Northern clinics of Istanbul最新文献

Objective: Medical students try to cope with challenging emotional experiences caused by stress factors specific to medical education during their education. In this process, students' cognitive emotion regulation (CER) strategies and psychological resilience (PR) act as protective mechanisms to alleviate the impact of challenging emotions. Therefore, it is important for medical students to use adaptive emotion regulation strategies and demonstrate psychological resilience in the face of challenging emotional experiences. This study aimed to reveal the effects of CER strategies and PR on the emotional well-being (EWB) of medical students and the mediating effect of PR in the relationship between CER strategies and EWB.

Methods: In this study, Structural Equation Modeling (SEM) was used to determine the mediating effect of PR in the relationship between CER strategies and EWB. The sample of the study consisted of 210 students who were randomly selected from the 1^st and 4^th year medical students and volunteered to participate in the study. Cognitive Emotion Regulation Scale, Psychological Resilience Scale and Emotional Well-Being Scale, which are the data collection tools of the study, were administered to the participants face-to-face by the researchers. Descriptive statistics and correlations were analyzed with SPSS 26. The SEM was analyzed with Jamovi 2.3.19 SEM module and R 4.1.1 Iavaan package.

Results: 54.8% (n=115) of the participants were 1^st-grade and 45.2% (n=95) were 4^th-grade students; 54.8% were male and 45.2% were female. The results of SEM analysis showed that the relationship between adaptive CER strategies in the two sub-scales (refocusing on plan; β=0.088, p=0.011 and positive reappraisal; β=0.175, p<0.001) and EWB was found to be mediated by the commitment sub-scale of PR.

Conclusion: This study showed that the relationship between positive reappraisal and refocusing on a plan, which are adaptive CER strategies, and EWB was mediated by PR-commitment. These results indicate that CER and PR stand out as concepts that support students' EWB in medical education.

Objective: In our study, our aim was to compare the clinical outcomes of utilizing a 6-stranded hamstring autograft (HAG) lacking tibial attachment site separation in Anterior Cruciate Ligament Reconstruction (ACLR), an approach previously unreported in literature, with alternative methodologies.

Methods: A total of 85 patients admitted to our Orthopedics and Traumatology clinic between April 2019 and July 2022 with Anterior Cruciate Ligament (ACL) rupture, who underwent surgical treatment, were retrospectively analyzed. ACLR was initiated using HAG in all patients. The surgical procedure was determined based on the length of the HAG used during ACLR. In all cases, femoral fixation was performed with an adjustable loop endobutton. 3 methods were applied to all patients. These are: repair with a 6-strand hamstring tendon graft without severing the tibial insertion (new method), repair with 4-strand hamstring tendon graft without severing the tibial insertion and repair with 4-strand hamstring tendon graft without protecting the tibial insertion. Preoperative and postoperative International Knee Documentation Committee (IKDC) subjective evaluation score, Lysholm score and Tegner activity score were used in the evaluation of the patients. Comparisons between groups were made according to these scores.

Results: 78 patients were included in the study. There were 31 patients in Group 1, 23 in Group 2 and 24 in Group 3. The mean age of the patients was 29 (19-40) in Group 1, 32 (16-49) in Group 2 and 31 (18-54) in Group 3. In the comparison of the groups, there was a significant increase in tendon thickness in Group 1 (p<0.001) and a significant decrease in the rate of re-rupture as a complication (p<0.05). There was no statistically significant difference between the groups in terms of age, side of surgery, follow-up period, and length of hospital stay. There was statistical significance between Group 1 and Group 2 in terms of tendon diameter (p<0.05) and re-rupture (p<0.05). In the comparison of Group 2 and Group 3, there was statistical significance between Group 2 and Group 3 in terms of tendon thickness and length of hospital stay (p<0.05), while no significant difference was found in terms of re-rupture (p>0.05).

Conclusion: ACLR with 6-strand tendon graft with preservation of the HAG insertion is not a method described in the literature. As a result of our study, it was concluded that the functional results of this newly described method are as good as other methods and have lower re-rupture rates.

Objective: The purpose of this study is to analyze the situation of Methicillin-Resistant Staphylococcus aureus (MRSA) in TRNC by examining the prevalence of Community-acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA)/Hospital-acquired Methicillin-Resistant Staphylococcus aureus (HA-MRSA) cases, the acceleration of CA-MRSA/HA-MRSA patients from past to present, the impact of pandemic, gender and age on MRSA cases.

