Medical Bulletin of Sisli Etfal Hospital最新文献

{"title":"The Burden of Stigma in Type 2 Diabetes: Evidence from a Rural Primary Care Sample in Türkiye.","authors":"Murat Gezer, Zeliha Yelda Ozer, Yusuf Kemal Arslan, Servet Yuce, Cagla Okyar","doi":"10.14744/SEMB.2026.18784","DOIUrl":"https://doi.org/10.14744/SEMB.2026.18784","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the presence of diabetes-related stigma and its relationship with disease control and family functioning among adults with type 2 diabetes mellitus (T2DM) living in rural Türkiye. A cross-sectional study was conducted between March and May 2025 at a Family Health Center (FHC). A total of 201 adults with physician-diagnosed T2DM participated in the study.</p><p><strong>Methods: </strong>Data were collected through face-to-face interviews using a sociodemographic questionnaire, the Diabetes Stigma Assessment Scale-2 (DSAS-2), and the Family APGAR scale, which assesses family functioning. Statistical analyses included correlation tests, group comparisons, and logistic regression to identify independent predictors of stigma.</p><p><strong>Results: </strong>The mean total DSAS-2 score was 39.4±9.2, indicating a moderate level of perceived stigma. Higher stigma scores were associated with very low income, polypharmacy, and the presence of comorbid chronic diseases (p<0.05). A positive correlation was found between the number of children and both the \"Treated Differently\" and \"Self-Stigma\" subdimensions of the DSAS-2 (r=0.202 and r=0.216, respectively). Family APGAR scores were generally high (mean=8.9±2.0), but no significant association was observed between family functioning and stigma levels. Logistic regression analysis showed that medication use was independently associated with higher stigma (OR: 2.48; 95% CI: 1.23-4.98; p=0.011), whereas moderate income was associated with lower stigma (OR: 0.165; 95% CI: 0.048-0.567; p=0.004).</p><p><strong>Conclusion: </strong>Diabetes-related stigma remains a notable psychosocial challenge for adults with T2DM in rural settings. Socioeconomic disadvantage, comorbidity, and family burden contribute to the internalization of stigma, whereas family support alone may not mitigate its effects. Addressing stigma within primary care through culturally tailored psychoeducation and empowerment programs may enhance both emotional well-being and disease management in rural populations.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"352-359"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult Recurrent Wilms' Tumor Presenting as a Large Mass: A Case Report and Current Literature Review.","authors":"Cagri Sevik, Osman Can, Abdullah Zilan, Onuralp Nisli, Akif Erbin, Halil Lutfi Canat","doi":"10.14744/SEMB.2025.34466","DOIUrl":"https://doi.org/10.14744/SEMB.2025.34466","url":null,"abstract":"<p><p>Wilms tumor (WT) is the most common renal malignancy in children but can be challenging to diagnose in adults because its clinical and imaging features often mimic those of renal cell carcinoma (RCC). Most diagnoses are made incidentally following nephrectomy performed for suspected RCC. Due to the lack of established adult-specific treatment guidelines, management typically follows pediatric protocols. This report presents the case of a 26-year-old woman who presented with abdominal pain, weight loss, and fatigue. Imaging revealed a large, irregular mass in the left kidney, which was confirmed as WT after nephrectomy. She underwent radical nephrectomy followed by adjuvant chemotherapy, including doxorubicin, vincristine, and actinomycin D. After two years of follow-up, recurrence was detected, leading to a second surgery followed by radiotherapy. This case highlights the diagnostic and therapeutic challenges associated with adult WT and emphasizes the need for individualized treatment strategies tailored to each patient.