Ufuk Universitesi Akademik Acikerisim Sistemi
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Management of bleeding risk before pleural procedures: A consensus statement of Turkish respiratory society – Pleura study group
No full textPleural effusion is a common clinical entity. Pleural procedures performed for the diagnosis and management of pleural effusions may increase the risk of bleeding, especially in patients with coagulopathies and comorbidities and those in need for antithrombotic drugs. Current literature provides sparse, low level of evidence, which is insufficient for safe implementation of pleural procedures among these patients. Thoracentesis, pleural biopsy (closed or percutaneous), catheter or chest tube drainage, and thoracoscopy are the main pleural procedures performed in these patients. Considering the bleeding risk associated with a specific pleural procedure, the risk is low for thoracentesis, moderate for insertion or removal of the chest tube or tunneled catheter, and moderate high for pleural biopsies and thoracoscopy. The current statement is prepared mainly for the pulmonologists and intended to provide recommendations to reduce the risk of bleeding following pleural procedures. The management of bleeding complication is out of the scope of this statement
Peri-operative blood transfusion in elective major surgery: incidence, indications and outcome - an observational multicentre study.
Get PDFBackground: Patients' demographic and epidemiological characteristics, local variations in clinicians' knowledge and experience and types of surgery can influence peri-operative transfusion practices. Sharing data on transfusion practices and recipients may improve patients' care and implementation of Patient Blood Management (PBM). Materials and methods: This was a multicentre, prospective, observational, cross-sectional study that included 61 centres. Clinical and transfusion data of patients undergoing major elective surgery were collected; transfusion predictors and patients' outcomes were analysed. Results: Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion. A total of 5,812 blood components were transfused: red blood cells (RBC), fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88 (1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019 (33%) patients. Half of the RBC units were used by patients in the age group 45-69 years. Specific procedures with the highest RBC use were coronary artery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%). Low haemoglobin concentration was the most common indication for intra-operative RBC transfusion (57%) and plasma and platelet transfusions were mostly initiated for acute bleeding (61.3% and 61.1%, respectively). The RBC transfusion rate in study centres varied from 2% to 72%. RBC transfusion was inappropriate in 99% (n=150/151) of pre-operative, 23% (n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBC transfusion episodes. Pre-operative haemoglobin, increased blood loss, open surgery and duration of surgery were the main independent predictors of intra-operative RBC transfusion. Low pre-operative haemoglobin concentration was independently associated with post-operative pulmonary complications. Conclusions: These findings identified areas for improvement in peri-operative transfusion practice and PBM implementation in Turkey
Mean platelet volume and related parameters may not contribute to the diagnosis in patients with ascending thoracic aortic aneurysm
Get PDFImpairment in heart functions and prognostic role of N‑terminal pro‑brain natriuretic peptide in patients with chronic obstructive pulmonary disease exacerbation
Get PDFINTRODUCTION: Chronic obstructive pulmonary disease (COPD) with comorbidities andcardiovascular disease is the most frequent one. The role of natriuretic peptides in determiningprognosis of COPD exacerbations is not yet clear. The frequency of pathologic findings of transthoracicechocardiography (TTE) during COPD exacerbation showed wide variability. This study aims toevaluate the predictive role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in determiningthe short-term prognosis of patients hospitalized with COPD exacerbation. As a secondary outcome,we aimed to investigate the frequency of TTE findings in these patients.MATERIALS AND METHODS: Eighty-six consecutive patients with COPD exacerbationwere included. NT-proBNP levels were measured and TTE was carried out to whole of theparticipants at administration. The primary outcome was development of “event” (readmissionor rehospitalization or mortality) within 30 days. The predictive role of NT-proBNP level for thedevelopment of “event” was evaluated. As a secondary outcome of the study, the frequency ofTTE findings was recorded.RESULTS: NT-proBNP level of the patients who developed event within 30 days had significantlyhigher than who did not (2343.16 ± 4107.17 pg/mL vs. 843.22 ± 2349.96 pg/mL, P = 0.001).A high negative correlation was found between NT-proBNP level and “time to event” (r =-0.992, P < 0.001). Multivariable logistic regression analysis showed that NT-proBNP levelwas an independent predictor for the development of “event” (P < 0.001) and the cutoff pointof it was found to be 303.5 pg/mL (0.639 sensitivity and 0.720 specificity). The most frequentechocardiographic findings were pulmonary hypertension (54.7%) and left ventricle diastolicdysfunction (39.5%).CONCLUSION: NT-proBNP level is a strong predictor for short-term prognosis of patients hospitalizedwith COPD exacerbation. Further and larger studies are needed to determine exact role of NT-proBNPin long-term prognosis of these patient
Does THA affect sexual dysfunction in female patients with DDH?
