Hamidiye Etfal Training Research Articles

Hastanemizde Nonpalpabl Meme Lezyonlu Bir Hasta Serisinde Stereotaktik Biyopsi Sonuçları

Aim: Although screening mammography has a high sensitivity in the clinical detection of nonpalpable breast cancer, most mammographically suspicious lesions referred to biopsy are seen to be benign. The rate of malignancy in such lesions that are biopsied with needle–wire localization ranges from 10 to 36%. In this study, we aimed to compare with the literature the pathological results and Breast Imaging Reporting and Data System (BI-RADS) scores of lesions subjected to mammography and excisional biopsy after ultrasonography-guided needle–wire localization and calculate a positive predictive value for each category. Materials and Methods: By electronically reviewing patient files and using the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, we identified patients who underwent excisional biopsy after stereotactic marking at the General Surgery Clinic of the Istanbul Sisli Hamidiye Etfal Training and Research Hospital between January 2003 and March 2009. A total of 64 patients were included in the study, of whom 43 had benign and 21 had malignant lesions on postoperative histopathological examination. Data on patient demographic characteristics, indications for marking, and histopathological diagnoses were recorded. The patient BI-RADS scores were determined based on the mammography and breast ultrasonography reports. The BI-RADS classification and histopathological examination results were compared in percentages. Results: The mean patient age was 48.9 (32–76) years. Based on the mammography reports, the most common indications for stereotactic marking and excisional biopsy were microcalcification cluster and spiculated mass. Histopathological examination results revealed malignancy in 8%, 51%, and 100% of the patients whose BI-RADS scores were mammographically determined to be BI-RADS 3, BI-RADS 4, and BI-RADS 5, respectively. Discussion and Conclusion: The BI-RADS-based classification of lesions detected by mammography and ultrasonography can help in predicting malignancy. While BI-RADS 4 and BI-RADS 5 lesions are referred to biopsy primarily, short-term follow-up of BI-RADS 3 lesions as an alternative to biopsy could reduce unnecessary biopsies.

Meme Koruyucu Cerrahi Sonrası (MKC) Simultane İntegre Boost (SIB) Tekniğinin Farklılığı

Whole breast irradiation after breast conserving surgery (BCS) is the standard treatment for early stage breast cancer. For early-stage breast cancer, breast-conserving surgery and subsequent postoperative radiotherapy are as effective as mastectomy. An early stage 10 breast cancer patient admitted to the Radiation Oncology Clinic of Sisli Hamidiye Etfal Training and Research Hospital was included in the study. The study is a retrospective study and patients were not treated with the plans and techniques used in the studies. In the study, the planning target volume (PTV) and the organs at risk (OAR) planned with Sequential Intensity Modulated Radiotherapy (IMRT) and Simultaneous Integrated Supplement (Boost) Intensity Modulated Radiotherapy (SIB IMRT) techniques in patients who have undergone breast conserving surgery due to breast cancer. It is aimed to be compared dosimetrically. For the study, patients with consecutive IMRT were given 50 Gy / 25 fraction to the whole breast and 10 Gy / 5 fraction to the boost area, while patients with SIB IMRT were given a total of 50.4 Gy / 28 fractions to the entire breast, while additional dose to the boost volume was given 60 Gy / 28 fraction dose. Ipsilateral lung, heart, the minimum and maximum doses of the PTV breast and PTV boost areas and the homogeneity index (HI), conformity index (CI) values were matched with the help of the t - test minitab program. SIB IMRT technique and Sequential IMRT technique the ipsilateral lung; When the average doses of V5 value for 10 patients are compared, the results are not statistically significant, while the V20 value is statistically significant when the average dose values for 10 patients are compared, it has been demonstrated that SIB IMRT technique can be performed with a lower dose in the ipsilateral lung V20. When the heart average and heart V20 values are compared for the two techniques, the SIB IMRT technique was not statistically significant, and it has no superiority over the Sequential IMRT technique. While dose homogeneity was better with SIB IMRT in whole breasts, there was no difference in boost area homogeneity and whole breast conformity index SIB IMRT technique for decreasing excess normal tissue volumes irradiated, shortening the treatment process, dose reduction in organs at risk, reducing the dose per fraction for the breast and increasing the dose per fraction to the boost area due to the low incidence of acute skin toxicity, standard use in breast protector RT it can be recommended for.

