Elvan ONAN, Özgür SÜRMELİOĞLU, Muhammed DAĞKIRAN, Çağlar EKER, Süleyman ÖZDEMİR, Özgür TARKAN, Sümbül BAYRAKTAR, Mete KIROĞLU

Akut invaziv fungal rinosinüzit tanılı diabetes mellitus hastalarında tedavi ve prognozu etkileyen faktörler

Giriş: Akut invaziv fungal rinosinüzit (AİFRS) çoğunlukla diabetik ve immün sistemi baskılanmış hastalarda görülen; yüksek morbidite ve mortalite oranına sahip ciddi bir hastalıktır. Gereç ve Yöntemler: Bu çalışmada Çukurova Üniversitesi Tıp Fakültesi Kulak Burun Boğaz Hastalıkları Anabilim Dalında Ocak 2010- Ocak 2020 tarihleri arasında AİFRS tanısı ile takip ve tedavi edilen on yedi diabetik hastayı medikal kayıtlardan retrospektif olarak incelendi. Hastaların demografik özellikleri, risk faktörleri, başvuru şikayetleri, tanı yaşları, fungal sinüzitin yaygınlığı, yapılan operasyon, ameliyat öncesi muayene ve lezyon yaygınlığı, prognozu etkileyen faktörler ve uygulanan tedaviler değerlendirilmiştir. Sonuçlar: Hastaların yaş ortalaması 52 idi. Hastaların %47’si (n:8) kadın, %53’ü (n:9) erkekti. Tüm hastalar diabetikti, 2 hastada ek olarak kronik böbrek hastalığı, 1 hastada ise kronik karaciğer hastalığı mevcuttu. En sık semptom yüzde şişlik ve ağrı (%58,8), periorbital ödem (%41,1) ve ateşti (%35,2). Hastaların 12 sine endoskopik sinüs cerrahisi, 5 ine açık ve endoskopik sinüs cerrahisi, 4 hastaya ise orbita ekzenterasyonu uygulanmıştır. Hayatta kalma oranı %53’dü. Serebral tutulumun, yüksek HbA1c seviyesinin, ileri evre sinonazal tutulumun kötü prognostik faktör olduğu görülmüştür. Karar: Akut invaziv fungal rinosinüzit, cerrahi ve medikal tedaviye rağmen hala yüksek mortaliteye sahip bir hastalıktır. Diabete bağlı immunsupresyon nedeniyle, bu hastalarda gözlenen her türlü sinonazal semptom ve bulgu klinisyenlerde invaziv fungal rinosinüzit için şüphe uyandırmalıdır. ABSTRACT İntroduction: Acute invasive fungal rhinosinusitis (AIFRS) which is a serious disease with a high morbidity and mortality rate is mostly seen in diabetic and immunocompromised patients. Material and Methods: In this study, seventeen diabetic patients who were treated for AIFRS in Çukurova University Faculty of Medicine, Department of Otorhinolaryngology between January 2010 and January 2020 were retrospectively analyzed from medical records.Demographic characteristics, risk factors, complaints at presentation, age at diagnosis, localization of fungal sinusitis, operation type, preoperative examination and lesion extensity, factors affecting prognosis and treatments of the patients were evaluated. Results: The mean age of the patients was 52 years. 47% (n:8) of the patients were female and 53% (n:9) were male. All patients were diabetic, 2 patients had additional chronic renal disease and 1 patient had chronic liver disease. The most common presenting symptoms of patients with AIFS were facial swelling and pain (58.8%), periorbital edema (41,1%) and fever (35.2%) We performed endoscopic sinus surgery in 12 patients, open and endoscopic sinus surgery in 5 patients and orbital exenteration in 4 patients.The overall survival rate was 53%. Intracranial extension, high HbA1c level and advanced sinonasal involvement were found to be poor prognostic factors. Conclusion: Acute invasive fungal rhinosinusitis is still a disease with high mortality despite surgical and medical treatment. Because of diabetes-related immunosuppression, when any sinonasal symptoms and signs observed in these patients, clinicians should raise suspicion for invasive fungal rhinosinusitis.

Anahtar Kelimeler:

Fungal sinüzit, mukor, diabetes mellitus

Does the Internet Provide Enough Information About Sepsis for the General Public

Purpose: To determine the quality and reliability of the information about sepsis on the internet. Material methods: The quality and reliability of the information on the websites accessed through the most frequently searched words about sepsis were evaluated with the JAMA Benchmark Criteria and the DISCERN scoring system. Data accuracy was compared with the Surviving Sepsis Campaign guidelines. Results: The search terms used resulted most frequently (36,5%) in information from private hospitals. Only 4 of the 63 sites related to sepsis search terms met all 4 JAMA criteria. The JAMA Benchmark score was found to be median 21.18 (min:0- max:4). Of the sites, 74,6% showed an update date. Only 31.7% of the sites examined had expert or author information. The mean DISCERN score was calculated as 368.51 (min 16-max 59). According to these results, the quality and reliability of internet-sourced information on sepsis was poor. Discussion: The provision of health information on the internet, mostly by private hospitals, may lead to ethical problems. Missing or erroneous information may delay medical treatment, whereas good quality medical information can be effective in reducing unnecessary medical expenses and hospital admissions. Conclusion: The quality and reliability of information about sepsis and related search terms on the Internet were low. It was concluded that public instutions and academic institutions should play a more active role in providing patients with accurate information.

Keywords:

Sepsis internet, information reliability, Discern score,

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