Influence of COVID-19 disease on subarachnoid hemorrhage and intracerebral hemorrhage.

This study aims to make a comparative evaluation of the change in the incidence of intracranial hemorrhage [intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)] cases that attended our hospital in the Covid-19 pandemic period with that of the same term one year ago. This study included 80 patients diagnosed with ICH and/or SAH in the period that started with the pandemic in 2020. It was determined that 51 patients had been diagnosed with ICH and/or SAH during the same period of 2019. A total of 131 ICH and SAH patients (2019; n=51, 39%; and 2020; n=80, 61 %) having an average age of 64.52±7.33 including 66 women (50.4 %) were included in the study in the nine -month follow-up periods covering the period of March-November of 2019 and 2020, respectively. It was determined that the number of patients diagnosed with ICH and SAH during the pandemic was higher than the number of those who attended our clinic in 2019 (80 vs 51) and that they were older (65.76±6.56 years vs 62.57±8.09 years) (p=0.014 and p=0.026, respectively). The incidence and distribution of ICH and SAH among the patients were similar (p >0.05). It was determined that in 1 patient, ICH and SAH co-existed. In the study, it was determined that among the patients treated for intracranial hemorrhage in 2020, 32.5 % were diagnosed with COVID-19 as validated by positive nasopharyngeal SARS-CoV-2 PCR. The evaluation of the patients in 2020 revealed that the average age and ICH and SAH incidence in COVID-19 (+) and COVID-19 (-) patients were similar. Although increased incidence of acute intracranial hemorrhage has been observed during COVID-19 pandemic a athophysiological correlation between the two clinical presentations could not be clearly demonstrated. When rapidly progressing neurological deterioration findings are present in COVID-19 patients, existence of intracranial hemorrhage should always be considered (Tab. 2, Ref. 21). Keywords: subarachnoid hemorrhage, intracerebral hemorrhage, COVID-19.

Lymphocyte/mean platelet volume ratio, a new marker; is it effective in predicting the prognosis of COVID-19 cases?

OBJECTIVES: This study aims to determine the prognostic significance of the lymphocyte/mean platelet volume ratio (LMR) in terms of the clinical course of the disease in patients with COVID-19. METHODS: Patients over 18 who were evaluated for COVID-19 during the period from April 1, to April 30, 2020 were retrospectively scanned. Patients with at least 1 positive PCR test result were as assigned to Group 1 while patients with negative test results were assigned to Group 2. The LMR ratio was calculated by dividing the lymphocyte value by that of MPV. The relationship between LMR, severity of patients' CT findings and 28-day mortality was evaluated. RESULTS: A total of 938 patients were included in the study. It was observed that the lymphocyte and LMR levels were significantly different in those who died within 28 days (p < 0.001, p ≤ 0.001). In the ROC analysis for the LMR level, the area under the curve (AUC) was found to be 0.737 (95% CI 0.639‒0.834). When the cut­off value of LMR was 0.045, the sensitivity was found to be 99.0 % and specificity was 15.2 %. CONCLUSION: LMR can be a guide in multiple cases of care provided to critical patients, as is the case in the COVID-19 pandemic and can be used in recognizing critical patients (Tab. 5, Fig. 1, Ref. 21).

[Tenolysis of extensor and flexor tendons of the hand]. / Tenolyse von Streck- und Beugesehnen an der Hand.

BACKGROUND: Unrestricted gliding of extensor and flexor tendons is essential for normal functioning of the hand. If tendon gliding is impaired, a restricted range of motion of finger joints and, finally, joint stiffness result. OBJECTIVES: To answer the questions about the causes of tenodesis in the hand, which examinations are most informative, how tenolysis is technically performed, and what results can be expected. METHODS: The reasons, examinations, surgical technique, and results of extensor and flexor tendon tenolysis are presented. RESULTS: Based on the data in the literature tenolysis of flexor tendons leads to range of motion that is only 50-60% of the preoperative range of motion. In about 20% of patients, deterioration as serious as secondary tendon rupture is observed. Meaningful results of extensor tendon tenolysis have not yet been published. CONCLUSIONS: Tenolysis of extensor and flexor tendons in the hand is a demanding surgical procedure, and in addition to detailed knowledge of anatomy and biomechanics, it requires sufficient experience-especially following the primary repair of tendon injuries. The earliest indication for tenolysis can occur at about 3 months, usually after 6 months, if continuous intensive hand therapy and splinting have not been successful. General and individual benefits and risks must be carefully weighed. The key to successful tenolysis is the patient's access to and unrestricted participation in competent postoperative treatment, ideally performed by a specialist in hand therapy, which may last for weeks or months.

