Comparison of the predictive validity of the Braden, Munro and 3S scales in surgical patients.

AIM OF THE STUDY: This research is a descriptive and cross-sectional study aimed at examining the use of three different scales to assess the risk of pressure injury (PI) in surgical patients. MATERIALS AND METHODS: This study was conducted between February 1 and July 1, 2022. The study included patients who had planned surgery in general surgery clinic. The sample size was 388 patients. Patients who agreed to participate in the study were asked to fill out the " Introductory Information Form " and perform a risk assessment using the Braden, Munro and 3S Scales. The statistics program IBM SPSS Statistics 25.0 packaged software was used in the analyses of data. RESULTS: It is evident that the relationship between the scales and the diagnosis of PI, as well as the strength of this relationship, are statistically significant (p < 0.05). The Munro Scale exhibited the highest value of Phi value and validity coefficient c, indicating a stronger association with the diagnosis of PI, thus suggesting its greater effectiveness in discrimination. According to the validity coefficients found, it can be stated that the correct classification percentages for Munro, Braden, and 3S Scales were 91 %, 71 %, and 66 %, respectively. CONCLUSION: The findings of this study indicate that both the Braden, Munro, and 3S Scales can be used for PI risk assessment in surgical patients, but the Munro Scale exhibits superior predictive validity compared to the Braden and 3S Scales in terms of overall sensitivity and specificity.

The clinical utility of tuberculin skin tests: a single-center experience

Background: Tuberculin skin test (TST) has played an essential in the diagnosis of latent tuberculosis infection (LTBI) for nearly a century. Objective: This study aimed to investigate the general characteristics of patients tested with TST in a tertiary hospital within two years. Methods: All patients who were evaluated to screen for tuberculosis and received a TST were included. The Mantoux method was used for TST administration. Results: A total of 661 patients, 345 (52.2%) men and 316 (47.8%) women, with a mean age of 43.0 ±15.9 years, were included in the study. Accordingly, TST was performed prior to anti-TNF biological agent therapy for 50% (331) of the participants, for LTBI screening before solid organ and/or hematological stem cell transplantation for 20.4% (135), for screening following contact with tuberculosis for 25.1% (166), for screening of healthcare professionals for 1.1% (7), and medical report for 3.3% (22). 2.7% of the patients who took TST were diagnosed with active tuberculosis (14 with pulmonary tuberculosis and 4 with extrapulmonary tuberculosis). QuantiFERON-TB Gold (QFT) test was performed in 332 (50.2%) patients with anergic TST results. According to TST and QFT test results, 28.3% (187) of the patients were started on tuberculosis prophylaxis. Conclusion: While TST is most performed for LTBI screening prior to biological agent therapy, almost one-fourth of patients taking TST require tuberculosis prophylaxis. On the other hand, about half of the patients require an additional QFT test.

Antecedentes: La prueba de la tuberculina ha jugado un papel fundamental en el diagnóstico de la infección latente por tuberculosis durante casi un siglo. Objetivo: Investigar las características generales de los pacientes a los que se les realizó la prueba de tuberculina en un hospital de tercer nivel. Métodos: Se incluyeron todos los pacientes que fueron incluidos en un tamizaje de tuberculosis mediante la prueba de tuberculina. Se utilizó el método de Mantoux para la administración de esta prueba. Resultados: Se incluyeron en el estudio un total de 661 pacientes, 345 (52.2%) hombres y 316 (47.8%) mujeres, con una edad media de 43.0 ±15.9 años. La prueba de tuberculina se realizó en el 50% (331) de los participantes, antes de la terapia con agentes biológicos anti-TNF; En el 20.4% (135) se hizo la prueba antes del trasplante de órganos sólidos y/o células madre hematológicas; para el 25.1% (166) se realizó tras contacto con la tuberculosis, el 1.1% (7) para tamizaje de los profesionales sanitarios y con informe médico para el 3.3% (22). El 2.7% de los pacientes que se realizaron la prueba de tuberculina fueron diagnosticados con tuberculosis activa (14 pulmonar y 4 extrapulmonar). La prueba QuantiFERON-TB Gold (QFT) se realizó en 332 (50.2 %) pacientes con resultados anérgicos para tuberculina. Según los resultados de las pruebas de tuberculina y QFT, el 28.3% (187) de los pacientes iniciaron profilaxis antituberculosa. Conclusión: Si bien la prueba de tuberculina se realiza comúnmente para la detección de tuberculosis latente antes de la terapia con agentes biológicos, casi una cuarta parte de los pacientes que se les hizo la prueba de tuberculina requieren profilaxis para tuberculosis. Por otro lado, aproximadamente la mitad de los pacientes requieren una prueba QFT adicional.

