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BACKGROUND: Although ultrasound (US)-guided regional anesthesia techniques are advantageous in the management of obese patients; the procedures can still be associated with technical difficulties and greater failure rates. The aim of this study is to compare the performance properties and analgesic efficacy of US-guided bilateral thoracic paravertebral blocks (TPVBs) in obese and non-obese patients. METHODS: Data of 82 patients, who underwent bilateral reduction mammaplasty under general anesthesia with adjunctive TPVB analgesia between December 2016 and February 2020, were reviewed. Patients were allocated into two groups with respect to their BMI scores (Group NO: BMI < 30 and Group O: BMI ≥ 30). Demographics, ideal US visualization time, total bilateral TPVB procedure time, needle tip visualization and performance difficulties, number of needle maneuvers, surgical, anesthetic and analgesic follow-up parameters, incidence of postoperative nausea and vomiting (PONV), sleep duration, length of postanesthesia care unit (PACU) and hospital stay, and patient/surgeon satisfaction scores were investigated. RESULTS: Seventy-nine patients' data were complete. Ideal US visualization and total TPVB performance times were shorter, number of needle maneuvers were fewer and length of PACU stay was shorter in Group NO (p < 0.05). Postoperative pain scores were generally similar within first 24 h (p > 0.05). Time to postoperative pain, total analgesic requirements, incidence of PONV, sleep duration, length of hospital stay were comparable (p > 0.05). Satisfaction was slightly higher in Group NO (p < 0.05). CONCLUSIONS: US-guided TPVB performances in obese patients might be more challenging and take longer time. However, it is still successful providing good acute pain control in patients undergoing reduction mammaplasty surgeries. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . TRIAL REGISTRATION: NCT04596787.
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Mamoplastia , Náusea e Vômito Pós-Operatórios , Feminino , Humanos , Estudos de Coortes , Náusea e Vômito Pós-Operatórios/epidemiologia , Mamoplastia/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Obesidade/complicações , AnalgésicosRESUMO
Endoplasmic reticulum (ER) stress and apoptosis are implicated in the pathogenesis of epilepsy. Here we examine the effects of valproic acid (VA) plus 4-phenylbutyric acid (4-PBA) on abnormal electrical brain activity, ER stress and apoptosis in acute seizures induced by pentylenetetrazole (PTZ). Forty male rats were randomly divided into five groups, each consisting of 8 rats as follows: Sham, PTZ, VA+PTZ, 4-PBA+PTZ, and VA plus 4-PBA+PTZ. The treated groups received VA, 4-PBA and VA plus 4-PBA by intraperitoneal application for 7 days prior to PTZ-induced seizure. On the 8th day, acute epileptic seizures were induced by PTZ (50 mg/kg, i.p.) injection, except for the sham group. Then, the seizure stage was observed and ECoG activities were recorded during the 30 min. At 24th post seizures, the hippocampus and blood samples were collected for biochemical and histopathological examinations. Administration of VA plus 4-PBA prior to PTZ-induced seizures significantly decreased seizure stage, the duration of generalized tonic-clonic seizure and the total number of spikes as increased the latency to the first myoclonic jerk when compared to the PTZ group. 4-PBA suppressed the increased levels of ER stress markers GRP78 and CHOP in the hippocampus. VA plus 4-PBA treatment before seizures significantly inhibited PTZ-induced elevations of apoptosis-related indicators caspase-3 and caspase-12, and significantly reduced the number of histopathological lesions of the hippocampus region at 24th post seizures. These findings suggest that administration of VA plus 4-PBA prior to PTZ-induced seizures may be involved in the neuroprotective potential of these agents for seizures.