Get PDFBackground: Sexual health, aside from reproduction, plays an important role in physical, intellectual,
emotional and social facets of life. Developmental dysplasia of the hip (DDH) is a chronic orthopedic
disease that has negative physical, social, and mental/spiritual effects, and lowers quality of life. However,
no studies exist in the literature that focus on sexual function and health in patients with DDH.
Methods: The preoperative and postoperative 6th month and 1st year sexual functions of women who
underwent surgical treatment (total hip arthroplasty) for DDH (Crowe 1e4) (n:50) and their spouses
(n:30) were evaluated with Arizona Sexual Experience scale (ASEX) questionnaire which evaluates sexual
function in 5 categories such as desire, arousal, erection/lubrication, orgasm, and satisfaction.
Results: The ASEX scores were 22.3 ± 3.5 preoperatively, 17.8 ± 2 at the 6th postoperative month, and
14.8 ± 1.3 at the 1st postoperative year. The decrease in the average score showed that sexual dysfunction
existed in the preoperative period and sexual function was positively affected in the postoperative period
over time. The ASEX scores of the patients younger than 35 in the postoperative 6th month had higher
scores (P ¼.29). The sexual life of the husbands was not affected by the wives’ surgery, even though their
spouses had a chronic condition causing functional difficulties.
Conclusion: This study showed that the sexual life of women with DDH, who had been treated with total
hip arthroplasty, was positively affected, whereas their husbands were unaffected. Further studies
focusing on the effect of physiological and emotional factors, in addition to the surgical treatment, on
sexual function are needed
The histopathological results of vestibulectomy specimens in localized provoked vulvodynia in Turkey
Get PDFIntroduction: Localized Provoked Vulvodynia (LPV) is a gynecological disease that is difficult to manage. Despite the wide spectrum of pathophysiological mechanisms and treatment modalities, there is limited success in the management of this disease. Surgical treatment is usually performed as the last resort. We aimed to investigate the histopathological results of 38 women with LPV who underwent surgical vestibulectomy.
Methods: of the 55 women that were diagnosed with LPV and underwent vulvar vestibulectomy, 38 patients with complete histopathological results were included in this retrospective study.
Results: in 14 patients, the pathological reports revealed Low-Grade Squamous Intraepithelial Lesions (LGSIL) (36.8%) whereas for 21 cases (55.2%), the findings were concordant with vestibulitis. The remaining three patients (7.8%) were diagnosed with lichen simplex chronicus.
Conclusion: the presence of LGSIL in the surgical specimens of LPV cases is noteworthy. In this group of patients, surgical excision may contribute to the prevention of progression into high-grade lesions. The relationship between Human Papilloma Virus (HPV) infections and LPV should be further investigated
Acute kidney injury following supine mini-PNL versus retrograde intrarenal surgery in patients with renal stones < 3 cm: a prospective comparative study
Get PDFBackground: The purpose of the current study was to prospectively compare mini-PNL and RIRS for development of
acute kidney injury (AKI), success, and complication rates in a cohort of patients with kidney stones less than 3 cm.
Methods: In this prospective study, data of 60 consecutive patients underwent mini-PNL (n=31) or RIRS (n=29)
was investigated. Urinary NGAL levels were measured preoperatively and at postoperative 6th hour to evaluate AKI.
Success and complication rates were also compared.
Results: The mean stone size was signifcantly higher in the mini-PNL group (24.6 mm vs. 18.2 mm, p=0.02). The
mean postoperative NGAL levels were 45.6±12.4 and 48.1±13.6 for the mini-PNL and RIRS groups, respectively. The
increase was statistically signifcant for both groups (p: 0.01). The diference between the two groups for mean postoperative NGAL measurements was not statistically signifcant (p=0.47). The SFR was signifcantly higher in the miniPNL group (96.7% vs. 79.3%, p=0.04). The complication rates were similar for the two groups (p=0.99). The mean
duration of operation was 48.2±22.5 min in the mini-PNL group and 62.6±18.1 min in the RIRS group (p=0.03). The
median duration of hospitalization was 1 day for both groups.
