Mycobacterium abscessus keratitis after LASIK surgery / Ceratite por Mycobacterium abscessus após cirurgia LASIK

ABSTRACT A 33-year-old male presented with unilateral subacute infectious keratitis 4 weeks after surgery. Corneal inflammation was resistant to standard topical antibiotic regimens. During diagnostic flap lifting and sampling, the corneal flap melted and separated. Through flap lifting, corneal scraping, microbiological diagnosis of atypical mycobacteria, and treatment with topical fortified amikacin, clarithromycin, and systemic clarithromycin, clinical improvement was achieved.

RESUMO Paciente do sexo masculino, 33 anos, apresentou ceratite infecciosa subaguda unilateral 4 semanas após a cirurgia. A inflamação da córnea foi resistente aos regimes de antibióticos tópicos padrão. A aba da córnea foi derretida e seccionada durante o levantamento e amostragem para diagnóstico. A melhora clínica só foi alcançada após levantamento do retalho, raspagem e diagnóstico microbiológico de micobactérias atípicas e tratamento com amicacina fortificada tópica, claritromicina e claritromicina sistêmica.

A novel agent for myeloma causing toxic keratopathy, belantamab mafodotin: a case report and literature review / Belantamabe-mafodotina, um novo agente para mieloma, causando ceratopatia tóxica: relato de caso e revisão da literatura

ABSTRACT A 60-year-old-male with refractory relapsed multiple myeloma presented with redness, pain, foreign body sensation, and blurred vision in both eyes that gradually increased after his third belantamab mafotodin infusion. Biomicroscopy revealed bilateral microcyst-like epithelial changes and epithelial crystal-like deposits, whereas in vivo confocal microscopy revealed intraepithelial and subepithelial hyperreflective deposits in corneal epithelium. Belantamab mafodotin therapy was discontinued for seven weeks due to corneal toxicity, which cleared progressively. We aim to demonstrate belantamab mafodotin-related corneal toxicity that may be detected using slit lamp and in vivo confocal biomicroscopy.

RESUMO Um homem de 60 anos, diagnosticado com mieloma múltiplo recidivante refratário, apresentou vermelhidão, dor, sensação de corpo estranho e visão turva em ambos os olhos, aumentando gradualmente após sua terceira infusão de belantamabe mafodotina. À biomicroscopia, foram observadas alterações epiteliais bilaterais semelhantes a microcistos e depósitos epiteliais semelhantes a cristais. A microscopia confocal in vivo revelou depósitos hiper-refletivos intraepiteliais e subepiteliais na córnea. Devido à toxicidade corneana, a terapia com belantamabe mafodotina foi interrompida por sete semanas e a toxicidade foi gradualmente resolvida. Nosso objetivo é demonstrar os achados à biomicroscopia confocal in vivo e à lâmpada de fenda da toxicidade corneana relacionada ao belantamabe mafodotina.

Percepciones de proveedores de servicios de salud sobre la salud sexual de los adultos mayores en Colombia

Introducción: La sexualidad y la salud sexual de las personas adultas mayores es una dimensión invisible en la prestación de los servicios de salud. Debido a esto, es importante conocer las percepciones y dificultades del personal de salud para brindar esta atención. Objetivo: Identificar diferencias y similitudes en la percepción que tienen los proveedores de servicios de salud en Colombia sobre la sexualidad y la salud sexual en el adulto mayor. Metodología: Se realizaron 5 grupos focales en Bogotá, Barranquilla, Cali y Medellín donde participaron 19 profesionales de la salud de una institución prestadora de servicios de salud sexual y reproductiva. Resultados: Los profesionales de la salud reconocen la sexualidad como un aspecto importante en la prestación de los servicios de salud en las personas mayores, a pesar de la invisibilidad actual del tema en la atención médica. Reconocen la complejidad de hablar sobre sexualidad en la interacción médico-paciente, en parte por la falta de entrenamiento de los profesionales de la salud y por las propias inhibiciones de los pacientes. Discusión: Persisten obstáculos sociales y teóricos para abordar los temas de sexualidad en consulta, al igual que diferencias de género para el tratamiento de temas de sexualidad y salud sexual. Conclusiones: Los prestadores de servicios de salud son claves para remover barreras a la atención, acompañamiento y comprensión de la salud sexual y la sexualidad de las personas mayores.

