Turkish version of impact on family scale: a study of reliability and validity

<p>Abstract</p> <p>Background</p> <p>Although there is a considerably high prevalence of developmental disorders in Turkey there are not many assessment tools related to evaluating the impact of these children on their family. The aim of this study was to determine the validity and reliability of the Turkish version of the Impact on Family Scale (IPFAM), a health related quality of life measurement to be utilized in clinical trials, health care services, research and evaluation.</p> <p>Methods</p> <p>Caregivers of 85 children with developmental disabilities answered the questionnaire and 65 of them answered it twice with a one week interval. The reliability of the measurement was assessed by Cronbach's alpha coefficient, and with intraclass correlation coefficient (ICC) for test-retest reliability. Construct validity was assessed by calculating the correlation between total impact score of IPFAM, WeeFIM and the physiotherapists' evaluation via Visual Analogue Scale (VAS) to determine the child's disability.</p> <p>Results</p> <p>Test-retest reliability was found to be ICC = 0.953 for total impact, 0.843 for financial support, 0.940 for general impact, 0.871 for disruption of social relations and 0.787 for coping. Internal consistency was tested using Cronbach's alpha and was found to be 0.902 for total impact of IPFAM. For construct validity the correlation between total impact score of IPFAM and WeeFIM was r = -0,532 (p < 0.001) and the correlation between total impact score of IPFAM and the physiotherapist's evaluation was r = 0.519 (p < 0.001).</p> <p>Conclusion</p> <p>The Turkish version of IPFAM was found to be a reliable and valid instrument for assessing the impact of developmental disorders of the child on the family.</p

Delayed diagnosis of PRES and eclampsia in a concealed pregnancy

Pre-eclampsia and eclampsia are well-known risk factors of posterior reversible encephalopathy syndrome. Early recognition and proper treatment result in complete reversibility of this disease. Concealed pregnancy obstacles a safe prenatal care and a safe planned delivery, because of latency in the diagnosis. We present a case of unrecognized posterior reversible encephalopathy syndrome, eclampsia and premature delivery due to concealed pregnancy

Massive cutaneous fistula secondary to an odontogenic submandibular abcess in an immunocompromised patient: a case report

Extraoral sinus tracts of dental origin often are a diagnostic challenge. A delay in correctly diagnosing these types of lesions can result in ineffective and inappropriate treatment. A 64 year-old immunocompromised female with a huge cutaneous draining tract was referred to our clinic complaining of a purulent discharge from her skin on her right submandibular area. In clinical examination and radiographic assessment, periapical lesion associated with roots of lower right first molar was noticed. According to the patient history, she had kidney transplantation 17 years ago. Following the identification of the source of infection, it was surgically and medically resolved, and skin closure was performed. Her postoperative healing period was supported with hyperbaric oxygen therapy as well. Sinus tract was successfully treated

Mycobacterium chimaera Infections Associated With Contaminated Heater-Cooler Devices Among Open Cardiac Surgery Patients: A Global Outbreak