An Investigation of the COMT Gene Val158Met Polymorphism in Patients Admitted to the Emergency Department Because of Synthetic Cannabinoid Use.

Catechol-O-methyl transferase (COMT) enzyme has a role in the inactivation of catecholamine neurotransmitters. Functional polymorphism in the COMT gene has been reported to play an important role in schizophrenia, bipolar affective disorder, aggressive and antisocial behavior, suicide attempts and the pathogenesis of Parkinson's disease. In this study, we aimed to investigate the effect of the Vall58Met polymorphism of the COMT gene on substance use, and treatment history in patients with synthetic cannabinoid (SC) intoxication. The COMT enzyme Val158Met polymorphisms from DNA of 49 patients who were evaluated in the Emergency Department after SC use and 50 healthy control groups aged 18-45 years, were identified by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analyses as reported in the literature. Information regarding recurrent intake or hospitalization due to substance use was obtained from hospital records. Wild-type (WT) genotypes in 14 (28.6%) patients, heterozygous genotypes in 25 (51.0%) and homozygous genotypes in 10 (20.4%) patients were detected. Wild-type genotypes The homozygous genotype was found to be significantly higher in patients hospitalized due to drug addiction and substance use (p 0.008). The Vall58 Met polymorphism of the COMT gene was not found to be significant in the first use after substance intake, while a significant relationship was found in terms of this polymorphism in patients with substance addiction diagnosis and treatment history.

Effects of trimetazidine on nerve regeneration in a rat sciatic nerve injury model.

AIM: The aim of this study was to evaluate the efficacy of trimetazidine(TMZ) after end-to-end repair in a peripheral nerve injury model. METHOD: We performed end-to-end primary repair of sciatic nerves in rats and showed TMZ's regenerative effect. For this objective 30 male Sprague Dawley albino rats were used. Surgery+water group, rats were assigned to a placebo group and were given water by oral gavage. Surgery+TMZ group, rats were given trimetazidine by oral gavage. All medications were given for 12 weeks. Motor function test was performed. Afterwards, electromyography (EMG) recording was done. Finally, blood samples were taken, the animals were euthanized andsciatic nerve was removed. RESULTS: The amplitudes of compound muscle action potential (CMAP) increased significantly in the Surgery+TMZ group when compared with the group that have been given Surgery+Water. Nerve growth factor (NGF) immunoexpression in the Schwann cell was significantly increased in the Surgery+TMZ group compared with the Surgery+Water group. Moreover, fibrosis score was reduced in the Surgery+TMZ group compared to the Surgery+Water group.CONCLUSIONS: In conclusion, we demonstrated the superiority of TMZ on nerve healing in our experimental study which was evaluated with comparative groups (Tab. 3, Fig. 2, Ref. 31).

Report of mecC-carrying MRSA in domestic swine.

