Güzide Ece Akıncı, Teymur Bornaun, Hamit Zafer Güven
Tubo-ovarian abscesses (TOAs) are identified as a severe and complex form of inflammatory disorder, marking an advanced progression of pelvic inflammatory disease (PID), mainly resulting from the escalation of polymicrobial infections within the female genital tract. This literature review is dedicated to elucidating the contemporary management strategies and associated complications of TOAs, amalgamating the current scholarly discourse while spotlighting the emerging therapeutic trends. The inherent complexity of TOAs, manifesting through a broad array of clinical presentations from mild symptoms to acute pelvic discomfort and fever, necessitates a comprehensive, multidisciplinary approach to achieve effective management. Traditional management has predominantly focused on antibiotic therapy, the cornerstone of initial treatment modalities. Nonetheless, this review expands on the increasing acknowledgment of minimally invasive surgical interventions, like ultrasound-guided drainage, especially in scenarios where medical therapy falters or in the presence of sizable abscesses, underscoring scenarios where antibiotic treatment may be insufficient. The discourse further explores the pivotal decision-making concerning surgical interventions, juxtaposing the benefits of abscess resolution against potential risks and complications, such as damage to adjacent structures and implications for future fertility. The review emphasizes the criticality of addressing PID’s risk factors and root causes to avert TOA development. It also ventures into the ramifications of the emergence of antibiotic-resistant bacterial strains for empirical antibiotic therapy selection, highlighting the imperative for continuous research and the adaptation of therapeutic guidelines. The complications associated with TOAs, including sepsis, infertility, and chronic pelvic pain, are meticulously examined to underscore the potential for significant long-term morbidity. Advocating for prompt diagnosis and encompassing management strategies to curtail these adverse outcomes, the review ultimately calls for intensified, quality research to refine TOA management further, particularly against the backdrop of evolving microbial resistance and the advancements in minimally invasive surgical technologies.
输卵管卵巢脓肿（TOAs）被认为是一种严重而复杂的炎症性疾病，是盆腔炎（PID）的晚期进展，主要由女性生殖道内多菌感染升级所致。这篇文献综述致力于阐明TOAs的当代治疗策略和相关并发症，综合了当前的学术论述，同时突出了新出现的治疗趋势。TOAs具有固有的复杂性，临床表现多种多样，从轻微症状到急性盆腔不适和发热，因此有必要采用综合、多学科的方法来实现有效治疗。传统的治疗方法主要集中在抗生素治疗上，这是初始治疗模式的基石。然而，本综述进一步探讨了微创手术干预的重要性，如超声引导引流术，尤其是在药物治疗无效或存在较大脓肿的情况下，强调了抗生素治疗可能不足的情况。论述进一步探讨了有关手术干预的关键决策，将脓肿解决的益处与潜在的风险和并发症（如对邻近结构的损害和对未来生育的影响）并列起来。综述强调了解决 PID 的风险因素和根本原因以避免 TOA 发展的重要性。它还探讨了抗生素耐药菌株的出现对经验性抗生素疗法选择的影响，强调了持续研究和调整治疗指南的必要性。该书仔细研究了与TOAs相关的并发症，包括败血症、不孕症和慢性盆腔疼痛，强调了长期发病的可能性。这篇综述主张及时诊断并采取全面的管理策略以减少这些不良后果，最终呼吁加强高质量的研究以进一步完善 TOA 的管理，尤其是在微生物耐药性不断发展和微创手术技术不断进步的背景下。
{"title":"Management and complications of tubo-ovarian abscesses: a brief literature review","authors":"Güzide Ece Akıncı, Teymur Bornaun, Hamit Zafer Güven","doi":"10.18621/eurj.1467569","DOIUrl":"https://doi.org/10.18621/eurj.1467569","url":null,"abstract":"Tubo-ovarian abscesses (TOAs) are identified as a severe and complex form of inflammatory disorder, marking an advanced progression of pelvic inflammatory disease (PID), mainly resulting from the escalation of polymicrobial infections within the female genital tract. This literature review is dedicated to elucidating the contemporary management strategies and associated complications of TOAs, amalgamating the current scholarly discourse while spotlighting the emerging therapeutic trends. The inherent complexity of TOAs, manifesting through a broad array of clinical presentations from mild symptoms to acute pelvic discomfort and fever, necessitates a comprehensive, multidisciplinary approach to achieve effective management. Traditional management has predominantly focused on antibiotic therapy, the cornerstone of initial treatment modalities. Nonetheless, this review expands on the increasing acknowledgment of minimally invasive surgical interventions, like ultrasound-guided drainage, especially in scenarios where medical therapy falters or in the presence of sizable abscesses, underscoring scenarios where antibiotic treatment may be insufficient. The discourse further explores the pivotal decision-making concerning surgical interventions, juxtaposing the benefits of abscess resolution against potential risks and complications, such as damage to adjacent structures and implications for future fertility. The review emphasizes the criticality of addressing PID’s risk factors and root causes to avert TOA development. It also ventures into the ramifications of the emergence of antibiotic-resistant bacterial strains for empirical antibiotic therapy selection, highlighting the imperative for continuous research and the adaptation of therapeutic guidelines. The complications associated with TOAs, including sepsis, infertility, and chronic pelvic pain, are meticulously examined to underscore the potential for significant long-term morbidity. Advocating for prompt diagnosis and encompassing management strategies to curtail these adverse outcomes, the review ultimately calls for intensified, quality research to refine TOA management further, particularly against the backdrop of evolving microbial resistance and the advancements in minimally invasive surgical technologies.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":"38 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141649037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deniz Kamacı Şener, M. Zarifoğlu, B. Hakyemez, N. Karlı, Nevin Türkeş
