Northern clinics of Istanbul最新文献

Objective: The cardiopulmonary exercise test (CPET), which is used as the gold standard in the evaluation of exercise capacity in patients with chronic heart failure (CHF), is not always possible to perform in clinics and field tests are preferred. The aim of this study was to determine the effectiveness of the symptom-limited stair climbing test (SLSCT) in patients with CHF.

Methods: Thirty-one patients (mean age: 65.52±7.57 years) with New York Heart Association (NYHA) Classification stage II-III CHF were included. Exercise capacity was assessed by SLSCT, 6-minute walk test (6MWT), and CPET. Predicted peak oxygen consumption (VO_2peak), heart rate (HR), blood pressure (BP), and left ventricular ejection fraction (LVEF), pulmonary functions were measured.

Results: The predicted VO_2peak calculated from SLCT was significantly higher than that of 6MWT and CPET (p<0.05). On analyzing the HR changes, SLSCT increased HR by more than 6MWT and less than CPET (p<0.05). There were significant correlations between the predicted VO_2peak values by SLSCT and LVEF, BMI (Body Mass Index), FEV1 (Forced Expiratory Volume in One Second), and FVC (Forced Vital Capacity), predicted VO_2peak of CPET (r=0.36-0.55, p≤0.05).

Conclusion: SLSCT was found to be effective and easy to use in assessing exercise capacity in CHF patients. Compared with 6MWT, SLSCT gives better results in determining the clinical status and hemodynamic responses of the patients. SLSCT can be an alternative method for assessing exercise capacity in the absence of CPET.

Objective: Scleroderma has a wide range of clinical manifestations due to vasculopathy, autoimmunity, altered endothelium function, and abnormal fibrosis, which are accused in the pathogenesis of the disease. The aim of this study is to shed light on the pathogenesis of the disease in childhood via dermal immunohistochemical analysis of the cases.

Methods: A single-blind clinical trial is conducted with evaluation of the tissue samples obtained from patients. The samples are stained with PAS, hematoxylin and eosin, E-Cadherin, Connective tissue growth factor (CTGF), Tunnel, and staining for Transforming growth factor beta 1 (TGF-β1) and evaluated by light microscopy. In addition, both TGF-β1 level and mRNA expression analyses in plasma and tissue samples from patients are performed. A total of 15 patients (systemic, n=8 or localized; n=7) were enrolled in the study.

Results: The mean age of onset of the disease was 9.2±1.2 years, and the mean age of diagnosis was 15.3±3.2 years. Antinuclear antibody (ANA) titer was between 1/160-1/640 in all patients with systemic sclerosis. There was no ANA positivity in patients with localized scleroderma. A total of 22 tissue samples (15 diseased tissues, 7 healthy tissues) were examined. Histopathological examination has shown that two clinically different subgroups have different characteristics at the tissue level.

Conclusion: TGF-β1 levels, which play a fundamental role in the pathogenesis of the disease, are found in both plasma and skin have been shown high. This elevation was found particularly in patients with systemic scleroderma to be more pronounced. Also, in patients with localized scleroderma, skin fibroblasts have been shown to limit the pathologic response.

Objective: Only few cases of intratesticular varicocele (ITV) have been reported in the literature, mostly as single cases or a case series. In this study, we aimed to describe the topographic distribution of ITVs in the testicular parenchyma and the correlation between ITV accompanying extratesticular varicocele (ETV) and age.

Methods: Approximately 10,537 patients with scrotal pain and swelling who visited our hospital between August 2014 and May 2020 and underwent scrotal colour Doppler ultrasonography were included in this study. Of these patients, 2285 had ETV, and the remaining patients (n=8252) had other testicular pathologies such as acute-chronic torsion, testicular mass, orchitis, significant testicular atrophy, or isolated extratesticular varicocele, and were thus excluded from the study. Among the 2285 patients, only 20 had ITV.

Results: Of the 20 patients with ITV, 2 had isolated ITV, and the remaining had ITV accompanying ETV, of whom only one had a right ETV. One patient had left testicular atrophy accompanying an isolated ITV. Among the ITV cases, subcapsular ITV was the most common (n=13), followed by central ITV (n=4) and subcapsular and hilar ITV (n=3). The patients' ages ranged from 18 to 30 years.

Conclusion: ITV is a rare clinical entity that occurs only in young men, with most cases accompanying ETV. ITV is generally peripherally located in the testicular parenchyma. In this study, no correlations were found between ITV, ETV, and age. As in this study, testicular atrophy is rarely observed in patients with ITV. No studies have presented ITV cases with spermiogram analysis results. Thus, the effect of ITV on male reproductive fertility is still unknown, and further study on this topic is needed.

Objective: To investigate the relationship between nutrition literacy (NL) of mothers and physical growth and development, dietary diversity and quality, and vitamin levels of their children aged 24-59 months.

