Predictive Power of Self-Efficacy on the Fear of Childbirth in Pregnant Women: Underlying Mechanisms of Social Support as a Mediator and the COVID-19 Fear as a Moderator.

BACKGROUND: Fear of childbirth (FOC) is a common problem associated with psycho-social factors in pregnant women. OBJECTIVES: This study aimed to determine the mediator of social support and the moderator role of fear of coronavirus disease 2019 (COVID-19) in the relationship between self-efficacy and FOC in pregnant women. MATERIALS AND METHODS: This descriptive and cross-sectional study was conducted with 422 pregnant women registered in 18 family health centers. Data were collected with the introductory information form, the Wijma Delivery Expectancy/Experience Questionnaire-A, the Childbirth Self-Efficacy Inventory, the Multidimensional Scale of Perceived Social Support, and the Fear of COVID19 Scale. The SPSS 22 package program and Hayes's process macro 3.2 were used in the analysis of the data. RESULTS: Findings showed that 19.9% of the pregnant women experienced severe FOC. Self-efficacy and social support negatively predicted FOC, while fear of COVID-19 predicted it positively. Perceived social support moderately mediated the relationship between FOC and self-efficacy. Fear of COVID-19 was found to be a marginally effective moderator in the relationship between self-efficacy and FOC. This indicates that as self-efficacy increases in pregnant women with low fear of COVID-19, the FOC is experienced less. CONCLUSION: In the relationship between self-efficacy and FOC, social support is a key factor in reducing FOC. To reduce the FOC, the social support of pregnant women should be strengthened, and the fear associated with acute crisis periods such as pandemics should be reduced with some preventive measures.

The prevalence of non-vascular pulmonary manifestations in Takayasu's Arteritis patients: A Retrospective multi-centred Turkish cohort study.

OBJECTIVES: Takayasu's arteritis (TAK) is a rare vasculitis characterized by inflammation of intermediate- to large-size arteries. Although pulmonary artery involvement (PAI) is an expected finding in some TAK patients, data on non-vascular pulmonary involvement (NVPI) are limited. We aimed to investigate the frequency of NVPI, including parenchymal infiltration, nodules/cavities, pleural effusion, and haemorrhage, in TAK. METHOD: We assembled a retrospective cohort of TAK patients from nine tertiary centres in Turkey. The demographics and clinical characteristics of patients were extracted from medical records and the imaging findings were evaluated for pulmonary manifestations. RESULTS: As of January 2021, 319 TAK patients (female/male 276/43; mean age 42.4 ± 13.5 years) were recruited. Eighty-two patients had cough and/or dyspnoea and four had haemoptysis as pulmonary symptoms. On computed tomography assessment, the overall frequency of NVPI was 7.2%; parenchymal infiltrations were present in 10 (3.1%), pleural effusion in eight (2.5%), nodules/cavities in six (1.9%), and pulmonary haemorrhage in four patients (1.3%). In the whole cohort, 10.3% of patients had pulmonary artery hypertension (PAH) and 5.6% had PAI. Among patients with PAH or PAI, the overall frequency of NVPI was significantly higher than in the rest of the group. CONCLUSIONS: In this TAK cohort from Turkey, we observed NVPI in 7.2% of patients, with parenchymal infiltrations being the most common, followed by pleural effusion. Notably, NVPI was more frequent in patients with PAH or PAI. Although not as common as PAI, NVPI should be kept in mind, especially in TAK patients with PAH or PAI.

Mortality in magnet hospitals: A systematic review.

Magnet hospitals are recognized for quality patient outcomes and nursing excellence. It was aimed to examine the effects of Magnet hospitals on mortality rate. Searches for this review were carried out using the PubMed, Scopus, and CINAHL databases without any year limitation. Search terms included Magnet hospitals, non-Magnet hospitals, and mortality. Inclusion criteria were: The identified 58 articles published in international journals, and 13 of those articles that met the inclusion criteria were included in this review. This systematic review adhered to the PRISMA guideline. Articles meeting the research criteria were evaluated for methodological quality with the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) Critical Appraisal Tool. The research types used of the included studies were descriptive comparative research (n = 8), cohort study (n = 4), and retrospective, two-stage panel design (n = 1). Three descriptive comparative studies found that there was no difference in the mortality rates of Magnet hospitals and non-Magnet hospitals. By contrast, five descriptive comparative studies and five longitudinal studies determined that mortality rates were lower in Magnet hospitals. Overall, the findings of this systematic review indicated that Magnet hospitals are associated with lower rates of mortality. Considering the organizational consequences of mortality such as quality and cost savings, this systematic review provides significant contributions to hospital executives, as well as the nurse-clinicians, whether or not to obtain magnet status.