Conclusions: In patients with renal stones<3 cm in diameter, mini-PNL in supine position provides higher SFR and
shorter operative times with similar rates of complications and AKI when compared with RIRS. Mini-PNL should be
considered as the primary treatment option together with RIRS for renal stones and should not be ruled out for being
a more invasive option
Higher incidence of metabolic syndrome components in vitiligo patients: a prospective cross-sectional study
Get PDFBackground/objectives: To investigate the association between vitiligo and metabolic syndrome.
Methods: A prospective cross-sectional study was conducted between 2014 and 2016. Study (n=155) and control groups (n=155) were evaluated for metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III and the International Diabetes Federation criteria. Study group was divided into three groups according to their vitiligo area severity index and vitiligo disease activity score values (Group 1: 6.89 for VASI score, Group A: -1-0, Group B: 1-2 and Group C: 3-4 for vitiligo disease activity score respectively). MetS rates according to both criteria were compared between the vitiligo disease activity score and vitiligo area severity index groups.
Results: Metabolic syndrome rates were 37.4% and 40% in the study group and 19.4% and 26.5% in the control group according to National CholesterolEducation Program Adult Treatment Panel III and International Diabetes Federation criteria, respectively (p<001 and p=0.011). Metabolic syndrome was more frequent in vitiligo area severity index Groups 2 and 3 compared to vitiligo area severity index Group 1, and in vitiligo disease activity score Group C compared to vitiligo disease activity score Groups A and B.
Study limitations: Single center experience, absence of more specific oxidative-stress markers and lack of long-term follow-up of the patients.
Conclusions: Frequency of metabolic syndrome was higher in patients with non-segmental vitiligo and the rate was higher in active/severe form of the disease
Voices of adolescent incest victims: a qualitative study on feelings about trauma and expectations of recovery
Get PDFBackground: Incest, is a serious social problem facing society and children/adolescents themselves. The purpose of this study is to explore the ways adolescents talk about and give meaning to their experiences of incest concerning cultural, ethnic factors relevant to southeastern of Turkey.
Method: We focused on in-depth interviews of five incest victims (14-16 years girls, from low socioeconomic status in southeastern of Turkey).
Results: Four key themes were constructed from the qualitative analysis: 1. Unable to understand/Delayed meaning-making: Adolescents provided definitive information about the first abuse memory but they were also unable to understand what they had experienced so they delayed meaning making. 2. Dysfunctional coping style with the incest: Adolescents told that they threatened the perpetrators in various phases of incest. 3. Avoidance of eye contact by the perpetrator: We recognized that perpetrators avoided social contact with the victim. This theme evokes dehumanizing of women during incest. 4. The urge to destroy happy memories: This theme presents data on the adolescents' expectations about recovery.
Conclusion: According to the themes, two fundamental therapeutic precepts could guide the treatment process for adolescent girl incest survivors: 1. Exploration of the delayed meaning making: Therapist could address dysfunctional family functioning and explain that it is normal for a child to be delayed in meaning making. 2. Recovery of the adolescent's lost self after semantic dehumanization in abuses: Therapist should help her to dispute irrational beliefs about worthlessness and to gain control of her body
A proinflammatory marker in chronic rhinosinusitis: serum calprotectin
Get PDFIntroduction: Studies have shown that calprotectin has a strong pro-inflammatory effect. Elevated calprotectin levels in the serum can be used as a strong clinical marker indicating the presence of inflammation. Objective: To investigate serum calprotectin levels in patients with chronic rhinosinusitis (CRS) and to determine the applicability of calprotectin as a potential molecular pro-inflammatory biomarker for CRS. Methods: The study consisted of three groups: chronic rhinosinusitis with polyps (CRSwNP group), chronic rhinosinusitis without polyps (CRSwoNP), and healthy control. CRS patients with polyps were further divided into two groups depending on the presence/absence of Samter's triad. The Nose Obstruction Symptom Evaluation (NOSE) scale score and serum calprotectin value were evaluated in all participants. Results: The mean serum calprotectin value was 79.5±11.8 ng/ml for the CRSwNP group, 71.3±16 ng/ml for the CRSwoNP group, and 61.9±11.6 ng/ml for the control group (p<0.001). The Samter's triad group had a significantly higher calprotectin value than the non-Samter's triad group (p=0.03). There was a significant correlation between the NOSE scores and calprotectin levels (rho=0.734, p<0.001). Conclusion: Serum calprotectin values were correlated with the severity of symptoms in patients with CRS; thus, it seems to be a valuable pro-inflammatory biomarker for the diagnosis of the disease and determining its severity. Further studies with larger series are needed to evaluate the preoperative and postoperative serum calprotectin values in patients undergoing surgery