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Subclinical biventricular systolic dysfunction in patients with systemic sclerosis
No full textWOS: 000463722800006PubMed ID: 31365343Objective: Silent myocardial involvement is associated with poor prognosis in patients with systemic sclerosis (SSc). Here we aimed to evaluate the subclinical left ventricular (LV) and right ventricular (RV) systolic dysfunction in patients with SSc without any cardiovascular diseases, by using both strain imaging methods, speckle tracking echocardiography (STE) and real-time 3D echocardiography (RT3DE). Methods: A total of 47 patients with SSc and 20 age- and gender-matched healthy controls (HC) were studied. Conventional echocardiography, STE-based strain imaging, and real-time 3D echocardiography (Bothell, WA, USA) were performed to assess the biventricular deformation. Clinical and serological findings were sought. Results: Conventional echocardiographic LV measurements were similar between SSc and HC. Both the LV and RV longitudinal peak systolic strain/strain rates were significantly impaired in SSc, demonstrating subclinical LV and RV systolic dysfunction (p <= 0.001). Systolic pulmonary artery pressure (SPAP) was negatively correlated with both the LV and RV longitudinal peak systolic strain/strain rates (LV, r=-0.554 and r=-0.642, respectively, p<0.001; and RV, r=-0.554 and r=-0.642, respectively, p=0.001). There was a trend for decreasing LV strain and increasing LEVSV in a 1-year analysis of patients with SSc. Conclusion: SSc is associated with myocardial systolic dysfunction. A deformation scrutiny conducted by both the STE-based strain imaging and end-systolic LV volume analysis by real-time 3D echocardiography are promising modalities that allow us for non-invasive, comprehensive investigation of subtle deterioration in the biventricular systolic function of patients with SSc
Patient satisfaction with the quality of nursing care
No full textWOS: 000461835600033PubMed ID: 30918704Aim To evaluate patients' satisfaction with the quality of nursing care and examine associated factors. Design A cross-sectional, descriptive survey study. Methods The sample was composed of 635 patients discharged from a private hospital. Data were collected using "Patient Satisfaction with Nursing Care Quality Questionnaire" with a total of 19 items, and a questionnaire designed to record socio-demographic characteristics and medical histories between January 1-May 31, 2015. Results Patients were more satisfied with the "Concern and Caring by Nurses" and less satisfied with the "Information You Were Given." Patients (63.9%) described nursing care offered during hospitalization as excellent. Patients who were 18-35 years old, married, college or university graduates, treated at the surgery and obstetrics-gynaecology units, and patients who stated their health as excellent and hospitalized once or at least five times were more satisfied with the nursing care. According to this study, the nurses needed to show greater amount of interest to the information-giving process
Pulmonary artery banding and venous bidirectional cava-pulmonary shunt for two-stage arterial switch procedure in late referral of patients with transposition of the great arteries and intact ventricular septum: Midterm results
No full textPubMed ID: 31230611Objective: Two-stage arterial switch operation and left ventricle retraining are necessary for the patients with left ventricle dysfunction and transposition of great vessels with intact ventricular septum (TGA-IVS) who are referred late.Material and methods: Forty-seven patients with the diagnosis of TGA-IVS and left ventricle dysfunction who underwent arterial switch operation in our centre between July 2013 and August 2017 were analysed retrospectively. The inclusion criteria for left ventricle retraining were patients older than 2 months of age at presentation, having an echocardiographic left ventricle mass index of less than 35 g/m, and having an echocardiographic banana-shaped left ventricle geometric appearance. The patients were divided into two groups: pulmonary artery banding and Blalock Taussig shunt were performed as the initial surgical procedure for later arterial switch operation in Group I (n = 19) and pulmonary artery banding and bidirectional cava-pulmonary shunt in Group 2 (n = 28).Results: The average age was found to be 122.3 ± 45.6 days in Group I and 145.9 ± 37.2 days in Group II. There was no statistically significant difference (p = 0.232 versus p = 0.373) between the average left ventricle mass index of the two groups neither before the first stage nor the second stage (26.6 ± 4.8 g/m versus 25.0 ± 4.9 g/m and 70.5 ± 12 g/m versus 673.8 ± 12.0 g/m, respectively). The average time interval for the left ventricle to retrain was 97.7 ± 42.9 days for Group I and 117.3 ± 40.3 days for Group II, significantly lower in Group I (p = 0.027). The time spent in ICU, length of the period during which inotropic support was required, and the duration of hospital stay were significantly higher in Group I (p<0.001, p < 0.001, and p < 0.00, respectively).Conclusion: Pulmonary artery banding and bidirectional cava-pulmonary shunt can be performed as a safe and effective alternative to pulmonary artery banding and arterial Blalock Taussig shunt for patients with TGA-IVS in whom arterial switch operation is needed beyond the neonatal period. This approach involves a shorter hospital stay and fewer post-operative complications. © Cambridge University Press 2019.
