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Neonatal effects of thyroid diseases in pregnancy and approach to the infant with increased TSH: Turkish neonatal and pediatric endocrinology and diabetes societies consensus report
No full textThyroid functions in the fetus and newborn carry importance in terms of the baby’s health and development of the central nervous system. Maternal iodine deficiency, exposure to iodine, thyroid diseases (Hashimoto thyroiditis, Graves’) and drugs used by the mother affect thyroid functions in the fetus. Reflections of these effects are observed immediately after delivery. Investigation of the mother in terms of thyroid diseases during pregnancy, recognition and appropriate assessment of the required conditions, screening of all newborns in the first days of life in terms of congenital hypothyroidism, timely and appropriate evaluation of the screening results, early diagnosis and appropriate treatment of cases of congenital hypothyroidism, assessment and management of cases of transient thyroid hormone disorders and close monitoring of the thyroid functions and development of patients in whom treatment has been initiated with a diagnosis of hypothyroidism are crucial in terms of developmental outcomes of the babies who have thyroid function disorders or hypothyroidism. This guideline was written with the objective of guiding pediatricians, neonatologists and pediatric endocrinologists in the issue of assessment, diagnosis and management of thyroid function disorders and thyroid diseases concerning the fetus and baby during gestation and neonatal period. © Copyright 2018 by Turkish Pediatric Association
Magnetic Resonance Guided Stereotactic Biopsy of Intracranial Lesions: Analysis of 310 Cases
Get PDFObjective: Stereotaxic biopsy is an important surgical procedure that provides definite diagnosis in brain lesions. It is possible to obtain diagnosis with minimal invasive manner in deeply located and critical localized lesions. There are large case series in the literature. We aimed to present our experience of magnetic resonance (MR) guided 310 stereotaxic biopsies in this study.
Method:We retrospectively evaluated age and gender distribution, locations of the lesions, histopathologic results, and complications of 310 cases which MR guided stereotactic biopsied was performed in our clinic between 2012 and 2018. In addition, technical information was also provided.
Results:Stereotactic frame application was performed with local anesthesia and surgical procedure was performed by under general anesthesia. Of 310 patients 169 were male (55%) and were 141 female (45%). Mean age was 57.28 (3-87). 184 of the lesions were hemispheric (59%), and the most common diagnosis was glioblastoma multiforme (34.19%). 8 patients were not diagnosed (2%). Complications developed in 13 cases (4%) and 2 of cases were died in the early phase due to the procedure (0.6%). Histopathological diagnostic success was 99%
Conclusion:The results of our study show that the stereotactic biopsy procedure applied in the MRI guideline is reliable and feasible with low complication rate and high effectiveness in cases where definitive histopathologic results are required for treatment planning
Cerebral Sinus Venous Thrombosis: Evaluation of Nineteen Patients
Get PDFObjective: Cerebral sinus venous thrombosis (CSVT) is a disease that can be seen in all age groups with various clinical findings and usually a good prognosis. In this study, evaluation of the complaints on admission, the possible risk factors, localization, findings and treatment approaches, and discussion of these findings with comparison to the literature were aimed.
Materials and Methods: The demographic, clinical, laboratory and the radiological characteristics of 19 patients with diagnosed with CSVT and followed at the Sakarya University Training and Research Hospital Clinic of Neurology.
Results: Nineteen patients (15 female, 4 male) with the diagnosis of CSVT were included. The mean age of the patients was determined as 31.3 +/- 11.2. Headache was determined to be the first symptom on admission in 17 patients. Nauseavomiting (n=10), blurred vision (n=4) and epileptic seizures (n=3) had accompanied headache. Altered state of consciousness (n=2), papilledema (n=4), dysarthria (n=1), and cerebellar disorder (n=1) were determined. Two of the patients were pregnant and 6 patients were in the postpartum period. CSVT due to infection was determined in 2 patients. No reason for etiological investigation was found in 4 of the cases. In 11 patients, more than one etiology were detected. Two patients had been diagnosed with Behcet's disease. MTHFR A1298Cgene heterozygous mutation was most detected. Fourteen patients were determined to have a single sinus venous thrombosis and 5 patients had more than one sinus venous thrombosis on magnetic resonance venography. Six patients had venous infarction.
