Postgraduate medicine最新文献

Objective: Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease for which colchicine is regularly used every day. Health literacy (HL) is the ability of individuals to acquire, understand and use health information. The aim of this study was to evaluate medication adherence and HL levels in adolescents with FMF and to investigate the impact of HL on colchicine adherence.

Methods: A cross-sectional, prospective study was conducted with FMF patients aged 12-18 years at the Pediatric Rheumatology Department. Medication adherence was measured using the Medication Adherence Scale in FMF Patients, with scores ≥60 indicating adherence. HL was assessed using the Health Literacy Scale for School-Age Children, categorizing scores as low (10-25), moderate (26-35), or high (36-40).

Results: Among 87 FMF patients, 53 (60.9%) were female. The mean age of the patients was 14.89 ± 1.69 years. HL levels were moderate in 64 (73.6%), high in 17 (19.5%) and low in 6 (6.9%) patients. Patients were divided into 2 groups according to medication adherence. Nineteen (21.8%) patients were colchicine adherent and 68 (78.2%) were colchicine non-adherent. A significant difference was observed between the groups in terms of HL levels (p < 0.05). None of the patients with low HL were adherent to colchicine treatment. Higher HL levels were associated with increased medication adherence (p < 0.05). There was no statistically significant difference between adherent and non-adherent patients in terms of gender, age, educational status, reminder methods, school absenteeism, frequency attacks at the last year, colchicine dose, number of colchicine tablets per day (p > 0.05).

Conclusion: Adolescents with FMF were generally found to have moderate levels of HL. Colchicine adherence was found to be higher as HL levels increased.

Objective: A new mobile application for video directly observed treatment (vDOT) was developed and implemented for tuberculosis (TB) patients in Turkey in 2023. This study evaluated its features and analyzed one-year user data.

Methods: A prospective observational study was conducted between 1 February 2023, and 31 January 2024, with 115 voluntary TB patients who met the inclusion criteria. Additionally, a satisfaction/adherence questionnaire prepared by the researchers was administered via telephone to 95 individuals who voluntarily used vDOT through the mobile application.

Findings: During the study period, a total of 12,839 videos were approved, with an average of 111.6 videos uploaded per patient. The average duration of vDOT use was 15.7 weeks. The median number of vDOT use days was 23.0, and in the last six months of the study, the number of vDOT use days was equal to or above the median. According to the satisfaction/adherence questionnaire, 72.6% of patients perceived the mobile application to be easy to use, and 94.7% stated that vDOT protected their privacy better than face-to-face monitoring. Patients with higher education levels, those living in city centers, and those owning a personal smartphone were significantly more likely to find the mobile application easy to use (p < 0.05).

Conclusion: This study revealed high usage rates for the mobile application, which was developed for vDOT and implemented as a telemedicine solution for the first time in Turkey. Additionally, the results on ease of use and satisfaction/adherence suggest that the mobile application can be used positively by the majority of patients.

Introduction: Cardiovascular disease (CVD) and chronic kidney disease (CKD) are major global health concerns, with CKD significantly amplifying cardiovascular mortality. Statins, widely used to manage hyperlipidemia, are recognized for their lipid-lowering properties and additional benefits, including anti-inflammatory, antioxidant, and plaque-stabilizing effects. This review explores the multifaceted role of statins in cardiovascular and renal protection, particularly among CKD patients.

Methods: This narrative review synthesizes evidence from clinical studies assessing the cardiovascular and renal outcomes of statin use in patients with CKD. It examines the effects of statins across various clinical scenarios, demographics, and comorbidities, with a focus on their impact on cardiovascular events, renal function.

Results: Statins significantly reduce all-cause mortality and major adverse cardiovascular events in patients with mild to moderate CKD, with evidence supporting their efficacy across diverse populations. Trials such as JUPITER and the Heart Protection Study highlight their cardiovascular benefits and potential to stabilize kidney function. In surgical settings, statins show promise in mitigating acute kidney injury through inflammatory pathway modulation. However, their impact on renal outcomes, such as proteinuria, albuminuria, and glomerular filtration rate, is inconsistent. High-dose statins, especially in advanced CKD, may carry risks including hematuria or rhabdomyolysis, particularly with improper dosing or drug interactions. Safety depends on statin type, dose, and renal function. Additionally, statins reduce the risk of contrast-induced nephropathy and slow CKD progression in select populations, though variability in study designs limits generalizability.