OBJECTIVES: We unexpectedly identified MRSA isolates carrying mecC (mecC-MRSA) from a Danish swine farm located in eastern Zealand. The objective of the present study was to investigate the origin of these isolates and their genetic relatedness to other mecC-MRSA isolates from Zealand. METHODS: WGS was used to infer the phylogenetic relationship between 19 identified mecC-MRSA isolates from the swine farm and 34 additional epidemiologically unrelated human isolates from the same geographical region of Denmark. Variations in the accessory genome were investigated by bioinformatics tools, and antibiotic susceptibility profiles were assessed by MIC determination. RESULTS: mecC-MRSA was isolated from a domestic swine farm, but not from cattle reared at the same farm. Phylogenetic analysis revealed that all mecC-MRSA isolates from both farm animals and workers formed a separate cluster, whereas human isolates from the same municipality belonged to a closely related cluster. Analysis of the accessory genome supported this relationship. CONCLUSIONS: To the best of our knowledge, this is the first report of mecC-MRSA isolated from domestic swine. The investigation strongly indicates that transmission of mecC-MRSA has taken place on the swine farm between the farmers and swine. The close clustering of farm isolates and isolates from the same municipality suggests a local transmission of mecC-MRSA.

Influence of influenza vaccination on recurrent hospitalization in patients with heart failure.

BACKGROUND: The current study aimed to evaluate the influence of regular annual influenza vaccinations on cardiovascular (CV) death and heart failure-related hospitalizations (HFrH) in stable outpatients with heart failure with reduced ejection fraction. METHODS: The Turkish research team-HF (TREAT-HF) is a network undertaking multicenter, observational cohort studies in HF. This study is a subgroup analysis of TREAT-HF outpatient cohorts who completed a questionnaire on influenza vaccination status and for whom follow-up data were available. A total of 656 patients with available follow-up data for CV death and HFrH including recurrent hospitalization were included in the study. Patients were classified into two groups: those who received regular influenza vaccination (40 %) and those who did not receive vaccination. RESULTS: During a mean follow-up of 15 ±6 months, 113 (18 %) patients had CV death and 471 (72 %) patients had at least one HFrH. The CV death rate was similar in both groups of patients (16 vs. 19 %, p = 0.37), whereas, HFrH and recurrent HFrH were significantly less frequently encountered in patients who received regular influenza vaccination than in those who did not receive vaccination (43 vs. 92 % and 16 vs. 66 %, p < 0.001, respectively). In a multivariate Cox proportional hazards model - in addition to a few clinical factors - vaccination status (HR = 0.30, 95 % CI = 0.17-0.51, p < 0.001) and graduation from university (HR = 0.35, 95 % CI = 0.17-0.72, p = 0.004) remained independently associated with the risk of recurrent HFrH. CONCLUSION: Regular influenza vaccination does not influence CV deaths; however, it decreases HFrH including recurrent episodes of HFrH in outpatients with heart failure with reduced ejection fraction.

The future of Turkish nursing 2050: perceptions of nurses and nurse educators.

AIM: To explore the perceptions of nurses and nurse educators regarding the future of nursing by the year 2050 in Turkey. BACKGROUND: Social changes, rapid population growth, globalization and worldwide environmental problems will cause greater changes in the field of health and health care in the near future than they have in the past. Undoubtedly, these changes will directly affect nursing. It is important that nurses and nurse educators forecast and direct the future and nursing to benefit from the effects of the changes that will occur in the future. DESIGN: A qualitative descriptive study which employed the use of individual in-depth interviews. METHODS: The study's sample participants were 21 hospital nurses and 16 nurse educators from universities in Istanbul, Turkey. They undertook individual in-depth interviews during July 2013-July 2014. Thematic analysis was used to analyse the qualitative data. FINDINGS: The study revealed that the participants' perceptions were based on the ideas that the future of nursing will be shaped in accordance with changes in humanity, environment and healthcare system, as well as worldwide future trends. Results indicated that participants were aware of the factors that will affect future of nursing and nursing education. CONCLUSION AND IMPLICATIONS FOR NURSING POLICY: Research showed that participants had focused on the near future; they were not forecasting distance future. Also research found that not only future scenarios are needed for nurses, but also three kinds of scenarios are required related to factor such as humanity, environment and healthcare system those effect nurses. Futurists, health policymakers and nurse educators should work collaboratively with each other.

Association between attitudes towards Internet usage and health practices in high-school students in 2 schools in Turkey: a cross-sectional study.