Methods: A cross-sectional survey-based study was conducted at well-child outpatient clinic. Eighty-eight mother-child pairs included. Mother's Evaluation Instrument of Nutrition Literacy for Adults (EINLA) scores and child anthropometric z-scores, age when reaching six gross motor milestones, dietary diversity and the Mediterranean Diet Quality Index scores, and serum vitamin A, B1, B2, B12, C, D, and E levels were measured. Two independent groups comparison statistics and Spearman rank correlations were performed.

Results: Thirty-four mothers (38.6%) had borderline and 54 mothers (61.4%) had adequate NL level. The percentages of wasted and acutely malnourished children were higher in the borderline NL group (17.6% vs. 1.9%, p=0.005 and 14.7% vs. 1.9%, p=0.030, respectively). There was no significant correlation between maternal EINLA score and child motor skill acquisition, dietary diversity, or serum vitamin status (p>0.05). There was a correlation between maternal EINLA score and child dietary quality score (r=0.218, p=0.041).

Conclusion: Increasing NL of mothers may be a step toward improving the dietary quality of children and reducing the burden of child undernutrition.

Objective: This study investigates the impact of leadership support, organizational culture and digital transformation on employee satisfaction, employee motivation, patient satisfaction, organizational learning capacity and innovative performance in the dental sector. Employee and patient satisfaction is critical to improve service quality and ensure a sustainable healthcare system. Leadership support promotes job satisfaction and motivation, while organizational culture supports collaboration and communication. Digital transformation increases operational efficiency, streamlines workflows and improves patient satisfaction. The study aims to provide theoretical and practical insights into health management and organizational development in dental clinics.

Methods: A quantitative research design was used involving 300 participants from dental clinics in Istanbul. Data were collected through questionnaires and analyzed using SPSS software. Statistical methods including factor, correlation and regression analyses were applied to test the hypotheses. The study examined the relationships between leadership, organizational culture, digital transformation and their effects on the dependent variables.

Results: The results show that leadership support significantly increases employee satisfaction, motivation, patient satisfaction, innovative performance, and organizational learning capacity. In addition, organizational culture and digital transformation showed positive but statistically insignificant effects on these variables. While digital transformation increased operational efficiency, it did not significantly affect employee motivation or patient satisfaction. The findings emphasize the importance of leadership in driving innovation and improving service quality in dental clinics.

Conclusion: Leadership significantly promotes employee and patient satisfaction, employee motivation, organizational learning and innovative performance. Organizational culture contributes positively to the dependent variables, but its effects are less pronounced. Digital transformation positively affects patient satisfaction. The study underlines the need for effective leadership strategies and the integration of digital technologies to improve dental service outcomes. These findings provide valuable guidance for developing management strategies in dentistry. Future research should investigate the long-term effects of digital transformation and innovative technologies on satisfaction, motivation and organizational performance.

Objective: Idiopathic urethritis (IU) is among the causes of macroscopic hematuria in children and primarily affects males aged between 5 and 15 years. Common symptoms include dysuria and hematuria. The etiology remains incompletely understood. Untreated IU may progress to urethral stricture in the long term. Conventional treatments like prolonged antibiotic therapy and nonsteroidal anti-inflammatory drugs have limited success. Recent studies suggest favorable outcomes with associated dysfunctional elimination syndrome treatment or steroid instillation. This study aims to present a 13-year retrospective analysis of patients diagnosed with IU via cystourethroscopy, assess long-term outcomes with or without steroid injection and explore the relationship between IU and voiding dysfunction.

Methods: Patients who underwent cystoscopy due to unexplained hematuria and/or dysuria between 2010 and 2023 were retrospectively screened. Patients diagnosed with IU were included and those who underwent steroid instillation (Group S) or received no steroid treatment (Group NS) evaluated separately. Available uroflowmetry (UFM) results were assessed.

Results: Thirty male patients were diagnosed with IU, with a mean age of 11.1 (2-17) years and mean symptom duration of 9.3 (0.1-36.5) months. Steroid instillation was performed in 21 patients (Group S), yielding a 57% recovery rate. In Group NS, symptoms resolved without treatment in 66% of patients. UFM results showed obstructive patterns in patients with urethral strictures.

Conclusion: Cystourethroscopy allows for accurate diagnosis of IU and targeted intervention. In our series, the promising steroid instillation therapy did not significantly alter long-term symptom-free survival compared to observation alone. Further research is warranted to elucidate IU's pathogenesis and establish standardized treatment approaches.

Objective: An experience regarding full-thickness rectal biopsies (FTRB) indications and results is presented.

Methods: The records of patients who underwent FTRB between January 2010 and January 2022 were retrospectively reviewed.

Results: 107 patients were included. There were 66 men (61.6%) and 41 women (38.3%). The median age at biopsy was 15 (1-196) months. FTRB was performed in 81 patients who were unable to pass meconium in the first 48 hours or had intractable constipation. A stoma was performed in 26 patients before the rectal biopsy. Contrast colon radiography was conducted in 61 patients and/or anorectal manometry in 32 patients. Of the biopsies, 74 were full-thickness while 33 were not. Biopsies were repeated in 12 patients. Of the 49 (45%) patients with aganglionic specimens, data about nerve hypertrophy was reported in 37. Among these, 33 had nerve hypertrophy and 4 did not. A definitive surgery was performed in 44 of the 49 patients diagnosed with Hirschsprung disease (HD). Complications were observed in 7 (6.5%) of the patients.

