In-hospital and short-term predictors of mortality in patients with intermediate-high risk pulmonary embolism

Introduction: The aim of this study was to evaluate the in-hospital and short-term predictive factors of mortality in intermediate-high risk acute pulmonary embolism (PE) patients with right ventricle (RV) dysfunction and myocardial injury.Methods: In this retrospective study, the medical records of 187 patients with a diagnosis of intermediatehigh risk acute PE were evaluated. A contrast-enhanced multi-detector pulmonary angiography was used to confirm diagnosis in all cases. All-cause mortality was determined by obtaining both in-hospital and 30 days follow-up data of patients from medical records.Results: During the in-hospital stay (9.5 +/- 4.72 days), 7 patients died, resulting in an acute PE related in-hospital mortality of 3.2%. Admission heart rate (HR), (Odds ratio (OR), 1.028 95% Confidence interval (CI), 0.002-1.121; P = 0.048) and blood urea nitrogen (BUN) (OR, 1.028 95% CI, 0.002-1.016; P = 0.044) were found to be independent predictors for in-hospital mortality in a multivariate logistic regression analysis. In total, 32 patients (20.9%) died during 30 days follow-up.The presence of congestive heart failure (OR, 0.015, 95%CI, 0.001-0.211; P = 0.002) and dementia (OR, 0.029, 95%CI, 0.002-0.516; P = 0.016) as well as low albumin level (OR, 0.049 95%CI, 0.006-0.383; P = 0.049) were associated with 30 days mortality.Conclusion: HR and BUN were independent predictors of in-hospital mortality and the presence of congestive heart failure, dementia, and low albumin levels were associated with higher 30 days mortality

Bir Sağlık Yüksekokulu’nda Okuyan Öğrencilerin Ölüm Kaygılarının Belirlenmesi

Aim: The descriptive study has been done in order to determination thoughts, feelings and death anxiety in health school students.Methods: The descriptive study has been done in order to determination death anxiety in students. This study includes 330 students attending Pamukkale University Denizli School of Health. Sample is comprised of 244 students who accepted to enrolled in the study between 01st-31th of May, 2009. Data have been collected with using a questionnaire and “Thorson-Powell Death Anxiety Scale”, T-Test, One-Way ANOVA, Kruskal-Wallis and Mann-Whitney U-Tests.Results: Average age of students who enrolled in the study was 21.44 ± 2.11. 65.6% of the students were girls, 26.6% were in 3rd class, 28.3% were seeing death as “ceasing to exist/ending”, 35.2% were feeling pain/sadness/anxiety when facing death. 63.1% had cared a dying patient, 17.2% felt sadness when they died, 23.0% continued caring in order to cope with death when they did, 43.9% didn’t felt himself enough when caring, 58.2% didn’t wan’t to take care of a dying patient, 63.9% didn’t have enough training at school in order to take care of a dying patient. There were significant relationship between death anxiety point average and students’ age groups, gender, attending class, perception of death, feelings/thoughts about death, feelings during care and wish to again take care of dying patient (p<0.05). In conclusion, male students, attending 3rd class, admitting to have felt helpless and feeling nothing while caring, students feeling adequate, willing to take care of another dying patient were found to have higher death anxiety. As a result of the study approached patients and their families with death while talking to students in addition to, the granting of student consulting services and topics with discussion of concrete cases has been proposed. Amaç: Bu çalışma, bir sağlık yüksekokulunda okuyan öğrencilerin yaşam sonu bakıma yönelik düşüncelerinin, duygularının ve ölüm kaygısı durumlarının belirlenmesi amacıyla tanımlayıcı olarak yapılmıştır. Yöntem: Çalışmanın evrenini Pamukkale Üniversitesi Denizli Sağlık Yüksekokulu’nda öğrenim gören 330 öğrenci oluşturmaktadır. Çalışmanın örneklemini 01-31 Mayıs 2009 tarihleri arasında çalışmaya katılmayı kabul eden 244 öğrenci oluşturmuştur. Veriler anket formu ve “ Thorson-Powell Ölüm Kaygısı Ölçeği” kullanılarak, yüzdelik, T- Testi, One-Way ANOVA, Kruskal-Walls ve Mann-Whıtney-U testleri kullanılarak değerlendirilmiştir.Bulgular: Çalışmaya alınan öğrencilerin yaş ortalamaları 21.44±2.11 olarak saptanmıştır. Öğrencilerin %65.6’sının kız olduğu, %26.6’sının 3. sınıfta okuduğu, %28.3’ünün ölümü “yok olma/sona erme” olarak tanımladığı, %35.2’sinin ölümle karşılaştıklarında acı/üzüntü/kaygı, hissettikleri belirlenmiştir. Öğrencilerin %63.1’inin ölümcül hastaya baktığı, bakım verirken %17.2’sinin üzüldüğü,  %23.0’ünün bakım vermeye devam ederek bu durumla baş ettiği, %43.9’unun bakım verirken kendilerini yeterli hissetmedikleri, %58.2’sinin ölümcül hastaya bakım vermek istemedikleri, %63.9’unun hemşirelik eğitiminde ölümcül hastaya bakım vermekle ilgili yeterli bilgi verilmediğini ifade ettikleri belirlenmiştir. Öğrencilerin yaş grupları, cinsiyetleri, öğrenim gördükleri sınıf, ölümü algılama, ölümle ilgili duygu/düşünceleri, bakım verirken hissettikleri ve ölümcül hastaya tekrar bakım vermeyi isteme durumlarına göre ölüm kaygısı puan ortalamaları arasında istatistiksel olarak anlamlı bir ilişkinin olduğu saptanmıştır (p<0.05). Çalışmaya alınan erkek öğrencilerin, 3.sınıfta okuyanların, bakım verirken kendini çaresiz hisseden ve bakım verirken hiçbir şey düşünmedim diyenlerin, ölümcül hastaya bakım verirken kendini yeterli hissedenlerin ve tekrar ölümcül hastaya bakım vermek isteyen öğrencilerin ölüm kaygıları yüksek bulunmuştur.Çalışmanın sonucunda ölüme yaklaşan hasta ve ailesi ile konuşurken öğrencilerin yanında bulunulması, öğrenciye danışmanlık hizmetlerinin verilmesi ve konunun vaka tartışmaları ile somutlaştırılması önerilmiştir