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Epilepsia , Fármacos Neuroprotetores , Animais , Masculino , Ratos , Anticonvulsivantes/farmacologia , Modelos Animais de Doenças , Epilepsia/tratamento farmacológico , Fármacos Neuroprotetores/efeitos adversos , Pentilenotetrazol/toxicidade , Fenilbutiratos , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico , Convulsões/patologia , Ácido Valproico/farmacologiaRESUMO
BACKGROUND: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory disease characterized by widespread and superficial sterile pustules on an erythematous background. OBJECTIVES: This multicentre study aimed to determine the clinical profile and course in a large cohort of patients with GPP. METHODS: One hundred and fifty-six GPP patients (mean age, 44.2 ± 18.7 years) who met the diagnostic criteria of the European Consensus Report of GPP were included in the study. Sociodemographic characteristics, quality of life, triggering factors of the disease, clinical, laboratory, treatment and prognostic features were evaluated. RESULTS: 61.5% of the patients were female. The rate of working at or below the minimum wage (≤$332.5/month) was 44.9%. Drugs (36.5%) were the most common trigger. While hypocalcaemia (35.7%) was the most important cause of GPP during pregnancy, systemic steroid withdrawal (20%) was the most frequently reported trigger for infantile/juvenile and mixed-type GPP (15%) (P < 0.05). Acute GPP (53.8%) was the most common clinic. Nails were affected in 43.6% of patients, and subungual yellow spots (28.2%) were the most common change. In annular GPP, fever (P < 0.001) and relapse frequency (P = 0.006) were lower than other subtypes, and the number of hospitalizations (P = 0.002) was lower than acute GPP. GPP appeared at a later age in those with a history of psoriasis (P = 0.045). DLQI score (P = 0.049) and joint involvement (P = 0.016) were also higher in this group. Infantile/juvenile GPP was observed in 16.02% of all patients, and arthritis was lower in this group (24.4 vs. 16%). GPP of pregnancy had the worst prognosis due to abortion observed in three patients. CONCLUSIONS: Recent advances in treatment have improved mortality associated with GPP, but abortion remains a significant complication. Although TNF-α inhibitors have proven efficacy in GPP, they can also trigger the disease. Mixed-type GPP is more similar to acute GPP than annular GPP with systemic manifestations and course.
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Doenças da Imunodeficiência Primária , Psoríase , Dermatopatias Vesiculobolhosas , Doença Aguda , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Prognóstico , Psoríase/complicações , Psoríase/tratamento farmacológico , Qualidade de Vida , Dermatopatias Vesiculobolhosas/complicações , Turquia/epidemiologiaRESUMO
Netherton syndrome (NS) is a rare genodermatosis characterized by the triad of ichthyosiform erythroderma, hair shaft abnormality and an atopic diathesis. We report a case of a 20-year-old male patient presented with pruritus, decreased sweat secretion and generalized erythema on his body. Netherton syndrome is caused by mutations in the SPINK5 gene that is a crucial role for epidermal barrier function in the skin. Different clinical and phenotypical features can occur based on various LEKTI-domains mutations. Diagnosis is made by the atopic story, hair shaft abnormality, cutaneous lesions and identification of the SPINK5 gene mutation. In our patient, we detected a new splice site mutation in the SPINK5 gene and pili annulati as hair abnormality. Affected patients are usually misdiagnosed because of cutaneous lesions such as atopic dermatitis. Therefore, each clinical finding should be evaluated together. We aimed to present a case with a new SPINK5 gene mutation and different clinical features in NS.
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AIM: The circadian timing system has a rhythm and one of the roles of this system is the mediation of hormonal and metabolic adaptations to lactation. This study was conducted to determine whether the time to stage II lactogenesis differed in women who underwent cesarean section (CS) in the daytime (DT) or night-time (NT). METHODS: This study was conducted at Süleymaniye Research and Education Hospital between June and December 2016. Two hundred and eighty-eight mothers who had a cesarean delivery and their healthy singleton neonates were included. Clinical and demographic data of the mothers and neonates, time of initiation of breastfeeding and time to stage II lactogenesis were analyzed according to DT or NT CS groups. RESULTS: There were no statistically significant differences in age, gravida, parity, body mass index, week of gestation at birth, postoperative hemoglobin level, cesarean indications, anesthesia type, previous history of breastfeeding, transfusion need, Apgar scores or birth weight-height of neonates between the DT and NT CS groups. While the time of initiation of breastfeeding did not differ statistically in terms of DT or NT CS groups, the time to stage II lactogenesis was significantly longer in the NT CS group. CONCLUSIONS: NT cesarean delivery is a risk factor for the delayed onset of lactogenesis. The results of this study may be useful to clinical practitioners counseling mothers who undergo NT cesarean delivery.