Objectives: Migraine is a complex neurological disease. In addition to headache, individuals with migraine may develop structural changes inside the brain and cognitive impairment. There is increased evidence associated with impairments in brain volume and cognitive functions in patients with migraine. The present study aimed to investigate the impairment in memory function in individuals with migraine using brain magnetic resonance imaging, volume measurement, and neuropsychological tests. Methods: The study included 20 patients with episodic migraine, 20 patients with chronic migraine, and 20 healthy controls. Subcortical volumes of all participants were measured by FreeSurfer, an automatic segmentation method. The Wechsler Memory Scale-Revised Form (WMS-R), Stroop test, Raven’s Standard Progressive Matrices, Verbal Fluency Test, and Lines Orientation Test were applied in all the study participants. Results: Putamen volume decreased as migraine duration increased, and subcortical gray matter, left cerebellar cortex, and bilateral thalamus volumes were lower in the chronic and episodic group compared to the control group, bilateral putamen and right cerebellar cortex volumes were lower in patients with chronic migraine compared to patients in episodic migraine and control groups. Upon neuropsychological examination, delayed memory was affected as the duration of migraine increased, and there was impairment in patients with chronic migraine upon fluency tests and mental control tests. Conclusions: Changes in subcortical volume and cognitive effects in patients with migraine raise questions about whether migraine qualifies as a benign disease. Structural changes and cognitive impairment may contribute to migraine-associated disability, and therefore, these causalities should be investigated by future studies. Silent infarcts, white matter damage, and cortical spreading depression, which occur in migraine cases, may be associated with subcortical volume changes and thus, cognitive effects. In the context, studies with larger samples to achieve a better understanding are needed.
{"title":"Comparison of patients with chronic and episodic migraine with healthy individuals by brain volume and cognitive functions","authors":"Deniz Kamacı Şener, M. Zarifoğlu, B. Hakyemez, N. Karlı, Nevin Türkeş","doi":"10.18621/eurj.1461935","DOIUrl":"https://doi.org/10.18621/eurj.1461935","url":null,"abstract":"Objectives: Migraine is a complex neurological disease. In addition to headache, individuals with migraine may develop structural changes inside the brain and cognitive impairment. There is increased evidence associated with impairments in brain volume and cognitive functions in patients with migraine. The present study aimed to investigate the impairment in memory function in individuals with migraine using brain magnetic resonance imaging, volume measurement, and neuropsychological tests. \u0000Methods: The study included 20 patients with episodic migraine, 20 patients with chronic migraine, and 20 healthy controls. Subcortical volumes of all participants were measured by FreeSurfer, an automatic segmentation method. The Wechsler Memory Scale-Revised Form (WMS-R), Stroop test, Raven’s Standard Progressive Matrices, Verbal Fluency Test, and Lines Orientation Test were applied in all the study participants.\u0000Results: Putamen volume decreased as migraine duration increased, and subcortical gray matter, left cerebellar cortex, and bilateral thalamus volumes were lower in the chronic and episodic group compared to the control group, bilateral putamen and right cerebellar cortex volumes were lower in patients with chronic migraine compared to patients in episodic migraine and control groups. Upon neuropsychological examination, delayed memory was affected as the duration of migraine increased, and there was impairment in patients with chronic migraine upon fluency tests and mental control tests. \u0000Conclusions: Changes in subcortical volume and cognitive effects in patients with migraine raise questions about whether migraine qualifies as a benign disease. Structural changes and cognitive impairment may contribute to migraine-associated disability, and therefore, these causalities should be investigated by future studies. Silent infarcts, white matter damage, and cortical spreading depression, which occur in migraine cases, may be associated with subcortical volume changes and thus, cognitive effects. In the context, studies with larger samples to achieve a better understanding are needed.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":"32 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141650591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This bibliometric analysis was conducted to determine the trends of studies on cardiovascular disease risk identification and prevention in primary care from 2013 to 2024 and visualize the latest developments. Methods: The data were collected in February-March 2024 from the database “Web of Science Core Collection,” the analysis was carried out using the VOSviewer program. The change in the number of publications of the published articles by year, author, country, and institution citation analyses, country, institution, and author collaboration analyses, journal and author co-citation analyses, and keyword analyses were evaluated. Results: Five hundred and ninety-two authors from 64 countries and 377 institutions contributed to 443 studies published in 80 journals between 2013 and 2024 on determining and preventing cardiovascular disease risk in primary care. "BMC Family Practice" was the journal in which most articles were published, and "Circulation" was the most cited. The first three countries that support published articles most are the United States, England, and Australia. Focusing on the topics "blood-pressure control", "coronary-artery calcium", "physician-pharmacist collaboration", "low-density lipoprotein cholesterol", "health-risk assessment", "pollution", "primary care", "coronary heart disease", "prevention", "cardiovascular disease" and "mortality" will help fill the gap in the field. Conclusions: This bibliometric analysis has shown increasing interest in studies related to cardiovascular disease risk and prevention in primary care. Primary prevention guidelines are important resources in addressing risk factors. Global collaborations and long-term studies are necessary in this field, led by developed countries with a high disease burden.
