Balkan Medical JournalPub Date : 2025-01-02Epub Date: 2024-11-22DOI: 10.4274/balkanmedj.galenos.2024.2024-7-144
Fevziye Çoksüer, Gökçen Kartal Öztürk, Handan Duman Şenol, Meral Barlık, Mehmet Mustafa Özaslan, Bahar Girgin Dindar, Ece Ocak, Ece Halis, Şükrü Atacan Öğütcü, Figen Gülen, Esen Demir
{"title":"Newborn Screening Program for Cystic Fibrosis in Türkiye: Experiences from False-Negative Tests and Requirement for Optimization","authors":"Fevziye Çoksüer, Gökçen Kartal Öztürk, Handan Duman Şenol, Meral Barlık, Mehmet Mustafa Özaslan, Bahar Girgin Dindar, Ece Ocak, Ece Halis, Şükrü Atacan Öğütcü, Figen Gülen, Esen Demir","doi":"10.4274/balkanmedj.galenos.2024.2024-7-144","DOIUrl":"10.4274/balkanmedj.galenos.2024.2024-7-144","url":null,"abstract":"<p><strong>Background: </strong>Since January 2015, the Cystic Fibrosis National Newborn Bloodspot Screening (CF-NBS) program has been implemented in Türkiye with two samples of immune reactive trypsinogen (IRT-1/IRT-2) testing.</p><p><strong>Aims: </strong>To evaluate the Turkish national CF screening program, which included patients referred to a tertiary pediatric pulmonology center, to ascertain the optimal cut-off values for IRT-1/IRT-2 and to identify alternative strategies for mitigating the number of late-diagnosed false-negative patients (FNPs) who initially exhibited screen negative results but were diagnosed subsequently based on clinical suspicion. The study also compared NBS-positive patients to FNPs to determine the influence of delayed diagnosis.</p><p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Methods: </strong>Screening for CF was conducted in accordance with the national CF-NBS program within 48-72 hours of birth by collecting a few drops of heel blood on Guthrie paper. A cut-off value of 90 μg/l was accepted for the first IRT, while 70 μg/l was accepted for the second sample. Infants with elevated IRT values in both samples were referred to the CF centers for a sweat test (ST). Based on the diagnosis, the NBS-positive infants referred to our CF center for ST analysis were divided into three groups: CF; cystic fibrosis-related metabolic syndrome/cystic fibrosis screen positive, inconclusive diagnosis (CRMS/CFSPID); and false-positive NBS. In addition, the study included NBS-negative patients who initially received negative screen results but were subsequently diagnosed with CF based on clinical suspicion.</p><p><strong>Results: </strong>Of the 227 NBS-positive infants referred within the study period, 53 (23.34%) were diagnosed with CF (true-positive NBS), 11 were classified as CRMS/CFSPID (4.84%), and 163 were classified as false-positive NBS (71.8%). CF was diagnosed in 66 infants, 53 (80.3%) of whom were confirmed using the NBS test, while the 13 (19.7%) patients who were missed on the NBS test were diagnosed based on clinical suspicion (FNP). The study findings indicate that the IRT/IRT approach exhibited a sensitivity of 80.3% and a positive predictive value (PPV) of 23.3%.</p><p><strong>Conclusion: </strong>The current study is the first to analyze the NBS program for CF using data from the Western Anatolian Region of Türkiye. Due to the low sensitivity and PPV of the IRT/IRT protocol and the high proportion of false-positive infants and FNPs, the current national program is not practicable for Türkiye. False-negative results significantly delay the diagnosis and invalidate the screening objectives. It is essential to establish optimal cut-off values for IRT-1/IRT-2 or revise existing strategies to reduce the number of FNPs missed by the screening program.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"45-53"},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Balkan Medical JournalPub Date : 2025-01-02DOI: 10.4274/balkanmedj.galenos.2024.2024-5-125
Tuğba Kemaloğlu Öz, Luigi P Badano
{"title":"Unlocking the Potential of Three-Dimensional Echocardiography for Diagnosing Pulmonary Valve Diseases.","authors":"Tuğba Kemaloğlu Öz, Luigi P Badano","doi":"10.4274/balkanmedj.galenos.2024.2024-5-125","DOIUrl":"10.4274/balkanmedj.galenos.2024.2024-5-125","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":"42 1","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Balkan Medical JournalPub Date : 2025-01-02DOI: 10.4274/balkanmedj.galenos.2024.2024-9-3.response
Çağlar Kaya, Kenan Yalta
{"title":"In response to \"Constrictive Pericarditis Associated with COVID-19 or Vaccination\".","authors":"Çağlar Kaya, Kenan Yalta","doi":"10.4274/balkanmedj.galenos.2024.2024-9-3.response","DOIUrl":"10.4274/balkanmedj.galenos.2024.2024-9-3.response","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":"42 1","pages":"89"},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Balkan Medical JournalPub Date : 2025-01-02DOI: 10.4274/balkanmedj.galenos.2024.2024-8-122
Gianluca Mondillo, Vittoria Frattolillo, Simone Colosimo, Alessandra Perrotta
{"title":"Artificial Intelligence in Pediatric Nail Diseases: Limitations and Prospects.","authors":"Gianluca Mondillo, Vittoria Frattolillo, Simone Colosimo, Alessandra Perrotta","doi":"10.4274/balkanmedj.galenos.2024.2024-8-122","DOIUrl":"10.4274/balkanmedj.galenos.2024.2024-8-122","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":"42 1","pages":"86"},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Balkan Medical JournalPub Date : 2025-01-02DOI: 10.4274/balkanmedj.galenos.2024.2024-8-7
