Opinions about Death in People Receiving Dialysis

ABSTRACT Objective: People receiving dialysis have a high mortality rate due to life-threatening, chronic renal failure. These patients experience the fear of pain and suffering, loneliness and death in the haemodialysis unit. This research aimed at determining the perception of death in people receiving dialysis. Methods: A cross-sectional, descriptive research was conducted under the supervision of the Ministry of Health in public hospitals in the cities of Mersin, Izmir, Antalya, Erzurum, Samsun and Gaziantep. A total 240 patients were treated in the dialysis units of these hospitals. Participants were selected with stratified random sampling. For data collection, a patient information form was prepared by the researcher. Data from the study were analysed with Tukey Honest Significant Difference and one-way ANOVA, using an SPSS version 11.5 software package (Statistical Package for the Social Sciences Windows, IBM Corp., Armonk, NY). The statistical significance level was defined as p < 0.05. Results: People receiving dialysis were found to be in a mildly depressive emotional state and they had death anxiety. Death-related anxiety and depression were more common among the female study participants compared to the male participants. Single patients exhibited higher levels of death anxiety compared to married patients. Conclusion: We recommend a holistic and personalised care to allow people receiving dialysis to express their feelings and to overcome the death anxiety. Further research is needed to improve dignified person-centred care for people receiving dialysis.

An osteometric study on humerus / Estudio osteométrico del húmero

Humerus is the longest and thickest bone of the upper limb. As a long bone, it has two epiphysis and diaphysis. In this study, we aimed to conduct morphometric measurements belonging to human humerus. This study was conducted on 60 humerus (28 right, 32 left) in collections of Necmettin Erbakan University Meram Medicine Faculty Anatomy Laboratory. Digital calipers, osteometric board and precision scales for humerus bone measurements were used. Measurements were classified as measurements of diaphysis and proximal and distal epiphysis of humerus. Each bone weight was determined. Also nutrient foramen number and localization was determined. In this study, it was determined that mean right humerus length 30.41±1.73 mm, mean left humerus length 30.04±2.39 mm. It was identified that mean right humerus weight was 115.05±28.06 g, mean left humerus weigh twas 111.63±33.34 g. In 9 humerus (15 %), supratrochlear foramen has been observed. 6 of these were oval and 3 of them were round. Nutrient foramen has not been observed in two humerus (3.3 %). Also, medium and weak correlation was identified between many parameters. We believe that the obtained data from this study may be qualities of reference for sex determination from humerus.

El húmero es el hueso más largo y grueso del miembro superior. Como un hueso largo, tiene dos epífisis y una diáfisis. En este estudio, se pretende realizar mediciones morfométricas pertenecientes al húmero humano. Este estudio se realizó en 60 húmeros (28 derechos, 32 izquierdos) en colecciones del Laboratorio de Anatomía de la Facultad de Medicina Meram,Necmettin Erbakan University, Se utilizaron calibradores digitales, tableros osteométricos y escalas de precisión para medir el húmero. Las mediciones se clasificaron como medidas de húmero proximal, corporal y distal. Se determinó el peso de cada hueso. También se determinó el número y la localización de los forámenes nutricios. La longitud media del húmero derecho fue de 30,41 ± 1,73 mm y la del húmero izquierdo fue de 30,04 ± 2,39 mm. El peso medio del húmero derecho fue 115,05 ± 28,06 g y el izquierdo 111,63 ± 33,34 g. En 9 húmeros (15 %), se observó un foramen supratroclear, seis de ellos eran ovales y tres redondos.No se observó foramen nutricio en dos húmeros (3,3 %). Además, se identificó una correlación media y débil entre varios parámetros. Creemos que los datos obtenidos de este estudio pueden ser de referencia para la determinación del sexo de un individio a partir del húmero.

Genetic polymorphisms of estrogen receptor alpha and catechol-O-methyltransferase genes in Turkish patients with familial prostate carcinoma.