Alterations in plasma miR-21, miR-590, miR-192 and miR-215 in idiopathic pulmonary fibrosis and their clinical importance.

BACKGROUND: Many studies have revealed that microRNA (miRNA) molecules may take part in idiopathic pulmonary fibrosis (IPF). But, the role of miRNAs in the development of IPF is not yet clear. METHODS: We investigated the plasma levels of miR-21, miR-590, miR-192, and miR-215 in IPF (n = 88) and healthy control (n = 20) groups in this study. We compared the expression levels of target miRNAs in patients with IPF and healthy participants. We grouped the patients with IPF according to age, forced vital capacity, carbon monoxide diffusing capacity (DLCO), gender-Age-pulmonary physiology (GAP) score, the presence of honeycombing and compared the expression levels of target miRNAs in these clinical subgroups. RESULTS: 82 (93.18%) of the patients with IPF were male and the mean age was 66.6 ± 8.6 years. There was no significant difference between the gender and age distributions of IPF and the control group. The mean plasma miR-21 and miR-590 levels in IPF group were significantly higher than in the control group (p < 0.0001, p < 0.0001, respectively). There was no significant difference between the miR-192 and miR-215 expression levels of the IPF and control group. Both miR-21 and miR-590 correlated positively with age (p = 0.041, p = 0.007, respectively) while miR-192 and miR-215 displayed a negative correlation with age (p = 0.0002, p < 0.0001, respectively). The levels of miR-192 and miR-215 increased as the GAP score decreased. The levels of miR-192 in patients with honeycombing were significantly lower than in those without honeycombing (p = 0.003). CONCLUSIONS: Our study showed that both miR-21 and miR-590 were overexpressed in IPF. The miR-21 and miR-590 were associated with DLCO, while miR-192 and miR-215 were associated with the GAP score and honeycombing.

The clinical utility of tuberculin skin tests: a single-center experience.

Background: Tuberculin skin test (TST) has played an essential in the diagnosis of latent tuberculosis infection (LTBI) for nearly a century. Objective: This study aimed to investigate the general characteristics of patients tested with TST in a tertiary hospital within two years. Methods: All patients who were evaluated to screen for tuberculosis and received a TST were included. The Mantoux method was used for TST administration. Results: A total of 661 patients, 345 (52.2%) men and 316 (47.8%) women, with a mean age of 43.0 ±15.9 years, were included in the study. Accordingly, TST was performed prior to anti-TNF biological agent therapy for 50% (331) of the participants, for LTBI screening before solid organ and/or hematological stem cell transplantation for 20.4% (135), for screening following contact with tuberculosis for 25.1% (166), for screening of healthcare professionals for 1.1% (7), and medical report for 3.3% (22). 2.7% of the patients who took TST were diagnosed with active tuberculosis (14 with pulmonary tuberculosis and 4 with extrapulmonary tuberculosis). QuantiFERON-TB Gold (QFT) test was performed in 332 (50.2%) patients with anergic TST results. According to TST and QFT test results, 28.3% (187) of the patients were started on tuberculosis prophylaxis. Conclusion: While TST is most performed for LTBI screening prior to biological agent therapy, almost one-fourth of patients taking TST require tuberculosis prophylaxis. On the other hand, about half of the patients require an additional QFT test.

