Menü Kapat

Life advices in patients with tracheostomy: Rational antibiotic use and cerebro-vascular prophylaxis-physiotherapy

Original Article

Life advices in patients with tracheostomy: Rational antibiotic use and cerebro-vascular prophylaxis-physiotherapy

Eylem Tuncay, Ozlem Yazicioglu Mocin, Sinem Gungor, Nezihe Ciftaslan Goksenoglu, Ilim Irmak, Cuneyt Salturk, Feyza Kargin, Huriye Berk Takir, Mustafa Ay, Veysel Garani Soylu, Emine Aksoy1, Gokay Gungor, Nalan Adiguzel, Zuhal Karakurt

   

Abstract
Tracheostomy is life-saving procedure in critical care patients which require long-term mechanical ventilation (MV) and an alternative to endotracheal intubation.(1,2) The factors affecting the survival of tracheostomized patients are not clearly known. The aim of this study was to investigate the factors affecting intensive care unit (ICU) and long-term mortality in the tracheostomized patients due to respiratory failure. A retrospective observational cohort study was planned between January 2016-2019 in tertiary ICU. Each patient underwent percutaneous and surgical tracheostomy was included. Demographic characteristics, diagnoses, causes of tracheostomy, comorbidities, Charlson and APACHE 2 scores, culture antibiogram results, ICU day and mortality (1-3 and 12 months) were recorded. In the analysis of the data, appropriate statistical tests and analyzes were used. 115 of 3620 patients admitted to tertiary ICU and underwent percutaneous and surgical tracheostomy due to respiratory failure between January 2016-2019 were included. 75 (65%) of the patients were male and median age was 68±14 years. Hospital mortality was higher in the group with Acinetobacter baumannii growth (p=0.04). According to Kaplan-Meier survival analysis, long-term follow-up of Acinetobacter baumanii growth did not affect survival (p=0.938). Patients with cerebro-vascular accident (CVA) had lower survival in long-term follow-up (p

Key words: Critical care, stroke, tracheostomy, pneumonia, Respiratory infection

Med-Science. 2020; 9(1): 1-5

 

 
Medicine Science Vol:9 Issue:1 Year:2020 PP:1–288

Mid-term outcome of wide resection in musculoskeletal fibrosarcoma patients

Original Article

Mid-term outcome of wide resection in musculoskeletal fibrosarcoma patients

Resit Sevimli, Adem Emeli, Semih Eriten

   

Abstract
The aim in this study, musculoskeletal system fibrosarcomas which are rare malignant soft tissue tumors that originate from fibroblasts, was to evaluate the mid-term outcome of patients that were diagnosed, treated and followed-up at our clinics. Methods: Included in the study were 12 patients treated for fibrosaecoma at our clinics between 2014 and 2017. The patients were evaluated in terms of age, location of tumor and time of resection, and were followed-up for mid-term recurrence. A wide resection was performed on all patients. Results: No recurrence was found in all but one patient during follow-up. Conclusions: Musculoskeletal system fibrosarcomas are rare but represent high mortality and morbidity risks since the diagnosis is commonly delayed. The most frequently seen symptom is a painless mass reaching large dimensions. Early diagnosis plays a major role in prognosis, as is the case with other malignant tumors. In conclusion, we suggest that malignancy should be considered in the presence of giant, fixed and painful tumors, and a wide resection should be applied.

Key words: Soft tumor, fibrosarcoma, wide resection, recurrence, primary organs, diagnose

Med-Science. 2020; 9(1): 6-8

 

 

Management of infective endocarditis and long-term outcomes of patients who underwent surgery: The fifteen-year experience of a tertiary care center

Original Article

Management of infective endocarditis and long-term outcomes of patients who underwent surgery: The fifteen-year experience of a tertiary care center

Baris Akca, Nevzat Erdil, Mehmet Cengiz Colak, Olcay Murat Disli, Bektas Battaloglu

   

