Standard internal limiting membrane peeling versus internal limiting membrane abrasion technique for primary epiretinal membrane surgery / Remoção padrão da membrana limitante interna versus técnica de abrasão da membrana limitante interna em cirurgia primária de membrana epirretiniana

ABSTRACT Purposes: The purpose of this study is to compare the standard inner limiting membrane peeling technique to the inner limiting membrane abrasion technique with respect to visual outcomes and central retinal thickness in the primary epiretinal membrane surgery. Methods: A total of 59 eyes from 57 epiretinal membrane patients were separated into two groups including the standard inner limiting membrane peeling group and the inner limiting membrane peeling with abrasion technique group. At 6, 12, and 24 months of follow-up, the mean alteration in best-corrected visual acuity and central retinal thickness were assessed for each group. Results: The study includes 32 (54%) standard inner peeling and 27 (46%) inner limiting membrane peeling with abrasion technique patients. The mean preoperative logMAR best-corrected visual acuity for the standard inner limiting membrane peeling and inner limiting membrane peeling with abrasion groups was 0.73 (±0.29) and 0.61 (±0.3) respectively. At 6, 12, and 24 months of follow-up, the best-corrected visual acuity improved significantly in each group. At each period of observation, the alteration in best-corrected visual acuity was not statistically significant (p=0.54, p=0.52, p=0.67). When comparing the alterations between the standard inner limiting membrane peeling and inner limiting membrane peeling with abrasion technique groups at 6 months (p=0.26) and 24 months (p=0.06), no statistically significant differences were observed, but they were statistically different at 12 months (p=0.03), reflecting a greater reduction in central retinal thickness for the inner limiting membrane peeling with abrasion technique group after one year. Conclusion: Abrasion of the inner limiting membrane with a diamond-dusted membrane scraper during epiretinal membrane surgery demonstrates similar effectiveness to the standard inner limiting membrane peeling technique. At 12 months, retinal thinning was found to be more significant in inner limiting membrane peeling with abrasion technique patients in terms of central retinal thickness values. As a result, it may be argued that the inner limiting membrane abrasion technique eliminates the inner limiting membrane and related structures more effectively while inflicting less retinal damage.

RESUMO Objetivo: Este estudo tem como objetivo comparar a técnica padrão de peeling da membrana limitadora interna com a técnica de abrasão da membrana limitadora interna com relação aos resultados visuais e à espessura central da retina na cirurgia primária de membrana epirretiniana. Métodos: Cinquenta e nove olhos de 57 pacientes com membrana epirretiniana foram divididos em dois grupos, incluindo o grupo de remoção padrão da membrana limitante interna e o grupo de remoção da membrana limitante interna com técnica de abrasão. A alteração média da melhor acuidade visual corrigida e da espessura central da retina foram medidas para cada grupo aos 6, 12 e 24 meses de acompanhamento. Resultados: O estudo incluiu 32 (54%) de padrão de membrana limitante e 27 (46%) de membrana interna com técnica de abrasão. A média de logMar pré-operatório de melhor acuidade visual corrigida foi de 0,73 (±0,29) e 0,61 (±0,3) para os grupos de remoção padrão da membrana limitante interna e de remoção da membrana limitante interna com técnica de abrasão, respectivamente. A melhor acuidade visual corrigida melhorou significativamente em cada grupo aos 6, 12 e 24 meses de acompanhamento. A alteração na melhor acuidade visual corrigida não foi estatisticamente significante (p=0,54, p=0,52, p=0,67) em cada período de observação. Quanto à espessura central da retina, diferenças estatisticamente significativas não foram observadas aos 6 meses (p=0,26) e 24 meses (p=0,06), mas foram estatisticamente diferentes aos 12 meses (p=0,03) quando comparadas às alterações entre os grupos de remoção padrão da membrana limitante interna e de remoção da membrana limitante interna com técnica de abrasão, refletindo uma maior redução da espessura central da retina para o grupo de remoção da membrana limitante interna com técnica de abrasão após um ano. Conclusão: A abrasão da membrana limitante interna com um raspador de membrana com pó de diamante em cirurgia de membrana epirretiniana demonstra eficácia semelhante com a técnica de remoção padrão de membrana limitante interna. Em relação aos valores de espessura central da retina, o afinamento da retina foi mais significativo em pacientes com remoção da membrana limitante interna com técnica de abrasão aos 12 meses. Assim, pode-se argumentar que a técnica de abrasão da membrana limitante interna remove a membrana limitante interna e as estruturas relacionadas de forma mais eficaz sem causar danos significativos à retina.

Psychometric Evaluation of a Turkish Version of the Diabetes Fear of Self-injecting and Self-testing Questionnaire (D-FISQ)

PURPOSE: To examine the psychometric properties of a Turkish version of the Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ). METHODS: Forward-backward translation of the D-FISQ from English into Turkish was conducted. Original English and translated forms were examined by a panel group. Validity was investigated using content, confirmatory factor analysis, and divergent validity. Reliability was assessed using Cronbach α values, item-total correlations, and intraclass correlations. The sample comprised 350 patients with diabetes. Data were analyzed using SPSS 15.0 for Windows and LISREL 8. RESULTS: The content validity index for the panel members was .90, which indicated perfect content validity; items in D-FISQ were clear, concise, readable, and distinct. Confirmatory factor analysis confirmed the original construct of the D-FISQ. All items had factor loadings higher than the recommended level of .40. The D-FISQ scores were discriminated by the level of anxiety. Reliability results were also satisfactory. Cronbach α values were within ideal limits. Item-total correlation coefficient ranged from .72 to .86. In terms of test-retest reliability, intraclass correlation coefficient was found to be over .90. CONCLUSIONS: D-FISQ is a valid and reliable questionnaire in assessing needle-prick fear among Turkish patients with diabetes. We recommend performing the Turkish D-FISQ in determining and screening patients with diabetes who have fear related to self-insulin injection and finger-prick test. Thus, health care professionals should be aware of the potential consequences of injection fear such as insulin misuse and poor self-monitoring of blood glucose, which may have unfavorable effects on optimal diabetes management.

