Objective: Malnutrition is associated with poor clinical outcomes in many diseases. The Controlling Nutritional Status (CONUT) is an objective index used for evaluating nutritional status of hospitalized patients. The aim of this study was to investigate the relationship between malnutrition assessed by CONUT score and the prognosis in patients undergoing carotid artery stenting (CAS). Methods: The study included 170 patients who underwent CAS due to symptomatic or asymptomatic severe carotid artery stenosis. Median follow-up period was 50 (interquartile range [IQR], 41-60) months. Patients were divided into two groups according to the CONUT score: (i) normal nutrition (<2) and (ii) malnutrition (≥2). Primary endpoint was accepted as MACE (major adverse cardiac events) including all-cause death and ischemic stroke. Results:The prevalence of MACE was significantly higher in the malnutrition group (p=0.001). Kaplan Meier analysis showed lower survival rates in the malnutrition group (log rank = 9.36, p=0.002; Figure 4). In multivariate logistic regression analysis, age and CONUT score were independent predictors of all-cause death and stroke after adjustment for confounding factors, respectively, (OR: 1.058, 95% CI: 1.013-1.105, p=0.011, OR: 1.318, 95% CI: 1.017-1.881, p=0.039). Conclusion: Higher CONUT scores were associated with adverse outcomes in patients with CAS. Malnutrition assessed by the CONUT score may provide valuable prognostic information in patients with CAS.
BACKGROUND: This study aims to determine nicotine dependence levels in pre and during pandemic and its correlations with COVID-19 phobia among healthy men during controlled social life: a sample of primary care population. METHODS: This cross-sectional study was conducted with 472 healthy men in Çorum, Black Sea Region, Turkey between February 2019 and October 2020. An online questionnaire was used to collect data including demographic profile, smoking behavior, intention to quit, Fagerström Nicotine Dependence test (FTND) pre and during COVID-19 pandemic and COVID-19 phobia scale. RESULTS: In this study, a percentage change of +6.2, +0.8, +1.9, -2.7, -5.1 was found in very low, low, medium, high and very high dependence categories respectively between pre-pandemic and during controlled social life in pandemic. A percentage change of +2.8 was seen in terms of intention to quit smoking. The mean score for COVID-19 phobia was 65.9 ± 15.8 and almost two-thirds of the participants (62%) had medium and high COVID-19 phobia. Men with high/very high dependence had significantly more COVID-19 phobia than the other two groups. There was a significant correlation between FTND scores and COVID-19 phobia. CONCLUSIONS: There were considerable changes in dependence levels and COVID-19 phobia was more common in high/very high dependence group. Controlled social life should be considered a golden opportunity for predicting levels of nicotine dependence and will bring benefit for lower smoking prevalence. COVID-19, Nicotine dependence, Phobia, men, Primary health care.
Introduction: Global medical advances within healthcare have subsequently led to the widespread introduction of biological products such as grafts, haemostats, and sealants. Although these products have been used for many decades, this subject is frequently not discussed during the consent process and remains an area of contention. Methods: A nationwide confidential online survey was distributed to UK-based junior registrars (ST3-5), senior registrars (ST6-8), post-CCT fellows, specialist associates/staff grade doctors and consultants working in general/vascular surgery, neurosurgery, otolaryngology, oral & maxillofacial surgery and plastic surgery. Results: Data was collected from a total of 308 survey respondents. Biological derivatives were correctly identified in surgical products by only 25% of survey respondents, only 19% stated that they regularly consent for use of these products. Our results demonstrate that most participants in this study do not routinely consent (81%) to the intra-operative use of biological materials. An overwhelming 74% of participants agreed that further education on the intra-operative use of biological materials would be valuable. Discussion: This study highlights deficiencies in knowledge that results in potential ethical compromise of the consenting process for surgical procedures. A solution to this would be for clinicians to increase their awareness via educational platforms and to incorporate an additional statement on the consent form which addresses the potential intraoperative use of biological products and what their derivatives may be. Conclusion: Modernising the current consent process to reflect the development and use of surgical biological products will help to ensure improved patient satisfaction, fewer future legal implications as well as a better surgeon-patient relationship.