Excessive usage of the Internet can negatively affect health and health practices especially among youth. To examine the issue among Turkish students, this study determined the association between high-school students' attitudes towards Internet usage and their health behaviour. The sample (n = 2043) was randomly drawn from all students at two high schools in Turkey: one in Anatolia and one (a vocational school) in Istanbul. Data were collected using the Structured Questionnaire, Attitude Scale towards Internet Usage (ASTIU) and Adolescent Lifestyle Profile (ALP). The mean age of the students was 16.3 years, 77.7% were male and 96.9% used the Internet; mean duration of Internet use was 18.8 h/week. Female students had more positive attitudes towards Internet usage. Mean scores for ASTIU and ALP were 72.58 (SD 17.64) and 111.34 (SD 16.61) respectively, which were average levels. There was a statistically significant but weak overall negative correlation between adolescents' attitudes towards Internet usage and their health behaviour. Our results concur with studies in different cultures which suggest some negative effects, of heavy Internet use.

Protective effect of thymoquinone against testicular torsion induced oxidative injury.

We aimed to determine the protective effects of thymoquinone (TQ), against ischaemia-reperfusion (I/R) injury in the testis tissue of rats. Twenty-seven male Wistar albino rats were randomly divided into three equal groups as follows: Group I, sham group; Group II, torsion group; and Group III, torsion + thymoquinone group. The ischaemia period was 2 h, and orchiectomy was performed after 30 min of detorsion. Testis tissue sections were analysed with the terminal transferase mediated dUTP-nick end labelling (TUNEL) assay to determine in situ apoptotic DNA fragmentation. Additionally, Caspase 3 and Bax proteins were analysed immunohistochemically. The superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) activity levels in the testis tissue were also measured. The superoxide dismutase activity and malondialdehyde levels in the torsion group were significantly higher than those of the sham group (P < 0.05). Thymoquinone administration significantly reduced these levels. Torsion significantly increased active-Caspase 3 and Bax expression, which was decreased by thymoquinone. The apoptotic index of the torsion group was significantly higher than that of the control group. However, thymoquinone significantly reduced the apoptotic index (P < 0.05). Our results indicate that thymoquinone plays a protective role in oxidative stress induced ischaemia-reperfusion in the testis tissue of rats.

Evaluation of the effect of selective serotonin reuptake inhibitors on bone mineral density: an observational cross-sectional study.

UNLABELLED: Sixty patients diagnosed with generalized anxiety disorder and treated with either paroxetine, sertraline, or citalopram for at least 12 months were enrolled in this study, and the bone mineral density (BMD) of the patients was compared with that of 40 healthy volunteers. Selective serotonin reuptake inhibitor (SSRI) therapy in generalized anxiety disorder was found to be related with decreased BMD values. INTRODUCTION: The objectives of this study were to evaluate the effect of SSRI therapy on BMD in postmenopausal women diagnosed with generalized anxiety disorder (GAD) and to identify the effects of the duration of disease and treatment on risk factors for osteoporosis. METHODS: Sixty patients diagnosed with GAD and treated with paroxetine, sertraline, or citalopram from the SSRI group for at least 12 months were enrolled. Social demographic features, the Hamilton Anxiety Scale (HAS) results, and the Hamilton Depression Scale (HDS) scores of all the patients were assessed. The BMD of the patients was measured by dual-energy X-ray absorptiometry (DXA) at the femoral and lumbar regions. The patients were divided into three groups which are the paroxetine, sertraline, and citalopram groups. The BMD of the patients was compared with that of 40 healthy volunteers. RESULTS: The L2-L4, total lumbar vertebrae, femoral intertrochanteric, total femoral Z-scores, and femoral Ward's region T-scores of the treatment group were lower than the median T- and Z-scores of the control group (p < 0.05). Of the treatment groups, the femoral neck, trochanteric and intertrochanteric T- and Z-scores, total femoral T- and Z-scores, and femoral Ward's T- and Z-scores of the sertraline group were significantly lower than the BMD values measured at the identical regions in the paroxetine and citalopram groups (p < 0.05).There was a significant negative correlation between the duration of treatment and the BMD values. CONCLUSION: SSRI therapy in GAD was found to be related with decreased BMD values. Further randomized controlled studies are warranted to determine whether SSRI use is a risk factor for osteoporosis; such studies should investigate these factors by performing BMD assessments before treatment.

