The relationship between inspiratory muscle strength, venous refilling time, disease severity, and functional capacity in patients with chronic venous insufficiency.

BACKGROUND: Our aim is to evaluate the relationship between inspiratory muscle strength and venous refilling time, disease severity, and functional capacity in patients with chronic venous insufficiency (CVI). METHODS: Sixty-one patients (49 female, aged 20-65 ) were enrolled in the study. The demographic characteristics of the patients were questioned. All patients were assessed with maximum inspiratory and expiratory pressure (MIP/MEP) for inspiratory and expiratory muscle strength, photoplethysmography for venous refilling time (VRT), venous clinical severity score (VCSS) for disease severity, and 6-min walk test (6-MWT) for functional capacity. RESULTS: The mean age of the patients was 49.48 ± 13.19 years, and the mean duration of disease was 9.18 ± 6.57 years. There was statistically significant positive association between MIP and VRT(r: 0.331, p: 0.009), 6-MWT (r: 0.616, p < 0.001) values, and there was negative association between MIP and VCSS(r: -0.439 p < 0.001) scores. CONCLUSION: Evaluation of inspiratory muscle strength and elimination of its deficiency, providing interventions to approach normative values have the potential to contribute positively to the treatment of the patient.

Separating the Physician and Patient: A Paradigm Shift for Routine Otolaryngology Examinations in COVID-19-Like Aerosol-Contaminated Environments.

OBJECTIVE: To evaluate the attitudes of physicians and patients toward physical examination in physically separated environments using a laryngoscopic examination model. MATERIALS AND METHODS: Six experienced laryngologists performed laryngoscopic examinations in 30 patients in a closed-chamber examination unit. The physicians and patients were asked to compare all domains with their previous standard laryngoscopic examination experience using a 10-point visual analog scale (0, poor performance; 10, good performance), including effectiveness of communication, difficulty of examination, perception of safety against airborne transmission of COVID-19, applicability of the unit for future examinations, perception of protective environment, and overall comfort. RESULTS: All laryngoscopic examinations were performed successfully. Effectiveness of communication, difficulty of examination, perception of protective environment, and overall comfort did not differ between physicians and patients (P > .05 for all comparisons). However, both physicians and patients found the examination to be difficult. While physicians evaluated the system as safe against airborne transmission of COVID-19, patients were not confident that the system was safe (8.70 ± 1.93 vs 2.87 ± 2.37, respectively, P = .001). Physicians also gave a higher score to future applicability of the unit for examinations than patients (8.90 ± 1.42 vs 7.10 ± 2.62, respectively, P = .001). CONCLUSION: Physically separating the physician and patient is a feasible method of physical examination in aerosol-contaminated environments.

Effects of inspiratory muscle training versus calf muscle training on quality of life, pain, venous function and activity in patients with chronic venous insufficiency.

OBJECTIVE: The aim of the present study was to evaluate the effects of inspiratory muscle training (IMT) and calf muscle exercise training (CMET), in addition to compression therapy (CT), on quality of life (QoL), venous refilling time, disease severity, pain, edema, range of motion, muscle strength, and functionality in patients with chronic venous insufficiency (CVI) compared with CT alone. METHODS: A total of 32 participants with a diagnosis of CVI were randomly divided into three groups: group 1, IMT plus CT; group 2, CMET plus CT; and group 3, CT alone. All 32 patients were assessed using the chronic venous disease QoL 20-item questionnaire, Nottingham health profile, photoplethysmography, venous clinical severity score, visual analog scale for pain, intraoral pressure measurements, dynamometer, digital goniometer, 6-minute walking test, and lower extremity functional scale. RESULTS: After treatment, group 2 had improved more than had groups 1 and 3 in QoL, venous refilling time, pain, edema, range of motion, muscle strength, and functionality. Group 1 had improved more than had groups 2 and 3 in disease severity and inspiratory and expiratory muscle strength values (P < .05). Only physical mobility and right leg venous refilling time had increased in group 3 (P < .05). CONCLUSIONS: The use of IMT and CMET had improved venous function in both legs in patients with CVI, and CT alone had improved venous function only in the right leg of patients with CVI.

A simple mathematical tool to forecast COVID-19 cumulative case numbers.