Dandan Ye, Wei Jiang, Deming Gu
{"title":"Association Between Platelet-Albumin-Bilirubin Grade and the 30-Day Mortality in Patients with Acute Respiratory Distress Syndrome: Evidence from the MIMIC-IV Database.","authors":"Dandan Ye, Wei Jiang, Deming Gu","doi":"10.4274/balkanmedj.galenos.2024.2024-8-7","DOIUrl":"10.4274/balkanmedj.galenos.2024.2024-8-7","url":null,"abstract":"<p><strong>Background: </strong>The platelet-albumin-bilirubin (PALBI) grade is a comprehensive assessment index of liver function. Liver dysfunction is a key determinant of the pathogenesis and resolution of acute respiratory distress syndrome (ARDS), which affects the prognosis of patients.</p><p><strong>Aims: </strong>To evaluate the association of PALBI grade with the risk of 30-day mortality in patients with ARDS.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Univariate and multivariate Cox proportional hazards models were used to evaluate the association between PALBI grade and the 30-day mortality in patients with ARDS; results were described as hazard ratios (HRs) and 95% confidence intervals (CIs). This association was further assessed by subgroup analyses stratified based on age, sex, and complications.</p><p><strong>Results: </strong>A total of 2,841 patients with ARDS were included, of whom, 703 (24.74%) died within 30 days. After adjusting all covariates, a higher PALBI grade was associated with higher odds of 30-day mortality (HR: 1.55, 95% CI: 1.05-2.29). High PALBI grade was related to higher odds of 30-day mortality in patients with ARDS aged ≥ 65 years (HR: 2.30, 95% CI: 1.06-5.01), males (HR: 2.10, 95% CI: 1.29-3.44), without sepsis (HR: 1.71, 95% CI: 1.11-2.64), without pneumonia (HR: 1.86, 95% CI: 1.19-2.91), and without any history of chronic obstructive pulmonary disease (HR: 1.93, 95% CI: 1.28-2.91).</p><p><strong>Conclusion: </strong>The PALBI grade was positively associated with 30-day mortality in patients with ARDS. The present study provides a reference for risk stratification management of patients with ARDS to improve short-term prognosis.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":"42 1","pages":"66-74"},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Balkan Medical JournalPub Date : 2025-01-02DOI: 10.4274/balkanmedj.galenos.2024.2024-111224
Gözde Aktürk, Özgür Gündüz
{"title":"Transdermal Drug Delivery: An Overview of the Evolving Field.","authors":"Gözde Aktürk, Özgür Gündüz","doi":"10.4274/balkanmedj.galenos.2024.2024-111224","DOIUrl":"10.4274/balkanmedj.galenos.2024.2024-111224","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":"42 1","pages":"3-4"},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Autoinflammatory Bone Diseases.","authors":"Fatih Haşlak, Nergis Akay, Ümit Gül, Aybüke Günalp, Elif Kılıç Könte, Sezgin Şahin, Özgür Kasapçopur","doi":"10.4274/balkanmedj.galenos.2024.2024-11-129","DOIUrl":"10.4274/balkanmedj.galenos.2024.2024-11-129","url":null,"abstract":"<p><p>Autoinflammatory bone diseases (AIBDs) constitute a recently identified subset of autoinflammatory diseases. These conditions are characterized by an exaggerated inflammatory response in the bones without any apparent etiology. Inflammatory bone lesions associated with AIBDs exhibit chronic inflammation, are typically culture-negative, and do not exhibit discernible microorganisms on histopathological examination. The most common and representative AIBD is chronic non-bacterial osteomyelitis (CNO), which is also known as chronic recurrent multifocal osteomyelitis. Another variant of CNO, which is typically observed in older teenagers or adults, is known as synovitis, acne, hyperostosis, pustulosis, osteitis syndrome. This condition is distinguished by its notable skin manifestations. Advancements in genetic research have led to the identification of three novel monogenic subtypes within the category of AIBDs. These include Majeed syndrome, pyogenic arthritis, pyoderma gangrenosum, and acne syndrome, and interleukin-1 receptor antagonist deficiency syndrome. Another monogenic AIBD, called cherubism, affects only the maxilla and mandible. Data on the diagnosis and treatment of these rare diseases are extremely limited. However, if not diagnosed and treated promptly, it can result in significant complications, including severe disability and mortality. Thus, it is imperative to maintain a high level of clinical awareness of these diseases. These rare diagnoses should be considered in patients with musculoskeletal complaints in whom no specific etiology can be identified or in patients with systemic manifestations such as cutaneous and gastrointestinal symptoms or fever. In such patients, the diagnostic process, which encompasses imaging and genetic studies, should be initiated promptly.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":"42 1","pages":"5-13"},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}