Demographics of patients with heart failure who were over 80 years old and were admitted to the cardiology clinics in Turkey

Objective: Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. Methods: The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: >= 50%). Results: A total of 1098 patients (male, 47.5%; mean age, 83.5 +/- 3.1 years) aged 80 years and 4596 patients (male, 50.2 %; mean age, 71.1 +/- 4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were >= 80 years and 27.1% for patients 65-79 years old. For patients aged >= 80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p= 80 years with HFrEF (p<0.01). Conclusion: HF is common in elderly Turkish population, and its frequency increases significantly with age. Females, diabetics, and hypertensives are more likely to have HFpEF, whereas CAD patients are more likely to have HFrEF.Turkish Society of CardiologyThis study was supported by Turkish Society of Cardiology

Long-term prognosis of patients with heart failure: Follow-up results of journey HF-TR study population

Background: Despite advances in therapeutic management of patients with heart failure, there is still an increasing morbidity and mortality all over the world. In this study, we aimed to present the 3-year follow-up outcomes of patients included in the Journey HF-TR study in 2016 that has evaluated the clinical characteristics and management of patients with acute heart failure admitted to the hospital and present a national registry data. Methods: The study was designed retrospectively between November 2016 and December 2019. Patient data included in the previously published Journey HF-TR study were used. Among 1606 patients, 1484 patients were included due to dropout of 122 patients due to inhospital death and due to exclusion of 173 due to incomplete data. The study included 1311 patients. Age, gender, concomitant chronic conditions, precipitating factors, New York Heart Association, and left ventricular ejection fraction factors were adjusted in the Cox regression analysis. Results: During the 3-year follow-up period, the ratio of hospitalization and mortality was 70.5% and 52.1%, respectively. Common causes of mortality were acute decompensation of heart failure and acute coronary syndrome. Angiotensin receptor blockers, beta-blockers, statin, and sacubitril/valsartan were found to reduce mortality. Hospitalization due to acute decompensated heart failure, acute coronary syndrome, lung diseases, oncological diseases, and cerebrovascular diseases was associated with the increased risk of mortality. Implantation of cardiac devices also reduced the mortality. Conclusions: Despite advances in therapeutic management of patients with heart failure, our study demonstrated that the long-term mortality still is high. Much more efforts are needed to improve the inhospital and long-term survival of patients with chronic heart failure

Unexpected complications of vasospastic coronary artery disease and its successful management

