Northern clinics of Istanbul最新文献

Objective: Red cell distribution width (RDW) is a hematological parameter that is routinely obtained as part of the complete blood count analysis. An increased RDW level, which helps identify erythrocyte anisocytosis, is also a good indicator of the severity and outcome of some other diseases. The aim of this study was to investigate the predictive power of the serum RDW level for determining (seven-days mortality) of patients with acute ischemic stroke (AIS).

Methods: A total of 527 adult patients with AIS presenting to our emergency department of tertiary-care hospital were retrospectively enrolled. The baseline characteristics, National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores, reflecting stroke severity and neurological outcome, and serum RDW values were recorded retrospectively. An univariate and multivariate logistic regression analyses were performed to identify independent predictors of seven-days mortality, including serum levels of RDW, age, NIHSS and mRS values.

Results: Serum RDW levels were significantly lower in patients who survived longer than seven-day compared with those who died within the first seven-days (15.36±1.04% v.s 16.61±1.28%, p=0.001). Furthermore, the mean NIHSS score was significantly lower in patients who survived longer than seven-days compared with those who died within the first seven-days. Additionally, the mean mRS score was significantly lower in patients who survived longer than seven-day compared with those who died within the first seven-day (p=0.001). Receiving operator characteristic analysis revealed a cut-off RDW level of 16.2%, with 66.1% sensitivity and 78% specificity, for distinguishing patients who survived longer than seven-days from who died within the first seven-day.

Conclusion: The serum RDW level may serve as a guide in diagnostic decision-making to predict neurological outcome and determine the short-term survival of patients with AIS.

Objective: Acne vulgaris is a chronic and common disease among adolescents. The effects of acne vulgaris on the caregiver's quality of life and its relationship to patient's quality of life have been seldom studied. This study aims to investigate impact of adolescent acne vulgaris on the patients' and their caregivers' quality of life and to evaluate the relationship between these two variables.

Methods: Acne vulgaris patients aged between 10 and 18 years and their caregivers were included in this prospective study. CDLQI (Children Dermatologic Quality of Life Index) and DFIS (Dermatological Family Impact Scale) questionnaires were used to assess the impact of acne vulgaris on the quality of life of patients and caregivers. SPSS version 21 was used for the statistical analysis; Spearman correlation test and Mann Whitney U test were used.

Results: This study has shown a significant correlation between DFIS and CDLQI, between severity of acne and CDLQI, and between the previous use of systemic antibiotics and DFIS. There is no relationship of age, sex, disease duration, number of siblings, amount of money spent and previous treatment modalities to CDLQI. There is no relationship between age, sex, acne severity, disease duration, number of children and amount of money spent on DFIS.

Conclusion: Acne vulgaris not only has an impact on the patient's quality of life but also on the caregiver's quality of life, which in turn affects the patient's quality of life.

Chromatography remains a cornerstone analytical technique in pharmaceutical and biomedical sciences, with recent innovations significantly expanding its capabilities. Advances such as fast chromatography, two-dimensional liquid chromatography (2D-LC), supercritical fluid chromatography (SFC), and hyphenated techniques, including liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS), have broadened the scope of its applications. These developments enhance resolution, sensitivity, and efficiency, enabling more robust analysis of complex biological and pharmaceutical samples. These methods address complex analytical challenges, improving precision, speed, and efficiency in separating and analyzing biomolecules. Emerging technologies, including miniaturized liquid chromatography, shear flow chromatography, column arrays, and microfluidic chip-based systems, present exciting opportunities for the future. These developments enhance the capability of chromatography to analyze trace compounds, optimize drug formulations, and ensure the quality control of pharmaceuticals. Chromatography is also increasingly integrated with cutting-edge techniques like metabolomics and proteomics, furthering its impact on biomarker discovery and personalized medicine. This paper reviews recent advancements in chromatographic methods and their practical applications in the pharmaceutical and biomedical fields. It highlights the critical role of chromatography in drug discovery, purification of therapeutic compounds, and metabolite profiling.