{"title":"A bibliometric analysis of studies conducted over the last 10 years on cardiovascular disease risk identification and prevention in primary care","authors":"Ayşe Dağıstan Akgöz","doi":"10.18621/eurj.1454763","DOIUrl":"https://doi.org/10.18621/eurj.1454763","url":null,"abstract":"Objective: This bibliometric analysis was conducted to determine the trends of studies on cardiovascular disease risk identification and prevention in primary care from 2013 to 2024 and visualize the latest developments.\u0000Methods: The data were collected in February-March 2024 from the database “Web of Science Core Collection,” the analysis was carried out using the VOSviewer program. The change in the number of publications of the published articles by year, author, country, and institution citation analyses, country, institution, and author collaboration analyses, journal and author co-citation analyses, and keyword analyses were evaluated.\u0000Results: Five hundred and ninety-two authors from 64 countries and 377 institutions contributed to 443 studies published in 80 journals between 2013 and 2024 on determining and preventing cardiovascular disease risk in primary care. \"BMC Family Practice\" was the journal in which most articles were published, and \"Circulation\" was the most cited. The first three countries that support published articles most are the United States, England, and Australia. Focusing on the topics \"blood-pressure control\", \"coronary-artery calcium\", \"physician-pharmacist collaboration\", \"low-density lipoprotein cholesterol\", \"health-risk assessment\", \"pollution\", \"primary care\", \"coronary heart disease\", \"prevention\", \"cardiovascular disease\" and \"mortality\" will help fill the gap in the field. \u0000Conclusions: This bibliometric analysis has shown increasing interest in studies related to cardiovascular disease risk and prevention in primary care. Primary prevention guidelines are important resources in addressing risk factors. Global collaborations and long-term studies are necessary in this field, led by developed countries with a high disease burden.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":"100 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141663923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Furkan Sarıdaş, Emine Rabia Koç, Güven Özkaya, Ömer Faruk Turan
Objectives: Fingolimod is approved in Turkey or the treatment of cases of multiple sclerosis (MS) which cannot be controlled with first-line treatments. There is limited information about its efficacy and safety in clinical practice in Turkey. The aim of this study was to evaluate the efficacy and safety of fingolimod treatment in patients with relapsing-remitting multiple sclerosis who were prescribed fingolimod by the Multiple Sclerosis specialists of Bursa Uludağ University Department of Neurology. Methods: This is a single-center observational study evaluating 142 patients using fingolimod who were followed up for at least 12 months in our center between April 2015 and October 2022. Efficacy results were evaluated in terms of mean number of attacks, annualized relapse rate, relapse-free patient rate, disease progression, clinical and radiological disease activity, and no evidence of disease activity (NEDA-3). The safety outcomes are the rates of treatment-related severe adverse events and patients' continuation rates. Results: Over 12 months of treatment with fingolimod, the average number of attacks decreased by 94.6%, the annual relapse rate decreased by 87%, and most patients did not relapse (83.1%). Alongside this, in 76.4% of cases, there was no disability progression and in 83.3% of cases, magnetic resonance imaging (MRI) activation was not observed. Excluding replacement due to ineffectiveness, 89.4% of patients continued fingolimod therapy. Cardiac events, treatment-related infections and a decreased lymphocyte count were observed as side effects. Conclusion: In our center, switching from first-line treatments to fingolimod was effective in reducing disease activity in patients with multiple sclerosis.
