Evaluation of Managerial Needs for Palliative Care Centers: Perspectives of Medical Directors.

BACKGROUND: Palliative therapies have an important role in increasing the quality of healthcare and in dealing with physical and psychosocial problems due to cancer. We here aimed to evaluate the managerial perspectives and opinions of the hospital managers and clinical directors about specialized palliative care centers. MATERIALS AND METHODS: This study was conducted in two large-scale hospitals in which oncology care is given with medical directors (n:70). A questionnaire developed by the researchers asking about demographic characteristics and professional experience, opinions and suggestions of medical directors about providing and integrating palliative care into healthcare was used and responses were analyzed. RESULTS: Potential barriers in providing palliative care (PC) and integrating PC into health systems were perceived as institutional by most of the doctors (97%) and nurses (96%). Social barriers were reported by 54% of doctors and 82% of nurses. Barriers due to interest and knowledge of health professionals about PC were reported by 76% of doctors and 75% of nurses. Among encouragement ideas to provide PC were dealing with staff educational needs (72%), improved working conditions (77%) and establishing a special PC unit (49)%. An independent PC unit was suggested by 27.7% of participants and there was no difference between the hospitals. To overcome the barriers for integration of PC into health systems, providing education for health professionals and patient relatives, raising awareness in society, financial arrangements and providing infrastructure were suggested. The necessity for planning and programming were emphasized. CONCLUSIONS: In our study, the opinions and perspectives of hospital managers and clinical directors were similar to current approaches. Managerial needs for treating cancer in efficient cancer centers, increasing the capacity of health professionals to provide care in every stage of cancer, effective education planning and patient care management were emphasized.

The effects of orthotic intervention on nerve conduction and functional outcome in carpal tunnel syndrome: A prospective follow-up study.

AIM: To evaluate the effects of using night orthosis for 6 weeks in patients with mild to moderate carpal tunnel syndrome (CTS), including a follow up after 3 months using electrophysiological and functional outcome measurements. STUDY DESIGN: 12 week follow-up prospective study. METHODS: Twenty-two patients with a total of 36 hands diagnosed as CTS were included. Subjects were informed about using a night orthosis for 6 weeks and were evaluated at the baseline, 6th and 12th week. RESULTS: Median motor distal latency was significantly decreased and median motor compound muscle action potential was significantly increased at the 6th week. Median sensory velocity was significantly increased at the 12th week. No significant difference was found in terms of functional outcome measurements. CONCLUSION: Electrophysiological follow-up findings support the positive effects of using a wrist orthosis on median nerve conduction for CTS patients.

Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: a multicenter study.

OBJECTIVE: The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. METHODS: This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants' age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. RESULTS: A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. CONCLUSION: Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients.

Gait speed and related factors in Parkinson's disease.

[Purpose] The aim of this study was to investigate the relationship between gait speed and various factors in ambulatory patients with idiopathic Parkinson's disease. [Subjects] Fifty ambulatory patients with idiopathic Parkinson's disease who were admitted to an outpatient clinic were included in this cross-sectional study. [Methods] The Hoehn and Yahr Scale was used for measurement of the disease severity. Gait speed was measured by the 10-Meter Walk Test. Mobility status was assessed by Timed Up and Go Test. The Hospital Anxiety and Depression Scale was used for evaluation of emotional state. Cognitive status was examined with the Mini-Mental State Examination. The Downton Index was used for fall risk assessment. Balance was evaluated with the Berg Balance Scale. Comorbidity was measured with the Cumulative Illness Rating Scale. The 36-Item Short Form Health Survey was completed for measurement of quality of life. [Results] The mean age was 66.7 (47-83) years. Twenty-eight (56%) patients were men. Gait speed was correlated positively with height, male gender, Mini-Mental Examination score, Berg Balance Scale score and physical summary scores of the 36-Item Short Form Health Survey. On the other hand, there was a negative correlation between gait speed and age, disease severity, TUG time, Downton Index, fear of falling, previous falls and the anxiety and depression scores of the Hospital Anxiety and Depression Scale. There was no correlation between gait speed and comorbidity. [Conclusion] The factors related with the slower gait speed are, elder age, clinically advanced disease, poor mobility, fear of falling, falling history, higher falling risk, and mood disorder.

