Effects of menopause on corneal topography and dry eye

Background: The aim of this study was to investigate the effect of estrogen and progesterone on central corneal thickness, corneal curvature, and the development of dry eye in postmenopausal women.Methods: This is a case-control study including 54 premenopausal and 54 postmenopausal women. The two groups were compared in terms of follicle stimulating hormone, estradiol, progesterone, and horizontal and vertical curvatures, astigmatism, central corneal thickness, Schirmer I test scores, and dry eye scores of both eyes.Results: In the postmenopausal women, central corneal thickness was significantly thinner in both eyes (p=0.017) and the Schirmer test scores were significantly lower both for the right (p=0.001) and the left eye (p=0.003). Estradiol levels were positively correlated with central corneal thickness (p=0.003-0.006) and Schirmer test scores (p=0.004-0.002) whereas progesterone levels showed a positive correlation only with Schirmer test scores (p=0.036-0.044). Although a significant positive correlation was found between estradiol levels and dry eye scores (p=0,009), no significant correlation was found between progesterone levels and dry eye scores (p=0,118).Conclusions: Age-related hormonal abnormalities lead to central corneal thinning, increased dry eye symptoms, and decreased tear flow, particularly in the postmenopausal term. Decreased estrogen levels are associated with central corneal thickness and dry-eye symptoms, decreased estrogen and progesterone levels correlates well with diminished tear production but progesterone levels does not effect dry-eye symptoms

Turkish version methodological validation study of the Decision Regret Scale

Background: Experiencing regret after receiving medical care or treatment is a normal aspect of health, based on the quality of service received. This is a considerable component of medical decisions. The Decision Regret Scale is a one-dimensional and five-item scale that evaluates patients' regret after receiving a medical procedure or health service. Objective: The aim of this study is to evaluate the validity and reliability of the Turkish version of the Decision Regret Scale. Methods: This is a methodological scale validation research conducted with patients from a university hospital in Istanbul, Turkey. Data was collected from 53 participants who had a total abdominal hysterectomy operation after myoma uteri diagnosis without oophorectomy. Data was collected using a structured questionnaire, which included socio-demographic information, Decision Regret Scale, and the World Health Organization's WHOQOL-BREF quality of life assessment scale. Data was evaluated using confirmatory factor analysis and correlation analyses. Results: The Cronbach alpha value of the Decision Regret Scale was 0.868, which indicated an acceptable internal consistency. Results of the confirmatory factor analysis were sufficient with satisfactory model fit statistics (p = 0.282, chi 2/clf = 1.3, RMSEA = 0.069, and GFI = 0.943). Discussion: The Turkish version of the Decision Regret Scale was a valid and reliable instrument for evaluating regret about receiving health services. Conclusions: The addition of regret as an outcome health care received will inform health care providers in terms of their decisions about the various treatment options and their associated feelings of regret. Thus, enabling decisions around health to be more informed, structured and more patient oriented

Misoprostol-induced termination of secondtrimester pregnancy in women with a history of cesarean section: A retrospective analysis of 56 cases

Objective: To assess the effectivity and safety of misoprostol induced termination of pregnancy in the second trimester in women with a history of previous caesarean section. Materials and Methods: Retrospective analysis of case records from the obstetrics and gynecology department of a tertiary care center between January 2009 and February 2012 was performed. Data derived from 219 women, who underwent a second trimester termination of pregnancy, was analyzed in terms of demographics, clinical findings, laboratory and procedural data. The study group consisted of 56 women with a previous caesarean section and the control group was composed of 163 women without such a history. Termination of pregnancies was conducted by administration of misoprostol at doses of 50-600 mcg intravaginally or by surgical evacuation in cases of failure of medical measures. Results: There was no statistically significant difference between two groups in terms of demographics such as age, menarche, number of pregnancies or live births, smoking habit and co-morbidities. Necessity for blood transfusion (p=0.05) and additional procedure for abortion (p=0.056) were found to be similar in both groups. However, laparotomy (p=0.004), uterine rupture (p=0.016), hysterotomy (

