Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Investigation of insulin resistance gene polymorphisms in differentiated thyroid cancers

Tıpta Uzmanlık TeziTiroid kanserleri endokrin malignensiler içerisinde en sık gözlenen malignensidir. Çoğunluğu tiroid folliküler hücrelerden köken alan, iyi diferansiye folliküler ve papiller tiroid kanserlerinden oluşur. Tiroid kanserinin patogenezinde diğer kanserlerde olduğu gibi genetik değişimler ve bazı çevresel faktörler temel rol oynamaktadır. Bu nedenle birçok solid tümör patogenezinde rolü olduğu düşünülen, ayrıca diferansiye tiroid kanserli hastalarda şu ana kadar çalışılmamış olan insülin reseptör substrat-1, insülin reseptör substrat-2 ve insülin benzeri büyüme faktörü bağlayıcı protein-3 genotiplerinin tiroid kanseriyle olan ilişkisini incelemek, ayrıca obezite ve insülin direnci gibi bazı çevresel faktörlerin diferansiye tiroid kansere olan etkisini araştırmayı amaçladık. Çalışmaya diferansiye tiroid kanser tanısı olan 93 hasta (79 kadın, 14 erkek) ve 111 sağlıklı kontrol olgusu (63 kadın, 48 erkek) alındı. Tüm olguların antropometrik ölçümleri, insülin direnci göstergesi olan homeostatik model değerlendirme sonuçları, lipidleri, tiroid fonksiyon testleri kaydedildi. Ayrıca insülin reseptör substrat-1, insülin reseptör substrat-2 ve insülin benzeri büyüme faktörü bağlayıcı protein-3 gen polimorfizmleri polimeraz zincir reaksiyonu ve restriksiyon fragmant uzunluk polimorfizmi yöntemleri kullanılarak belirlendi. Diferansiye tiroid kanserli olguların insülin direnci göstergesi olan homeostatik model değerlendirme sonuçları, vücut kitle indeksi, bel çevresi ve kolesterol düzeyleri kontrol grubuna nazaran daha yüksek saptandı. Diferansiye tiroid kanserli hastalarla kontrol grubu arasında açlık kan glukoz, insülin, trigliserid düzeyleri ile Diabetes Mellitus tanısı olanların sayısı açısından fark izlenmedi. İnsülin reseptör substrat-1, insülin reseptör substrat-2 ve insülin benzeri büyüme faktörü bağlayıcı protein-3 polimorfizm sıklığı; diferansiye tiroid kanserli hastalar ile sağlıklı olgular arasında farklı değildi. Ayrıca bu polimorfizmlerin; lenf bezi metastazı ve tümör evrelemesine etkisi olmadığı gözlendi. Diferansiye tiroid kanser patogenezinde; insülin reseptör substrat-1, insülin reseptör substrat-2 ve insülin benzeri büyüme faktörü bağlayıcı protein-3 polimorfizmlerinin rol oynamadığını saptadık. Ancak diferansiye tiroid kanser gelişiminde; obezite, insülin direnci göstergesi olan homeostatik model değerlendirme sonuçları artışının, ileri yaş ve kadın cinsiyetin önemli olduğunu tespit ettik.AbstractThyroid cancer is the most common malignancy within the endocrine malignancies. The majority of thyroid cancers are well differentiated follicular and papillary thyroid cancer originating from thyroid follicular cells. Genetic alterations and environmental factors play a key role in the pathogenesis of thyroid cancer such as the other cancer varieties. Therefore, in this study we aimed to investigate insulin receptor substrate-1, insulin receptor substrate -2, insulin-like growth factor binding protein-3 genotypes which thought to be involved in the pathogenesis of many solid tumors, besides these genotypes in patients with differentiated thyroid cancer that so far has not been studied. Moreover the effect of environmental factors such as obesity and insulin resistance on differentiated thyroid cancer was also studied. The study consisted of 93 patients diagnosed with differentiated thyroid cancer (79 females, 14 males) and 111 healthy control subjects (63 females, 48 males) were included. The anthropometric measurements, lipids, thyroid function tests and homeostatic model assessment results as an indicator of insulin resistance of all patients were recorded. In addition insulin receptor substrate-1, insulin receptor substrate-2, insulin-like growth factor binding protein-3 gene polymorphisms was determined using polymerase chain reaction and restriction fragment length polymorphism. Homeostasis model assessment of insülin resistance, body mass index, waist circumference and cholesterol levels of patients with differentiated thyroid cancer were significantly higher than control group. The fasting blood glucose, insulin, and triglyceride levels of patients with differentiated thyroid cancer have no statistical difference with the patients with Diabetes Mellitus. İnsulin receptor substrate-1, insulin receptor substrate -2, insulin-like growth factor binding protein-3 polymorphisms of patients with differentiated thyroid cancer have no difference between healthy patients. In addition, these polymorphisms did not showed any effect on lymph node metastases or tumor staging. We determined that insulin receptor substrate-1, insulin receptor substrate -2, insulin-like growth factor binding protein-3 polymorphisms did not play a role in the pathogenesis of differentiated thyroid cancer. However we found obesity, increased homeostasis model assessment of insülin resistance, older age and female gender should play an important role in differentiated thyroid cancer development