Vasospastic coronary artery disease (CAD) usually occurs during the percutaneous interventions and responds to conventional medical treatment. However, in rare conditions, it may be resistant to medical treatment, resulting in lethal complications, including acute myocardial infarction, ventricular arrhythmia, cardiopulmonary arrest, cardiogenic shock, and acute pulmonary edema. In this case report, a 44-year-old woman was admitted to the hospital with a diagnosis of non-ST-segment elevation myocardial infarction. During a diagnostic coronary angiography and in-hospital stays, multiple catastrophic complications due to vasospastic CAD occurred, and we were able to demonstrate a successful management strategy of these complications

Evelyn Waugh'un üç romanında ana temaların öğretimi

This research is based on Evelyn Waugh's three major novels. The first book questioned is author's first novel 'Decline and Fall' by which he made himself known to literature. The second novel taken into consideration is 'Vile Bodies' because Evelyn Waugh wrote the novel in the worst stretch of his life. Here it is observed that comparison of two subsequent novels, in their mood and language, 'Vile Bodies' and 'Decline and Fall' can reflect Waugh's real life experiences. 'Brideshead Revisited', which made Waugh known to World literature, is the third book taken. The research begins by investigating Eveh/n Waugh's life from his birth to his death. The reason which lies behind this is to see in which emotional or social circumstances Waugh wrote his books and introduced himself to his readers. The second step followed is to examine his writing style, which makes İt possible for us to interpret his novels on the right way. Then his three major novels are examined in a detailed way through their published dates. At the end of the research, a study on how to teach Evelyn Waugh's three major novels in ELT classes takes place. In this dissertation pre-intermediate or intermediate levels are target levels. Therefore, activities related to teaching Eveh/n Waugh's three major novels are much suitable for those levels.Bu araştırma, ünlü İngiliz yazar Evelyn Waugh'nun üç romanındaki ana temaların öğretilmesine dayanmaktadır. Araştırmada incelenen ilk roman yazarın kendisini edebiyat dünyasına tanıttığı ilk romanı Decline and Fail' dur. İncelenen ikinci roman yazarın hayatının en kötü döneminde yazdığı Vile Bodies' dir. Araştırmada gözlemlenmiştir ki bu ard arda yayımlanmış olan iki roman, dili ve tarzı bakımından karşılaştırıldığında Eveyln Waugh'nun yaşam tecrübelerini yansıtmaktadır. İncelenen üçüncü roman Waugh'un dünya edebiyatına kendisini tanıttığı Brideshead Revisited'tır. Araştırma, Evelyn Waugh'un doğumundan ölümüne kadar olan yaşamım anlatmakla, başlar. Bunun arkasında yatan neden Waugh'un hangi duygusal ve sosyal koşullarda romanlarım yazdığım anlayabilmektir. Araştırmadaki ikinci aşama yazarın yazım dilini, romanlarında kullandığı temaları inceleme yönündedir. Sonra, seçilen üç roman yayım tarihlerine göre ayrıntılı bir şekilde incelendi. Araştırmanın son bölümünde, Evelyn Waugh'un bu üç romanındaki ana temaların öğretilmesi yönünde öneriler verilmiştir

Effects of size grading and large individuals on growing performance of hybrid tilapia (o.niloticus ? × o.aureus?) fry.

TEZ9347Tez (Yüksek Lisans) -- Çukurova Üniversitesi, Adana, 2012.Kaynakça (s. 55-63) var.xi, 65 s. : res. (bzs. rnk.), tablo ; 29 cm.Bu çalışmada, Oreochromis niloticus? ve Oreochromis aureus? damızlıklarının çiftleştirilmesinden elde edilen melez tilapia yavrularında boylamanın ve büyük bireylerin küçük bireylerin büyüme performansına etkilerinin belirlenmesi amaçlanmıştır. Henüz larva aşamasını tamamlamamış olan 0 yaş yaklaşık 1,00 gr lık melez yavrular havuz içerisine yerleştirilen 1 m3 lük kafeslere 50 adet/ m3 stoklanmış ve 60 gün boyunca yetiştirilmiştir. Deneme grupları, tamamı küçük bireylerden oluşan boylanmış bir grup, %50 si ve %75 i küçük olan iki karışık gruptan oluşmuştur. Deneme sonunda boylanmış grubun (26,36±0,51), karışık gruplardaki küçük bireylerden daha iyi büyüdüğü gözlemlenmiştir. Boylanmış grubun günlük canlı ağırlık kazancı (0,42±0,01), spesifik büyüme oranı (5,45±0,03), oransal ağırlık artışı (2537,86±48,23%) karışık gruplardaki küçük bireylere göre daha yüksek bulunmuştur. Yem değerlendirme oranında ise üç grupta da birbirine yakın değerler saptanmıştır (p<0.05). Boylamanın yem değerlendirme oranına herhangi bir etkisinin olmadığı gözlemlenmiştir. Sonuç olarak boylamanın kafes ortamında melez tilapia yavrularının büyüme performansı üzerine pozitif bir etkisinin olduğu görülmüştür.The aim of this study is to investigate the effects of size grading and large individuals on the growing performance of small individuals of hybrid tilapia fry produced by crossbreeding broodstock of Oreochromis niloticus? and Oreochromis aureus?. The 0 age 1.00 g hybrid fry which have not completed the larval period were stocked as 50 fry/m³ in 1 m³ cages placed in a pond and cultured for 60 days. The test group comprises three groups, one graded group consisting of only small individuals and two mixed groups consisting of 50% and 75% small individuals respectively. After the trial it was observed that the growing of the graded group (26.36±0.51g) is better than the small individuals of the mixed groups. The daily average weight gain (0.42±0.01g/day), specific growth ratio (5.45±0.03 %/day) and porportional weight increase (2537.86±48.23%) of the graded group were found to be higher than the small individuals of the mixed groups. The food conversion ratio of the three groups were similar to each other (p<0.05). It was determined that the size grading has no effect on feed conversion ratio. Consequently it was observed that size grading has a positive effect on growing performance of hybrid tilapia fry in cage culture condition.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi tarafından desteklenmiştir. Proje No: SÜF2010YL25