After the first report of Mycobacterium chimaera infections following cardiac surgery from Switzerland in 2013, more than 100 cases of M. chimaera infections (infective endocarditis, vascular graft infections, sternal surgical site infections etc.) generally involving prosthetic valves, vascular grafts, and left ventricular assist devices have emerged from Australia, Canada, France, Germany, Hong Kong, Ireland, Netherlands, Spain, United Kingdom, and United States of America (USA). M. chimaera infections following cardiac surgery have been attributed to the use of heater-cooler devices (HCDs) which are integral for cardiopulmonary bypass operations. There is not any contact between the HCU water and the patient blood during the operation, but it was shown that these infections are associated with the contamination of the surgical field or the implanted prosthetic device by M. chimaera-containing bioaerosols produced by HCDs. To date, all M. chimaera infections have been attributed to a specific model of HCD, Sorin (Stockert (R)) 3T Heater-Cooler System (LivaNova PLC, London, United Kingdom; formerly Sorin Group Deutschland GmbH, Manich, Germany). These HCDs were most likely contaminated at the manufacturing facility, as M. chimaera has been recovered from in-use Sorin (Stockert (R)) 3T HCUs within hospitals worldwide, from new unused 3T HCUs, and from water samples obtained at the manufacturing site of LivaNova PLC. Whole-genome sequencing confirms that this is a common-source outbreak, with nearly identical isolates found in 3T HCDs and patients from multiple countries. It is therefore likely that most 3T HCDs manufactured over the past decade are contaminated with the same M. chimaera strain. Although HCDs made by other companies have been found to be contaminated with M. chimaera, they have not been associated with the current outbreak. As these Sorin (Stckert (R)) 3T HCDs have been used since 2006, holds 60 and 75% of the market share in USA and Turkey, respectively, and is used in 200 000 and 50 000 surgeries yearly in the USA and Turkey, respectively; the potential for exposure is significant. Although there hasn't been any case report in Turkey by now and the number of cases is very low compared to the huge number of the cardiovascular surgery procedures performed all over the world, the extent of this outbreak is yet unknown and the incidence will likely increase. Diagnosis of HCD-associated M. chimaera infections is challenging as the symptoms of the infection may be nonspecific; the incubation period could be as long as 6 years; mycobacterial blood cultures are not typically performed in immunocompetent patients but are required for the diagnosis; and the knowledge and awareness of the physicians about this organism and its infections is very low at the moment. In the current situation, M. chimaera should be considered in the differential diagnosis of the patients who have infective endocarditis or vascular graft infections and whose routine blood cultures were found to be negative; blood cultures should be taken using bottles that support the growth of the mycobacteria from these patients. The risk of infection in an affected center is currently estimated to be 1/100-1/1000 patients, but is likely variable based upon the types of surgery performed in the center, how centers use their HCDs, cleaning protocols utilized, and the location and orientation of the HCD in the operating room

Infective endocarditis in elderly patients

Infective endocarditis (IE) is a rare disease, but it is still associated with high mortality and elderly represent a growing proportion of patients with this disease. At the moment, more than one third of the IE patients is over 70 years old in developed countries. Although mean age of patients with endocarditis is still between 40 and 50 years old in our country, it is a fact that more elderly patients with IE will be seen in the coming years because of the prolongation of the life span and the increase in the proportion of the elderly. According to the information obtained from the case series, the clinical presentation of elderly patients with IE was remarkable for a more indolent course, lower rates of embolism and smaller vegetation. Additionally IE was more frequently associated with health care and a prosthetic device among elderly patients. The leading causative organisms were either health-care associated Staphylococci or Streptococcus gallolyticus and enterococci originated from the digestive or the urinary tract. In addition, antimicrobial therapy is also difficult for elderly patients because of the higher rate of the side effects and drug interactions. In order to be able to cope with all these difficulties, elderly patients with IE should be managed by a team consisting of geriatric, cardiology and infectious diseases specialists and cardiac surgeons

Infective Endocarditis: An Update

Although infective endocarditis (IE) has been recognized for years and despite the advances in the diagnosis and treatment, it is associated with a mortality rate as high as 20% even in developed countries in which IE cases have more access to new diagnostic technologies and surgical facilities. The mortality rate is even higher in Turkey and is reported to be 30%. There are many guidelines on the management of IE, but compliance with these guidelines is poor in daily clinical practice. A standardised strategy based on a local consensus of IE among infectious diseases and clinical microbiology specialists, cardiologists and cardiac surgeons (i.e., infective endocarditis team) can result in reproducibility of treatment for all patients regardless of the attending physician. In this review, epidemiology, etiology, diagnosis and prevention of IE in Turkey and other parts of the world were discussed in the light of current guidelines and recent research; and some recommendations were made to improve the management of IE