Yeni Kurulan Kalp ve Damar Cerrahisi Kliniğinde Açık Kalp Cerrahisi: İlk 450 Olgunun Retrospektif Değerlendirmesi

Introduction: The Department of Cardiovascular Surgery at the Sisli Hamidiye Etfal Training and Research Hospital was founded in 2014, and the first open heart surgery was performed on November 19, 2014. We aim to evaluate the results of the first 450 open heart surgeries retrospectively.

Vaccine rejection and hesitation in Turkey

ABSTRACT In Turkey, primary care staffs have observed an increased rate of vaccination refusal in recent years. The aim of the present study was to determine the prevalence of vaccination refusal and hesitancy in Turkey, in addition to the demographic features and underlying reasons. The present descriptive cross-sectional study was conducted in İstanbul and Tekirdağ, two big Turkish cities that are exposed to widespread internal migration. To reflect Turkey’s demographic structure, 1004 participants were selected using cluster sampling based on birthplace, age, and level of education, from all individuals who attended family medicine outpatient clinics at Namık Kemal University and Şişli Hamidiye Etfal Training and Research Hospital. A face-to-face questionnaire method was used. Data show that this decline was mainly the result of the increasing rate of vaccine rejection and hesitation, for which the most important reason was found to be distrust of vaccine companies. It can be concluded that individuals who display vaccine refusal and hesitation are mostly born in the developed geographical regions of Turkey and have high income and educational levels. According to these results, we anticipate that vaccination rates may fall in Turkey in the coming years.

Is Vaginal Hysterectomy Safe for an Enlarged Uterus?

ObjectiveThe purpose of this study was to compare the surgical outcomes between two sets of women undergoing vaginal hysterectomy (VH) for benign gynecological conditions: those with moderately enlarged ( ≥12 weeks') uteruses and those with normal-sized uteruses.Materials and MethodsThe medical records of 84 women who underwent vaginal hysterectomies for benign gynecological conditions at Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey between 2013 and 2015 were reviewed. Age, uterine sizes, indications, duration of hospitalization, operation time, hematocrit (HCT) levels, and complications were analyzed.ResultsThe most common indications for VH were uterine descensus. However, most women had presented with more than one indication. The mean age of the patients who underwent VH was 56.12. The maximum volume of the uterus was found to be 1244.74 ml, and the smallest volume was found to be 18.83 ml. The mean volume of the uterus was found as 122.6629 ml. The mean duration of operation was 159.70 minutes, whereas the mean duration of hospital stay was 3.79 days. The mean preoperative HCT and hemoglobin (Hgb) values were 37.098 (±3.64) gr/dl and 12.365 (±1.35) gr/dl respectively. Postoperative HCT and Hgb values were 31.363 (±3.94) gr/dl and 10.52 (±1.38) respectively.ConclusionVH is usually a simple procedure with low morbidity. It is important to choose the appropriate patient when deciding on the operation. In addition, having experienced surgeons in the field of VH increases the success of surgery.

Comparison of Risk Factors and Outcomes in Carbapenem-Resistant and Carbapenem-Susceptible Gram-Negative Bacteremia.

Background:Carbapenem-resistant Gram-negative bacteremia (CR-GNB) is seen with increasing frequency and result in high mortality. The aim of this study was to compare the risk factors and results of carbapenem-resistant and carbapenem-susceptible Gram-negative bacteremia and to determine the factors related to mortality.Methods:The study was conducted as a retrospective observational comparative case series between June 2016 and November 2017 in Şişli Hamidiye Etfal Training and Research Hospital. The patients were divided into two groups as carbapenem-susceptible and carbapenem-resistant according to antibiotic susceptibility data of blood cultures. The risk factors for the development of carbapenem resistance, length of hospital stay, mortality rates, and mortality related factors were investigated between these two groups.Results:Two hundred and eleven cases were included in the study. Of these cases, 54 were resistant to carbapenem and 157 were susceptible to carbapenem. Mortality occurred in 60 (28.4%) patients. The 14 and 28 day mortality rates of patients with carbapenem resistance were significantly higher than those without carbapenem resistance. There was no statistically significant difference between two groups in length of stay in the hospital after bacteremia. Pittsburgh bacteremia score, cardiovascular disease, urinary catheterization, and inappropriate empirical antibiotic therapy were the most significant risk factors for mortality.Conclusions:Carbapenem resistance is associated with increased mortality and inappropriate empirical antibiotic treatment increases mortality. Therefore, patients should be evaluated for risk factors in predicting CR-GNB and treatment for resistant pathogens should be applied in appropriate patients.

