Prognostic factors affecting deaths from adult tetanus

ABSTRACTThe objective of this study was to determine prognostic factors related to death from adult tetanus. Fifty-three cases of tetanus, 25 females and 28 males, were treated in (Çukurova University Hospital during 1994-2000. The mean age was 46.6 years. Forty-one (77.7%) patients came from rural areas. Most (64.1%) cases had minor trauma, but 19 (35.8%) had deep injuries. The mean incubation period was 11.5 days. Mortality was high (52.8%), caused by cardiac or respiratory failure or complications, and was related to the length of the incubation period. In cases with an incubation period ≤7 days, the mortality rate was 75% (p 0.07). Mortality was significantly associated with generalised tetanus (p < 0.05), fever of ≥ 40 °C, tachycardia of >120 beats/min (p < 0.05), post-operative tetanus (p 0.03), and the absence of post-traumatic tetanus vaccination (p 0.068). Patients who were given tetanus human immunoglobulin or tetanus antiserum (p > 0.05) had similar outcomes. Patients who were given penicillin had a mortality rate similar to patients who were given metronidazole (p 0.15). The mortality rate was higher (92%) in patients with severe tetanus than in patients with moderate disease (53%). By multivariate analysis, the time to mortality caused by tetanus, and also the mortality rate, were both related significantly to age and tachycardia

Value of preoperative spirometry to predict postoperative pulmonary complications

AbstractIn order to determine the incidence of postoperative pulmonary complications (POPC) and the value of preoperative spirometry to predict pulmonary complications after upper abdominal surgery, 24 women and 36 men (total 60 patients) were studied prospectively (mean age 48·3 years). On the day before the operation and for 15 days after the operation, each patients's respiratory status was assessed by clinical examination, chest radiography, spirometry and blood gas analysis, and patients were monitored for pulmonary complications by a chest physician and a surgeon independently. In this study, postoperative pulmonary complications developed in 21 (35%) patients (pneumonia in 10 patients, bronchitis in nine patients, atelectasis in one patient, pulmonary embolism in one patient). Of 31 patients with abnormal preoperative spirometry, 14 (45·2%) patients showed complications, whereas among 29 patients with normal preoperative spirometry, 7 (24·1%) patients showed complications (P<0·05). The incidence of POPC was higher in patients with advanced age, smoking, preoperative abnormal findings obtained from physical examination of the chest, higher ASA class and longer duration of operation. The sensitivity (0·76) and specificity (0·79) of abnormal preoperative findings obtained from physical examination to predict POPC were higher than abnormal preoperative spirometry (0·67 and 0·56 retrospectively). There was no significant difference between patients with and without pulmonary complications in regard to weight, serum albumin, type of incision, incidence of abnormal preoperative blood gases and duration of postoperative hospital stay. We conclude that POPC is still a serious cause of postoperative morbidity. Multiple risk factors include preoperative abnormal spirometry responsible for development of POPC. If used alone, spirometry has limited clinical value as a screening test to predict POPC after upper abdominal surgery

Road traffic injuries and risk factors

This study determines the characteristics of Road Traffic Injuries (RTIs) among Qatari drivers and examines the human behavioural and environmental risk factors associated in occurrence of RTIs. This cross sectional survey was conducted in the primary health care centers during the period of February – July 2009. A random sample of 1800 Qatari drivers was approached and 1406 drivers responded and agreed to participate in this study (78.1%). Face to face interview was conducted by well trained research assistants based on a questionnaire. The study revealed that of the studied Qatari drivers (1406), 14.5% of them were injured. Young drivers in the age group (25 – 34) years were more involved in RTIs (35.8%). The RTIs occurred more among male drivers than females with the ratio 1.7:1 (

Does the decision in a validation process of a surrogate endpoint change with level of significance of treatment effect? A proposal on validation of surrogate endpoints

PubMedID: 18809512Background: In recent years the use of surrogate end points (S) has become an interesting issue. In clinical trials, it is important to get treatment outcomes as early as possible. For this reason there is a need for surrogate endpoints (S) which are measured earlier than the true endpoint (T). However, before a surrogate endpoint can be used it must be validated. For a candidate surrogate endpoint, for example time to recurrence, the validation result may change dramatically between clinical trials. The aim of this study is to show how the validation criterion (R2trial) proposed by Buyse et al. are influenced by the magnitude of treatment effect with an application using real data. Methods: The criterion R2trial proposed by Buyse et al. (2000) is applied to the four data sets from colon cancer clinical trials (C-01, C-02, C-03 and C-04). Each clinical trial is analyzed separately for treatment effect on survival (true endpoint) and recurrence free survival (surrogate endpoint) and this analysis is done also for each center in each trial. Results are used for standard validation analysis. The centers were grouped by the Wald statistic in 3 equal groups. Results: Validation criteria R2trial were 0.641 95% CI (0.432-0.782), 0.223 95% CI (0.008-0.503), 0.761 95% CI (0.550-0.872) and 0.560 95% CI (0.404-0.687) for C-01, C-02, C-03 and C-04 respectively. The R2trial criteria changed by the Wald statistics observed for the centers used in the validation process. Higher the Wald statistic groups are higher the R2trial values observed. Conclusion: The recurrence free survival is not a good surrogate for overall survival in clinical trials with non significant treatment effects and moderate for significant treatment effects. This shows that the level of significance of treatment effect should be taken into account in validation process of surrogate endpoints. © 2008 Elsevier Inc. All rights reserved

