Objective: Prolonged jaundice is a common reason for neonatal outpatient visits and is usually benign; however, it may occasionally indicate underlying pathological, treatable conditions. This study aimed to evaluate the etiological and clinical characteristics of term newborns presenting with prolonged jaundice. Material and Methods: In this single-center retrospective study, 150 term newborns diagnosed with prolonged jaundice were included between March 2022 and September 2022. Demographic and clinical data were recorded, and laboratory results were evaluated to determine potential underlying causes. All data were analyzed statistically. Results: Among 150 newborns, 54.7% (n=82) were male. The mean gestational age and birth weight were 38.7±1.2 weeks and 3229±396 g, respectively. Late-onset breast milk jaundice was the most common etiology (57.3%), followed by urinary tract infection (22.7%), ABO/Rh incompatibility (14%), sepsis (3.3%), glucose-6-phosphate dehydrogenase deficiency (2%), and congenital hypothyroidism (0.7%). While 46% of the infants presented with jaundice, additional symptoms such as poor feeding (33%), vomiting (11%), and restlessness (5%) were observed in the remainder of the cohort. No significant differences were observed in demographic or laboratory parameters between infants with late-onset breast milk jaundice and those with pathological causes. Conclusion: Late-onset breast milk jaundice is the leading cause of prolonged jaundice in term newborns. Nevertheless, a systematic clinical and laboratory evaluation is warranted in all infants with prolonged jaundice to exclude underlying pathological conditions, even in the absence of additional symptoms. Breastfeeding should be continued during evaluation and follow-up, considering the unique and well-established benefits of breast milk.
Objective: This study aimed to evaluate the clinical spectrum, treatment characteristics, and outcomes of therapeutic apheresis (TA) procedures performed at a tertiary care university hospital, with particular emphasis on thrombotic thrombocytopenic purpura (TTP). Material and Methods: In this retrospective cohort study, 303 patients who underwent 2,289 apheresis procedures between 2010 and 2015 were evaluated. Patients were categorized according to the primary procedure performed: therapeutic plasma exchange [(TPE); n=110], therapeutic cytapheresis (n=85), and peripheral blood stem cell collection [(PBSC); n=59]. The remaining 49 patients underwent other apheresis procedures. PBSC cases were excluded from treatment-response analyses. TTP was diagnosed clinically on the basis of thrombocytopenia and microangiopathic haemolytic anaemia, with or without organ involvement, after exclusion of other thrombotic microangiopathies; ADAMTS13 activity testing was not routinely available during the study period. Results: Haematological diseases were the most common indication for apheresis (n=190, 62.7%). TPE was performed in 110 patients, including 22 (20.0%) with TTP. Among 244 patients eligible for outcome analysis, response status could be clearly classified for 218 patients: 144 (59.0%) had a complete response, 17 (7.0%) had a partial response, and 57 (23.4%) had no response. The mean number of apheresis sessions per patient was 7.5±3.9. In the TTP subgroup, 17 of 22 patients (77.2%) achieved a clinical response; 7 (31.8%) relapsed during follow-up, and 4 (18.2%) died from refractory disease or underlying critical illness. Procedure-related complications were infrequent; 209 patients (69.0%) had no complications. No deaths were directly attributed to the apheresis procedure. Conclusion: TA was widely used across multiple disciplines and showed an acceptable safety profile in our centre. Haematological disorders, particularly TTP and acute leukaemia, constituted the largest indication group. These findings support the continued role of TPE in routine clinical practice and emergency settings, while highlighting the need for contemporary prospective studies that incorporate ADAMTS13-guided evaluation and assess newer agents such as caplacizumab.
Acute pancreatitis associated with severe hypertriglyceridemia, especially when it develops in the context of familial hyperlipidemia and chylomicronemia syndrome, is characterized by rapid clinical deterioration, a necrotizing course, and multiple organ dysfunction. Therapeutic plasma exchange (TPE) may be considered a treatment option in severe cases due to its rapid triglyceride (TG)-lowering effect. In our patient, TG levels above 2000 mg/dL, together with necrotizing pancreatitis, metabolic acidosis, and acute kidney injury, indicated rapid clinical deterioration. The observed reduction in TG levels and the clinical improvement in this patient suggest that TPE could be considered in selected severe cases. Early use of TPE in intensive care settings may be an option in selected cases; however, further studies are required.