The Compatibility of Hemoglobin A1c with Oral Glucose Tolerance Test and Fasting Plasma Glucose

Objectives:Diabetes mellitus (DM) is a chronic metabolic disease requiring lifelong medical care, and its prevalence is increasing worldwide. Early diagnosis of prediabetes and diabetes is significant in view of the mortality, morbidity and cost associated with them. Because of the difficulties in application and reproducibility of oral glucose tolerance test (OGTT), which is considered to be the gold standard in the diagnosis of DM, more feasible diagnostic tests are needed. This study aims to evaluate the validity of hemoglobin A1c (HbA1c) in predicting prediabetes and diabetes in the Turkish population and to evaluate the compatibility of HbA1c with other diagnostic tests.Methods:The patients who were admitted to Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital internal diseases and endocrinology outpatient clinics between 01.01.2013 and 30.06.2014 enrolled in this study. The participants were >18 years of age and were not diagnosed with prediabetes or DM earlier. The results of OGTT, fasting plasma glucose (FPG) and HbA1c tests were retrospectively screened, and the correlation of them was analyzed.Results:In this study, 201 participants enrolled. Of these cases, 127 were women and 74 were men. Mean age of the group was 49.3±10.4 years. HbA1c was observed <5.7% in the 15%, 5.7-6.4% in the 60%, and ≥ 6.5% in the 25% of the cases. While FPG was <100 mg/dL in 24% of the participants, it was found to be between 100-126 mg/dL in 71% and ≥126 mg/dL in 5% of the participants. According to the OGTT data, 23% of the cases were healthy, 59% were prediabetic and 18% were diabetic. The sensitivity and specificity of HbA1c were calculated as 50% and 80%, respectively. While the sensitivity of FPG was 17% and specificity was 97%.Conclusion:The data obtained from our study show that HbA1c is a more sensitive test compared to FPG in the diagnosis of DM. Prospective studies with broad participation at national and international levels are needed to redefine HbA1c cut-off points for the diagnosis of DM and prediabetes. Thus, it will be possible to revise the diagnostic guidelines accordingly.

HCV Genotype Distribution of Patients with Chronic Hepatitis C in Istanbul.

Objectives:Hepatitis C virus (HCV), which has no protective vaccine, is a common cause of chronic hepatitis, which is a severe public health threat. There are differences in nucleotide and amino acid sequences in different regions of the HCV genome. As a result of these differences, HCV has been shown to have at least seven major genotypes and many subtypes. In Turkey, the prevalence of genotype 1 is between 51.7% and 97.1%, the highest rate among all genotypes, while subtype 1b is the genotype with the highest rate. It is important to detect mixed genotype infection reliably as it causes treatment failure. This study aims to reveal the distribution of the HCV genotypes in our hospital in Istanbul over the years and to contribute to the epidemiological data of Turkey.Methods:For this purpose, 385 patient samples sent to Sisli Hamidiye Etfal Training and Research Hospital, Clinical Microbiology Laboratory for HCV genotype determination between January 2016 and June 2019 were evaluated retrospectively. Anti-HCV was screened by enzyme immunoassay and confirmation was performed by Line immunoassay. HCV genotyping assays targeting highly conserved 5’UTR and most variable region NS5B regions were used.Results:The most common genotype was genotype 1 (81.3%) with 313 cases and subtypes 1a and 1b were detected at the rates of 10.9% and 67.8%, respectively. In addition, genotype 3, 2, 4, 5 were detected at the rates of 8.8%, 3.4%, 2.9%, 0.8%, respectively and mixed genotype was found in 2.9% of cases. Although genotype 5 is seen in South Africa, it is found in the Middle East region, albeit at a low rate. In our study, it was observed that genotype 5 was detected in different years from patients of Syrian origin.Conclusion:In this study, genotype 1 was the most common genotype with a rate of 81.3% and subtype 1b was 67.8%, in accordance with the literature. However, genotypes 3, 2, 4 and 5 were also present at low rates. It is important to monitor these rare genotypes since some of them are dominant in surrounding countries. In addition, 2.9% of HCV mixed genotype was detected and this should be considered concerning management of HCV infection.