The Impact of Affective State on Quality of Life in Focal Epilepsy in Turkey
No full textWOS: 000462821600018PubMed ID: 31001016Context: Seizures and accompanying situations including social, medical, and psychiatric problems threaten the quality of life (QOL) in patients with epilepsy. The World Health Organization defines health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Aims: This study examines the prevalence of both depression and anxiety symptoms and also impact of the affective state on QOL in patients with focal epilepsy in Turkey. Settings and Design: One hundred and five patients with focal epilepsy over 18 years old were included in this study. The patients were classified into four groups according to the presence of AS and seizure control. Subjects and Methods: Patients' affective symptoms (AS) and QOL were examined using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and QOL in Epilepsy Inventory-31 (QOLIE-31). Statistical Analysis Used: We used descriptive statistics, Chi-square test, independent samples t-test, one-way analysis of variance, Mann-Whitney U-test, Kruskal-Wallis H-test, and also Pearson's and Spearman's correlation test for correlations. Results: There were positive correlations between total QOLIE-31 score and epilepsy surgery, employment, and seizure freedom, whereas negative correlations were found with antiepileptic drug use, anxiety, and depression. Statistically significant differences were found in QOLIE-31 totals and subscores between Groups 3 and 4 (P < 0.05). Conclusions: The presence of AS has a negative impact on QOL in patients with focal epilepsy. Physicians should be aware that psychiatric comorbidities in epilepsy have a severe impact and epilepsy treatment requires comprehensive management
Experience in Liver Transplantation Due to Primary Sclerosing Cholangitis: A Single Center Experience
No full textPurpose: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown origin. Although the course of PSC is variable, it frequently is progressive, leading to cirrhosis and requiring a liver transplantation (LT) in more than half of the patients. PSC is the fifth most common indication for LT in the United States and one of the leading indications in Scandinavian countries, whereas PSC affects fewer than 5% of patients undergoing LT in Turkey. In this study, we analyzed our results in the patients with LT owing to PSC. Materials and Methods: Between March 2013 and August 2017, all adult patients (>18 years) with LT owing to PSC were analyzed, and clinical data were obtained via retrospective review of patient charts. Demographic features, presence of any concomitant inflammatory bowel disease (IBD), time to LT, and outcome data were recorded. Results: There were 15 patients (8 men and 7 women) with a mean age of 46 ± 13 (age at diagnosis = 36 y). Median time to transplantation was 3 years (range: .5–14 yrs.). All patients had a pretransplant history of IBD. Concomitant cholangiocarcinoma was diagnosed in 1 patient (6.5%). Postoperative complications were observed in 4 patients (26%), and in 2 patients (13%) PSC recurred at a mean of 52 months postorthotopic LT. Disease-free survival and overall survival were 37.3 and 38 ± 21 months, respectively. One of the patients with recurrence and 1 with graft failure owing to rejection died in the follow-up period. Conclusions: In one single-center study of adults with PSC, we found that all patients with PSC had IBD at diagnosis. The recurrence rate (13%) was comparable to the literature (20% [5.7–59%]). Despite the low frequency of PSC in our clinic, LT in these patients resulted in favorable outcomes regarding postoperative morbidity and mortality compared with other etiologies. © 2019 The Author
Kidney Transplantation Outcomes in Temporarily Protected Syrian Patients With End-Stage Renal Failure in Turkey
