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Prevention of microbial colonization of feeding tubes in the intensive care unit
No full textBackground Various microorganisms which increase the mortality rate in the intensive care unit (ICU) cause microbial colonization of the nasogastric tube (NGT) and use the NGT as a reservoir. Aim To detect the colonization on the NGT and to determine the effect that training regarding hand hygiene, NGT management, and enteral feeding (EF) provided to ICU nurses and auxiliary service staff (ASS) has on the level of NGT colonization. Methods A quasi-experimental pre-test and post-test control design was used in this study. Microbial samples were taken from the outer and inner parts of NGT. The microorganisms were categorized as: group 1, no risk; group 2, low risk pathogenic; group 3, high-risk pathogenic group. The training was given to nurses (n = 15) and ASS (n = 7). Hand hygiene, NGT, and EF care training are provided to nurses and ASS by researchers. A total of three training sessions were scheduled to be held in 3 weeks so that all health care staff members were trained. Each session lasted 2 h in total. Patients were assigned to a group if one of the microorganisms presented on the outer surface of the patient's feeding tube and/or on the hub. The hand hygiene compliance was evaluated by direct observation according to the World Health Organization hand hygiene indications. Results The study was conducted with 46 patients. Evaluating the patients for the presence of microorganisms before education revealed that 4.3% were in group 1, 21.8% were in group 2, and 73.9% were in group 3. After the education, evaluating the samples for the presence of microorganisms revealed that 39.1% were in group 1, 13% were in group 2, and 47.8% were in group 3. A statistically significant difference was found between the number of samples included in the groups after the participants had received training (H = 8.186; p = .017). Conclusions An NGT could act as a reservoir of microbial colonization and high-risk microorganisms could be on the tube. Providing training not only to nurses but also to ASS will help reduce the risk of colonization. Relevance to Clinical Practice Eliminating such colonization with effective hand hygiene during NGT feeding is a cost-effective method. Providing training not only to nurses but also to ASS will help obtain the optimum benefit from patient care.Turkish Society of Clinical Enteral & Parenteral Nutrition [7]Turkish Society of Clinical Enteral & Parenteral Nutrition, Grant/Award Number: Grant number:
Prostat Kanserinin Saptanması ve Derecelendirilmesinde Voksel İçi Tutarsız Hareket (IVIM) Parametrelerinin Tanısal Değeri
No full textAmaç Voksel içi tutarsız hareket (IVIM) parametrelerinin, prostat kanseri (PK) ile normal prostat dokusu ve benign prostat lezyonlarından ayırmadaki başarısını ve PK’yi dere- celendirmedeki yararını saptamak. Yöntem ve Gereçler Bu metodolojik araştırmaya 1,5 T cihaz kullanılarak prostata yönelik yapılan çok parametreli manyetik rezonans görüntüleme (Mp-MRG)’si ve doku tanısı olan toplam 68 hasta (21 prostatit, 19 benign prostat hiperplazisi, 27 PK) dahil edildi. Rutin Mp-MRG’ye, 0 ile 1200 s/mm2 arasında değişen 15 farklı b değeri içeren IVIM sekansı eklendi. Tüm b değerlerinden yapılan ölçümler baz alınarak; görünür difüzyon katsayısı (ADC), gerçek difüzyon katsayısı (D), kan akışıyla ilişkili yalancı difüzyon katsayısı (D*) ve perfüzyon fraksiyonu (f) parametreleri elde edildi. Kolmogorov-Smirnov testine göre tüm veriler normal dağılım göstermekte idi. Bu parametrelerin prostat lezyonlarını saptamadaki ve PK derecelendirmesindeki farklılıkları t testi ile analiz edildi, PK derecesi ile korelasyonu Pearson korelasyon testi ile saptandı. Parametrelerin tanısal performansını değerlendirmek için ROC analizi yapıldı. IVIM sekansının Mp-MRG’ye ek katkısının araştırılması amaçlı lineer diskriminant analizi (LDA) kullanıldı. Bulgular ADC, D, D* ve f parametrelerinin rutin Mp-MRG’ye eklenmesi ile duyarlılık, özgüllük ve doğruluk oranları sırası ile %87, %92 ve %90’dan %92, %95 ve %94’e yükseldi. Bu dört parametre de PK ile sağlıklı prostat dokusunu ayırmada faydalı idi (her biri için p<0,0001). ADC ve D parametreleri PK’yi benign lezyonlardan ayırt etmede başarılı iken (ikisi için de p<0,0001); D* ve f parametreleri başarısız idi (sırasıyla p=0,603 ve p=0,454). ADC, D, D* ve f parametrelerinin düşük ve orta/yüksek dereceli PK’yi ayırmadaki yararı istatiksel olarak anlamlı bulunmadı (sırasıyla p=0,314; p=0,413; p=0,619 ve p=0,628). Sonuç IVIM parametrelerinin PK’yi normal dokudan ayırmada başarılı olduğu ve rutin Mp-MRG’ye ek katkı sunduğu görülmüştür