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"417-420"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Emergency Tube Thoracostomy: Complications and Independent Risk Factors in a Five-Year Cohort.","authors":"Mehmet Necmeddin Sutasir, Ahmet Bas, Emir Zyanbekovich Zhanybekov, Fatma Sarac","doi":"10.14744/SEMB.2026.10734","DOIUrl":"https://doi.org/10.14744/SEMB.2026.10734","url":null,"abstract":"<p><strong>Objectives: </strong>Tube thoracostomy is a frequently performed emergency procedure in pediatric patients; however, complication patterns and risk stratification in emergency settings remain incompletely defined. This study aimed to evaluate 30-day complication rates and identify independent predictors of adverse outcomes in pediatric patients undergoing tube thoracostomy in emergency settings.</p><p><strong>Methods: </strong>This retrospective observational cohort study included 451 consecutive pediatric patients (0-18 years) who underwent tube thoracostomy between June 2020 and June 2025 at a tertiary referral center. Emergency settings included procedures performed in the Emergency Department (ED), Pediatric Intensive Care Unit (PICU), or urgent perioperative settings. The primary outcome was 30-day procedure-related complications. Variables with p<0.10 in univariate analysis were entered into a multivariate logistic regression model to determine independent predictors. Model calibration and discrimination were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>The overall 30-day complication rate was 21.3% (96/451). More than half of the procedures were performed in the ED (53.9%). Complication rates were highest in children younger than 6 years (38.2%, p=0.001) and in those with traumatic presentations (36.0% vs. 19.5%, p=0.04). General anesthesia was associated with higher complication rates compared with local anesthesia with or without sedation (34.5% vs. 13.4%, p<0.001). Multivariate analysis identified age <6 years (adjusted OR: 2.42, 95% CI: 1.38-4.24), traumatic etiology (adjusted OR: 1.86, 95% CI: 1.02-3.39), and general anesthesia (adjusted OR: 2.18, 95% CI: 1.34-3.54) as independent predictors. Procedure location was not independently associated with complications. Model discrimination was acceptable (AUC: 0.71).</p><p><strong>Conclusion: </strong>In pediatric emergency tube thoracostomy, younger age, traumatic presentation, and the use of general anesthesia are independently associated with 30-day complications. Comparable complication rates across the ED and other emergency settings support the safety of emergency department-based tube thoracostomy when performed by trained providers. These findings may guide risk stratification and clinical decision-making in pediatric emergency medicine.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"329-337"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphea Triggered by COVID-19 Vaccination.","authors":"Aysegul Oz, Birgul Ozkesici Kurt, Onur Sivaz, Pinar Ozdemir Cetinkaya, Asli Aksu, Deniz Tuncel, Ilknur Kivanc Altunay","doi":"10.14744/SEMB.2026.70104","DOIUrl":"https://doi.org/10.14744/SEMB.2026.70104","url":null,"abstract":"<p><p>Since the onset of the COVID-19 pandemic in 2019, various vaccines have been developed to control its spread. Initially, conventional inactivated virus vaccines, such as CoronaVac (Sinovac), were introduced, followed by more advanced mRNA-based vaccines, such as BNT162b2 (Pfizer-BioNTech). COVID-19 vaccines have been associated with several adverse effects, particularly dermatological manifestations. Morphea, also known as localized scleroderma, is an inflammatory and sclerosing skin disease that leads to sclerosis and loss of skin elasticity. Genetic and environmental factors, along with immune dysregulation, are thought to play a role in its pathogenesis. We report a case of morphea in a 72-year-old woman who developed localized skin lesions at the vaccination site following CoronaVac administration. To the best of our knowledge, this is the first reported case of morphea potentially triggered by CoronaVac.