factors associated with disease mismanagement in young patients with type 1 diabetes: a qualitative study

The objective of this qualitative study on young adults with type 1 diabetes was to determine the factors associated with mismanagement of diabetes. In this qualitative study, a descriptive phenomenological and psychological method was followed. Purposeful sampling method was used in this study. 28 young adults aged 18-25 with type 1 diabetes [16 females, 12 males] with HbA[1]c levels >6.5% were interviewed in-depth. Each interview lasted 40-45 minutes. The recorded interviews were transcribed verbatim, examined line-by-line and coded using open coding techniques and managed by QSR NVivo 7. During the research period, Guba ve Lincolln criteria were used to ensure the accuracy and precision of the study findings. The study identified seven themes which affect the diabetes management of the patients. These themes were negative emotions about the disease, difficulties arising from living condition, difficulties arising from the treatment treatment process, lack of social support, not solution oriented coping methods, concerns about the future and issues of developing knowledge and attitude regarding diabetes management. There are multiple factors affecting the management of diabetes in young adults with type 1 diabetes. Diabetes has a biopsychosocial impact on young adults' lives, developing a negative attitude toward their future and that of their family

Identification of learning needs of patients hospitalized at a university hospital

This study was designed as a descriptive trial aimed at identifying learning needs of patients hospitalized at a university hospital and understanding whether these learning needs vary depending on certain patient characteristics. The study sample consisted of 1190 patients/caregivers hospitalized at all departments except for the psychiatry clinic, who were planned to be discharged from the hospital. Data were collected using Patient Information Form and the Patient Learning Needs Scale [PLNS]. The evaluation of responses to the PLNS and its subscales revealed that the mean scores were 26.93 +/- 10.62 for drugs; 26.15 +/- 11.43 for activities of living; 19.78 +/- 5.54 for community and follow up; 16.86 +/- 5.47 for feelings related to condition; 34.3 +/- 6.99 for treatment and complications; 28.20 +/- 7.40 for enhancing quality of life; and 13.64 +/- 6.54 for skin care. The PLNS total mean score was 165.95 +/- 45.44. According to the evaluation of the PLNS total score, patient learning needs vary depending on age, gender, occupation, level of education, the departments at which the respondent is treated, and whether the respondent is the patient him/herself or the caregiver

Spectral domain optical coherence tomography for early detection of retinal alterations in patients using hydroxychloroquine.

Objective: To determine whether early toxic effects from hydroxychloroquine (HCQ) could be detected by spectral-domain optical coherence tomography (SD-OCT) before symtomatic visual loss occured. Materials and Methods: Fifteen subjects with a history of the chronic use of hydroxychloroquine monotherapy for less than five years without fundus changes (group 1) and 15 visually normal healthy subjects (group 2) were enrolled in this study. All participants underwent systemic and ocular examination, visual field testing, and macular scan imaging using SD-OCT. Results: There were no significant differences in sex and ages between the groups (P > 0.05). Mean duration of HCQ usage in group 1 was 2.5 ± 1.34 (range:1-5) years. Visual field testing with central 10-2 threshold program was normal in all subjects. Inner retinal thickness in parafoveal and perifoveal area were found to be significantly lower in group 1 compared to group 2 (P < 0.01 for perifoveal, P < 0.05 for parafoveal retinal measurements). However, significant thinning was demonstrated only in full retinal thickness of perifoveal area in group 1 compared to group 2 (P: 0.013). Parafoveal and perifoveal inner retinal thickness measurements of inferior quadrants were significantly reduced in group 1 compared to group 2 (P < 0.01). Conclusion: Significant thinning of inner retinal layer especially in parafoveal and perifoveal areas in the absence of clinical fundus changes was observed in our study. We consider that SD-OCT may determine when inner retinal thinning starts in these patients and may contribute a quantitative approach to the early diagnosis and progression of retinal changes.

Are all fixed dose combinations equally effective in blood pressure control? the analysis of four different fixed dose antihypertensive combinations

Hypertension guidelines recommend the use of fixed dose combinations as the first step treatment in patients with stage 2 and 3 hypertension. The aim of this study was to compare the antihypertensive effects of four different fixed-dose preparations containing beta blocker [BB]-diuretic, ACE inhibitor [ACEI]-diuretic, angiotensin receptor blocker [ARB]-diuretic, and calcium channel blocker [CCB]-ACEI. Eighty patients with newly diagnosed hypertension whose sitting blood pressure [BP] >/= 160/100 mmHg were randomized to receive either of those four fixed dose antihypertensive preparations: atenolol 50 mg-hydrochlorotiazide [HCTZ] 12.5 mg, or lisinopril 20 mg-HCTZ 12.5 mg, or telmisartan 80 mg-HCTZ 12.5 mg or verapamil 180 mg- trandolapril 2 mg. All the patients were followed up for six months. Both systolic BP [SBP] and diastolic BP [DBP] were reduced similarly in all groups [45.7/22.4 mmHg in BB-diuretic group, 45.8/18.1 mmHg in ACEI-diuretic group, 54.6/17.6 mmHg in ARB-diuretic group and 38.9/16 mmHg in ACEI-CCB group. For SBP p=0.19 and for DBP p=0.43]. All investigated fixed dose antihypertensive combinations were found similarly effective in reducing blood pressure