ANXIETY AND POST-TRAUMATIC STRESS DISORDER SYMPTOMS IN PREGNANT WOMEN DURING THE COVID-19 PANDEMIC’S DELAY PHASE

Background: The Coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China and has spread all over the world and affected global mental health. Pregnant women may be particularly vulnerable and experience high levels of distress during an infectious disease outbreak. The aim of this study was to determine anxiety and post-traumatic stress disorder (PTSD) symptoms in pregnant women during the COVID-19 pandemic. Subjects and methods:This cross-sectional study surveyed a total of 283 pregnant women within the period of May 11 to May 28,2020. During their regular antenatal visit, pregnant women were invited to participate in the study. The self-created personal information form was used to assess the main characteristics of the participants. Anxiety and PTSD symptoms of the pregnant women were measured by the Spielberger State-Trait Anxiety Inventory (STAI) and Impact of Events Scale-Revised (IES-R), respectively. Results: The mean age of the pregnant women was 29.20±5.55 years. Regarding gestational age, 72 (25.4%), 86 (30.4) and 125 (44.2) were in the first, second and third trimesters, respectively. The mean gestational age was 23.82±11.05 weeks. The mean STAIS and STAI-T scores were 39.52±10.56 within the cut-off value (39-40) of the instrument and 42.74±8.33, respectively. Furthermore, the mean total IES-R score was 36.60±15.65 within the cut-off value (24) of the instrument. Multiple regression analysis revealed that pregnancy complication (p=0.01) and employment status of husband (p=0.04) were the best predictors of state anxiety. Additionally, the presence of COVID-19-related symptoms (p=0.01) and educational level (p=0.01) were found to predict PTSD symptoms. Conclusions: Pregnant women would be likely to experience high levels of anxiety and PTSD symptoms during the COVID-19 pandemic’s delay phase. The results should sensitize the medical team to increased anxiety and PTDS symptoms of the pregnant women in order to prevent negative outcomes for women and their fetuses

The frequency of gestational diyabetes mellitus in a maternity hospital antepartum clinic

Objectives: The aim of this study was to determine gestational diabetes mellitus (GDM) frequency and age related frequency with GDM screening tests in patients whom referred to our hospital’s antepartum clinic for routine follow-up.Materials and methods: Totally, 2617 pregnant women who did not have any risk factors for GDM and attended to our antepartum clinic for routine follow-up between August 2009 and March 2011 enrolled in this study. A 50-g glucose challenge test (GCT) applied at 24-28 weeks’ gestation. The patients who had a value of blood glucose ≥ 140 mg/dl undergone 100-g oral glucose tolerance test (OGTT). Patients who had a value of ≥200 mg/dl blood glucose in GCT or one value of ≥200 mg/dl in OGTT or had two values exceeded normal ranges in OGTT were accepted as GDM. Age related GDM frequency was also determined.Results: Of the 2617 pregnant women 110 patients diagnosed as GDM (4.2%). For the age related frequency, there was a tendency towards GDM after the age of 33. The age 44 was the most risky with a 33% ratio of GDM occurrence rate.Conclusion: In this study the GDM frequency in our hospital’s routine follow-up clinic was found as compatible with the 1% to 6% frequency reported in the literature. The higher frequency of GDM was found in advanced age pregnancies

Procedural Outcomes of Double Vs. Single Fluoroscopy for Fixing Supracondylar Humerus Fractures in Children: A Case-Control Study

Background: Supracondylar humerus fractures (SHFs) are frequently seen in the pediatric population. The aim of this study was to compare single- and double-fluoroscopy methods for the closed reduction and percutaneous pinning (CRPP) of Gartland type 2 and type 3 SHFs. Materials and Methods: Forty patients who underwent surgery between March 2016 and April 2018 were evaluated retrospectively. Twenty-one patients (group 1) who received double fluoroscopy and 19 patients (group 2) who had single fluoroscopy were evaluated. The preparation period, surgical duration, radiation exposure time, fracture types, sex distributions, distribution of sides, radiologic results at the third month, cosmetic and functional results, and the incidence of complications were recorded. Results: The mean age of the patients in group 1 and group 2 was 4.76 and 4.68 years, respectively. The mean preparation time of group 1 was 11.3 min; whereas in group 2, it was 8.7 min (p < 0.01). The mean surgical duration was 31.76 min in group 1, and 40.47 min in group 2 (p < 0.01). The mean radiation exposure time in group 1 and group 2 was 41.19 and 47.36 s, respectively (p = 0.04). There were statistically significant differences between the two groups in terms of the preparation period, surgical duration, and radiation exposure time. Radiation exposure time and surgical duration were significantly shorter in group 1; the preparation period was shorter in group 2. Conclusions: The double-fluoroscopy technique can significantly reduce surgical duration and radiation exposure time during surgery while treating SHFs of children. © 2020, Indian Orthopaedics Association