Antecedentes: La prueba de la tuberculina ha jugado un papel fundamental en el diagnóstico de la infección latente por tuberculosis durante casi un siglo. Objetivo: Investigar las características generales de los pacientes a los que se les realizó la prueba de tuberculina en un hospital de tercer nivel. Métodos: Se incluyeron todos los pacientes que fueron incluidos en un tamizaje de tuberculosis mediante la prueba de tuberculina. Se utilizó el método de Mantoux para la administración de esta prueba. Resultados: Se incluyeron en el estudio un total de 661 pacientes, 345 (52.2%) hombres y 316 (47.8%) mujeres, con una edad media de 43.0 ±15.9 años. La prueba de tuberculina se realizó en el 50% (331) de los participantes, antes de la terapia con agentes biológicos anti-TNF; En el 20.4% (135) se hizo la prueba antes del trasplante de órganos sólidos y/o células madre hematológicas; para el 25.1% (166) se realizó tras contacto con la tuberculosis, el 1.1% (7) para tamizaje de los profesionales sanitarios y con informe médico para el 3.3% (22). El 2.7% de los pacientes que se realizaron la prueba de tuberculina fueron diagnosticados con tuberculosis activa (14 pulmonar y 4 extrapulmonar). La prueba QuantiFERON-TB Gold (QFT) se realizó en 332 (50.2 %) pacientes con resultados anérgicos para tuberculina. Según los resultados de las pruebas de tuberculina y QFT, el 28.3% (187) de los pacientes iniciaron profilaxis antituberculosa. Conclusión: Si bien la prueba de tuberculina se realiza comúnmente para la detección de tuberculosis latente antes de la terapia con agentes biológicos, casi una cuarta parte de los pacientes que se les hizo la prueba de tuberculina requieren profilaxis para tuberculosis. Por otro lado, aproximadamente la mitad de los pacientes requieren una prueba QFT adicional.

The Effect of Vitamin D Deficiency in Chronic Obstructive Pulmonary Disease.

OBJECTIVE: It has been suggested that Vitamin D Deficiency (VDD) worsens lung functions and COPD lowers vitamin D levels, but this has not been proven yet. MATERIAL AND METHODS: The study was carried out between January 2014 and September 2015. All the COPD patients with 25 (OH) D3 measurements were included in this study. The patients < 40-year-old, or with a smoking history of less than 10 package-year, or with asthma, bronchiectasis, pneumonia, tuberculosis, cancer, were excluded from the study. Medical records about age, gender, pulmonary function test, body mass index (BMI), annual exacerbations/hospitalizations, modified British Medical Research Council (mMRC) level and serum 25 (OH) D3 were obtained. RESULTS: The data of 216 (83.8% male) patients were examined in the study. The mean age was 66.88 ± 10.3 years. The mean vitamin D level was 21.1 ± 13.73 ng/mL. Of the patients, 57.9% had VDD, and even 19.9% were in severe VDD. Only 26.4% had adequate vitamin D level. There was a significant in BMI, FEV1, FVC, annual exacerbation and hospitalisations between the patients with vitamin D levels > 20 ng / mL and ≤ 20 ng / mL. Vitamin D level of patients with mMRC level 1 was significantly higher than those with mMRC 2, 3, 4 (respectively P = .03; P = .026; P = .014). CONCLUSION: In this study, we found that lung function was worse in COPD patients with VDD and VDD increased with increasing severity of COPD.

Effect of dexamethasone on unfolded protein response genes (MTJ1, Grp78, Grp94, CHOP, HMOX-1) in HEp2 cell line.

The endoplasmic reticulum (ER) is related to the various signal routes that are activated in unfolded protein response (UPR). The Grp78, Grp94, CHOP, MTJ1 and HMOX1 genes expressions demonstrate UPR activity. In this study, we investigated the UPR gene expressions in larynx epidermoid carcinoma (HEp2) to which dexamethasone (dex) was applied. HEp2 cells were administered for 48 h with different combinations using 0.1 microM and 1 microM dex, 1 mM phenyl butyric acid (PBA) and 100 ng/ml lipopolysaccharide (LPS). The Grp78, Grp94, CHOP, MTJ1 and HMOX1 genes expression was determined using quantitative RT-PCR. The Grp78, MTJ1 and HMOX1 gene expression increased with the administration of 1 microM dex. CHOP expression, on the other hand, decreased with 0.1 microM dex. When dex was combined with LPS, nearly all gene expressions decreased. The increase in Grp78, Grp94, HMOX1 and MTJ1 gene expression was greater in groups in which dex was administered in combination with PBA than in groups in which dex was administered alone. Dex in low dose (0.1 microM) caused a decrease in CHOP expression in HEp2 cells and an increase in Grp78 expression, in particular. The changes in UPR genes expressions may lead to the extended survival of the cells.