{"title":"Fingolimod real life experience in non-naive multiple sclerosis patients","authors":"Furkan Sarıdaş, Emine Rabia Koç, Güven Özkaya, Ömer Faruk Turan","doi":"10.18621/eurj.1422897","DOIUrl":"https://doi.org/10.18621/eurj.1422897","url":null,"abstract":"Objectives: Fingolimod is approved in Turkey or the treatment of cases of multiple sclerosis (MS) which cannot be controlled with first-line treatments. There is limited information about its efficacy and safety in clinical practice in Turkey. The aim of this study was to evaluate the efficacy and safety of fingolimod treatment in patients with relapsing-remitting multiple sclerosis who were prescribed fingolimod by the Multiple Sclerosis specialists of Bursa Uludağ University Department of Neurology.\u0000Methods: This is a single-center observational study evaluating 142 patients using fingolimod who were followed up for at least 12 months in our center between April 2015 and October 2022. Efficacy results were evaluated in terms of mean number of attacks, annualized relapse rate, relapse-free patient rate, disease progression, clinical and radiological disease activity, and no evidence of disease activity (NEDA-3). The safety outcomes are the rates of treatment-related severe adverse events and patients' continuation rates.\u0000Results: Over 12 months of treatment with fingolimod, the average number of attacks decreased by 94.6%, the annual relapse rate decreased by 87%, and most patients did not relapse (83.1%). Alongside this, in 76.4% of cases, there was no disability progression and in 83.3% of cases, magnetic resonance imaging (MRI) activation was not observed. Excluding replacement due to ineffectiveness, 89.4% of patients continued fingolimod therapy. Cardiac events, treatment-related infections and a decreased lymphocyte count were observed as side effects.\u0000Conclusion: In our center, switching from first-line treatments to fingolimod was effective in reducing disease activity in patients with multiple sclerosis.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":"31 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140980442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Since the first years of native heart valve replacement by - prosthetic valves; prosthesis thrombogenicity has kept its importance as a serious problem causing post-operative morbidities and mortality. This study aims to evaluate early postoperative morbidity and mortality of patients diagnosed with prosthetic valve thrombosis and treated surgically or non-surgically. Methods: Thirty-one patients diagnosed with and treated for prosthetic valve thrombosis were evaluated retrospectively. The patients were followed up for 58 months. Results: There were 24 females and 7 males. The mean patient age at the time of prosthetic valve thrombosis diagnosis was 40.7±11 (range, 10-57) years. The mean duration between prosthetic valve replacement and the first signs of prosthetic valve thrombosis was 67.67±66 (range, 1 to 300) months. All patients presented with a functional capacity of NYHA Class III or IV. A total of 32 interventions; 27 surgical and 5 thrombolytic treatments due to elevated aortic prosthetic valve pressure gradient which did not improve with thrombolysis. Of 27 surgical interventions for thrombosed prosthetic valves, 21 involved mitral, 2 aortic, and 4 tricuspid positions. A total of 9 patients died during follow-up. The overall mortality rate was 29.03%. The mortality rate was 29.62% after surgical interventions and 20% after thrombolytic treatment. Conclusion: Currently prosthetic valve replacement is the basic palliation method in the management of patients with diseased native heart valves. In the majority of mechanical prosthetic valve obstructions, the main pathology is fibrous tissue proliferation-related to irregular warfarin usage, which in turn causes the development of acute symptoms secondary to acute valve thrombosis. The necessary treatment method for prosthetic valve obstructions should be either the use of thrombolytic agents or the replacement of the obstructed prosthetic valve with a new one.
