Bezmialem Vakıf Üniversitesi Kurumsal Akademik Arşiv
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Subacromial Spacer Implantation During Arthroscopic Partial Repair in Patients With Massive Irreparable Rotator Cuff Tears Provides Satisfactory Clinical and Radiographic Outcomes: A Retrospective Comparative Study
No full text© 2022 The AuthorsPurpose: To compare the clinical and radiographic outcomes of partial rotator cuff repair (RCR) with and without implantation of a biodegradable subacromial spacer in the treatment of symptomatic irreparable massive rotator cuff tears (MRCTs). Methods: Patients with MRCT who underwent arthroscopic partial repair alone (PR) or combined with subacromial spacer augmentation (PRS) were included. Patient-reported outcomes, including visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant scores in addition to range of motion (ROM) were collected preoperatively and at the final follow-up. Additionally, we determined the percentages of all of the patients in groups that achieved the minimal clinical important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptomatic state (PASS) for the VAS, ASES, and Constant scores. Acromiohumeral distance (AHD) was determined as well. Results: A total of 32 patients were included. Group PR included 20 patients with a median age of 68 years (range: 64-73) and median follow-up 28.0 months (14.0-60.0). Group PRS included 12 patients with a median age of 68.5 years (range: 63-74) and median follow-up of 17.0 months (12.0-32.0). At the final follow-up, the ASES, VAS, and Constant scores were significantly higher in the PRS group (75.5 [55-88.3], 1.0 [0-3], and 70.0 [43-79], respectively, compared to the PR group (55.0 [37.5-65], 2.0 [0-4], and 55.0 [31-79], respectively; P < .05). The only statistically significant differences were found between the PR and PRS groups in terms of the proportions of the patients who achieved MCID for the ASES (70% vs. 100%; P = .04) and in terms of the proportions of the patients who achieved SCB for the ASES (60% vs 100%; P = .01) There was also statistically significant difference between the PR and PRS groups, in terms of the proportions of the patients who achieved PASS for the VAS and ASES ([30 % vs 66.7 %; P = .04] and [0 % vs 50 %; P = .001], respectively). AHD was also improved in the PRS group (8.4 [7-9.5] vs 7.85 [5.5-9]; P < .05). ROM was greater in the PRS group at final follow-up with median forward flexion degree, 140.0° (90°-150°) versus 120.0° (80°-153°) (P < .001) and median abduction degree, 100.0° (70°-130°) versus 90.0° (70°-110°). There was no difference in terms of external rotation between groups (3° [2°-5°] vs 3.0° (2°-4°); P = .4). Conclusions: Arthroscopic partial RCR with implantation of a subacromial spacer leads to satisfactory clinical and radiographic outcomes in patients with symptomatic irreparable MRCT compared with patients treated with partial repair alone. Level of Evidence: Level III, retrospective comparative study
Analysis of the effects of ha-330 hemo adsorption column application on mortality andmorbidity of adult patients with sepsis in general intensive care unit
No full textSepsis is a leading cause of mortality and morbidity in critical care units. The objective of this study is to evaluate if using the HA-330 Sepsis Adsorption Column in the intensive care unit reduces mortality and morbidity in patients with sepsis. This study was designed as a retrospective study evaluating demographic and laboratory parameters in the General Intensive Care Unit. The study involved 200 sepsis patients who were followed in the critical care unit between June 2019- December 2020 and were treated with the HA-330 Sepsis Adsorption Column. The length of hemoperfusion in patients who died was statistically significantly longer than in patients who recovered. The mean lactate and the hemoperfusion time/day value had a weak but significant negative correlation. In the recovery and death observations, the improvements in repeated C-reactive protein and Procalcitonin measurements were statistically significantly different. The differences in repeated pH and lactate measurements in the recovery and mortality observations were statistically identical, according to the observations. Sepsis-related deaths are a severe issue in critical care units. HA-330 Sepsis Adsorption Column, it can be thought that it can be an inexpensive, useful, and effective method that can be used in the prognosis of the patients. In antibiotic-resistant sepsis, hemoperfusion may be recommended
Superficial Femoral Artery Mirror Lesions; Risk Factors, Diagnosis, and Clinical Presentation
No full text© 2022, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Two-sided atherosclerotic involvement of peripheral arteries is common in clinical practice; however, the data about it in the literature is limited. This study aimed to investigate the frequency, clinical characteristics, and predictors of bilateral symmetric total superficial femoral artery (SFA) occlusions (mirror lesions). Between January 2015 and April 2020, 167 patients with symptomatic total SFA occlusions were retrospectively analyzed. Unilateral and bilateral SFA occlusions were determined, and the risk factors and clinical presentation were investigated between the two groups. Among 167 patients, 95 (57%) had bilateral SFA lesions, and 30 (18%) presented with critical limb ischemia (CLI). In the bilateral SFA occlusion group, male sex was dominant (p=0.002), and peripheral artery disease (PAD) history was higher (p=0.030). Additional iliac lesions (p = 0.003) and below-knee lesions (p <0.001) were more common in the bilateral SFA occlusion group. The sensitivity of Doppler ultrasonography in detecting SFA occlusions was 83.9%. In multivariate logistic regression analysis, younger age (OR; 0.95 CI; 0.91-0.99 p = 0.030) and history of PAD (OR; 2.08 CI; 1.02-4, 24 p = 0.040) were identified as independent markers for predicting mirror SFA occlusions Our study demonstrates that the mirror lesion pattern is common in patients with symptomatic SFA total occlusion. Thus, the non-index leg evaluation should be recommended. The younger the age, and PAD history were the predictors of mirror total SFA occlusions
A case of diabetes and deafness with heteroplasmic mutations in the mitochondrial DNT1 gene
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Identification of Drug-Related Problems and Investigation of Related Factors in Patients with COVID-19: An Observational Study
No full textObjective: Clinical prognosis of coronavirus disease-19 (COVID-19) may be severe and unexpected. Patients may quickly progress to respiratory failure, infections, multiple organ dysfunction, and sepsis. The main objective of this study is to investigate the drug-related problems of patients with COVID-19 and related factors.