No full textBackground: Approximately 6.3 million Syrian people migrated to other countries due to war since 2011. There are more than 3.5 million Syrian people living in Turkey under temporary protection. Syrian people receive free health care in Turkey, including kidney transplantation. Our institution started a kidney transplantation program about 3 years ago. It is the first institution performing living, related kidney transplantation for Syrian patients with end-stage renal failure. Methods: All living, related kidney transplantations to Turkish and Syrian patients from the beginning of our transplantation program until September 2018 were enrolled in this study. Donor and recipient characteristics, induction and maintenance immunosuppression, length of hospital stay, creatinine values at first week and first month, treatment incompatibility, and graft survival were evaluated. Results: Of the 25 living, related kidney transplantations 20% were Syrian. Three of 5 Syrian recipients were in the pediatric age group. None of the Syrian transplantations were preemptive, while half of the Turkish transplantations were preemptive (P = .005). Immunosuppression protocols, creatinine values, length of hospital stay, and graft survival rates were similar between groups. None of the Syrian recipients had treatment incompatibility (0%), unlike the Turkish recipients (15%). Conclusion: Outcomes of kidney transplantation for Syrian recipients are similar to those of Turkish recipients. Having this no-cost facility is great for Syrian kidney failure patients. The number of transplantations for Syrian patients under temporary protection in Turkey is expected to increase in the future, with these favorable results and easy to access, free health care facilities. © 2019 Elsevier Inc
Efficacy and safety of endoscopic retrograde cholangiopancreatography in pregnancy: A high-volume study with long-term follow-up
No full textBackground/Aims: Pancreaticobiliary diseases are observed more frequently in pregnancy due to increased biliary stone formation. There are some concerns about the use of endoscopic retrograde cholangiopancreatography (ERCP) because of potential fetal exposure to radiation and serious adverse events, such as post-ERCP pancreatitis, which increases fetal or maternal morbidity and mortality. The aim of this study was to evaluate the efficacy and safety of ERCP during pregnancy and to present our experience. Materials and Methods: This study included 25 pregnant patients who underwent ERCP due to biliopancreatic pathologies between 2010 and 2017. Indications for ERCP were choledocholithiasis (n=12), biliary pancreatitis (n=9), and acute cholangitis (n=4). ERCP procedures were performed using fluoroscopy (n=18) and the non-radiation technique (n=7). The duration of fluoroscopy was recorded in all cases. Fetal and maternal complications were both assessed. Results: The mean age of patients was 29.4 (range, 21–40) years, and the mean duration of pregnancy was 19.9 weeks. All the 25 ERCP procedures were performed successfully. Biliary sphincterotomy was performed in all patients, and 18 patients with choledocholithiasis underwent stone extraction. The average procedure duration was 11 min, and the average duration of fluoroscopy was 6 s. There were no major complications in any patient. After the deliveries, the newborns were apparently healthy during the follow-up period of 1–7 years. Conclusion: Either conventional or non-radiation ERCP procedures can be performed successfully in pregnancy, with no increase in the number of feto-maternal complications when performed by experienced endoscopists
Special Designed Routing Device To Ease Endoscopic Transforaminal Lumbar Disc Surgery: A Cadaveric Study
No full textBackground Data: Fully endoscopic lumbar disc (FELD) surgery via transforaminal (TF) approach may be more demanding to adopt for surgeons experienced with conventional microdiscectomy, due to the necessity of a new anatomic orientation and understanding. We designed a routing device to facilitate access to safe anatomic triangle defined by Kambin at the level of foramen in cadavers. Purpose: To show that the transforaminal route for endoscopic lumbar disc herniations is safely applicable with the aid of a new routing device. Materials and Methods: Ten cadavers between the ages 18-75, with no history of lumbar spinal surgery or trauma, with previous abdominal computed tomography (CT) scans included in our study. Postmortem abdominal CT scans were performed. Images were examined and transforaminal entrance angles without causing damage to retroperitoneal structures for each lumbar disc space and anatomical differences were recorded. TF approach was performed in cadavers using the angles measured from abdominal CTs and the entry point determined with the help of routing device. Results: L1-L2, L2-L3, L3-L4, L4-L5 disc spaces were operated in ten cadavers. Kambin’s triangle was