The effects of artistic and social activities during hemodialysis on the life quality, pain perception, anxiety status of the patients and intradialytic complications

Introduction: We aimed to investigate the effects of social and artistic activity support on quality of life, pain perception, and anxiety status in hemodialysis (HD) patients and the relation between occupational therapy and frequent complications of HD.Methods: Volunteer instructors trained 22 patients participated in this study for wood painting for 4 hours/day, 2-3 days a week for six months. The State-Trait Anxiety Inventory (STAI I and STAI II) and Visual Analog Scale were applied before the social activity and at the 6th month. The quality of life evaluated with Short Form-36.Results: The patients who participated in the social activity more than 25 hours formed the study group (n=9), and those participated less than 25 hours made control group (n=13). There were significant differences in initial and 6th month values in both STAI I and STAI II scores of the study group, and only in STAI II score in the control group (p=0.008, p=0.015, p=0.003, respectively). In the study group, while STAI I and II mean was 49.9 and 52.8 in the first month, respectively, it decreased to 30.0 and 38.8 in 6th month, respectively. In the control group, in the first month mean of STAI II score was 56.9 and it decreased to 45.3 in the sixth month. The mean of physical function capacity from SF-36 parameters increased from 73.9 to 84.4 (p=0.026) in the study group and from 47.7 to 75.8 (p=0.002) in the control group. The difference between study and control group was statistically significant (p = 0.029). Conclusions: Our results support that social and artistic activities during HD have positive effects on chronic HD patients in terms of physical functioning level

Ofloxacin plus Rifampicin versus Doxycycline plus Rifampicin in the treatment of brucellosis: a randomized clinical trial [ISRCTN11871179]

BACKGROUND: The combination therapies recommended by the World Health Organization for treatment of brucellosis are doxycycline plus rifampicin or doxycycline plus streptomycin. Although highly successful results have been obtained with these two regimens, relapse rates as high as 14.4%. The most effective and the least toxic chemotherapy for human brucellosis is still undetermined. The aim of the present study was to investigate the efficacy, adverse effects and cost of ofloxacin plus rifampicin therapy, and doxycycline plus rifampicin therapy and evaluate in the treatment of brucellosis. METHODS: The open trial has been carried out prospectively by the two medical centers from December 1999 to December 2001 in Duzce region Turkey. The diagnosis was based on the presence of signs and symptoms compatible with brucellosis including a positive agglutination titre (≥1/160) and/or a positive culture. Doxycycline and rifampicin group consisted of 14 patients who were given doxycycline 200 mg/day plus rifampicin 600 mg/day during 45 days and this group Ofloxacin plus rifampicin group was consisted of 15 patients who were given ofloxacin 400 mg/day plus rifampicin 600 mg/day during 30 days. RESULTS: Regarding clinical and/or demographic characteristics no significant difference was found between two groups of patients that underwent two different therapeutic regimens. At the end of the therapy, two relapses were seen in both groups (p = 0.695). Although duration of therapy was two weeks shorter in group treated with rifampicin plus ofloxacin, the cure rate was similar in both groups of examinees. Fever dropped more rapidly in the group that treated with rifampicin plus ofloxacin, 74 ± 30 (ranges 48–216) vs. 106 ± 26 (ranges 48–262) hours (p = 0.016). CONCLUSIONS: Ofloxacin plus rifampicin therapy has advantages of shorter treatment duration and provided shorter course of fever with treatment than in doxycycline plus rifampicin therapy. However, cost of ofloxacin plus rifampicin treatment is higher than doxycycline plus rifampicin treatment. Because of the similar effects, adverse effects and relapses rates between two regimens, we still advice doxycycline plus rifampicin for the treatment of brucellosis for countries, which have limited resources

Primary subcutaneous cyst hydatic disease in proximal thigh: an unusual localisation: a case report

BACKGROUND: Musculoskeletal hydatidosis is very rare and represents 1% – 5.4% of all cases of echinococcosis. On clinical basis, infection mimics a soft-tissue tumor, and the preoperative radiological diagnosis is very important to avoid biopsy. CASE PRESENTATION: We report an unusual case of primary subcutaneous hydatidosis in proximity to vastus lateralis muscle. It was diagnosed according to the computed tomography appearance, clinical and pathological findings. A 43 year old female patient was admitted with a history of pain at proximal thigh for the last 30 days. On physical examination, a mass which was 4 × 5 cm in diameter, painful and erythamatous, was palpated over greater trochanter. Sedimentation rate was 40 mm in the first hour. CT (Computed Tomography) scan demonstrated, a soft tissue mass with central cystic component in the subcutaneous tissue near vastus lateralis muscle. Histopathological examination of the specimen revealed a pericystic structure, which consisted of connective tissue and scattered hyaline cells showing a necrotic basophilic structure that resembled a cuticular membrane. Treatment with high dose albendazole was conducted for 4 weeks. CONCLUSIONS: This case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when they occur in areas where the disease is endemic

Crimean-Congo hemorrhagic fever in Turkey: Current status and future challenges

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral disease of humans that affects a wide geographic area of Africa and Eurasia, including Turkey, Iran, Pakistan, Afghanistan and Russia. Since the first detection of CCHF cases in Turkey in 2002, more than 9700 patients have been reported, with an overall mortality rate just under 5%. This article assesses the present epidemiological situation of CCHF in Turkey, with an updated literature review, describes national practices and summarizes lessons learned in preparation for future outbreaks. (C) 2015 Elsevier B.V. All rights reserved