Conclusion: HD was histopathologically diagnosed. Biopsies that are not full-thickness can be of value when using immunohistochemistry stains.

Objective: To assess the health status and functional impairments in patients with axial spondyloarthritis (axSpA) using the Assessment of SpondyloArthritis International Society Health Index (ASAS-HI) and Environmental Factors (ASAS-EF) Index, and to evaluate the correlation of these indices with established clinical parameters.

Methods: This cross-sectional study included 91 patients diagnosed with axSpA at the Rheumatology Department between November 2017 and July 2018. Participants were evaluated using ASAS-HI, ASAS-EF, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, and Health Assessment Questionnaire (HAQ). Descriptive statistics and correlation analyses were performed to examine relationships between these indices and various clinical and demographic variables.

Results: The study found that 49.5% of patients had a BASDAI score >4, indicating high disease activity. The mean ASAS-HI score was 6.8, reflecting moderate to severe functional impairment in the study population. Significant positive correlations were observed between ASAS-HI and BASFI, BASDAI, spinal pain, and HAQ scores (p<0.05). However, no significant correlations were found between ASAS-HI and ASQoL, disease duration, CRP, or ESR. ASAS-EF was also positively correlated with BASFI, BASDAI, spinal pain, and HAQ scores.

Conclusion: The ASAS-HI and ASAS-EF indices effectively evaluate health status and functional impairments in patients with axSpA. The significant correlations with established clinical parameters highlight the indices' utility in capturing the multifaceted impact of axSpA, emphasizing the importance of comprehensive disease assessment in guiding targeted interventions.

Objective: Pseudomonas aeruginosa is considered one of the leading pathogens responsible for community- and healthcare-associated infections. P. aeruginosa infections are difficult to treat due to antibiotic resistance, various virulence factors, and the capacity to build biofilms, which provide resistance to drugs and immune cells. Antibiotics used to treat biofilm-associated infections over an extended period resulted in the establishment of resistance strains. In this study, we comparatively investigated the efficacy of natural compounds (Furanone-C30 [F], Ellagic-acid C11 [EA], Tobramycin [TOB], Ciprofloxacin [CIP], and Meropenem [MEM]) and antibiotics in inhibiting and eradicating P. aeruginosa biofilm.

Methods: The Minimum Biofilm Inhibition Concentrations (MBIC) and Minimum Biofilm Eradication Concentrations (MBEC) were determined using a micro broth dilution technique, and their effects on the biofilm were evaluated by crystal violet staining and cell viability tests (MTT).

Results: F significantly suppressed P. aeruginosa biofilm formation in a dose-dependent way, with 100% inhibition at 512 and 256 g/mL and 92% inhibition at 128 µg/mL. F also eradicated 92.9% of the biofilm at 512 µg/mL and 90% at 256 µg/mL. EA provided 41.6% biofilm inhibition and 33.1% biofilm eradication at 512 µg/mL.

Conclusion: Our findings indicate that the natural compounds displayed a dose-dependent effect on P. aeruginosa biofilm, with F being found to be more effective than EA. In conclusion, this study suggests that furanone may hold promise as a natural alternative for the treatment of P. aeruginosa biofilm and highlights the need for further research to support this hypothesis.

Objective: To investigate the effects of methylenetetrahydrofolate reductase (MTHFR) gene C677T/A1298C polymorphisms on serum homocysteine levels and hypertension.

Methods: Venous blood samples were collected in EDTA tubes from patients and controls (80 hypertensive patients and 67 healthy controls) and genomic DNA was isolated. The polymorphisms of MTHFR C677T and A1298C were identified using the polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLP) technique. The enzyme-linked immunosorbent assay (ELISA) method was used to determine serum homocysteine levels. ANOVA, Student's t-test, chi-square test and logistic regression analysis tests used in the evaluation of statistical analysis between patient and control groups were performed with SPSS 21.0 program.

Results: A statistically significant difference was observed between the patient group, which were hypertension-diagnosed patients, and control group for C677T polymorphism (p<0.001), but not for the A1298C polymorphism (p=0.058). When serum homocysteine levels were compared between the patient and control groups, no significant difference was observed (p=0.065). A significant difference was observed between C677T allele frequency (TT + CT versus CC) and homocysteine levels in both groups (p=0.027), whereas no significant difference was observed between A1298C allele frequency (CC + AC versus AA) and homocysteine levels (p=0.996).

Conclusion: The MTHFR C677T polymorphism is more common in hypertensive patients. T allele frequencies (CT and TT genotypes) and TT genotypes might increase the risk of hypertension and homocysteine levels. Although the A1298C C allele frequency (AC and CC genotypes) might increase the risk of hypertension, CC genotype distributions and homocysteine levels show no statistical significance on hypertension. C677T polymorphism is associated with hypertension thus it may be used as a potential biomarker.