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Aleitamento Materno/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Ritmo Circadiano/fisiologia , Lactação/fisiologia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Fatores de Tempo , Adulto JovemRESUMO
Behçet's disease (BD) is a multisystemic inflammatory disease believed to be triggered by microbial or environmental factors on a genetic platform. Clinically, it may have an impact on many body systems, including the mucocutaneous, ocular, articular, vascular, and neurological systems. In this study, we aimed to determine the HLA-B51 subtypes and their correlations with the clinical findings of BD. Fifty-one patients with BD and 44 gender- and age-matched healthy subjects were included in this study. The HLA-B51 subtypes of all participants were determined, and the correlations of the clinical manifestations of the disease with the HLA-B51 subtypes were analyzed. HLA-B51 positivity was found to be significantly higher in the patient group (P < 0.001, RR = 15.20), which had significantly more frequent HLA-B5101, HLA-B5102(01), HLA-B5109, and HLA-B5122 subtypes than the healthy subjects (all P < 0.05). Furthermore, considering the correlation between the genetic makeup and clinical findings, the HLA-B5109 subtype was found to be less frequent in patients with papulopustular skin lesions (P = 0.042). The frequency of HLA-B5103 was significantly higher in patients with central nervous system involvement (P = 0.015). There may be a relationship between HLA-B5102(01), HLA-B5109, and HLA-B5122 in addition to HLA-B51 and HLA-B5101(01) in Turkish patients with BD. The HLA-B5109 subtype can be protective against papulopustular lesion development; however, the HLA-B5103 subtype may pose a risk for neuro-Behçet development in BD.
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Síndrome de Behçet/genética , Estudos de Associação Genética , Antígeno HLA-B51/genética , Sistema Nervoso/patologia , Úlceras Orais/patologia , Pele/patologia , Adulto , Idoso , Alelos , Síndrome de Behçet/imunologia , Síndrome de Behçet/patologia , Estudos de Casos e Controles , Feminino , Expressão Gênica , Frequência do Gene , Genótipo , Antígeno HLA-B51/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Sistema Nervoso/imunologia , Úlceras Orais/imunologia , Fenótipo , Pele/imunologia , TurquiaRESUMO
BACKGROUND AND AIMS: Costoclavicular brachial plexus block is gaining popularity due to its ease of application. Lateral and medial costoclavicular approaches have recently been defined. In the current study, we aimed to investigate the procedural execution of these approaches in the pediatric population. METHODS: In this study 55 children aged between 2 and 10 years were randomized to receive lateral (LC group) or medial (MC group) costoclavicular brachial plexus block after induction of general anesthesia for postoperative analgesia. All patients received bupivacaine (1â¯mg/kg, 0.25%) within the center of the cord cluster. The number of needle maneuvers was recorded as primary outcome. Block performing features (ideal ultrasound-guided brachial plexus cords visualization, needle pathway planning time, needle tip and shaft visualization difficulty, requirement of extra needle maneuver due to insufficient local anesthetic distribution, block performance time, total procedure difficulty) and postoperative pain-related data (block intensities, pain scores and analgesic requirements) were all compared as secondary outcomes. RESULTS: The LC group patients required less ultrasound visualization time (median 14â¯s, range 11-23â¯s vs. median 42â¯s, range 15-67â¯s, pâ¯< 0.001) and fewer needle maneuvers (median 1, range 1-2 vs. median 3, range 2-4, pâ¯< 0.001) compared to the MC group. Similarly, the median block performance duration was shorter (median 67â¯s, range 47-94â¯s vs. median 140s, 90-204â¯s, pâ¯< 0.01) and procedures were perceived as easier (median 4, range 4-5 vs. median 3, range 2-5, pâ¯= 0.04) in the LC group. All other parameters were comparable (pâ¯> 0.05). CONCLUSION: The lateral approach required less needle maneuvers than the medial approach. Both techniques represented a good safety profile with favorable analgesic features.
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Bloqueio do Plexo Braquial , Criança , Pré-Escolar , Humanos , Analgésicos , Anestésicos Locais , Bloqueio do Plexo Braquial/métodos , Ultrassonografia de IntervençãoRESUMO
Rapid allograft infection complicates liver transplantation (LT) in patients with hepatitis C virus (HCV). Pegylated interferon-α and ribavirin therapy after LT has significant toxicity and limited efficacy. The effect of a human monoclonal antibody targeting the HCV E2 glycoprotein (MBL-HCV1) on viral clearance was examined in a randomized, double-blind, placebo-controlled pilot study in patients infected with HCV genotype 1a undergoing LT. Subjects received 11 infusions of 50 mg/kg MBL-HCV1 (n=6) or placebo (n=5) intravenously with three infusions on day of transplant, a single infusion on days 1 through 7 and one infusion on day 14 after LT. MBL-HCV1 was well-tolerated and reduced viral load for a period ranging from 7 to 28 days. Median change in viral load (log10 IU/mL) from baseline was significantly greater (p=0.02) for the antibody-treated group (range -3.07 to -3.34) compared to placebo group (range -0.331 to -1.01) on days 3 through 6 posttransplant. MBL-HCV1 treatment significantly delayed median time to viral rebound compared to placebo treatment (18.7 days vs. 2.4 days, p<0.001). As with other HCV monotherapies, antibody-treated subjects had resistance-associated variants at the time of viral rebound. A combination study of MBL-HCV1 with a direct-acting antiviral is underway.
