Dietary sodium and potassium intake were associated with hypertension, kidney damage and adverse perinatal outcome in pregnant women with preeclampsia

Objectives: In this study, we hypothesized that dietary salt and potassium intake may be related with blood pressure, kidney damage and perinatal outcome in pregnants with preeclampsia (PE). Methods: In total, 200 women (50 control women with healthy pregnancy, 150 women with PE) were recruited for the study. Daily salt and potassium intake was estimated based on calculation of 24-hour urinary sodium U[Na+] and potassium U[K+] excretion. U[Na+]/[K+] was calculated by dividing U[Na+] by U[K+]. At the end of the measurements, the pregnant women with PE (n=150) were divided into tertiles according to U[Na+]/[K+]: low Na/K group (n=50, mean U[Na+]/[K+]: 1,04±0,32), medium Na/K group (n=50, mean U[Na+]/[K+]: 2,49± 0,54), high Na/K group (n=50, mean U[Na+]/[K+]: 6,62±3,41). Results: The mean SBP and DBP levels were significantly lower in low Na/K group compared with medium or high Na/K groups (p=0.024, p=0.0002; respectively). Serum creatinine was significantly lower in low Na/K group than high Na/K group (p=0.025). Frequency of severe preeclampsia is lower in low Na/K group than medium or high Na/K groups (p=0.002, p=0.0001; respectively). Birth weight and gestational age at birth were higher in low Na/K group compared with high Na/K group (p=0.045, p=0.0002; respectively). After adjusting for covariates, SBP and DBP and creatinine levels were independently associated with 24 hours urinary [Na+]/[K+] Conclusion: These findings suggest that pregnant with PE with high dietary salt and low potassium intake may have greater maternal and neonatal morbidity risk than pregnant with PE under low dietary salt and high potassium intake

Elastosonographic Evaluation of Endometrium in Postmenopausal Bleeding

OBJECTIVE: The aim of this study was to evaluate the elastosonographic changes of endometrium in postmenopausal women with uterine bleeding. STUDY DESIGN: A total of 80 women in their postmenopausal period were enrolled for the study; 19 with postmenopausal bleeding and 61 normal healthy controls. All patients with a history of previous uterine surgery (including myomectomy) and/or endometrial interventions such as endometrial ablation, polyp removal, hysteroscopic interventions (except solely diagnostic procedures) and endometrial sampling within one year were excluded from the study because of the possibility of endometrial changes that may interfere with elastosonographic starin ratios. B-mode scanning, Doppler and real-time tissue elastography (RTE) were performed by the same single operator, blinded to the study design. The ultrasonographic findings (strain ratio, endometrial thickness, uterine artery Doppler indices) were evaluated between groups. RESULTS: The means of age were 57.84±5.36 years and 56.34±3.32 years for the study group and the controls respectively. The groups were similar in regard to age (p=0.328). The parity of the postmenopausal bleeding group was significantly higher than the controls (p<0.001). When uterine artery Doppler indices were compared between groups, study group was found to have lower values in regard to controls (p<0.001). The medians of endometrial thickness were 4.30 (IQR=3.80)mm in the study group and 2.60 (IQR=0.90) mm in the control group and the difference was found to be significant (p<0.001). The medians of elastosonographic B/A ratios were 0.98 (IQR=0.18) and 1.27 (IQR=1.78) for the study group and controls respectively. The B/A ratios were found to be significantly lower in the study group (lower tissue elasticity) (p<0.001). CONCLUSION: Tissue biopsy for histopathologic evaluation is still the gold standart in cases with postmenopausal bleeding. However, the need for a noninvasive method with high sensitivity and specificity is still under search. Some women who had been offered biopsy but did not accept the intervention because of the invasive nature of the procedure will be eft undiagnosed for a possible malignancy. Evaluation of the endometrium with real-time tissue elastosonography is one of the noninvasive methods with this potential and the diagnostic value of RTE could be possible with multicentric studies including more subjects

The Role of Mean Platelet Volume on Distinction of Submucosal Myomas from Other Etiologies in Increased Endometrial Thickness

