Hospital-acquired pressure injury: our seven years of experience.

OBJECTIVE: A pressure injury (PI) happens on the skin and in deeper tissues. Generally, it occurs due to prolonged compression over bony structures. A PI, when occurring during a hospital stay, is regarded as a hospital-acquired pressure injury (HAPI), and is considered as a marker for patient care quality. It might cause medical, legal or economic problems, and could be a burden on health systems. In this study we evaluate the factors contributing to HAPI formation. METHOD: Between June 2014-June 2021, we retrospectively investigated the files of patients who were hospitalised with different medical conditions in Bayindir Sögütözü Hospital, Ankara, Turkey, for patients' age, sex, Waterlow scale score, mobilisation status, application of zinc-containing and/or barrier creams (ZnBC), airbed usage, hospitalisation period, and the day of wound opening. RESULTS: The study cohort comprised 2327 hospitalised patients: 303 (13%) developed Stage 2 and deeper PIs; 2024 patients were hospitalised and discharged without wound opening. We found an increased risk in male patients and a lack of efficacy of ZnBC in protection from HAPI in our study population. However, we observed that ZnBC helped to delay wound opening and that the most protective treatment was the use of airbeds. CONCLUSION: Health professionals should be more aware of HAPI formation with prolonged hospitalisation periods. Only the use of an airbed for a patient hospitalised for a long period appears to be protective against PI formation. On the other hand, use of ZnBC delays wound opening. However, further research is needed to demonstrate the protective effect of ZnBC, due to the lack of randomisation in our study and the lack of some nursing records.

Evaluation of irrational drug use of individuals over the age of 18 who applied to a university hospital.

BACKGROUND: Irrational drug use not only causes a delay in the treatment of patients, failure to achieve full well-being, drug interactions and side effects, drug resistance but also creates economic negativities such as waste of resources and unnecessary workload. This study aims to investigate the irrational drug use behaviors of individuals over the age of 18 who applied to a university hospital. METHODS: This sectional study included 1247 people over the age of 18 who applied for Gazi University Health, Research and Application Center. A questionnaire was applied to the applicants by face-to-face interview technique. Logistic regression analysis was performed among the factors associated with the subcomponents of irrational drug use. RESULTS: Participants (20.1%) used medication without a doctor's prescription (self-medication), 3.4% did not comply with the recommended dose and duration for medications, 47.4% applied to the physician to prescribe the medication they wanted, 65% had medication for later use at home. It was determined that 24.1% of them used drugs without looking at the expiration date and 45.5% of them used drugs without reading the patient information leaflet. Among the risk groups identified for the different irrational drug use behaviors mentioned are the following: males, lower educational groups, housewives, not having social insurance, continuous drug users. DISCUSSION: Irrational drug use behaviors are still observed in society. The fact that the risk is higher in lower education groups is an example of the negative consequences of limited health literacy. The fact that different risk groups have been identified for different behaviors related to irrational drug use shows that intervention studies on this subject should be directed to specific groups. The effect of having social security reveals its connection with universal health coverage and rational drug use.

Evaluation of the effect of methylprednisolone and N-acetylcystein on anastomotic degeneration and regeneraton of the facial nerve.

OBJECTIVES: This study was aimed to determine the effects of methylprednisolone and N-acetylcystein on nerve healing in facial nerve anastomosis. METHODS: Thirty rabbits were randomly divided into 3 groups: Group I: control group received no medication; Group II: 50mg/kg/day N-acetylcystein administered group; Group III, 1mg/kg/day Methylprednisolone administered group. All rabbits underwent the same standard surgical procedure. A 1mm segment was resected from the facial nerve and the free ends were anastomosed. The drugs were administered for two months twice a day. At the end of the second month, the anastomosed regions were dissected and examined under electron and light microscopy. RESULTS: Best nerve regeneration was observed in the N-acetylcystein and the control groups, respectively, whereas the weakest regeneration was determined in the methylprednisolone group. In the N-acetylcystein group, due to Schwann cell and glial cell proliferation, the increased regeneration rate was significantly higher compared to that of the methylprednisolone group. In the methylprednisolone group, no significant regeneration was observed despite the presence of degenerative signs of significant axonal withdrawal and an increase in the number of myelin debris. CONCLUSION: In the present study, we demonstrated that methylprednisolone had no beneficial effect in nerve regeneration after facial nerve anastomosis. It further caused increased degeneration. On the contrary, N-acetylcystein administration significantly increased the extent of regeneration, whereas it decreased the extent of degeneration compared to the control and the methylprednisolone groups.

Efficacy of glial growth factor and nerve growth factor on the recovery of traumatic facial paralysis.