Objective: To evaluate the relationship between quantitative muscle ultrasound parameters of the abductor pollicis brevis (APB) and disease severity in carpal tunnel syndrome (CTS). Material and Methods: This cross-sectional, comparative clinical study included 76 patients. Participants were stratified into four electromyography (EMG)-based categories (EMG-normal, mild, moderate, and severe CTS). In the transverse ultrasound images of the APB, we measured cross sectional area and thickness of the muscle. Differences in muscle thickness, cross-sectional area (CSA), and pinch strength among four groups were analyzed. Results: The CSA of the APB muscle decreases with increasing disease severity. Thickness and pinch strength are significantly decreased in severe CTS. There is a significant negative correlation between the CSA of the APB muscle and the distal motor latency of the median nerve. Conclusion: Quantitative ultrasound parameters of the APB muscle are useful for evaluating disease severity in CTS.
Objective: To determine the diagnostic efficiency of using an event recorder (ER) in evaluating paroxysmal symptoms such as palpitations, syncope, and chest pain in children and to compare it with 24-hour rhythm Holter monitoring. Material and Methods: The study included 61 pediatric patients who presented with paroxysmal symptoms and could not be diagnosed using standard tests. Patients’ demographic data, clinical complaints, 24-hour Holter recordings, and ER records were analyzed retrospectively. Results: The most common reason for admission was palpitations (57.4%). The most common rhythm finding detected by the ER was sinus tachycardia, identified in 28 patients (73.7%) during symptomatic episodes. Pathological arrhythmias were detected in 10 cases: ventricular extrasystoles (n=8), including uniform and bigeminal patterns and supraventricular tachycardia (n=2). Notably, while supraventricular extrasystoles were detected in two patients on 24-hour Holter monitoring, these findings were absent from the symptomatic recordings obtained with the ER. Gender, age, and the presence of structural heart disease had no statistically significant effect on the success of the ER (p>0.05). Conclusion: ERs offer significantly higher diagnostic success than 24-hour Holter monitoring in the diagnosis of infrequent rhythm disorders in children. Given their effectiveness in establishing symptom-rhythm correlation and promoting patient compliance, they should be considered a priority option for evaluating symptoms that cannot be explained by conventional methods.
Objective: Peripartum/postpartum hysterectomy is a rare but life-saving intervention for uncontrolled obstetric hemorrhage. Placenta accreta spectrum (PAS) and uterine atony are the most common indications; yet their clinical context and operative pathways may differ, particularly in centers where PAS is managed under urgent or emergent conditions. We evaluated indications, surgical management, and outcomes over a 10-year period and explored differences between uterine atony–related and PAS-related cases. Material and Methods: This retrospective, single-center study included women who underwent peripartum or postpartum hysterectomy for uncontrolled obstetric hemorrhage between January 2015 and June 2025. Cases were classified as uterine atony or PAS/placenta previa–related hemorrhage based on operative findings, clinical course, and pathology. Continuous variables were summarized as median [interquartile range (IQR)] and compared using the Mann–Whitney U test; categorical variables were compared using Fisher’s exact test. Effect estimates with 95% confidence intervals (bootstrap for continuous variables) are provided in the tables; comparisons were exploratory. Results: Among 31,571 deliveries, 34 hemorrhage-related peripartum/postpartum hysterectomies were identified (incidence: 1.1 per 1,000 deliveries): 18 for uterine atony (52.9%) and 16 for PAS-related hemorrhage (47.1%). All PAS cases met an a priori definition of urgent or emergent. Transfusion requirements were higher in the uterine atony group than in the PAS group, with median packed red blood cells (PRBCs) of 4 (3-6) vs. 2 (0.8-3.2) units (p=0.003), and median fresh frozen plasma of 2 (2-4) vs. 1 (0-2.2) units (p=0.020). Intensive care unit (ICU) admission occurred in 66.7% of uterine atony cases and in 43.8% of PAS cases (p=0.300). Overall ICU length of stay (including 0.0 days for non-admitted patients) was 1.0 (0.0–2.0) days vs. 0.0 (0.0–1.0) days (p=0.048). Median hospital stay was 6.5 (5.0–11.0) vs. 5.5 (4.0-7.0) days (p=0.265). One maternal death occurred in the uterine atony group; none occurred in the PAS group. Conclusion: Hemorrhage-related peripartum/postpartum hysterectomy was rare but associated with substantial maternal morbidity. PAS cases were managed predominantly in urgent or emergent conditions. Exploratory comparisons suggested a greater transfusion burden and longer ICU stays among uterine atony cases, underscoring institutional preparedness, timely escalation, and multidisciplinary hemorrhage management.