Abstract
Infective endocarditis (IE) is still associated with severe complications and poor prognosis. The surgery of IE has various technical difficulties due to severe infection, inflammation of heart tissue, and systemic effects, so controversies continue about the optimal timing of operation. This study presents the treatment approaches, early and late-term outcomes of IE patients, who underwent surgery.This retrospective descriptive study is conducted with 46 patients (31males) operated between 2002-2018. The demographics and preoperative, intraoperative and postoperative data of patients were analyzed from the clinical database and patient records. Emergency surgery was performed to 15 (32.26%) patients.Numbers of patients with mitral valve, aortic valve, and prosthetic valve endocarditis were 14, 25, 7 respectively. Aortic valve replacement (AVR), mitral valve replacement (MVR), MVR + AVR and mitral valve repair were performed in 24, 12, 8 and 2 patients, respectively. Additionally, pericardial patch repair (periannular abscess or damage (n=12), aorta-right atrial fistulae (n=3)), debulking of associated tricuspid valve vegetation (n=2), tricuspid De Vega annuloplasty (n=3), Bentall operation (n=1) and aortic root enlargement (n=5) were performed. The mean follow-up period and mortality rates were 24.86 ± 38.98 months, 13.04% respectively. The mean survival and reoperation-free time were 179.02 ± 13.78 and 203 ± 10.09 months, respectively. Patients can be managed appropriately with early diagnosis, aggressive medical and surgical treatment via a multidisciplinary approach with customized management according to guidelines in terms of individual characteristics. In cases of worsening hemodynamic status, uncontrolled infection, large and mobile vegetations surgery should be performed as soon as possible.

Key words: Infective endocarditis, cardiac surgical procedures, disease management, heart valve diseases

Med-Science. 2020; 9(1): 9-15

 

 

Platelet levels and neutrophil to lymphocyte ratio in thyroid nodules with and without cancer diagnosis

Original Article

Platelet levels and neutrophil to lymphocyte ratio in thyroid nodules with and without cancer diagnosis

Soycan Mizrak, Sirin Kucuk

   

Abstract
Nodular formation of thyroid tissue is a very common endocrinologic pathology. Approximately 5% of thyroid nodules can prove to be cancerous. The usefulness of mean platelet volüme(MPV) and neutrophil to lymphocyte ratio (NLR) is determined as an indicator of immunological response and subclinical inflammation in recent years. In this study we evaluate the association of thyroid stimulating hormone (TSH), platelet, mean platelet volüme(MPV) and NLR levels between the thyroid nodules that turn into cancer and do not convert. Our study consisted of patients with thyroid nodules that converted to thyroid cancer (n = 100) and didn’t convert to thyroid cancer (n = 100). These patients were selected retrospectively using the Hospital Information System. The TSH, NLR, platelet and MPV levels were recorded preoperatively and the difference between them was evaluated statistically with SPSS 21. Differences between groups were examined with using Mann Whitney U Test. P

Key words: Thyroid cancer, neutrophil, lymphocyte, platelet

Med-Science. 2020; 9(1): 16-20

 

 

The effects of anaesthesia induction with propofol or ketofol on cerebral oxygenation in patients above 60 years of age

Original Article

The effects of anaesthesia induction with propofol or ketofol on cerebral oxygenation in patients above 60 years of age

Harun Tolga Duran, Ersin Koksal, Yasemin Burcu Ustun, Sezgin Bilgin, Fatih Ozkan

   

Abstract
Side effects such as hypotension and cerebral perfusion disorder may be encountered after anaesthesia induction, especially in elderly patients. Some studies have attempted to determine whether hypotension during induction and associated organ perfusion disorders can be prevented when propofol is used in combination with ketamine. However, no study has come to light investigating the effects of ketamine added to propofol on cerebral oximetry. The present study aimed to compare the effects of anaesthesia induction with propofol or propofol+ketamine (ketofol) on haemodynamic changes and cerebral oximetry in elderly patients undergoing anaesthesia induction.
A total of 40 patients were randomly divided into two groups. Cerebral oximetry sensors were placed in the right and left of the frontal region. Patients in Group P were treated with 1.5 mg/kg propofol IV induction and patients in Group K were treated with the 0.2 ml/kg ketofol IV. The patients in both groups received 0.5 mg/kg lidocaine, 0.6 mg/kg rocuronium and a 0.1 mcg/kg/min infusion of remifentanil. Heart rate (HR), systolic, diastolic and mean arterial pressure (SBP, DBP, MAP) and cerebral oxygen saturation (RSO2) values before and 1, 3, 5, 10, 30 and 60 minutes after induction were recorded.SBP, DBP and MAP values were significantly lower in the propofol group at 1, 3 and 5 minutes after induction (p < 0.05). The right-side RSO2 values were significantly lower at 3 and 5 minutes after induction in the propofol group compared to the ketofol group and the left-side RSO2 values were similarly significantly lower after 1, 3 and 5 minutes (p < 0.05). Ketofol used in anaesthesia induction has less effect than propofol on mean arterial pressure and cerebral oxygen saturation values. Therefore, ketofol appears to be a good choice for use in anaesthesia induction in elderly patients.