Perspectives of Young Otolaryngologists on Pediatric ENT and the Future of the Field in Turkey

Objective: The purpose of this study was to examine the current status and the future of pediatric otolaryngology in Turkey by evaluating the opinions of young otolaryngologists on pediatric otolaryngology.Methods: The study included 224 otolaryngology physicians who were senior residents registered with the Turkish Otolaryngology and Head-Neck Surgery Association (TORL-HNS). The physicians were in their last two years of otolaryngology training (154 physicians) or had completed their residency training and were in their first year of otolaryngology practice (70 physicians). They were approached via e-mail and Short Message Service (SMS) in October through December 2019 with a descriptive letter and asked to voluntarily complete an online questionnaire consisting of total 25 questions in five sections.Results: The online questionnaire was sent to 224 physicians, and 109 (49%) participated in the survey. All 109 participants answered all the questions. Overall, 71 participants (65.1%) were in training for residency and 38 (34.9%) were in their first year of expertise. According to their professional interests, the participants listed rhinology (45 participants, 41.3%), head and neck surgery (27 participants, 24.8%), facial plastic surgery (19 participants, 17%), otology-neurotology (16 participants, 14.7%), and laryngology-phoniatry (2 participants, 1.8%) as their first preference for subspecialty. Pediatric otolaryngology was never a first choice among the participants, although four (3.7%) listed pediatric otolaryngology as their second preference.Conclusion: The aim of this study was to shed light on the current and future status of pediatric otolaryngology in Turkey. We believe the establishment of exclusive pediatric otolaryngology clinics under the umbrella of general ear, nose and throat (ENT) clinics and the foundation of officially approved fellowship programs would bring this subspecialty field to its deserved and desired level in our country

Relaparotomia po pierwotnym leczeniu chirurgicznym w położnictwie i ginekologii: analiza 113 przypadków