OBJECTIVES: Estrogen is one of the most crucial hormones participating in the proliferation and carcinogenesis of the prostate glands. Genetic polymorphisms in the estrogen metabolism pathway might be involved in the risk of prostate carcinoma development. We evaluated the association between genetic polymorphisms in estrogen receptor alpha (ESR1) and catechol‑O‑methyltransferase (COMT) genes and the risk of developing familial prostate carcinoma. MATERIALS AND METHODS: In this study, 34 cases with prostate carcinoma whose first‑degree relatives had prostate carcinoma and 30 healthy age‑matched male controls were enrolled. The genotypes of ESR1 and COMT genes were analyzed employing polymerase chain reaction‑restriction fragment length polymorphism method. 34 cases with prostate carcinoma, whose first degree relatives had prostate carcinoma and 14 age‑matched male controls were enrolled to analyze the genotype of these two genes. RESULTS: Among control patients, the ESR1 PvuII genotypes of C/C, C/T and T/T were observed in 37%, 26% and 37%, respectively, whereas the C/C, C/T and T/T genotypes were observed in 18%, 41% and 41% of case patients, respectively. Among controls, the ESR1 PvuII allele frequencies of C and T were equally observed, whereas the C and T allele frequencies were observed in 38% and 62% of patients, respectively. Among ESR1 PvuII genotypes there were not any significant difference in terms of genotype (P = 0.199) and allele (P = 0.181) frequencies. Among controls, the ESR1 XbaI genotypes of G/G, G/A and A/A were observed in 33%, 37% and 33%, respectively, whereas the G/G, G/A and A/A genotypes were observed in 12%, 47% and 41% of patients, respectively. Among controls, the ESR1 XbaI allele frequencies of A and G were observed equally, respectively, whereas the A and G frequencies were observed in 65% and 35% of patients, respectively. Among ESR1 × baI, there was not any significant difference in terms of genotype (P = 0.111) and allele (P = 0.093) frequencies. But the C/C genotype of the PvuII site and G/G genotype of the XbaI site in the ESR1 gene were associated significantly with the risk of developing prostate carcinoma. The G/G, G/A and A/A genotypes of the COMT gene were observed in 50%, 29% and 21% of control patients and in 53%, 21% and 26% of case patients, respectively. The A and G allele frequencies of the COMT gene were observed in 36.7%, 63.3% of control patients and in 36.8%, 63.2% of case patients, respectively. In COMT gene, there was not any significant difference in terms of genotype (P = 0.843) and allele (P = 0.991) frequencies. But the G/A genotype of the COMT gene had a weak tendency toward increased risk. CONCLUSION: Polymorphisms of ESR1 gene in the estrogen metabolism pathway were associated significantly with familial prostate carcinoma risk. Single nucleotide polymorphisms of low‑penetrance genes are targets for understanding the genetic susceptibility of familial prostate carcinoma.

Isolated Pancreas Fracture after a Go-Kart Accident.

Isolated pancreatic trauma is extremely rare because of pancreas’ anatomic localization. Also, diagnosis of pancreatic injury may be difficult due to lack of sensitivity of initial clinical findings, laboratory and imaging examinations in emergency department. Morbidity and mortality is much higher in delayed presentation or if the trauma is unrecognized. In this paper we report a 20-year-old female with isolated pancreas fracture after a blunt abdominal trauma due to a go-kart accident. Repeated evaluation of patient by taking into account of mechanism of trauma and suspicion of pancreatic injury is essential for early diagnosis.

Association between pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections disease and tumor necrosis factor-α gene−308 g/a, −850 c/t polymorphisms in 4-12-year-old children in Adana/Turkey.