Assessment of internet usage for health-related information among clients utilizing primary health care services.

OBJECTIVE: This study aimed to identify the frequency and goals of Internet usage to access health-related information among primary health care service clients. METHODS: The study was conducted in a primary health care centre with a sample of 788 adults. The data were collected through a questionnaire developed by the researchers. RESULTS: The results showed that 81% (n = 640) of the participants used the Internet. All Internet user participants reported that they used the Internet to access health-related information. Of the participants, 67% reported that they used the Internet primarily to obtain information about diseases with 94% reporting that they found the online information reliable and 92% reported that they did not confirm the information they obtained online. The frequency of Internet use to obtain health-related information increased with increase in the level of education of participants. Participants with higher education found the online information to be more reliable and comprehensible. The results showed that while the use of Internet to obtain health-related information was high, the information presented online was not always checked for accuracy. CONCLUSION: Hence, provision of current and evidence-based information on health-related websites is crucial to preserve community health care.

Binding of periodate-oxidized guanine nucleotides to eukaryotic elongation factor 2.

Periodate-oxidized guanine nucleotides (GTPox and GDPox) were shown to bind stoichiometrically to rat liver elongation factor 2 (EF-2). This binding was quantitatively inhibited in the presence of GTP. After binding, oxidized nucleotides remained on EF-2 despite extensive dialysis. They exchanged, however, with free quanine nucleotides in the course of prolonged (greater than 1 h) incubations. The prior reduction EF-2.GTPox with NaBH4 abolished, to a large extent, this slow exchange. Thus, a Schiff's base was implicated to be formed between EF-2 and oxidized guanine nucleotides. Mg2+ increased the GTPox concentration necessary for a stoichiometric binding to EF-2. EF-2-oxidized nucleotide conjugates bound in the presence of ribosomes a second molecule of GTP (or GTPox). GTPox bound to EF-2 in the presence of ribosomes appeared to exchange readily with free GTP. Moreover, GTPox proved to be active as substrate in EF-2 and ribosome-dependent GTPase reaction: Km values found for GTPox and GTP were 7.7 and 3.4 microM, respectively. The binding of GTPox to EF-2 inhibited only partially the subsequent ribosome-dependent GTP binding, and GTPase reaction or polyphenylalanine (polyPhe) synthesis. On the other hand, the binding of GuoPP[CH2]Pox to EF-2 inhibited all of these reactions strongly. The nature of the binding site involved in the direct interactions of EF-2 with guanine nucleotides is discussed in the light of these results.

Mutations in 23 S ribosomal RNA perturb transfer RNA selection and can lead to streptomycin dependence.

Escherichia coli ribosomes with a G to C transversion at position 2661 in 23 S ribosomal RNA are more accurate in tRNA selection than wild-type ribosomes. This enhanced accuracy is due to improved initial selection of ternary complexes rather than proofreading of aminoacyl tRNAs. The 2661C mutation reduces the binding rate of cognate ternary complexes to the A-site. This binding rate deficiency becomes dramatic when ribosomes also harbour an S12 mutation with a streptomycin-resistant, hyperaccurate phenotype. In this case, severe loss of kinetic efficiency in EF-Tu function leads to cell death. Streptomycin restores viability by increasing the association rate of ternary complex to these doubly altered ribosomes. The binding rate of EF-G to 2661C ribosomes is also reduced while the translocation rate is unaffected.

Kinetic properties of Escherichia coli ribosomes with altered forms of S12.

