Northern clinics of Istanbul最新文献

Objective: Diabetes is a chronic, broad-spectrum metabolic disorder that requires continuous medical care, in which the organism cannot adequately benefit from carbohydrates, fats, and proteins due to insulin deficiency or defects in the effect of insulin. Vascular complications are considered to be the main cause of mortality in diabetic patients. Platelet activation plays a role in the development of vascular complications. The aim of this study was to evaluate the relationship between HbA1c, which is the parameters that we can evaluate in primary healthcare institutions, and increased Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) levels, which are thought to be a platelet activation markers in patients with Type 2 diabetes mellitus.

Methods: In our study, the data for 600 patients who applied to Internal Medicine outpatient clinic of our hospital between January 01, 2022, and June 31, 2022, were obtained by examining their epicrisis through the hospital information management system. Six hundred patients, including 300 control group with HbA1c level below 6.5 and 100 patients each 7-8.5 8.5-10 and above 10, were included in the study. HbA1c, MPV, and PDW levels of the patients were recorded.

Results: Among 600 patients who applied to internal medicine polyclinics of our hospital between January 01, 2022, and June 31, 2022, 412 participants were female, while 188 participants were male. It was determined that the participants were 46.91±12.68 years old on average, the youngest participant was 18 years old and the oldest participant was 66 years old. It was determined that the mean HbA1c value of the participants participating in the study was 7.6±2.4, the lowest HbA1c value was 4.3, and the highest HbA1c value was 19.3. It was determined that the mean MPV value of the participants was 10.1±1.1, the lowest MPV value was 7.7, and the highest MPV value was 13.3. It was determined that the mean PDW value of the participants was 16.0±0.4, the lowest PDW value was 14.8, and the highest PDW value was 17.2.

Conclusion: In this study, it was determined that MDV and PDW levels showed a statistically significant difference according to the HbA1c value ranges of the patient group. Accordingly, the MPV and PDW levels of the participants whose HbA1c value range is >10 are higher. It was observed that MPV and PDW levels increased as the HbA1c value range increased.

Objective: Factor 2 and Factor 5 mutations are among the most common procoagulant genetic disorders and are routinely evaluated in donor preparation. Homozygous mutations are contraindicated for surgery, but heterozygous mutations cannot be said to be an impediment. We aimed to investigate the effect of heterozygous gene mutation of F2 and/or F5 on complications.

Methods: In our study, 210 living liver donors were examined. The available data of Factor 2 and 5 heterozygous positive donors were evaluated in terms of 21 donor patients and 30 liver recipients. The heterozygous positive group and the control group were statistically compared in terms of age, gender, length of hospital stay, post-operative deep vein thrombosis, pulmonary embolism, portal vein thrombosis, bile duct stenosis and bile leakage complications, lung infection and atelectasis, and wound infection. In addition, these patients were statistically compared in terms of laboratory tests. In addition, complications in recipients implanted with mutant grafts were evaluated statistically and numerically.

Results: Hospital staying was longer statistically in the donor group with heterozygous mutations than in the control group. Hemoglobin and albumin blood levels were lower (p=0.031, p=0.016); INR and ALT levels were higher (p=0.005, p=0.047) statistically in the control group than in the donor group with heterozygous mutations. There was no statistically significant difference between heterozygous mutant groups in terms of biliary tract complications and hepatic vessel thrombosis in recipients.

Conclusion: Considering the longer hospital stay in the presence of these mutations, the increased need for treatment in this process and the close follow-up of liver functions should be considered.

Objective: There is a worldwide increase in the incidence of malignant melanoma (MM). Although it is a highly aggressive tumor and associated with high mortality and morbidity rates, it is highly curable if diagnosed early. Both genetic and environmental risk factors are associated with MM, which may show geographic variations. In this study we aimed to investigate the demographic and clinical features of cutaneous melanoma patients who are under follow-up in our department and whether there is an association between patients' characteristics and disease features.

Methods: Thirty-four patients with cutaneous MM who were under follow-up in the dermatology outpatient clinic, and dermoscopy unit at our hospital were retrospectively analyzed. The patients' demographic data and features related to MM were evaluated.