Objective: Hill-Sachs lesions are considered as an a priori risk factor for glenohumeral instability. Determination of glenoid and coracoacromial arch morphometric properties of patients with Hill-Sachs lesions may aid in the diagnosis, identification of optimal treatment strategies and prevention of recurrence.

Methods: Computed tomography (CT) images of individuals between the ages of 20-40 were examined and the morphometric characteristics of the 39 patients with Hill-Sachs lesions and 71 control patients with healthy shoulder structures were compared. Glenoid inclination (GI), acromio-humeral distance (AHD), glenoid height (GH), glenoid superior width (GWs), glenoid inferior width (GWi), glenoid surface (GS), coraco-acromial distance (CAD), coraco-glenoid distance (CGD) and acromio-glenoid distance (AGD) were determined as morphometric features.

Results: The average values of the measurements in Hill-Sachs and control groups, respectively, were; glenoid inclination (1.06±6.61°; 4.33±6.20°), acromio-humeral distance (6.66±1.26; 7.67±1.64 mm), glenoid height (33.90±2.34; 35.03±3.29 mm), glenoid superior width (19.89±5.89; 19.83±2.37 mm), glenoid inferior width (24.28±2.53; 26.04±3.06 mm), glenoid surface (647.93±91.26; 721.58±136.86 mm²), coraco-acromial distance (40.24±3.99; 38.10±3.80 mm), coraco-glenoid distance (29.39±3.64; 29.96±4.44 mm) and acromio-glenoid distance (31.44±3.45; 31.64-33.56 mm). Glenoid inclination (p=0.011), acromio-humeral distance (p=0.001), glenoid height (p=0.039), glenoid inferior width (p=0.001), glenoid surface area (p=0.002) and coraco-acromial distance (p=0.008) were significantly different between the groups.

Conclusion: The glenoid and coracoacromial arch morphometry showed significant differences in patients with Hill-Sachs lesions. Recognizing these differences can reduce recurrence rates by reducing risk factors in the treatment of glenohumeral instability and providing the closest anatomical integrity to normal.

Objective: Tuberculosis and drug reactions due to antituberculosis drugs are important public health problems. Severe cutaneous adverse drug reactions (SCARs) due to antituberculosis drugs are factor that makes tuberculosis treatment difficultchallenging. In this real-life study, we present our experience with SCARs due to antituberculosis drugs and their management.

Methods: Patients hospitalized in the tuberculosis ward of tertiary care reference hospital between January 1, 2015, and September 1, 2023, were retrospectively reviewed. Patients who consulted the immunology and allergy clinic were included in the study.

Results: A total of 4,039 patients were hospitalized with tuberculosis during the study period. A total of 316 (7.8%) patients were consulted, and out of these, eight (2.5%) patients were evaluated as SCARs. Of the eight patients, seven (87.5%) were diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS), and one was diagnosed with Stevens-Johnson syndrome (SJS) (12.5%). The peripheral blood eosinophil count of patients with DRESS ranged between 740 and 8,690 cells/µL. One patient tested positive for human immunodeficiency virus and developed SJS. Methylprednisolone intravenous 1 mg/kg and Fexofenadine 180 mg/day per oral were used in the treatment of SCARs in all cases. Ad-on treatment for three cases used mepolizumab (anti-IL5 monoclonal antibody) for DRESS. All patients were switched to an alternative treatment protocol and tolerated the new regimen well.

Conclusion: In cases with developed SCARs, a new treatment protocol consisting of different medications can be applied after the symptoms improve. DRESS was the most common SCAR of antituberculosis drugs. Monitoring the eosinophil count can help in early diagnosis. Systemic steroids and antihistamines may be effective in the treatment. Mepolizumab can be used with off-label approval in the treatment of DRESS cases to accelerate the treatment process.