Increased prevalence of metabolic syndrome in patients with psoriatic arthritis.

OBJECTIVE: The increased incidence of cardiovascular disease (CVD) in patients with psoriatic arthritis (PsA) has been reported previously. We aimed to evaluate the presence of metabolic syndrome and to assess the insulin resistance associated with chronic inflammation in patients with PsA. METHODS: Fifty-nine (34 females, 25 males) consecutive PsA patients were enrolled in this study. The control group consisted of 82 (46 females, 36 males) healthy volunteers. All subjects were questioned about criteria of National Cholesterol Education Program Adult Panel III (NCEP ATP III) and also the modified World Health Organization (WHO) definition. Disease activity, damage, and functional activity were assessed by using functional indices [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index (PASI), Disease Activity Score in 28 joints (DAS28), The Multi-Dimensional Health Assessment Questionnaire-function (MDHAQ-function), The Multi-Dimensional Health Assessment Questionnaire-Routine Assessment of Patient Index Data scores (MDHAQ-RAPID-3)]. Fasting blood samples were collected for complete biochemical analysis. RESULTS: According to the NCEP criteria, 21 (35.5%) of PsA patients and 12 (14.6%) of healthy controls were classified as having metabolic syndrome (P=0.004). According to the NCEP criteria, hypertension and hyperglycemia were more common in the PsA group than the healthy controls (P=0.000 and P=0.043, respectively). According to the WHO criteria, 14 (23.7%) of the patients and 14 (17%) of the healthy controls had metabolic syndrome (P=0.328). No correlation was observed between functional indices and cardiovascular risks factors that were among the metabolic syndrome components. CONCLUSIONS: This study demonstrated an increase in the frequency of metabolic syndrome, which is a major risk factor for atherosclerosis in patients with PsA. Patients with PsA should be closely followed in terms of cardiovascular events, and aggressive treatment should be performed for both cardiovascular risk factors and the disease itself.

Long-term prognosis of mild functional tricuspid regurgitation after mitral valve replacement.

OBJECTIVE: Functional tricuspid regurgitation (FTR) is the most common type of tricuspid insufficiency and occurs approximately in 30% of patients with mitral valve disease. The major etiologic factor in the triggering of right ventricular dilation and thus causing functional tricuspid regurgitation, is pulmonary artery hypertension secondary to mitral valve disease. We aimed to analyze long-term outcomes of patients with mild tricuspid regurgitation at the time of mitral valve replacement. METHODS: Sixty-six patients with mild tricuspid insufficiency who underwent mitral valve replacement were included in this observational retrospective study. Mean follow-up time was 8.3 ± 0.7 years. Patients whose tricuspid regurgitation remained unchanged or decreased following operation were enrolled to group 1 (n=32), patients whose tricuspid regurgitation increased were included to group 2 (n=34) and data were compared statistically with t-test, Mann-Whitney U, Chi-square and Fisher Exact test. Multiple regression analysis was performed to determine independent risk factors for FTR progression. REESULTS:Preoperatively female gender (p=0.02), body surface area (p=0.04), left atrium diameter (p=0.01), functional capacity (p=0.03), right ventricle diameter (p=0.04), and left ventricle mass index (p=0.04) were found to be statistically significant between groups. In the follow-up; functional capacity, grade of tricuspid insufficiency, pulmonary artery pressure, vena contracta width (p<0.001), TAPSE (tricuspid annular plane systolic excursion index) (p=0.04), annulus diameter (p=0.02), right ventricle diameter (p=0.01), left ventricle mass index (p=0.05), and ejection fraction (p=0.02) were found to be statistically different between groups. In multiple logistic regression analysis; preoperative LA diameter (OR=5.05; 95% CI:1.49-17.12; p=0.009) and female gender (OR=10.93; 95% CI:1.77-67.31; p=0.01) were found as independent risk factors for FTR progression. CONCLUSION: This study revealed that mild FTR might advance to moderate to severe grade in more than half of the patients in the follow-up. Thus, surgical approach to even mild FTR should be individualized based on patient's risk assessment.