Results: Nineteen (55.9%) women and 15 (44.1%) men were enrolled in the study. When the patients were evaluated according to their Fitzpatrick skin types, type 2 was the most common in 21 (61.8%) of the patients, followed by type 3 in 9 (26.5%), and 1 in 4 (11.8%) patients. Twenty-two (64.7%) of the patients had a history of regular sun exposure. Twelve (35.3%) patients had a history of working outdoors. Sixteen of the patients (47.1%) had at least one sunburn history during childhood. The mean age at which patients were diagnosed with MM was 50.12±12.67 years. Age at diagnosis was found to be higher in those with actinic keratosis and those with solar lentigo (p=0.030, p=0.030; respectively). It was determined that there was a statistically significant difference in terms of localization according to the place of birth of the patients (p=0.007).

Conclusion: We believe that defining the patients' characteristics and developing follow-up strategies accordingly, will improve the treatment rates in melanoma. Dermatologists should schedule personalized follow-up programs for patients who have priorly defined and regional risk factors.

Objective: Although it is accepted as an effective and safe treatment way, side effects can be observed as a result of subcutaneous immunotherapy (SCIT). In our study, it was aimed to evaluate the local and systemic reactions in children after SCIT and the factors that may be associated with these reactions.

Methods: Our study included 138 house dust mite allergic patients with asthma and/or allergic rhinitis who underwent SCIT in the Pediatric Allergy and Immunology Outpatient Clinic between November 2013 and April 2022. Sociodemographic, clinical, laboratory features, and development of adverse reactions after SCIT were analyzed from patient files.

Results: The median age of 138 patients was 9.0 years. About 56.5% (n=78) were male, 43.5% (n=60) were female. Of the patients, 55.1% (n=76) had asthma and allergic rhinitis. A total of 7366 SCIT injections were administered to all patients in our clinic. The total number of observed adverse reaction was 118. 50.7% of the patients (n=70) experienced at least one adverse reaction after SCIT. The rate of development of adverse reactions per injection was 1.6% (local: 1.0%, large local: 0.1%, systemic: 0.5%).

Conclusion: Although serious systemic reactions and death were not observed in our patients; care should be taken in terms of the development of adverse reactions during SCIT in children.

Objective: Nectin-4 is a transmembrane protein belonging to the nectin family of immunoglobulin-like molecules which is found in the placenta and trachea under physiological conditions and its expression has been shown in many cancer types. We aimed to investigate for the 1^st time nectin-4 expression in human prostate cancer tissues.

Methods: We retrospectively analyzed the prostate pathology specimens of 82 patients who underwent initial transrectal ultrasound-guided prostate biopsy or transurethral prostate resection and were found to have atypical small acinar proliferation (ASAP) and incidentally prostate cancer. Tissue samples with prostatic cancer were used as a control for alpha-methylacyl-CoA racemase (AMACR), and benign prostatic glands in the same tissue provided the negative control. The intensity and extent of nectin-4 expression were determined microscopically using the histochemical scoring system which was defined as the product of the staining intensity (score: 0-3) and percentage of stained cells (0-100) at a given intensity.

Results: We conducted immunohistochemical analysis of nectin-4 and AMACR expression in all 82 samples. While AMACR expression was positive in prostate cancer tissues with a GS of <7 (n=24, 100%), 7 (n=18, 100%), and ≥8 (n=15, 100%), it was negative in all ASAP samples (n=25, 100%) (p<0.001). Nectin-4 expression was not detected in any of the GS <7, GS 7, or GS ≥8 samples but was found in benign prostatic gland tissues and all 25 (100%) ASAP samples (p<0.001).

Conclusion: We found that nectin-4 was not expressed in prostate cancer tissues but was expressed in ASAP-and benign prostate gland containing tissues. We believe that prospective studies with more patients and samples including radical prostatectomy materials will reveal the relationship between nectin-4 and prostate cancer more clearly.