{"title":"Obstructions of prosthetic heart valves: diagnosis and treatment considerations","authors":"Mehmet Nuri Karabulut, R. Günay, M. Demirtaş","doi":"10.18621/eurj.1429266","DOIUrl":"https://doi.org/10.18621/eurj.1429266","url":null,"abstract":"Objectives: Since the first years of native heart valve replacement by - prosthetic valves; prosthesis thrombogenicity has kept its importance as a serious problem causing post-operative morbidities and mortality. This study aims to evaluate early postoperative morbidity and mortality of patients diagnosed with prosthetic valve thrombosis and treated surgically or non-surgically. \u0000Methods: Thirty-one patients diagnosed with and treated for prosthetic valve thrombosis were evaluated retrospectively. The patients were followed up for 58 months. \u0000Results: There were 24 females and 7 males. The mean patient age at the time of prosthetic valve thrombosis diagnosis was 40.7±11 (range, 10-57) years. The mean duration between prosthetic valve replacement and the first signs of prosthetic valve thrombosis was 67.67±66 (range, 1 to 300) months. All patients presented with a functional capacity of NYHA Class III or IV. A total of 32 interventions; 27 surgical and 5 thrombolytic treatments due to elevated aortic prosthetic valve pressure gradient which did not improve with thrombolysis. Of 27 surgical interventions for thrombosed prosthetic valves, 21 involved mitral, 2 aortic, and 4 tricuspid positions. A total of 9 patients died during follow-up. The overall mortality rate was 29.03%. The mortality rate was 29.62% after surgical interventions and 20% after thrombolytic treatment. \u0000Conclusion: Currently prosthetic valve replacement is the basic palliation method in the management of patients with diseased native heart valves. In the majority of mechanical prosthetic valve obstructions, the main pathology is fibrous tissue proliferation-related to irregular warfarin usage, which in turn causes the development of acute symptoms secondary to acute valve thrombosis. The necessary treatment method for prosthetic valve obstructions should be either the use of thrombolytic agents or the replacement of the obstructed prosthetic valve with a new one.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140979968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alparslan Yurtbay, Ahmet Ersoy, Cahit Şemsi Şay, F. Say
Objectives: The increase in the number of arthroplasty surgeries worldwide also leads to an increase in revision surgeries. This study examines the costs of primary and revision arthroplasty treatments in a tertiary university hospital's orthopedics and traumatology clinic. It also explores the impact of revision surgeries on the healthcare system. Methods: Seventy-six patients who had total knee arthroplasty at a university hospital between 01.01.2017 and 30.09.2022 were included in the study. The patients were divided into three groups: primary (n=25), aseptic reasons one-stage revision (n=27), and septic reasons two-stage revisions (n=24). For each patient included in the study, detailed documents regarding medical supplies, anesthesia, operating room, intensive care, consultation, medicine/serum, medical treatment, laboratory, blood and blood products, microbiology, radiology, food, bed, and attendant fees were provided separately by the hospital purchasing and statistics departments. Results: When comparing the costs of primary, one-stage revision, and two-stage revision surgeries, the average costs were 5689 Turkish Lira (₺), 8294.97 ₺, and 40919.67 ₺, respectively. In patients with septic reasons, the group that underwent two-stage revisions had significantly higher costs than the aseptic group in terms of surgery time, hospital stay duration, medication, treatment, surgery, anesthesia, intensive care, laboratory tests, imaging, blood center services, consultations, visits, meal expenses, and invoiced amount (P<0.001). Conclusion: Preventing and treating periprosthetic infections is costly and challenging. We need more research to develop effective protocols and reduce costs. As the number of patients undergoing knee arthroplasty is expected to rise, healthcare systems must ensure the sustainability of public financial resources, especially in public university hospitals.
{"title":"The economic impact of two-stage knee arthroplasty revisions: a projection for a specialized health center in Türkiye","authors":"Alparslan Yurtbay, Ahmet Ersoy, Cahit Şemsi Şay, F. Say","doi":"10.18621/eurj.1418269","DOIUrl":"https://doi.org/10.18621/eurj.1418269","url":null,"abstract":"Objectives: The increase in the number of arthroplasty surgeries worldwide also leads to an increase in revision surgeries. This study examines the costs of primary and revision arthroplasty treatments in a tertiary university hospital's orthopedics and traumatology clinic. It also explores the impact of revision surgeries on the healthcare system.\u0000Methods: Seventy-six patients who had total knee arthroplasty at a university hospital between 01.01.2017 and 30.09.2022 were included in the study. The patients were divided into three groups: primary (n=25), aseptic reasons one-stage revision (n=27), and septic reasons two-stage revisions (n=24). For each patient included in the study, detailed documents regarding medical supplies, anesthesia, operating room, intensive care, consultation, medicine/serum, medical treatment, laboratory, blood and blood products, microbiology, radiology, food, bed, and attendant fees were provided separately by the hospital purchasing and statistics departments.\u0000Results: When comparing the costs of primary, one-stage revision, and two-stage revision surgeries, the average costs were 5689 Turkish Lira (₺), 8294.97 ₺, and 40919.67 ₺, respectively. In patients with septic reasons, the group that underwent two-stage revisions had significantly higher costs than the aseptic group in terms of surgery time, hospital stay duration, medication, treatment, surgery, anesthesia, intensive care, laboratory tests, imaging, blood center services, consultations, visits, meal expenses, and invoiced amount (P<0.001).\u0000Conclusion: Preventing and treating periprosthetic infections is costly and challenging. We need more research to develop effective protocols and reduce costs. As the number of patients undergoing knee arthroplasty is expected to rise, healthcare systems must ensure the sustainability of public financial resources, especially in public university hospitals.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":" 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140993387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Neutrophil/lymphocyte ration (NLR) and platelet/lymphocyte ratio (PLR) levels can be used as systemic infallamotory parameters. Asymmetric dimethyl arginine (ADMA) inhibits endothelial nitric oxide synthase. Phase Angle (PhA) is a potential paremeter to screen for inflammatory abnormalities. In present study we aimed to determine the relations between NLR, PLR, ADMA, and PhA in terms of early markers for nutritonal status in addition to their well-known role in inflammation. Methods: A total of 89 patients undergoing maintenance hemodialysis 3 days a week at least 6 months were enrolled. To assess nutritional status, we performed the dietary questionnaire and mini nutritional assessment score (MNAS). ADMA was measured by ELISA. NLR and PLR are calculated from monthly complete blood count tests. Patients were divided into 2 groups accordng to NLR levels as group 1 (NLR≥4.6; n=48) ve and group 2 (NLR<4.6, n=41). Results: The mean ADMA level was 0.03±0.01 µmol/L, the mean PhA was 7.2±1.1º. In subgroup analysis, MNAS, albumin levels and phase angle of patients in group 1 were lower and CRP, PLR, ADMA levels were higher when compared to group 2. In correlation analysis, NLO was positively correlated with PLR, CRP and ADMA however negatively correlated with albumin and PhA levels. In regression analysis, NLR, PLR and ADMA were detected as independent predictors of MNAS. Conclusion: In conclusion our study suggests that NLR, PLR and ADMA are independent predictors for nutritional status and inflammation in patients ongoing hemodialysis.