Frequency and predictors for falls in the ambulatory patients with rheumatoid arthritis: a longitudinal prospective study.

The aim of this multicentre study is to investigate the incidence and risk factors for falls in ambulatory rheumatoid arthritis (RA) patients. One hundred and eighty-five ambulatory RA patients who have been followed up in 3 different centres were included in study. Patients were a part of Turkish League Against Rheumatism-Follow-up Program. All patients were evaluated at the baseline in terms of demographic features, falls history in the last year, disease-specific characteristics and co-morbidities. Functional status was evaluated by chair stand test with five repetitions and heel-toe walking. Erythrocyte sedimentation rate and CRP values were measured. Study patients were followed by the three monthly visits during a year. Patients were asked to fill the fall diary and/or call the doctor when a fall happens. The features of falls were recorded to the files at the time of the fall. The mean age was 56.7 ± 11.4 years. Four patients were drop out the study. Thirty-four patients fell and 2 had fractures during 1 year. Falls were found to be correlated with age, visual analogue score for pain, previous falls, use of assistive devices for ambulation, use of two or more medications and ability to do heel-toe walking. In the multivariate regression analysis, previous falls and use of assistive device for ambulation were found to be independent risk factors for falls (p = 0.004 OR 3.3 95 % CI 1.5-7.4, p = 0.001 OR 6.2 95 % CI 2-19.1). Fall history in the last year and using an assistive ambulation device are the predictors of the falls.

Evaluation of turbidimetric inhibition immunoassay (TINIA) and HPLC methods for glycated haemoglobin determination.

BACKGROUND: Various factors may affect the accuracy of hemoglobin (Hb) A1c measurements that are widely used to monitor glycemic control in diabetic patients. This study was aimed to compare the values of HbA1c obtained by two different methods, Roche Tina-quant second and thirdgeneration HbA1c assays based on the turbidimetric inhibition immunoassay (TINIA), and high-performance liquid chromatography (HPLC) cation-exchange method used by Arkray Adams HA-8160 analyzer. METHODS: Measurements of HbA1c were carried out in blood samples from 2,917 patients using above-mentioned methods. Linear regression was used for the correlation analysis and linear equations. Bland-Altman plots were performed from method comparison data using MedCalc statistical software. RESULTS: For the low control, the second generation Tina-quant assay had within-run and between-run CVs 0.8% and 0.9%; for the high control within-run and between-run CVs were 1% and 0.96%, respectively. HPLC method for the low control had within-run CV 1% and between-run CV 1.3%; for the high control within-run CV was 0.6% and between-run CV was 0.9%. CONCLUSION: There was a good concordance between the results of TINIA and HPLC methods (y = 1.091x - 0.363; r(2) = 0.96).

Is there a real adrenal axis dysfunction in patients with amyloidosis associated with familial Mediterranean fever?

Systemic amyloidosis with AA-type amyloid deposition is the major complication of FMF, leading to end stage renal disease. There is no clear data on the prevalence of adrenal involvement in patients with FMF amyloidosis. The aim of this study is to determine the adrenal axis function in patients FMF with amyloidosis. Twenty patients with FMF with amyloidosis (F/M: 10/10, mean age; 38 ± 11 SD years), twenty without amyloidosis (F/M: 14/6, mean age 32 ± 10 years), and healthy controls (F/M: 12/8, mean age: 30 ± 7.6 SD years) were recruited. A dose of 250 mg tetracosactide (Synacthen) was then administered intravenously and further blood samples collected 30 and 60 min later. Blood samples were separated and collected at 4°C, and serum cortisol levels were measured. A normal cortisol response to Synacthen was defined as a post-stimulation peak cortisol value of >18 mg/d either at 30 or 60 min. sample. The mean disease duration was 8.8 ± 6 SD years, (range, 2-21) in FMF patients without amyloidosis compared to 16 ± 9.5 years (range, 0-30) in FMF with amyloidosis (P = 0.001). The cortisol concentrations increased significantly at 30 and 60 min compared to baseline after injection of synacthen in all groups. There were no statistically significant differences found among three groups, for basal, 30 and 60 min for cortisol levels (P = 0.154). FMF patients with amyloidosis do not exhibit overt adrenal insufficiency even though their basal cortisol levels were mildly lower.

