Investigation of Thyroid Metabolism Diseases in Kütahya Region

Aim: The study was performed on the sera sent for other diagnostic purposes like thyroid function tests (thyroid-stimulating hormone, total triiodothyronine and total thyroxin) to the Laboratory of Kütahya Hıfzısıhha Institute. Material and Method: Patients visiting 13 health care centers province and districts of Kütahya province were included in this study. The study popula-tion consisted of 320 patients. Serum levels of cholesterol, trigliserid, HDL-cholesterol, LDL-cholesterol and lipid were measured. Results: The results of our study showed 250 individuals (78.12%) to be within normal ranges, 42 (13.12%) as hypothyroid, and 28 (8.75%) were hyperthyroid. Hypothyroid pa-tients had significantly higher levels of cholesterol, LDL-cholesterol, lipid and thyroid-stimulating hormone levels (p<0.05). While hyperthyroid patients had significantly lower levels of cholesterol, LDL-cholesterol and lipid levels when compared with patients with normal thyroid hormone levels (p<0.05); Thyroxin levels were significantly higher (p<0.05). Discussion: The results of this study showed that the population under study was at risk of goiter diseases

Analyzing of iron-deficiency anemia in pregnancy using rule-based intelligent classification models

Introduction: Iron deficiency anemia is the most common cause of anemia worldwide, and increased iron requirement during pregnancy increases the risk of anemia. Anemia in pregnancy is associated with adverse pregnancy outcomes such as low birth weight, preterm and intrauterine growth restriction. This study used a Rule-based Intelligent Classification Models to predict socio-demographic, nutritional, antenatal care and obstetric factors on iron deficiency anemia during pregnancy Methods: This retrospective study was a secondary analysis of a community-based cross-sectional study conducted between January and June 2019 in the province of Elazig in eastern Turkey. Data of 495 pregnant women were included in the study iron deficiency anemia was defined as hemoglobin   lt; 11 g/dl, and ferritin lt; 30 µg/L. Rule-based machine learning methods were used to predict factors associated with anemia during pregnancy. Results: The mean age of 495 pregnant women were 30.06 ± 5.15 years. The prevalence of anemia was 27.9% in study population. Maternal age, educational status, occupation, nutrition education status, nutritional property, gravida, and parity were significantly related to anemia. Jrip, OneR, and PART algorithms estimated factors associated with anemia with 96.36%, 85.45%, and 97.98% accuracy, respectively. Conclusion: Rule-based machine learning algorithm may offer a new approach to risk factors for iron deficiency anemia during pregnancy. With the use of this model, it is possible to predict the risk of anemia both before and during pregnancy and to take preventative measures

Serum apelin and resistin levels in patients with impaired fasting glucose, impaired glucose tolerance, type 2 diabetes, and metabolic syndrome

Introduction: The aim of this study was to investigate serum apelin and resistin levels in patients with impaired fasting glucose, impaired glucose tolerance, type 2 diabetes and metabolic syndrome. Material and methods: The study comprised 18 patients with type 2 diabetes mellitus (T2DM) (nine females, nine males), 18 patients with impaired fasting glucose (IFG) (nine females, nine males), 18 patients with impaired glucose tolerance (IGT) (nine females, nine males), 18 patients with metabolic syndrome (MeS) (nine females, nine males), and 16 healthy individuals (eight females, eight males); serum adiponectin, apelin, resistin levels, fasting and postprandial blood glucose, insulin resistance markers, and lipid parameters were measured. Results: In the study, serum apelin levels were determined to be significantly lower in IGT, MeS, and T2DM groups compared with the control group (p = 0.002, p = 0.006, and p < 0.001, respectively). Serum resistin levels were determined to be significantly higher in IGT and T2DM groups compared with the control group (p < 0.001 and p < 0.001, respectively). Conclusions: Apelin and resistin are thought to affect glucose metabolism and insulin resistance. Apelin is an important indicator in individuals with IGT in the prediabetic period and may play a role in preventing diabetic complications and treatment of T2DM

Does hormonal control obviate positive airway pressure therapy in acromegaly with sleep-disordered breathing?

SummaryIntroductionAcromegaly is a disease in which uncontrolled release of growth hormone occurs after closure of epiphyseal plates, causing changes in the body that can lead to sleep disordered breathing (SDB). No definite guidelines regarding the treatment of SDB in acromegaly are available. In this study, we aimed to investigate the prevalence of SDB in acromegaly and whether hormonal control alters the necessity of positive airway pressure (PAP) therapy in acromegaly patients with SDB.MethodsForty-two acromegaly patients were included in the study and divided into two groups according to disease status, i.e., active or well controlled. All patients underwent polysomnography. Fourteen patients with active acromegaly were diagnosed with SDB and were evaluated for PAP therapy with polysomnography both before and 6 months after disease control was achieved.ResultsSleep-disorder breathing was diagnosed in 22 of 42 patients, 7 of 20 patients with controlled-disease and 15 of 20 patients with active diseases. There were significant reductions in respiratory disturbance index (RDI), apnea index, desaturation index, central apnea number, and rapid eye movement-phase RDI at the control polysomnography. Initially, PAP therapy was indicated in 12 of 14 patients and PAP therapy indication held in 11 patients after acromegaly control was achieved.ConclusionOur study revealed that over half of patients with acromegaly had SDB. Furthermore, SDB severity decreases with acromegaly treatment; however, this decrease does not change the indication for PAP therapy; therefore, PAP therapy should not be delayed in acromegalic SDB patients