Introduction: The sexuality and sexual health of older people is an invisible dimension in the provision of health services. Therefore, it is important to know the perceptions and difficulties of health personnel to provide this care. Objective: To identify differences and similarities in the perception that health service providers in Colombia have about sexuality and sexual health in the elderly. Methodology: A total of 5 focus groups were held in Bogotá, Barranquilla, Cali and Medellín with the participation of 19 health professionals from an institution that provides sexual and reproductive health services. Results: Health professionals recognize sexuality as an important aspect in the provision of health services in the elderly, despite the current invisibility of the issue in medical care. They recognize the complexity of talking about sexuality in the doctor-patient interaction, partly due to the lack of training of health professionals, and due to the patients' own inhibitions. Discussion: Social and theoretical obstacles persist to address sexuality issues in consultation, as well as gender differences for the treatment of sexuality and sexual health issues. Conclusions: Health service providers are key to removing barriers to care, accompaniment and understanding of the sexual health and sexuality of the elderly.

Clinicopathological and molecular analyses of uterine carcinosarcomas using next-generation sequencing: A single-center experience

Background: Uterine carcinosarcomas (UCS) constitute 3–4% of all uterine malignancies and 16% of deaths caused due to uterine neoplasms. Aim: In this study, we aimed to perform DNA-based mutation analysis in 12 genes (KRAS, NRAS, EGFR, C-KIT, BRAF, PDGFRA, ALK, ERBB2, ERBB3, ESR1, RAF1, PIK3CA) to determine the molecular subtypes of UCS using next-generation sequencing (NGS) in patients with aggressive UCS and poor prognosis. We aimed to compare the results of our analysis with clinicopathological data to contribute to the development of targeted therapy approaches related to the molecular changes of UCS. Materials and Methods: In this study, we included 12 cases diagnosed with uterine carcinosarcomas and examined the changes in oncogenes that play a role in UCS pathogenesis. For the analysis of mutation, the clinicopathological data were compared with the variations in the DNA-based gene panel consisting of 12 genes and 1237 variants in the UCS using the NGS method. Results: EGFR mutation was found in 91.7% of the cases, mutation in 41.7%, PDGFRA mutation in 25%, KRAS and PIK3CA mutation in 16.7%, and C-KIT mutation in 8.3% of the cases. Although no statistical significance was found between the detected mutation and clinicopathological data, it was concluded that PDGFRA mutation might be associated with advanced-stage disease development. Conclusion: This study's findings regarding different molecular types of UCS and information on oncogenesis of UCS can provide inferences for targeted therapies in the future by identifying targetable mutations representing early oncogenic events and thereby contribute toward further studies on this subject.

Prognostic role of metabolic 18F?FDG PET/CT parameters and hematological prognostic indicators in patients with colorectal cancer

Background: The aim of this study is to evaluate the role of preoperative 18F?fluorodeoxyglucose (FDG) positron emission tomography朿omputed tomography (PET/CT) parameters, including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), hematologic prognostic indicators in patients with colorectal cancer (CRC) in terms of predicting prognosis. Methods: One hundred and one patients who had undergone 18F?FDG PET/CT for initial staging were evaluated retrospectively. Patient data including pathologic stage at presentation, histology, tumor location, and overall survival (OS) were analyzed. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), serum carcinoembryonic antigen (CEA) (ng/mL), CA?125 (cancer antigen 125) (U/mL), and CA19?9 (U/mL) levels, which were obtained within 2 weeks of the PET/CT examination, were used for hematological data. Results: The TNM Classification of Malignant Tumors stage and PET/CT parameters, including SUVmax, MTV, and TLG, were found to be correlated with survival rate in univariate analysis (P < 0.05). All hematological markers excluding PLR were also significantly associated with survival time. Receiver operating characteristics (ROC) analysis revealed that the optimal SUVmax cutoff value for predicting survival time in patients with CRC was >17.9 (Area under curve (AUC) = 0.625; P < 0.05). The calculated sensitivity and specificity values for this cutoff were 60% and 65.7%, respectively. To predict the survival time in these patients, the optimal MTV cutoff value was >34.29 (AUC = 0.775; P < 0.001; sensitivity = 85%; specificity = 62.3%). The optimal TLG cutoff value for predicting survival time was >270.4 (AUC = 0.790; P < 0.001; sensitivity = 77.5%; specificity = 68.9%). Conclusions: FDG PET/CT metabolical parameters are useful for predicting the prognosis in patients with CRC. High preoperative NLR and high tumor markers were also shown to be negative independent prognostic factors in these patients

Depth of cure, mechanical properties and morphology of dual-cure bulk-Fill composites / Profundidad de curado, propiedades mecánicas y morfología de resinas compuestas duales