The Effect of Different Colimator Angles in Prostate Radiotherapy Plans with Volumetric Modulated Arc Therapy (VMAT) Technique

The aim of this study was to compare the differences in tumor and critical organ doses by using different collimator angles in the treatment plans of 10 prostate cancer patients who received radiotherapy treatment in the Radiation Oncology Clinic of Şişli Hamidiye Etfal Training and Research Hospital. The plans of 10 prostate cancer patients treated with the Varian Trilogy model linear accelerator were evaluated using the double field Volumetric Modulated Arc Therapy (VMAT) planning technique in the Eclipse (ver.13.6) treatment planning system. In VMAT technique, treatment plans were made when the collimator angles were clockwise (CW) and counter clockwise (CCW) 30°-330°. Critical organs and target organs are re-calculated by changing CW and CCW (15°-345°, 45°-315°, 60°-300°, 75°-285°, 90°-270°) in VMAT calculations without changing the optimization values. Dose distributions were obtained and the effect of collimator angle on dose distribution was examined. The collimator angles, which we obtained the best dose distribution, were determined for VMAT technique and evaluated for statistical significance. Quality control of the statistically significant treatment plans was performed with Electronic Portal Imaging Device (EPID) and the results were compared with 3% dose difference and 3 mm distance difference criteria for each patient in linear accelerator. It was found that the collimator angle which provides optimal dose distribution for the treatment of prostate cancer patients was consistent both statistically and as a result of measurements.

Aile Hekimliği Uzmanlık Eğitiminde ‘Eğitim Aile Sağlığı Merkezleri’ Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Deneyimi

Aile Hekimliği Uzmanlık Eğitiminde ‘Eğitim Aile Sağlığı Merkezleri’ Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Deneyimi

Investigation of The Effect of Intermediate Dose Calculation Module on Dose Dıstrıbutıon in Lung Cancer Radiotherapy Patients

The aim of this study was to investigate the effect of the use of intermediate dose calculation module on dose volume histogram (DVH) during dose optimization in the treatment plans of radiotherapy patients diagnosed with lung cancer. This study was carried out by using Eclipse (Version 15.3) treatment planning system with Trilogy model Linear Accelerator device in Radiation Oncology Department of Şişli Hamidiye Etfal Training and Research Hospital. Ten patients with lung cancer were included in the study. In this study, critical organ doses, conformity index (CI) and homogenity index (HI) were compared by making optimization in cases where intermediate dose calculation module was active and inactive. The plans using the Intermediate dose calculation model are more homogeneous and uniform. Differences between critical organ doses, conformity index (CI) and homogenity index (HI) were statistically significant when using the Intermediate dose calculation module. It has been demonstrated that the intermediate dose calculation method in heterogeneous lung cancer patients is superior in terms of dose homogeneity and tumor volume enveloping, which improves the quality of treatment plans.

Investigation From Different Calculation Solutions In Vertebra Plans And The Reliability Of Different Dose Rate Dose

In this study, it was aimed to investigate the effect of different dose rate and different computational resolutions on stereotactic vertebrae irradiation with the results of the verification schemes on Gamma analysis and the effect on dose for critical organ and target volume. Ten patients with vertebrae participated in the study. Patients participating in the study were investigated for their effect on doses for critical organ and target volume by recalculating treatment plans at different dose rates and different computational resolutions without changing the optimization parameters using Intensity Modulated Radiation Therapy (IMRT) technique in the Eclipse treatment planning system with Varian Trilogy Linear Accelerator located in Şişli Hamidiye Etfal Training and Research Hospital , Radiation Oncology Department. Verification schedules of all the treatment plans The results were compared by using the Electronic Portal Imaging Device (EPID). Using different dose rates did not affect our treatment planning accuracy. However, it was seen that the high resolution calculated plans represented the target and critical organ doses better.

Does Food Allergy Require Any Change in Measles-Mumps-Rubella Vaccination?

