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Maternal serum preptin levels in the pathogenesis and diagnosis of gestational diabetes mellitus
Get PDFBackground: Gestational diabetes mellitus (GDM) is a metabolic disorder that occurs during pregnancy that increases both maternal and fetal mortality and morbidity. It was investigated whether there is a change in circulating levels of preptin, a new peptide secreted from pancreatic beta cells, due to GDM in pregnant women. The relationship between serum preptin levels with insulin and other metabolic parameters was also evaluated in these subjects. Methods: Eighty-five patients diagnosed as GDM and 89 healthy pregnant women with 75 mg oral glucose tolerance test (OGTT) was assessed in terms of serum preptin levels. Results: The serum preptin levels of the GDM group were significantly higher than those of the control group (p=0.001; p < 0.01). For the cut-off value of preptin measurement of 335.3 ng/L, the sensitivity was 97.65%, specificity was 87.64%, positive predictive value was 88.3% and negative predictive value was 97.5%. The risk of developing the disease is 294.273 times higher in patients with preptin level of 335.3 and above. Conclusions: We think that the reason for the increase in serum preptin levels in GDM is probably the response to glucose. The current results indicate that preptin plays an important role in elucidating the pathology of GDM. In addition, the search for a practical marker for the diagnosis of GDM suggests that the measurement of preptin level is promising
Timing of Colonoscopy for Hemodynamically Stable Patients With Acute Lower Gastrointestinal Bleeding
Get PDFAcil kolonoskopi yapılmasına rağmen alt gastrointestinal sistem (GİS) kanamalarının etyolojisini tespit etme oranı düşüktür. Etiyoloji belirlenmiş olsa bile tekrar kanama olasılığı belirsizdir. Ayrıca acil durumlarda kolonoskopi için gerekli bağırsak temizliği sağlanamadığı için işlem başarısızlıkla sonuçlanabilmektedir. Bu çalışmanın amacı alt GİS kanaması olan hastaların barsak hazırlığı sonrası hastaneye ilk yatışları ve taburculuk sonrası etiyolojik tanılarını karşılaştırmaktır.
Üst GİS kanaması sonrası hemodinamik olarak stabil olan hastalar belirlenerek 2 gruba ayrıldı. Birinci gruptaki hastalara ilk yatışlarında kolonoskopi yapıldı. İkinci gruptaki hastalar taburcu olduktan 2 hafta sonra tekrar kolonoskopiye çağrıldı. Hastalar yaş, cinsiyet, kanama etiyolojisi, tam kolonoskopi işleminin mümkün olup olmadığı (çekum entübe edildi ve bağırsak temizliği bağırsak mukozasını değerlendirmek için yeterliydi), kolonoskopik girişim yapılıp yapılmadığına göre sınıflandırıldı.
Hastaneye ilk yatışlarında hemodinamik olarak stabil olan ve acil müdahale gerektiren hastaların oranı %5'tir. İlk yatış grubunda kolonoskopi tekrarlama oranı %70 olup, ikinci kolonoskopiye rağmen %50 oranında bulgusu olmayan hastalar elektif olarak tekrar değerlendirilmektedir.
Çalışmamız hemodinamik olarak stabil hastalarda kolonoskopinin tam bağırsak temizliği sonrasında elektif koşullarda yapılması gerektiğini düşündürmektedir.The detection rate of the etiology of the lower gastrointestinal system (GIS) hemorrhage has been low, although urgent colonoscopy has been performed. Even if the etiology has been specified, the possibility of rebleeding is uncertain. Furthermore, adequate bowel cleansing required for colonoscopy cannot be achieved in emergency situations, so the procedure may fail. The aim of this study is to compare the etiological diagnoses of patients with lower GIS bleeding after bowel preparation at their first hospitalization and after discharge.
Patients who were hemodynamically stable after upper GIS bleeding were identified and divided into 2 groups. Colonoscopy was performed in the first group of patients at their first hospitalization. The second group of patients was called again for colonoscopy within 2 weeks after discharge. Patients were classified according to their age, gender, bleeding etiology, whether complete colonoscopy procedure was possible (The cecum was intubated, and the bowel cleansing was sufficient to evaluate the intestinal mucosa), and whether the colonoscopic intervention was performed.