E. coli ribosomes with alterations in S12 leading to streptomycin resistance (SmR), dependence (SmD) and pseudodependence (SmP) were studied with the quench-flow technique. Kinetic changes at the various steps of the elongation cycle were identified. The rate of hydrolysis of GTP in the ternary complex in the ribosomal A-site is decreased drastically in SmD and moderately in SmP in relation to wild-type ribosomes. Addition of streptomycin restores much of the wild-type behaviour. The SmD, SmP and SmR ribosomes have an enhanced GTP-hydrolysis idling reaction on EF-Tu, which is correlated with how aggressive proofreaders these ribosomes are in steady-state assays. We use our in vitro findings to discuss the in vivo physiology of these mutants as well as mechanistic features of E. coli translation.

An A to U transversion at position 1067 of 23 S rRNA from Escherichia coli impairs EF-Tu and EF-G function.

Escherichia coli ribosomes with an A to U transversion at nucleotide 1067 of their 23 S rRNA are impaired in their effective association rate constants (kcat/KM) for both EF-Tu and EF-G binding. In addition, the times that EF-G and EF-Tu spend on the ribosome during elongation are significantly increased by the A to U transversion. The U1067 mutation impairs EF-Tu function more than EF-G function. The increase in the time that EF-Tu remains bound to ribosome is caused, both by a slower rate of GTP-hydrolysis in ternary complex and by a slower EF-Tu.GDP release from the mutated ribosomes. There is, at the same time, no change in ribosomal accuracy for aminoacyl-tRNA recognition. With support from these new data we propose that nucleotide 1067 is part of the ribosomal A-site where it directly interacts with both EF-G and EF-Tu.

Long-term results of pediatric renal transplantation at one center in Turkey.

Kidney transplantation is more frequently indicated in children than in adults because growth retardation is an additional problem associated with chronic kidney disease in the pediatric age group. This study retrospectively analyzed the data from 75 kidney transplantations performed on 73 children (38 male and 35 female) at a center in Turkey from late 1975 through 2003. The aim of the study was to investigate the case characteristics and the long-term outcomes in this patient group. Patient ages ranged from 8 to 16 years (mean, 14.9 +/- 2.2 years). Sixty (82.1%) children were on hemodialysis, and 12 (16.4%) on peritoneal dialysis prior to transplantation. Pre-emptive transplantation was performed for one (1.4%) patient. Fifty-nine transplantations used organs from live donors (78.7%) and 16 cadaver transplants (21.3%). The mean cold ischemia time for the cadaveric transplantations was 38.6 hours (range, 23-56 hours). All recipients were placed on a low-dose immunosuppressive regimen. One graft was lost due to hyperacute rejection. Twenty-one patients (28.8%) experienced a total of 24 acute rejection episodes. The follow-up period ranged from 1 to 190 months (mean, 44.1 +/- 31.8 months). Concerning postoperative complications, four patients (5.5%) developed a lymphocele; there were two cases each (2.7% each) of distal ureteral stricture, perirenal hematoma, or renovascular stenosis; and one patient (1.4%) developed a urine leakage. Two patients (2.7%) developed Kaposi's sarcoma at 17 and 3 months after transplantation. Six recipients died (mortality 8%), four of whom had a functioning graft. Two patients (2.7%) underwent retransplantation at 4 and 2 years after the initial operation. The 1-, 3-, and 5-year graft survival rates for living-related transplantations were 92%, 81%, and 70%, and the corresponding patient survival rates were 98%, 93%, and 92%, respectively. The 1-, 3-, and 5-year graft survival rates for cadaveric transplantations were 90%, 78%, and 68%, and patient survival rates 98%, 91%, and 90%, respectively. These results indicate that kidney transplantation is successful in pediatric end-stage renal disease patients particularly from living-related donors.

Long-term results of pediatric kidney transplantation at one center in Turkey.