OBJECTIVE: The aim of the study was to determine whether it is possible to differentiate submucosal fibroids before interventional procedures based on mean platelet volume (MPV), in reproductive-age patients presenting with endometrial thickening and abnormal uterine bleeding. STUDY DESIGN: This study included 581 reproductive-age women who underwent diagnostic procedures (curettage or operative hysteroscopy) and were subsequently divided into two groups based on clinico-pathological findings. The first group included those with benign endometrial pathology (control group, n=438), and the second group consisted of those with submucosal leiomyomas (n=143). The demographic characteristics and complete blood count (CBC) data of these patients were collected retrospectively, and comparisons were made between groups. RESULTS: No statistically significant difference was found between the groups according to demographic features and CBC parameters such as hemoglobin levels and white blood count (p>0,05). Platelet counts were significantly higher and MPV values were significantly lower in submucosal leiomyoma patients compared with the control subjects (p<0,05). CONCLUSIONS: MPV may be a useful predictive marker when differentiating submucosal leiomyoma from other benign causes of abnormal uterine bleeding. The ability to predict the possibility of the presence of submucosal leiomyoma before surgery can assist in determining the most appropriate type of invasive procedure

Gastrostomy in hospitalized patients with acute stroke: "NoroTek" Turkey point prevalence study subgroup analysis

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69±14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin’s scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.Amaç: Akut nörovasküler hastalıklarda nütrisyonel durum ve disfaji değerlendirmesi ve enteral beslenme kararı önemli prognoz belirleyicilerindendir. Gereç ve Yöntem: NöroTek, 10 Mayıs 2018’de (Dünya İnme Farkındalık Günü) Türkiye’nin tüm sağlık alt bölgelerine yayılmış 87 hastanenin katılımıyla gerçekleştirilen bir nokta prevalans çalışmasıdır. Hastanede yatan ve bu alt çalışma için toplanan verisi tam olan toplam 972 nörovasküler hasta (kadın: %53, yaş: 69±14 yıl; 845’i akut iskemik inme; 119’u intraserebral hematom ve 8’i post-resüsitasyon ensefalopatisi) analiz edildi. Bulgular: Gastrostomi iskemik inmeli hastaların %10,7, intraserebral kanamalıların %10,1 ve post-resusitasyon ensefalopatisi olanların %50’sine uygulanmıştır. Perkütan endoskopik gastrostomi (PEG) gereksiniminin bağımsız belirleyicileri, iskemik inme grubunda kabul NIHSS [exp (β): 1,09, %95 güven aralığı (GA): 1,05-1,14, puan başına] ile hem iskemik hem de hemorajik inmelerde mekanik ventilasyon uygulanmış olmasıdır [iskemik için: exp (β): 6,18, %95 GA: 3,16- 12,09] ve hemorajik inme için: [exp (β): 26,48, 95% GA: 1,36-515,8]. İnme olgularında PEG uygulaması hastane içi mortalite için bağımsız belirleyici değildi [exp (β): 1,731, 95% GA: 0,785-3,829]. Ancak, PEG uygulanmış olması taburculuk esnasında iyi prognoza (modifiye Rankin skoru 0-2) sahip olabilme için anlamlı bir negatif etmen olarak bulundu [exp (β): 0,032, %95 GA: 0,004-0,251]. Hastanede yatan nörovasküler hastaların yaklaşık üçte ikisinde malnütrisyon ve yutma bozukluğu açısından değerlendirme yapılmıştı. Nutrisyonel status değerlendirmesinin %69’u ve disfaji değerlendirmesinin %76’sı ilk 48 saat içinde gerçekleştirilmişti. Tüple enteral nütrisyon uygulama oranı %39’du. Beslenme tüplerinin %83,5’i ilk 2 gün içinde yerleştirilirken beslenme tüpü olan hastaların %28’ine daha sonra PEG açılmıştı. Sonuç: NöroTek çalışması ile Türkiye’de hastanede yatan akut inme hastalarında nutrisyonel uygulamaların temel kalite ölçütlerine ilişkin ilk güvenilir ve büyük ölçekli veri sağlanmıştır. Ekonomik olması ve doğruluğu açısından nokta yaygınlık yönteminin bu tip verilerin temini için daha fazla kullanılması mantıklıdır