Revista da Associacao Medica Brasileira (1992)最新文献

Objective: The aim of the study was to investigate the relationship between echocardiographic parameters and clinical outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy, aiming to identify predictors of poor prognosis despite successful recanalization.

Methods: This retrospective, single-center study included 320 acute ischemic stroke patients treated with mechanical thrombectomy for large vessel occlusion. Demographic, clinical, and echocardiographic data were collected. Univariable and multivariable logistic regression and receiver operating characteristic analyses were used. Futile recanalization was defined as achieving modified Thrombolysis in Cerebral Infarction 2b-3 with a poor functional outcome (mRS 3-6).

Results: Of the 320 patients, 176 (55%) were classified as favorable and 144 (45%) as futile recanalization. The futile group had a higher mean age (77.3±12.7 vs. 67.6±12.8; p<0.001), National Institutes of Health Stroke Scale score (median 17 vs. 14; p=0.007), and puncture-to-recanalization time (47.5 vs. 30 min; p=0.017), and lower Alberta Stroke Program Early Computed Tomography score (7.5 vs. 10; p<0.001). Echocardiographically, they had lower left ventricular ejection fraction (55 vs. 57.5%; p=0.036) and larger left ventricular end-diastolic diameter (4.8 vs. 4.5 cm; p=0.002). Multivariable analysis identified low Alberta Stroke Program Early Computed Tomography score (OR 0.192; p=0.002), high National Institutes of Health Stroke Scale (OR 1.212; p=0.029), and low left ventricular ejection fraction (OR 0.919; p=0.047) as independent predictors. Alberta Stroke Program Early Computed Tomography had the highest predictive value (area under the curve : 0.851), followed by left ventricular ejection fraction (area under the curve: 0.631), while National Institutes of Health Stroke Scale showed lower predictive power (area under the curve: 0.326).

Conclusion: Poor outcomes after mechanical thrombectomy are associated with low Alberta Stroke Program Early Computed Tomography scores, high National Institutes of Health Stroke Scale, and reduced left ventricular ejection fraction. Echocardiographic evaluation, particularly of left ventricular ejection fraction, may aid in prognostication and treatment planning in acute ischemic stroke.

Objective: Despite the longstanding clinical use of low-molecular-weight heparins and their well-characterized mechanisms of action, their effects on mitophagy pathways in acute myocardial ischemia remain incompletely delineated. The aim of this study was to investigate the enoxaparin effect on cardiomyocyte morphology and the immunopositivity of mitophagy-associated Parkin-LC3 proteins in a rat model of acute myocardial ischemia.

Methods: Female Wistar albino rats (median weight: 400 g, minimum: 375 g-maximum: 415 g) were divided into sham (n=7), control (n=7), and treatment (n=7) groups. The control group received subcutaneous 0.9% saline (0.2 mL/kg) twice daily for 28 days, followed by the induction of myocardial ischemia. The treatment group was administered subcutaneous enoxaparin sodium (1 mg/kg) twice daily for the same duration before undergoing myocardial ischemia. Myocardial ischemia was induced by occluding the proximal left anterior descending coronary artery using a 6-0 polypropylene suture for 10 min. Morphometric calculations of cardiomyocytes (cell length and diameter) were performed using light microscopy. Immunohistochemical analysis was performed using anti-Parkin and anti-LC3 antibodies, and immunopositive cells were counted.

Results: Statistically significant differences were found between the groups (p<0.001). Post-hoc analysis revealed significant differences between the control and treatment groups based on cell length, cell diameter, Parkin, and LC3 values (p<0.001, p=0.001, p<0.001, and p=0.001, respectively).

Conclusion: This study demonstrated that enoxaparin preserved cardiomyocyte morphology and reduced the number of Parkin-LC3 immunopositive cells in a model of induced acute ischemic injury in rat myocardium.

Objective: This research sought to examine the relationship between toilet behaviors and recurrent urinary tract infections in women.

Methods: This descriptive correlational study was conducted with female patients with recurrent urinary tract infections who applied to the urology outpatient clinic of a city hospital in Istanbul between March 2023 and April 2024. Data were collected using the Patient Information Form and Toileting Behavior-Women's Elimination Behaviors Scale.

Results: The total mean score of the Toileting Behavior-Women's Elimination Behaviors Scale was found to be 49.79±9.98 in the patients. When the total mean scores of the Toileting Behavior-Women's Elimination Behaviors Scale were examined according to the individual characteristics of the patients, it was found that there was a statistical difference in the mean score of the Toileting Behavior-Women's Elimination Behaviors Scale according to marital status, education level, incontinence status, preferred toilet position inside, and outside the home (p<0.05) and that there was a statistical relationship between age and the mean score of the Toileting Behavior-Women's Elimination Behaviors Scale (p<0.05).

