Northern clinics of Istanbul最新文献

Objective: Necrotizing fasciitis (NF) is a severe and potentially life-threatening soft tissue infection characterized by rapid necrosis, primarily affecting the fascia and deep soft tissues. Despite its low incidence, NF poses significant challenges due to its aggressive nature and high mortality rates. This retrospective study aimed to assess clinical characteristics and prognostic factors influencing mortality rates among patients diagnosed with NF at a tertiary care facility.

Methods: Patients diagnosed with NF at the emergency department of tertiary care hospital in Turkiye between August 1, 2017, and July 31, 2023, were included in the study. Demographic data, clinical features, underlying factors, laboratory findings, and outcomes were reviewed.

Results: A total of 69 adult patients were included in the study. Among cases, 51 survived (73.5%) and 18 died (26.5%). There were 43 males (62.3%) and 26 females (37.7%) with a mean age of 55.8±16.1 years. The most common symptoms were pain/tenderness (84.1%), erythema (75.4%), local swelling (72.5%), and crepitus (44.9%). Diabetes mellitus, lower systolic blood pressure, higher pulse rates, elevated white blood cell counts, and polymicrobial infections were associated with poor outcomes (p<0.001, p=0.020, p<0.001, p=0.016, and p<0.001, respectively).

Conclusion: NF is a rare surgical emergency. Early diagnosis, prompt intervention, and multidisciplinary management are crucial in mitigating NF's devastating consequences. Recognizing poor prognosis factors in patients can guide their management.

Objective: The incidence of aspiration pneumonia (AP) is rising due to an increasing population with chronic conditions. This study investigates the association between albumin-based composite indicators-blood urea nitrogen/albumin (B/A), lactate dehydrogenase/albumin (L/A), and C-reactive protein/albumin (C/A) ratios-and AP-related mortality.

Methods: In this retrospective study, adult patients diagnosed with AP between 2022 and 2023 were analyzed. Patients' demographics, clinical data, and lab results were recorded. Albumin-based composite indicators were calculated, and outcomes were observed up to 28 days post-admission, categorizing patients as survivors or non-survivors.

Results: The study involved 67 patients, with a median age of 80. The 28-day mortality rate was 38.8% (n=26). There were no substantial demographic or clinical differences between survivors and non-survivors (p>0.05). However, non-survivors exhibited notably lower serum albumin levels (p>0.001). Additionally, B/A and C/A ratios were significantly higher in non-survivors (p<0.05). B/A ratios above 1.03 and C/A ratios above 6.15 correlated significantly with mortality (p=0.023 and p=0.026).

Conclusion: The results indicate that lower serum albumin levels and higher B/A and C/A ratios are significantly linked to AP-induced mortality. These albumin-based indicators may serve as useful markers for early risk assessment and outcome prediction in AP patients.

Objective: Sarcopenia is defined as an age-related loss of muscle quantity as well as quality. Also, it is associated with morbidity and mortality. Multiple myeloma (MM) has a unique aspect with its bone involvement. We aimed to investigate the effect of hematopoietic stem cell transplantation on sarcopenia in MM patients using both CT and metabolic compartment of F-18 FDG PET/CT.

Methods: Patients with MM who received first-line treatment and were eligible for autologous stem cell transplantation (ASCT) were included. FDG PET images before transplantation and after 120 days of ASCT were recorded.

Results: When were grouped as below and above 60 years of age, a decrease in muscle mass after treatment was observed in both groups (p<0.001). For patients older than 60 years, age was observed to have a significant effect on muscle mass, independent of the treatment (p=0.001). Regarding metabolic assessment of muscles with PET imaging, the lumbar region was observed to be affected by treatment for both age groups (p<0.001). Metabolic volume measurement of the femoral region did not show such difference related to treatment or age.

Conclusion: We observed a loss in muscle mass in patients with MM related with treatment. Since PET / CT imaging is routinely used to evaluate disease, it may also be used for the evaluation of muscle as quantity as quality. Awareness of sarcopenia should be increased in patients with MM and caregivers and be supported by physiotherapists to preserve and even to increase muscle mass and strength.

Objective: There is limited knowledge regarding the clinical, biochemical, and functional characteristics of patients with osteosarcopenia. The present study aims to explore the presence of osteosarcopenia in patients aged 65 years and over who have a history of falls and hip fractures.