Methods: In order to analyze the trend of MRSA cases and the effects of selected parameters on MRSA cases, statistical tests are employed to the obtained data including ANOVA test, regression analysis tests and Post-hoc Tukey test.

Results: Incidence rate of MRSA carriage in the community has increased over the years to 45.6%. p-value of the relationship between community-acquired MRSA cases and hospital-acquired MRSA cases is less than 0.05. The results also revealed that the p-value of both the relationship between COVID-19 and MRSA cases and the relationship between 50+ age and MRSA cases are significant. On the other hand, p-value of the relationship between gender and MRSA cases is found to be greater than 0.05.

Conclusion: It is concluded that MRSA carriage in the community has increased over the years and CA-MRSA and HA-MRSA cases are related since p<0.05. Moreover, it's revealed that there is an effect of COVID-19 pandemic and 50+ age (66% of the cases) on MRSA cases because of p<0.05 while the gender is not an effect for MRSA cases in the country, since p-value for gender comparison is greater than 0.05.

Objective: The aim of this study is to determine the frequency and clinical features of diagnosed rheumatological disease in patients who have no previous history of rheumatic disease and are consulted to the rheumatology clinic from other departments to investigate the etiology of early-onset ischemic stroke.

Methods: Patients aged 18-65, who had not previously been diagnosed with rheumatic disease, had ischemic stroke for the first time, and were consulted to rheumatology clinic to investigate the etiology of the disease, were retrospectively included in the study. Demographics, clinic laboratory, imaging data and the final diagnosis of the patients were obtained from hospital records.

Results: A total of 115 patients who had their first ischemic stroke were identified in the study. 70 of them were detected to have young ischemic stroke. Of these patients, 1 was diagnosed with lupus with secondary antiphospholipid syndrome (APS) and Sjögren's syndrome 1 with lupus and secondary APS, 2 with primary APS, 1 with lupus, 1 with primary Sjögren's syndrome and 1 with granulomatous with polyangiitis.

Conclusion: Determining the correct etiological diagnosis of ischemic stroke, especially in young adults, is important in terms of preventing recurrent ischemic attacks. It is important to raise awareness of clinicians in terms of rheumatic diseases and to refer patients to the rheumatology department if deemed necessary.

Objective: Urinary tract infections (UTIs) are among the most common bacterial infections. The misuse of antibiotics is one of the factors contributing to the global increase in antimicrobial resistance (AMR), making the management of UTIs more challenging. Our study aims to evaluate the causative agents of UTIs and the factors influencing resistance, as well as to identify antibiotics that can be used in the outpatient treatment of patients diagnosed with UTIs.

Methods: This retrospective study was conducted by collecting urine sample results between 2015-2023. The culture results of the urine samples and the results of the antibiotic sensitivity tests of the Enterobacteriaceae isolates were analyzed. Antimicrobial susceptibilities of the isolates were defined using the VITEK^®2 Compact system (bioMérieux, Marcyl'Etoile, France) and PheonixTM (Becton-Dickinson, NJ, USA). All sensitivity statuses were determined according to EUCAST standards. Data analysis was conducted using SPSS software version 23.

Results: 1842 culture results were included. 71.5% of the included samples were from women, and the average age of the cases was 63±18. The most commonly grown agent in urine cultures is Escherichia coli. The resistance profile of the Enterobacteriaceae to antibacterial agents was examined, and it was found that the highest resistance rates were against ampicillin (77.92%), cefazolin (52.36%), ciprofloxacin (49.5%), and trimethoprim/sulfamethoxazole (45.5%), while the lowest resistance rates were against meropenem (4.9%), amikacin (7.6%), fosfomycin (11.4%), and nitrofurantoin (11.6%). Comparing resistance rates before and after 2019, a significant increase in resistance to amikacin and nitrofurantoin was observed (p≤0.001). It was found that resistance rates were higher in urine samples from male cases.

