Skuteczność oznaczania parametrów morfologii w diagnostyce ciąży ektopowej jajowodowej

Objective: Ectopic pregnancy (EP) is the major cause of maternal morbidity and is responsible for maternal mortality in the first trimester. In order to reduce undesirable results, it is necessary to find rapid and accurate, non-surgical diagnostic tests for EP. The goal of the study was to investigate the differences in complete blood count parameters between tubal EPs and healthy pregnancies in be used in the diagnosis of ectopic pregnancy. Study design: White blood cell (WBC), neutrophil, monocyte, lymphocyte, platelet (PLT) counts, mean PLT volume (MPV) and PLT distribution width (PDW) levels in the complete blood count samples have been obtained from subjects with diagnosed tubal EP (n=78; study group) and women with healthy intrauterine gestations (n=79; control group). Statistical comparisons between groups were performed using the t test. Results: PDW levels were found to be significantly higher in the control group than EP (pCel: Ciąża ektopowa (EP) jest główną przyczyną śmiertelności matek w pierwszym trymestrze ciąży. Aby zmniejszyć niekorzystne wyniki tej choroby, konieczne jest znalezienie szybkiego i właściwego testu nieoperacyjnego służącego do rozpoznania EP. Celem badania była ocena różnic w wynikach morfologii pomiędzy pacjentkami z ciążą ektopową a zdrowymi ciężarnymi. Materiał i metoda: W próbkach pełnej krwi zbadano następujące parametry: leukocyty (WBC), neutrofile, monocyty, limfocyty, płytki krwi (PLT), średnią objętość płytki krwi (MPV), szerokość rozdziału płytek (PDW) u pacjentek z rozpoznaną ciążą jajowodową (n=78, grupa badana) oraz u zdrowych ciężarnych (n=79, grupa kontrolna). Analiza statystyczna porównująca obie grupy została wykonana przy pomocy testu t. Wyniki: PDW był istotnie wyższy w grupie kontrolnej niż w grupie EP (

Geriatrik olgularda muskuloskeletal fizyoterapi sonrası hastalık şikayetlerindeki azalma oranları

Amaç: Bu araştırma fizik tedavi ve rehabilitasyon programına alınan 65 yaş ve üzeri bireylerde fizik tedavi ve rehabilitasyon programı sonrası şikayetlerindeki azalma oranlarını belirlemek amacıyla gerçekleştirilmiştir. Yöntem: Çalışmaya 65 yaş üzeri (73.61±6.02) 648’i (%78,4) kadın ve 179’u (%21,6) erkek olmak üzere, toplam 827 olgu dahil edildi. Olgulara toplam 10,482 seans, ortalama 12.7 seans/ hasta fizik tedavi ve rehabilitasyon programı uygulandı. Çalışmaya dahil edilen hastaların hastalıkları; romatizmal hastalıklar (osteoartrit, ankilozan spondilit, fibromyalji), periferik sinir yaralanmaları, tendinit, tenosinovit, bursit, spondiloz, disk dejenerasyonu gibi muskuloskeletal hastalıklardı.Tedavi programı tamamlandığında, tedavi öncesi ve sonrası belirlenen bulgu ve şikayet sayısındaki değişim yüzdelik oran olarak hesaplandı. Bulgular: Fizik tedavi ve rehabilitasyon programı; uygulanan olgulardan 6’sı (0,7) %25, 5’i (%0,6) %40, 9’u (%1.1) %50, 27’si (%3,3) %60, 4’ü (%0,5) %65, 84’ü (%10,2) %75, 119’u (%14,4) %80, 5’i (%0,6) %85, 1’i (%0,1) %90 ve 505’i (%61,1) %100 oranında şikayetlerinin azaldığını; 9’u (%1,1) şikayetlerinde azalma olmadığını belirtirken, 53 olgu (%6,4) herhangi bir yorumda bulunmadı. Sonuç: Geriatrik olgularda, fizik tedavi ve rehabilitasyon programı sonrası tüm şikayetlerin azalma oranının yüzde altmış seviyesinde kalması; tedavinin semptomatik iyileşmeyi etkileyecek çoklu değişkenler nedeniyle tam iyileşme sağlamadığına yorumlandı. Sonraki çalışmada, geriatrik hasta memnuniyetinin hastalık, hasta ve sağlık profesyonelleriyle olan etkileşiminin ayrıştırılarak incelenmesi planlandı