To determine the allergic reactions that develop after Measles and Measles-Mumps-Rubella (MMR) vaccination, and whether any delay in the timing of vaccination occurs in children with food allergy. Children with food allergy who were admitted to the Şişli Hamidiye Etfal Training and Research Hospital Healthy Child Clinic between 1st January 2015 and 30th June 2018 for Measles or MMR vaccination were studied retrospectively. Their age, delayed days of vaccination, the types of allergic food, the results of the specific IgE and skin tests, and any reaction after the vaccination were recorded. During the studyperiod, 159 patients were vaccinated and 170 doses of Measles or MMR vaccine were administered. Children allergic to egg were 50.3%, allergic to egg and milk were 25.8%, and 13.2% had multiple food allergy including egg. The rate of post-vaccination reactions in the patients with food allergy was 1.76%. Minor reaction was observed in three patients and no anaphylaxis was seen in any patient. Delayed days of vaccination in the patients referred by another center were greater than followed-up by present clinic (p < 0.001). Any serious allergic reaction was not observed in this study. Food allergy does not necessitate modification of routine vaccination. Anaphylaxis may develop in any vaccinated child regardless of whether he/she has food allergy or not. Therefore, vaccines should be administered in a healthcare facility that can treat anaphylaxis.

Nosocomial Infection Agents of Şişli Hamidiye Etfal Training and Research Hospital: Comparison of 1995 and 2017 Data.

Objectives:Healthcare-associated infections (HCAI), which are important causes of mortality and morbidity, are high cost but preventable infections. This study aimed to determine hospital infections and isolates in Şişli Hamidiye Etfal Training and Hospital and to determine our local data. The changes in the distribution of the isolates in this process were evaluated by comparing the data of 1995 and today.Methods:Materials sent to the microbiology laboratory of our hospital in 1995 and 2017 from the patients hospitalized in the period between June 1-December 31 were evaluated concerning hospital infection. The standard manual methods were used in 1995, while in 2017, MALDI-TOF MS was used for identification and BD Phoenix automated system for antibiotic susceptibility.Results:In 1995, in total, 100 bacteria were isolated from pediatric and adult patients, of which 48 Pseudomonas aeruginosa (48/100), 37 Klebsiella spp (37/100). In 2017, Acinetobacter baumannii causing an important resistance problem was found to be increased in number. The main hospital infection causes were Acinetobacter baumannii (37/179), Klebsiella spp (41/179). In 2017, bacterial diversity was also increased.Conclusion:Isolated strains, as in the past, are gram-negative bacteria, Pseudomonas spp decreased in 2017, and Acinetobacter spp increased. The findings suggest that the automated systems used in microbiology laboratories may have a role in the detection of bacterial diversity.

Risk Factor Assessment and the Incidence of Neonatal Hypoglycemia in the Postnatal Period.

Objectives:The aim of this study was to evaluate risk factors used for the assessment of neonatal hypoglycemia and to examine the follow-up outcomes observed in the first 48 hours of postnatal life.Methods:The records of infants born between 2015 and 2017 (3 years) at Şişli Hamidiye Etfal Training and Research Hospital who had a blood glucose level test performed within the first 24 hours after birth and who had follow-up results for 48 hours were included in the study. Data of gestational age; birth weight; gender; antenatal, natal and postnatal characteristics; blood glucose measurement method and time during the first 48 hours postpartum; glucose values and follow-up; nutritional status; and the need for hospitalization due to a low blood glucose value were recorded. Groups were created based on data of a diabetic mother, small for gestational age (SGA), large for gestational age (LGA), late preterm birth (34-36+6/7 gestational weeks), fetal distress, and feeding intolerance. Blood glucose measurement values and reasons for hypoglycemia and assessment were compared in subgroups.Results:The data of 9480 infants were reviewed and included in the study. It was determined that blood levels were checked in 28.7% (n=2720). The mean birth weight and gestational age of the infants was 3143±804 g and 37.7±2.5 weeks, respectively. In the study group, 54.7% were male, and 57.5% were delivered via cesarean section. The most frequent factors prompting blood glucose measurement were LGA status (25.9%), prematurity (18%), transient tachypnea (17.3%), and SGA status (11.6%). Results revealed that the blood glucose values of 2009 (73.9%) infants were within normal limits, and there was no further monitoring of blood glucose level during the first 48 hours. In 711 (26.1%), a low blood glucose level finding led to follow-up assessment. The incidence of hospitalization with a preliminary diagnosis of hypoglycemia was 2.5% (n=67). Subgroup analysis indicated that at the first hour, the mean blood glucose value of the patients with multiple factors that were risks for hypoglycemia suggesting further evaluation was lower than those with transient tachypnea and fetal distress (p<0.001), and the mean blood glucose value of premature and LGA neonates were significantly lower than the infants of diabetic mothers at the sixth hour (p<0.001).Conclusion:In the postnatal period, the rate of monitoring blood glucose levels in newborn babies was found to be 28.7% and the most commonly predicted risk factor was LGA babies. The frequency of postpartum hospitalization due to hypoglycemia was found to be 2.5%, and blood sugar levels were lower in the first hour in groups with multiple causes.