Key words: Propofol, ketamine, cerebral oximeter, elderly patients

Med-Science. 2020; 9(1): 21-5

 

 

A retrospecti̇ve evaluation of the epitelial lesions / neoplasms of the gallbladder in Uşak city and determination of the visual frequency

Original Article

A retrospective evaluation of the epitelial lesions / neoplasms of the gallbladder in Uşak city and determination of the visual frequency

Sirin Kucuk, Ersoy Ercihan, Asli Ucar Uncu, Mehmet Gundogan, Cengiz Kocak

   

Abstract
Cholecystectomy is one of the most common types of surgical operations and includes many pathologies ranging from the most common cholecysistitis to randomly detected dysplasia and cancer. In this study, it is aimed to obtain a general regional incidence by documenting gallbladder pathology data in Usak province and to contribute to literature in this field. Between 2015 and 2019, 1712 cholecystectomy specimens were analyzed retrospectively in the Department of Pathology, Usak University Training and Research Hospital; adenocarcinoma (primary invasive carcinomas), low and high grade dysplasias (Biliary intraepithelial neoplasia – BillN1,2 ), neoplasms / adenomas, intestinal – pyloric metaplasia, reactive atypia and other lesions were re-evaluated with Olympus CX41 light microscope and based on recent diagnoses. Epithelial changes / lesions were reported in 11.3% of cholecystectomy materials. Of these epithelial lesions, 6.18% had adenocarcinoma, 4,6% had high-grade dysplasia, 29,3% had low-grade dysplasia, 27,3% reactive / regenerative atypia and 2,06% – 14,9% – 15,4 %, neoplastic polyps, intestinal metaplasia and intestinal + pyloric metaplasic respectively. Of the cases with dysplasia and carcinoma, 39.3% and 33.4% were male, 60.7% and 66% female, respectively. The mean age was 57 in dysplasia and 66 in carcinoma. The female / male ratio in carcinoma cases was 2/1 and 41.6% of these cases had stones. The remaining lesions (88,7%) were non-neoplastic polypoid / hyperplastic leions and pyloric metaplasia. According to our findings, we suggest that, even in the absence of clinical symptoms, an adequate number of samples should be taken from the specimen during histopathological examination, especially in elderly women with long-standing stones due to the risk of developing precancerous lesions.

Key words: Gallbladder, cholecystectomy specimens, epithelial changes, sampling

Med-Science. 2020; 9(1): 26-32

 

 

Disturbed sleep quality and increased depression scores in alopecia areata patients

Original Article

Disturbed sleep quality and increased depression scores in alopecia areata patients

Aynure Oztekin, Coskun Oztekin

   

Abstract
Alopecia areata (AA) is a chronic inflammatory disease that affects the hair follicle and sometimes the nails. Comorbidity between alopecia areata and psychiatric disorders is well known. The aim of this study is to evaluate the relationship between the clinical characteristics of AA and sleep quality and depression. This study included 52 patients above 18 years of age who admitted to the dermatology clinic and diagnosed as alopecia areata, and 51 healthy volunteers. Sociodemographic data form, Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI) were filled by the patients. Information about the severity of AA, the duration of the disease, the treatments they received, and comorbid illnesses were also recorded. The median BDI total score of the AA patients was higher than that of the control group. In AA patients, PSQI total score and most of the subscale scores were significantly higher than those of the control group. No difference could be found in BDI or PSQI scores according to the presence or absence of poor prognostic criteria. The results of our study support the long-standing relationship between AA and psychiatric disorders and indicate that sleep quality is impaired in addition to the increase in depression level. In particular, a more careful assessment of female AA patients and patients with comorbid atopic dermatitis is important in order not to miss comorbid psychiatric problems.

Key words: Alopecia areata, depression, sleep quality, hair

Med-Science. 2020; 9(1): 33-8

 

 

Evaluation of helicobacter pylori eradication therapy with serum myeloperoxidase levels

Original Article

Evaluation of helicobacter pylori eradication therapy with serum myeloperoxidase levels

Meside Gunduzoz, Servet Birgin Iritas, Servet Guresci, Murat Buyuksekerci, Osman Gokhan Ozakinci, Yasar Nazligul

   

Abstract
Helicobacter pylori (H. pylori) is associated with chronic gastritis, peptic ulcers, and gastric adenocarcinomas. H. pylori-infected patients produce reactive oxygen species (ROS) in gastric mucosa. Production of ROS induces the myeloperoxidase (MPO) activity. This study aims the determination of the relationship between MPO level and H. pylori infection and eradication therapy. One hundred seven (107) patients were enrolled in the study. H. pylori were detected by histopathological examination of the specimens. The patients were divided into two groups: Group 1 (H. pylori-negative), Group 2 (H. pylori-positive). The tissue MPO activity and serum MPO levels of these two groups were compared. Patients with H. pylori infection received eradication therapy. Post-treatment serum MPO levels were also compared. Histopathological examination revealed that 28(26.2%) patients were H. pylori-negative (Group 1), whereas 79(73.8%) patients were H. pylori-positive (Group 2). Tissue MPO activity of the groups was compared, and a significant difference was found between two groups, 0.5(1) and 2(1), respectively (p