This study evaluated selected structural and physical properties, such as degree of conversion (DC), Vickers hardness (VHN), and compression strength (CS), of three new dual-cure bulk-fill resin-based composites (RBCs; ACTIVA, HyperFIL, and Fill-Up) and compared them to those of a conventional RBC (Filtek Z250) at three clinically relevant depths. Samples (n=180) were prepared in three depths (2,4, and 6mm). Fourier-transform infrared spectroscopy (FTIR) analysis and VHN and CS tests were performed. The DC value was calculated by considering the relative change in the aliphatic C=C peaks. The fractured surfaces of representative samples were characterized using scanning electron microscopy (SEM). Data were statistically evaluated using two-way analysis of variance and post hoc Bonferroni tests (p<0.05). According to the VHN results, Filtek Z250 showed the highest bottom/top hardness ratio (97.94±1.01) at 2mm thickness and ACTIVA showed the lowest bottom/top hardness ratio (43.48±5.64) at 6mm thickness (p<0.001). According to the FTIR results, the DC decreased with increasing thickness in all materials (p<0.05). Filtek Z250 showed the highest (301±12.4 MPa) and ACTIVA exhibited the lowest (232±17.2 MPa) CS values at 2mm thickness (p<0.05). The lowest CS values were obtained for ACTIVA, and the highest values were obtained for Filtek Z250 for samples with thicknesses of 4 and 6mm, respectively (p<0.05). The structural features of restorative composites, such as the resin chemistry and filler type and content, and the operational parameters (i.e., material thickness and curing conditions) strongly affect crosslinking reactions and thus the DC, VHN, and CS values.

Este estudio evaluó propiedades físicas y estructurales, como el grado de conversión (DC), la dureza Vickers (VHN) y la resistencia a la compresión (CS), de tres nuevos compósitos a base de resina de curado dual tipo bulk (RBC; ACTIVA , HyperFIL y Fill-Up) y los comparó con los de una resina compuesta convencional (Filtek Z250) en tres profundidades clínicamente relevantes. Se prepararon muestras (n=180) en tres profundidades (2,4 y 6mm). Se realizaron análisis de espectroscopia infrarroja por transformada de Fourier (FTIR) y pruebas VHN y CS. El valor de DC se calculó considerando el cambio relativo en los picos alifáticos C=C. Las superficies fracturadas de muestras representativas se caracterizaron mediante microscopía electrónica de barrido (MEB). Los datos se evaluaron estadísticamente mediante análisis de varianza de dos vías y pruebas post hoc de Bonferroni (p<0,05). De acuerdo con los resultados de VHN, Filtek Z250 mostró la relación de dureza inferior/superior más alta (97,94±1,01) con un espesor de 2mm y ACTIVA mostró la relación de dureza inferior/superior más baja (43,48±5,64) con un espesor de 6mm (p<0,001). De acuerdo con los resultados de FTIR, la DC disminuyó al aumentar el espesor en todos los materiales (p<0,05). Filtek Z250 mostró los valores de CS más altos (301±12,4 MPa) y ACTIVA los más bajos (232±17,2 MPa) a 2mm de espesor (p<0,05). Los valores más bajos de CS se obtuvieron para ACTIVA y los valores más altos para Filtek Z250 para muestras con espesores de 4 y 6mm, respectivamente (p<0,05). Las características estructurales de las resinas compuestas de restauración, como la química; además del tipo y contenido del relleno, y los parámetros operativos (es decir, el espesor del material y las condiciones de curado) afectan en gran medida las reacciones de interacción química y, por lo tanto, los valores de DC, VHN y CS.

Macular vessel densities by optical coherence tomography angiography in patients with intermediate uveitis

Purpose: To evaluate the macular microvascular changes in patients with intermediate uveitis (IU) using optical coherence tomography angiography (OCT?A) and to determine the relationship of OCT?A measurements with disease duration and activity. Methods: This cross?sectional study was performed at the uvea department of a tertiary hospital. Patients with IU (8 women, 8 men; mean age: 28.80 ± 12.80 years) were included in the study. The macular thickness measurements obtained by optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany) and macular superficial and deep vessel density (VD) parameters obtained by OCT?A (Avanti RTVue?XR; Optovue, Fremont, CA, USA) were compared with healthy subjects (12 men, 22 women; mean age: 28.40 ± 8.32 years). Eyes with pathology including marked obvious edema in the macula were not included in the study. Results: The macular thickness was found to be higher in the patient group (p < 0.001). The deep and superficial VD measurements in almost all quadrants in both superficial and deep layers were significantly lower in the IU patient group (p < 0.05). Macular thickness was increased in the active state of IU (p = 0.03), however, none of the OCT?A parameters showed a significant difference between active and inactive IU patients (p > 0.05). No correlation was observed between OCT?A parameters and total IU disease duration. Conclusion: Quantitative analyses of macular vascular structures demonstrate significantly reduced VD in both superficial and deep retinal layers in IU patients. Considering the importance of the macula in visual prognosis, OCT?A can provide crucial data for the monitoring and follow?up of IU patients.