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Anticorpos Monoclonais/farmacologia , Hepacivirus/fisiologia , Hepatite C/tratamento farmacológico , Transplante de Fígado , Idoso , Biópsia , Método Duplo-Cego , Feminino , Genótipo , Hepatite C/virologia , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , RNA Viral/análise , Fatores de Tempo , Proteínas do Envelope Viral/imunologiaRESUMO
BACKGROUND: Vitiligo is an acquired depigmentation disorder, and oxidative stress is suggested to have a major role in its aetiopathogenesis. AIM: To assess whether oxidative stress has a greater role in generalized than in localized vitiligo. METHODS: We assessed 31 patients with active vitiligo (17 localized, 14 generalized) and 38 healthy controls. Serum total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were determined. RESULTS: Patients with vitiligo had significantly lower TAS and higher TOS and OSI values than controls. Both localized and generalized vitiligo were associated with lower TAS and higher TOS and OSI values, compared with controls, and all three did not differ with vitiligo type. CONCLUSIONS: A systemic oxidative stress exists in patients with vitiligo. These results indicate that the global antioxidant capacity of patients might have been exhausted through a defence mechanism against oxidative processes. The imbalance in TOS/TAS status may have an important role in the aetiopathogenesis of vitiligo, regardless of the clinical variant of the disease.
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Antioxidantes/metabolismo , Espécies Reativas de Oxigênio/sangue , Vitiligo/sangue , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/fisiologia , Vitiligo/etiologia , Vitiligo/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: Recent studies suggested that increased oxidant products and decreased antioxidant system functions may be involved in the pathogenesis of psoriasis. In this study, we investigated total oxidative status, Paraoxonase (PON)1/arylesterase enzyme activities and severity of the disease in smoker and non-smoker psoriatic patients. METHODS: Fifty-four patients with plaque type psoriasis (28 smokers and 26 non-smokers) and 62 healthy volunteers (16 smokers and 46 non-smokers) were enrolled in the study. Serum total oxidant status (TOS), total antioxidant capacity (TAC) and arylesterase levels were measured, and oxidative stress index (OSI) was calculated in all participants. RESULTS: Psoriasis Area and Severity Index scores were significantly higher in smoker patients than in non-smoker patients (P = 0.014). Both smoker and non-smoker patients had significantly increased TOS levels and OSI values and decreased TAC levels than healthy subjects (all P values = 0.000). The TAC and TOS levels, OSI values and arylesterase activities were similar between smoker and non-smoker patients. The levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were not significantly different between smoker and non-smoker psoriasis patients. When compared with non-smoking controls, only smoking psoriasis patients had significantly higher TG (P = 0.005), lower HDL (P = 0.022) and lower arylesterase levels (P = 0.015). There were no significant correlations with Psoriasis Area and Severity Index (PASI) scores and TAC, TOS, OSI, TG, TC, HDL and LDL levels in all psoriasis patients. CONCLUSIONS: Oxidative stress is increased in psoriasis patients regardless of their smoking status. The decreased arylesterase activity in smoker psoriasis patients suggested that smoking may be a considerable risk factor that increases the severity of psoriasis by increasing oxidative stress in these patients.