Criminal activities of the elderly in Turkey during the years 2000-2005.

The aging of the population is one of the most important demographic events of the 21st century. The aim of this study is to define the basic variables related with criminal behavior among the elderly for cases over 60 years. A retrospective assessment of the criminal data (255 cases) consists of the period between 2000 and 2005 of the Council of Forensic Medicine, Turkish Ministry of Justice. Of the cases whose average age is 68.2±6.9, 25 of the 56 cases were diagnosed as ill. Out of 225 elderly who had committed a criminal act 56 of them had a medical antecedent which is a psychiatric diagnosis. Whether or not they had a medical antecedent the Board made 90 psychiatric diagnosis. This comprised of 25 out of the 56 who also had a medical antecedent and 65 out of the 199 who did not have a medical antecedent. Delusional disorder (43.3%) and schizophrenia (25.6%) are the most frequent diagnoses. Specializing and developing standards for determining the criminal responsibility of the elderly is required.

Frequency, features, and factors for falls in a group of subacute stroke patients hospitalized for rehabilitation in Istanbul.

Falling is a major complication seen in stroke patients. The purpose of this study was to investigate the frequency, features, and factors for falls affecting subacute stroke patients hospitalized for rehabilitation. Ninety-nine subacute stroke patients, hospitalized for rehabilitation were evaluated prospectively in this study. All patients were evaluated using the functional independence measurement (FIM), the Barthel index (BI), the Berg balance scale (BBS), the mini mental state examination (MMSE), the hospital anxiety depression scale (HADS), and the Downton index (DI), performed by the same physician. Proximal femur bone mineral density (BMD) measurements were performed using the dual-energy X-ray absorbtiometry (DXA). During the period of hospitalization, 17 patients (17.2%) reported falling once. The calculated incidence rate for falls was 6.3/1000 hospital days (95% confidence interval, CI=3.7-10.1). Furthermore, 41% of the falls occurred in patients' rooms, 82% between the hours 06:00- 20:00, 47% while walking and 65% on the side affected from the stroke. Despite the fact that 30% of the patients had osteoporosis, no fractures were observed after these falls, 88% had only soft tissue injury. Overall, 88% of the patients reported they had a fear for falling. Admission DI scores were significantly lower in the group of patients with no falls compared to the group with falls (p<0.05). Falls occurred most frequently during daytime, while subacute stroke patients were walking. DI is useful in stroke patients that are to be hospitalized for rehabilitation and accordingly, preventive action taken on those patients with a high risk for falls.

[Evaluation of "life-threatening" definition and negligence in children treated in the emergency surgery service burn unit (from the viewpoint of forensic medicine)]. / Acil cerrahi yanik ünitesinde tedavi edilen çocuklarda yasamsal tehlike taniminin ve ihmalin adli tip açisindan irdelenmesi.

BACKGROUND: The aim of this study is to outline the sociodemographic and traumatic characteristics of children who were referred to the Burn Unit of Emergency Service with burn injuries, to discuss the doctors' approach to these cases, and to compare the prognosis of patient groups with and without life-threat. METHODS: This epidemiological study was carried out between 14 October 2004 and 31 December 2006 and included a total of 134 pediatric patients aged between 0-18 years. A semi-structured questionnaire form was designed to obtain the information from the study population. The obtained data were statistically evaluated. RESULTS: 66.2% (n=90) of the cases were male and 33.8% (n=46) were female. The mean age of the study population was 3.9+/-4.1 years and the mean percentage of burned body area was 22.47+/-17.37. The main cause of burn was scalding with hot water, with a frequency of 77.2% (n=105). When the percentage of burn area of the body was lower than 20%, the mortality was 6.3% (n=6), whereas it was 61% (n=25) when the burn area exceeded 20% of the body (p=0.0001). While the mortality was 21.0% (n=25) among the cases with first-degree burns, it was 35.3% (n=6) among those with second- and third-degree burns (p=0.189). Mortality ratio among the cases with life-threat was higher than those without life-threat, and this difference was statistically significant (p=0.033). CONCLUSION: Extent of burn is a determinative factor for prognosis in children. Evaluation of all burn cases in children should be approached as cases of neglect/abuse; protection of these children in this manner will serve as an important practice of preventive medicine.