Effect of seasons on delirium in postoperative critically ill patients: a retrospective analysis

Abstract Background and objectives Postoperative delirium is common in critically ill patients and is known to have several predisposing and precipitating factors. Seasonality affects cognitive function which has a more dysfunctional pattern during winter. We, therefore, aimed to test whether seasonal variation is associated with the occurrence of delirium and hospital Length Of Stay (LOS) in critically ill non-cardiac surgical populations. Methods We conducted a retrospective analysis of adult patients recovering from non-cardiac surgery at the Cleveland Clinic between March 2013 and March 2018 who stayed in Surgical Intensive Care Unit (SICU) for at least 48 hours and had daily Confusion Assessment Method Intensive Care Unit (CAM-ICU) assessments for delirium. The incidence of delirium and LOS were summarized by season and compared using chi-square test and non-parametric tests, respectively. A logistic regression model was used to assess the association between delirium and LOS with seasons, adjusted for potential confounding variables. Results Among 2300 patients admitted to SICU after non-cardiac surgeries, 1267 (55%) had postoperative delirium. The incidence of delirium was 55% in spring, 54% in summer, 55% in fall and 57% in winter, which was not significantly different over the four seasons (p= 0.69). The median LOS was 12 days (IQR = [8, 19]) overall. There was a significant difference in LOS across the four seasons (p= 0.018). LOS during summer was 12% longer (95% CI: 1.04, 1.21; p= 0.002) than in winter. Conclusions In adult non-cardiac critically ill surgical patients, the incidence of postoperative delirium is not associated with season. Noticeably, LOS was longer in summer than in winter.

Study of the potential toxicity of adrenaline to neurons, using the SH-SY5Y human cellular model

Abstract Prolonged overexposure to catecholamines causes toxicity, usually credited to continuous adrenoceptor stimulation, autoxidation, and the formation of reactive pro-oxidant species. Non-differentiated SH-SY5Y cells were used to study the possible contribution of oxidative stress in adrenaline (ADR)-induced neurotoxicity, as a model to predict the toxicity of this catecholamine to peripheral nerves. Cells were exposed to several concentrations of ADR (0.1, 0.25, 0.5 and 1mM) and two cytotoxicity assays [lactate dehydrogenase (LDH) release and 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl tetrazolium bromide (MTT) reduction] were performed at several time-points (24, 48, and 96h). The cytotoxicity of ADR was concentration- and time-dependent in both assays, since the lowest concentration tested (0.1mM) also caused significant cytotoxicity at 96h. N-acetyl-cysteine (1mM), a precursor of glutathione synthesis, prevented ADR-induced toxicity elicited by 0.5mM and 0.25mM ADR following a 96-h exposure, while the antioxidant Tiron (100µM) was non-protective. In conclusion, ADR led to mitochondrial distress and ultimately cell death in non-differentiated SH-SY5Y cells, possibly because of ADR oxidation products. The involvement of such processes in the catecholamine-induced peripheral neuropathy requires further analysis.

Arterial Stiffness in Patients with Bipolar Disorder

Objective@#Bipolar disorder (BD) is an inflammatory and metabolic disease. The disease and the drugs used to treat it may affect cardiovascular disease (CVD) risk. The aim of this study is to investigate arterial stiffness in patients with BD and compare them with healthy controls. @*Methods@#Thirty-nine patients with BD type I in remission and 39 healthy control subjects were included in the study.Carotid and femoral artery intima-media thickness (IMT) and arterial thickness parameters were measured by Doppler ultrasonography. @*Results@#The elastic modulus value of the carotid artery was significantly higher in the patients than in the control group (p = 0.015). Although the IMT of both carotid and femoral artery was thicker in patients than in healthy control subjects, this difference was not statistically significant (p = 0.105; p = 0.391). There was a significant positive correlation between chlorpromazine equivalent dose and femoral elastic modulus value (p = 0.021, r = 0.539). There was a positive correlation between lithium equivalent dose and carotid compliance; a significant negative correlation between lithium equivalent dose and carotid elastic modulus was also determined (both p = 0.007, r = 0.466; p = 0.027, r = −0.391, respectively). No predictor was observed between drug dose and arterial stiffness parameters. @*Conclusion@#Arterial stiffness might be investigated for its potential to reduce CVD risk in patients with BD. Given the established CVD complications in this patient population, further studies are needed to determine whether the results are specific to antipsychotic treatment or BD and to clarify the potential arterial protective effects of mood stabilizers.