Investigation of insulin resistance gene polymorphisms in differentiated thyroid cancers

Tıpta Uzmanlık TeziTiroid kanserleri endokrin malignensiler içerisinde en sık gözlenen malignensidir. Çoğunluğu tiroid folliküler hücrelerden köken alan, iyi diferansiye folliküler ve papiller tiroid kanserlerinden oluşur. Tiroid kanserinin patogenezinde diğer kanserlerde olduğu gibi genetik değişimler ve bazı çevresel faktörler temel rol oynamaktadır. Bu nedenle birçok solid tümör patogenezinde rolü olduğu düşünülen, ayrıca diferansiye tiroid kanserli hastalarda şu ana kadar çalışılmamış olan insülin reseptör substrat-1, insülin reseptör substrat-2 ve insülin benzeri büyüme faktörü bağlayıcı protein-3 genotiplerinin tiroid kanseriyle olan ilişkisini incelemek, ayrıca obezite ve insülin direnci gibi bazı çevresel faktörlerin diferansiye tiroid kansere olan etkisini araştırmayı amaçladık. Çalışmaya diferansiye tiroid kanser tanısı olan 93 hasta (79 kadın, 14 erkek) ve 111 sağlıklı kontrol olgusu (63 kadın, 48 erkek) alındı. Tüm olguların antropometrik ölçümleri, insülin direnci göstergesi olan homeostatik model değerlendirme sonuçları, lipidleri, tiroid fonksiyon testleri kaydedildi. Ayrıca insülin reseptör substrat-1, insülin reseptör substrat-2 ve insülin benzeri büyüme faktörü bağlayıcı protein-3 gen polimorfizmleri polimeraz zincir reaksiyonu ve restriksiyon fragmant uzunluk polimorfizmi yöntemleri kullanılarak belirlendi. Diferansiye tiroid kanserli olguların insülin direnci göstergesi olan homeostatik model değerlendirme sonuçları, vücut kitle indeksi, bel çevresi ve kolesterol düzeyleri kontrol grubuna nazaran daha yüksek saptandı. Diferansiye tiroid kanserli hastalarla kontrol grubu arasında açlık kan glukoz, insülin, trigliserid düzeyleri ile Diabetes Mellitus tanısı olanların sayısı açısından fark izlenmedi. İnsülin reseptör substrat-1, insülin reseptör substrat-2 ve insülin benzeri büyüme faktörü bağlayıcı protein-3 polimorfizm sıklığı; diferansiye tiroid kanserli hastalar ile sağlıklı olgular arasında farklı değildi. Ayrıca bu polimorfizmlerin; lenf bezi metastazı ve tümör evrelemesine etkisi olmadığı gözlendi. Diferansiye tiroid kanser patogenezinde; insülin reseptör substrat-1, insülin reseptör substrat-2 ve insülin benzeri büyüme faktörü bağlayıcı protein-3 polimorfizmlerinin rol oynamadığını saptadık. Ancak diferansiye tiroid kanser gelişiminde; obezite, insülin direnci göstergesi olan homeostatik model değerlendirme sonuçları artışının, ileri yaş ve kadın cinsiyetin önemli olduğunu tespit ettik.AbstractThyroid cancer is the most common malignancy within the endocrine malignancies. The majority of thyroid cancers are well differentiated follicular and papillary thyroid cancer originating from thyroid follicular cells. Genetic alterations and environmental factors play a key role in the pathogenesis of thyroid cancer such as the other cancer varieties. Therefore, in this study we aimed to investigate insulin receptor substrate-1, insulin receptor substrate -2, insulin-like growth factor binding protein-3 genotypes which thought to be involved in the pathogenesis of many solid tumors, besides these genotypes in patients with differentiated thyroid cancer that so far has not been studied. Moreover the effect of environmental factors such as obesity and insulin resistance on differentiated thyroid cancer was also studied. The study consisted of 93 patients diagnosed with differentiated thyroid cancer (79 females, 14 males) and 111 healthy control subjects (63 females, 48 males) were included. The anthropometric measurements, lipids, thyroid function tests and homeostatic model assessment results as an indicator of insulin resistance of all patients were recorded. In addition insulin receptor substrate-1, insulin receptor substrate-2, insulin-like growth factor binding protein-3 gene polymorphisms was determined using polymerase chain reaction and restriction fragment length polymorphism. Homeostasis model assessment of insülin resistance, body mass index, waist circumference and cholesterol levels of patients with differentiated thyroid cancer were significantly higher than control group. The fasting blood glucose, insulin, and triglyceride levels of patients with differentiated thyroid cancer have no statistical difference with the patients with Diabetes Mellitus. İnsulin receptor substrate-1, insulin receptor substrate -2, insulin-like growth factor binding protein-3 polymorphisms of patients with differentiated thyroid cancer have no difference between healthy patients. In addition, these polymorphisms did not showed any effect on lymph node metastases or tumor staging. We determined that insulin receptor substrate-1, insulin receptor substrate -2, insulin-like growth factor binding protein-3 polymorphisms did not play a role in the pathogenesis of differentiated thyroid cancer. However we found obesity, increased homeostasis model assessment of insülin resistance, older age and female gender should play an important role in differentiated thyroid cancer development