{"title":"ADMA, neutrophil to lymphocyte, platelet to lymphocyte ratios and phase angle: effects on inflammation and nutrition in hemodialysis patients","authors":"Bahar Gürlek Demirci, Mine Sebnem Karakan","doi":"10.18621/eurj.1404126","DOIUrl":"https://doi.org/10.18621/eurj.1404126","url":null,"abstract":"Objectives: Neutrophil/lymphocyte ration (NLR) and platelet/lymphocyte ratio (PLR) levels can be used as systemic infallamotory parameters. Asymmetric dimethyl arginine (ADMA) inhibits endothelial nitric oxide synthase. Phase Angle (PhA) is a potential paremeter to screen for inflammatory abnormalities. In present study we aimed to determine the relations between NLR, PLR, ADMA, and PhA in terms of early markers for nutritonal status in addition to their well-known role in inflammation. \u0000Methods: A total of 89 patients undergoing maintenance hemodialysis 3 days a week at least 6 months were enrolled. To assess nutritional status, we performed the dietary questionnaire and mini nutritional assessment score (MNAS). ADMA was measured by ELISA. NLR and PLR are calculated from monthly complete blood count tests. Patients were divided into 2 groups accordng to NLR levels as group 1 (NLR≥4.6; n=48) ve and group 2 (NLR<4.6, n=41). \u0000Results: The mean ADMA level was 0.03±0.01 µmol/L, the mean PhA was 7.2±1.1º. In subgroup analysis, MNAS, albumin levels and phase angle of patients in group 1 were lower and CRP, PLR, ADMA levels were higher when compared to group 2. In correlation analysis, NLO was positively correlated with PLR, CRP and ADMA however negatively correlated with albumin and PhA levels. In regression analysis, NLR, PLR and ADMA were detected as independent predictors of MNAS. \u0000Conclusion: In conclusion our study suggests that NLR, PLR and ADMA are independent predictors for nutritional status and inflammation in patients ongoing hemodialysis.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Diabetic ketoacidosis (DKA) poses a life-threatening risk in uncontrolled diabetes. Current diagnostic criteria rely on invasive measures, leading to potential delays in treatment initiation. This study aimed to assess the diagnostic utility of noninvasive end-tidal carbon dioxide (EtCO2) measurements in DKA patients. Methods: A prospective, cross-sectional study was conducted in a tertiary-level Emergency Medicine Clinic from January 2021 to January 2023. Participants included adults with DKA symptoms and those with stable vital signs as controls. EtCO2 levels were measured using a capnograph device. Diagnostic criteria for DKA were blood glucose ≥250 mg/dL, ketonuria, ketonemia, and metabolic acidosis (pH<7.3 or bicarbonate <15 mEq/dL). Statistical analysis was performed using SPSS Statistics. Results: Of 730 participants, 120 had DKA, 410 did not, and 200 served as controls. EtCO2 levels significantly differed between DKA, non-DKA, and control groups (P<0.05). EtCO2 correlated with pH, lactate, base deficit, and bicarbonate (P<0.05). ROC analysis showed an AUC of 0.86 for EtCO2 in diagnosing DKA (P<0.01), with 91.67% sensitivity and 74.39% specificity at a cut-off value 23.7. Conclusion: This study suggests that EtCO2 measurement is a valuable noninvasive tool for diagnosing and assessing the severity of DKA in the emergency department. An EtCO2 threshold of <23.7 could prompt consideration of DKA in patients with elevated blood glucose levels. More extensive multicenter studies are warranted to validate these findings further. EtCO2 measurement could facilitate early DKA diagnosis and improve patient outcomes.
