Ufuk Universitesi Akademik Acikerisim Sistemi
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Does luteal phase support effect pregnancy rates in intrauterine insemination cycles a prospective randomised controlled study in a tertiary center
Get PDFIntrauterine insemination (IUI) is a common treatment for couples with subfertility. Clomiphene citrate, gonadotropins, and letrozole are used for ovulation induction in IUI cycles. It has been well documented that luteal support with exogenous progesterone after in vitro fertilization is associated with higher pregnancy and live birth rates. Yet, luteal phase support in IUI cycles has become a debatable issue. The aim of this prospective controlled study was to assess the effect of luteal phase vaginal progesterone supplementation on beta-hCG positivity and clinical pregnancy rates in women undergoing IUI. This prospective controlled randomised study was conducted at a tertiary infertility center. 87 patients with unexplained infertility or male subfertility who were treated with IUI using gonadotropins were enrolled. Patients in the study group (n = 44) received luteal phase vaginal progesterone supplementation. Patients in the control group (n = 43) did not receive any luteal phase support. There was no statistical difference between two groups in terms of beta-hCG positivity and clinical pregnancy rates. Our findings do not show any beneficial effect of luteal phase support in IUI cycles stimulated with gonadotropins. Although luteal phase support in IUI cycles stimulated with gonadotropins is widely adopted, there is a lack of robust evidence
Morphological overview of cardiovascular comorbidities in chronic obstructive pulmonary disease: Frank's sign
Get PDFObjective: Cardiovascular diseases are the most common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). Literature indicates that there may be a relationship between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Accordingly, the present study aimed to assess the relationship with DELC and cardiac comorbidities in patients with COPD during routine physical examination. Materials and Methods: In this prospective cohort study, we evaluated the demographic data, pulmonary function test (PFT) results, lipid profile, oxygen saturation, and the presence of DELC in patients with COPD and control subjects. Results: DELC was diagnosed in 155 (62%) of COPD patients and these patients had a higher prevalence of CAD (p = 0.044). Moreover, DELC was diagnosed in 135 men (68.5%) and 20 (37.7%) women in the COPD group (p<0.001) and in 39 (48.8%) men and 14 (56.0%) women in the control group (p = 0.527). On the other hand, CAD was diagnosed in 18% of patients with early-stage COPD (n = 104) and in 30.8% of patients with late-stage COPD (n = 146) (p = 0.041). The sensitivity and specificity of DELC positivity in predicting CAD were 80.65% and 44.15% in COPD patients, respectively. Conclusion: The presence of cardiac comorbidities in COPD patients may play a vital role in the severity of the disease, exacerbations, and may also reduce the treatment response. Accordingly, an earlobe examination of patients with COPD may be useful in predicting the presence of cardiac comorbidities with high sensitivity. (C) 2020 Elsevier Inc. All rights reserved
Calcinosis Cutis Universalis in a Patient with Systemic Sclerosis
No full textSystemic sclerosis (Scl) is a multisystemic autoimmune disorder that is characterized by immune dysregulation, vasculopathy, and overproduction of collagen leading to skin and internal organ fibrosis. Calcinosis is a well known manifestation of Scl, which occurs the deposition of calcium in the dermis and subcutaneous tissues with normal levels of serum calcium and phosphorus. However, calcinosis on extremities and trunk is unfrequently seen. Herein we present the case of a 44-year-old female patient with diffuse cutaneous systemic sclerosis who has calcinosis stiutated bilaterally at upper and lower extremities and trunk which is an unfrequent condition
Measurement and interpretation of anxiety and depression susceptibility among doctors by university and state hospital
No full textAnksiyete bozukluğu ve depresyon günümüzde yaygın hastalıklar arasında yer almaktadır. Sağlık hizmeti sunan bireylerin bu rahatsızlıklara sahip olması topluma sunulan sağlık hizmetlerinin kalitesini düşürebilir ve toplum sağlığını etkileyebilir. Sistemsel olarak üniversite hastaneleri ve devlet hastaneleri birbirinden farklı kuruluşlardır. Bu iki sağlık kurumu türünün hangisinde çalışan doktorların anksiyete ve depresyona daha yatkın olduğu hastane anksiyete ve depresyon ölçeği ile araştırılmıştır. Aynı meslekten olup çalışma şartları farklı olan üniversite hastanesi hekimleri ile devlet hastanesi hekimleri üzerinde yapılan bu çalışmada, üniversite hastanesinde çalışan hekimlerin anksiyete ve depresyon yatkınlığının devlet hastanesinde çalışanlara göre daha fazla olduğu %95 güven düzeyinde gözlemlenmiştir. Hekim sağlığını korumak için hekimlerin çalışma şartları tekrar gözden geçirilmeli, hekimlerin anksiyete ve depresyona olan yatkınlıklarının sebepleri araştırılmalıdır.Anxiety disorder and depression are among the common diseases nowadays. The fact that individuals providing health services have these ailments to society can reduce the quality of health services provided and affect community health. University Hospital and Public Hospitals are systematically different institutions from each other. In which of these two types of health institutions doctors work, which hospital is more prone to deoression and anxiety, was investigated with anxiety and depression scale. In this study on the state hospital doctors and university hospital doctors who have same profession and different working conditions, it was observed 95% confidence level that the doctors who work at the university hospital have more predisposition of the anxiety and depression than the state hospital doctors. To protect physician health, working conditions of physicians should be reviewed again, the reasons for the predisposition of physicians to anxiety and depression should be investigated