Cancer antigen 125 levels and increased risk of new-onset atrial fibrillation.

OBJECTIVE: Elevated cancer antigen 125 (CA-125) levels are associated with cardiopulmonary disorders such as acute and chronic heart failure (HF), coronary artery disease, chronic obstructive pulmonary disease, and atrial fibrillation (AF). The development of atrial fibrillation (AF) is related to morbidity and mortality in patients with HF: therefore, it is important to identify patients with increased risk for development of AF. We investigated whether plasma CA-125 levels in patients with hospitalized systolic HF could predict the development of AF. PATIENTS AND METHODS: A total of 149 consecutive patients with sinus rhythm who were admitted to the emergency department with hospitalized systolic HF were evaluated prospectively. Serum CA-125 levels were obtained after initial stabilization during their hospital stay. RESULTS: AF developed in 36 (% 24.2) patients during a follow-up period of 22.1 ± 11  months (range 3-61). CA-125 levels were significantly higher in patients who developed AF than in patients with sinus rhythm [99 U/ml (48-172) vs. 47 U/ml (18-108), p = 0.001]. The optimal cut-off level of CA-125 to predict development of AF was found to be > 68.49 U/ml. CA-125 > 68.49 U/ml, left atrial diameter, right ventricular dilatation, moderate to severe mitral and tricuspid regurgitations were found to have prognostic significance in univariate analysis. In a multivariate Cox proportional hazards model with the backward stepwise method, CA-125 > 68.49 U/ml (HR = 2.693, % 95 CI = 1.285-5.641, p = 0.009) and moderate to severe mitral regurgitation (HR = 2.708, % 95 CI = 1.295-5.663, p = 0.008) were associated with an increased risk of new-onset AF after adjustment for variables found to be statistically significant in univariate analysis and correlated with CA-125 level. CONCLUSION: CA-125 level is associated with the development of AF in patients with hospitalized systolic HF.

Effects of coronary artery bypass grafting surgery on retinal vascular caliber, ocular pulse amplitude and retinal thickness measurements.

AIM: The retina and ocular vasculature are vulnerable to alterations in systemic hemodynamics, such as in open heart surgeries. Our aim was to investigate retinal vascular caliber (RVC), ocular pulse amplitude (OPA), peripapillary retinal nerve fiber layer (RNFL) and macular thickness in coronary artery bypass grafting (CABG) surgery patients. METHODS: Twenty-six patients who had a history of CABG surgery and 26 age-sex-matched healthy participants were recruited for this prospective, cross-sectional and comparative study. The RVC, peripapillary RNFL and macular thickness measurements were taken with spectral-domain optical coherence tomography. The OPA, a surrogate of pulsatile ocular blood flow, was measured with the Pascal dynamic contour tonometer. RESULTS: There were no statistically significant differences between the CABG surgery patients and the controls with regard to RVC, OPA, peripapillary RNFL thickness and macular thickness measurements (p>0.05). CONCLUSIONS: CABG surgery does not affect retinal structures and pulsatile ocular blood flow in the long-term follow-up.

Prognostic factors influencing survival in 35 patients with malignant peritoneal mesothelioma.