The rate of patients who are hemodynamically stable and require emergency intervention at their first hospitalization is 5%. The colonoscopy repeat rate is 70% for the first hospitalization group, and the patients with no findings despite the second colonoscopy at a rate of 50% are re-evaluated electively.
Our study suggests that colonoscopy should be performed in elective conditions after a complete bowel cleansing in hemodynamically stable patients
Covid-19 geçiren kişilerde entübasyona bağlı oluşan yutma bozukluğunun değerlendirilmesi = Evaluation of swallowing disorder due to intubation in people with Covid-19
No full textBu araştırmanın amacı invaziv mekanik ventilasyon yöntemi ile entübe edilen kişilerde entübasyonun yutma yapılarına zarar verip vermediğini ortaya koymaktır. Çalışmaya COVİD-19 teşhisi alıp entübe edilmiş 10 birey (X erkek, Y kadın) ile COVİD-19 teşhisi alıp entübe edilmeden tedavi görmüş 15 birey (X erkek, Y kadın) dâhil edildi. Entübe edilen katılımcıların yaş ortalaması 55,22±22 iken entübe edilmeyen katılımcıların yaş ortalaması ise 52,11±11'dir. Tüm katılımcılar Eating Assessment Tool (EAT-10), The Gugging Swallowing Screen (GUSS) ve Swallow Quality of Life Questionnaire (SWAL-QOL) ile değerlendirildi. Elde edilen bulgular istatistiksel olarak analiz edildi. Çalışmamızda entübe edilen gruptaki kişilerin EAT-10 değerleri entübe edilmeyenlerin EAT-10 değerleri arasında anlamlı farklılık (p=0,001) elde edildi. Entübe edilen grubun GUSS ölçeğinden aldığı puan ile entübe edilmeyen grubun aldığı puan arasındaki fark çok az olmasına karşın istatistiksel olarak anlamlı bir farklılık (p=0,027) saptandı. Entübe edilen ve edilmeyen gruplar arasında SWAL-QOL anketinin "Communication" alt boyutu (p=0,326) hariç tüm alt boyutlarında ("Burden" p=0,009, "Food Selection" p=0,009, "Eating Duration" p=0,044, "Eating Desire" p=0,039, "Fear" p=0,002, "Sleep" p=0,008, "Fatigue" p=0,000, "Mental Health" p=0,003, "Social" p=0,027) anlamlı farklılık saptandı. Elde edilen bulgulara göre COVİD-19'a bağlı olarak invaziv mekanik ventilasyon yöntemi ile entübe edilen bireylerde yutma bozukluğu gelişme ihtimali vardır.The aim of this study was to determine whether intubation damages swallowing structures in patients intubated with invasive mechanical ventilation. The study included 10 individuals (X male, Y female) who were diagnosed with COVID-19 and intubated and 15 individuals (X male, Y female) who were diagnosed with COVID-19 and treated without intubation. The mean age of intubated participants was 55.22±22 years, while the mean age of non-intubated participants was 52.11±11 years. All participants were evaluated with the Eating Assessment Tool (EAT-10), The Gugging Swallowing Screen (GUSS) and Swallow Quality of Life Questionnaire (SWAL-QOL). The findings were statistically analyzed. In our study, a significant difference (p=0.001) was obtained between the EAT-10 values of the intubated group and the EAT-10 values of the non-intubated group. Although the difference between the GUSS scale score of the intubated group and the non-intubated group was very small, a statistically significant difference (p=0.027) was found. There was a statistically significant difference between the intubated and non-intubated groups in all sub-dimensions of the SWAL-QOL questionnaire ("Burden" p=0.009, "Food Selection" p=0.009) except for the "Communication" sub-dimension (p=0.326), "Eating Duration" p=0.044, "Eating Desire" p=0.039, "Fear" p=0.002, "Sleep" p=0.008, "Fatigue" p=0.000, "Mental Health" p=0.003, "Social" p=0.027) were significantly different. According to the findings, swallowing disorder is likely to develop in individuals intubated with invasive mechanical ventilation method due to COVID-19
Sağ beyin hasarının dil üzerindeki etkisi = Effect of RİGHT brain damages on language