Vitamin D deficiency in pregnancy may affect fetal thymus development

Objectives: The aim of our study was to evaluate the association of vitamin D deficiency (VDD) during pregnancy with thymus size in full-term fetuses. Material and methods: In this prospective study, we evaluated mid-pregnancy serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations. The fetal thymus size was measured by ultrasound in the third trimester. Neonatal 25(OH)D3 levels were evaluated by umbilical cord blood sampling. Correlation of maternal and neonatal vitamin D levels and association between thymus size and both, maternal and neonatal vitamin D concentrations were investigated. Results: Serum 25(OH) D3 concentrations were within the normal range in 48 (29.8%) mothers and 10 (13.1%) new­borns. A strong correlation between mid-pregnancy maternal and neonatal 25(OH)D3 concentration (r = 0.8, p < 0.001) was found. A significant linear correlation was observed between both, maternal and neonatal 25(OH)D3 concentrations and thymus perimeter length (r = 0.45, p = 0.04 and r = 0.43, p < 0.01, respectively). Both, maternal and fetal VDDs were associated with decreased thymus perimeter (p = 0.04, p = 0.03). Conclusions: Vitamin D deficiency during pregnancy may be associated with smaller fetal thymus. Our data suggest that VDD in pregnancy may lead to systemic inflammatory response in the fetus

Why do some patients with stage 1A and 1B endometrial endometrioid carcinoma experience recurrence? A retrospective study in search of prognostic factors

Objectives: Endometrial endometrioid carcinoma (EEC) is the most encountered subtype of endometrial cancer (EC). Our study aimed to investigate the factors affecting recurrence in patients with stage 1A and 1B EEC. Material and methods: Our study included 284 patients diagnosed with the International Federation of Gynecology and Obstetrics stage 1A/1B EEC in our center from 2010 to 2018. The clinicopathological characteristics of the patients were obtained retrospectively from their electronic files. Results: The median age of the patients was 60 years (range 31–89). The median follow-up time of the patients was 63.6 months (range 3.3–185.6). Twenty-two (7.74%) patients relapsed during follow-up. Among the relapsed patients, 59.1% were at stage 1A ECC, and 40.9% were at stage 1B. In our study, the one-, three-, and five-year recurrence-free survival (RFS) rates were 98.9%, 95.4%, and 92.9%, respectively. In the multivariate analysis, grade and tumor size were found to be independent parameters of RFS in all stage 1 EEC patients. Furthermore, the Ki-67 index was found to affect RFS in stage 1A EEC patients, and tumor grade affected RFS in stage 1B EEC patients. In the time-dependent receiver operating characteristic curve analysis, the statistically significant cut-off values were determined for tumor size and Ki-67 index in stage 1 EEC patients. Conclusions: Stage 1-EEC patients in the higher risk group in terms of tumor size, Ki-67, and grade should be closely monitored for recurrence. Defining the prognostic factors for recurrence in stage 1 EEC patients may lead to changes in follow-up algorithms

The impact of Ki-67 index, squamous differentiation, and several clinicopathologic parameters on the recurrence of low and intermediate-risk endometrial cancer

Endometrial endometrioid carcinoma (EEC) represents approximately 75-80% of endometrial carcinoma cases. Three hundred and thirty-six patients with EEC followed-up in the authors’ medical center between 2010 and 2018 were included in our study. Two hundred and seventy-two low and intermediate EEC patients were identified using the European Society for Medical Oncology criteria and confirmed by histopathological examination. Recurrence was reported in 17 of these patients. The study group consisted of patients with relapse. A control group of 51 patients was formed at a ratio of 3:1 according to age, stage, and grade, similar to that in the study group. Of the 17 patients with recurrent disease, 13 patients (76.5%) were Stage 1A, and 4 patients (23.5%) were Stage 1B. No significant difference was found in age, stage, and grade between the case and control groups (p > 0.05). Body mass index, parity, tumor size, lower uterine segment involvement, SqD, and Ki-67 index with p<0.25 in the univariate logistic regression analysis were included in the multivariate analysis. Ki-67 was statistically significant in multivariate analysis (p = 0.018); however, there was no statistical significance in SqD and other parameters. Our data suggest that the Ki-67 index rather than SqD needs to be assessed for recurrence in patients with low- and intermediate-risk EEC