Kidney transplantation is considered the treatment of choice for children with end-stage renal disease (ESRD). From November 1975 to June 2004, 80 of a total of 1477 kidney transplantations were performed in 78 pediatric patients. We retrospectively reviewed the records of 42 boys and 36 girls. Patient age ranged from 8 to 16 years (mean, 14.9 +/- 2.2). Sixty-three (78.7) grafts were from living donors and 17 (21.3%) from deceased donors. Two patients (2.6%) underwent preemptive transplantation, while 76 had preoperative renal replacement therapy with either hemodialysis in 62 (79.5%) or peritoneal dialysis in 14 (17.9%). Although the cause of ESRD could not be established in 30 cases, the other 48 showed the most common etiologies to be reflux nephropathy and glomerulonephritis. In conclusion, despite relatively poor socioeconomic conditions and health care problems in our country, the overall outcomes for pediatric patients at our transplantation center are good. We seek to perform more preemptive kidney transplantations in children with ESRD, and to increase our efforts to educate the Turkish public about organ transplantation and donation.

Duct-to-duct biliary anastomosis with a "corner-saving suture" technique in living-related liver transplantation.

OBJECTIVES: Biliary complications after living-related liver transplantation (LRLT) remain a major source of morbidity for recipients. We describe our technique and early results with 32 recipients who underwent LRLT with duct-to-duct anastomoses during the last 2 years. METHODS: Between January 2003 and December 2004, 50 patients underwent liver transplantation in our center with overall patient and graft survival rate of 86.4% and 86.4%. Of 50 patients, 41 (82.0%; 17 adult and 24 pediatric) underwent LRLT, 32 (78.0%) of whom had duct-to-duct biliary anastomoses with a "corner-saving suture" technique. RESULTS: Of 32 patients in whom duct-to-duct biliary anastomoses were performed, 4 (12.5%) had an anastomotic leak with 2 eventually developing bile duct strictures within 3 months. One patient required reoperation for a bile leak. All other anastomotic leaks and strictures were treated with percutaneous drainage and balloon dilatation with excellent outcomes. There was no long-term morbidity and no graft loss owing to biliary complications. Seven patients died during follow-up (0.5 to 25 months); 43 are doing well with optimal liver function in the early posttransplantation period. CONCLUSION: According to our early results, we recommend duct-to-duct anastomosis in LRLT when calibration of the ducts show suitable results and when there is no tension on the anastomosis site. Otherwise, Roux-en-Y hepaticojejunostomy should be performed to decrease risk of biliary complications.

Living-related liver transplantation in pediatric patients.

INTRODUCTION: Many developments in surgical technique, immunosuppression, and patient selection criteria have led to improved long-term patient and graft survival in pediatric patients receiving liver transplants. In this study, we examined the early results of 26 pediatric recipients who underwent 26 liver transplantations between January 2003 and December 2004 at our institution. MATERIALS AND METHODS: The most common indications for liver transplantation were cholestasis in 10 patients (38.5%) and Wilson's disease in 8 (30.8%). Other indications were fulminant hepatic failure (4 patients, 15.4%), tyrosinemia (2 patients, 7.7%), Caroli disease (1 patient, 3.8%), and cryptogenic cirrhosis (1 patient, 3.8%). One recipient with Byler disease and two with tyrosinemia also had incidental hepatocellular carcinoma. RESULTS: Of 26 patients, 24 (92.3%) underwent living-related liver transplantation and 2 (7.7%) underwent cadaveric transplantation. The medical records of all patients were retrospectively reviewed. Twenty-two of 26 survived with excellent graft function, showing 91.2%, 86.4%, and 81.6% at 3, 12, and 24 months graft and patient survival rates, respectively. Sixteen patients (61.5%) developed various morbidities with biliary and vascular complications being the most common. Four patients (15.3%) developed bile leaks. Four patients (15.3%) developed hepatic artery thromboses. Five patients (19.2%) developed life-threatening infections. Four patients (15.4%) died during the study period, three owing to infectious complications. The other patient died due to acute respiratory distress syndrome. CONCLUSION: Despite technical difficulties and a donor organ shortage, the results of liver transplantation in pediatric patients with end-stage liver disease have demonstrated promising results at our institution.

Switchability of neoral and equoral according to Food and Drug Administration rules and regulations.