The effects of berberine on ischemia-reperfusion injuries in an experimental model of ovarian torsion / 대한생식의학회지

Objective@#Ovarian torsion is a gynecological disorder that causes ischemia-reperfusion injuries in the ovary. Our study investigated berberine’s short- and long-term effects on ovarian ischemia-reperfusion injuries. @*Methods@#This study included 28 Wistar albino female rats weighing 180 to 220 g, which were divided into four groups: sham (S), torsion/detorsion (T/D), torsion/ detorsion+single dose berberine (T/D+Bb), and torsion/detorsion+15 days berberine (T/D+15Bb). The torsion and detorsion model was applied in all non-sham groups. In the T/D+Bb group, a single dose of berberine was administered, while in the T/D+15Bb group, berberine was administered over a period of 15 days. After the rats were euthanized, their ovaries were excised. The left ovaries were used for histopathologic evaluation, which included ovarian injury scoring and follicle count, while the right ovaries were used for biochemical analyses (tissue transforming growth factor-β [TGF-β] and alpha-smooth muscle actin [α-SMA] levels). @*Results@#The histopathologic evaluation scores for the ovaries were significantly lower in the T/D+B group (p<0.05) and the T/D+15B group (p<0.005) than in the T/D group. The follicle counts in the T/D group were lower than those in both the sham and treated groups (p<0.005). The TGF-β levels were significantly lower in the T/D+15B group (p<0.005), whereas the α-SMA levels did not show a significant difference. @*Conclusion@#Both short- and long-term berberine use could potentially have therapeutic effects on ovarian torsion. Long-term berberine use exhibited anti-inflammatory effects by reducing TGF-β levels, thereby preventing ischemia-reperfusion injuries. Therefore, we suggest that long-term berberine use could be beneficial for ovarian torsion.

A survey evaluating hematology physiciansÊ perspectives on central nervous system prophylaxis

Background@#Central nervous system (CNS) prophylactic options for diffuse large B-cell lymphoma (DLBCL) are administered differently in most centers. Unfortunately, there is still not a consensus on which patients, which regimen, for how many cycles, and when prophylaxis should be administered. Thus, this remains an unmet clinical need. @*Methods@#We administered a survey study under the Lymphoma Scientific Subcommittee of the Turkish Society of Haematology. The questions were directed to hematologists through the monkey survey system. @*Results@#The CNS International Prognostic Index score is a factor that clinicians frequently use when deciding on prophylaxis and is considered reliable. Although the perspective on anatomical risk factors is similar to that reported in the literature, breast involvement is still considered a critical risk factor in Turkey. Participants considered double or triple hit and double/triple expressor lymphoma as significant risk factors. Various methods have been used to demonstrate CNS relapses. Intrathecal prophylaxis is the preferred method. @*Conclusion@#There are diverse methodological and technical ideas. The controversial results reported in the literature on the effectiveness of CNS prophylaxis may explain this finding. Although CNS prophylactic methods for patients with DLBCL are still controversial, the effect of secondary CNS involvement on survival is inevitable. Standard practices followed by national guidelines may be effective in reducing the variety of application methods and creating homogeneous results for efficacy and survival follow-up studies.

Bridging the gap or widening the divide: A call for capacity-building in Artificial Intelligence for Healthcare in the Philippines

@#The emerging field of generative artificial intelligence (GAI) and some of its well-known technologies: ChatGPT, Google Bard and Claude, have gained substantial popularity due to their enormous potential in healthcare applications, as seen in medically fine-tuned models such as Med-PaLM and ChatDoctor. While these advancements are impressive, the dependence of AI development on data volume and quality raises questions about the generalizability of these models. Regions with lower medical research output risk bias and misrepresentation in AI-generated content, especially when used to assist clinical practice. Upon testing of a prompt concerning the isoniazid dosing of Filipinos versus other ethnic and racial groups, responses from GPT-4, GPT-3, Bard and Claude resulted in 3 out of 4 outputs showing convincing but false content, with extended prompting illustrating how response hallucination happens in GAI models. To address this, model refinement techniques such as fine-tuning and prompt ensembles are suggested; however, refining AI models for local contextualization requires data availability, data quality and quality assurance frameworks. Clinicians and researchers in the Philippines and other underrepresented regions are called to initiate capacity-building efforts to prepare for AI in healthcare. Early efforts from all stakeholders are needed to prevent the exacerbation of health inequities, especially in the new clinical frontiers brought about by GAI.

Effects of COVID-19 fear and anxiety on attitudes towards complementary and alternative medicine use in women with gynecological cancer during the COVID-19 pandemic / 中西医结合学报