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"424-427"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"Comparative Analysis of Girls With Slowly Progressive Central Precocious Puberty vs. Rapidly Progressive Central Precocious Puberty: Single-Center Experience\".","authors":"Emre Aygun","doi":"10.14744/SEMB.2026.62357","DOIUrl":"https://doi.org/10.14744/SEMB.2026.62357","url":null,"abstract":"","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"433-434"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency of Celiac Disease in a Cross-Sectional, JIA-Predominant Cohort of Children with Rheumatologic Diseases.","authors":"Ozlem Kalaycik Sengul, Eda Nur Dizman, Ilke Aktas, Ezgi Dilan Sencan, Elif Kucuk, Fatih Haslak, Kubra Ozturk, Sebahat Cam","doi":"10.14744/SEMB.2026.23169","DOIUrl":"https://doi.org/10.14744/SEMB.2026.23169","url":null,"abstract":"<p><strong>Objectives: </strong>Celiac disease (CD) is an immune-mediated disorder that may present with gastrointestinal or extraintestinal manifestations or remain asymptomatic. Although an increased prevalence has been reported in some autoimmune diseases, data regarding CD frequency in pediatric rheumatologic diseases are limited, and routine screening remains controversial. This study aimed to evaluate the frequency of CD among children with rheumatologic diseases and the necessity of routine serological screening.</p><p><strong>Methods: </strong>This cross-sectional study included 94 children with rheumatologic diseases who underwent systematic CD screening between January 2020 and November 2023. Screening was performed using anti-tissue transglutaminase immunoglobulin A and endomysial antibody tests regardless of symptoms. Patients with positive serology underwent upper gastrointestinal endoscopy and intestinal biopsy. The prevalence of biopsy-confirmed celiac disease was calculated with 95% confidence intervals.</p><p><strong>Results: </strong>The median age was 171 months (Q1-Q3: 124.25-192.25), and 55.3% were female. Juvenile idiopathic arthritis (JIA) was the most common diagnosis (88.3%). Serological positivity suggestive of CD was detected in two patients (2.1%), both of whom were diagnosed with JIA. Biopsy-confirmed CD was identified in one patient, corresponding to a prevalence of 1.06% (95% confidence interval: 0.03-5.79), which was not significantly different from the prevalence reported in Turkish school children (two-proportion z-test, p=0.553). Both patients who underwent endoscopy had normal growth parameters and no classical gastrointestinal symptoms.</p><p><strong>Conclusion: </strong>The prevalence of CD in children with rheumatologic diseases was low and similar to that of the general pediatric population. Routine screening for CD in asymptomatic patients with rheumatologic diseases may not be necessary, and a more individualized, risk-based approach may be more appropriate.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"399-404"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Our Experience with the Use of a Pneumatic Kerrison Rongeur in Spinal Surgery: A Retrospective Study.","authors":"Okan Kahyaoglu, Kivanc Yangi, S Meltem Can, Halit Cavusoglu, Ahmet Murat Musluman, Ismail Yuce, Adem Yılmaz, Yunus Aydin","doi":"10.14744/SEMB.2026.66809","DOIUrl":"https://doi.org/10.14744/SEMB.2026.66809","url":null,"abstract":"<p><strong>Objectives: </strong>The Pneumatic Kerrison Rongeur (PKR) was introduced to overcome challenges associated with classical Kerrison Rongeurs (KRs), such as surgeon fatigue, limited dexterity, and potential tissue damage. This study aimed to evaluate the efficacy and advantages of the PKR in neurosurgical procedures compared with the classical KR.</p><p><strong>Methods: </strong>Surgical outcomes, including operation time, blood loss, incision length, and postoperative pain scores, were assessed in groups using the PKR versus the classical KR.</p><p><strong>Results: </strong>Surgeries performed using the PKR were associated with shorter operation times, reduced blood loss, and shorter incision lengths. No significant difference was found in preoperative or postoperative pain scores between the two groups. However, changes in Visual Analog Scale (VAS) scores on the first postoperative day were significant in both groups. Notably, the PKR provides enhanced dexterity, allowing surgeons to use both hands regardless of hand dominance. This increased flexibility may account for the shorter incision lengths observed. Despite its benefits, hesitancy to adopt the PKR in certain regions was observed, primarily due to concerns about uncontrolled biting and potential neural injury.</p><p><strong>Conclusion: </strong>The Pneumatic Kerrison Rongeur offers distinct advantages over the classical KR, particularly in reducing operation time, blood loss, and incision size. These improvements may potentially reduce risks and complications, especially in elderly patients undergoing bilateral microdecompression for spinal canal stenosis.