Conclusion: Increasing age had a negative effect on early voiding and straining behaviors, and the presence of incontinence had a negative effect on early voiding and general toilet behavior in women with recurrent urinary tract infections.

Objective: In obesity, the fat storage in the body increases excessively and affects the whole metabolism.

Methods: Sixty-two obese patients were included in the study. The effect of weight loss, which was achieved with a 3-month diet/exercise program, on the following analytes was investigated; serum total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triacylglycerol, triglycerides (TAG), glucose, resistin, apelin, and a transcription factor sterol regulatory element binding protein-1c, and blood hemoglobin A1c. Basal (prediet/exercise) levels of analytes were taken as control values, and they were compared to the postdiet/exercise levels.

Results: After the 3-month diet/exercise program, apelin, hemoglobin A1c, and triacylglycerol, triglycerides levels decreased compared to basal levels, and those of sterol regulatory element binding protein-1c, glucose, and low-density lipoprotein-cholesterol increased.

Conclusion: Considering the insulin-like effects of apelin, high levels of apelin in prediet/exercise phase can be interpreted as a kind of resistance to apelin, and the decreased postdiet/exercise apelin levels as a kind of normalization of it. The decrease in hemoglobin A1c and triacylglycerol, triglycerides levels following weight loss can be appreciated. High basal serum sterol regulatory element binding protein-1c levels suggest an increase in lipogenesis. The increases in glucose and low-density lipoprotein-cholesterol after diet/exercise program remain in a physiological range. However, we think that a longer diet/exercise follow-up in a larger population will further elaborate on the issue.

Objective: The aim of this study was to investigate maternal and paternal perceptions of breastfeeding self-efficacy in the postpartum period in Turkey between December 2023 and June 2024.

Methods: The present study was designed as a cross-sectional study. The sample consisted of 150 mothers and 150 fathers, making a total of 300 participants. Data were collected through face-to-face interviews using the "Descriptive Information Form for Mothers and Fathers," the "Breastfeeding Self-Efficacy Scale," and the "Paternal Breastfeeding Self-Efficacy Scale-Short Form." Data collection was carried out between December 2023 and June 2024. The obtained data were analyzed using the SPSS 25.0 statistical program, and a statistical significance level of p<0.05 was accepted.

Results: Mothers' scores were higher than fathers' scores (p<0.001). It was found that paternal breastfeeding self-efficacy significantly affected mothers' breastfeeding self-efficacy (r=0.520, p<0.001). In the multiple regression analysis, monthly income, breastfeeding education, and the time of first breastfeeding were found to affect mothers' breastfeeding self-efficacy (R2=0.099, p=0.02). Also found that employment status, breastfeeding experience, and planned pregnancy variables affected paternal breastfeeding self-efficacy (R2: 0.161, p<0.001).

Conclusion: Empowering fathers about breastfeeding with in-service training and multidisciplinary approach is very important to increase breastfeeding rates. In addition, it is recommended that fathers should be handled together with pregnant women from the prenatal period, and counseling services should be provided to support the positive development of their perspective on breastfeeding.

Objective: The aim of the study was to evaluate the cardiotoxic effects of pantoprazole in Wistar rats submitted to cardiac ischemia and reperfusion.

Methods: Cardiac ischemia and reperfusion was induced in rats through tourniquet of the left anterior descending coronary artery (10 min) followed by reperfusion (75 min). The incidences of ventricular arrhythmias, atrioventricular block, and lethality were evaluated by electrocardiogram analysis and compared between the control group (saline solution+cardiac ischemia and reperfusion) and the animals treated with pantoprazole 36 mg/kg (pantoprazole+cardiac ischemia and reperfusion), intravenously, immediately before cardiac ischemia (pantoprazole+cardiac ischemia and reperfusion) or before cardiac reperfusion (pantoprazole+cardiac reperfusion).

Results: There were no differences between the incidences of ventricular arrhythmias in the groups studied. Treatment with pantoprazole before cardiac ischemia and reperfusion increased the incidence of atrioventricular block and lethality and myocardial injuries compared to the saline solution+cardiac ischemia and reperfusion group, but treatment of animals with pantoprazole before cardiac reperfusion decreased these parameters and serum creatine kinase-MB levels.