Condensation: Even though relaparotomy is unavoidable in some cases, several measures such as careful surgical technique, meticulous hemostasis and aseptic conditions must be undertaken to prevent unnecessary interventions in obstetrics and gynecology. Objective: To assess the indications, procedures, risk factors and outcome for relaparotomy after obstetric and gynecological operations. Study Design: A retrospective observational study during a four-year period in a tertiary care center was performed. Demographics such as age, parity, and indications for relaparotomy as well as outcome measures in terms of complications and mortality rates were assessed in 113 patients who had undergone a relaparotomy after the initial obstetric or gynecological surgery. Results: The overall incidence of mortality after relaparotomy was 3.5%. Leading indications for the initial operation included placental abruption in 10 cases (8.8%), followed by the HELLP syndrome and previous cesarean section both in 5 cases (4.4%), and postpartum atonia in 4 (3.5%). The most common operations performed initially were cesarean section in 78 cases (69.0%) and 31 hysterectomies (27.5%). Principal indications for relaparotomy were bleeding and hematoma in 80 cases (70.8%) and abscess in 10 cases (8.8%). The most frequently performed procedures at relaparotomy were drainage and resuturing of hematomas (n=42, 37.1%), hypogastric artery ligation (n=32, 28.3%), hysterectomy (n=31, 27.5%), and drainage of abscess (n=7, 6.2%). A second relaparotomy was performed in 4 cases (3.5%). Complications were encountered in 4 patients and 4 cases ended up with mortality. Conclusion: Hemorrhagic and infectious complications were the main indications for relaparotomy after obstetric and gynecologic surgeries. Cases with a history of placental abruption, HELLP Syndrome and previous cesarean section were under risk for relaparotomy. Despite favourable outcome, preventive measures such as careful surgical technique, meticulous hemostasis and aseptic conditions should be undertaken.Chociaż relaparotomia jest w niektórych przypadkach nie do uniknięcia, powino się podjąć wszelkie środki, takie jak: dokładna technika operacyjna, skrupulatna hemostaza i warunki aseptyczne, aby zapobiec niepotrzebnym interwencjom w położnictwie i ginekologii. Cel: Ocena wskazań, procedur, czynników ryzyka i wyników leczenia relaparotomią po operacjach ginekologicznych i położniczych. Metoda: Przeprowadzono retrospektywne badanie obserwacyjne w ciągu 4 lat w ośrodku III stopnia referencyjności. Dane demograficzne, takie jak: wiek, rodność, wskazania do relaparotomii oraz jej wynik w postaci powikłań i śmiertelności, oceniono u 113 pacjentek operowanych ponownie po pierwotnej operacji położniczej lub ginekologicznej. Wyniki: Ogólna częstość zgonów po relaparotomii wynosiła 3,5%. Wiodącym wskazaniem do pierwotnej operacji było oddzielenia łożyska w 10 przypadkach (8,8%), następnie zespół HELLP i cięcie cesarskie w wywiadzie – oba po 5 przypadków (4,4%), oraz atonia poporodowa w 4 (3,5%). Najczęściej wykonaną pierwotną operacją było cięcie cesarskie – 78 przypadków (69%) i usunięcie macicy – 31 (27,5%). Głównym wskazaniem do relaparotomii było krwawienie i krwiak w 80 przypadkach (70,8%) oraz ropień w 10 przypadkach (8,8%). Najczęściej wykonywanymi procedurami podczas relaparotomii były: drenaż i ponowne założenie szwów na miejsca krwawiące (n=42, 37,1%), podwiązanie tętnicy podbrzusznej (n=32, 28,3%), usunięcie macicy (n=31, 27,5%), i ewakuacja ropnia (n=7, 6,2%). Ponowna relaparotomia była przeprowadzona w 4 przypadkach (3,5%). Powikłania dotyczyły 4 pacjentek i 4 pacjentki ostatecznie zmarły. Wnioski: Powikłania krwotoczne i infekcyjne były głównym wskazaniem do relaparotomii po pierwotnych operacjach ginekologicznych i położniczych. Przypadki z przedwczesnym oddzieleniem łożyska, zespołem HELLP i cięciem cesarskim w wywiadzie były związane z większym ryzykiem relaparotomii. Pomimo korzystnych wyników, powinno się podjąć środki zaradcze w postaci dokładnej techniki operacyjnej, skrupulatnej hemostazy oraz zapewnienie warunków aseptycznych

Convalescent plasma therapy in patients with COVID-19

There are currently no licensed vaccines or therapeutics for COVID-19. Anti-SARS CoV-2 antibody-containing plasmas, obtained from the recovered individuals who had confirmed COVID-19, have been started to be collected using apheresis devices and stored in blood banks in some countries in order to administer to the patients with COVID-19 for reducing the need of intensive care and the mortality rates. Therefore, in this review, we aim to point out some important issues related to convalescent plasma (CP) and its use in COVID-19. CP may be an adjunctive treatment option to the anti-viral therapy. The protective effect of CP may continue for weeks and months. After the assessment of the donor, 200-600 mL plasma can be collected with apheresis devices. The donation interval may vary between countries. Even though limited published studies are not prospective or randomized, until the development of vaccines or therapeutics, CP seems to be a safe and probably effective treatment for critically ill patients with COVID-19. It could also be used for prophylactic purposes but the safety and effectiveness of this approach should be tested in randomized prospective clinical trials

A Case of Cerebral Sinus Venous Thrombosis Resulting in Mortality in Severe Preeclamptic Pregnant Woman

Cerebral venous sinus thrombosis (CVST) is a rarely encountered condition during pregnancy. A 21-year-old pregnant woman with labour pains was hospitalized in our clinic. Diagnosis of severe preeclampsia was made based on her clinical and laboratory findings. She suffered from convulsive episodes during postpartum period which lead to initiation of treatment for eclampsia. However neurological and radiological examinations were performed after emergence of additional neurological symptoms disclosed the diagnosis of CVST. In this paper, we aimed to present a case with CVST which diagnosis was confused with eclampsia and resulting in maternal mortality