Objective: Umbilical hernia repair can be easily performed simultaneously with laparoscopic cholecystectomy. The use of mesh is recommended for hernias larger than 1 cm. In this study, patients with primary repair of umbilical hernia simultaneously with laparoscopic cholecystectomy were evaluated. It aimed to present the effectiveness of this method and the effect of body mass index (BMI) on treatment results.

Methods: The records of patients who underwent primary repair of umbilical hernia simultaneously with laparoscopic cholecystectomy between 2014 and 2021 were reviewed retrospectively. Patients' age, gender, BMI, length of hospital stay, recurrence and reoperation information, and follow-up times were analyzed. The patients were examined in three groups according to their BMI, and the effect of BMI on treatment was investigated.

Results: patients were included in the study. Median values of the patients for age, BMI, hospitalization, and follow-up were 63 (28-94), 31 (20-51) kg/m², 1 (1-25) days, and 23 (0.6-76) months, respectively. Recurrence was detected in 8 patients. BMI was <25 in one patient with recurrence and >30 in 5 patients. There was no significant correlation between length of stay, number of relapse and reoperation, and BMI (p>0.05).

Conclusion: In our study, the recurrence rate was found to be higher than the studies reported with the use of mesh, and most of the patients with recurrence are obese, although it is not statistically significant. If the recurrence rate is acceptable, we believe that repair with primary suture is feasible in umbilical hernia.

Objective: In this study, the frequency of chronic fatigue syndrome (CFS), sleep disturbances, and quality of life levels in mothers of children with cerebral palsy (CP) was compared in relation to the functional status of the child.

Methods: The caregivers were evaluated with the sociodemographic data form, Chalder fatigue scale (ChFS), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index, and Short Form-12, respectively. In addition, the functional status of the child with CP was evaluated with the gross motor function classification system, manual ability classification system (MACS), communication function classification system, and eating and drinking ability classification system.

Results: According to CDC-1994 criteria, 80.4% of the participating mothers have CFS (n=45). While the mean ChFS and FSS scores of housewives were found to be significantly higher than those of full-time workers (p=0.002; p=0.003, respectively), the mean SF-12 MCS was found to be significantly lower (p=0.007). The rate of housewives was found to be significantly higher in those diagnosed with CFS (p<0.001). The relationship between independent variables and dependent variables data sets as a result of canonical correlation analysis was obtained as 0.815. While the variable with the highest effect among the independent variables is the MACS variable, the variable with the highest percentage of explanation for the dependent variables is ChFS.

Conclusion: The frequency of CFS is very high in mothers of children with CP, and the most important factors in the presence and severity of CFS are the mother's occupational status and the child's manual skills.

Objective: This article evaluates the effects of unilateral and bilateral inferior oblique myectomy (IOM) on fundus torsion in primary and secondary inferior oblique overaction (IOOA).

Methods: This study analyzed 230 OCT images of 53 eyes of 32 patients who had undergone IOM by a single surgeon in the last two years. The disc-foveal angle (DFA) was calculated by digitally measuring the angle between the horizontal line passing through the geometric center of the optic disc and the curved line connecting the fovea to the geometric center of the optic disc. DFA was classified into intorsion, normal torsion, and extortion. The DFA was measured from the OCT images before the operation in the first week, first month, third month, and sixth month.

Results: When all the patients in our study were evaluated together, IOM statistically reduced the mean DFA in the third month (p=0.00). The DFA was higher in the secondary IOOA group than in the primary IOOA group (p=0.24). Bilateral IOM statistically significantly reduced DFA in the third month (p=0.00) and decreased the DFA difference between the two eyes in the third month (p=0.583). Unilateral IOM increased the DFA, rather than decreasing it, in the first week in operated eyes (p=0594) and increased the DFA difference between the two eyes after surgery (p=0.477). When we evaluated the localization of the macula as an intorsion, normal intorsion, or extortion, the extortion decreased from 36 to nine in the third month after bilateral IOM, and intorsion was seen in only two. Unilateral surgery did not significantly change fundus torsion in primary IOOA, and it caused intorsion in 3 of 6 (50%) operated eyes in secondary IOOA.