OBJECTIVES: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a newly defined disease in neuropsychiatry and occurs with an autoimmune mechanism after Group A Beta Hemolytic Streptococcus (GABHS) infection. Tumor necrosis factor (TNF), encoded by TNF-α gene has an important role in the apoptotic mechanisms of autoimmune diseases. Recently, TNF-α polymorphisms and autoimmune/psychiatric disorders have been reported to be related. In this regard, we focused on to investigate a possible relation between the TNF-α gene promoter region−308 G/A and − 850 C/T polymorphisms and PANDAS. MATERIALS AND METHODS: In this study, ages of PANDAS patient and control groups were ranging from 4 years to 12-year-old. Patient group includes childhood onset PANDAS patients (n = 42) and control group includes healthy children (n = 58). Diagnoses have been carried out according to Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) criteria with Affective Disorders and Schizophrenia-Present and Lifetime (KSAD-S-PL) and Children Yale-Brown Obsessive Compulsive Scale Moreover, PANDAS criteria established by the American National Psychiatry Institute have been employed for diagnoses. For identifying polymorphisms; Polymerase Chain Reaction, Restriction Fragment Length Polymorphism and Polyacrylamid Gel Electrophoresis were used. RESULTS AND DISCUSSION: For −308 polymorphism, 37 of 42 PANDAS patients’ results and for −850 C/T polymorphism, 38 of 42 PANDAS patients’ results were obtained. According to our statistical analysis there is a positive relationship between PANDAS patients for −308 G/A polymorphism but not for −850 C/T polymorphism. There is no positive relationship between −308 G/A polymorphism and antistrep-tolysin O (ASO) titers and no relationship between −850 C/T polymorphism and ASO titers. We found, however, positive relationship between genders of patients (boys) and the disease. According to our results, we propose that the AA polymorphism of −308 G/A polymorphism can be used as a molecular indicator for PANDAS.

A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG.

The aim of this prospective, randomized, and double-blinded study was to compare the effects of desflurane, sevoflurane, propofol on both atrial and ventricular wall function by measurement of QT dispersion (QTd), corrected QT dispersion (QTcd), and P dispersion (Pd) on electrocardiogram (ECG). Forty-six patients from the American Society of Anesthesiologists class I−II undergoing noncardiac surgery, were enrolled in this study. Patients were randomly allocated to receive desflurane, sevoflurane or propofol anesthesia. ECG recordings were taken before and after 5 minutes of drug administration. Induction with desflurane significantly increased the QTd compared to baseline (38 ± 2 ms vs. 62 ± 6 ms, P < 0.05). Sevoflurane and propofol anesthesia was not associated with any changes in QTd. QTcd was increased with desflurane induction and decreased with sevoflurane and propofol induction, but this decrease was only significant in the propofol group (67 ± 5 ms vs. 45 ± 3 ms, P < 0.05). Pd was significantly increased after induction with desflurane (34 ± 3 vs. 63 ± 6 ms, P < 0.05). There was a significant increase in QTd and Pd in desflurane group, but this increment did not cause any dangerous arrhythmias. QTcd significantly decreased in propofol group. We believe that further investigations are required for using desflurane as safe as sevoflurane and propofol in noncardiac surgery patients who have high cardiac arrhythmia and ischemia risk.

Intravenous immunoglobulin for prophylaxis of nosocomial sepsis.

A total of 76 premature newborn infants with gestational age of 34 weeks or less were enrolled in a randomized controlled study to determine whether intravenously administrated immunoglobulin (IVIG) is able to prevent nosocomial sepsis. Forty infants were given 0.5 g/kg IVIG on the first day of life and 36 infants with similar gestational age and birth weight were selected as controls and did not receive IVIG. The frequency of proven sepsis, with a positive blood and/or cerebrospinal fluid culture, was significantly lower in infants who received IVIG as compared to controls (42.5 vs 80.0%) (p < 0.01). The mortality rate attributable to infection was not different in IVIG recipients and in controls (41 vs 48%) (p > 0.05). The overall mortality rates in the two groups were not different either (35.0 vs 44.4%) (p > 0.05). The majority of micro-organisms isolated from the blood culture of the patients were gram negative microorganisms (Klebsiella, Enterobacter). IVIG therapy was believed to be effective for prophylaxis of nosocomial infection, but such therapy was not able to reduce overall mortality rate or mortality rate due to systemic infection in prematurely born infants in our intensive care unit where the causative pathogens are usually gram negative microorganisms.