Ouabain targets the unfolded protein response for selective killing of HepG2 cells during glucose deprivation.

Ouabain is a cardiotonic steroid and specific inhibitor of the Na(+)/K(+)-ATPase. The relationship between ouabain treatment and the unfolded protein response (UPR) in cells is not precisely understood. Therefore, we studied the possible effects of ouabain on proliferation, apoptosis, and the UPR. HepG2 cells were cultured overnight and then treated with various concentrations of ouabain (0.75 to 750 nM) in the absence or presence of 10 mM 2-deoxyglucose (2-DG) for 48 hours. We also used real-time polymerase chain reaction to obtain quantitative measurements of expression levels of Grp78, Grp94, CHOP, MTJ-1, HKII, MDR-1, MRP-1, HO-1, and Par-4. Cell number, viability, and proliferation of HepG2 cells were monitored with a real-time cell analyzer system (xCELLigence). We show that ouabain modulates the UPR transcription program and induces cell death in glucose-deprived tumor cells. Ouabain at all concentrations showed no cytotoxicity whereas all concentrations were very effective under 2-DG stress conditions. Our findings show that disruption of the UPR during glucose deprivation could be an attractive approach for selective cancer cell killing and could provide a chemical basis for developing UPR-targeting drugs against solid tumors. Ouabain use as an adjunct to conventional cancer therapy also warrants vigorous investigation.

The diagnostic yield of exercise stress testing as a screening tool for subclinical coronary artery disease in patients with moderate to severe obstructive sleep apnea.

STUDY OBJECTIVE: To address the yield of routine exercise stress testing as a screening tool for subclinical coronary artery disease (CAD) in patients with moderate to severe obstructive sleep apnea (OSA). DESIGN AND SETTING: A cross-sectional study in a university hospital. PARTICIPANTS: Of 380 consecutive patients with OSA, data from 206 subjects (mean apnea-hypopnea index [AHI] 41 ± 21 events/h) were studied; data from 78 with a history of CAD and 96 with mild OSA (AHI 5-15 events/h) were excluded. MEASUREMENTS: Routine exercise stress testing. RESULTS: Six subjects could not reach maximal exercise capacity. Of the remaining 200 patients, the results of exercise stress testing were normal in 189. Three had a positive stress test, with coronary angiography confirming the diagnosis of CAD. Eight patients had suspected positive findings on the stress test, but the results of the myocardial perfusion study were negative. CONCLUSION: The prevalence of subclinical CAD in this selected population with OSA was 1.5%, which is not higher than that in a general population. Our results do not support the routine use of exercise stress testing in patients with moderate to severe OSA who do not have symptoms of CAD.

The role of heart-type fatty acid-binding protein in the evaluation of carbon monoxide poisoning in rats.

Acute carbon monoxide (CO) poisoning can cause early and persistent damages in tissues sensitive to hypoxia. This study investigated serum heart-type fatty acid-binding protein (H-FABP) levels as a biomarker of acute CO poisoning in rats. The rats were exposed to a mixture of either 3000 (group A) or 5000 (group B) parts per million (ppm) CO in air, or to ambient air (group C, control group). Blood samples were taken just before, immediately after and 6 hours after the exposure, and serum H-FABP and troponin-I levels were measured. The consciousness level was evaluated just after the exposure. The survival rate was monitored for 7 days. Serum H-FABP levels increased just after the CO exposure in both groups A and B. Additionally, H-FABP level was higher in group B than in group A, immediately after the exposure. However, serum troponin-I levels only increased at 6 hours after the CO exposure in groups A and B. Consciousness and survival rates in group B were lower than that in group A. Our results suggest that H-FABP might have potential to be an early and quantitative parameter of clinical severity and prognosis in CO poisoning.