Introduction The COVID-19 vaccination programme is under way. Anecdotal evidence is increasing that some people with Type 1 Diabetes Mellitus (T1DM) experience temporary instability of blood glucose (BG) levels post-vaccination which normally settles within 2-3 days. We report an analysis of BG profiles of 20 individuals before and after vaccination. Methods We examined the BG profile of 20 consecutive adults (18 years of age or more) with T1DM using the FreeStyle® Libre flash glucose monitor in the period immediately before and after COVID-19 vaccination. The primary outcome measure was percentage(%) BG readings in the designated target range 3.9-10mmmol/L as reported on the LibreView portal for 7 days prior to the vaccination (week -1) and the 7 days after the vaccination (week +1). Results There was a significant decrease in the %BG on target following the COVID-vaccination for the 7 days following vaccination (mean 45.2% ±se 4.2%) vs pre-COVID-19 vaccination (mean 52.6% ±se 4.5%). This was mirrored by an increase in the proportion of readings in other BG categories 10.1-13.9%/ ≥14%. There was no significant change in BG variability in the 7days post COVID-19 vaccination. This change in BG proportion on target in the week following vaccination was most pronounced for people taking Metformin/Dapagliflozin+basal bolus insulin (-23%) vs no oral hypoglycaemic agents (-4%), and median age <53 vs ≥53 years (greater reduction in %BG in target for older individuals (-18% vs -9%)). Conclusion In T1DM, we have shown that COVID-19 vaccination can cause temporary perturbation of BG, with this effect more pronounced in patients talking oral hypoglycaemic medication plus insulin, and in older individuals. This may have consequences for patients with T2DM who are currently not supported by flash glucose monitoring.
Background: Pediatric Emergency Care Applied Research Network (PECARN) is a useful Clinical Decision Support Tool (CDST) to identify traumatic brain injuries and reduce the use of head CT scans among pediatric patients. The present Meta-analysis aims to evaluate the diagnostic accuracy of the PECARN rule from 2009 to 2020 in children with a very low risk of blunt head trauma. Methods: A detailed search was conducted from the databases of Medline (via PubMed), Cinahl (via Ebsco), Scopus, Web of Sciences, from 2009 till the end of December 2020 using the keywords like decrease use of CT scan, blunt head trauma (BHT) combined with accuracy, Pediatric Emergency Care Applied Research Network (PECARN) OR Clinical Decision Support Tool (CDST). Studies showing the diagnostic accuracy of the PECARN rule in children younger than 18 years of age with minor BHT were included. Results: 13 studies were included in the present analysis. Pooled sensitivity of 0.08, (95% confidence interval of 0.074 - 0.087), pooled specificity of 0.20 ( 95% CI of 0.196 - 0.213) and diagnostic odds ratio of 0.004 (95% CI of 0.000-0.1666) was in <2 years of age. The overall sensitivity of 0.07, specificity of 0.66, and diagnostic odds ratio of 0.54 (95% CI of 0.10 -2.78) was seen in ≥2 years of age. Overall sensitivity of 0.13 (95% CI 0.12-0.14), specificity of 0.81 (95% CI 0.80-0.82) and diagnostic odds ratio of 0.79 (95% CI of 0.08 -7.71) was in 0-18 years of age. Conclusion: The present analysis indicates the PECARN decision tool as an accurate CDST in low-risk minor blunt head trauma cases in children below two years of age and can become a useful tool in reducing Head CT’s scan overuse in pediatric emergency departments.