Objective:This study aimed to evaluate the clinical, microbiological, and sociodemographic characteristics of patients diagnosed with cellulitis and to identify risk factors associated with the development of recurrence. Material and Methods: This retrospective, single-center observational study included 120 adult patients (aged ≥18 years) treated for cellulitis as inpatients or outpatients over a one-year period. Demographic, clinical, and laboratory data were extracted from electronic medical records. Predisposing factors, infection sites, treatment characteristics, and variables associated with recurrence were evaluated. Recurrence was defined as a history of at least two episodes of lower extremity cellulitis. Univariable and multivariable logistic regression analyses were performed to identify factors associated with recurrence. Statistical significance was set at a p value <0.05. Results: Among the 120 patients diagnosed with cellulitis, the mean age was 56.4±15.7 years; 51% were male. The most commonly affected site was the lower extremity (91%). Although all patients presented with edema and erythema, increased local temperature (96%) and pain (80%) were also frequent findings, whereas fever was less common (15%). The most prevalent predisposing factors were tinea pedis (64.2%), obesity (56.7%), and onychomycosis (47.5%). The recurrence rate was 36.7%. Statistically significant associations were found between recurrence and advanced age, lymphedema, peripheral arterial disease, higher body mass index (BMI), and living alone or being homeless (p<0.05). In multivariable logistic regression analysis, living alone or being homeless [odds ratio (OR): 6.27, 95% confidence interval (CI): 1.36-28.87, p=0.018], older age (OR: 1.03 per year, 95% CI: 1.001-1.06, p=0.045), and the presence of lymphedema (OR: 3.08, 95% CI: 1.17-8.14, p=0.023) were independently associated with recurrence, while BMI showed a borderline association (OR: 1.06, 95% CI: 0.99-1.14, p=0.084). Additionally, C-reactive protein levels were positively correlated with duration of antibiotic treatment and length of hospital stay. Conclusion: The findings suggest that cellulitis recurrence is closely associated not only with the treatment of the acute infection but also with the comprehensive management of underlying chronic conditions. In particular, controlling modifiable risk factors such as lymphedema, peripheral arterial disease, and higher BMI may play a crucial role in reducing recurrence rates. These results highlight the importance of risk-based and individualized approaches in clinical management.
Objective: To assess the clinical and laboratory effects of prophylactic enoxaparin use after vaginal delivery on bleeding, wound complications, and hematological parameters. Material and Methods: This retrospective cohort study included 36 postpartum women who received enoxaparin prophylaxis for deep vein thrombosis and 95 who did not; all delivered at 37-41 weeks of gestation. Maternal demographic characteristics, delivery-related data, bleeding- and wound-related complications, as well as hemoglobin, hematocrit, and platelet counts before delivery, at 6 hours postpartum, and on the 10th postpartum day were retrieved from the hospital database. Changes in laboratory values between 6 hours and 10 days postpartum were calculated. All variables were compared between the enoxaparin and non-enoxaparin groups. Results: Women who received enoxaparin were older, had higher body mass index and greater parity, and had significantly lower episiotomy rates (p<0.001), compared with those who did not receive enoxaparin. No significant differences were observed between the groups in rates of labor induction or in bleeding- or wound-related complications. The differences in hemoglobin (1.90±0.67 vs. 1.57±0.67 g/dL, p=0.115), hematocrit (6.84±2.40 vs. 5.76±2.21%, p=0.127), and platelet counts (113.94±62.70 vs. 125.10±70.89×103/µL, p=0.592) between the 10th day and 6 hours postpartum were also not significantly different between groups. Conclusion: Prophylactic enoxaparin use after vaginal delivery was not associated with significant adverse effects on bleeding, wound complications, hemoglobin, hematocrit, or platelet counts. Risk-based enoxaparin prophylaxis appears safe and feasible for women after vaginal delivery. Our findings need to be confirmed by large-scale prospective studies.
Sudden cardiac death (SCD) in children and adolescents participating in sports, although rare, represents a devastating event with significant clinical and social implications. Preparticipation cardiac screening has been proposed as a preventive strategy to identify individuals at risk before they develop life-threatening arrhythmias or cardiac arrest during exercise. Current evidence demonstrates that the leading causes of SCD in young athletes include hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, anomalous coronary arteries, myocarditis, and inherited channelopathies. International guidelines provide divergent recommendations regarding screening strategies. The American Heart Association and the American College of Cardiology advocate a focused history and physical examination without the routine use of electrocardiography (ECG), whereas the European Society of Cardiology endorses the inclusion of a standard 12-lead ECG. More recent consensus statements, such as those from the International Olympic Committee and Fédération Internationale de Football Association, aim to harmonize approaches across countries. While ECG has been shown to increase sensitivity for detecting silent cardiac conditions, concerns remain about false positives, limited specificity, cost-effectiveness, and the need for experienced interpretation. Emerging strategies, including advanced imaging modalities, genetic testing in selected populations, and artificial intelligence-assisted ECG analysis, may enhance risk stratification in the future. This review summarizes the current evidence, highlights key controversies, and discusses future perspectives on preparticipation cardiac screening in children and adolescents involved in sports.