{"title":"Practical method in the diagnosis of diabetic ketoacidosis: end-tidal carbon dioxide","authors":"Ahmet Kayalı, E. Bora","doi":"10.18621/eurj.1430099","DOIUrl":"https://doi.org/10.18621/eurj.1430099","url":null,"abstract":"Objectives: Diabetic ketoacidosis (DKA) poses a life-threatening risk in uncontrolled diabetes. Current diagnostic criteria rely on invasive measures, leading to potential delays in treatment initiation. This study aimed to assess the diagnostic utility of noninvasive end-tidal carbon dioxide (EtCO2) measurements in DKA patients.\u0000Methods: A prospective, cross-sectional study was conducted in a tertiary-level Emergency Medicine Clinic from January 2021 to January 2023. Participants included adults with DKA symptoms and those with stable vital signs as controls. EtCO2 levels were measured using a capnograph device. Diagnostic criteria for DKA were blood glucose ≥250 mg/dL, ketonuria, ketonemia, and metabolic acidosis (pH<7.3 or bicarbonate <15 mEq/dL). Statistical analysis was performed using SPSS Statistics.\u0000Results: Of 730 participants, 120 had DKA, 410 did not, and 200 served as controls. EtCO2 levels significantly differed between DKA, non-DKA, and control groups (P<0.05). EtCO2 correlated with pH, lactate, base deficit, and bicarbonate (P<0.05). ROC analysis showed an AUC of 0.86 for EtCO2 in diagnosing DKA (P<0.01), with 91.67% sensitivity and 74.39% specificity at a cut-off value 23.7.\u0000Conclusion: This study suggests that EtCO2 measurement is a valuable noninvasive tool for diagnosing and assessing the severity of DKA in the emergency department. An EtCO2 threshold of <23.7 could prompt consideration of DKA in patients with elevated blood glucose levels. More extensive multicenter studies are warranted to validate these findings further. EtCO2 measurement could facilitate early DKA diagnosis and improve patient outcomes.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":"85 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The provision of health services at a satisfactory level and low cost is the main objective of all health systems. For this purpose, we evaluated carpal tunnel surgery performed under local anesthesia in the local procedure room and under a laryngeal mask in the operating room in terms of cost analysis. In this way, we aimed to reveal the controllability of health service expenditures and inadequacies in costing. Methods: A total of 119 patients who underwent local anesthesia (LA) in the local procedure room (Group I) and 45 patients who underwent laryngeal mask anesthesia (LMA) in the operating room (Group II) were retrospectively evaluated. In the calculation of cost analysis, since there were no hospitalization procedures in Group I cases, total costs were calculated only in minutes, multiplied by a coefficient of 7. In Group II cases, total costs were calculated by multiplying total procedure times in minutes by a coefficient of 12 and adding 50 units of hospitalization cost. Results: Postoperative Quick Disabilities of the Arm, Shoulder, and Hand score is statistically similar in both groups (P=0.714). The operation duration has an average value of 15.39±2.37 in the group of patients who received local anesthesia and 29.71±4.78 in the group treated in the operating room (P<0.001). It has been found that the intervention performed in the operating room is 2.2 times more costly than the local intervention. Conclusion: Our study is extremely valuable in terms of demonstrating that health service expenditures can be controlled in appropriately selected patients.
目标：以低成本提供令人满意的医疗服务是所有医疗系统的主要目标。为此，我们从成本分析的角度，对在当地手术室局部麻醉和在手术室喉罩下进行的腕管手术进行了评估。通过这种方法，我们旨在揭示医疗服务支出的可控性和成本核算的不足之处：方法：我们对 119 名在当地手术室接受局部麻醉（LA）的患者（I 组）和 45 名在手术室接受喉罩麻醉（LMA）的患者（II 组）进行了回顾性评估。在计算成本分析时，由于 I 组病例中没有住院过程，因此总成本仅以分钟为单位乘以 7 系数计算。 在 II 组病例中，总成本的计算方法是以分钟为单位的总过程时间乘以 12 系数，再加上 50 个单位的住院费用。结果：两组患者术后手臂、肩部和手部快速残疾评分在统计学上相似（P=0.714）。接受局部麻醉组患者的手术时间平均值为（15.39±2.37）分钟，而在手术室接受治疗组患者的手术时间平均值为（29.71±4.78）分钟（P<0.001）。研究发现，在手术室进行干预的费用是局部干预的 2.2 倍：我们的研究非常有价值，它证明了经过适当选择的患者可以控制医疗服务支出。
{"title":"Retrospective evaluation of functional results and cost analysis of two different anesthesia methods in carpal tunnel syndrome surgery","authors":"Bilal Aykaç","doi":"10.18621/eurj.1403401","DOIUrl":"https://doi.org/10.18621/eurj.1403401","url":null,"abstract":"Objective: The provision of health services at a satisfactory level and low cost is the main objective of all health systems. For this purpose, we evaluated carpal tunnel surgery performed under local anesthesia in the local procedure room and under a laryngeal mask in the operating room in terms of cost analysis. In this way, we aimed to reveal the controllability of health service expenditures and inadequacies in costing.