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Use of a Modified Surgical APGAR Score for Prediction of Postoperative Complications in Emergency Surgery: an observational retrospective study

BACKGROUND: The surgical Apgar score (SAS) was defined by Gawande et al. in 2007. It has been shown that this scoring system was highly effective for predicting the incidence of post-operative complications and mortality. In this study, we aimed to define a new, modified SAS (mSAS) for predicting the incidence of post-operative complications and mortality in emergency surgery. We also wanted to quantify the effectiveness of this modified scoring system, comprising of the duration of the operation in addition to the three intraoperative parameters of the SAS score.METHODS: Five hundred and seventy-nine patients who underwent emergency surgery were enrolled in this retrospective obser-vational study. At the end of the operation, the SAS was calculated from the data obtained from the examination of the patients and the mSAS was calculated by adding the duration of the operation to data used in the calculation of the SAS (Surgical duration &gt;8 h; –4 points; 7.01–8 h; –3 points; 5.01–7 h; –2 points; 3.01–5 h; –1 points; 0–3 h; 0 points added).RESULTS: There was a statistically significant relationship between the mSAS and the total number of complications (as operative time [OT] increased, the number of complications increased) (r=0.360; p=0.001). The compliance levels of the SAS and mSAS were 98.4% and they have been found as statistically significant (ICC: 0.984; p=0.001; p&lt;0.01).CONCLUSION: We suggest that the OT should be included as a simple, objective and practical indication of the SAS risk score in major operations. The mSAS was an independent predictor of post-operative mortality and complications. With the widespread use of electronic medical record systems and the effective use of pre-operative medical data, the mSAS can be used as an easy and new scoring system to predict prognosis.</p

Yoğun bakımda tedavi edilen COVID-19 olgusunda nadir bir septisemi etkeni: Ralstonia insidiosa

Giriş\Amaç: COVID-19, milyonlarca ölüme ve enfekte vakaya neden oldu (1). Hastalarda, immünmodülatör (2-4) tedavilerinolumlu etkilerine rağmen, sekonder enfeksiyon riski halen tartışılmaktadır (5). Bu olgu sunumunda, mikrobiyoloji uzmanı olanbir hastada, daha önce COVID-19 olgularında tanımlanmamış Ralstolnia insidiosa septisemisini paylaştık. Olgu: Bilinen RA tanısı ve NSAİİ kullanım öyküsü olan 42 yaşında kadın hasta, dispne şikayetiyle hastanemize başvurdu. Torakstomografisi, orta/ağır COVID-19 tutulumu (Figür 1.a-b) saptanan hastada PCR testi COVID-19 tanısını doğruladı. Acil servisbaşvurusunda, rezervuarlı maske ile 8 L/dk oksijen desteği dışında organ destek gereksinimi olmayan hastada (TA:105/71 mmHg,KTA:114/dk, SS:24/dk, SpO2:%94, Ateş 36.3 °C), HS Troponin I değerleri belirgin artmış tespit edildi. Göğüs ağrısı ve patolojikEKG bulgusu yoktu. Hastanın laboratuvar bulguları Tablo 1’de özetlenmiştir. Ekokardiyografide, EF:%45, posterolateralhipokinezi ve minimal perikardiyal sıvı saptandı. COVID-19 ilişkili miyokardit düşünülen hastada, olası akut koroner sendromihtimali nedeniyle, hastaya klopidogrel (1 x 75 mg), ASA (1x100 mg), enoksaparin (2x0.6 IU), metoprolol (1x50 mg), perindopril(1x5 mg) ve atorvastatin (1x40 mg) başlandı. Tedaviye deksametazon (1x6 mg) eklendi. Hasta yoğun bakıma yatırıldı.Konvansiyonel oksijen desteğinde PaO2: 58.6 mmHg saptanan hastada HFNO uygulamasına geçildi. Lökositozu, CRP ve PCTyüksekliği nedeniyle sefepim (2x1 g) başlandı. Yatışın 2. gününde, kan kültüründe gram negatif basil sinyali alındı. Sonraki gün,kanda Ralstolnia insidiosa üremesi bildirildi. Sefepim tedavisine devam edildi. Hastada solunum desteği azaltılarak maske ileoksijen desteğine geçildi. EKG bulgusu olmayan, kardiyak markerlarda belirgin regresyon izlenen, kontrol ekokardiyografide,LVEF:%60, sağ yapılar olağan saptanan ve miyokardiyal hareket kusuru, perikardiyal efüzyon, kapak patoloji saptanmayanhastada, ASA ve klopidogrel tedavisi sonlandırıldı. Kan kültür negatifliği teyit edilen hastada, taburculuk sonrası 20. günderadyolojik düzelme de sağlandı (Figür 1.c-d).Tartışma\Sonuç: R.insidiosa, immünsüprese hastalarda patojenik olduğu gösterilmiş çevresel bir bakteridir (6). Bu olgusunumunda, hastanın aktif çalışan bir mikrobiyoloji uzmanı olması, etken kaynağını tartışmalı hale getirse de COVID-19olgularında kortikosteroid kullanımının, hastaları R.insidiosa için riskli hale getirebileceği unutulmamalıdır.</p