The frequency of dissociation and childhood trauma among obsessive-compulsive patients by comparing with healthy controls

Objective: To determine the frequency of dissociation and childhood trauma among obsessive-compulsive patients by comparing with healthy controls. Methods: This study comprises of a group of 50 patients attending to Hamidiye Etfal Training and Research Hospital Psychiatric Outpatients Department who had been diagnosed as obsessive-compulsive disorder according to DSM-5 and a control group of 50 participants with no psychiatric diagnosis. The groups were collected between September 2014 and January 2015. SCID-I, SCID-D, Dissociative Experiences Scale (DES), Childhood Trauma Quetionnaire (CTQ-28) and a short instrument gathering qualitative information about childhood traumatic experiences were administered to all attendees with a sociodemographic form. Results: Mean DES and CTQ-28 total scores were determined as significantly different between OCD and control groups. In the OCD group, the percentage of existence of at least one type of dissociative disorder was 14%. In CTQ-28 subscales scores, there were significant differences between OCD and control groups for emotional neglect, emoti-onal abuse and physical abuse. Moreover, 70% of the OCD group has had at least one type of childhood trauma. In childhood trauma subscales, there were also significant differences between OCD and control groups for at least one type of childhood trauma, emotional neglect, emotional abuse, physical abuse and sexual abuse. Discussion: Findings of significant differences between OCD patients and healthy controls according to dissociation and child-hood trauma, 14% of at least one type of dissociative disorder and 70% of at least one type of childhood trauma in OCD patients are main findings of this study. Our study differentiates from other studies in our country that its having a control group. Considering above findings, it has revealed that because of its probable effects on the diagnosis and treatment, co-existence of OCD with dissociation and childhood trauma is needed to be taken account.

Demographic characteristics and visual outcomes of open globe injuries in a tertiary hospital in Istanbul, Turkey

To evaluate the demographic characteristics and visual outcomes of patients with open globe injury (OGI) in a tertiary hospital in Istanbul, Turkey. The data of patients admitted with OGI to Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey from January 2012 to December 2017 were reviewed retrospectively, and 100 of the 154 patients were included in the study. There were 79 (79%) male and 21 (21%) female patients with the average age of 33.7 ± 20.7 (1-83). Presentation of the patients was more frequent in the first 3days of the week (Monday 20%; Tuesday 17%; and Wednesday 20%) and within working hours (8a.m.-5p.m., 71%). The most common injury type was penetrating injury (75%), which was mostly caused by sharp objects (metal objects 32% and broken glass 22.7%). The ocular trauma score (OTS) was significantly higher in patients with penetrating injury and intraocular foreign body injury (p < 0.001), and those results were correlated with better visual prognosis. The patients with penetrating injury among the injury types and zone I injury among the injury zones had the highest final visual acuity. Patients in the age group of 0-14years had statistically better visual outcome when compared to those in the other age groups (p = 0.003). The higher initial visual acuity and OTS, penetrating injury, zone I injury and pediatric age are good prognostic factors for OGI. Additionally, scheduling a prepared surgical team and tools in working hours will be beneficial according to the frequency of admissions.

Evaluation of Comorbidities in Patients with Autoimmune Bullous Diseases: A Retrospective Study.

