The Evaluation of Family Physicians’ Knowledge on the Use of Inhalation Devices

Objective: Nowadays, inhalation techniques have an important role in treatment of asthma and chronic obstructive pulmonary disease (COPD). Correct application of inhalation devices is important for optimal therapeutic efficacy. Showing inhalation techniques to patients receiving inhaler therapy in more than one visit reduce the device usage errors. It is important to observe the deficiencies and errors of the patients in the primary health care where the patients frequently admitted. In our study we aimed to evaluate the knowledge of family physians on inhaler device usage in their clinical practice. Methods: Family physicians who work in primary health care services were visited face to face. Fifty family physicians who were in the institution at visit day and agreed to participate in the study were included in the study. The questionnaire consisting of 15 questions were asked each family physician. Then, seven different inhalation devices were evaluated with 10 step scoring system of inhaler device usage. Results: Twenty eight (56%) physicians were female and 22 (44%) were male. The mean age was 36.3±6.7 years and mean working time as a family physician was 5.12±2.8 years. Nineteen physicians participated to a meeting about usage of inhaler devices in the past. Average scores for inhaler devices were found 7.96±2.91 for metered-dose inhaler, 7.54±3.93 for discus, 7.28±4.04 for handihaler, 6.38±4.4 for aerolizer, 6.12±4.22 for turbuhaler, 5.98±4 for easyhaler and 5.72±4.59 for sanohaler, respectively. There was no relation between the inhaler devices usage scores and sex, age, duration of being family physician (p>0.05). The average scores of physicians who participated to a training were better than the physicians who didn’t participate for metered-dose inhalers, turbuhaler, aerolizer and handihaler (p=0.049, p=0.05, p=0.013 and p=0.021, respectively). Conclusion: We thought that training of family physicians for inhaler devices is necessary to improve patients’ compliance and successful treatment

MYOCARDIAL INFARCATION IN A YOUNG PATIENT WITH HIGH HDL-CHOLESTEROL LEVEL AND NO OTHER RISK FACTORS APART FROM SMOKING

There is a low incidence of myocardial infarction (MI) for those under 45 years old. Many risk factors have been described for MI. Some risk factors may be especially important for younger people. A 23 year-old young patient with acute anterior myocardial infarction and no prior symptoms was presented. The patient was treated with precutaneous transluminal coronary angioplasty (PTCA). Although we investigated the risk factor in detail. We couldn’t find any risk factors apart from cigarette smoking. The patient had high HDL-cholesterol level and as it is known this eliminate one positive risk factor. The occurence of MI in a patient with high HDL cholesterol who has no other risk factors apart from cigarette smoking is a remarkable sample that cigarette smoking is an extremely important risk factor for young patients and that HDL cholesterol level is not sufficient enough to prevent the negative effects of this risk factor

The effect of bifurcation angulation on flow characteristics and hemodynamic indicators in an idealized left coronary artery

Atherosclerosis is a pathological condition characterized by inflammation in the main arteries, which serves as the primary factor for the development of cardiovascular disease. This condition represents the prevailing medical and surgical issue. Clinically, consequences of this condition might include stroke, coronary artery and heart disease, or peripheral vascular disease. In this study, the hemodynamic effect of three different angulations is numerically analyzed on left coronary artery and constant degree of stenosis (DoS) which equals to 50 % is implemented on each branch of three models to create stenotic arteries. The idealized left main coronary artery (LM) is modeled with its primary branches, namely left anterior descending (LAD) and left circumflex (LCx). The bifurcation angulations between LAD and LCx are considered 30°, 75° and 120°. All numerical analyses are carried out in transient regime, blood is considered as a non-Newtonian fluid and the Carreau viscosity model is selected to describe the viscosity variation of blood. The outcomes of all numerical analyses revealed that the blood flow across the branches is closely related to bifurcation angle. Recirculation is vital in the post-stenotic regions of LAD and LCx, and velocity enhances its breadth. WSS is highest in the stenosis and carina regions. OSI values are greater in the post-stenotic LAD and LCx regions where recirculation and plaque development are more likely. Helical flow appears in the post-stenotic region of the LM when velocity is lowest and in the stenotic area when velocity is highest

The eye splash injuries of echinococcal fluid during surgery of the peritoneal ecohinococcosis: our experience due to two cases

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Is obstructive sleep apnea syndrome a risk factor for pulmonary thromboembolism?