\u0000Methods: A total of 119 patients who underwent local anesthesia (LA) in the local procedure room (Group I) and 45 patients who underwent laryngeal mask anesthesia (LMA) in the operating room (Group II) were retrospectively evaluated. In the calculation of cost analysis, since there were no hospitalization procedures in Group I cases, total costs were calculated only in minutes, multiplied by a coefficient of 7. In Group II cases, total costs were calculated by multiplying total procedure times in minutes by a coefficient of 12 and adding 50 units of hospitalization cost. \u0000Results: Postoperative Quick Disabilities of the Arm, Shoulder, and Hand score is statistically similar in both groups (P=0.714). The operation duration has an average value of 15.39±2.37 in the group of patients who received local anesthesia and 29.71±4.78 in the group treated in the operating room (P<0.001). It has been found that the intervention performed in the operating room is 2.2 times more costly than the local intervention.\u0000Conclusion: Our study is extremely valuable in terms of demonstrating that health service expenditures can be controlled in appropriately selected patients.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":" 693","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140382981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Epilepsy, a neurological disorder affecting approximately 65 million people worldwide, frequently presents with various comorbidities, including cognitive impairment. The factors contributing to cognitive impairment are complex and multifaceted. This study aimed to investigate the influence of social phobia on cognitive function in patients with idiopathic generalized tonic-clonic epilepsy. Methods: This prospective study recruited 87 adult idiopathic generalized tonic-clonic epilepsy patients diagnosed according to the International League Against Epilepsy 2017 classification. Differential diagnosis involved electroencephalography, magnetic resonance imaging, and neurological examinations. All participants were assessed for cognitive impairment, social phobia, depression, and anxiety using the Montreal Cognitive Assessment, Liebowitz Social Anxiety Scale, Beck Depression Inventory, and Beck Anxiety Inventory, respectively. Results: A significant majority (73.6%) of participants reported social phobia. Compared to those without social phobia, the Montreal Cognitive Assessment total score was significantly lower in the social phobia group (P=0.002). Additionally, epilepsy duration was significantly longer in the social phobia group (P=0.03). Montreal Cognitive Assessment scores showed a negative correlation with Liebowitz Social Anxiety Scale-avoidance, Liebowitz Social Anxiety Scale-total, and age (P=0.003, P=0.005, and P<0.001, respectively). Conclusions: This study suggests that individuals with idiopathic generalized tonic-clonic epilepsy experiencing social phobia may exhibit lower cognitive function compared to those without. This indicates that comorbid social phobia might negatively impact cognitive abilities in idiopathic generalized tonic-clonic epilepsy patients.
{"title":"The relationship between social phobia and cognitive impairment in idiopathic generalized epilepsy patients: a cross-sectional study","authors":"Idris Kocatürk, Ali Inaltekin","doi":"10.18621/eurj.1421296","DOIUrl":"https://doi.org/10.18621/eurj.1421296","url":null,"abstract":"Objectives: Epilepsy, a neurological disorder affecting approximately 65 million people worldwide, frequently presents with various comorbidities, including cognitive impairment. The factors contributing to cognitive impairment are complex and multifaceted. This study aimed to investigate the influence of social phobia on cognitive function in patients with idiopathic generalized tonic-clonic epilepsy.\u0000Methods: This prospective study recruited 87 adult idiopathic generalized tonic-clonic epilepsy patients diagnosed according to the International League Against Epilepsy 2017 classification. Differential diagnosis involved electroencephalography, magnetic resonance imaging, and neurological examinations. All participants were assessed for cognitive impairment, social phobia, depression, and anxiety using the Montreal Cognitive Assessment, Liebowitz Social Anxiety Scale, Beck Depression Inventory, and Beck Anxiety Inventory, respectively.\u0000Results: A significant majority (73.6%) of participants reported social phobia. Compared to those without social phobia, the Montreal Cognitive Assessment total score was significantly lower in the social phobia group (P=0.002). Additionally, epilepsy duration was significantly longer in the social phobia group (P=0.03). Montreal Cognitive Assessment scores showed a negative correlation with Liebowitz Social Anxiety Scale-avoidance, Liebowitz Social Anxiety Scale-total, and age (P=0.003, P=0.005, and P<0.001, respectively).\u0000Conclusions: This study suggests that individuals with idiopathic generalized tonic-clonic epilepsy experiencing social phobia may exhibit lower cognitive function compared to those without. This indicates that comorbid social phobia might negatively impact cognitive abilities in idiopathic generalized tonic-clonic epilepsy patients.","PeriodicalId":509363,"journal":{"name":"The European Research Journal","volume":"19 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139775321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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