Aims: To our knowledge, this is the first study investigating the impact of high visceral adiposity index on female sexual dysfunction (FSD). We aimed to show the impact of increased levels of visceral adiposity index (VAI) on FSD compared to body mass index (BMI) and waist circumference (WC). Methods: We included 158 participants in two groups: Group 1 (n=68 with normal sexual function) and Group 2 (n=90 with sexual dysfunction). Demographic, clinic data, presence of metabolic syndrome (MeTS) and comorbidities were recorded. The BMI, WC and the visceral adiposity index were calculated. Sexual function was assessed using the female sexual function index (FSFI). Results: The mean age and all the anthropometric variables were similar between the groups (p>0.05). Metabolic syndrome was associated with lower arousal and lubrication scores than those without metabolic syndrome (p=0.023). The higher VAI was associated with lower desire, lubrication and orgasm scores (p<0.05). Each integer increase of the VAI weakly predicted decrease of desire (p=0.015), arousal (p=0.015), lubrication (p=0.005) and satisfaction (p=0.046). Conclusion: The VAI was linked with lower scores in some female sexual function subdomains, but the correlation coefficient was low, indicating a weak association. Further studies with a higher number of participants are needed to conclude that the VAI may increase the risk of FSD, particularly in patients with metabolic syndrome.
Background: Flaxseed may be beneficial for the management of obesity due to its high content of alpha-linolenic acid, fiber, and lignans. Objective: We aimed to evaluate the effects of Flaxseed consumption on serum lipids, adiponectin, leptin, and weight loss in overweight or obese women. Methods: This randomized controlled clinical trial involved 60 overweight or obese women. Participants were randomly allocated to two groups; a) a balanced diet plus 30 g/day milled Flaxseed and b) a balanced diet plus 30g/day milled rice (as control group), for 12 weeks. Anthropometric indices, serum lipids, leptin, and adiponectin levels were measured at baseline and at the end of intervention. Results: After 12 weeks of intervention, there were significantly higher reductions in waist circumference (WC) and waist to hip ratio (WHR) (both P<0.05) in the flaxseed group compared to the controls. Moreover, adiponectin level was significantly increased in the flaxseed group (17.15±6.1) compared to the controls (16.83±10.5), (P=0.001). However, there were no significant differences in serum lipid levels between the study groups before and after the intervention (all p>0.05). Conclusion: Flaxseed consumption may improve adiposity markers, as well as adiponectin levels Thus, flaxseed consumption could be an adjunctive therapy to attenuate central obesity. Serum lipid profile has not changed significantly after flaxseed consumption. Keywords: obesity, flaxseed, adiponectin, Leptin, blood lipids
Objective: Pulmonary embolism (PE) is usually a complication of deep vein thrombosis and is an important cause of mortality and morbidity. Vascular endothelial growth factor D (VEGF-D) is a secretory protein that plays a role in the remodeling of blood vessels and the lymphatic system. This study aimed to determine the relationship between VEGF-D level and clinical risk scoring in patients with PE. Methods: The study included 117 patients admitted for PE that were divided into 4 groups: high-risk patients (n=35), high-intermediate-risk patients (n=30), low-intermediate-risk patients (n=24), and low-risk patients (n=28). Plasma VEGF-D was measured from peripheral venous blood samples (5 cc) using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Pulmonary Artery Obstruction Index (PAOI) was calculated from CT angiography imaging. Results: VEGF-D levels in the low-risk PE group differed significantly from those in the high-intermediate and high-risk groups (p=0.001 for both) but not from that in the low-intermediate-risk PE group (p=0.155). There was no significant difference in troponin-I and NT-proBNP levels between the high-intermediate-risk and high-risk PE patients, whereas VEGF-D levels differed significantly (p=0.134, p=0.146, p=0.016). VEGF-D level was moderately correlated with mean pulmonary artery pressure and PAOI (r=0.481, p=0.01; r=0.404, p=0.01). In ROC curve analysis, a cut-off of 370.1 pg/ml for VEGF-D had 91.4% sensitivity and 67.4% specificity in the differentiation of high-intermediate-risk and high-risk PE patients. Conclusion: This study showed that plasma VEGF-D level was more reliable than troponin-I and NT-proBNP in clinical risk scoring and demonstrating thrombus burden. VEGF-D can be used as a biomarker in clinical risk scoring and estimation of thrombus burden in patients with acute PE.