Lower urinary tract symptoms, pain and quality of life assessment in chronic non-bacterial prostatitis patients treated with ?-blocking agent doxazosin; Versus placebo

PubMedID: 12899226The efficacy of doxazosin monotherapy in chronic non-bacterial prostatitis was investigated in terms of urinary symptom, pain and quality of life assessment versus placebo. A total of 60 men with chronic non-bacterial prostatitis were randomised to daily supplement of 4 mg doxazosin or a placebo, for 3 months. International Prostate Symptom Score (IPSS) questionnaire was self administered at the entry and at 3 months after the cessation of the treatment. In addition, patients were asked to complete 2-item questionnaire on pain related symptoms of chronic prostatitis. Quality of life was assessed with a single item included in IPSS. Three months after cessation of the treatment there was a significant difference between the overall mean IPSS, pain and quality of life scores of the two groups in favour of ß-blocking agent use (p = 0.001, p < 0.001 and p < 0.001, respectively). In patients undergone doxazosin treatment; symptom, pain and quality of life status revealed 32.94 ± 5.27%, 36.57 ± 5.67% and 36.78 ± 4.75% overall improvement, respectively. IPSS appeared to be a valuable tool in assessing treatment outcome of chronic non-bacterial prostatitis

Comparison of serum cholesterol levels by three different methods

Purpose: Determination of serum cholesterol may be the initial step in the early diagnosis of coronary heart disease. Literally hundreds of cholesterol methods have been published, usually as modifications of chemical and enzymatic methods. The purpose of this study was to evaluate the agreement among the three most commonly used cholesterol methods. Methods: Serum cholesterol levels were measured in 20 serum specimens by three different methods from which two of them were enzymatic and the other was a chemical method. The results were compared by statistical methods such as regression analysis and correlation coefficent. Results: The meon concentrations of serum cholesterol levels obtained from Boehringer-Manheim CHOD-RAP. Biotrol Enzymatic and Chemical Zlatkis Zak methods have been found to be 179 ± 20 mg/dl, 190 ± 24 mg/dl, and 208 ± 26 mg/dl, respectively. Although statistically significant difference is found among the mean values obtained from the three different methods by repeated measures analysis of variance, a strong association was established by linear regression with the calculation of correlation coefficient. Conclusion: The reliability of the methods was confirmed by the strong correlation, however it should be stated that each method must be considered in its own reference intervals since the mean values were statistically different from each other

Etiologic, electrocardiographic and echocardiographic evaluation of the patients with paroxysmal and chronic atrial fibrillation

The aim of the present study was to evaluate the etiologic and electrocardiographic (ECG) findings of the patients with paroxysmal (PAF) and chronic atrial fibrillation (CAF). Total of 400 patients (178 male and 222 female), aged between 25-86 (mean 53.6 ± 15.6) were studied. All patients had developed PAF or CAF in the last 3 years. Patients with PAF and CAF did not show any difference in terms of age (p>0.05). In etiologic evaluation, the most frequent cause was valvular heart diseases in CAF (80.4%) and ischemic heart diseases in PAF (52.6%) (p0.05). In conclusion, our findings supported that as a cause of AF, rheumatic heart disease is still a health problem in Turkey

Incidence of left ventricular thrombus and effects of long-term anticoagulation in patients with acute myocardial infarction

[No abstract available

Trichophyton tonsurans scalp carriage among wrestlers in a national competition in Turkey

Trichophyton tonsurans tinea gladiatorum is an emerging epidemic among combat-sport athletes across the globe. In the present study, we investigated the prevalence of symptomatic and asymptomatic dermatophytic infections among wrestlers in the National Greco-Roman Championship in Turkey. In total, 194 wrestlers from 32 provinces and 72 clubs were examined for scalp, trunk, groin, and toe web dermatophytic infections. We also administered a questionnaire to obtain information on the participants' lifestyles, wrestling characteristics, and risk factors for dermatophytic infections. The hairbrush method was used for scalp and trunk sampling, whereas a cotton swab was used for groin, toe web, and mat sampling. Three wrestling mats in the gymnasium were surveyed for dermatophytes using the touch preparation method. A total of 17 (8.8%) wrestlers harbored dermatophytes, and 22 strains were isolated: 13 (59.1%) T. tonsurans and 9 (40.9%) T. rubrum. These isolates were found on the scalp (8), trunk (2), forearm (1), hand (1), groin (3), and feet (7). In addition, we recovered 8 dermatophyte strains from the 150 mat samples (5.3%): T. rubrum in 6 samples (75%) and T. tonsurans in two samples (25%). T. tonsurans was only recovered from 11 out of 194 (5.7%) wrestlers. Scalp carriage represents the predominant (72.7%) clinical picture of a T. tonsurans infection in these Greco-Roman wrestlers in Turkey. © 2011 Springer Science+Business Media B.V.Acknowledgments The present study was partly supported by the Turkish Wrestling Federation. We gratefully acknowledge Mr. Önder Yaks¸i, the General Coordinator of the Turkish Wrestling Federation, who kindly helped in the organization of this study, making the present study possible. In addition, we appreciate and give our sincere thanks to two anonymous reviewers for their critical comments on earlier drafts of this paper

A TRIAL OF 2 FLUOROURACIL CONTAINING ADJUVANT CHEMOTHERAPY REGIMENS IN THE TREATMENT OF THE PATIENTS WITH COLORECTAL CANCER

XVI International Cancer Congress -- OCT 30-NOV 05, 1994 -- NEW DELHI, INDIAWOS: A1994BD09K00371