Predictive value of urinary neutrophil gelatinase-associated lipocalin and serum ischemia-modified albumin for early diagnosis in patients with contrastinduced acute kidney injury
Get PDFAim: The aim of this study was to investigate whether urinary neutrophil gelatinase-associated lipocalin (NGAL) and serum ischemia-modified albumin (IMA) levels could serve as early biomarkers of contrast-induced acute kidney injury (CI-AKI) in patients with normal serum creatinine values who undergo coronary angiography (CAG). Methods: This study was conducted in 78 patients undergoing CAG. Urinary NGAL and serum IMA values which measured prior to and 6 hours after CAG were compared with creatinine values that measured prior to and 48 hours after CAG. Results: IMA and NGAL values obtained 6 hours after CAG differed significantly from those obtained at baseline. Statistically significant differences were found between the baseline and 6th-hour values of urinary NGAL and serum IMA (p<0.001). There was no significant difference between baseline and 48th hour serum creatinine levels (p=0.081). In addition, a statistically significant positive correlation was found between pre-processing and 6th-hour NGAL and IMA levels, (r=0.277, p=0.014; r=0.407 and p<0.001, respectively). Conclusion: An increase in urinary NGAL and serum IMA levels were detected without an increase in serum creatinine values which is routinely used in determining CI-AKI. When compared to serum creatinine, urinary NGAL and serum IMA may be early and sensitive biomarkers for predicting CI-AKI.
Rare congenital anomalies of the internal carotid artery: anatomic and radiologic aspects of three cases and review of the literature
Get PDFPurpose Congenital anomaly of the internal carotid artery (ICA) is a rare entity. It is usually discovered incidentally by color doppler carotid sonography, angiography, computerized tomography (CT), or magnetic resonance imaging of the head and neck region taken for some other reasons. The aim of this study was to detect congenital ICA anomalies, to delineate existing collateral vessels and to find out its incidence. Methods 1847 patients' CT angiography images of the head and neck region taken between May 2013 and February 2018 were retrospectively evaluated for ICA anomalies. Results We detected three cases (0.16%) with unilateral agenesis of ICA, bilateral agenesis of ICA and bilateral hypoplasia of ICA, respectively. Most patients are asymptomatic because of collateral cerebral circulation supplied by the communicating arteries of the circle of Willis, intercavernous anastomosis, communicating arteries from the external carotid artery, and by persistent embryologic arteries to the carotid artery territory. Conclusion Recognition of ICA anomalies has important implications during planned carotid or transsphenoidal surgery, in thromboembolic disease, and in the follow-up and detection of associated cerebral aneurysms
Place of magnesium sulfate in cardiopulmonary resuscitation. A systematic review and meta-analysis
No full textINTRODUCTION: Sudden cardiac arrest treatment is challenging, And the effectiveness of resuscitation procedures — especially in pre-hospital conditions — is low. The purpose of this meta-analysis is to investigate the effects of magnesium sulfate (MgSO4) in cardiac arrest on the return of spontaneous circulation (ROSC) and survival to hospital discharge. MATERIAL AND METHODS: We searched in MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov, Web of Science up to May 25, 2020, and we conducted a systematic review and meta-analysis. We synthesized results by using mean differences, and odds ratios. The overall incidence and outcome of cardiac arrest were assessed using a random-effects meta-analysis. RESULTS: A total of 5 eligible studies were included in this meta-analysis. Survival to discharge was higher in magnesium sulfate group compared to placebo group (9,5% vs. 8.2% respectively; OR = 1.17; 95% CI: 0.61, 2.23; p = 0.64). Higher survival rate to hospital admission was observed in the placebo group — 26.9% compared to the group where magnesium was administered — 25.7% (OR = 0.93; 95% CI: 0.59, 1.47; p = 0.77. CONCLUSIONS: In conclusion, this meta-analysis indicates no statistically significant benefit of resuscitation with magnesium sulfate compared to the placebo. Thus, due to the low number of studies we recommend future randomized controlled trials to identify which anti-arrhythmic drug we should use on shock-refractory cardiac arrest. Copyright © 2020 Via MedicaEuropean Research Council, ERCAcknowledgments: Study supported by the ERC Research NET and Polish Society of Disaster Medicine
A clinical analysis of microvascular decompression surgery with sacrification of the superior petrosal venous complex for trigeminal neuralgia a single-surgeon experience
Get PDFAIM: To report the surgical outcomes in patients with trigeminal neuralgia (TN) who underwent microvascular decompression (MVD) with superior petrosal vein sacrification. MATERIAL and METHODS: Data from 63 patients, whose information was obtained from a group of 113 patients who underwent surgery from 2008 to 2018, were reviewed retrospectively by the first author who was not part of the surgical team, and the pain conditions were evaluated objectively. RESULTS: Following surgery, pain relief occurred in 84% of patients during the early postoperative period and in 69.8% of patients during long-term follow-up. The major offending vessel was the superior cerebellar artery. CONCLUSION: MVD surgery, in particular for patients with typical pain, is one of the most effective treatment strategies for TN. Superior petrosal vein sacrification is a safe method that helps neurosurgeons to visualise the surgical area and perform a better work-up. Neurosurgeons should not be afraid to carry out superior petrosal vein sacrification
Does the hyper IgM phenotype affect prognosis in ataxia telangiectasia?