Robotic vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting a median of 7-year long-term oncological and functional outcomes
No full textAim of this study was to compare operative, long-term oncological and functional outcomes of laparoscopic (LISR) and robotic (RISR) intersphincteric resection in low-lying rectal cancer. Retrospective analysis of prospectively maintained database was performed. 115 cases (LISR, n = 55; RISR, n = 60) were performed by a single surgeon (January 2011-January 2020). Clinical characteristics did not differ between the groups. Operating time was longer in RISR (160.0 +/- 45.7 vs. 205.0 +/- 36.5 min, p = 0.035). There was no conversion in RISR, whereas in LISR, two patients (3.6%) converted to open surgery. Complete mesorectum was 61.8% and 83.3% for LISR and RISR (p = 0.046), respectively. Circumferential radial margin involvement was 10.9% and 8.3% in LISR and RISR (p = 0.365), respectively. Median follow-up was 82.8 (30-138) months for LISR and 83.6 (30-138) months for RISR. Three-, five-, and seven-year overall survival rates (OS) for LISR and RISR were: 88.6%, 80.4%, 73.4% and 90.4%, 86.3%, 76.9%, respectively. Three-, five-, and seven-year disease-free survival (DFS) rates for LISR and RISR were 80.5%, 75.2%, 70.4% and 84.4%, 81.4%, 79.8% (p = 0.328), respectively. Three-, five-, and seven-year local recurrence-free survival rates in LISR and RISR were: 96.1%, 92.6%, 88.4% and 96.7%, 94.2%, 90.4% (p = 0.573), respectively. Mean Wexner score for LISR (n = 32) and RISR (n = 40) was: 10.5 +/- 4.7 and 9.8 +/- 4.2 (p = 0.782), respectively. Colostomy-free survival in LISR and RISR was: 3 years 94.5%/95.2%, 5 years 89.1%/91.7%, and 7 years 83.6%/85.0%. RISR is associated with better mesorectal integrity, no conversion, and lower postoperative complication rate. RISR has longer operation time. Oncological and anorectal functional outcomes are similar in both groups
Effects of demographic and clinical character on differences in self-care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approach
No full textIntroduction Hemodialysis (HD) patients should be trained to develop self-care behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. Methods A cross-sectional study was conducted involving 89 patients. Results Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. Conclusion Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well
Warfarin is associated with the risk of vascular calcification in abdominal aorta in hemodialysis patients: a multicenter case-control study
No full textBackground/aim: Vascular calcifications (VCs), recognized risk factor for increased mortality, are highly prevalent in hemodialysis (HD) patients. We aimed to investigate the relation between VC and warfarin use with plain radiography. Materials and methods: VCs were assessed using Adragao (radial and digital) and Kauppila (aortic) scores in 76 HD patients from six centers. Out of a total 711 HD patients, there were 32 (4.5%) who had been treated with warfarin for at least 1 year, and we included 44 control patients. Results: Of the patients, 47% were females, the mean age was 66 ± 9 years, 23% were diabetics, the mean dialysis vintage was 68 ± 38 months. In warfarin group, median Kauppila score was higher than in control group [11 vs 6.5, (25%–75% percentile, 5 vs. 15), p = 0.032] and the percentage of the patients with a Kauppila score of >6 was higher, as well (76.6% vs. 50%; p = 0.029). Median Adragao score was not significantly different between the two groups [7 vs. 6, (%25,%75 percentile 6 vs. 8), p = 0.17]. Logistic regression analysis revealed that warfarin treatment was independently associated with Kauppila scores of >6 (OR 3.60, 95% CI 1.18–10.9, p = 0.024). Conclusion: In this study, we found that warfarin is associated to vascular calcifications, especially in aorta of HD patients.Key words: Hemodialysis, vascular calcification, vitamin K, warfari
G-protein Coupled Estrogen Receptor Expression in Growth Hormone Secreting and Non-Functioning Adenomas