Key words: Helicobacter pylori (H.pylori), myeloperoxidase (MPO), H.pylori eradication therapy, reactive oxygen species (ROS)

Med-Science. 2020; 9(1): 39-44

 

 

Serum angiostatin levels in diabetic patients with heart failure taking oral antidiabetic therapy or basal insulin and its clinical significance

Original Article

Serum angiostatin levels in diabetic patients with heart failure taking oral antidiabetic therapy or basal insulin and its clinical significance

Birol Yildiz, Ismail Erturk, Galip Buyukturan, Bilgin Bahadir Basgoz, Ramazan Acar, Kenan Saglam

   

Abstract
Diabetes mellitus is a metabolic disorder with an increasing incidence all over the world leading to high sequelae and high mortality rates behind other microvascular and macrovascular complications. The deterioration in angiogenesis in particular is known to cause deterioration of vascular complications of diabetes. After the discovery of a natural angiogenesis inhibitor, angiostatin in the ethiopathogenesis of retinopathy and nephropathy, which are frequent complications of diabetes, several successful clinical trials have been made. However, the most lethal complication of diabetes, diabetic heart failure, lacks any trial about effectiveness of angiostatin. In this study, the levels and the clinical significance of angiostatin were investigated in oral antidiabetic or Insulin treated diabetic patients with heart failure. The patient group consisted of 31 patients with a diagnosis of diabetes mellitus and heart failure and the control group included 30 patients with heart failure without diabetes mellitus. Serum levels of angiostatin were studied. A total of 61 subjects were enrolled in the study. The patient group consisted of 31 patients; between the age of 56-88 (73.06 ± 8.7) years, of which 16 (51.6%) were female and 15 (48.4%) were male. The control group included 30 patients; 15 (% 50) women and 15 (50%) of were male, between the ages of 57 to 85 (74.23 ± 8.27). In the case group, the average angiostatin levels were 133.25 ± 78.46 and in the control group it was found to be 121.7 ± 71.81. The average angiostatin levels were similar in diabetic and non-diabetic heart failure groups (p=0.55). The average serum angiostatin levels showed a significant negative correlation with the level of fasting blood glucose. In our study, diabetic patients with heart failure, when compared with non-diabetic patients with heart failure, showed no significant difference in the levels of angiostatin. Levels of angiostatin are not affected by the level of HbA1c. Fasting blood glucose level has a negative correlation with the level of angiostatin. In order to be used in determining the prognosis in diabetic patients with heart failure, further studies are needed on angiostatin levels.

Key words: Diabetic heart failure, angiogenesis, angiostatin, HbA1c

Med-Science. 2020; 9(1): 45-8

 

 

Volume of intensive care unit patients in the emergency department: Clinical experience in a training and research hospital

Original Article

Volume of intensive care unit patients in the emergency department: Clinical experience in a training and research hospital

Murat Guzel, Şener Cindoruk, Mehmet Tevfik Demir, Mehmet Yorgun, Erdinc Yavuz, Emre Ozgen, Murat Yucel, Ahmet Baydin

   

Abstract
There is an increasing tendency for critically ill patients to present to emergency departments (EDs). In this study, it was aimed to assess patients who presented to the ED and admitted to the intensive care unit (ICU) and to identify waiting times in the ED. This retrospective study was conducted by reviewing data from 4904 patients (aged >18 years) who presented to the ED for whom the decision was made for hospitalization in the ICU between January 1st, 2016, and December 31st, 2017. Waiting time in the ED, demographic data, and length of ICU stay were reviewed for 3572 patients who were admitted to ICUs from the ED. The total number of patients who presented to the ED between January 1st, 2016, and December 31st, 2017 was 200,603. Among these patients, the ICU admission rate was 2.4%. Of 4904 patients who presented to the ED and the decision was made for ICU admission, 1332 patients were transferred to other facilities. When these patients were excluded, the ICU admission rate was found as 1.8% in our facility. When time to ICU admission from the ED was assessed, it was found that the shortest time recorded for admission from the ED to the burns unit was 48 minutes. The second shortest waiting time (148 min) was seen in patients admitted to the coronary intensive care unit. The mean waiting time of ICU patients in the ED was 282 min. The increase in the patients who have been decided to hospitalization in the ICU in the ED remains an important problem that should be managed in the ED crowd. Long waiting times for ICU patients in the ED make the already existing crowd more complicated.

Key words: Emergency department, intensive care, emergency department crowding

Med-Science. 2020; 9(1): 49-53