Conclusion: Although unilateral IOM provides a clinical improvement in secondary IOOA, it increases the difference in DFA between both eyes and causes intorsion in 50% of patients. Masked IOOA was detected in 3 of 11 (27.3%) patients who underwent unilateral IOM. When deciding on unilateral surgery, the possibility of increased DFA difference between both eyes, intorsion in the operated eye, and masked IOOA in the other eye should be considered.

Objective: Appendicitis typically develops secondary to obstruction of appendiceal lumen and one of the causes of obstruction is appendicolith. Appendicolith has become a relevant issue due to heightened interest in the treatment of uncomplicated appendicitis with antibiotics. This study aimed to determine the prevalence of appendicolith in pediatric patients with appendicitis and to investigate the association between the presence of appendicoliths and radiological disease severity.

Methods: Patients under the age of 18 diagnosed with appendicitis between March 2021 and April 2022 and had available preoperative computed tomography (CT) images were identified retrospectively. The presence of an appendicolith and if present, its longest diameter in the axial plane, its visibility on direct radiographs, appendiceal diameter, degree of inflammation, and the presence of perforation were evaluated. Radiological severity of inflammation was rated on a 3-point scale.

Results: CT scans were available in 77 (32.1%) of 240 patients with histopathologically confirmed diagnosis of acute appendicitis. 39% (n=30) of the patients were girls and the median age was 13 years. The prevalence of appendicoliths detected on CT scans was 32.5% (n=25) and the median size of appendicoliths was 6 mm. In only 1 patient, appendicolith was detected by direct radiography. The median appendiceal diameter was significantly greater in the group with appendicoliths (10 mm vs. 8 mm; p=0.001). A moderate correlation was found between appendicolith size and appendiceal diameter (r=0.407, p=0.043). Perforation was present in 10.4% (n=8) of the patients with appendicitis and 25% (n=2) of them had appendicoliths. The presence of appendicoliths was not significantly associated with the occurrence of perforation (p=0.485). Periappendiceal inflammation scores were 1.52±0.74 in the group with appendicoliths and 1.42±0.63 in the group without appendicoliths (p=0.591).

Conclusion: The prevalence of CT-detected appendicoliths was 32.5% in pediatric patients with appendicitis. Patients with appendicoliths showed higher inflammation scores and greater appendiceal diameter than those without appendicoliths. These factors may be associated with poor outcomes in patients with appendicoliths treated with antibiotics. Therefore, knowledge of the prevalence of appendicoliths and questioning their presence may guide clinicians when deciding on the suitability of nonoperative treatment in a patient diagnosed with uncomplicated acute appendicitis.

Objective: Atopic diseases are the most common chronic conditions in childhood. The best treatment for allergic disease is possible with early diagnosis. The purpose of the study was to assess the predictive value of total immunoglobulin E (IgE) and eosinophil levels for allergy test positivity in patients diagnosed with asthma, allergic rhinitis (AR), atopic dermatitis (AD), and food allergy (FA).

Methods: Pediatric patients between 0 and 18 years old diagnosed with asthma, AR, AD, and FA were included in the study. Demographic characteristics of the patients, total IgE, eosinophil (absolute and %) values, specific igE (SPIGE), and skin prick test (SPT) results were recorded.

Results: The data of 2665 patients were evaluated in the study. Of the patients, 58.6% were male, whereas 41.4% were female. The median age of the children was significantly higher both in SPT-positive and SPIGE-positive patients (p<0.001). If the criteria positivity is accepted as total IgE value is ≥104.5 (for AD: 86.5, asthma: 116.5, AR: 120.5, FA: 42.5) and absolute eosinophil ≥500 and/or eosinophil (%) ≥5%; test positivity was higher for each disease and all patients (p<0.001).

Conclusion: Total IgE and eosinophil levels can be used to identify atopy in patients with symptoms of AD, asthma, and AR. Total IgE and eosinophil values are suitable and easily obtainable parameters for better evaluation of health-care resources for the diagnosis and follow-up of atopic illnesses.