No full textPurpose To evaluate the expression of G-protein coupled estrogen receptor (GPER1), aromatase, estrogen receptor α (ERα), estrogen receptor β (ERβ), pituitary tumor transforming gene (PTTG), and fibroblast growth factor 2 (FGF2) in GH-secreting and non-functioning adenomas (NFA). Methods Thirty patients with acromegaly and 27 patients with NFA were included. Gene expression was determined via quantitative reverse transcription polymerase chain reaction (QRT-PCR). Protein expression was determined via immunohistochemistry. Results There was no difference, in terms of gene expression of aromatase, ERα, PTTG, and FGF2 between the two groups (p>0.05 for all). ERβ gene expression was higher and GPER1 gene expression was lower in GH-secreting adenomas than NFAs (p0.05 for all). GPER1 gene expression was positively correlated to ERα, ERβ, PTTG, and FGF2 gene expression (p<0.05 for all). There was a positive correlation between aromatase and GPER1 protein expression (r=0.31; p=0.04). Conclusions GPER1 is expressed at both gene and protein level in a substantial portion of GH-secreting adenomas and NFAs. The finding of a positive correlation between GPER1 and ERα, ERβ, PTTG, and FGF2 gene expression and aromatase and GPER1 protein expression suggests GPER1 along with aromatase and classical ERs might mediate the effects of estrogen through upregulation of PTTG and FGF2. © 2020. Thieme. All rights reserved.Istanbul Üniversitesi: 46991The study was supported by the Research Fund of the Istanbul University, Istanbul, Turkey, project number 46991
Do Immunohistochemical Studies Have a Role in Predicting Prognosis of Laryngeal Squamous Cell Carcinomas? CD44 and Fascin Experience
No full textBackground and objectives: The diagnosis of laryngeal squamous cell carcinoma (LSCC) can be made easily based on histopathological findings, but the relationship between morphological findings and prognosis is not clear. In addition to morphological findings, the use of novel markers may contribute to the development of new treatment strategies and improved patient prognosis. CD44, which is a cancer stem cell marker, and Fascin-1, an actin-binding protein has been associated with poor prognosis in many tumors. The aim of this study was to investigate the relationship between CD44 and Fascin-1 expression and clin-icopathologic parameters in LSCC and their roles in the determination of clinical behavior and prognosis. The aim of this study is to investigate whether CD44 and Fascin have a relationship with clinicopathological parameters and have a role in determining clinical behavior and prognosis in LSCC. Methods: 130 patients who were operated in our hospital for LSCC between 2012 and 2018 were included in this study. Fascin-1 and CD44 stains were applied immunohistochemically to the paraffin blocks of the tumors. Immunostained specimens were scored according to the intensity of staining and the percentage of staining for each marker. Overall scores were summed and was designated as immunoreactivity score (IRS). Finally, IRS was catego-rized into two groups; Low and High CD44/Fascin IRS. Results: There were no statistically significant differences between low and high CD44 and Fascin IRS groups in terms of clinicopathologic parameters, overall and disease-free survival (p> 0.05). Conclusion: Immunhistochemical studies are not yet sufficient to predict patient prognosis. Morphological findings still remain of priority and importance for pathologists. (www .actabiomedica.it). © Mattioli 1885
The Status of Iron Stores in the Women with Beta Thalassemia Minor
No full textObjective: Patients with beta-thalassemia minor are often exposed to unnecessary iron replacement therapies due to hypochrome microcytic change in erythrocyte morphology. However, in these patients, ineffective erythropoiesis may increase iron absorption in the intestines and excessive iron accumulation in the body. In this study, retrospectively, we aimed to show the iron storage status in our patients with beta-thalassemia minor with both biochemical parameters and bone marrow examinations. Methods: Fifteen beta-thalassemia minor patients, who underwent bone marrow aspiration and biopsy for any reason in our hospital but had no additional diagnosis except thalassemia, were detected from the hospital records. Their related laboratory values were examined retrospectively. The pathological materials were reevaluated for erythroblast, and sideroblast. Results: The median age was 43 [interqurtile range (IQR): 27- 54] years and the median ferritin values was 24 (IQR: 14.1-84.8) ng/mL. The ferritin values was 15 ng/mL in four cases. Sideroblast values were under the normal limit in all but one case. The median sideroblast value was 6% (IQR: 1.5-15.0%). Transferrin saturation was less than 20% in only one case. There was a moderate positive correlation between ferritin and sideroblast (r=+0.598; p=0.032) while there was not any positive or negative significant correlation between other parameters. Conclusion: In this study, where iron storage status was examined both biochemically and histopathologically, 66% of cases with iron deficiency could have been overlooked if the iron status of the patients was evaluated only by the serum iron panel. The examination of bone marrow aspiration with prussian blue is a gold standard method for determining iron storage status