No full textDilsel işlemlemede sol serebral hemisferin baskınlığı, pek çok araştırma ile ortaya konmuş ve kabul görmüştür. Güncel nörogörüntüleme bulguları, sağ serebral hemisferin dilin prozodik ve sosyal kullanım boyutu ile ilgili süreçleri yönettiği ve işitsel anlamanın erken kortikal evrelerinde görev aldığını göstermektedir. Türkçe konuşan bireylerde sağ serebral hemisferin vasküler hasarlarının neden olduğu dil bozuklukları ile ilgili yeteri sayıda çalışma bulunmamaktadır. Bu amaçla sağ serebral hemisfer lezyonu olan bireyler; sol serebral hemisfer lezyonu olan ve herhangi nörolojik hastalığı olmayan sağlıklı bireyler ile Afazi Dil Değerlendirme testi (ADD) ve anlatı analizi üzerinden karşılaştırılmıştır. Sağ serebral hemisfer hasarı olan bireylerde afazi tanısı olmamasına rağmen, ADD alt testlerinden konuşma akıcılığı alt testinde sağlıklı kontrollere göre düşük performans göstermişlerdir. Benzer biçimde anlatı analizinde ifade revizyonu tipindeki çabalar ve toplam çaba oranı sağlıklı kontrollere göre anlamlı ölçüde yüksek sıklıktadır. Planlama, soyutlama ve görsel yapılandırma becerisini gerektiren Saat Çizimi testinde sağ hemisfer hasarlı bireyler sağlıklı kontrollere göre daha düşük skorlar elde etmişlerdir. Sonuçlar, sağ serebral hemisfer hasarının dilin çeşitli bileşenleri ve yürütücü işlevlerde bozulmaya yol açtığını göstermektedir.The dominance of the left cerebral hemisphere in linguistic processing has been demonstrated and accepted by many studies. Recent neuroimaging findings suggest that the right cerebral hemisphere manages processes related to prosodic and social use of language and is involved in the early cortical stages of auditory comprehension. There are not enough studies on language disorders caused by vascular damage to the right cerebral hemisphere in Turkish-speaking individuals. For this purpose, individuals with right cerebral hemisphere lesions were compared with healthy individuals with left cerebral hemisphere lesions and without any neurological disease on the Aphasia Language Assessment Test (ADT) and narrative analysis. Although individuals with right cerebral hemisphere damage did not have a diagnosis of aphasia, they showed lower performance than healthy controls in the speech fluency subtest of the ADD subtest. Similarly, in narrative analysis, expression revision type efforts and total effort rate were significantly higher than healthy controls. In the Clock Drawing test, which requires planning, abstraction and visual structuring skills, individuals with right hemisphere damage scored lower than healthy controls. The results suggest that right cerebral hemisphere damage leads to impairment in various components of language and executive functions
Prediction of Preterm Delivery Using Serum Ischemia Modified Albumin, Biglycan, and Decorin Levels in Women with Threatened Preterm Labor
Get PDFObjective The serum ischemia modified albumin (IMA), biglycan, and decorin levels of pregnant women who were hospitalized for threatened preterm labor were measured.Methods Fifty-one consecutive pregnant women with a single pregnancy between the 24( th) and 36 (th) weeks with a diagnosis of threatened preterm labor were included in the present prospective cohort study.Results As a result of multivariate logistic regression analysis for predicting preterm delivery within 24 hours, 48 hours, 7 days, 14 days, <= 35 gestational weeks, and <= 37 gestational weeks after admission, area under the curve (AUC) (95% confidence interval [CI[) values were 0.95 (0.89-1.00), 0.93 (0.86-0.99), 0.91 (0.83-0.98), 0.92 (0.85-0.99), 0.82 (0.69-0.96), and 0.89 (0.80-0.98), respectively. In the present study, IMA and biglycan levels were found to be higher and decorin levels lower in women admitted to the hospital with threatened preterm labor and who gave preterm birth within 48 hours compared with those who gave birth after 48 hours.Conclusion In pregnant women admitted to the hospital with threatened preterm labor, the prediction preterm delivery of the combined model created by adding IMA, decorin, and biglycan in addition to the TVS CL measurement was higher than the TVS CL measurement alone
The effect of transverse friction massage on pain and quality of life in women with chronic pelvic pain: A quasi-experimental study
No full textBackground/Aims Chronic pelvic pain is defined as pain located to the pelvis or lower abdominal region, lasting for at least 6 months, and not associated with menstruation, coitus or pregnancy. The aim of this study was to investigate the feasibility and effectiveness of transverse friction massage on pain and quality of life in women with chronic pelvic pain. Methods A total of 20 women participated in this study. Eight sessions of transverse friction massage were performed twice a week for 4 weeks, with each session lasting 30 minutes. Pelvic floor muscles (in terms of tenderness, trigger point, spasm and scar presence) were evaluated by digital palpation by an expert physiotherapist. The outcome measures used were the visual analogue scale, the 36-item Short Form-36 Survey and the Beck Depression Inventory. Participants were evaluated before treatment, at