OBJECTIVE: Mathematical models are known to help determine potential intervention strategies by providing an approximate idea of the transmission dynamics of infectious diseases. To develop proper responses, not only are more accurate disease spread models needed, but also those that are easy to use. MATERIALS AND METHODS: As of July 1, 2020, we selected the 20 countries with the highest numbers of COVID-19 cases in the world. Using the Verhulst-Pearl logistic function formula, we calculated estimates for the total number of cases for each country. We compared these estimates to the actual figures given by the WHO on the same dates. Finally, the formula was tested for longer-term reliability at t = 18 and t = 40 weeks. RESULTS: The Verhulst-Pearl logistic function formula estimated the actual numbers precisely, with only a 0.5% discrepancy on average for the first month. For all countries in the study and the world at large, the estimates for the 40th week were usually overestimated, although the estimates for some countries were still relatively close to the actual numbers in the forecasting long term. The estimated number for the world in general was about 8 times that actually observed for the long term. CONCLUSIONS: The Verhulst-Pearl equation has the advantage of being very straightforward and applicable in clinical use for predicting the demand on hospitals in the short term of 4-6 weeks, which is usually enough time to reschedule elective procedures and free beds for new waves of the pandemic patients.

Acute Aortic Dissection Surgery in a Patient With COVID-19.

Acute aortic dissection is one of the most common life-threatening diseases that affects the aortic vessel. We present a case of acute Stanford type A aortic dissection in a patient with coronavirus disease 2019 (COVID-19) under treatment with angiotensin-converting enzyme inhibitors. A 68-year-old woman complaining of acute chest pain and dyspnea was admitted to the emergency clinic of our hospital on May 6, 2020. She had history of diabetes and hypertension. This is one of the first acute aortic surgery cases among patients with COVID-19.

A Randomized Controlled Trial Comparing Platelet-Rich Plasma, Low-Level Laser Therapy, and Complex Decongestive Physiotherapy in Patients with Lower Limb Lymphedema.

Background: Platelet-rich plasma (PRP) is an autologous concentrated preparation of platelets characterized by lymphangiogenetic and tissue-repairing effects. Although PRP has been safely used in many different fields, there is no clinical study regarding the use of PRP in lymphedema treatment in humans. We assessed the clinical outcomes of PRP in patients with lower extremity lymphedema (LEL) in a randomized controlled trial. Methods and Results: Patients with secondary LEL were randomly allocated to one of three groups consisting of treatment with PRP with complex decongestive physiotherapy (PRP+CDP group), low-level laser therapy with CDP (LLLT+CDP group), and only CDP (CDP group). Assessment of Lymphedema Quality of-Life Questionnaire (LYMQOL) for health-related quality of life, lower-extremity-circumference (LEC) for edema, tissue dielectric constant (TDC) for extremity volume, 6-minute walking test (6MWT) for functional capacity, and numeric rating scale (NRS) scoring for extremity fullness were evaluated both before and after treatment. Forty-five patients (68.8% female) with mean age 40.84 ± 15.81 years were included in the study. Significant differences in LYMQOL, LEC, NRS, and TDC values both before and after treatment were found in all groups; however, there were no statistically significant difference in values between the three groups. In the PRP+CDP group, LYMQOL values had a larger effect size than the other two groups. Significant differences in 6MWT values both before and after treatment were found in PRP+CDP and LLLT+CDP groups; however, there was no statistically significant difference in the CDP group. Conclusion: This is the first clinical study to evaluate the usage of PRP in patients with secondary LEL. PRP might be an additional treatment option of lymphedema management; however, more clinical trials in humans are needed to yield more evidence in the usage of PRP in patients with lymphedema.

Applications of Platelet-Rich Plasma in Lymphedema.

Platelet-rich plasma (PRP) is an autologous concentrated preparation of human platelets contained in a small volume of plasma that is characterized by hemostatic and tissue-repairing effects. Being enriched by various kinds of growth factors, and their tissue-repairing effects have made them the focus of attention for use in tissue regeneration. PRP has been safely used and documented in many different fields, including orthopedics, sports injuries, dental and periodontal surgery, and cosmetic, plastic, cardiovascular, general, and maxillofacial surgery. The current evidence obtained from in vitro and animal studies pointed out that PRP may potentially be used to regenerate injured lymphatic vessels to treat or prevent lymphedema. Therefore, we have reviewed existing literature on the clinical uses of PRP in lymphedema and inquired whether there is enough evidence to support the use of PRP in clinical practice as a treatment option. In contrast to in vitro and animal models, there is no clinical trial regarding the use of PRP in lymphedema treatment. Only two animal studies matched to our research yielded positive and promising results in terms of the potential role of PRP in future for lymphedema therapies. In the light of these findings, it is clear that this is an important issue that should be studied in greater depth to clarify the efficacy of PRP in the management of lymphedema.

The Beneficial Effect of Hypnosis in Elective Cardiac Surgery: A Preliminary Study.