OBJECTIVE@#Patients with gynecological cancer commonly use complementary and alternative medicine (CAM) methods to cope with the disease. However, despite the existence of treatment strategies, the effect of fear and anxiety caused by coronavirus disease 2019 (COVID-19) pandemic on attitudes about CAM use is unclear. This study was carried out to investigate the effect of fear and anxiety experienced by patients with gynecological cancer during the COVID-19 pandemic on their attitudes towards the use of CAM.@*METHODS@#This is a cross-sectional and descriptive study that included 177 women with gynecological cancer; participants were recruited from a social networking site for cancer patients in Turkey between June and December 2021. Data were collected using an online survey that included the Personal Information Form, the Fear of COVID-19 Scale, the Coronavirus Anxiety Scale, and the Attitude Towards Holistic Complementary and Alternative Medicine Scale. Descriptive statistics, t-test, Pearson's correlation test, and simple linear and multiple regression analyses were performed to analyze the data.@*RESULTS@#During the pandemic, 55.4% of the participants reported using CAM methods, but only 22.6% were using CAM before the pandemic. The participants who used CAM during the pandemic also scored higher on the fear of COVID-19 and coronavirus anxiety scales (20.69 ± 5.37 and 13.09 ± 6.29, respectively) compared to the participants who did not use CAM (9.29 ± 2.72 and 6.35 ± 2.06, respectively). Fear of COVID-19 accounted for 52% of the CAM attitude score, while coronavirus anxiety accounted for 15% of the CAM attitude score. Fear of COVID-19 and coronavirus anxiety together accounted for 53% of CAM attitude.@*CONCLUSION@#Gynecological cancer patients with high levels of COVID-19-related anxiety and fear during the pandemic used CAM more. Given that the psychological effects of the pandemic will continue in the coming years, CAM use should be evaluated as a coping strategy, especially due to the COVID-19-related anxiety and fear experienced by patients with gynecological cancer. While the rational and effective CAM methods should be supported, strategies should be developed to prevent misuse of CAM and its interference in prescribed medical treatments. Please cite this article as: Uslu-Sahan F, Yesilcınar I, Kurt G, Hancer E, Guvenc G. Effects of COVID-19 fear and anxiety on attitudes towards complementary and alternative medicine use in women with gynecological cancer during the COVID-19 pandemic. J Integr Med. 2023; 21(4): 377-384.

Sociodemographic characteristics associated with indications for surgical menopause in women: a retrospective study

SUMMARY OBJECTIVE: The aim of this study was to evaluate the surgical menopause indications and sociodemographic characteristics of women. METHODS: In this retrospective study, we analyzed the sociodemographic characteristics of women with indications for surgical menopause in 2010-2020. The R Version 4.1.1 (2021-08-10) software and logistic regression analysis were used to evaluate the data. RESULTS: A total of 704 women's data were obtained in this study. Surgical menopause indications were found to stem from bleeding (46.0%), cancer (28.3%), cancer risk (18.9%), and other causes (6.8%). Surgical menopause indications originating from cancer were increased by 0.08 times (95%CI 0.01-0.68) due to smoking, 0.45 times (95%CI 0.23-0.88) due to regular drug use, and 0.36 times (95%CI 0.19-0.69) due to the presence of chronic disease (p<0.05). CONCLUSION: More than half of the women with surgical menopause indications were between 41 and 46 years of age. Additionally, 54.9% of the women had a chronic disease. Therefore, it is recommended to plan preventive health services for morbidity and mortality risks that may develop due to surgical menopause.

Comparison of the fibrosis degree using acoustic radiation force impulse elastography and diffusion-weighted magnetic resonance imaging in chronic hepatitis cases

SUMMARY OBJECTIVE: The aim of this study was to investigate the correlation of fibrosis stages in cases of chronic hepatitis by comparing shear wave elastography and diffusion-weighted magnetic resonance imaging. METHODS: A total of 46 chronic hepatitis patients with an age range of 20-50 years were classified into three groups based on their fibrosis stages. Comparison group 1: the presence of fibrosis (S0 and S1≤); comparison group 2: the presence of significant fibrosis (≤S2 and S3≤); and comparison group 3: the presence of cirrhosis (≤S4 and S6). Shear wave velocities were measured by acoustic radiation force impulse elastography. Diffusion-weighted magnetic resonance imaging was performed on a 3.0 Tesla MRI device. RESULTS: In comparison group 1 (S0 and S1≤), the area under the curve, sensitivity, and specificity of acoustic radiation force impulse values were 0.784, 87, and 60%, respectively, while these values were 0.718, 80, and 66%, respectively, for apparent diffusion coefficient . In comparison group 2 (≤S2 and S3≤), the area under the curve, sensitivity, and specificity of acoustic radiation force impulse values were 0.917, 80, and 86%, respectively, and the apparent diffusion coefficient values were 0.778, 90, and 66%, respectively. In comparison group 3, the area under the curve, sensitivity, and specificity of acoustic radiation force impulse values were 0.977, 100, and 95%, respectively. There was no statistically significant difference between the apparent diffusion coefficient values of the cases in the three groups (p=0.132). CONCLUSION: Noninvasive methods are gaining importance day by day for staging hepatic fibrosis. Acoustic radiation force impulse elastography was evaluated as a more reliable examination than diffusion-weighted magnetic resonance imaging in revealing the presence of fibrosis, determining significant fibrosis, and diagnosing cirrhosis.

