Conclusion: Foods in infants and drugs in older children were the leading causative allergens of anaphylaxis. The most common clinical manifestations were respiratory and cutaneous symptoms. The older age at onset of the reaction and the occurrence of the reaction in hospital conditions were determined to be significant risk factors for severe anaphylaxis. It was determined that the frequency of AAI use was low among patients and their families.