Conclusion: Our study revealed that patients should be carefully evaluated in terms of the necessity of culture requests and patients should be informed about culture requests due to the high rate of non-growth and contamination in urine culture results. The high rates of antimicrobial resistance were detected, and the outpatient treatment options of UTI patients are narrowing which can increase hospital admission rates. Our study is important because it shows that nitrofurantoin and fosfomycin can be included in the outpatient and empirical treatment of UTI patients.

Objective: Flexible bronchoscopy (FB) is an important tool for evaluating pediatric patients with respiratory issues. This study aims to investigate the clinical features of children who underwent FB.

Methods: The study included 191 children who underwent FB between April 1, 2021 and December 31, 2022. Demographic and clinical data were retrospectively reviewed.

Results: One hundred ninety-one children (45% girl) were enrolled to study. Median age was 25 months (min 1, max 214 months) and median duration of complaints was 4 (min 1, max 80) months. Among the patients, 61.7% of them had a chronic disease. The main indications were stridor (17.6%) and extubation failure (13.5%). Rate of patients in the ICU during FB was 27.5% and 15.5% of them were intubated. Airway secretions in the lower respiratory tract and isolated laryngomalacia were the most common abnormal FB results (30.1% and 9.8% respectively). The most common abnormal FB findings were in children with extubation failure (92.3%). Forty percent of patients with chronic cough had abnormal FB findings. Bronchoalveolar lavage (BAL) sampling was performed in 61.6% (n=119) of patients and Haemophilus influenzae was the most common pathogen in these patients (n=40).

Conclusion: FB is a valuable tool for investigating airway pathology and BAL sampling in children with respiratory problems.

Objective: This study aims to explore the predictive performance of machine learning-based radiomic features extracted from T2-weighted magnetic resonance imaging (MRI) in differentiating between women with polycystic ovary syndrome (PCOS) and healthy counterparts.

Methods: The study included patients diagnosed with PCOS who had undergone pelvic MRI in the endocrine department between 2014 and 2022, along with an age-matched control group. The ovaries were manually segmented from T2-weighted images using the 3D Slicer software. Both first- and second-order features, including wavelet filters, were extracted from the images. Utilizing the Python 2.3 programming language and the Pycaret library, various machine learning algorithms were employed to identify highly correlated features. The optimal model was selected from the 15 algorithms assessed.

Results: The study involved a total of 202 ovaries from 101 patients with PCOS (mean age 23±4 years) and 78 ovaries from the control group comprising 40 individuals (mean age 24±5 years). In the training set, the machine learning models displayed accuracy and area under the curve (AUC) values ranging from 72% to 83% and 0.50 to 0.81%, respectively. Notably, the Light Gradient Boosting Machine (LightGBM) model emerged as the most effective model among the various machine learning algorithms, exhibiting an AUC of 0.81 and an accuracy of 83%. When evaluated on the test set, the AUC, accuracy, recall, precision and F1 values of the LightGBM model were 0.80, 82%, 91%, 86%, 88%, respectively.

Conclusion: Machine learning-based T2-weighted MRI radiomics seems viable in differentiating between individuals with and without PCOS.

Objective: Lung cancer is one of the most prevalent malignancies worldwide, with 80-85% of cases diagnosed as non-small cell lung cancer (NSCLC). The majority of NSCLC patients present with advanced disease, contributing to high mortality and limited treatment options. Angiogenesis, a crucial process in cancer progression, is largely regulated by growth factors and cytokines. Vascular Endothelial Growth Factor (VEGF) is a key regulator of angiogenesis. Asymmetric Dimethyl Arginine (ADMA) inhibits endothelial nitric oxide synthase (eNOS), leading to reduced nitric oxide (NO) release and subsequent endothelial dysfunction. The aim of this study is to investigate the serum levels of ADMA, NO, VEGF and several tumor markers including Carcinoembryonic Antigen (CEA), Cancer Antigen 125 (CA 125), Neuron Specific Enolase (NSE), Lactate dehydrogenase (LDH) and Cyfra 21-1 in NSCLC patients to assess their potential role in early diagnosis, tumor invasion, and staging of the disease.

Methods: Our study consisted of 56 newly diagnosed NSCLC patients and 32 controls with similar demographic characteristics. Patients with chronic diseases and inflammatory disorders were excluded. Statistical analysis was conducted using R Statistical Software.