Malignant mesothelioma is a rare but highly lethal form of cancer that affects the serosal membranes. Malignant peritoneal mesothelioma (MPM) is the second most common form of malignant mesothelioma (pleural mesothelioma is the most common). The aim of this study was to evaluate prognostic factors influencing the survival of patients with MPM. A retrospective analysis was performed on 35 patients who were admitted to our hospital between March 2005 and July 2013. The patients' demographic and clinical data, laboratory results, radiological signs, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and treatment outcomes were evaluated. The mean age of the 35 patients was 59.0±14.4 years, the mean survival time was 16.2±12.9 months, and the majority of the histopathological types of MPM were epithelial (68.6%). 82.9% of the patients had been exposed to asbestos, and the mean duration of exposure was 28.3±14.5 years. The most frequent symptoms were abdominal distention/pain, weight loss, dyspnea, and chest pain. The mean interval between the onset of symptoms and the diagnosis was 4.6±3.3 months. Platinum-based combination chemotherapy in combination with supportive care was used in the treatment of 68.6% of the patients, while supportive treatment alone was used in the others. Our results revealed that patients who were >60 years old (p=0.019), who were exposed to asbestos >20 years (p=0.033), who had an ECOG PS of 3 (p=0.000) were more likely to have a poor MPM prognosis.In conclusion, increased age, duration of environmental asbestos exposure and ECOG PS are important factors that influence the prognosis of MPM patients.

Three-dimensional transesophageal echocardiographic evaluation of cor triatriatum in adults.

We present the cases of two adult patients with cor triatriatum due to left atrial membrane with atrioventricular septal defect and right atrial membrane. Two-dimensional and real-time three-dimensional transthoracic echocardiography were performed. These noninvasive modalities provided a comprehensive anatomic and hemodynamic evaluation of the anomaly.

The impact of the duration of admission to the emergency room on the mortality of intensive care patients.

OBJECTIVE: There are many factors affecting the mortality of patients admitted to the intensive care unit (ICU). Among these are the patients' age, diagnosis, and concomitant pathology. The aim of this retrospective study was to investigate whether there is an adverse effect of the time between admission to the Emergency Room (ER) and admission to the ICU on the mortality of these patients. MATERIALS AND METHODS: The medical records of the patients who were admitted to the Emergency Department (ED) of the Bolu Izzet Baysal State Hospital and subsequently were admitted to the ICU between December 2009 and August 2011 were analyzed in terms of the time of admission, the season of admission, and the waiting and the stand-by times in the ER. RESULTS: A total of 2380 patients, who were admitted to the ED of the Bolu Izzet Baysal State Hospital and subsequently to the ICU, were included in the study. The median waiting time in the ER was 1.23 h (10 min to 10.02 h). After completion of the admission procedures, the median hospitalization time in the ER was 0.16 h (3 min to 2.58 h). There was no statistically significant difference between the patients who died after admission to the ICU and the ones who survived, in terms of the waiting and the stand-by times in the ER ( P > 0.05). CONCLUSION: The waiting times at the ED did not affect the mortality of the ICU patients.

Relationship between endothelial dysfunction and prosthetic heart valve thrombosis: a preliminary investigation.

AIM: The etiopathogenesis of prosthetic heart valve thrombosis (PHVT) is multifactorial. Since the relationship between PHVT and endothelial function is never studied, we aimed to analyze the role of endothelial function in patients with PHVT. PATIENTS AND METHODS: Twenty-two patients with PHVT (14 female, 31.8% with atrial fibrillation, mean age 46.0±12.2) and 22 controls with prosthetic heart valves (17 female, 36.4% with atrial fibrillation, mean age 45.7±11.5) were prospectively evaluated. Two groups had similar demographic and echocardiographic characteristics. Endothelial function was evaluated in all patients by the non-invasive measurement of flow mediated dilatation (FMD) of brachial artery. High-resolution ultrasound was used to measure brachial artery diameter at rest, during reactive hyperemia (endothelium-dependent, FMD), and following sublingual administration of nitroglycerin (endothelium-independent, nitroglycerin-mediated vasodilatation, NMD). RESULTS: Functional capacity at presentation determined as mean NYHA functional capacity class was worse in patients with PHVT than in control group (2.1±0.6 vs. 1.3±0.6; p < 0.0001). FMD was significantly reduced in patients with PHVT compared with control group (4.01±1.52 vs. 8.48±3.37; p < 0.0001). NMD did not differ between two groups (11.77±2.30 vs. 13.38±3.50; p = 0.08). FMD level of < 5.65 predicted prosthetic valve thrombosis with an 82% sensitivity and 77% specificity (area under the curve = 0.888, p < 0.0001). CONCLUSIONS: This study demonstrated the endothelial dysfunction in patients with PHVT compared with well-matched control group. In this study, we found that patients with PHVT have endothelial dysfunction which might contribute to the development of thrombosis.