Background Single-session hypnosis has never been evaluated as a premedication technique in patients undergoing coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the beneficial effects of clinical hypnotherapy on perioperative anxiety, pain perception, sedation, and necessity for ventilator assistance in patients undergoing CABG. Methods Double-blind, randomized, clinical trial was performed. Forty-four patients undergoing CABG surgery were randomized into two groups. The patients in group A received preprocedural hypnosis by an anesthesiologist. Patients in group B (control) had only information on the surgical intervention by the same anesthesiologist. State-Trait-Anxiety Index-I (STAI-I) and Beck Depression Inventory (BDI) were performed preoperatively in both groups. Visual analog scale (VAS) and Ramsay sedation scale (RSS) were evaluated on 0th, 1st, 2nd, 4th, 6th, 8th, 10th, 12th, and 24th hours, postoperatively. Postoperative anxiety level, analgesic drug consumption, and duration of ventilator assistance and intensive care unit (ICU) stay were also documented. Results When anxiety and depression levels were compared, significantly lower STA-I and BDI values were detected in group A after hypnotherapy (p = 0.001, p = 0.001, respectively). Significantly less total doses of remifentanil (34.4 ± 11.4 vs. 50.0 ± 13.6 mg) and morphine (4.9 ± 3.3 vs. 13.6 ± 2.7 mg) were administered in group A in the postoperative period. Ventilator assistance duration (6.8 ± 2.0 vs. 8.9 ± 2.7 hours) was also shorter in group A when compared with that in group B (p = 0.007). Conclusion Hypnosis session prior to surgery was an effective complementary method in decreasing presurgical anxiety, and it resulted in better pain control as well as reduced ventilator assistance following CABG surgery.

Concomitant transarterial and transvenous embolization of a pelvic arteriovenous malformation using a new liquid embolic agent, squid-12 and detachable coils.

We describe a complex congenital pelvic AVM with multiple feeding arteries arising from the side branches of the right internal iliac artery and a single draining vein in a male patient. Concomitant transarterial and transvenous embolization with a new liquid embolic agent Squid-12 and metallic coils enabled a complete embolization at a single session. Squid-12 is composed of ethylene vinyl alcohol copolymers and its lower viscosity makes it a promising agent for the treatment of AVMs. The patient showed prompt resolution of the symptoms and complete devascularization of the AVM lesion was persisted on the 1-month control angiography. The patient was asymptomatic on the 6th month follow-up.

Hybrid approach in patients with recurrent brachial artery embolism: adjunctive tissue plasminogen activator infusion following embolectomy.

Acute ischemia of an upper extremity occurs less frequently than vascular events of the leg and accounts for 15%-32% of all cases. Embolectomy provides prompt and effective treatment in the majority of cases. Recurrence of embolism and failed reperfusion can result in poor outcomes, even extremity loss. Adjunctive managements become important in this patient group. In this report, we present percutaneous intraarterial drip tissue plasminogen activator infusion to rescue the extremity in a patient with small cell lung cancer who experienced thromboembolism an additional six times following embolectomy.

Prolidase activity in patients with coronary artery aneurysm.

Decreased collagen biosynthesis and increased collagenolysis may induce aneurysmal progress in arterial walls. Prolidase plays a role in collagen synthesis. In this study, we sought to evaluate whether there is a correlation between nonatherosclerotic coronary artery aneurysms (CAAs) and prolidase activity. A total of 174 CAAs were diagnosed in 144 (2.1%) patients among 6845 coronary angiographies performed between 2009 and 2012. In all, 23 (15.9%) patients had nonatherosclerotic aneurysms. Prolidase activity was compared to the results of 19 healthy volunteers with normal coronary arteries. Demographic parameters were similar between the groups. Mean prolidase activity was 241.6 ± 54.4 mU/mL in the coronary aneurysm group and 730.3 ± 243.1 mU/mL in the control group (P < .001). The incidence of CAAs ranges between 0.3% and 5.3% in the general population. Decreased prolidase activity may reduce collagen biosynthesis that may contribute to aneurysm formation.

[Comparison of standard Euroscore, logistic Euroscore and Euroscore II in prediction of early mortality following coronary artery bypass grafting]. / Koroner arter baypas greftleme sonrasi erken mortalitenin belirlenmesinde standart, lojistik Euroscore ve Euroscore II'nin karsilastirilmasi.