Conclusion: Pregnancy and postpartum period are significant risk factors for CSVT. The association of more than one reason in the etiological investigations of patients despite the presence of one significant risk factor has been emphasized
Organ damage mitigation with the Baskent Sickle Cell Medical Care Development Program (BASCARE)
Get PDFThe Eastern Mediterranean is among the regions where sickle cell disease (SCD) is common. The morbidity and mortality of this disease can be postponed to adulthood through therapies implemented in childhood. The present study focuses on the organ damage-reducing effects of the Baskent Sickle Cell Medical Care Development Program (BASCARE), which was developed by a team who lives in this region and has approximately 25 years of experience. The deliverables of the program included the development of an electronic health recording system (PRANA) and electronic vaccination system; the use of low citrate infusion in routine prophylactic automatic erythrocyte exchange (ARCE) programs including pregnant women; the use of leukocyte-filtered and irradiated blood for transfusion; the use of magnetic resonance imaging methods (T2(*)) for the management of transfusion-related hemosiderosis; and the implementation of an allogeneic hematopoietic stem cell transplantation protocol for adult patients. The sample was composed of 376 study subjects and 249 control subjects. The hospital's Data Management System and the central population operating system were used for data collection. BASCARE enabled better analysis and interpretation of complication and mortality data. Vaccination rates against influenza and pneumococcal disease improved (21.5% vs 50.8% and 21.5% vs 49.2%, respectively). Effective and safe ARCE with low citrate infusion were maintained in 352 subjects (1003 procedures). Maternal and fetal mortality was prevented in 35 consecutive pregnant patients with ARCE. Chelating therapy rates reduced from 6.7% to 5%. Successful outcomes could be obtained in all 13 adult patients who underwent allogeneic peripheral stem cell transplantation from a fully matched, related donor. No patients died by day 100 or after the first year. Cure could be achieved without graft loss, grades III to IV acute graft versus host disease, extensive chronic graft versus host disease, or other major complications. The BASCARE program significantly improved patient care and thereby prolonged the life span of SCD patients (42 +/- 13 years vs 29 +/- 7 years, P < .001). We may recommend using such individualized programs in centers that provide health care for patients with SCD, in accordance with holistic approach due to the benign nature but malignant course of the disease
Dutch citizens of Turkish origin who utilize healthcare services in Turkey: a qualitative study on motives and contextual factors
Get PDFBackground: Dutch residents of Turkish origin frequently utilize healthcare in Turkey.
Methods: To investigate their motives for doing so, we conducted a qualitative study among these healthcare users using semi-structured interviews. We complemented this with informal conversations with Turkish healthcare providers and observations at the registration offices and waiting rooms of outpatient clinics in several Turkish hospitals.
Results: Respondents believed their perceived needs for referral to specialist care and diagnostic assessments to quantify their health were not being met in the Netherlands.
Conclusions: These mismatches in expectations of what constitutes "good care" led to dissatisfaction with Dutch primary care. Consequently, respondents utilized healthcare in Turkey if the opportunity arose, and were encouraged in this by their social networks. Establishing cross-border communication between healthcare providers is necessary, because there is currently no continuity of care for cross-border patients
Publication rates of dissertations written in medical faculties of Turkey in the field of urology between the years 2008, and 2011, and citation analysis: A cross-sectional study
Get PDFObjective: In our country, preparing dissertation is essential for the research assistants in order to complete their expertise in medicine. It is aimed to produce hypothesis for researchers via writing their dissertations, to collect data for the hypothesis established, to make the analysis and interpretation of these data, and to gain the ability for the comparison of the findings obtained with the literature. In this study, we want to investigate the publication rates and citations of urology dissertations that are written at the university hospitals in our country between 2008 and 2011.
Material and methods: Urology dissertations that are written at the university hospitals between 2008 and 2011 were reviewed by entering the website of Board of Higher Education Dissertation between 23-27 March 2017 and 229 dissertations were reported. The publication rates of these dissertations were analysed.
Results: Hundred and fourteen of 229 dissertations (49.7%) analysed were published. Of these publications, 75 (32.7%) in Science Citation Index Expanded, 24 (10.4%) in international, 15 (6.5%) are published in national indexed peer-reviewed journals. While the publication rate of 81 dissertations written in universities located in 3 metropolitan cities (Istanbul, Ankara, and Izmir) of Turkey was 50.6%, the publication rate of 148 dissertations written in remaining universities was 49.3%; and no statistically significant difference was found between the two groups (p=0.96).
Conclusion: Preparing dissertation is a challenging process that requires considerable effort and time. At the end of this process, it is necessary to publish the dissertation in order to have it reach more people and to contribute to the literature. Even though publication rate of dissertations written in urology at university hospitals in Turkey was at acceptable level, there have still been problems required to solve
Lung Cancer Related Central Airway Obstruction: Who Benefits Better from Radiotherapy?