Background: The nonclassic presentation of pediatric celiac disease (CD) becomes increasingly common in daily practice, which requires an awareness of its extraintestinal clinical findings. To evaluate eye involvement and effect of gluten free diet on ocular involvement in pediatric CD patients by measuring the thicknesses of choroid and ganglion cell complex(GCC) composed of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and inner plexiform layer (IPL) using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: Forty-three CD patients aged between four and 16 years (mean age;9.9 ± 4.1, 12 boys and 31 girls), and 48 healthy children (mean age; 11.3 ± 4.1,17 boys and 31 girls) were compared. Following comprehensive eye examinations, thicknesses of choroid at three points and GCC layers (RNFL at five points, GCL and IPL) were obtained using EDI-OCT. Measurement of thicknesses of choroid and GCC layers by a trained EDI-OCT technician and an ophthalmologist who were not aware about group of children in pediatric CD patients with one year gluten free diet. Results: All layers of subfoveal, nasal, temporal choroid were significantly thinner in CD than in the control group (p < .001, p < .001, and p < .001, respectively). No significant difference were observed between the CD and control groups in terms of GCC thicknesses (p > .05). Conclusion: Pediatric CD causing thinning of subfoveal, nasal and temporal areas of choroid, and this change is apparent even after one year gluten free diet. This extraintestinal involvement should be more closely screened at diagnosis and long term clinical results of thin choroid should be determined. Thicknesses of GCC layers were not different in CD group may be revealing the effect of diet or not involvement.
Objective: To analyze the serum markers for the early diagnosis of intestinal anastomotic leak (AL) after the gyne-oncological operations. Methods: Between September 2017 and March 2021, patients with an intestinal anastomosis performed during the gyne-oncological surgeries were identified from a tertiary center in Turkey. As the local guideline of the clinic, all these patients were followed by measuring serum samples including procalcitonin (PCT) and C-reactive protein (CRP) on postoperative day (POD) 1 through the day of discharge or the day of re-operation for AL. Results: 12.5% (5/40) of the patients suffered an AL and 4 of them were re-operated. The mean albumin values on POD 3-4 and the mean platelet values on POD 1 were lower in the AL group (p<0.05). Although it was not statistically significant (p>0.05), median PCT values (ng/mL) on POD 8-10 were higher in the AL group compared with no leak group. The best cutt-off point for PCT on POD 9 was determined to be 0.11 ng/mL (AUC: 0.917, Sensitivity = %100.0, specifity = %66.7, positive predictive value = %66.7, negative predictive value = %100.0). Conclusion: Serum PCT and CRP concentrations were not found to be helpfull for the early diagnosis of AL in patients operated for gyne-oncological malignancies. Low levels of albumin and platelets in the first days after the operation may be clue for a possible AL.