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Estresse Oxidativo , Psoríase/fisiopatologia , Índice de Gravidade de Doença , Fumar , Adulto , Feminino , História do Século XVII , Humanos , MasculinoRESUMO
The increase in poultry production and the high cost of soybean led to the search for alternative protein sources. One of these sources is vinasse, a by-product of the baker's yeast industry. Modified dried vinasse (MDV) can be produced for use in poultry nutrition by making some improvements in vinasse. Therefore, the present study aimed to examine the effect of the usage of MDV in broiler diets. A total of 192 daily male Ross 308 chicks were randomly assigned to four groups. MDV was included at the levels of 0%, 2%, 4%, and 6% in the diets for 42-day trial. Linear significant improvements in the final weight, body weight gain, feed efficiency, and digestibility were seen with increasing MDV levels. The use of MDV caused a significant reduction in feed consumption. The relative weight percentages of abdominal fat and serum cholesterol concentration were reduced linearly with increases in MDV levels. MDV inclusion linearly decreased the malondialdehyde concentration, but increased 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity in breast meat significantly. The protein content in breast meat was increased with MDV. Cecal beneficial microorganisms and serum IgG levels were increased linearly with MDV. In conclusion, results suggested that MDV could be a feasible option for alternative protein sources for broilers.
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Galinhas , Suplementos Nutricionais , Animais , Masculino , Galinhas/metabolismo , Ração Animal/análise , Dieta/veterinária , Proteínas Alimentares/metabolismo , Carne/análiseRESUMO
Brucellosis is considered the most widespread zoonosis in the world. It has been reported that the prevalence of seropositivity among the Turkish population varies from 3% to 14%. We present a case of brucellosis after pediatric liver transplantation. A 15-year-old boy with the diagnosis of neuro Wilson's disease underwent deceased-donor liver transplantation. The postoperative immunosuppressive protocol consisted of steroids and tacrolimus. Two months after the operation the patient experienced fever to 40°C. The patient complained of poor appetite, headache, and diarrhea. He had had pancytopenia. Despite administration of appropriate antibiotics, antiviral and antifungal agents, fever persisted for > 1 month. Multiple blood, urine, stool, and sputum cultures were negative. Bone marrow aspirate revealed hypocellularity. Liver biopsy was performed, but rejection was not observed on biopsy specimen. Brucella serology was positive and Brucella agglutination titer was 1:320. Bone marrow culture was positive for Brucella but blood culture was negative. The patient was then treated with oral doxycycline and rifampin for 8 weeks. No previous case report about Brucella infection after liver transplantation has appeared in the literature, to our knowledge; our case is presented as the first. Bone marrow hypoplasia is a rare feature of Brucella infection. Our patient with brucellosis and pancytopenia had had hypocellular bone marrow. The clinical and hematologic findings resolved with treatment of the infection. Brucella infection should be suspected in liver transplanted recipients with fever of unknown origin, especially in a recipient who has lived in an endemic area. Brucella also should be considered as a possible diagnosis in patients with pancytopenia.
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Antibacterianos/uso terapêutico , Brucella/isolamento & purificação , Brucelose/etiologia , Transplante de Fígado/efeitos adversos , Pancitopenia/etiologia , Doadores de Tecidos , Adolescente , Antibióticos Antituberculose/uso terapêutico , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Humanos , Masculino , Pancitopenia/diagnóstico , Pancitopenia/tratamento farmacológico , Rifampina/uso terapêuticoRESUMO
Multidetector computed tomography (MDCT) angiography is a reliable technique for assessing pre-operative renal anatomy in living kidney donors. The method has largely evolved into protocols that eliminate dedicated venous phase and instead utilize a combined arterial/venous phase to delineate arterial and venous anatomy simultaneously. Despite adoption of this protocol, there has been no study to assess its accuracy. To assess whether or not MDCT angiography compares favorably to intra-operative findings, 102 donors underwent MDCT angiography without a dedicated venous phase with surgical interpretation of renal anatomy. Anatomical variants included multiple arteries (12%), multiple veins (7%), early arterial bifurcation (13%), late venous confluence (5%), circumaortic renal veins (5%), retroaortic vein (1%), and ureteral duplication (2%). The sensitivity and specificity of multiple arterial anomalies were 100% and 97%, respectively. The sensitivity and specificity of multiple venous anomalies were 92% and 98%, respectively. The most common discrepancy was noted exclusively in the interpretation of right venous anatomy as it pertained to the renal vein/vena cava confluence (3%). MDCT angiography using a combined arterial/venous contrast-enhanced phase provides suitable depiction of renal donor anatomy. Careful consideration should be given when planning a right donor nephrectomy whether the radiographic interpretation is suggestive of a late confluence.
