Effectiveness of multimedia-assisted training on inhaler usage technique, which is the optimum technique?

OBJECTIVE: In this study, we aimed to investigate the most appropriate education method for patients to use their inhaler devices with the proper technique. PATIENTS AND METHODS: The study had a cross-sectional, multicenter design. 525 consecutive patients who had never used an inhaler therapy before were included in the study. Seven different types of inhalers were evaluated. 75 patients were included for each device type. For each device type, 25 patients were trained by their own physicians who personally demonstrated the use of the device [verbal education with physical demonstration (VEWPD)], 25 were given multimedia-assisted training (MAT), and 25 received both types of training together (first VEWPD followed by MAT). After the patients were trained, inhaler medications were used under the supervision of a physician. Correct use of the inhaler devices and perceptions of convenience were scored. RESULTS: For Ellipta inhaler device and Levered Diskus inhaler device, the proportion of patients using their devices properly was significantly higher in patients who were instructed with both of the methods together compared to other education groups (p = 0.011, p = 0.015). The effects of different types of training on learning in Sanohaler, Diskus inhaler, and Pressurized metered dose inhaler devices were the same. CONCLUSIONS: We could not come to a conclusion that multimedia training was more beneficial than other training. As an unexpected result, in almost all of the devices, patients who received multimedia training in combination with verbal training did not develop better learning despite being shown the use of the device twice (except Ellipta inhaler, and Levered Diskus inhaler device).

Frequencies of organophosphate resistance-associated mutations in the acetylcholinesterase gene of field collected olive fly (Bactrocera oleae) populations under different insecticide regimes.

In the present study, the frequencies of three organophosphate (OP) resistance-associated mutations in acetylcholinesterase gene of Bactrocera oleae (BoAce) populations collected from 8 different important olivegrowing areas in the west part of Turkey were determined. Populations were sampled from the areas that have been treated with only the pyrethroid α-cypermethrin; pyrethroids plus OPs; deltamethrin with pheromone eco-traps, and no insecticide treatment applied areas for many years. For Ile214Val and Gly488Ser point mutations PCR-RFLP and for Δ3Q deletion mutation PCR diagnostic tests were carried out. Seventy-two percent of the total individuals analyzed in the study were exhibited heterozygous genotype (RS) for both Ile214Val and Gly488Ser point and homozygous susceptible genotype (SS) for Δ3Q deletion mutations. This RS/RS/SS combination together with RS/RR/SS with the frequency of 13% were the most common two combinations observed in all of the populations under different insecticide regimes, even in the populations under no insecticide pressure for many years. Independent evaluation of the three mutations resulted in 0.450, 0.534 and 0.037 frequency values for the resistant alleles of 214Val, 488Ser and Δ3Q mutations, respectively. Among the studied populations, the frequencies of resistant alleles for the positions of 214 and 488 were not differed from each other. However, in 3 of the populations the frequency of the R allele of Δ3Q was zero and it changed between 0.025 and 0.100 in the remaining five populations. Results of this study contributed to the distribution pattern of the two point mutations in Europe and a pattern for Δ3Q mutation was determined for the first time in the field collected olive fly samples.

The genetic basis of malathion resistance in housefly (Musca domestica L.) strains from Turkey.

Organophosphate insecticide (parathion/diazinon) resistance in housefly (Musca domestica L.) is associated with the change in carboxylesterase activity. The product of MdalphaE7 gene is probably playing a role in detoxification of xenebiotic esters. In our research, we have isolated, cloned and sequenced the MdalphaE7 gene from 5 different Turkish housefly strains. High doses of malathion (600 microg/fly) were applied in a laboratory environment for one year to Ceyhan1, Ceyhan2, Adana and Ankara strains while no insecticide treatment was performed in the laboratory to Kirazli strain. Trp251 --> Ser substitution was found in the product of MdalphaE7 gene in all malathion resistant and Kirazli stocks. In addition, we checked the malathion carboxylesterase (MCE), percent remaining activities in acetylcholinesterase (AChE), glutathion-S-transferase (GST), and general esterase activities in all 5 strains used in this study. In comparing with universal standard sensitive control WHO, a high level of MCE and GST activities were observed while lower level of general esterase activities was detected in the tested strains. In addition, a higher percent remaining activities in AChE than WHO susceptible strain were observed in all malathion resistant strains.

Effect of Helicobacter pylori eradication on peptic ulcer disease complicated with outlet obstruction.