The effect of CYP1A2 gene polymorphisms on Theophylline metabolism and chronic obstructive pulmonary disease in Turkish patients.

Cytochrome P450 (CYP) 1A2 gene polymorphisms are thought to be involved in the metabolism of theophylline (TP). We aimed to investigate the effect of CYP1A2*1C, CYP1A2*1D, CYP1A2*1E, and CYP1A2*1F polymorphisms of the CYP1A2 on TP metabolism by PCR-RFLP in 100 Turkish patients with chronic obstructive pulmonary disease (COPD) receiving TP. One hundred and one healthy volunteers were included as control group. The genotype frequencies of the CYP1A2*1D and CYP1A2*1F were found to be significantly different in the patients compared to the controls. The "T" allele at -2467 delT and the "C" allele at -163 C > A in the CYP1A2 displayed association with a significantly increased risk for COPD. "T" allele at - 2467 delT was also associated with a high risk of disease severity in COPD. In conclusion, our data suggest that genetic alterations in CYP1A2 may play a role both in the pharmacogenetics of TP and in the development of COPD.

A case of allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis.

Allergic bronchopulmonary aspergillosis usually occurs in children with underlying airway disease such as asthma and cystic fibrosis. While the colonization and infection of pre-existing tuberculosis lesions by aspergillus species is well known, occurrence of allergic bronchopulmonary aspergillosis following pulmonary tuberculosis in children has not been reported yet. Here, an 11-year-old girl who developed allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis is reported and the mechanisms of causality are also speculated.

Doppler ultrasonography versus venography in the detection of deep vein thrombosis in patients with pulmonary embolism.

In patients with acute pulmonary embolism (PE) the frequency of deep vein thrombosis (DVT) varies between 13-93%. The aim of this study was to compare Doppler ultrasonography (DUSG) and venography in the detection of DVT in patients with PE. Fifty-one patients who were clinically diagnosed as having PE from January 1st 2001 to January 31st 2005 were entered into the study and comorbid conditions and risk factors were noted. The diagnosis of PE was confirmed by ventilation-perfusion (V/Q) scintigraphy, spiral tomography and angiotomography while the diagnosis of DVT was made by DUSG and venography. DVT was confirmed by both DUSG and venography in 19 (37,3%) patients. In the remaining 32 patients DUSG was negative. Venography confirmed DVT in 6 of these patients while in 26 no DVT was found. The sensitivity and specifity of DUSG in the diagnosis of DVT were 76% and 100% respectively and the negative and positive predictive values were 81% and 100% respectively. The mean d-dimer concentration was 1,187 in patients with DVT and 641 in patients without DVT (p > 0.05). Aquired risk factors were found in 4 of 6 patients with DVT, CRP was elevated in 5 (83%) and ALT-AST were elevated in 2 (33%). Although DUSG alone is considered sufficient for the diagnosis of DVT, venography still remains the gold standard in the diagnosis of DVT. Especially in patients with PE, where the diagnosis of DVT may increase the success of treatment, venography or other diagnostic tools may be used instead of a second DUSG if the first DUSG is negative.

The prevalence of asthma, allergic rhinitis, and atopy in Antalya, Turkey.

