Morphometric Evaluation of Thoracic Vertebrae Using Multidetector Computed Tomography in Patients with Scoliosis

Aims:Many people have congenital and acquired deformities associated with the vertebral column. Vertebral surgery is practiced in cases like scoliosis, traffic accidents, falling down from height, cancer, and disc hernia. We aimed to reduce morbidity and mortality by creating alternative predictions for surgery and treatment with the findings and results we obtained in our study in patients with scoliosis. Methods: Patients with scoliosis (eight male, eight female) who underwent thoracic vertebrae imaging by multidetector computed tomography at Selcuk University Faculty of Medicine between 2013 and 2017 and who were not operated and those without scoliosis (eight male and nine female) who underwent imaging for other reasons were retrospectively evaluated. The group aged >15 years was created in a similar way. Similarly, groups with thoracic X-ray and tomography were created; Cobb angles and the width, height, and distance between the dorsal tips of the transverse process were measured in the 12 thoracic vertebrae. Lateral distances from the midline junction of the right lamina of vertebra to the lateral of the right transverse process and pedicle of vertebra junction were measured; measurements were repeated for the left side and recorded. Measurements were made in 780 thoracic vertebrae. Results: Mean Cobb angle of 8 in 10–14-year-old male patients with thoracic scoliosis was 30.9° and mean age was 13 years. Mean Cobb angle of 8 in 10–14-year-old female patients with thoracic scoliosis was 32.72° and mean age was 12.75 years. Conclusion: Our results will be useful for manufacturers and surgeons in terms of producing personalized screws and plaques

Trakeal bronkus: Bir olgu sunumu

Trakeal bronkus, trakeadan kaynaklanan sağ bronchus lobaris superior olup, ilk olarak 1785’te tanımlanmıştır. Genelde karinanın sağ üst tarafında, sağ akciğerin üst lobunun segmentum apicale’sini havalandıran nadir görülen konjenital bir anomalidir ve üç tipi vardır. Bir yıldır öksürük ve nefes darlığı şikayeti olan 41 yaşındaki erkek hastanın çekilen kontrastlı aksiyal ve koronal reformat toraks bilgisayarlı tomografisinin incelenmesi sonucunda sağ akciğerindeki bronchus lobaris superior’unun karina üstünden ayrıldığı görülmüştür. Tekrarlayan akciğer enfeksiyonu olan hastalarda ve özellikle Down sendromu olmak üzere konjenital kalp hastalıkları, aspleni sendromu ve kosta anomalileri gibi ek anomalisi olan vakalarda olası trakeobronşial anomaliler akılda tutulmalıdır. Bu hastalara uygulanan yanlış endotrakeal entübasyonun, atelektazi ve pnömotoraks gibi komplikasyonlara neden olabileceği düşünülmelidir. Bunun yanı sıra anestezi öncesi bilgisayarlı tomografi ile anatomik yapının değerlendirilmesi varyasyonların tanımlanması açısından önemlidi

Effects of 3D Bone Models on Anatomy Education: Student Survey

Background/Aims: Anatomy education is of great importance in evaluating the human body as a whole and understanding the normal functioning of organs and systems. Knowledge of human anatomy plays a critical role in the diagnosis of diseases, surgical interventions, evaluation of the health status of patients, and interpretation of the results of advanced imaging techniques. This study aims to evaluate the satisfaction of learning anatomy with the three-dimensional virtual anatomy atlas we developed and to investigate the effect of virtual three-dimensional applications on learning compared to traditional materials.Methods: The 3D applied atlas we developed was sent to the Faculty of Medicine term 1-2, Dentistry term 1, and Physiotherapy and Rehabilitation term 1 students. Students were asked to use the 3D applied atlas in addition to traditional medical education materials in their anatomy learning process. A 9-question Google Forms survey was prepared to evaluate their satisfaction of the application.Results: 471 participants from the Faculty of Dentistry, Medicine Term 1-2, and Physiotherapy Rehabilitation classes participated in our survey. Of the participants, 140 were Faculty of Dentistry students, 70 were Physical Therapy and Rehabilitation (PTR), 172 were Faculty of Medicine 1st Term and 89 were Faculty of Medicine 2nd Term. The number of students who found two-dimensional atlases useful was 198, while the number of students who found 3D models useful was 231. The number of students who found the cadaver model useful was 161.Conclusions: Based on the survey data we obtained, we can say that the students are satisfied with our 3D atlas application and have a positive attitude towards three-dimensional educational materials