Methods: Seventy-six participants (77.6% women) aged 65 years and over (mean age 81±6.75 years) were admitted to the orthopedic clinic of our hospital due to hip fracture. The diagnosis of osteopenia/osteoporosis was established based on the bone mineral density measurement using dual-energy X-ray absorptiometry. The SARC-F scale was used to screen patients for sarcopenia. The muscle mass was determined by the appendicular lean mass (ALM). The muscle strength was evaluated by the handgrip strength. SPSS for Windows 25.0 (IBM Statistical Package for Social Sciences) software package was used in the statistical analysis of the study data.

Results: A total of 76 patients were evaluated, including 59 (77.6%) females and 17 (22.4%) males. The mean age of the patients was 81±6.75 years. The prevalence of osteosarcopenia in the entire study group was 36.8%. The prevalence rate was higher in males (59%) than in females (30.5%) (p<0.05). The ALM and the handgrip strength were lower in patients with osteosarcopenia (p<0.05). The mean body weight, total fat mass, fat mass index, and upper arm circumference were the lowest in the group of patients with osteosarcopenia (p<0.05).

Conclusion: The present study found that the prevalence of osteosarcopenia was higher in patients with hip fracture. There is a limited number of studies in literature directly evaluating the relationship between osteosarcopenia and hip fracture. The presence of osteosarcopenia is often overlooked when the bone fracture is the prevailing clinical condition. Osteosarcopenia is frequently the accompanying diagnosis in patients with hip fracture.

Objective: Candida auris (C. auris), a novel species, has been increasingly associated with hospital outbreaks worldwide in recent years. C. auris is regarded as a global health problem due to issues with the identification of C. auris, variable antifungal resistance profiles and the requirement for infection prevention and control (IPC) measures. With this study, we aimed to present our experience with two patients with C. auris fungemia who were referred to the Pediatric Burn Center of our hospital at different timepoints and share the antifungal treatment strategy and IPC management policies implemented in the clinic.

Methods: C. auris isolates were identified using MALDI-TOF MS (VITEK MS, bioMérieux, France). Antifungal susceptibility tests were performed at the Turkish Public Health Institution (THSK) using the broth microdilution (BMD) method. The BMD was carried out in accordance with the Clinical and Laboratory Standards Institute procedures.

Results: A patient (3-year-old girl) with C. auris which was identified at an external center and negative fungal screening results was transferred to our pediatric burn center. On the 41^st day of her hospitalization, she was diagnosed with catheter-related bloodstream infection (CRBSI) by C. auris. She received antifungal treatment for a total of 52 days, including caspofungin for 12 days, followed by micafungin for 40 days. Three months after the detection of the index case, a second patient (2-year-old girl) was diagnosed with CRBSI by C. auris on the 27^th day of hospitalization. This patient received antifungal treatment for a total of 42 days, including 30 days of combination therapy (liposomal amphotericin B and voriconazole). Immediately after the recognition of the index C. auris case, infection prevention and control (IPC) measures were formulated and implemented. IPC measures included strict isolation of the patient infected with C. auris, and screening of all other patients and the environment. C. auris was not detected in any of the patients screened. None of the environmental swabs tested positive for C. auris.

Conclusion: Collaboration between clinical microbiology laboratories and the IPC committee is essential for making correct and early diagnosis, optimizing the management of precautions and reducing the spread of infection in the hospital.

Objective: It is considered that the underlying reason for metabolic anomalies and ovarian dysfunction in polycystic ovary syndrome (PCOS) is low-grade chronic inflammation. Therefore, we aimed to investigate Tenascin-C (TN-C) levels in PCOS. This is the first study to document the impact of inflammation with TN-C in this specific population.

Methods: A total of 90 participants, consisting of 30 PCOS patients, 30 polycystic ovarian morphology (PCOM) patients, and 30 matched healthy controls between September 2018 and April 2019 enrolled. All participants were randomized by age and body mass index. Demographic, clinical characteristics, ultrasonographic features, lipid profile, hormonal and metabolic parameters were collected.

Results: When comparing serum TN-C levels between PCOS, PCOM and control subjects, a statistically significant difference was observed only between subjects with PCOS and control subjects (p=0.009). ROC analysis demonstrated that PCOS could be predicted with 89.7% sensitivity and 45.5% specificity when TN-C levels are cut off at 1.87 ng/ml.

Conclusion: This study indicated that TN-C level was higher in the PCOS group compared to PCOM and control groups, while it was similar between the PCOM and the control groups. It may be suggested that TN-C levels may contribute to the differentiation between PCOS and PCOM.