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Angiografia/métodos , Sobrevivência de Enxerto , Transplante de Rim/diagnóstico por imagem , Doadores Vivos , Artéria Renal/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Humanos , Cuidados Pré-Operatórios , Prognóstico , Artéria Renal/anatomia & histologia , Veias Renais/anatomia & histologia , Sensibilidade e EspecificidadeRESUMO
Rejection is independently associated with liver graft loss in children. We report the successful rescue of grafts using ATG+/-OKT3 in late rejection associated with cholestasis. Retrospective chart review was performed after IRB approval. Between 2003 and 2010, 14 pediatric liver transplant recipients received anti-lymphocyte treatment for "cholestatic" rejection. Median age at transplantation was 12.7 yr (range 0.9-23.4), eight were boys, and immunosuppression was tacrolimus based. Median time from transplantation to rejection was five yr (range 1.1-10.5). Median peak total bilirubin was 11.1 mg/dL (range 1.4-18). All showed moderate to severe acute rejection and hepatocellular cholestasis on histology. ATG/OKT3 was started as first-line therapy in six and in the remaining eight as second-line therapy after failure of pulse steroids. Thirteen responded with normalization of aminotransferases and bilirubin, median time 16 wk (range 7-112); one non-adherent recipient has still not achieved normal graft function at last follow-up. Patient survival is 100%, with no re-transplantation and no post-transplant lymphoproliferative disease, median follow-up 2.9 yr (range 1.1-7.2). Cholestasis associated with acute rejection occurring late after liver transplantation may herald steroid resistance. First-line therapy with anti-lymphocyte preparations, prophylactic anti-microbial therapy, and close monitoring allow excellent rates of patient and graft survival.
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Soro Antilinfocitário/uso terapêutico , Colestase/prevenção & controle , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Fígado/efeitos adversos , Muromonab-CD3/uso terapêutico , Adolescente , Adulto , Criança , Pré-Escolar , Colestase/etiologia , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Tacrolimo/uso terapêutico , Adulto JovemRESUMO
OBJECTIVES: Vision plays an important role in postural stability. It has also been shown that visual information from the environment and visual cues significantly contribute to balance skills. The aim of this study was to investigate the effects of visual acuity on postural stability and mobility before and after cataract surgery. METHODS: The study group was composed of 25 male and 11 female patients (age 57-84, mean 66.6 +/- 4.7) who had been operated for age-related cataract. Postural stability and mobility were assessed before and four weeks after the surgery by means of Biodex stability system (BSS), Tinetti, Time up and go (TUG) and Functional reach (FR) tests, as well as by gait analysis (gait velocity, step length, step width, cadence, stride length). RESULTS: Postoperative visual acuity was significantly improved. Gait velocity and cadence increased significantly but step length, stride length, and step width did not change significantly. Postoperative improvement of Tinetti balance, TUG and FR tests were significant. Similarly, antero-posterior stability index (APSI), mediolateral stability index (MLSI) and overall stability index (OSI) that were examined with BSS improved significantly after the cataract surgery. CONCLUSION: These results demonstrated that gain in visual acuity after cataract surgery improves the postural stability and mobility of patients (Tab. 2, Fig. 1, Ref. 29). Full Text in free PDF www.bmj.sk.
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Facoemulsificação , Equilíbrio Postural , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Catarata/fisiopatologia , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: This study was conducted to evaluate the diabetes education efficiency of individuals over 65 years old in Turkey, which has the highest prevalence of diabetes in Europe. METHODS: We retrospectively evaluated 320 patients who attended Turkey diabetes self-management group education program (TDSMEP) between 2016 and 2020 in a secondary hospital. Participants who have been followed up for a maximum of 9 months are grouped as over 65 years old and under. RESULTS: Of the 320 patients, 114 formed the geriatric group and 206 the non-geriatric group. After the training, the number of patients who had HbA1c≤7% increased significantly in both the geriatric (28.1-45.6%) and non-geriatric (19.9-42.2%) (P=0.001) groups. After the training, similar HbA1c goals were achieved in the geriatric and non-geriatric groups. The most significant HbA1c decrease was observed at the 3rd month of follow-up and remained stable until the 9th month. In logistic regression analysis, the factors affecting HbA1c failure (HbA1c>7%) after training in the geriatric group were long diabetes duration (OR=1.07, 95% CI: 1.02-1.13, P=0.01), high basal HbA1c levels (OR=1.31, 95% CI: 1.03-1.67, P=0.03), and low education level (OR=3.88, 95% CI: 1.54-9.76, P=0.001). CONCLUSIONS: This is the first study to evaluate the effectiveness of TDSMEP for geriatric individuals whose HbA1c≤7% increased from 28% to 45.6% during follow-up after the training. TDSMEP is recommended for all adult age groups, regardless of age range.