Clinical Features and Types of Articular Involvement in Patients with Psoriatic Arthritis

[Abstract Not Available

Clinical features and types of articular involvement in patients with psoriatic arthritis

Psoriatic arthritis (PsA) is a psoriasis-associated inflammatory arthritis which causes joint destruction. There are some epidemiologic data about PsA; however, there are no sufficient data from Turkey. Herein, we evaluated the frequency of PsA in the Thrace region of Turkey according to hospital-based data. In addition, we evaluated clinical features and types of joint involvement in PsA patients. We included 172 PsA patients fulfilling CASPAR criteria admitted to the Division of Rheumatology, Trakya University Medical Faculty, between 2003 and 2012. Data from Turkish Statistical Institution was used to calculate the incidence and prevalence of PsA. Patients' demographic features, durations of psoriasis and PsA, number of tender and swollen joints, treatment modalities, laboratory data, and X-ray film findings were recorded from hospital files. The annual incidence of PsA was 2.8/100,000. The mean annual incidence was 3.47/100,000 in females and 2.15/100,000 in males. The overall prevalence of PsA in our region was 27.9/100,000 (95 % confidence interval (CI) 23.7-32.1) in individuals > 16 years. The prevalence of PsA was higher in females than in males (34.7/100,000 vs. 21.5/100,000). Polyarthritis was present in 67 (38.9 %), oligoarthritis in 47 (27.3 %), spondyloarthritis in 39 (22.6 %), and distal interphalangeal (DIP) arthritis in 19 (11.0 %) patients. The duration of psoriasis was significantly longer in polyarticular PsA patients than in DIP and oligoarticular groups (p values = 0.016 and 0.018, respectively). The number of swollen joints correlated with age (r = 0.21, p = 0.006), duration of psoriasis (r = 0.20, p = 0.01), number of tender joints (r = 0.92, p a parts per thousand currency signaEuro parts per thousand 0.001), ESR (r = 0.24, p = 0.001), and CRP (r = 0.17, p = 0.026). The frequency of PsA in Thrace region is similar to that in low-frequency regions. The most frequent type of involvement was polyarticular, and it correlated with the duration of psoriasis and erosive disease

Anaplastic variant of diffuse large B-cell lymphoma associated with cutaneous fistulas; an unusual presentation

[Abstract Not Available