According to the US Food and Drug Administration (FDA), if a drug product contains a drug substance that is chemically identical and is delivered to the site of action at the same rate and extent as another drug product, then it is equivalent and can be substituted (switchable) for that drug product. Methods used to define bioequivalence as stated by the FDA rules (FDA 21 CFR 320, 24) are (1) pharmacokinetic (PK) studies in healthy volunteers, (2) comparative clinical trials, and (3) pharmacodynamic (PD) studies (bioactivity). We evaluated the switchability of Equoral (IVAX-USA) with Neoral (Novartis Switzerland using all FDA rules. In a single oral dose, we undertook a comparative bioavailability study of Equoral (IVAX, USA) Neoral (Novartis, USA), and Neoral (Novartis UK). The pharmacokinetics of Equoral and Neoral were determined with blood levels at 0, 0.25, 0.5, 0.75, 1, 1.25, 1.5, 1.75, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 10, 12, 16, 24, 30, 36, 42, and 48 hours. The area under curve (AUC), AUC extrapolated to infinity (AUC0-inf), rate of absorption (Tmax), extent of absorption (Cmax), half time (t1/2) of Equoral and Neoral were all within the 90% confidence interval of 80% to 125% boundaries. A comparative multinational multicenter clinical trial in stable renal transplant patients included 70 patients (22 women and 48 men) of mean age of 33 years (range, 26 to 43) was performed in Turkey, Lebanon, and Pakistan. In this study the ratios of LSM and the 90% confidence intervals for the Nontransformed/Parameters (AUC0-t, AUCinf, Tmax, and Cmax) of Equoral and Neoral SGC were 98% and 95%, respectively, which are within the 80% to 125% FDA acceptance range. For immunosuppressive drugs, the site of action is the lymphocyte and the measurable response is the decrease in lymphocyte count caused by the relative concentration of the drug in the lymphocyte. In a controlled switch, fixed-dose study, both Equoral and Neoral achieved the same concentration in the lymphocytes and caused the same degree of lymphocyte count reduction. The results of the testing (bioavailability-bioequivalence, clinical studies, and pharmacodynamic-bioactivity) required by FDA for interchangeability ("switchability") of immunosuppressive agents suggests that Neoral and Equoral are switchable.

The usefulness of trauma scores in determining the life threatening condition of trauma victims for writing medical-legal reports.

OBJECTIVES: In the Turkish legal system the severity of the victim's injury determines the severity of the criminal penalty, and the life threatening condition stated in the medical-legal report is one of the main determinants for injury severity. The aim of this study is to investigate the effectiveness and usefulness of the trauma scores in determining the life threatening condition of trauma victims from the forensic aspect in order to write accurate medical-legal reports. METHODS: Data of 296 forensic cases with blunt and penetrating trauma were obtained. The life threatening condition of patients stated in the medical-legal reports according to the criteria based on traditional forensic opinion were examined. For each case, Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) were calculated. The ROC curve analysis was used to investigate the success of the trauma scores in distinguishing patients with/without life threatening conditions. Logistic regression analysis was performed to measure the association between trauma scores and life threatening conditions. RESULTS: The relations between all scores and groups (with and without life threatening risk) were found statistically significant. ISS was the most successful method in distinguishing traumatised patients both in a life threatening or non life threatening condition. CONCLUSIONS: Trauma scores can be used for making more objective, standardised, and accurate judgement on whether the injury was a life threatening one or not. These advantages of using trauma scores in such situations will also be helpful for the conclusion of the lawsuits shortly, but further studies are needed to confirm these findings.

Is translation inhibited by noncognate ternary complexes?

We studied the influence of an error-prone isoacceptor (tRNALeu4), as well as an intermediate (tRNALeu2) and a weak (tRNAVal) competitor of tRNAPhe on the poly(Phe) synthesis rate. Even at very high excess concentrations of these noncognate ternary complexes there was no significant effect on the translation rate. Our result argues against the assertion that in vivo translation is slowed down by noncognate tRNA and favours the hypothesis that the incorrect ternary complex concentrations are too low to saturate the ribosomes in vivo.

Two GTPs are consumed on EF-Tu per peptide bond in poly(Phe) synthesis, in spite of switching stoichiometry of the EF-Tu.aminoacyl-tRNA complex with temperature.