Conclusion: Our results indicate that when pantoprazole is administered before cardiac ischemia and reperfusion, it promotes cardiotoxicity; however, when administered before cardiac reperfusion, it promotes cardioprotection in Wistar rats.

Objective: The aim of the study was to evaluate the effects of epidural and spinal anesthesia techniques on neonatal cerebral oxygenation during cesarean surgery using near-infrared spectroscopy.

Methods: Pregnant women aged 18-35 years, classified as American Society of Anesthesiologists (ASA) II, scheduled for elective cesarean surgery at >37 weeks of gestation, and their newborns were included. Two groups, one to receive spinal anesthesia (Group S) and the other epidural anesthesia (Group E), were determined. Appearance Pulse Grimace Acitivity Respiration (APGAR) scores, heart rates, and SpO2 values of the newborns were recorded, and umbilical venous blood gas was collected. Near-infrared spectroscopy and rSO2 (regional cerebral oxygen saturation) change percentage were measured.

Results: A total of 80 patients were statistically analyzed, with 40 patients in Group S and 40 patients in Group E. Neonatal SpO2 values at 2.5 min were found to be significantly lower in Group S, while in blood gas parameters, PaO2 values were significantly lower in Group S. Near-infrared spectroscopy values at 2.5 and 5 min were significantly lower in Group S, and rSO2 change percentages were significantly lower at 2.5 min in Group S. Maternal hypotension was observed to be significantly higher in Group S (52.5%) than in Group E (22.5%). The amount of ephedrine administered until delivery was higher in Group S, but this difference was not statistically significant between the two groups.

Conclusion: We found significantly lower near-infrared spectroscopy values at 2.5 and 5 min and rSO2 change percentage at 2.5 min in the spinal group. We believe that epidural anesthesia has minimally more positive effects on early neonatal cerebral oxygenation compared to spinal anesthesia.

Objective: The aim of this study was to determine the association of unilateral multicystic dysplastic kidney in fetuses with genetic disorders, syndromic conditions, accompanying anatomical anomalies, and postnatal prognosis.

Methods: Cases diagnosed with multicystic dysplastic kidney and followed at the Perinatology Clinic of Samsun Ondokuz Mayıs University between January 2012 and June 2024 were retrospectively reviewed. Demographic, ultrasonographic, genetic, and postnatal outcomes were analyzed.

Results: Thirty-eight fetuses with multicystic dysplastic kidney were identified during intrauterine life. The diagnosis was made via antenatal ultrasonography in 97.2% of cases. Laterality was on the left side in 55.3% and on the right side in 44.7% of multicystic dysplastic kidney cases. The cohort consisted of 42.1% females and 57.9% males. Major extrarenal anomalies were present in 21.1% of fetuses with unilateral multicystic dysplastic kidney. Amniocentesis for karyotyping was performed in 23.7% of cases, all of which yielded normal karyotypes. Contralateral kidney anomalies were detected in 13.2% of cases, and ureterocele was observed in 15.8%. The most common postnatal anomalies were ureteropelvic junction obstruction and grade four-five vesicoureteral reflux. During a mean follow-up period of 7 years, no cases of hypertension or Wilms tumor were identified.

Conclusion: Prenatal diagnosis of multicystic dysplastic kidney is crucial for early detection of potential contralateral kidney anomalies and predicting postnatal outcomes. In cases of isolated multicystic dysplastic kidney, the likelihood of karyotypic abnormalities, malignancies, or hypertension is very low, and the postnatal prognosis is favorable.

Objective: This study was conducted to determine the effect of genital self-image on sexual function and satisfaction in married women.

Methods: The study included 353 married women in Central Anatolia. Data were collected using the Descriptive Information Form, the Female Genital Self-Image Scale, the Female Sexual Function Index-6, and the Golombok-Rust Inventory of Sexual Satisfaction.

Results: The participants' mean total scores were 20.36±4.03 on the Female Genital Self-Image Scale, 19.46±4.98 on the Female Sexual Function Index-6, and 55.84±16.79 on the Golombok-Rust Inventory of Sexual Satisfaction. The regression analysis indicated that Female Sexual Function Index-6, age, marriage duration, and total Golombok-Rust Inventory of Sexual Satisfaction scores collectively predicted Female Genital Self-Image Scale scores, accounting for 13.2% of variance and suggesting a modest yet meaningful effect.

Conclusion: Approaches that enhance genital self-image support women's sexual health, and it is essential for healthcare professionals to provide quality care by taking these factors into consideration.