Objective: The aim of the study is to evaluate an established biomarker such as blood urea nitrogen (BUN)/Creatinine ratio in predicting upper gastrointestinal bleeding versus lower GI and stratify its severity. The aim of this study is to evaluate the diagnostic performance in clinical practice and predestination as a prognostic factor, including admission to an intensive care unit (ICU) or mortality rate for BUN/Creatinine ratio.

Methods: A total of 300 patients controlled in our hospital between January 2022 and January 2024 were evaluated retrospectively due to hospitalization by acute GI bleeding. Gastroscopy and/or colonoscopy were used to stratify patients into the upper or lower GI bleeding group. Data included demographic information, clinical presentation history and vital signs, comorbidity status, medication use, clinical outcomes and laboratory tests including hemoglobin, hematocrit, urea, creatinine levels and so on. The BUN/Creatinine ratio was determined and correlated with site as well as severity of bleeding. Statistical techniques, such as logistic regression and receiver operating characteristic (ROC) analysis, were used to assess the diagnostic performance of the ratio and to choose a cut-off value.

Results: Among the 300 patients, 215 (71.7% had upper GI bleeding, and 85 (28.3% had lower GI bleeding. Hematemesis and melena were significantly associated with upper GI bleeding, whereas hematochezia was more common in lower GI bleeding. Patients with upper GI bleeding had significantly higher BUN, urea, and BUN/Creatinine ratios, while hemoglobin and hematocrit levels were lower. The optimal BUN/Creatinine cut-off value of 23.3 demonstrated high sensitivity (89.3%) and specificity (94.1%) for distinguishing between upper and lower GI bleeding. Multivariate analysis revealed BUN/Creatinine ratio, hematochezia and endoscopic intervention as an independent predictor of bleeding location. Patients with BUN/Creatinine ratio >23.3 showed increased frequency of red blood cell transfusion, endoscopic intervention, and mortality.

Conclusion: The BUN/Creatinine ratio is a sensitive, noninvasive biomarker for distinguishing between upper and lower GI bleed and severity. Its introduction into clinical practice may enhance the decision process and patient care, especially in critical care contexts. Additional research is indicated to confirm these results and to define standardized cut-off values for wider use.

Objective: It was aimed to compare the prognostic risk factors and multidisciplinary treatments affecting mortality in acute mesenteric ischemia (AMI).

Methods: We retrospectively analyzed 111 patients treated for acute mesenteric ischemia between January 2012 and January 2023. Patients were divided into 2 groups as alive and dead for early survey (postoperative 28 days). The characteristics of the two groups were compared and the factors affecting early mortality were investigated. Factors affecting the presence of perioperative ischemia, the length of ischemia, the length of the resected bowel, and the length of the remaining small bowel from the ligament of Treitz were investigated. The results of different treatment processes were analyzed.

Results: The mean age was 71.67, years with 64 (57.6%) males and 47 (42.3%) females. Early mortality rate was 47.7%. Envas was applied to 9 (8.1%) patients. EnvasSurg to 19 (17.1%) patients. Surg to 71 (64%) and SurgEnvas to 12 (10.8%) patients during the treatment process. Preoperative D-dimer (p=0.013). lactate (p=0.006). creatine (p=0.001). LAR (p=0.031) were significantly different between the groups when compared according to the treatment process. The resected bowel length was significantly less in patients who underwent EnvasSurg compared to the other groups (p=0.002), CCI (p=0.041), D-dimer (p=0.016), lactate (p<0.001), creatine (p<0.001), LAR (p<0.001) and ischemia length (p<0.001) were found to be significantly different between the groups.

Conclusion: The prognosis can be predicted with serum-based blood tests and indicators at the time of diagnosis, and organ loss and prognosis can be changed with the selected treatment process.

REV-ERB α/β proteins play critical roles in circadian rhythm regulation and are considered to be specialized members of the nuclear receptor family. These so-called "orphan" proteins, whose endogenous ligands were initially unidentified, have become exogenously interferable through synthetic agents with the discovery of their endogenous ligands. This feature has made them an important target for clinical research in recent years. Unlike other nuclear receptors, the unique structure of REV-ERB proteins allows them to perform only transcription inhibition, which makes them even more intriguing. This review summarizes the structural features of REV-ERB α/β proteins and their role in the circadian cycle. We also discuss findings in the literature on the function of REV-ERB α/β proteins in the metabolic and immune systems, emphasizing their importance in these systems.