Objective: To evaluate the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on prostate volume, prostate-specific antigen (PSA) values, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q_max) andpostvoid residual urine volume (PVR) of patients with BPH.

Methods: After retrospectively review the hospital database, the study included 104 patients aged 40-75 years, who were detected to have SARS-CoV-2 according to the reverse transcription-polymerase chain reaction (RT-PCR) test of combined oro-nasopharyngeal swab samples between March 2020 and December 2020 who were being followed for BPH and had undergone prostate volume, PSA, IPSS, Q_max and PVR measurements within one year prior to their COVID-19 diagnosis. The prostate volume, PSA, IPSS, Q_max and PVR parameters were compared before and after COVID-19.

Results: The prostate volume, PSA, IPSS, Q_max and PVR values were compared pre-COVID-19 and post-COVID-19. No statistically significant changes were found in prostate volume and PSA levels (p>0.05), while a statistically significant difference was observed in IPSS, Q_max and PVR values, independent of the severity of the disease (p<0.001).

Conclusion: COVID-19 appears to have a negative impact on IPSS, Q_max, and PVR in BPH patients in the short term.

To examine the global epidemiology of human T-lymphotropic viruses (HTLVs), with a focus on under-reported and under-studied regions such as Turkiye, and to highlight public health challenges, including insufficient surveillance and lack of awareness. A comprehensive review of published literature and epidemiological data was conducted to identify trends, prevalence rates, and gaps in surveillance. Key sources included peer-reviewed journals and global health reports. HTLV-1 was identified as highly endemic in regions such as Japan, the Caribbean, South America, and sub-Saharan Africa. Limited data were available for Turkiye and adjacent regions, with estimated prevalence rates below 0.1%. Insufficient screening, stigma, and resource constraints were noted as major barriers to improved surveillance and prevention. HTLVs remain a neglected public health issue with significant implications for healthcare systems. Targeted research, expanded surveillance, and public health interventions are urgently needed, particularly in under-studied regions like Turkiye and Southeast Asia. Human T-lymphotropic viruses (HTLVs) are globally distributed retroviruses with significant health implications, particularly in endemic regions. Despite the known association of HTLV-1 with adult T-cell leukemia/lymphoma (ATLL) and HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP), comprehensive epidemiological data are lacking for several regions. This review examines the global epidemiology of HTLV, with a particular focus on under-reported and under-studied areas, including Turkiye. Highlighting the public health challenges posed by insufficient surveillance, lack of routine screening, and limited awareness, this review emphasizes the urgent need for global efforts to address this neglected public health issue.

Objective: Peripheral blood lymphocyte count and serum albumin level are crucial predictors of mortality across various diseases, including sepsis. However, previous studies have focused primarily on individual indicators (lymphocyte count or albumin) in relation to sepsis prognosis. Given the limitations of these single indicators, we investigated the relationship between the Prognostic Nutritional Index (PNI)-a composite indicator combining serum albumin level and lymphocyte count-and 28-day all-cause mortality in elderly septic patients.

Methods: This retrospective study analyzed data from elderly septic patients in the Medical Information Mart for Intensive Care (MIMIC-IV, v2.2) database from 2008 to 2019. Patients were categorized into survival and mortality groups based on 28-day outcomes, and baseline data were compared between the groups. Restricted cubic spline (RCS) analysis was used to determine PNI values at which the hazard ratio (HR) for 28-day mortality was 1. Patients were then classified into extreme (PNI<29.24 or PNI>47.77) and moderate (29.24≤PNI≤47.77) PNI groups. Kaplan-Meier survival curves were used to analyze cumulative 28-day survival rates, and Cox regression models assessed the relationship between PNI and 28-day outcomes.