The association between mean platelet volume and coronary collateral circulation.

BACKGROUND: Platelets are important in the pathogenesis of atherosclerotic complications. Higher mean platelet volume (MPV) levels are related to greater in vitro aggregation, and have been identified as an independent risk factor for myocardial infarction, and for death or recurrent vascular events. AIM: To determine the relationship between MPV and the coronary collateral circulation. METHODS: The sample consisted of 96 patients with coronary artery disease, and patients were separated into two groups according to their poorly developed or well-developed collateral circulation. Coronary collateral vessels were analyzed according to the Cohen and Rentrop grading system of 0-3. RESULTS: All analyses were conducted using SPSS 11.5 (SPSS for Windows 11.5, Chicago, IL, USA). Continuous variables were expressed as mean ± SD, and categorical variables were expressed as percentages. Comparison of categorical and continuous variables between the group with well-developed coronary collateral vessels and the group with poorly developed vessels was performed using the chi-squared test and independent samples t-test, respectively. Platelet count and MPV values were similar between the two groups. CONCLUSIONS: Our study found that MPV levels are not related to coronary collateral circulation.  

Effects of treatment regimens on survival in patients with malignant pleural mesothelioma.

BACKGROUND AND OBJECTIVE: In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment regimens, including best supportive care (BSC), chemotherapy, surgical group and multimodality (MM) therapy. PATIENTS: A retrospective analysis was performed on clinical data and treatment outcomes of 400 patients registered in our hospital with MPM between January 1989 and April 2010. RESULTS: Mean age (p < 0.001), presence of asbestos exposure (p = 0.0014), presence of smoking history (p < 0.001), Karnofsky performance status (p < 0.001), histological subtype (p = 0.034) and stage (p < 0.001) variables were found to be significantly different among the four treatment regimens. Mean survival time of all patients was 12.32 months. Mean survival time 10.5 months for the BSC group, 15.7 for the surgical group, 16.02 for the chemotherapy group, and 26.55 for the MM group. There were significant differences in mean survival time among the four treatment regimens. In addition, a significant difference was found in survival time between the two chemotherapy groups (p = 0.032). Mean survival time for cisplatin + gemcitabine was found to be 14.49 months and for cisplatin + pemetrexed, 18.34 months. CONCLUSIONS: The MM group had better survival rates than the other groups. The new chemotherapy combination, cisplatin + pemetrexed, can be helpful in improving survival time.      

Non-valvular atrial fibrillation in the elderly; preliminary results from the National AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) Study.

OBJECTIVE: This study aimed at the assessment of the clinical approach to atrial fibrillation (AF) in the older population and the consistency with the guidelines based on the records of the multicenter, prospective AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) study. PATIENTS AND METHODS: 2242 consecutive patients admitted to the Cardiology Outpatient Clinics of 17 different tertiary Health Care Centers with at least one AF attack determined on electrocardiographic examination, were included in the study. Among the patients included in the study, 631 individuals aged 75 years and older were analyzed. RESULTS: The mean age of the patients was determined as 80.3±4.2 years. The most frequent type of AF in geriatric population was the persistent-permanent type with a percentage of 88%. 60% of the patients with AF were female. Hypertension was the most common co-morbidity in patients with AF (76%). While in 16% of patients a history of stroke, transient ischemic attack or systemic thromboembolism was present, a history of bleeding was present in 14% of the patients. 37% of the patients were on warfarin treatment and 60% of the patients were on aspirin treatment. In 38% of the patients who were on oral anticoagulant treatment, INR level was in the effective range. CONCLUSIONS: The rate of anticoagulant use in the elderly with AF was 37% and considering the reason of this situation was the medication not being prescribed by the physician, one should pay more attention particularly in the field of treatment.