Aim Sacroiliac joint dysfunction is an especially common cause of pain during pregnancy. Treatment options during pregnancy are very limited in order to reduce pain and increase the quality of life. We aimed to determine the efficacy of kinesiotaping (KT) in the treatment of sacroiliac joint pain in pregnant women. Methods A total of 50 pregnant women with sacroiliac joint pain were included in the study. Patients were randomized into two groups as KT and sham KT groups. Women in the KT group underwent a total of five weeks of KT once per week; the sham KT group also underwent five weeks of KT applications, but without tension in the kinesiotape. Patients were assessed before and five weeks after the treatment with a visual analogue scale (VAS) for pain and the Roland-Morris Disability Questionnaire (RMDQ) and Pelvic Girdle Questionnaire (PGQ) for disability and quality of life. Results The KT and sham KT groups were similar in terms of age, parity, gravidas, gestational week, and body mass index. At the beginning of the study, there were no statistically significant differences between the two groups in their VAS, RMDQ, or PGQ scores. Five weeks later, the KT group showed significant improvement in all parameters, but no significant differences were observed for the sham KT group in terms of VAS, RMDQ, or PGQ. Conclusions KT treatment improved the pain levels, functioning, and quality of life among pregnant women with sacroiliac joint pain. Keywords Sacroiliac joint pain; Pregnancy; Kinesiotaping
Objective: De Quervain tenosynovitis is the most common cause of lateral wrist pain. The diagnosis can be made with the Finkelstein test when pain is provoked with wrist ulnar deviation. Conservative treatment including rest, non-steroidal anti-inflammatory medication and physical therapy is applied first, then there may be a need for corticosteroid injections, and in resistant cases, surgery. The aim of this study was to evaluate the effectiveness of neural therapy (NT) on pain and hand functions in patients with De Quervain tenosynovitis. Methods: A total of 36 patients admitted between May 2019 and March 2020 were randomly assigned to neural therapy (NT) and control groups. Hand rest and thumb spica splint were applied to all the patients, and NT interventions to the NT group only. A visual analog scale (VAS) and the Duruöz Hand index (DHI) were used to measure pain and functionality at baseline, then at 1 and 12 months after the end of the treatment. Results: The NT and control groups both showed improvements in VAS and DHI scores at 1 and 12 months compared to baseline. The VAS scores were significantly lower at both 1 and 12 months compared to baseline in the NT group. The DHI scores were lower in the NT group at 1 month, and at 12 months there was no significant difference between the two groups. No adverse effects were seen in any patient. Conclusion: NT seems to be effective in reducing pain and improving hand functions in patients with De Quervain tenosynovitis.
Background: Obesity is a global issue. Energy density (ED) can influence on body compositions (BCs). Consumption of HED (high energy density) foods can increase body fat mass (BFM) and inflammatory markers. Methods: This study was a cross-sectional research among 391 women. Body composition analyzer (BIA) and food frequency questionnaire (FFQ) was used to assess BCs and food intake of individuals. Blood samples and serum level of high-sensitive C-reactive protein (hs-CRP), plasminogen activator inhibitor- 1 (PAI-1) and transforming growth factor-β (TGF-beta) were collected. ED per one gram of foods were calculated and divided to quartiles. Linear logistic regression tests were used to investigate the association between BCs across quartiles of ED intake. Results: Results demonstrate skeletal muscle mass (SMM), total body water (TBW), intracellular water (ICW), fat free mass (FFM), visceral fat area (VFA) and fat free mass index (FFMI) was seem to be under the effect of hs-CRP among ED intakes. TBW, extracellular water (ECW), FFM with PAI-1, bone mineral content (BMC) with PAI-1 and TGF-beta, and Skeletal lean mass (SLM) with hs-CRP were inversely associated. Fat right arm (FRA), fat right arm (FLA), fat right and left leg (FRL,FLL), fat trunk, TBW, ICW, ECW, BFM, FFM, SMM, SLM, waist circumference (WC), FFMI and FMI were positively under the influence of TGF-beta after following higher ED food intakes. FRA, FLA, FRL, FLL, fat trunk, ICW, BFM, SMM, SLM, WC, FFMI and FMI were positively under the influence of PAI-1. Conclusion: All adipose tissue content of subcategories of BC were strongly associated with ED intake in the mediatory role of PAI-1 and TGF-beta.