Objectives:The purpose of the present study was to define the accompanying diseases of patients with autoimmune bullous diseases (ABDs).Methods:One hundred forty-two patients with ABD who were followed up in the dermatology and venereology inpatient clinic of Şişli Hamidiye Etfal Training and Research Hospital between January 1999 and December 2015 were enrolled in the study. Age, gender, and accompanying diseases of the participants were recorded and compared with the healthy subjects.Results:Eighty patients with pemphigus, 62 patients with pemphigoid, and 217 healthy subjects were included in the study. The pemphigoid group had a statistically significant higher prevalence of hypertension, diabetes mellitus, coronary artery diseases, cataract, malignancy, dementia, Alzheimer’s disease, Parkinson’s disease, and cerebrovascular events relative to the pemphigus and control groups (p<0.01, p<0.01, p=0.001, p<0.01, p=0.02, p=0.008, p=0.001, p=0.001, and p<0.01, respectively). The prevalence of asthma, benign prostatic hyperplasia, and cataract was higher in the pemphigus group than in the controls (p=0.02, p=0.04, and p=0.02, respectively).Conclusion:To the best of our knowledge, this is the first study comparing accompanying diseases between controls and patients with pemphigus and pemphigoid. It is disputable whether the diseases mentioned occur due to some common pathophysiological pathways or coexist just coincidentally. We believe that it is important to evaluate accompanying diseases in patients with ABD.

Are Symptoms Sufficient in the Decision to Start Antibiotics in Tonsillopharyngitis?

Objectives:Unnecessary use of antibiotics is one of the causes of antibiotic resistance. Rapid Antigen Test (RAT) is recommended to prevent unnecessary use of antibiotics by providing bacteria/virus isolation in patients with tonsillopharyngitis. However, in patients with typical symptoms, false-negative test results may lead to doubt in doctors. In this study, we aimed to evaluate the relationship between patients’ symptoms and RAT results.Methods:In this study, we chose the patients that referred to the University of Health Sciences (SBÜ) Şişli Hamidiye Etfal Training and Research Hospital Family Medicine Polyclinics and got a diagnosis of tonsillopharyngitis with RAT. This study was conducted by a retrospective file scanning method. We examined the age, sex, symptoms, RAT results and throat culture results of the patients. SPSS 15.0 for Windows program was used for the statistical analysis. The level of statistical significance was accepted as p<0.05.Results:In this study, the RAT of 265 patients and the throat culture of 141 patients were examined. We found RAT positivity as 28.7%, Group A Beta Hemolytic Streptococcus (AGBHS) detection rate in throat culture was 22.5%, and the antibiotic prescription rate was 37%. There were 32 patients with AGBHS positivity in throat culture. Twenty-seven of them got RAT positivity, too. When symptoms and RAT positivity were examined, there was no significant relationship between RAT positivity and fever higher than 38 oC, but RAT was more often positive in patients with a fever higher than 38 oC. On the other hand, there is a statistically significant relationship between RAT positivity and the presence of tonsillar exudate (p=0.000). When the relationship between symptoms and RAT according to age groups was examined, the presence of LAP and tonsillitis were significant (p=0.000; p=0.001). In the age group of 18 years and over, the presence of tonsillar exudates was significant (p=0.001).Conclusion:In our study, tonsillar exudate was a common symptom in both age groups of <18, and ≥18 years of age; at the same time, there is a statistically significant relation with RAT. Tonsillar exudates are not seen only in bacterial infections but also in viral infections. Thus, we think that antibiotics should not be started based on symptoms, and RAT should be used effectively.

Benign soft tissue tumors of the hand: A retrospective review of 17-year experience

Objective: Tumors of the hand are common and mostly benign. Benign soft tissue tumors of the hand can arise from the skin, tendons, vessels, nerve and subcutaneous tissue. Tumors can be removed by surgical excision for cosmetic reasons and a possibility of malignancy. The objective of this retrospective study was to evaluate the types of benign soft tissue tumors of the hand in comparison to the literature. Materials and Methods: We conducted a retrospective review of all surgically excised benign soft tissue tumors of the hand at the University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital between March 2000 and October 2017. A total of 426 patients (208 males and 218 females) were included in this study. The mean age was 39.4 years (range, 4-61 years). 426 patients were evaluated according to their ages, genders, anatomic location and histopathology of tumors and their treatment modalities. Results: The most common benign tumor of the hand was pyogenic granuloma (25%). The other diagnosed benign tumors of the hand with the decreasing percentage were ganglion cysts (15%), giant cell tumors of the tendon sheaths (GCTTS) (15%), other hand tumors (13%), hemangiomas (8%), neurinomas and schwannomas (6%), fibromas and fibrolipomas (5%), epidermal cysts (3%), glomus tumors (2%) and arteriovenous malformations (2%). Conclusion: A comprehensive history and detailed physical examination performed by specialists are essential in the diagnosis of the tumor. The vast majority of hand tumors are benign, and if a tumor of the hand is suspected, a biopsy should be performed before definitive treatment.