Expression of Ki-67, p53 and vascular endothelial growth factor (VEGF) concomitantly in growth hormone-secreting pituitary adenomas; which one has a role in tumor behavior ?

OBJECTIVE: In many pituitary tumor, immunohistochemical studies have been shown to be correlated with different aspects of tumor behavior.There is no study up to date in which markers of Ki-67, p53, VEGF were evaluated concomitantly in GH-secreting adenomas.This study aims to determine which marker has a major role in tumor behavior and whether these markers have a cut-off value to distinguish invasive adenoma from non-invasive pituitary adenoma. METHODS: Fourty-seven acromegalic patients operated by the same neurosurgeon were included in this study.Twenty-one patients(5micro/16 macro) had non-invasive adenomas and 26 had invasive macroadenomas.Eight patients(6 invasive macroadenomas, 2 microadenomas) were treated with OCT-LAR until one month prior to surgery with treatment duration range of 3-11 months.These patients were excluded from the study group as the noninvasive and invasive adenomas were compared.A separate analysis was performed in invasive adenomas to compare OCT(+) and OCT(-)patients. RESULTS: Both Ki-67 and p53 expressions showed no correlation with the invasive character of adenomas, but VEGF expression in invasive adenomas was significantly higher with respect to noninvasive group.Our study has taken intermediate staining (>25 %)for VEGF as a cut off value for invasive adenomas.It was also observed that the decrease in VEGF staining in OCT pretreated invasive adenomas was significantly more than those not treated with OCT. CONCLUSION: VEGF becomes an independent stimulator of angiogenic growth and progression for GH-secreting adenomas with >25% cytoplasmic immunoreactivity.This cut-off value may be useful in determination of prognosis and appropriate treatment strategy.A short term preoperative OCT treatment may be useful as adjunctive therapy especially for locally invasive GH- secreting adenomas.

Paraoxonase-1 55/192 genotypes in schizophrenic patients and their relatives in Turkish population.

BACKGROUND: Oxidative stress and free radical-induced toxicity have been implicated in the pathophysiology of schizophrenia. In this study, we examined paraoxonase (PON1)-55/192 polymorphisms and PON1 activity in patients with schizophrenia, first-degree relatives of schizophrenic patients, and healthy controls. METHODS: This study consisted of 292 healthy participants, 267 unrelated patients with schizophrenia and 311 first-degree relatives of schizophrenic patients. PON1 55 (rs 854560) and PON1 192 (rs 662) polymorphisms were performed by restriction fragment length polymorphism. RESULTS: The frequencies of the QQ and LL genotypes were significantly overpresented in controls compared with those of schizophrenic patients and their relatives. In contrast, the RR genotype was more prevalent in patients than their relatives and healthy controls. The frequencies of the LM and QR genotypes in relatives were higher than controls. Serum PON1 activities of controls were significantly higher when compared with both schizophrenic patients and their relatives. The RR and LL genotypes were associated with a significantly increased PON1 activity as compared with QR or QQ and MM or LM genotypes, respectively, in all groups. CONCLUSION: This is the first study that shows the association between PON1-55/192 polymorphisms and schizophrenia. Our data suggest that the subjects carrying R allele or RR genotype might be susceptible to schizophrenia and subjects with QQ or LL might be protected against schizophrenia. First-degree relatives of schizophrenic patients have higher heterozygote genotypes, suggesting that this group can shift either to patient or control group depending on their allele types and environmental factors. PON1 genetic variations are also associated with PON1 activities. Reduced PON1 activity in patients and their relatives might result from the combined effects of more than one polymorphic variant in PON1 or other genes and/or increased oxidative stress, supporting the hypothesis that reactive oxygen species-mediated cellular damage might contribute to the neuropathology of schizophrenia.

Combined impact of matrix metalloproteinase-3 and paraoxonase 1 55/192 gene variants on coronary artery disease in Turkish patients.