Conclusion: Statins provide substantial cardiovascular benefits for CKD patients, but their renal effects remain uncertain. Future research should aim to optimize treatment strategies, including personalized regimens, to balance cardiovascular protection and renal safety effectively.

Objectives: Nasal irrigation is a safe and low-cost procedure. This study explores parents' knowledge, attitudes, and behaviors regarding nasal irrigation for young children.

Methods: We conducted a prospective, exploratory study at Ankara Bilkent City Hospital from August to September 2024, surveying parents of patients aged 0-24 months in the Pediatric Emergency Department. The survey collected data on demographic information, nasal cleaning practices, and related knowledge, attitudes, and behaviors. Data was compared across three age groups: 0-6 months (Group 1), 7-12 months (Group 2), and 13-24 months (Group 3).

Results: A total of 107 parents participated. Nasal irrigation was most commonly used for nasal congestion (79%) and difficulty breathing (44%), and was mainly performed once a day (30%) or 2-3 times a day (26%). The most preferred tools for nasal irrigation were syringes (58%) and normal saline solution (81%). Seventy-four participants stated they were effectively performing nasal irrigation. Twenty-one reported receiving training on nasal irrigation, and 36 expressed a desire to receive training on nasal irrigation. Only four (3.7%) participants correctly answered all the knowledge-assessment questions about nasal irrigation, while 19 (17.8%) responded accurately to six out of seven questions. The median total score was 4 [3-5], and there was no significant difference between the groups (Group 1: 5 [3-5], Group 2: 4 [3-5], Group 3: 4 [3-5], 4 [3-5], p = 0.972). No significant association was found between the employment status of the parents and the total score (p = 0.494 and p = 0.645, respectively). Parents in Group 1 demonstrated a lower frequency of correctly answering the statement regarding accurate head positioning during nasal irrigation (p = 0.025).

Conclusion: Most parents of young children presented to the pediatric emergency department have insufficient knowledge of nasal irrigation. Targeted educational initiatives and awareness campaigns are needed to enhance parents' understanding and promote the effective use of nasal irrigation.

Objectives: To determine the frequency of malnutrition, including undernutrition and overnutrition, in pediatric patients with familial Mediterranean fever (FMF), and to assess the impact of colchicine treatment on nutritional outcomes and factors associated with malnutrition.

Methods: The medical records of patients with FMF who were followed up in our pediatric rheumatology clinic between 2011 and 2024 were reviewed. Patients were divided into 3 groups according to their nutritional status: normal, undernutrition and overnutrition. Demographic and clinical characteristics and disease severity were compared before and after treatment. The international severity scoring system for FMF (ISSF) was used to assess disease severity.

Results: This retrospective study included 532 (50.6% female) pediatric patients with a median (IQR) age at diagnosis of 6.5 (6) years. Malnutrition was detected in 32.7% of patients at the time of diagnosis, after colchicine treatment this rate declined to 20.7%, significant reductions in undernutrition (from 23.5% to 12.8%) and marginal improvements in overnutrition (from 9.2% to 7.9%) (p < 0.001) groups were observed. The ISSF was significantly higher in both the undernutrition and overnutrition groups compared to patients with normal nutritional status before and after colchicine treatment (p < 0.001). A severe disease phenotype and malnutrition at the time of diagnosis were identified as significant risk factors for persistent malnutrition (p < 0.001).

Conclusion: Malnutrition, including undernutrition and overnutrition, is a common condition in pediatric FMF patients that can be improved with colchicine. The presence of malnutrition at diagnosis and a more severe disease phenotype seemed to be the most important determinants of persistent malnutrition.

Background: Persistent shoulder pain is often driven by inflammatory conditions, including tendinopathy, bursitis, and frozen shoulder. Treatment remains uncertain, but targeting underlying mechanisms like inflammation, metabolic factors, and nervous system disturbances may be more effective.

Objective: This perspective review summarizes these underlying mechanisms' roles in patients with inflammatory-driven shoulder pain and potential effective treatments for these mechanisms.