In Vivo Assessment of the Effect of Hexagonal Boron Nitride Nanoparticles on Biochemical, Histopathological, Oxidant and Antioxidant Status
No full textThe aim of our study is to investigate the dose-dependent biological system effect of hexagonal boron nitride (hBN) nanoparticles, which is directly produced nanoscale, in vivo. Wistar albino rats (n = 80) weighing 200–250 g were divided into eight groups (n = 10). The acute effects of hBN NPs (i.v) on the rats were investigated by measuring the biochemical, hematological parameters and oxidant-antioxidant status. The results show that no significant change was observed in the hematological and biochemical parameters when the control group and other low dose groups were compared, except for the 1600 and 3200 µg/kg b.w. dose groups. Histological detection indicated that 1600 and 3200 µg/kg hBN NPs treatment could induce significant damage in the liver, kidney, heart, spleen and pancreas. With the findings obtained, it can be seen that hBN NPs cannot be evaluated independently of particle morphology, and that the hBN NPs used in this study may be suitable for biomedical applications where low doses between 50 and 800 µg/kg are not toxic. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.19ADP163; Eskişehir Teknik Üniversitesi, ESTÜThis study was supported by Eskişehir Technical University Scientific Research Projects Commission. (Project No: 19ADP163). The authors would like to thank BORTEK Boron Technologies and Mechatronic Inc. for their material support and Dr. Umut SAVACI for his help to use Transmission Electron Microscopy (TEM) (Eskisehir Technical University, Turkey).This study was supported by Eskişehir Technical University Scientific Research Projects Commission. (Project No: 19ADP163). The authors would like to thank BORTEK Boron Technologies and Mechatronic Inc. for their material support and Dr. Umut SAVACI for his help to use Transmission Electron Microscopy (TEM) (Eskisehir Technical University, Turkey)
Oligometastatic Bone Disease in Castration-Sensitive Prostate Cancer Patients Treated With Stereotactic Body Radiotherapy Using Ga-68-PSMA PET/CT TROD 09-004 Study
No full textSELEK, UGUR/0000-0001-8087-3140; Zoto Mustafayev, Teuta/0000-0001-6029-1995PubMed: 33661210WOS:000651397900015Purpose To evaluate the outcomes of metastasis-directed treatment (MDT) using stereotactic body radiotherapy (SBRT) for bone-only oligometastasis (OM) detected with gallium prostate-specific membrane antigen (Ga-68-PSMA) PET/CT in castration-sensitive prostate cancer (PC) patients. Methods In this multi-institutional study, clinical data of 74 PC patients with 153 bone lesions who were undergoing MDT were retrospectively evaluated. Twenty-seven patients (36.5%) had synchronous, and 47 (63.5%) had metachronous OM. All patients had PC with 5 metastases or fewer detected by Ga-68-PSMA PET/CT and treated using SBRT with a median dose of 20 Gy. The prognostic factors for PC-specific survival (PCSS) and progression-free survival (PFS) were analyzed. Results The median follow-up was 27.3 months. Patients with synchronous OM were older and received higher rates of androgen deprivation therapy after SBRT compared with patients with metachronous OM. The 2-year PCSS and PFS rates were 92.0% and 72.0%, respectively. A prostate-specific antigen (PSA) decline was observed in 56 patients (75.7%), and 48 (64.9%) had a PSA response defined as at least 25% decrease of PSA after MDT. The 2-year local control rate per lesion was 95.4%. In multivariate analysis, single OM and PSA response after MDT were significant predictors for better PCSS and PFS. In-field recurrence was observed in 4 patients (6.5%) with 10 lesions at a median of 13.1 months after MDT completion. No serious late toxicity was observed. Conclusions We demonstrated that SBRT is an efficient and well-tolerated treatment option for PC patients with 5 bone-only oligometastases or fewer detected with Ga-68-PSMA PET/CT