successfully reached with help of routing device using data obtained from CT (X’, ?) and C-arm fluoroscopy (X, Y, Y’). Y’ marker with protractor on routing device, and the metal rod on this Y’ marker with an opening through which only the punction needle could pass were very important in reaching the target. The metal bar horizontal movement and fixation to this mechanism contributed to operation of device. Entrance points and angles calculated with the help of CT scans were found to be compatible with the images obtained from fluoroscopy and endoscopy during operation. Conclusions: In this study, it has been showed that TF approach can be safely performed with help of the new designed routing device
Relationship of Popliteus sulcus depth and tibiofemoral rotational alignment with popliteus tendinitis in professional folk dancers exposed to turnout positions an MRI analysis
No full textPubMed: 31482172AIMS: the popliteus musculotendinous unit plays the major role in range of motion, rotation and stabilization of the knee. Frequent repetition of the rotational strains such as turnout in dancers may be the cause of popliteus tendinitis. in addition, popliteus sulcus depth (PSD) and PSD/lateral condyle width (LCW) ratio are also highly related with popliteal tendinitis in professional folk dancers. in this study, we evaluated the association between clinically diagnosed popliteus tendinitis and PSD with analysis of the PSD/LCW ratio as measured on MRI and tibiofemoral rotational alignment in professional folk dancers. This study was intended to clarify any anatomical liability to popliteal tendinitis in professional folk dancers. Therefore, we looked for the anatomical variances affecting popliteal musculotendinous unit. METHODS: Thirty-two MRI scans from 32 members of a professional folk dance group (mean age 30.2±7.9 yrs, range 18–38) were analyzed retrospectively. Popliteal tendinitis was detected in 5 knees (5 dancers). the relationship of popliteal tendinitis to the tibiofemoral rotational angles (condilary twist angle, posterior codilary angle, posterior tibiofemoral angle), PSD, and PSD/LCW ratio were investigated. RESULTS: the popliteus tendinitis group had statistically significantly higher PSD and PSD/LCW ratio than the group without popliteal tendinitis (p=0.0001). There was no statistically significant difference between the two groups in the tibiofemoral rotational angles. CONCLUSION: in addition to long hours of practice and the turnout position, PSD and PSD/LCW ratio can place the professional folk dancer at increased risk for popliteus tendon injury. © 2019 Science & Medicine
Comparison of Exit-Site Infection Frequency in Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients: A Single-Center Experience
No full textHasbal, Nuri Baris/0000-0002-2229-5140; sevinc, mustafa/0000-0003-2804-4884WOS: 000500949700009PubMed: 32377113Objectives: Catheter exit-site infection (ESI) is generally caused by skin flora. Continuous ambulatory peritoneal dialysis (CAPD) patients have more contact with their catheters than automated peritoneal dialysis (APD) patients as a result of performing multiple exchanges per day. the aim of the present study was to compare the frequency of ESIs between these 2 peritoneal dialysis (PD) modalities. Methods: PD patients from 2001 to 2015 were enrolled in the study. Patients transferred from CAPD to APD were excluded. All of the data were collected retrospectively. the rate of ESI occurrence and culture results in the CAPD and APD groups were compared. Results: the data of 280 patients were evaluated. APD patients represented 23.2% of the study cohort. Prevalence of peritonitis was 87.6% if a patient had an ESI and 50.7% if there was no ESI (p=0.000). the frequency of ESI was similar between the 2 peritoneal dialysis modalities (p=0.343). There was a statistically significant difference in the causative organism of infection between the 2 groups (p=0.021). Conclusion: the ESI rate was similar in the CAPD and APD patients though CAPD requires more exchanges, and therefore there is more contact with the catheter. All PD patients, regardless of the treatment modality used, are expected to perform exchanges according to standard rules for connecting the catheter to the PD solution bag. As long as patients observe these guidelines, there would appear to be no increased ESI risk related specifically to the modality