Annakkaya, Ali Nihat N/0000-0002-7661-8830; Balbay, Ege Gulec/0000-0002-1557-7019WOS: 000311265100022PubMed: 23075730Background In many studies, obstructive sleep apnea (OSA) has been shown to be an independent risk factor for cardiovascular disease. Conversely, there are few reports establishing possible relation between OSA and venous thromboembolism (VTE). In this study, the aim is to evaluate OSA via polysomnography in patients with pulmonary embolism and drawing the attention of clinicians to the presence of obstructive sleep apnea syndrome (OSAS) may be a risk factor for pulmonary embolism. Methods Fifty consecutive patients who were diagnosed with pulmonary embolism (PE) were evaluated prospectively for OSAS. Polysomnographic examination was conducted on 30 volunteer patients. The frequency of OSAS in PE was determined and PE cases were compared to each other after being divided into two groups based on the presence of a major risk factor. Results The study consisted of a total of 30 patients (14 females and 16 males). In 56.7% of the patients (17/30), OSAS was determined. The percent of cases with moderate and severe OSAS (apnea hipoapnea index >15) was 26.7% (8/30). Patients who had pulmonary thromboembolism (PTE) without any known major VTE risk (n=20), were compared to patients with VTE risk factors (n=10), and significantly higher rates of OSAS were seen (70% and 30% respectively; P=0.045). The mean age of the group with major PE risk factors was lower than the group without major PE risk factors (52 years old and 66 years old, respectively; P=0.015), however, weight was greater in the group with major PE risk factors (88 kg and 81 kg, respectively; P=0.025). By multivariate Logistic regression analysis, in the group without any visible major risk factors, the only independent risk factor for PE was OSAS (P=0.049). Conclusions In patients with PTE, OSA rates were much higher than in the general population. Moreover, the rate for patients with clinically significant moderate and severe OSA was quite high. PTE patients with OSA symptoms (not syndromes) and without known major risk factor should be examined for OSA. There seems to be a relationship between OSA and PTE. However, whether this relationship is a causal relationship or a relationship due to common risk factors or long-term complications of OSA is not clear. Further comprehensive studies on those special topics are needed to clarify these points. Chin Med J 2012;125(20):3712-371

Thyrotoxic periodic paralysis: a case report and review of the literature

Thyrotoxic periodic paralysis (TPP) is an uncommon disorder characterized by simultaneous thyrotoxicosis, hypokalaemia, and paralysis and is the most common acquired form of periodic paralysis. It is usually associated with low plasma potassium levels and is often precipitated by physical activity or ingestion of carbohydrates. We presented a 35-year-old man with hyperthyroidism who admitted applied to the emergency department with an episode of flaccid quadriparalysis following oral diclophenac sodium usage for lumbar disk hernia and the review of the literature on this subject. Physical and laboratory examination revealed sinus tachycardia, diffuse toxic goiter, flaccid quadriparalysis, a low serum potassium level (1.51 mmol/L), ST segment depression, coincidental horseshoe kidney. Potassium chloride was admitted via both parenteral and orally. Meanwhile antithyroid treatment (propylthiouracil and propranolol) was also given. Early diagnosis is important for planning antithyroid treatment, protecting the patient from further episodes of paralysis and avoidance of precipitating factors. In our patient, electrolyte imbalance appeared secondary to polyuria and vomiting, serious pain and physical stress may have triggered TTP