Correlation of pulse oximetry oxygen saturation with blood gas arterial oxygen saturation in patients with heart failure reduced ejection fraction: Prospective cohort study

Abstract Aim: An estimation of accurate oxygen saturation is a critical in the management of patients with heart failure (HF). However, obtaining peripheral arterial blood samples may be technically difficult in some cases. The purpose of this study was to evaluate the correlation of pulse oximetry SO2 with arterial SO2 in patients with HF reduced ejection fraction (HFrEF). Material and Methods: In total, 29 consecutive patients who were admitted to cardiology clinics with HFrEF were prospectively enrolled in this study. We enrolled all patients if the chief physician ordered an atrial blood gas analysis. Simultaneous atrial blood gas sample and pulse oximetry measurements were collected and compared. The strength of association between atrial blood gas and pulse oximetry measurements was determined by Pearson correlation and Bland and Altman analysis. Results: We evaluated 29 heart failure patients (the mean age was; 70.7±10.9, 44.8 % of patients were male) with a mean EF of 29.6 ± 5.5. We observed that the mean pulse oximetry SO2 and arterial SO2 in the study were 92.8 ± 4.4 and 93 ± 5.2, respectively. We found significantly positive linear correlation between two methods according to Pearson analysis (r = 0.683, p < 0.001). A low bias was found between two methods according to Bland and Altman method (-0.2296, p = 0.23). Conclusion: The present data may suggest that pulse oximetry oxygen saturation is an acceptable substitute for the arterial oxygen saturation in patients with HFrEF

Quantification of rheumatic mitral stenosis severity with three-dimensional vena contracta area

WOS: 000458874600020PubMed ID: 30548321Introduction: Rheumatic mitral stenosis (MS) is an important health issue in developing countries. Assessment of the correct mitral valve area (MVA) is essential for the timing of intervention. Most of the parameters for the assessment of rheumatic MS are derived from Two-dimensional (2D) echocardiography. Three-dimensional (3D) echocardiography is commonly used in our daily practice at the present time. The aim of this study was to assess the value of 3D echocardiography mitral valve vena contracta area (VCA) in predicting the severity of Rheumatic MS by comparing 3D planimetry. Methods: The patients, who had been diagnosed as mild, moderate, and severe rheumatic MS with conventional methods (pressure half time, planimetry) by 2D transesophageal echocardiography (TEE)/ transthoracic echocardiography (TTE), underwent 3D TEE evaluation. Also, the patients who had an atrial fibrillation and more than moderate aortic regurgitation were included in the study. 3D TEE full volume mitral valve VCA was measured in end-diastole during its largest dimensions. 3D TEE full volume and 3D zoom MVA planimetry were measured at the end-diastole during the mitral valve's largest opening. Results: We studied 40 patients (the mean age: 51.1 +/- 11.6 years, 31 females) with rheumatic MS. 3D TEE VCA was found to be highly correlated with the 3D TEE MVA (r = 0.82, P < 0.001). Conclusion: Our study findings provide evidence that 3D TEE mitral valve VCA can be additionally used in detecting the severity of rheumatic MS