Background: Injury represents 260,000 hospitalisations and $27 billion in healthcare costs each year in Canada. Evidence suggests that there is significant variation in the prevalence of hospital admissions among ED presentations between countries and providers but we lack data specific to injury admissions. We aimed to estimate the prevalence of potentially low-value injury admissions following injury in a Canadian provincial trauma system, identify diagnostic groups contributing most to low-value admissions and assess inter-hospital variation. Methods: We conducted a retrospective multicenter cohort study based on all injury admissions in the Québec trauma system (2013-2018). Using literature and expert consultation, we developed criteria to identify potentially low-value injury admissions. We used a multilevel logistic regression model to evaluate inter-hospital variation in the prevalence of low-value injury admissions with intraclass correlation coefficients (ICC). We stratified our analyses by age (1-15; 16-64; 65-74; 75+ years). Results: The prevalence of low-value injury admissions was 16% (n=19,163) among all patients, 26% (2136) in children, 11% (4695) in young adults and 19% (12,345) in older adults. Diagnostic groups contributing most to low-value admissions were mild traumatic brain injury in children (48% of low-value pediatric injury admissions; n=922), superficial injuries (14%, n=660) or minor spinal injuries (14%, n=634) in adults aged 16-64, and superficial injuries in adults aged 65+ (22%, n=2771). We observed strong inter-hospital variation in the prevalence of low-value injury admissions (ICC=37%). Conclusion: One out of six hospital admissions following injury may be of low-value. Children with mild traumatic brain injury and adults with superficial injuries could be good targets for future research efforts seeking to reduce health care services overuse. Inter-hospital variation indicates there may be an opportunity to reduce low-value injury admissions with appropriate interventions targeting modifications in care processes.
ABSTRACT Introduction: Sjögren syndrome is a chronic, systemic, inflammatory disease characterized with lymphocytic infiltration of the exocrine glands, frequently manifested by dryness in the region affected. Although the most common extraglandular involvement in SS is pulmonary involvement. Early diagnosis and treatment is considered to be important. It was aimed to evaluate the frequency of early lung involvement, high resolution computed tomography (HRCT) findings and data of pulmonary function test (PFT) in SS in this study. Material-Method: Thirty five patients diagnosed with SS and referred by the Department of Rheumatology to determine potential lung involvement to the 8th chest diseases outpatient clinic of our hospital between September 2015 and December 2018 were included in this study. Respiratory signs, demographic features, length of disease and treatment regimens, PFT, data of 6-minute walk test (MWT) and findings of HRCT of the patients were retrospectively obtained from hospital information system and patient files. Results: The mean age of the patients was 54.4 ± 9.2. The majority of the patients were women (94.3%). When the HRCT findings were evaluated, 28 (80%) patients had CT findings, while 7 (20%) patients had no CT findings. The most common HRCT findings found in patients were peribronchial thickening (48.6 %), ground glass appearance (28.6%) and prominence in interstitial scars. Conclusion: We think that the evaluation of HRCT and PFTs in patients diagnosed with SS for assessing early pulmonary involvement will be guiding in terms of follow-up and treatment.
Objective:After radical prostatectomy,prostate-specific antigen(PSA) value measuring ≥0.1ng/ml is defined as persistent PSA(pPSA) and in many studies,it was found to be associated with aggressive disease and poor prognosis.Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic center and to make a nomogram,predicting pPSA value based on operative data,useful. Methods:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative,operative,and postoperative data were collected.Based on the PSA values (ng/ml) measured after 4-to-8 weeks of RARP,patients were divided into 2 groups as pPSA group (Group1)(n=97) with PSA values ≥0.1ng/ml and undetectable PSA group (Group2)(n=778) with PSA values <0.1ng/ml.Later on,Group1 was further divided into Group1a (PSA:0.1-0.2ng/ml) and Group 1b (PSA≥0.2ng/ml) to evaluate biochemical recurrence(BCR). Results:Multivariate logistic regression analyses of the collected data revealed that PSA>20ng/ml,operation time,a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4, and pN were independently associated with pPSA.According to the results, a nomogram predicting pPSA was developed(Table 4).By looking at the nomogram pPSA was found in 98.9% of the cases with a PSA value of ≥20ng/ml, an operation time of 150 minutes, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a PSA value of <20 ng/ml, an operation time of 100 minutes, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4, and pN-.The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (p<0.001).Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (p<0.001). Conclusion:For the patients who underwent RARP,factors associated with aggressive disease can predict the PSA persistence.To plan our treatment modalities accurately,an applicable nomogram in daily practice would be useful.