Spontaneous rupture of the spleen in a hemodialysis patient

Hypovolemic shock and spontaneous splenic rupture (SSR) are unusual fatal complications in the uraemic patients. We described a case of SSR in a 29-year-old hemodialysis (HD) patient. The diagnosis was confirmed with the acute abdomen picture included the left upper abdominal and left shoulder pain together with shock and ultrasound findings. The splenectomy was performed. The postoperative course was uneventful and the patient was discharged from hospital on the 5th day. The mechanism of the rupture is still unknown, but the rupture and subcapsular haematomas of spleen may be induced by the uraemic coagulopathy, the use of anticoagulants during HD, malignant hypertension and unrecognised microtrauma. Splenic rupture should be considered in any patient with abdominal pain and shock, regardless of a history of trauma or previously known risk factors for spontaneous rupture. An aggressive multidisciplinary approach to the management of these patients may decrease the mortality rate

A Comparative Review Of Pediatric And Adult Patients With Miliary Tuberculosis

Aim: Miliary tuberculosis (MTB) is a serious and rare form of tuberculosis. Studies comparatively reviewed children and adults with MTB are lacking. Methods: We retrospectively evaluated 56 pediatric and 26 adult MTB patients at a university hospital, between 1990 and 2003 Results: The median age at presentation was 3.5 years for children and 38 years for adults. Thirty-eight of all patients of whom 86.8% were children had family history of tuberculosis Presenting symptoms and signs of adult and pediatric patients were loss of weight (51.8% vs. 61.5%), anorexia (76.9% vs. 57.8%), dyspnea (12.5% vs. 57.8%), diarrhea/vomiting (35.0% vs. 27.0%), fever (53.8% vs. 17.9%), hepatomegaly (30.8% vs. 51.8%), pulmonary crepitations (42.3% vs. 42.9) and cough (46.2% vs. 35.7%), respectively. The presenting symptoms/signs and laboratory abnormalities were generally more frequent in adults. Detected laboratory abnormalities were leukocytosis (73.2%), increased sedimentation rate (73.2%), anemia (52.4%), hypoalbuminemia (47.6%), elevated liver transaminases (36.6%), elevated lactate dehydrogenase (50.0%) and hyponatremia (25.6%) in whole study group. The diagnosis was proven microbiologically in 15 (18.3%) patients. Among 56 pediatric cases, there were 8 (14.3%) children with positive BCG scar and only 16 (28.6%) children with positive reaction to 5TU tuberculin test. Radiological findings of all patients, either on chest X-ray or high resolution computerized tomography, were characteristic for MTB. One fourth of patients had accompanying tuberculous meningitis. Predisposing factors for TB were found in 13 patients (15.9%). No patients had HIV infection. Overall 6 (7.3%) patients had died. Conclusion: High rate of history of family contact and low rate of BCG vaccination in our patients with MTB were significant public health problems. Identifying different features in children and adults may contribute to early diagnosis of MTB, which is highly relevant to its outcome

The effects of viral cirrhosis on cardiac ventricular function

Liver cirrhosis is a severe disease with complications and viruses take the first place in the etiology of cirrhosis. In this study, the effects of liver cirrhosis due to viral hepatitis cardiac ventricular functions were analyzed. Thirty patients (mean age 43.6±12, 20 male) with liver cirrhosis underwent echocardiographic studies and were compared with 30 healthy controls (mean age 37.3±2, 22 male). Right and left atrium and right ventricle dimensions, interventricular septum, right ventricle free wall thickness, pulmonary artery diameter and assumed mean pulmonary artery pressure measured with 2-dimensional echocardiography were significantly increased in the patient group. In Doppler echocardiographic studies, right ventricle diastolic functions were significantly impaired in the patient group. There were no significant differences in left ventricle systolic and diastolic functions between the groups. In conclusion, liver cirrhosis causes dilatation in right heart spaces and diastolic dysfunction