Results: In our study, compared to the control group, the serum VEGF, NO, ADMA, CA 125, CEA, Cyfra 21-1 and NSE levels were significantly higher in NSCLC group (p=0.001, p=0.013, p=0.041, p<0.001, p<0.001, p<0.001 and p=0.001, respectively). In the diagnosis of NSCLC, Cyfra 21-1 exhibited the highest diagnostic efficacy with a 71% sensitivity and 94% specificity. The combination of VEGF, CA125, and Cyfra 21-1 showed a 73% sensitivity and 100% specificity, while the combination of CA125, CEA, and Cyfra 21-1 achieved an 85% sensitivity and 91% specificity.

Conclusion: Our study revealed that the serum concentrations of VEGF, NO, ADMA, CA125, Cyfra 21-1, CEA, and NSE were significantly elevated in patients with NSCLC compared to the control group, and that levels of Cyfra 21-1, LDH, and NSE increased with advancing TNM stage. The combination of markers distinguished NSCLC with high sensitivity and specificity. Further studies involving larger populations, including those with benign lung diseases, are needed to validate and expand upon our findings.

Objective: Cardiovascular disease (CVD) is the most common cause of death in chronic kidney disease (CKD) patients. The prevalence of CVD is significantly increased in CKD patients, and the frequency of CVD increases as the CKD stage worsens. Although atherosclerosis is more common in CKD patients, the lipid profile may change as the CKD stage changes. Many mechanisms cause this. Also, mortality is more common in patients with advanced CKD. In this study, we aim to emphasize the incidence of cardiovascular diseases and dyslipidemia in patients with CKD at different stages and the effect of these variable conditions on patient mortality.

Methods: Patients who applied to the internal medicine outpatient clinic and were diagnosed with chronic kidney disease were examined. Mortality and complications were followed up for one year. A total of 1323 patients with a diagnosis of CKD between stages 3a-5 were included in the study. The relationships between kidney functions and lipid profiles, biochemical values, and prognosis of the patients were evaluated.

Results: Non-survivors had lower glomerular filtration rate (GFR) and higher C-reactive protein (CRP) levels. High-density lipoprotein (HDL), low-density lipoprotein (LDL), and albumin values decreased, and CRP increased as the disease stage progressed. More survivors had CKD and hyperlipidemia than non-survivors. It was observed that the stage remained the same in patients with hyperlipidemia at a higher rate. In contrast, the stage worsened or remained at stage 5 more in patients with cardiovascular disease or diabetes mellitus. Declining CKD stage and increasing CRP were influential risk factors that affect mortality.

Conclusion: It is essential to closely monitor the changes in laboratory parameters at baseline and follow-up in CKD patients to predict or prevent comorbidities, mortality, and deterioration in patients' renal functions.

Objective: Preseptal cellulitis is an infection of the palpebrae and the periorbital superficial tissue and is more common in children than adults. This study aims to evaluate the demographic and clinical characteristics of children hospitalized for preseptal cellulitis and the factors affecting these characteristics.

Methods: In this retrospective, single-center study, 101 children hospitalized for preseptal cellulitis between March 2019 and March 2022 were included. The patients were divided into 2 groups as under five years old and over five years old.

Results: 56 patients (55.4%) were male and the median age was 56 (24-89) months. All patients had eye swelling. Periorbital erythema was seen in 81 (80.1%), conjunctivitis in 39 (38.6%), eye discharge in 30 (29.7%) patients. The most common treatment was ampicillin-sulbactam+clindamycin (77.2%). Mean treatment duration was 8.42±2.89 days, clinical improvement was 5.01±2.20 days. Patients with leukocytosis had longer duration of treatment compared to patients without leukocytosis (9.3±3.1 vs. 7.8±2.5 days, p=0.009). While the lymphocyte level was higher in patients under 5 years of age compared to patients over 5 years of age (p<0.001); neutrophil (p<0.001), hemoglobin (p=0.002) and NLR (p<0.001) levels were low. The duration of clinical improvement was short in patients under 5 years of age (4.4±1.6 vs. 5.6±2.5 days, p=0.005).

Conclusion: The most common finding in patients with preseptal cellulitis was swelling in the eye. The presence of leukocytosis in patients may be used to predict the duration of treatment. Age was an important factor in predicting the duration of clinical improvement in patients.