Validity and reliability of the assessment tool for Asthma (ATA) questionnaire: the ATA study

OBJECTIVES: A multicenter trial was designed to validate the “Assessment Tools for Asthma (ATA)” questionnaire, a newly developed questionnaire, which evaluates both asthma control and risk factors associated with asthma control with a single instrument. MATERIALS AND METHODS: This cross-sectional study involved 810 cases from 14 clinics in 9 Turkish cities. The ATA questionnaire and Asthma Control Test (ACT) were administered. The Visual Analog Scale (VAS) was used to evaluate the control status of 100 randomized cases. ATA is an eight-item physician-administered questionnaire. It comprises the following two sections-ATA1, assesses symptomatic control criteria, and the remaining section, queries the flre-up of asthma, control of comorbidities, treatment adherence, and inhaler technique. RESULTS: The mean scores for ATA1, ATA total, VAS, and ACT were 24.7±14.8, 53.8±19, 7.1±3, and 18.8±5.5, respectively. According to the ATA questionnaire, among all patients, 34.3% had controlled, 18.8% had partly controlled, and 46.9% had uncontrolled asthma. Furthermore, 16.6% patients had flre-ups between visits, 96.4% patients had uncontrolled comorbidity, 17% patients had irregular asthma treatment, and only 8.4% patients used the incorrect inhaler technique. The ATA questionnaire showed internal consistency (Cronbach’s alpha coeffiient=0.683). ACT, ATA1, and two specialists’ evaluations using VAS correlated strongly with the ATA total scores (Spearman correlation coeffiient (r) values: 0.776, 0.783, and 0.909, respectively; p-values: p<0.001, p<0.001, and p<0.001, respectively). According to Receiver Operating Characteristic analysis, the cut-off value of ATA was 50 (sensitivity=84.4%, specifiity=82.40%). CONCLUSION: The validated ATA questionnaire may be a practical tool for physicians in asthma management

Evaluation of Patients with Delirium in the Emergency Department

Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating course of globally altered mental status. It has been reported that the frequency of delirium among patients hospitalized with any disorder ranges from 2 to 30%. However, in the literature, few studies have evaluated the frequency of delirium in hospitalized patients, including those older than 65 years. According to our knowledge, this is the first study on adult patients in all age groups in an emergency department. We aimed to classify delirium according to its etiological causes and to compare the age groups for frequency and these causes. Material and Methods: Forty-three patients were included in the study; they had been diagnosed with delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV in an emergency department from December 2002 to December 2003. The patients were divided into two groups (group I: age <65 years, group II: age ≥65 years). Following a detailed history, each patient underwent a physical and neurological examination. Additionally, the Mini-Mental State Examination was administered. Radiological and hematological examinations were conducted on all patients who had indications for such testing.Results: Of the patients with delirium, 18 were female and 25 were male. Mean age was 61.18 years (range 18 to 90 years). Of the 43 patients, 21 were in group I and 22 were in group II. The most common causes of delirium were metabolic disorders. There was no significant difference between group I and II for the frequency or etiological causes of delirium. Conclusion: In emergency departments, all patients with delirium should be evaluated for etiological factors, especially metabolic disorders, as treatment of the underlying cause is essential in delirium

Aripiprazole-ınduced parkinsonism: report of two cases

treatment of psychosis related to schizophrenia, depression, bipolar disorder, and Parkinson’s disease. Well-documented side effects associated with the use of aripiprazole include insomnia, anxiety, headache, nausea, vomiting, and somnolence. Aripiprazole is associated with infrequent extrapyramidal side effects. Parkinsonism is caused by some drugs that block dopamine receptors. The sign of drug-induced parkinsonism (DIP) has a subacute onset and the clinical picture is usually dominated by akinetic-rigid symptoms. The symptoms of parkinsonism generally disappear within a few months after cessation of the drug. Aripiprazole, a dopamine system stabilizer, has fewer extrapyramidal side effects than typical antipsychotics. In this paper, we present two cases of aripiprazole-induced parkinsonism.Aripiprazol şizofreni tedavisinde onaylanmış, bipolar bozukluk tedavisinde etkili olan ikinci jenerasyon bir atipik antipsikotiktir (1). Nöroleptik ve antiemetik gibi santral sinir sistemini bloke eden ilaçlara bağlı olarak, parkinsonizm, tardif diskinezi, tardif distoni, akatizi, myoklonus ve tremor gibi hareket bozuklukları ortaya çıkmaktadır (2). Bunlar içinde en sık görüleni ilacın indüklediği parkinsonizmdir (İİP). Olgular klinik olarak idiyopatik parkinson hastalığına (İPH) çok benzediğinden, yanlışlıkla İPH tanısı alıp, tedavi başlanabilmektedir (3). Aripiprazolün bilinen en sık yan etkileri baş ağrısı, uykusuzluk,anksiyete, bilinç değişikliği, bulantı ve kusmadır (4). Atipik antipsikotiklerin tipik nöroleptiklere göre daha az ekstrapiramidal yan etki profiline sahip olduğu öne sürülmektedir. Literatürde aripiprazol ilişkili parkinsonizm ile ilişkili yazı son derece azdır ve olgu sunumları şeklindedir. Bu yazıda aripiprazole bağlı parkinsonizm gelişen iki olgu sunulmuştur