Results: Literature links inflammatory-driven shoulder pain to low-grade inflammation, obesity, hypertension, diabetes mellitus, and/or autonomic and central nervous system disturbances, which are interconnected. Both acute and chronic inflammation are evident in tissue around the shoulder joint, potentially compromising treatment outcomes and predisposing tissue to hyperresponsiveness. Persistent inflammation can disrupt endocrine and nervous system functions, leading to additional health issues. Metabolic factors, characterized by low-grade inflammation, increase the risk for developing inflammatory-driven shoulder pain. Patients with inflammatory-driven shoulder pain often exhibit autonomic and somatosensory dysregulation. The autonomic nervous system's involvement in the inflammatory pathway can be influenced by or influence inflammation when dysregulation precedes shoulder pain development. Its pathways overlap with pain processing, potentially affecting each other. Prolonged stress (mental or biological) can lead to a maladaptive state and trigger somatosensory dysregulation. Interventions targeting these mechanisms go beyond the joint and include pain neuroscience education, exercise therapy, graded motor imagery, stress management, lifestyle interventions, and combinations of these. However, evidence specific to shoulder pain is limited.

Conclusion: Future research should prioritize understanding these underlying mechanisms in patients with inflammatory-driven musculoskeletal shoulder pain and evaluating targeted interventions' effects on shoulder disabilities.

Objective: The relationship between lipid profile components and health-related quality of life (HRQoL) has gained attention in general populations along with disease conditions; however, scant data is clarifying these connections in cirrhosis. We sought to identify which lipid profile component was associated with HRQoL in hospitalized cirrhotics and delineate the relationship by performing multiple linear regression and generalized additive model (GAM) analyses.

Methods: This cross-sectional study recruited 344 patients with lipid profile data, which comprised total cholesterol, low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol (HDL-C). HRQoL was defined by the EuroQol Group 5 Dimension (EQ-5D) utility index.

Results: The levels of HDL-C were positively correlated with the utility index (r: 0.159, p = 0.003). Multiple linear regression analysis showed an increase in HDL-C was independently associated with better EQ-5D-defined HRQoL (β: 0.088 [0.015, 0.161], p = 0.018). Moreover, sex disparities concerning the dose-response relationship between male versus female patients existed via GAM analysis. In males, GAM indicated a non-linear correlation between HDL-C and EQ-5D utility index, whilst a linear correlation was observed in females.

Conclusions: We disentangled the association between increased HDL-C levels and better EQ-5D-defined HRQoL in hospitalized cirrhotics. Furthermore, the dose-response relationship between HDL-C and EQ-5D utility index differed between males and females, suggesting sex-dimorphic mechanisms linking HDL-C to HRQoL. If validated in interventional studies, sex-specific HDL-C pathway modulation might inform future adjunctive approaches.

Introduction and aim: Factors determining the prognosis of ischemic stroke include clinical, laboratory, and demographic variables, such as initial neurological status, brain imaging findings, blood glucose levels, inflammatory markers, and early treatment response. This study aimed to assess the prognostic value of the frontal QRS-T angle in predicting prognosis in patients with acute ischemic stroke.

Materials and methods: This prospective, single-center, observational prognostic value study was conducted at the Emergency Department of the University of Health Sciences Ümraniye Training and Research Hospital. Adult patients presenting to the emergency department with stroke symptoms between 1 September 2022, and 1 September 2023, were included. The study population consisted of patients with ischemic stroke confirmed by radiological and clinical evaluations. Demographic data, comorbidities, electrocardiography parameters, laboratory results, affected arteries and hemispheres, and in-hospital mortality were recorded.

Results: The study involved the evaluation of 149 patients presenting to the emergency department with stroke symptoms, of whom 40.3% were women, with a median age of 73 years. The in-hospital mortality rate was 8.7%. The most common comorbidity was hypertension (64%). The median frontal QRS-T angle was 50.5 (interquartile range [IQR]: 19.0-122.5) in the survival group and 90 (IQR: 58-133) in the mortality group (p = 0.069, Mann-Whitney U test). Multivariate logistic regression analysis revealed that age ( >68, odds ratio [OR]: 8.92), heart rate ( >110, OR: 19.8), RR interval ( <525 ms, OR: 38.7), P interval ( <94 ms, OR: 9.36), QTcB interval ( >467 ms, OR: 7.27), and atrial fibrillation (OR: 8.31) significantly increased the risk of mortality.

Conclusion: According to the findings of this study, no significant difference was observed in the frontal QRS-T angle between survivors and non-survivors among patients with acute ischemic stroke.