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Acil servislerde çalışan hemşireler tarafından adli vakaların tanımlanması

Acil servisler, kriminal veya kişiler arası şiddet kullanımı olaylarında kurban ve faillerin sıkça başvurduğu birimlerdir. Bu nedenle, acil servis hemşirelerinin adli kanıtları tespit etme, toplama ve muhafaza etmesi konularındaki rolü önem kazanmaktadır. Bu çalışma, acil servislerde çalışan hemşirelerin karşılaştıkları adli olguların tanılanmasına yönelik uygulamaları ve mevcut durumun değerlendirilmesi amacıyla yapılmıştır. Çalışma, 01.08.2005-01.03.2006 tarihleri arasında acil servislerde çalışan 35 hemşire ve hekim tarafından doldurulan 69 adli raporun incelenmesiyle gerçekleştirilmiştir. Veri toplama aracı olarak literatür bilgisine dayalı hazırlanan 2 farklı anket formu ve semt karakolundaki adli raporlar kullanılmıştır. Yaş ortalaması 27,4±3,0 olan hemşirelerin, %57,1’i lisans mezunudur. Hemşirelerin %97.1’si acil servislerde çalışmaya başlamadan önce adli tıp eğitimi almamıştır. %77,2’si adli hemşireliğin tanımını bilmemektedir. Yine hemşirelerin %57,1’i adli olguları değerlendirmediklerini ifade etmiştir. Sonuç olarak; hemşirelerin adli kanıtların toplanması, saklanması, ilgili mercilere ulaştırılması ve adli olguların değerlendirilmesi konularında uygulama eksikliklerinin olduğu, düzenlenen adli raporların hiçbirinde kadın ve çocuğa yönelik istismar olgusunun olmadığı, hemşirelerin ifadeleriyle adli rapor bilgilerinin genellikle uyuşmadığı, bu sonuçların hemşirelerin adli hemşirelik konusundaki bilgi eksiklerinden, konuyla ilgili standart protokollerin bulunmamasından, hekim ve hemşirelerin ekip anlayışı içerisinde çalışmamasından ve bu konulardaki yasal düzenlemelerden haberdar olmamalarından kaynaklandığı kanatine varılmıştır. SUMMARY DIAGNOSING OF FORENSİC CASES BY THE NURSES WORKING IN EMERGENCY SERVICES Emergency services are the units which victims and offenders often apply in the events of criminal or using interpersonal violence. Therefore, the role of the nurses in emergency services in determining, collecting and keeping the legal evidences has become important. This study has been performed in order to evaluate the applications concerned with diagnosing forensic facts the nurses working in emergency services come across and the existing situation. This study was carried out with analysing 69 forensic reports filled by 35 nurses and doctors working in emergency services between the dates of 01.08.2005 and 01.03.2006. As a data collecting tool, 2 different forms of questionaires based on literature and legal reports in local police station were used. The nurses whose average age is 27,4±3,0 are university graduates. %97.1 of the nurses did not have forensic medicine training before working in emergency services. %77,2 of the nurses do not know the definition of forensic nursing. %57,1 of the nurses have expressed that they do not evaluate the forensic facts. Consequently, it is concluded that the nurses have the lack of application in collecting, keeping, delivering the forensic evidences to the relevant authority and evaluating the forensic facts; none of the forensic facts composed does not have exploitation fact aimed at women and children; the statements of the nurses and the information of the forensic reports generally do not comply with each other; these results are caused by the lack of information of the nurses about forensic nursing, not having standard protocols relating to the subject, nurses and doctors not working in the understanding of team work and not knowing the forensic regulations about the this subject