Results: The study included 2,121 patients. PNI values were significantly lower in the mortality group compared to the survival group (p<0.05). RCS analysis indicated a nonlinear relationship between PNI and 28-day all-cause mortality risk (X²<0.001, p<0.001), with mortality risk decreasing as PNI increased at lower PNI values. Kaplan-Meyer survival curves revealed that patients in the extreme PNI groups had significantly lower cumulative 28-day survival rates than those in the moderate PNI group (p<0.001). Cox regression models further confirmed that extreme PNI values (either extremely high or extremely low) were independent risk factors for 28-day all-cause mortality (HR=1.349, p=0.004).

Conclusion: To our knowledge, this study is the first to reveal a nonlinear relationship between PNI values and 28-day all-cause mortality in elderly septic patients. Our findings associated extreme PNI values with increased mortality risk, and suggest that PNI may serve as an effective tool for prognostic risk stratification.

Objective: Our aim in the study is to investigate circadian rhythm, season, age, gender, and hemogram parameters in children diagnosed with febrile convulsions.

Methods: The data of a total of 478 children, consisting of 160 patients with febrile convulsions (90 male/70 female) and 318 control groups (healthy, convulsiyon free- febrile), were compared.

Results: The average age of all patients was 25.7±14.7 (minimum 6-maximum 60) months, and the most common convulsion age was 13-18 months. Circadian rhythm was similar, application seasons were similar. The male/female ratio was 1.3. MPV in winter was lower than other seasons (p=0.002). At younger ages, lymphocyte count was higher (p=0.048) and NLR was lower (p=0.036). NLR was lower in patients with febrile convulsions with anemia than in patients with febrile convulsions without anemia (p=0.029). NLR was lower in patients with febrile convulsions with anemia than in the convulsion-free febrile control group with anemia (p=0.001). In patients with febrile convulsions, MPV was lower (p=0.033) and NLR was higher (p=0.001) than in the convulsion-free febrile control group. One third of the patients had hypocapnia.

Conclusion: Young age, anemia, inflammation, and hypocapnia may facilitate the occurrence of febrile convulsions. MPV and NLO, which are hemogram parameters, can guide us about inflammation. Blood gases may provide information regarding hypocapnia. These rapid examinations may help elucidate the etiology. Prospective studies are needed for circadian rhythm in febrile convulsions.

Objective: Anaphylaxis is a life-threatening reaction in every age groups. The causative factors, incidence, and severity of anaphylaxis differ between children and adults. Literature on anaphylaxis during childhood is insufficient. We believe that the data of this study will make important contributions to the literature.

Methods: A retrospective analysis was conducted on patients aged 0-18 years who were admitted to the Pediatric Allergy Outpatient Clinic at Erciyes University between 2015 and 2021 and diagnosed with anaphylaxis.

Results: The majority of the patients were male. Females, however, exhibited greater prevalence during adolescence (p<0.001). Of the total number of patients, 153 (86.9%) had atopy, whereas 25.56% had non-allergic chronic diseases. Food-induced anaphylaxis was identified in 49 (27.84%) patients, drug-induced anaphylaxis in 41 (23.29%), venom-induced anaphylaxis in 62 (35.22%) and idiopathic anaphylaxis in 19. The study observed that anaphylaxis affected several systems, including the skin/mucosa (91.47%), respiratory (72.15%), GI (40.34%), cardiovascular system (20.45%), and central nervous system (17.04%). It was also found that drug-induced anaphylaxis increased the severity of symptoms (p=0.003). Additionally, it was statistically significant that antibiotic-induced anaphylaxis (p=0.002) and wasp sting-induced anaphylaxis (p=0.003) developed within the first minute. Patients received intramuscular adrenaline in 95.46% of cases, while 4.54% did not receive appropriate treatment.

Conclusion: Anaphylaxis is a completely reversible reaction when diagnosed correctly and treated promptly. Therefore, it is essential to recognize the common triggers, know the risk factors, and provide patients with appropriate treatment. We believe that this study will contribute to better recognition of deficiencies in the management of anaphylaxis by highlighting important information for anaphylaxis.