La calidad de vida, relacionada con la salud oral, en el Centro del Adulto Mayor de San Isidro, Lima / Quality of life, related to oral healthcare, in the Elderly Center de San Isidro, Lima

Introducción: El mantenimiento de la calidad de vida es uno de los resultados más importantes de los servicios de atención. Varios planes respaldan la importancia de realizar su medición en los adultos mayores. Objetivo: Evaluar la calidad de vida, relacionada con la salud oral, en los miembros de un centro del adulto mayor en Lima, Perú. Métodos: Se realizó un estudio descriptivo transversal en una población de 1800 adultos mayores. La muestra estuvo conformada por 184 participantes. El instrumento perfil de impacto de salud oral (OHIP14sp) se utilizó para medir la calidad de vida en relación con la salud oral. La validez de contenido se realizó mediante un grupo de evaluadores y la consistencia del cuestionario se evaluó con la prueba alfa de Cronbach. Se resumió la información en porcentajes y se utilizaron pruebas de hipótesis de Fisher y chi cuadrado para identificar la relación de la calidad de vida con el sexo y la edad, y la regresión de Poisson. Resultados: La calidad de vida de los adultos mayores fue mala en el 9,8 por ciento, buena en el 23,4 por ciento, y excelente en el 66,8 por ciento. Las mujeres (71 por ciento) tuvieron mejor calidad de vida que los hombres (58 por ciento). Se observó que a menor edad mejor es la calidad de vida. La mayoría de los adultos podían realizar sus actividades diarias salvo un 7,1 por ciento. La salud bucal no tuvo un impacto negativo en la calidad de vida de los adultos mayores en términos de malestar psicológico, limitación funcional y minusvalía, solo en un 61 por ciento, 49 por ciento y 17 por ciento, respectivamente. Conclusiones: El impacto en la salud oral en Lima identificó como excelente o regular la calidad de vida en relación con la salud bucal de los adultos mayores concurrentes al Centro del Adulto Mayor de San Isidro(AU)

Introduction: Maintaining quality of life is one of the most important results of care services. Several plans support the importance of measuring it in older adults. Objective: To assess oral health-related quality of life in members of a senior center in Lima, Peru. Methods: A descriptive cross-sectional study was carried out in a population of 1800 older adults. The sample consisted of 184 participants. The oral health impact profile instrument (OHIP14sp) was used to measure quality of life in relation to oral health. Content validity was performed by a group of evaluators and the consistency of the questionnaire was evaluated with Cronbach's alpha test. The information was summarized in percentages and Fisher's and chi-square hypothesis tests were used to identify the relationship of quality of life with gender and age, and Poisson regression. Results: The quality of life of older adults was poor in 9.8 percent, good in 23.4 percent, and excellent in 66.8 percent. Women (71 percent) had a better quality of life than men (58 percent). It was observed that the younger the age, the better the quality of life. Most of the adults were able to perform their daily activities except for 7.1 percent. Oral health did not have a negative impact on the quality of life of older adults in terms of psychological discomfort, functional limitation and handicap, only 61 percent, 49 percent and 17 percent, respectively. Conclusions: The impact on oral health in Lima identified as excellent or regular the quality of life in relation to oral health of older adults attending the San Isidro Senior Center(AU)

Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation / Efeito da septoplastia no desempenho miocárdico ventricular esquerdo em pacientes com desvio de septo nasal

Abstract Introduction: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. Objective: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. Methods: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. Results: Significantly higher left ventricular myocardial performance index (0.52 ± 0.06 vs. 0.41 ± 0.04, p < 0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p < 0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p < 0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p = 0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p = 0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p < 0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p =0.224). Conclusion: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Resumo Introdução: O desvio do septo nasal é a principal causa de obstrução das vias aéreas superiores. A obstrução crônica das vias aéreas superiores pode causar lesão miocárdica devido à hipóxia crônica. Os efeitos da septoplastia nas funções diastólica e sistólica do ventrículo esquerdo não são bem conhecidos. O índice de desempenho miocárdico é um parâmetro confiável e fácil de aplicar que reflete as funções cardíacas sistólica e diastólica. Objetivo: Investigar o efeito da septoplastia nasal no índice de desempenho miocárdico em pacientes com desvio de septo nasal. Método: Este estudo prospectivo consistiu em 50 pacientes consecutivos submetidos a septoplastia devido a desvio de septo nasal significativo sintomático em S ou C. A ecocardiogarfia transtorácica foi feita em todos os pacientes antes e 3 meses após a septoplastia. Os índices de desempenho miocárdico calculados foram comparados. Resultados: Um valor de indice de desempenho miocárdico ventricular esquerdo significantemente maior (0,52 ± 0,06 vs. 0,41 ± 0,04, p < 0,001), tempo mais longo de relaxamento isovolumétrico (95,0 ± 12,5 vs. 78,0 ± 8,6 ms, p < 0,001), tempo mais longo de contração isovolumétrica (45,5 ± 7,8 vs. 39,5 ± 8,6 ms, p < 0,001), tempo de desaceleração mais longo (184,3 ± 32,5 vs. 163,6 ± 45,4 ms, p = 0,004), maior razão de pico de velocidade transmitral precoce e tardia (E / A) (1,42 ± 0,4 vs. 1,16 ± 0,2, p = 0,006) e menor tempo de ejeção (270,1 ± 18,3 vs. 286,5 ± 25,8 ms, p < 0,001) foram observados antes da septoplastia quando comparados aos valores obtidos 3 meses após a septoplastia. A fração de ejeção sistólica do ventrículo esquerdo foi semelhante antes e após a septoplastia (63,8 ± 2,8% vs. 64,6 ± 3,2%, p = 0,224). Conclusão: A cirurgia de septoplastia não apenas reduz os sintomas em pacientes com desvio de septo nasal, mas também pode melhorar o desempenho ventricular esquerdo. Assim, o tratamento precoce do desvio de septo nasal é sugerido para prevenir possíveis eventos cardiovasculares futuros.