Get PDFWe aimed to assess the efficacy of external beam radiotherapy (EBRT) in central airway obstruction (CAO) and associated factors for metastatic lung cancer (MLC) patients. Records of 72 MLC patients presenting with CAO were retrospectively analyzed. The serial chests X-rays prior and after the EBRT were compared for response assessment. The primary end-point was radiologic response, while overall-(OS) and CAO-free survival, and predictors of better outcomes constituted secondary endpoints. The EBRT doses ranged between 8 to 40 Gy (1-13 fractions). Median follow-up and OS were 5.6 (range: 1.3-17.8) and 7.6 months (95% CI: 6.5-8.7), respectively. Objective CAO resolution was achieved in 58 patients (80.6%) on serial chest X-rays with a median time to maximum CAO response of 23 days (range: 3-86). In responders the response was durable (8.1 months) almost nearly for all their remaining life spans (8.3 months) with only 19.0% CAO recurrences. Median OS was also significantly longer in responders (8.3 vs. 2.4 months; p= 39 Gy (p= 39 Gy (p=0.008) were the factors to relate with better OS on multivariate analyses. The EBRT proves effective and durable CAO palliation with only 19.0% re-CAO rate in MLC patients. Better CAO responses may be achieved in patients treated with smaller tumor size, small-cell histology, and higher BED10 values
Case of an Unusual Suprascapular Neuropathy: Case Report and Literature Review
Get PDFSuprascapular neuropathy is a rare cause of shoulder pain and muscle weakness. Common causes include space-occupying lesions such as paralabral cysts, soft tissue or bone tumors, recurrent overhead activities in athletes, direct trauma, fractures of the scapula and iatrogenic causes. Diagnosis of suprascapular neuropathy can be difficult due to overlap in the clinical presentation with cervical region and other pathologies of the shoulder. We present a 33-year-old male patient admitted to our clinic with complaints of left shoulder pain and arm weakness starting in 8 months ago. The clinical and electrophysiological evaluations confirmed the left suprascapular nerve lesion at suprascapular notch level. This case is presented to emphasize that suprascapular neuropathy should keep in mind in the differential diagnosis of shoulder pain also without of a mass, trauma or excessive physical activity that may cause the neuropathy
Assessing the validity and reliability of the Turkish versions of craving beliefs and beliefs about substance use questionnaire in patients with heroin use disorder: demonstrating valid tools to assess cognition-emotion interplay
Get PDFBackground: Cognitions associated with craving and substance use are important contributors for the psychological theories of Substance use disorders (SUD), as they may affect the course and treatment. In this study, we aimed to validate Turkish version of two major scales 'Beliefs About Substance Use'(BSU) and 'Craving Beliefs Questionnaire'(CBQ) in patients with heroin use disorder and define the interaction of these beliefs with patient profile, depression and anxiety symptoms, with an aim to use these thoughts as targets for treatment.
Methods: One hundred seventy-six inpatients diagnosed with heroin use disorder and 120 participants in the healthy comparison group were evaluated with CBQ, BSU, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and sociodemographic data questionnaire. Patient group was also evaluated with Addiction Profile Index. Reliability and validity analysis for scales were conducted. Linear regression analysis was conducted to evaluate the determinants of BSU and CBQ scores.
Results: Cronbach alpha level was 0.93 for BSU and 0.94 for CBQ. Patient group showed significantly higher CBQ, BSU, BAI and BDI scores (p < 0.001). BSU score significantly correlated with API-substance use profile score, API-diagnosis, BAI, BDI and CBQ (p < 0.005), whereas CBQ scores significantly correlated with API-diagnosis, API-impact on life, API-craving, API-total score, BSU, BAI, BDI and amount of cigarette smoking (p < 0.002). Number of previous treatments and age of onset for substance use were not correlated with either BSU or CBQ. BAI and BDI scores significantly predicted BSU score, however only BDI score predicted CBQ score (p < 0.003).
Conclusions: Craving beliefs were highly correlated with addiction profile. Anxiety and depression are significant modulators for patients' beliefs about substance use and depression is a modulator for craving and maladaptive beliefs, validating emotion-cognition interplay in addiction
Comparison of the effects of intravenous Dexketoprofen Trometamol versus Paracetamol on postoperative analgesia in patients undergoing Septoplasty: A randomised double-blind clinical trial
Get PDFBackground and Objective: Septoplasty operations are associated with moderate to severe postoperative pain which has unfavourable effects on patient's recovery and postoperative outcome. The aim of this study was to compare effects of intravenous paracetamol and dexketoprofen on postoperative analgesia, tramadol consumption and side effects after septoplasty.
Methods: In total 72 patients (aged 18-65 years) who had undergone an elective septoplasty from August 2013 to January 2015 in Baskent University Faculty of Medicine, in the Department of Anesthesiology and Reanimation Clinics were included in this study. The patients were randomised into one of two groups: those who received intravenous paracetamol; and those who received intravenous dexketoprofen. All patients were treated with tramadol for 24 hour postoperatively. The primary endpoint was pain intensity as measured by a visual analogue scale (VAS). Tramadol consumption and drug related side effects were also recorded.
Results: The pain scores in the dexketoprofen group were significantly lower at recovery, 15 and 30 minutes and two hour (p< 0.05). The pain scores had no difference at other time points. Tramadol consumption in the recovery period was significantly lower in the dexketoprofen group, but cumulative tramadol consumption did not differ between the groups. The incidence of nausea was lower but not statistically significant in the dexketoprofen group at 15 and 30 minutes and two hour.
Conclusions: Compared with paracetamol, preemptive dexketoprofen is associated with lower VAS scores and tramadol consumption in the early postoperative period after septoplasty. However, the cumulative tramadol consumption did not significantly differ between the groups