the end of the treatment, and 4 weeks after the end of the treatment. Results Participants' mean age was 49.7 +/- 0.31 years. There was a decrease in pain intensity and an increase in quality of life scores (P0.001). Four weeks after the end of the treatment, significant decreases in pain severity, quality of life and depression were observed (P<0.001). Conclusions Transverse friction massage is a feasible treatment option that can safely be used by physiotherapists to treat patients with chronic pelvic pain. It is inexpensive and can help to reduce pain and increase patients' quality of life. Randomised controlled trials are recommended to further confirm the findings from this study
Impact of Promising Biomarkers on Severity and Outcome of Acute Pulmonary Embolism
Get PDFBackground: Acute pulmonary embolism (APE) is a common clinical condition. Its severity ranges from asymptomatic radiological findings to fatal obstructive shock. The potential circulating biomarkers have been studied to predict APE outcomes. This study aimed to explore their predictive power on prognosis in APE.Material and Method: It was a prospective observational study between March 2008 and April 2010. All consecutive patients diagnosed with APE were categorized as massive/high-risk, submassive/moderate-risk, and non-massive/low-risk. Cardiac troponin T (cTnT), myoglobin, N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (H-FABP), growth differentiation factor-15 (GDF-15), and D-dimer levels were measured.Results: Of these patients, 14 (29.8%), 16 (34.0%), and 17 (36.2%) patients were categorized as low-risk, moderate-risk, and high risk-patients, respectively. There was no significant difference between the patient groups categorized based on the risk stratification in terms of demographic and clinical characteristics. The cTnT, myoglobin, HFABP, and D-dimer levels have also not differed significantly between the groups. There was a significant difference between the groups in respect of NT-proBNP and GDF-15 levels (p=0.009 and p=0.037, respectively). Nine (19.1%) patients had died by the 3rd-month follow-up. Adverse events were seen in 26 (55.3%) patients. GDF-15 had the highest area under the curve (AUC) value for predicting any adverse event (cut-off value=9.3 ng/ mL, AUC=0.796, CI (confidence interval) 95%: 0.653-0.899). NT-ProBNP was determined as the best predictor for mortality (cut-off value=229.2 pg/mL, AUC=0.889, CI 95%: 0.756-0.964).Conclusion: Higher levels of NT-proBNP and GDF-15 were found to be associated with more severe APE, worse outcomes, and mortality
Individual factors impacting tourist satisfaction and revisit intention in slow tourism cities: an extended model
Get PDFPurposePostpandemic efforts to rebuild have steered the global economy toward a more sustainable trajectory. It is imperative to acknowledge the pressing need for further enhancements in the sustainable development of the tourism industry. This study aims to examine the influence of personal factors, including environmental concern, cultural interest, travel lifestyle and involvement, on tourist satisfaction and revisit intention, using the theory of planned behavior (TPB) as its framework.Design/methodology/approachThe data was gathered through surveys conducted in three of Turkiye's most famous slow travel destinations: Seferihisar, Gokceada and Akyaka. The analysis was carried out using SPSS and SmartPLS software, with subsequent structural model testing.FindingsThis study presents an extended model that incorporates four individual factors, tourist satisfaction, TPB and revisit intention. All hypotheses have been rigorously tested, and the model accounts for 60.4% of the variance in revisit intention. The findings are comprehensively discussed in this article, supported by relevant theoretical frameworks.Research limitations/implicationsFuture research avenues could delve into the evolution of slow tourism in both developed and developing countries, assess disparities in revisit intentions between slow tourism and mass tourism destinations and investigate the prospects of sustainable tourism development in the postpandemic era.Originality/valueThe authors use the TPB to examine individual factors, tourist satisfaction and revisit intentions, aiming to build an extended model to gain a deeper understanding of the slow tourist decision-making process
Does Electrical Status Epilepticus in Sleep Adversely Affect Language in Self-Limiting Focal Epilepsies of Childhood?