BACKGROUND: We investigated the association of matrix metalloproteinase-3 (MMP-3) and paraoxonase 1 (PON1) 55/192 polymorphisms with coronary artery disease (CAD) and the number of diseased vessels in patients with CAD. MATERIAL/METHODS: One hundred thirty-nine CAD patients and 119 healthy control subjects were included in the study. Genotypes for PON1 55/192 and MMP-3 5A/6A polymorphisms were determined by restriction fragment length polymorphism. RESULTS: Although distributions of the RR genotype of PON1 192 and the 5A5A genotype of MMP-3 were more frequent in patients, frequencies of the QQ genotype of PON1 192, the MM genotype of PON1 55, and the 6A6A genotype of MMP-3 were significantly lower in patients compared with healthy control subjects. The combined genotypes of RR/LL and/or 5A5A are increased the risk of CAD when compared with subjects who possess neither the MMP-3 5A5A nor the PON1 RR/LL genotype. While the MMP-3 5A/6A genetic variants were not associated with the number of diseased vessels, PON1 55/192 variants were associated with the number of diseased vessels. CONCLUSIONS: The combined PON1 55/192 and MMP-3 5A/6A genetic variants are associated with CAD; PON1 seems to be connected with the number of diseased vessels, and hypertension and hyperlipidemia are related with PON1 192 and MMP-3 in CAD patients.

Deaths of the elderly exposed to violence in Turkey.

Due to the socio-cultural and demographical changes that have been taking place in Turkey, differences in types of violence are coming on the scene. The purpose of the present study is to reveal the number of violence deaths and the variation by time in the types of violence resulting in death in the elderly of ages 65 and above in Turkey. Using a retrospective (descriptive) epidemiological method, this study was carried out with 1,326 subjects of ages 65 and above among 17,015 criminal autopsies between years 1996-2001. According to the crime scene investigations, the percentage of deaths caused by firearm injuries increased to 4.0% in 2001 from 1.9% in 1994. The dispersion of the subjects according to autopsy findings were pathologically caused death (32.3%), negative autopsy (20.3%), general body trauma (20.1%) and hanging (6.3%). Changes in the rates of deaths caused by cutting/piercing tool injuries are 1.9% and 4.3%, respectively. Regulations are needed to reinforce and financially support the family, to secure humanely life standards for the elderly, and to ensure homecare to an optimum extent.

Burn and vital risk criteria in industrial accidents (as forensic medicine approach).

BACKGROUND: Burn traumas resulting from industrial accidents may generate a death risk. In such cases a forensic report should be filled up. In forensic findings, the death risk which is associated with the degree of trauma, of the victim is as important as the treatment of the subject. The aim of our research was to investigate what degree of burns causes fatality and which type of industrial accidents cause them. METHODS: This research was done between the dates October 2004 and December 2006 with the descriptive epidemiology method by the evaluation of all data entered emergency surgical room- burn unit. The results of the study were analyzed with respect to its socio-demographic characteristics clinical findings of the type of burn and the type of the event which caused the burn. Categorical variables were assessed using Chi-square test, continuous variables were tested by Pearson's correlation. RESULTS: For the total 128 incidents, 69.5% (n=89) were males and 30.5% (n=39) females. 28.9% (n=37) of the incidents were industrial accidents. 48.6% (n=18) of the burns were caused by boiling water, 32.4% (n=12) due to contact by flame, 10.8% (n=4) electrocution and %8.2 (n=3) due to burns by contact with chemicals. The 19.50% (n=25) of the incidents had ended up by loss of life, 80.5% (n=103) were cured and discharged. The incidents which had resulted under 20%, the mortality rate was 1.3% (n=1), the incidents which had above 20%, the mortality rate was 49.0% (n=24) (p=0.0001). CONCLUSION: The degree of burn was found to be valuable in determining the death risk but the extent of the burned area was found to be more deterministic in assessing this particular risk.

Body composition after stroke.