OBJECTIVE: EuroSCORE is the most widely used risk prediction system. Standard EuroSCORE, which had been published in 1999, was revised as a Logistic EuroSCORE in 2003. Further, it was reconsidered and published as EuroSCORE II in 2011. In this study we compared Standard, Logistic EuroSCORE and EuroSCORE II in prediction of early mortality following coronary artery bypass grafting. METHODS: We retrospectively analyzed 406 patients who underwent coronary artery bypass grafting operation between 2011-1012. Standard, Logistic and new version were compared with ROC analysis. RESULTS: In general population, mean standard EuroSCORE was 3.25±1.05, mean logistic EuroSCORE was found 2.48±0.58, mean EuroSCORE II was found 1.30 ± 0.09 and overall mortality was 10 (10/406 2.46%). Area under curve (AUC) was found 0.992 95% CI: 0.978-0.998 for standard EuroSCORE, 0.992 95% CI: 0.977-0.998 for logistic EuroSCORE and 0.990 95% CI: 0.975-0.997 for EuroSCORE II. In high risk patients (patients with standard EuroSCORE ≥ 6) AUC was found 0.870 95% CI 0.707-0.961 for standard EuroSCORE, 0.857 95% CI 0.691-0.954 for logistic EuroSCORE, and 0.961 95% CI: 0.829-0.998 for EuroSCORE II. CONCLUSION: Standard, Logistic EuroSCORE and EuroSCORE II are similarly successful in mortality prediction. EuroSCORE II may be better in high-risk patients which needs confirmation in large prospective studies.

Spontaneous triple coronary artery dissection.

Multivessel spontaneous coronary artery dissection (SCAD) is extremely rare, and to the best of our knowledge, triple-vessel dissection has been reported in only 7 patients to date. We present the successful surgical treatment of the triple coronary artery dissection in a 57-year-old man. The patient had aortic valve replacement simultaneously. Triple SCAD is a rare and life-threatening condition, and long-term results are necessary for an optimum treatment approach. It should be kept in mind that triple SCAD may be more common and fatal than thought, as uninvestigated cases of sudden death could mask the true incidence and prognosis of triple SCAD.

Hyperhomocysteinemia in patients with stasis dermatitis and ulcer: a novel finding with important therapeutic implications.

BACKGROUND: Although homocysteine (Hcy) has profound effects concerning vascular lesions and thrombosis, it has not previously been investigated in patients with stasis dermatitis and ulcer. OBJECTIVE: To evaluate plasma Hcy levels in patients with stasis dermatitis and ulcer. METHODS: A total of 25 patients (17 male, eight female; mean age of 36 +/- 5.97 years) with stasis dermatitis, 40 patients with stasis ulcer (27 male, 13 female; mean age of 38.5 +/- 7.96 years) and 35 healthy control individuals (25 male, 10 female; mean age of 36.9 +/- 6.49 years) were included in this study. Patients taking vitamin supplements or patients with folic acid or vitamin B12 deficiency, diabetes mellitus, chronic hepatitis, renal failure and chronic alcoholism which might affect Hcy levels were excluded from the study. RESULTS: Hcy levels were found to be elevated in patients with stasis dermatitis (p = 0.00) and stasis ulcer (p = 0.00) compared to healthy controls with a median (range) of 19.1 micromol/l (15-28), 18.98 micromol/l (15-29), and 8.1 micromol/l (5-12.2), respectively. There was no statistically significant difference in Hcy level in patients with stasis dermatitis and ulcer (p = 0.877). CONCLUSION: As hyperhomocysteinemia can be treated by selected vitamin supplementation even in patients with normal serum vitamin concentrations, ulcer formation might be prevented by lowering Hcy in the clinical stage of stasis dermatitis.

Significance of serum interleukin-8 levels in patients with Behcet's disease: high levels may indicate vascular involvement.

BACKGROUND: Interleukin-8 (IL-8) has been shown previously to associate with different individual clinical manifestations and activity of Behcet's disease (BD), but its association with vascular involvement has not been established. METHODS: Forty-five untreated patients with BD and 29 healthy individuals were included in the study. The activity of patients was based on the existence of two or more symptoms and a statistically significantly high Behcet's Disease Activity Index (BDAI) at the time of the study. IL-8, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) results were evaluated with respect to activity, vascular involvement, and other specific individual clinical manifestations of the disease. RESULTS: IL-8 levels were found to be significantly elevated in active BD compared with inactive BD (P = 0.006) and healthy controls (P = 0.000), with median values of 267 (53-2000), 137 (52-290), and 58 pg/mL (53-160 pg/mL), respectively. Unlike ESR and CRP, IL-8 levels showed a high correlation with BDAI scores (r = 0.743, P = 0.00) and the number of active clinical manifestations (r = 0.646, P = 0.00). Serum levels of IL-8 were increased in patients with oral ulcers, genital ulcers, eye lesions, and vascular lesions, with median values and significance levels of 254.5 (53-2000), P = 0.05; 254.5 (52-1400), P = 0.03; 254.5 (72-2000), P = 0.029; and 593 pg/mL (110-2000 pg/mL), P = 0.001, respectively. In addition, IL-8 levels in the active patient group with vascular involvement were significantly higher than the levels in those without vascular involvement. CONCLUSION: Serum IL-8 levels are increased in the active phase of BD. This marker may be useful in the early detection of vascular involvement.