Ofloxacin plus Rifampicin versus Doxycycline plus Rifampicin in the treatment of brucellosis: a randomized clinical trial [ISRCTN11871179]

Abstract Background The combination therapies recommended by the World Health Organization for treatment of brucellosis are doxycycline plus rifampicin or doxycycline plus streptomycin. Although highly successful results have been obtained with these two regimens, relapse rates as high as 14.4%. The most effective and the least toxic chemotherapy for human brucellosis is still undetermined. The aim of the present study was to investigate the efficacy, adverse effects and cost of ofloxacin plus rifampicin therapy, and doxycycline plus rifampicin therapy and evaluate in the treatment of brucellosis. Methods The open trial has been carried out prospectively by the two medical centers from December 1999 to December 2001 in Duzce region Turkey. The diagnosis was based on the presence of signs and symptoms compatible with brucellosis including a positive agglutination titre (≥1/160) and/or a positive culture. Doxycycline and rifampicin group consisted of 14 patients who were given doxycycline 200 mg/day plus rifampicin 600 mg/day during 45 days and this group Ofloxacin plus rifampicin group was consisted of 15 patients who were given ofloxacin 400 mg/day plus rifampicin 600 mg/day during 30 days. Results Regarding clinical and/or demographic characteristics no significant difference was found between two groups of patients that underwent two different therapeutic regimens. At the end of the therapy, two relapses were seen in both groups (p = 0.695). Although duration of therapy was two weeks shorter in group treated with rifampicin plus ofloxacin, the cure rate was similar in both groups of examinees. Fever dropped more rapidly in the group that treated with rifampicin plus ofloxacin, 74 ± 30 (ranges 48–216) vs. 106 ± 26 (ranges 48–262) hours (p = 0.016). Conclusions Ofloxacin plus rifampicin therapy has advantages of shorter treatment duration and provided shorter course of fever with treatment than in doxycycline plus rifampicin therapy. However, cost of ofloxacin plus rifampicin treatment is higher than doxycycline plus rifampicin treatment. Because of the similar effects, adverse effects and relapses rates between two regimens, we still advice doxycycline plus rifampicin for the treatment of brucellosis for countries, which have limited resources.</p

A taboo in healthcare; life support decisions at the terminal stage

Public who are the target audience of health care system need to be actively involved in the system for more effective health care provision. Advance directives which are the important examples of participation in treatment decisions are written documents that, in the situation of a serious illness, either clarify an individual's wishes for health care or determine a person to make health care decisions for that individual who becomes unable to do so. Living wills, health care power of attorney, directive of do-not-resuscitate, withholding of life support and withdrawing of life support are included in advance directives. Advance directives are being implemented in the United States of America (USA) and some European countries. The legal status of advance directives vary by country. There is no data on the use and writing of advanced directives in our country. It is necessary to start discussing about people's decisions on terminal care and implementations by analyzing the material and moral broughts of patient care at the end of life in both individual and social terms

A taboo in healthcare; life support decisions at the terminal stage

Public who are the target audience of health care system need to be actively involved in the system for more effective health care provision. Advance directives which are the important examples of participation in treatment decisions are written documents that, in the situation of a serious illness, either clarify an individual's wishes for health care or determine a person to make health care decisions for that individual who becomes unable to do so. Living wills, health care power of attorney, directive of do-not-resuscitate, withholding of life support and withdrawing of life support are included in advance directives. Advance directives are being implemented in the United States of America (USA) and some European countries. The legal status of advance directives vary by country. There is no data on the use and writing of advanced directives in our country. It is necessary to start discussing about people's decisions on terminal care and implementations by analyzing the material and moral broughts of patient care at the end of life in both individual and social terms

Complicated brucellar spondylodiscitis: experience from an endemic area

The demographical, clinical, and therapeutical features of patients with brucellar spondylodiscitis (BS) were evaluated in this study. Of the 96 patients with brucellosis, 20 (20.8 %) were diagnosed with spondylodiscitis. Patients who had BS were more likely to be older (p = 0.001), have higher erythrocyte sedimentation rates (p = 0.01), and more likely to be anemic (p = 0.017). Lumbar segment (18/20) was frequently involved region. BS was complicated with paravertebral or epidural abscess in seven, radiculitis in six, and psoas abscess in five of cases. Antibiotic regimens including two or three antibiotics with combination of doxycycline, rifampin, and streptomycin were used. In this series, the mean duration of antimicrobial therapy was 18 weeks (range 12-56 weeks). Attention is drawn to this disease given the need for prolonged duration of treatment especially in complicated cases in order to avoid possible sequelae

Haemophilus influenzae serotype e meningitis in an adult

The incidence of Haemophilus influenzae type b (Hib) invasive disease has declined significantly in countries with routine infant Hib immunization. Accordingly, infections caused by other H. influenzae serotypes or by encapsulated H. influenzae strains are of growing interest. H. influenzae serotype e (Hie) is a rare cause of infection. Invasive Hie infections reported in adults are generally in individuals who had previous underlying conditions, in contrast to infections in childhood. We present the first report of Hie meningitis in Turkey. It is of interest that meningitis due to this organism occured as a complication of transsphenoidal hypophysectomy, which to our knowledge has never been documented. Further identification of H. influenzae strains isolated from patients with invasive disease, especially those with predisposing factors and/or who have been vaccinated, is essential

Device-associated infection rates and bacterial resistance in the intensive care units of a Turkish referral hospital

Objectives: To determine device-associated infection (DAI) rates, and the microbiological and antibiotic resistance profiles of infecting pathogens in our hospital