Recent observations indicate that the stoichiometry for the complex between EF-Tu.GTP and aminoacyl-tRNA (aa-tRNA) changes with temperature. At 37 degrees C two EF-Tu.GTPs bind one aa-tRNA in an extended ternary complex, but at 0 degrees C the complex has 1:1 stoichiometry. However, the present experiments show that there are two GTPs hydrolyzed on EF-Tu per peptide bond in poly(Phe) synthesis at 37 degrees C as well as at 0 degrees C. This indicates two different pathways for the enzymatic binding of aa-tRNA to the A-site on the ribosome.

Two GTPs are hydrolysed on two molecules of EF-Tu for each elongation cycle during code translation.

A new experimental design has been used to determine the number of GTPs hydrolysed per peptide bond in EF-Tu function in a poly(U)-translation system. We find that two GTPs are consumed for every amino acid incorporated into the nascent poly(Phe)-chains, in accordance with previous findings with other techniques. These results necessitate a revision of current views concerning E coli translation; also new schemes for ribosome function are discussed.

Mutations in ribosomal proteins L7/L12 perturb EF-G and EF-Tu functions.

In vitro cycling rates of E. coli ribosomes and of elongation factors EF-Tu and EF-G have been obtained and these are compatible with translation rates in vivo. We show that the rate of translocation is faster than 50 s-1 and therefore that the EF-G function is not a rate limiting step in protein synthesis. The in vivo phenotype of some L7/L12 mutants could be accounted for by perturbed EF-Tu as well as EF-G functions. The S12 mutants that we studied were, in contrast, only perturbed in their EF-Tu function, while their EF-G interaction was not impaired in relation to wild type ribosomes.

Long-term follow-up of 102 living kidney donors.

This study evaluated 102 randomly selected living-related kidney donors who were operated between November 1975 and December 1996 after a mean follow-up period of 10.2 years (range 8 months to 22 years). The donor male:female ratio was 45:57, and mean age was 41.0 years (range 21 to 65 years). The average preoperative and last follow-up blood creatinine levels were 73.37 micromol/l (range 44.2-106.8 micromol/l) and 78.67 micromol/l (range 8.84-318.2 micromol/l), respectively (p:NS), and the corresponding average creatinine clearance values were 108.4 ml/min (range 100-130 ml/min) and 96.8 ml/min (range 27 to 125 ml/min) (p: NS). Four donors had 24-hour urine protein excretion above 0.1 gram (2 G, 0.7 G, 0.2 G, and 0.14 G, specifically). The donors' mean systolic blood pressures before, and after the operation on the last follow-up were 131.7 +/- 21.2 mmHg and 139.6 +/- 20.9 mmHg, respectively (p:NS). Nine donors (8.8%) developed hypertension which required anti-hypertensive treatment. The mean age of the hypertensive group was 48.0 years (range 30 to 65 years), whereas that for the nonhypertensive group was 39.4 years (range 18 to 76 years) (p <0.02). Only one donor (0.9%), a 41 year-old female, was diagnosed with chronic renal disease related to pyelonephritis. These results support the utilization of living donors for kidney transplantation, an option which helps broaden a limited donor pool.

Optic disk neovascularization in a patient with cytomegalovirus retinitis associated with renal transplantation.

PURPOSE: To report the development of optic nerve head neovascularization during the recovery phase of cytomegalovirus (CMV) retinitis in a renal allograft recipient. CASE REPORT: A 46-year-old male renal allograft recipient developed CMV retinitis seven months after transplantation. At the time of the diagnosis, the patient was being immunosuppressed with prednisone, cyclosporine, and azathioprine, and was treated with repeated intravitreal and intravenous ganciclovir. Six weeks after the initiation of therapy, optic disk neovascularization developed. This was confirmed by fluorescein angiography, which showed no areas of retinal capillary nonperfusion. At this stage, active retinal lesions were partially resolved. Apart from intraocular inflammation, no other cause of neovascularization was detected. Over the following six months, optic disk neovascularization regressed spontaneously without causing vitreous hemorrhage or visual loss. There was no recurrence of CMV retinitis during follow-up. CONCLUSION: Optic disk neovascularization may develop in the healing phase of CMV retinitis in renal transplant recipients.