Evaluation of neurological disorders that develop concurrently with COVID-19 pneumonia: a retrospective analysis / Avaliação de transtornos neurológicos concomitantes à pneumonia por COVID-19: análise retrospectiva

ABSTRACT Background: During the pandemic, many neurological symptoms have been evaluated as complications of COVID-19 pneumonia. Objective: To investigate the frequency and characteristics of neurological findings, and their effects on the prognosis of patients with COVID-19 pneumonia who consulted with the Neurology department. Methods: Data on 2329 patients who were hospitalized with the diagnosis of COVID-19 pneumonia in our hospital were scanned. The clinical, laboratory and radiological findings relating to treatment of 154 patients who required neurological consultation were retrospectively evaluated by reviewing the clinical notes. Results: The number of COVID-19 pneumonia patients who required neurological consultations while hospitalized in the ICU was 94 (61.0%). The most common symptom among these patients was hyperactive delirium. Mean age, ferritin levels and CRP values ​​of those with delirium were higher, while the mean lymphocyte percentage were lower, than those of the patients without delirium. Epileptic seizures were observed in eight patients without an epilepsy diagnosis. Two patients were diagnosed with GBS and one patient with ICU neuropathy. The D-dimer levels of patients with acute hemorrhagic CVD and the thrombocyte levels of patients with acute ischemic CVD were found to be higher than in patients without acute ischemic CVD. Conclusion: The proportion of patients who required neurological consultations was higher in the ICUs. We observed neurological symptoms more frequently in the advanced age group. There were no significant increases in the incidence of other neurological conditions except delirium, in COVID-19 patients. We think that further studies are needed to support our data.

RESUMO Antecedentes: Durante a pandemia, muitos sintomas neurológicos foram avaliados como complicações da pneumonia por COVID-19. Objetivo: Investigar a frequência e as características dos achados neurológicos e seus efeitos no prognóstico de pacientes com pneumonia por COVID-19 que consultaram o departamento de Neurologia. Métodos: Foram analisados os dados de 2.329 pacientes internados com diagnóstico de pneumonia por COVID-19 em nosso hospital. Os achados clínicos, laboratoriais e radiológicos relativos ao tratamento de 154 pacientes que necessitaram de consulta neurológica foram avaliados retrospectivamente por meio da revisão das anotações clínicas. Resultados: O número de pacientes com pneumonia por COVID-19 que necessitaram de consultas neurológicas enquanto internados na UTI foi de 94 (61,0%). O sintoma mais comum entre esses pacientes foi o delírio hiperativo. A média de idade, os níveis de ferritina e os valores de PCR daqueles apresentando delírios foram maiores, enquanto a porcentagem média de linfócitos foi menor do que em pacientes sem delírios. Crises epilépticas foram observadas em oito pacientes sem diagnóstico de epilepsia. Dois pacientes foram diagnosticados com SGB e um paciente com neuropatia na UTI. Os níveis de dímero D de pacientes com DCV hemorrágica aguda e os níveis de trombócitos de pacientes com DCV isquêmica aguda foram maiores do que em pacientes sem DCV isquêmica aguda. Conclusão: A proporção de pacientes que necessitaram consultas neurológicas foi maior nas UTIs. Observamos sintomas neurológicos com mais frequência em pacientes de faixa etária avançada. Não houve aumentos significativos na incidência de outras condições neurológicas, exceto delírio, em pacientes com COVID-19. Acreditamos que mais estudos são necessários para apoiar nossos dados.