Method: A prospective observational study was conducted on patients with COVID-19 between September 2020 and May 2021. Patients’ demographics, comorbid diseases, prescribed medicines and laboratory findings were recorded. Drug-related problems (DRPs) were identified by a clinical pharmacist according to recent guidelines, UpToDate® clinical decision support system and evidence-based medicine. Results: The median age of 107 patients was 64 and 50.46% of them were male. The median number of comorbidities was 3 (2-4) per patient. The majority of the patients had at least one comorbidity (88.79%) other than COVID-19 and the most frequent comorbidities were hypertension, diabetes mellitus and coronary artery disease. The total number of DRPs was recorded as 201 and at least one DRP was seen in 75 out of 107 patients. The median number of DRPs was 2 (0-8). In multivariate model, number of comorbidities (odss ratio (OR)=1.952; 95% confidence interval (CI)=1.07-3.54, p<0.05, number of medications (OR=1.344; 95% CI=1.12-1.61, p<0.001), and serum potassium levels (OR=5.252; 95% CI=1.57-17.56, p<0.001) were the factors related with DRP.
Conclusion: This study highlights the DRPs and related factors in patients with COVID 19 in hospital settings. Considering unknown features of the infection and multiple medication use, DRPs are likely to occur. It would be beneficial to consider the related factors in order to reduce the number of the DRPs
OTİZM SPEKTRUM BOZUKLUĞU OLAN BİREYLERDE HEMŞİRELİK BAKIMI
No full textÖzet: Otizm spektrum bozukluğu (OSB) tanım olarak çocukluk çağında belirti veren, ortaya çıkış nedeni tam olarak belli olmayan, nöro-gelişimsel bir hastalıktır1. OSB’nin etiyolojisi tam olarak açıklanamasa da son on yıla bakıldığında bu durumun genetik, çevresel, nöroanatomik, nörokimyasal ve nörofizyolojik birçok etkenden kaynaklı olabileceğine yönelik çalışmalar mevcuttur 1,2. OSB’nin bireyde tanı koyulabilmesi için Amerikan Psikiyatri Birliği (APA) tarafından hazırlanan DSM-5 kriterleri kullanılmaktadır. DSM-5’e göre, otizm tanılamasında iki temel klinik özellik vardır. Bunlar toplumsal iletişim ve etkileşimde bozulma ile kısıtlı yineleyici davranışlardır. OSB’li bireyler; bilişsel, duyuşsal, davranışsal, iletişim ve sosyal etkileşim kurmada birçok sorun yaşamaktadır 1,2,3. OSB’li bireylerin tedavisinde ise bireye uygun bir eğitim planlanmasının yanı sıra çeşitli bilişsel ve davranışsal terapilerin uygulanması, hastalık sürecinin yönetilmesi bakımından önem taşımaktadır2,3. OSB erken çocuklukta görülen, kesin tedavisi olmayan bir bozukluk olmasına rağmen hastalığın erken dönemde saptanması birey için tedavideki başarı şansını arttırmaktadır. Son yıllarda OSB’nin tanısındaki artış, toplumda OSB’nin erken tanılama sürecinin başlatılmasında sağlık profesyonellerinin önemli rolü olduğunu göstermektedir2,3. Yaygın gelişimsel bozukluk olan OSB’nin erken çocukluk döneminde tanılanmasında ise hemşireler özellikle uygulayıcı, eğitici, rehberlik ve danışmanlık görevleri kapsamında anahtar bir role sahiptir3,4,5. Hemşireler bu rolleri doğrultusunda çocuk bakımında ve büyüme-gelişme izleminde yapacakları fiziki muayene ile OSB’nin erken tanılanmasında yardımcı olabilir, doğru iletişim tekniklerini kullanarak OSB’li bireyin bakımında etkin rol oynayabilir ve ebeveynlerin gelişimselbozukluklar konusunda bilgilendirilmesini sağlayarak, tedavi sürecinin daha etkin ve etkili yönetilmesine rehberlik edebilir4,5,6,7. Literatürde yapılan çalışmalar incelendiğinde; hemşirelerin OSB’li bireylerin tanılanmasında önemli bilgi birikimine sahip oldukları6 ve OSB hakkında eğitim alan hemşirelerin OSB’li bireylerin tanılanmasında bilgi düzeylerinin yüksek olduğu7 saptanmıştır. Sonuç olarak hemşireler, OSB’nin erken tanılanma ve müdahale süreçlerinde aracı ve önemli bir role sahiptir. Bu kapsamda hemşirelerin OSB’nin tespit edilmesinde gerekli bilgi, beceriye sahip olmaları, OSB’li bireyin büyüme-gelişiminde erken müdahalelerde bulunmaları, ebeveynleri desteklemeleri ve OSB’nin tedavi sürecinin yönetiminde diğer sağlık ekibi üyeleriyle iş birliği içerisinde olup çeşitli stratejiler geliştirmeleri gerekmektedir. Anahtar Kelimeler: Otizm spektrum bozukluğu, hemşirelik bakımı, erken tanı, tedavi