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Diabetes Mellitus Tipo 2 , Geriatria , Autogestão , Adulto , Idoso , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobinas Glicadas/análise , Humanos , Estudos Retrospectivos , Turquia/epidemiologiaRESUMO
The availability of hepatitis B immune globulin (HBIG) and several oral antiviral therapies has reduced but not eliminated hepatitis B virus (HBV) recurrence. We aimed to determine the rate of HBV recurrence after orthotopic liver transplantation (OLT) in relation to virologic breakthrough pre-OLT and HBIG regimens post-OLT. Data from the NIH HBV-OLT database were analyzed. A total of 183 patients transplanted between 2001 and 2007 followed for a median of 42 months (range 1-81) post-OLT were studied. At transplant, 29% were hepatitis B e antigen (HBeAg) (+), 38.5% had HBV DNA > 5 log(10) copies/mL, 74% were receiving antiviral therapy. Twenty-five patients experienced virologic breakthrough before OLT. Post-OLT, 26%, 22%, 40% and 12% of patients received intravenous (IV) high-dose, IV low-dose, intramuscular low-dose and a finite duration of HBIG, respectively as maintenance prophylaxis. All but two patients also received antiviral therapy. Cumulative rates of HBV recurrence at 1 and 5 years were 3% and 9%, respectively. Multivariate analysis showed that listing HBeAg status and HBV DNA level at OLT were the only factors associated with HBV recurrence. In conclusion, low rates of HBV recurrence can be accomplished with all the HBIG regimens used when combined with antiviral therapy including patients with breakthrough pre-OLT as long as rescue therapy is administered pre- and post-OLT.
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Hepatite B/tratamento farmacológico , Imunoglobulinas/uso terapêutico , Transplante de Fígado/efeitos adversos , Adolescente , Adulto , DNA Viral/análise , Feminino , Hepatite B/prevenção & controle , Antígenos E da Hepatite B/imunologia , Humanos , Imunoglobulinas/administração & dosagem , Transplante de Fígado/imunologia , Masculino , Pessoa de Meia-Idade , Prevenção SecundáriaRESUMO
Two new programs, MTENSOR and TENSOR, hosted on the open-access website known as the Bilbao Crystallographic Server, are presented. The programs provide automatically the symmetry-adapted form of tensor properties for any magnetic or non-magnetic point group or space group. The tensor is chosen from a list of 144 known tensor properties gathered from the scientific literature or, alternatively, the user can also build a tensor that possesses an arbitrary intrinsic symmetry. Four different tensor types are considered: equilibrium, transport, optical and nonlinear optical susceptibility tensors. For magnetically ordered structures, special attention is devoted to a detailed discussion of the transformation rules of the tensors under the time-reversal operation 1'. It is emphasized that for non-equilibrium properties it is the Onsager theorem, and not the constitutive relationships, that indicates how these tensors transform under 1'. In this way it is not necessary to restrict the validity of Neumann's principle. New Jahn symbols describing the intrinsic symmetry of the tensors are introduced for several transport and optical properties. In the case of some nonlinear optical susceptibilities of practical interest, an intuitive method is proposed based on simple diagrams, which allows easy deduction of the action of 1' on the susceptibilities. This topic has not received sufficient attention in the literature and, in fact, it is usual to find published results where the symmetry restrictions for such tensors are incomplete.
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We describe results from a clinical program, which aimed at improving adherence to medications in children who had a liver transplant. We followed the medical outcomes of 23 children and adolescents who participated in a clinical adherence-improvement protocol during the years 2001-2002. The protocol included identification of non-adherent patients by examining tacrolimus blood levels and intervention by increasing the frequency of clinic visits for non-adherent patients. In the two-yr preintervention (1999-2000), there was no improvement in any of the outcomes. After the intervention, the number of patients with high alanine aminotransferase levels (100 and above) decreased significantly, from eight before the intervention to four afterwards. Other outcomes, including the number of rejection episodes (three before, none after) and the degree of adherence to tacrolimus, also improved, but the improvement did not reach statistical significance. Although non-adherent patients were called to clinic more often under the protocol, the intervention did not lead to increased outpatient costs. This adherence--improvement intervention appears to be promising in improving outcomes in pediatric liver transplant recipients. Larger, controlled studies are needed to establish the efficacy of this or other approaches.