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"313-318"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locking Plate Fixation versus Nonoperative Management in Patients Aged ≥65 Years with Proximal Humerus Fractures: Clinical and Functional Outcomes from a Retrospective Cohort Study.","authors":"Bahadir Balkanli, Enver Ipek, Yusuf Altuntas, Mehmet Ali Bozca, Burhan Kaan Erkan, Osman Tugrul Eren","doi":"10.14744/SEMB.2026.05926","DOIUrl":"https://doi.org/10.14744/SEMB.2026.05926","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare the clinical and functional outcomes of geriatric patients (≥65 years) with proximal humerus fractures treated with locking plate fixation or nonoperative management and to identify factors associated with the development of complications. We hypothesized that fracture pattern, rather than treatment modality alone, would be more strongly associated with functional outcomes and complication risk in this population.</p><p><strong>Methods: </strong>Patients aged 65 years and older who were treated for proximal humerus fractures were included in this retrospective cohort study. Patients were divided into two groups according to treatment modality: surgical treatment with locking plate fixation and nonoperative management. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Oxford Shoulder Score (OSS). To explore factors associated with functional outcomes and complications, multivariable linear and logistic regression models were constructed.</p><p><strong>Results: </strong>No significant differences were observed between the groups in demographic characteristics, fracture side, or mechanism of injury (p>0.05). There were no statistically significant differences between the surgical and nonoperative treatment groups in VAS or DASH scores (p>0.05). Although unadjusted Oxford Shoulder Scores did not differ significantly between the groups (28.4±10.1 vs. 24.7±11.1; p=0.09), multivariable analysis identified nonoperative management as independently associated with lower Oxford Shoulder Scores after adjustment for confounders, with the surgical group serving as the reference category (β=-6.85; 95% CI: -11.15 to -2.55; p=0.002). In multivariable analysis, Neer fracture classification was independently associated with worse DASH scores (β=6.33; p=0.008). Additionally, Neer classification was identified as an independent risk factor for complication development, with odds ratios increasing with fracture complexity: 3-part vs. 2-part (OR 5.95; 95% CI 1.02-34.78; p=0.048), 4-part vs. 2-part (OR 12.98; 95% CI 2.19-76.86; p=0.005), and displaced 4-part vs. 2-part (OR 33.28; 95% CI 3.47-318.97; p=0.002). Treatment modality was not independently associated with complication development.</p><p><strong>Conclusion: </strong>In patients aged 65 years and older, no significant difference in functional outcomes between surgical and nonoperative treatment of proximal humerus fractures was observed in this cohort. Fracture pattern appeared to be more strongly associated with functional outcomes and complication risk than treatment modality. Neer classification should be considered when determining the appropriate treatment strategy. Treatment decisions should primarily be based on fracture characteristics together with the patient's overall clinical condition.</p>","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"295-303"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author's Reply.","authors":"Mehmet Kostek, Mehmet Uludag","doi":"10.14744/SEMB.2026.84429","DOIUrl":"https://doi.org/10.14744/SEMB.2026.84429","url":null,"abstract":"","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"430"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound Risk Stratification Systems and SUVmax in PET-Positive Thyroid Incidentalomas: Competing or Complementary Tools?","authors":"Yusuf Ozturk","doi":"10.14744/SEMB.2026.99825","DOIUrl":"https://doi.org/10.14744/SEMB.2026.99825","url":null,"abstract":"","PeriodicalId":42218,"journal":{"name":"Medical Bulletin of Sisli Etfal Hospital","volume":"60 3","pages":"428-429"},"PeriodicalIF":1.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}