Bronchial asthma is a common chronic inflammatory disorder of the airways that causes serious morbidity and mortality. The prevalence of the disorder has been increasing, especially in developed countries. The population-based asthma prevalence studies provide data from Ankara, Istanbul, Gaziantep, Trabzon, Izmnir, and Kayseri in our country and asthma prevalence ranges between 1.4 and 3%. However, the prevalence of adult asthma in our city was not known. We aimed to determine the prevalence of asthma, allergic rhinitis, and atopy in the adult population of Antalya and compare the data with other countries and other regions of our country. The European Commission Respiratory Health Survey, the first study to assess the geographical variation in asthma and allergic diseases, provided comparable data from 22 countries and 140,000 individuals. Therefore, the European Commission Respiratory Health Survey protocol was preferred in our study. The first stage consisted of 1000 subjects; of these 1000 subjects, 200 subjects were randomly selected for the second stage. The response rates were 99.5 and 55.4% for stages I and II, respectively. The current prevalence of asthma, allergic rhinitis, and atopy in Antalya was 9.4, 27.7, and 31.1%, respectively. The most prevalent type of sensitization was mite allergy detected in 31 (20.9%) subjects. Sensitization to more than one allergen was frequent in subjects with asthma and allergic rhinitis. Bronchial asthma, allergic rhinitis, and atopy are frequent in our city and when compared with previous studies performed in Turkey, the highest results were in Antalya.

[The effect of comorbidity on prognosis in patients with COPD]. / KOAH'da komorbiditenin prognoza etkisi.

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of death from causes other than COPD. A study was undertaken to identify the most common comorbid diseases and to assess prognostic role of comorbidity in COPD. A cohort of 406 COPD patients, mean (+/- SD) 64 +/- 9 years were evaluated. Age, sex, smoking history, FEV1, comorbid conditions were recorded. Follow-up was conducted by means of telephone calls. Logistic regression analysis was used to identify the independent predictors of death. The mean (+/- SD) FEV1 was 1.40 +/- 0.58 L. The most common comorbid diseases were hypertension (22%), coronary heart disease (8.9%), diabetes mellitus (7.4%), cancer (6.4%), heart failure (4.9%) and cerebrovascular disease (2%). The median follow-up was (+/- SD) 21 +/- 11 months. Twenty-four (5.9%) patients died during the follow-up period. Deaths from COPD were associated with FEV1 [RR 0.143 (95% CI 0.75-1.21)], heart failure (RR 0.177) and cancer (RR 0.064). In conclusion; while the most common comorbid diseases in COPD were hypertension, coronary heart disease and diabetes mellitus; FEV1, heart failure and cancer were associated factors with increased risk of death from COPD.

Acute respiratory failure and tracheal obstruction in patients with posterior giant mediastinal (intrathoracic) goiter.

The extension of a thyroid goiter into the mediastinum, commonly known as a substernal goiter, is commonly located in the anterior mediastinum. Substernal enlargement of a goiter can cause compression of several mediastinal structures including the trachea. Tracheal compression may rarely lead to acute respiratory failure. We present a patient with tracheal compression and respiratory failure due to a posterior mediastinal goiter in the light of the literature.

[Effects of salbutamol and ipratropium bromide on arterial blood gases in patients with stable COPD]. / Stabil KOAH'li hastalarda salbutamol ve ipratropium bromidin arteryel kan gazlari üzerine etkileri.

The aim of this study was to evaluate the acute effects of inhaled salbutamol and ipratropium bromide on arterial blood gases in patients with chronic obstructive pulmonary disease (COPD). We measured arterial blood gases and spirometry after inhalation of salbutamol (200 micro g) or ipratropium bromide (36 micro g) in 25 patients with COPD. After at least 2 days of washout period, the same patients inhaled the other drug, and the procedure of study was repeated. Blood specimens were taken just before the inhalation and at 5, 10, 20, 30, 60, 90,120 minutes after inhalation, and spirometry was done before and 60 minutes after inhalation. Both drugs caused a small decrease in PaO(2) levels, however the decrease in PaO(2) after inhalation of salbutamol was significantly higher than that after ipratropium (p< 0.05). Both drugs caused a little, but not statistically significant decrease in D(A-a)DO(2) and PaCO(2) (p> 0.05). There were a little increase in FEV1 and FVC at 60 minutes after inhalation of both drugs, especially with salbutamol, compared to ipratropium bromide; but both increases were statistically insignificant (p> 0.05). The results revealed that, salbutamol caused a significant, but small and transient decrease in PaO2 and a little, but insignificant increase in D(A-a)DO(2) when used in recommended doses. Although salbutamol and ipratropium bromide which are used in treatment of COPD, can cause small decreases in PaO(2) after inhalation, the declines are trancient and clinically insignificant.