BACKGROUND: At present, the prevalence of Helicobacter pylori (H. pylori) in complicated peptic ulcer and the effect of H. pylori eradication on complicated peptic ulcer have not been fully established. In this study, we report the prevalence of H. pylori in peptic ulcer patients complicated with gastric outlet obstruction, effectiveness of oral eradication therapy on these patients, and their long-term follow up. PATIENTS AND METHODS: Ten consecutive patients presenting with clinically and endoscopically significant obstructed peptic ulcers were included in this study. During each endoscopy, seven gastric biopsy specimens were obtained and analyzed for H. pylori colonization. RESULTS: The antral mucosal biopsy specimens were positive for H. pylori in nine patients. H. pylori infection was eradicated and complete ulcer healing was observed in all patients. The mean follow-up period was 14 (7-24) months. One patient had duodenal perforation and underwent surgical intervention following medical treatment, despite the eradication of H. pylori. Ulcer recurrence was noted in two (22.2%) of nine patients, and in one of them the recurrent ulcer was complicated with obstruction (11. 1%). The mean time to ulcer recurrence was 17 months (range, 10-24 months). The biopsies and CLOtests were H. pylori negative at the time of ulcer or erosion recurrence in two patients. CONCLUSION: We suggest that H. pylori eradication may improve the resolution in obstructive ulcer cases with colonization.

The effect of dividing the sphincter of Oddi at endoscopic sphincterotomy on the filling and emptying aspects of function of the gallbladder.

The effect of dividing the sphincter of Oddi at endoscopic sphincterotomy (EST) on the filling and emptying aspects of gallbladder function has not been definitely established in humans. This prospective study is designed to examine the effects of EST on gallbladder emptying. In 13 patients (8 men and 5 women; mean age, 60.54 years +/- 2.14; range, 45-75 years), postprandial gallbladder emptying was measured ultrasonographically before and after EST (within 1-4 days). The fasting volumes after 8 hours of fasting, at times 0 min and before the test meal was given, residual volume (the smallest postprandial volume), gallbladder ejection fraction (EF), and total ejection volume, at 10, 20, 30, 40, 50, 60, 70, 80, and 90 min after the test meal, were studied. The fasting gallbladder volume and the residual volume tended to decrease after EST, but the differences were not significant (40.21 +/- 10.79 mL and 35.48 +/- 11.21 mL, 17.79 +/- 4.83 mL, and 13.10 +/- 4.83 mL, respectively; p > 0.05). Maximum EF was found to be 19.72% at 40 min and increased to 28.62% at 70 min after EST. Although the difference was not statistically relevant, a trend of improvement was evident after EST. The ejected volumes after EST have depicted a trend toward increase, without reaching to any statistical significance (p > 0.05). Our results demonstrate at least no adverse effects of EST and further support some positive effects on gallbladder kinetics.

Mirizzi syndrome: choice of surgical procedure in the laparoscopic era.

Impaction of a calculus in gallbladder neck or cystic duct or even in its remnant may produce common hepatic duct stricture by direct mechanical impression or associated inflammation. This clinical entity is referred to as Mirizzi syndrome. Four patients were operated on for Mirizzi syndrome. This represents 0.9% of the 444 patients who underwent laparoscopic cholecystectomy in our clinic. Two cases with Mirizzi syndrome type I, one of which had a stone in a gallbladder remnant, were successfully treated by laparoscopic cholecystectomy without any complications. One patient developed a bile leakage; fistulography via a sump drain revealed bile leakage from the laceration site of the stone, and the patient was reoperated on to perform a Roux-en-Y hepaticojejunostomy. The patient was lost due to cardiopulmonary arrest originating from septic shock. In another case diagnosed as Mirizzi type II, the operation was converted to an open procedure due to intense inflammation and fibrosis around the area of the Calot's triangle. Subtotal cholecystectomy was done and the defect on the common hepatic duct repaired by means of a gallbladder flap over the T tube.

Crohn's disease of the esophagus.

A 26-yr-old woman presented with odynophagia, dysphagia, and intermittent bloody stools. Clinical, endoscopic, and microscopic evidence confirmed the diagnosis of severe Crohn's disease of the oropharynx, esophagus, proximal stomach, terminal ileum, and colon.

Tracheal carinal angle and left atrial size.

Left atrial enlargement is a significant finding, usually indicating elevated left ventricular end-diastolic pressure. An increased tracheal carinal angle has been reported as one indicator on chest radiography of left atrial enlargement. This study retrospectively compared echocardiographically determined left atrial size with carinal angle on plain films. Enlarged left atria and paired, age-matched normal left atria by echocardiography were selected. The carinal angle was measured on roentgenogram (standard and portable films) by goniometer. The left atrium could be accurately predicted to be larger than 5.0 cm in diameter if the carinal angle was 100 degrees or greater. A carinal angle greater than 100 degrees is an easy, inexpensive, reliable method of predicting left atrial enlargement.