Picturing asthma in Turkey: results from the Turkish adult asthma registry

Introduction: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. Methods: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. Results: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3–5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. Conclusion: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery

Familial Mediterranean fever (FMF) in Turkey: results of a nationwide multicenter study

Familial Mediterranean fever (FMF) is an autosomal recessive disease that is prevalent among eastern Mediterranean populations, mainly non-Ashkenazi Jews, Armenians, Turks, and Arabs. Since a large proportion of all the FMF patients in the world live in Turkey, the Turkish FMF Study Group (FMF-TR) was founded to develop a patient registry database and analyze demographic, clinical, and genetic features. The cohort was composed of 2838 patients (mean age, 23.0 +/- 13.33 yr; range, 2-87 yr), with a male:female ratio of 1.2:1. There was a mean period of 6.9 +/- 7.65 years from disease onset to diagnosis; the period was about 2 years shorter for each decade since 1981. Ninety-four percent of patients were living in the central-western parts of the country; however, their familial origins (70% from the central-eastern and Black Sea regions) reflected not only the ongoing east to west migration, but also the historical roots of FMF in Turkey. Patients' clinical features included peritonitis (93.7%), fever (92.5%), arthritis (47.4%), pleuritis (31.2%), myalgia (39.6%), and erysipelas-like erythema (20.9%). Arthritis, arthralgia, myalgia, and erysipelas-like erythema were significantly more frequent (p < 0.001) among patients with disease onset before the age of 18 years. Genetic analysis of 1090 patients revealed that M694V was the most frequent mutation (51.4%), followed by M680I (14.4%) and V726A (8.6%). Patients with the M694V/M694V genotype were found to have an earlier age of onset and higher frequencies of arthritis and arthralgia compared with the other groups (both p < 0.001). In contrast to other reported studies, there was no correlation between amyloidosis and M694V homozygosity in this cohort. However, amyloidosis was still remarkably frequent in our patients (12.9%), and it was prevalent (27.8%) even among the 18 patients with a disease onset after age 40 years. Twenty-two patients (0.8%) had nonamyloid glomerular diseases. The high prevalence of vasculitides (0.9% for polyarteritis nodosa and 2.7% for Henoch-Schonlein purpura) and high frequency of pericarditis (1.4%) were striking findings in the cohort. Phenotype II cases (those patients with amyloidosis as the presenting or only manifestation of disease) were rare (0.3% or less). There was a high rate of a past diagnosis of acute rheumatic fever, which suggested a possible misdiagnosis in children with FMF presenting with recurrent arthritis. To our knowledge, this is the largest series of patients with FMF reported from 1 country. We describe the features of the disease in the Turkish population and show that amyloidosis is still a substantial problem

Characteristics of asthma in an older adult population according to sex and control level: why are asthma symptoms in older women not well-controlled?

ObjectiveThe older adult population in Turkey has increased by 22.6% in the last 5 years, and the characteristics of such patients with asthma remain uninvestigated. Therefore, we aimed to evaluate the characteristics of older adults with asthma according to sex and asthma control status to provide an in-depth overview of asthma in this population in Turkey.MethodsThe data of older adults (age 65 years and over) with asthma were obtained from a multicenter, cross-sectional asthma database registry (Turkish Adult Asthma Registry, TAAR) funded by the Turkish Thoracic Society. Comparisons were made based on sex and asthma control levels using the Global Initiative for Asthma (GINA) Asthma Symptom Control Questionnaire.ResultsOf the 2053 (11.5%) patients registered with the TAAR, 227 were older adults (median age, 69 (8), women, 75.8% (n = 172)). Of these, 46.5% (n = 101) had obesity to some degree. Compared with men, women had lower education, income levels, and employment rates. Additionally, women exhibited a higher prevalence of obesity, hypertension, and thyroid gland disease than men. Being female (OR: 2.99; 95% CI: 1.307-6.880), the presence of gastroesophageal reflux disease (OR: 2.855; 95% CI: 1.330-6.130), and a predicted forced expiratory volume in the first-second value lower than 80% (OR: 2.938; 95% CI: 1.451-5.948) were associated with poorly controlled asthma.ConclusionsHerein, older adults comprised 11.5% of adult patients with asthma. Being female poses a disadvantage in terms of both asthma prevalence and control in the older adult asthmatic population owing to the prevalence of comorbidities and socioeconomic sex-related distinguishing factors

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research