The aim of this study was to compare the body composition, including lean tissue mass, fat tissue mass, and bone mineral content, of the paretic leg with that of the nonaffected leg in patients with stroke and to evaluate the effects of time since stroke, spasticity, and motor recovery on the body composition specifically within the first year after stroke. Thirty-five stroke patients with mean age and standard deviation of 62.69+/-9.54 years were included in the study. A full physical examination including Brunnstrom motor recovery and modified Ashworth spasticity scale was performed. Fat tissue mass (grams), lean tissue mass (grams), and bone mineral content (grams) of both the paretic and nonaffected lower extremities were obtained from the total body scans determined by using dual-energy X-ray absorptiometry (Lunar DPX-PRO). Lean tissue mass and bone mineral content of the paretic side were found to be significantly lower than those of the nonaffected side (P<0.05). A significant correlation was found between the lean tissue mass and bone mineral content of both the paretic and nonaffected legs after adjusting for age and weight (P=0.000, r=0.679; P=0.000, r=0.634, respectively). Bone mineral content and lean tissue mass of both the paretic and nonaffected sides showed a significant negative correlation with time since stroke in patients with stroke for < or =1 year (P<0.05). A higher lean tissue mass and bone mineral content were found in patients with moderate to high spasticity in comparison with patients with low or no spasticity (P<0.05). Stroke causes loss of lean tissue mass and bone mineral content prominently in the paretic side. The loss increases with increasing time since stroke. Spasticity seems to help in preventing the loss of bone mineral content and lean tissue mass.

Differences in risk factors for acute coronary syndromes between men and women.

OBJECTIVE: The aim of this study is to evaluate the presence of risk factors for coronary heart diseases in men and women in our population. MATERIAL AND METHODS: 414 patients (335 men, 79 women) admitted to our coronary intensive care unit with the diagnosis of acute coronary syndrome were evaluated for risk factors. RESULTS: 74.7% of women and 84.8% of men were observed to belong to sex-specific risk groups. This finding was statistically significant (P = 0.005). Prevalence of hypertension was significantly higher in women (58.2%) than in men (28.1%) (P = 0.0001). Prevalence of diabetes mellitus in women was (51.9%) and significantly higher than in men (28.1%, P = 0.0001). Smoking was 2.5 times higher in men: 77.0% and 31.6%, respectively (P = 0.0001). Body mass index was high in both groups and in women exceeded that of men (P = 0.0001). CONCLUSION: The fact that risk factors for acute coronary syndromes were frequently observed in male and female patients presenting with acute coronary syndromes warned us to arrange our health policy towards the priority of the prevention of these risk factors.

Risk factors for mortality of nosocomial bacteraemia in intensive care units.

OBJECTIVE: The aim of this study was to follow critically ill patients prospectively in intensive care units (ICUs) to determine risk factors for mortality and outcome associated with nosocomial bacteraemia (NB). SUBJECTS AND METHODS: A case-control study of 176 patients was conducted to identify the risk factors for mortality of NB in ICU patients. The study was performed in emergency, surgical and general surgical ICUs with 23 beds during a 15-month period. A total of 1,450 patients were admitted to the ICUs during the study period. The USA Center for Disease Control and Prevention definitions were used to diagnose nosocomial infections. Nosocomial bacteraemia was defined as the isolation of one or more organisms from blood cultures taken at least 48 h after admission, which were not related to a problem present on admission. An assessment of whether the isolated organisms represented true bacteraemia rather than contamination was made by clinical or laboratory evidence of infection. RESULTS: A total of 214 bacteraemia episodes were found in the 176 patients (64 female, 112 male; 51.3 +/- 21.3 years old), 90 of whom died and 86 survived. The bacteraemia rate was 12.1%. The most common etiological agents of bacteraemia were Klebsiella pneumoniae: 46 (21.5%), methicillin-resistant Staphylococcus aureus: 46 (21.5%), Pseudomonas aeruginosa: 32 (14.9%), and Escherichia coli: 20 (9.3%). Multivariate analysis showed that the requirement of mechanical ventilation for more than 7 days (p < 0.001), total parenteral nutrition (p = 0.034), inotropic drug (p < 0.001), and increased creatinine level (p = 0.034) were independent risk factors for mortality of NB in ICUs. CONCLUSIONS: Nosocomial infections caused by Gram-negative bacteria continue to be one of the major sources of morbidity and mortality.