Get PDFIntroduction: The electrical status epilepticus in sleep (ESES) accompanies a wide spectrum of focal and generalized epilepsies, which manifest with cognitive-linguistic regression. Both ESES and language impairment can be seen in self-limited focal epileptic syndromes of childhood (SFEC). The association between the presence of ESES pattern on the EEG and the severity of the language impairment has not been adequately clarified.
Methods: Twenty-eight SFEC cases without intellectual and motor disabilities and 32 healthy children were recruited. Cases with active ESES (A-ESES, n=6) and without ESES pattern on EEG (non-ESES, n=22) were compared in terms of clinical features and linguistic parameters by both standard and descriptive assessment tools.
Results: The only significantly different clinical feature in the A-ESES group was the increased prevalence of polytherapy. While most of the linguistic parameters were impaired in A-ESES and non-ESES groups compared to healthy controls, A-ESES patients differed from non-ESES patients only in terms of decreased complex sentence production, which was assessed by narrative analysis. A-ESES patients also showed trends toward producing lower numbers of words, nouns, verbs, and adverbs during narrative analysis. There were no differences among patients under polytherapy and monotherapy in terms of these language parameters.
Conclusion: Our results show that ESES increases the negative effect of chronic epilepsy on complex sentence and word production. Linguistic distortions that are not reflected in objective tests can be detected by narrative tools. Complex syntactic production obtained by narrative analysis is an important parameter that extensively characterizes language skills in school-age children with epilepsy
In vitro effects of heparin-binding epidermal growth factor on adhesion stage of implantation
Get PDFA member of the epidermal growth factor (EGF) family, the heparin-binding EGF (HB-EGF) is expressed in the uteri of both humans and mice during the implantation process. To study the effects of HB-EGF on adhesion stage, we developed an in vitro implantation model employing Ishikawa cell line and JAR cell line, which may attach to Ishikawa cells. For 1, 6, 12, and 24 hours, co-cultures of JAR spheroids grown on Ishikawa monolayers were treated with 1, 10, and 100 ng/mL doses of HB-EGF. Using immunocytochemistry and Western blot analysis, the effects of HB-EGF on the protein expressions of E-cadherin, Erb-B2 receptor tyrosine kinase 4 (ErbB4), and integrin alpha nu beta(3) in Ishikawa and JAR cells were examined semi-quantitatively and quantitatively. Ultrastructural changes of in vitro implantation model were investigated by transmission electron microscopy. We revealed that HB-EGF influenced trophoblast cell adhesion to endometrial cells by upregulating the expression of the proteins ErbB4 and trophoblastic integrin alpha nu beta(3). Decrease in trophoblastic E-cadherin expression and increase in endometrial E-cadherin expression were demonstrated accompanying morphological variations in cells required for the invasion. We discovered ultrastructurally that Ishikawa cells acquired uterodome-like appearance, including the organelles, when 10 and 100 ng/mL dosages of HB-EGF were administered for 12 and 24 hours. However, following additional hours of adhesion and invasion, their intercellular spaces enlarged. The trafficking of vesicular transport was enhanced by JAR spheroids. We therefore discovered that in this implantation paradigm, HB-EGF may enhance the receptivity of Ishikawa cells and the adherence of JAR cells