Get PDFObjective: To evaluate the characteristics of the patients who were followed-up with the diagnosis of ataxia telangiectasia (AT) and to
assess the relationship between the hyper IgM (HIGM) phenotype and their prognosis.
Materials and Methods: From 2007 to 2019, the study included 68 patients aged 3-35 years who were followed-up with the diagnosis of
AT. We retrospectively evaluated the clinical and immunological characteristics and follow-up results.
Results: There were 36 girls and 32 boys with a median follow-up of 10 years (1-12 years). The most common complaints upon
admission were unsteady walk in 87%, infection in 6%, presence of a family history in 6%, and intracranial mass in 1%. The marriage
was consanguineous in 85% of the parents. Ataxia was seen in 100% of the patients, telangiectasia in 97%, and immune deficiency in
88%. Bronchiectasis was observed in 23.5% of the patients, chronic diarrhea in 19%, lymphoproliferation in 15%, malignancy in 10%,
autoimmunity in 10%, liver failure in 6%, and granulomatous skin lesions in 6%. Thirteen patients (19%) died during follow-up. The
HIGM phenotype was identified in 31% of the patients. Recurrent upper and lower respiratory tract infections (p=0.004 and p<0.0001,
respectively), liver failure (p=0.005), and autoimmune diseases (p=0.023) were significantly higher in the HIGM (+) group than the
HIGM (-) group. Life expectancy was shorter in the HIGM (+) group with 14 ± 0.73 years (CI 95% 12.55-15.44) compared to the HIGM
(-) group with 18 ± 1.64 years (CI 95% 14.77-21.22) (p=0.054).
Conclusion: During the early childhood period and before the characteristic findings of AT develop, the patients might present at a
hospital with infections, autoimmunity, lymphoproliferation, or malignancy. Physical examination, high alpha-fetoprotein (AFP) levels
and immunological testing provide important data for the correct diagnosis. The HIGM phenotype aggravates the clinical course of the
disease resulting in fatalities at an earlier age and at a higher rate
Ameliyat Öncesi Değerlendirilen Hastaların Antikoagülan ve Antiplatelet İlaç Kullanım Farkındalığı
Get PDFObjective: To determine anticoagulant and anti-platelet medication awareness of peri-operative patients
Method: A questionnaire was applied to the 208 preoperative patients taking anticoagulants (AC) or anti-platelets (AP).
The questionnaire included the questions about whether they were using any drug that thinners blood or prevents clots,
indication and duration of drug use, whether they underwent an operation while using the drug, whether they knew
that the drug should be discontinued in case of undergoing an operation and presence of a planned surgical procedure
when commencing the drug.
Results: Mean age of the study population was 63.3±12.7 years and 50.5% of the patients were male, 27.9 % of the
patients were illiterate, 39.4% of patients were not aware of using AC or AP and 12.5% of patients didn’t know duration
of AC or AP use. An operation had been planned before commencement of the drug in 9.1% of the patients. The incidence
of undergoing a surgical procedure while using AC or AP was 18.8%. While 23.1 % were urgent, 76.9% were elective
procedures. General anesthesia was applied in 41% of these patients. When the patients who were aware or unaware of
AC or AP use were compared, mean age was younger and level of education was higher among the patients who were
aware of using AC or AP (p=0,018 and p<0,001 respectively). No difference was detected between the patients who were
using old or new generation drugs with regard to awareness of drug use (p=0.113).
Conclusion: Patients who are taking AC or AP may have to undergo surgical procedures more than once while using
these drugs. However, an important proportion (39.4 %) of these patients was found to be unaware of using AC or AP