Toxicity of non-steroidal anti-inflammatory drugs: a review of melatonin and diclofenac sodium association

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the purpose of anti-inflammation, antipyretic, and analgesia. For this aim, they are used for the alleviation of pain, fever, and inflammation associated with rheumatoid arthritis, sports injuries, and temporary pain. However, treatment with NSAIDs may be accompanied by adverse effects such as gastrointestinal damage and platelet dysfunction. As with the other NSAIDs, diclofenac sodium (sodium-(o-((2,6-dichlorophenyl)-amino)-phenyl)-acetate) (DS), an NSAID, has potent anti-inflammatory, analgesic, and antipyretic effects. However, treatment with DS may cause some adverse cerebral and cerebellar effects such as convulsions, disorientation, hallucination, and loss of consciousness. Melatonin (MLT) is a free-radical scavenger and possesses antioxidant properties. It has been reported to easily cross the blood-brain barrier, and is found in high concentrations in the brain after exogenous administration. It is also a neuroprotector in a wide range of conditions affecting the central nervous system CNS due to its free-radical scavenging activities and lipophilic-hydrophilic properties. Neuroprotective actions of MLT have been discovered in both in vitro and in vivo, and are a powerful scavenger of oxygen and nitrogen free radicals. Thus, MLT can protect the cell membrane, organelles, and core against free-radical damage. Therefore, it has been postulated that exogenous MLT acts as a neuroprotector contrary to DS neurotoxicity. In this review, we aimed to discuss the possible neuroprotective effects of MLT on DS toxicit

The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results

PURPOS

Evaluation of Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange, in Severe Sepsis or Septic Shock in Critically Ill Children

Background and objective: Severe sepsis and septic shock are life-threatening organ dysfunctions and causes of death in critically ill patients. The therapeutic goal of the management of sepsis is restoring balance to the immune system and fluid balance. Continuous renal replacement therapy (CRRT) is recommended in septic patients, and it may improve outcomes in patients with severe sepsis or septic shock. Therapeutic plasma exchange (TPE) is another extracorporeal procedure that can improve organ function by decreasing inflammatory and anti-fibrinolytic mediators and correcting haemostasis by replenishing anticoagulant proteins. However, research about sepsis and CRRT and TPE in children has been insufficient and incomplete. Therefore, we investigated the reliability and efficacy of extracorporeal therapies in paediatric patients with severe sepsis or septic shock. Materials and methods: We performed a multicentre retrospective study using data from all patients aged &lt;18 years who were admitted to two paediatric intensive care units. Demographic data and reason for hospitalization were recorded. In addition, vital signs, haemogram parameters, and biochemistry results were recorded at 0 h and after 24 h of CRRT. Patients were compared according to whether they underwent CRRT or TPE; mortality between the two treatment groups was also compared. Results: Between January 2014 and April 2019, 168 septic patients were enrolled in the present study. Of them, 47 (27.9%) patients underwent CRRT and 24 underwent TPE. In patients with severe sepsis, the requirement for CRRT was statistically associated with mortality (p &lt; 0.001). In contrast, the requirement for TPE was not associated with mortality (p = 0.124). Conclusion: Our findings revealed that the requirement for CRRT in patients with severe sepsis is predictive of increased mortality. CRRT and TPE can be useful techniques in critically ill children with severe sepsis. However, our results did not show a decrease of mortality with CRRT and TPE

Daily Practice of Mechanical Ventilation and Weaning in Turkish PICUs: A Multicenter Prospective Survey

Objectives

Daily Practice of Mechanical Ventilation and Weaning in Turkish PICUs: A Multicenter Prospective Survey.

Objectives