The aim of this study was to assess the effects of Glial growth factor (GGF) and nerve growth factor (NGF) on nerve regeneration in facial nerve anastomosis. In this study, approximately a 1-mm segment was resected from the facial nerve and the free ends were anastomosed. All animals underwent the same surgical procedure and 30 rabbits were grouped randomly in three groups. Control group, the group without any medications; NGF group, the group receiving 250 ng/0.1 ml NGF in the epineurium at the site of anastomosis; GBF group, the group receiving 500 ng/0.1 ml GGF in the epineurium at the site of anastomosis. Medications were given at the time of surgery, and at 24 and 48 h postoperatively. After 2 months, the sites of anastomosis were excised and examined using the electron microscope. It was found that the best regeneration was in the group receiving GGF as compared to the control group in terms of nerve regeneration. Schwann cell and glial cell proliferation were found to be significantly higher in the group receiving GGF as compared to the group receiving NGF. Besides, the number of myelin debris, an indicator of degeneration, was significantly lower in the group with GGF as compared to NGF and control groups (p < 0.005). Using GGF and NGF in order to increase regeneration after nerve anastomosis in experimental traumatic facial nerve paralysis may be a hopeful alternative treatment option in the future. However, further studies on human studies are required to support these results.

[Ear symptoms accompanying temporomandibular joint diseases]. / Temporomandibüler eklem hastaliklarinda kulakla ilgili semptomlar.

OBJECTIVES: We investigated symptoms of otologic diseases in patients with temporomandibular joint diseases. PATIENTS AND METHODS: The study included 44 patients (26 females, 18 males; mean age 36+/-10.7 years; range 21 to 58 years) with temporomandibular joint disease. A questionnaire was administered to the patients to inquire into otological symptoms accompanying temporomandibular joint disease. RESULTS: Temporomandibular joint disease was bilateral in 11 patients. Accompanying otological symptoms were as follows: click voice with jaw movements (n=21; 47.7%), headache (n=15; 34.1%), pain in the ear with jaw movements (n=14; 31.8%), tinnitus (n=8; 18.2%), fullness in the ear (n=6; 13.6%), vertigo or dizziness (n=6; 13.6%), and hearing loss (n=3; 6.8%). Pure-tone audiometry revealed sensorineural hearing loss in one patient, being 28 dB on the right and 30 dB on the left. CONCLUSION: Our findings suggest that otologic symptoms may accompany temporomandibular joint diseases, requiring that patients presenting with otologic symptoms must be investigated for temporomandibular joint diseases.

Roles of free radicals, nitric oxide, and scavenging enzymes in nasal polyp development.

The aim of this study was to investigate the role of nitric oxide (NO), free oxygen radicals, and scavenging enzymes in the development of nasal polyp (NP) disease. This study included 41 patients who underwent endoscopic surgery because of NPs. Control specimens were taken from the inferior turbinate of 32 patients who underwent septoplasty. The levels of malondialdehyde (MDA), NO, and superoxide dismutase (SOD) were measured in intraoperative specimens of polyp tissue and turbinate mucosa. The levels of tissue NO were 191.06 +/- 26.62 micromol/mg of protein in patients with NPs and 145.30 +/- 19.19 micromol/mg of protein (p < .001) in the control group. The levels of MDA in the study and control groups were 12.47 +/- 2.12 nmol/mg and 8.83 +/- 1.08 nmol/mg (p < .01), respectively. The levels of SOD in the study and control groups were 50.77 +/- 14.74 U/mg and 77.93 +/- 15.31 U/mg (p < .001), respectively. It was determined that the levels of MDA in plasma and erythrocytes were higher in the patients with NPs than in the control group (p < .05). The levels of NO in plasma and erythrocytes in both groups were similar. The levels of SOD in plasma and erythrocytes were lower in patients with NPs than in the control group (p > .05). Increases in the levels of tissue MDA and NO and decreases in scavenging enzymes in patients with NPs as compared to control groups may indicate the presence of free radical damage in patients with nasal NPs. New studies are needed to clarify the efficacy of using antioxidants in the treatment of NPs.

The role of viruses in idiopathic peripheral facial palsy and cellular immune response.

PURPOSE: The purpose of this study is to investigate the role of viruses on the idiopathic peripheral facial palsy and show the interaction of immune system. MATERIALS AND METHODS: The levels of immunoglobulin (Ig) G and IgM antibodies against to varicella-zoster virus (VZV), herpes simplex virus (HSV), cytomegalovirus (CMV), Ebstein-Barr virus (EBV), and mumps virus in venous blood taken from patients in the amount of 10 mL have been investigated by enzyme-linked immunosorbent assay method. Tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and transforming growth factor-beta (TGF-beta) were also examined. Of lymphocyte subpopulation, antibodies of CD3(+), CD4(+), CD8(+), CD19(+), and CD16(+) plus 56(+) were analyzed. RESULTS: Ten of the patients had HSV-1 IgG; 1 of the patients IgM, 5 of the patients EBV IgG, 6 of the patients VZV IgG, 1 of the patients IgM, 9 of the patients mumps IgG, 1 of the patients IgM, and finally in 7 of the patients CMV IgG antibodies were obtained. It was found that CD4(+) cell and ratio of CD4(+)/CD8(+) lower and the percentage of the CD8(+) and CD16(+) plus 56(+) cells higher compared with the control group (P < .05). The levels of TNF-alpha were lower, whereas IFN-gamma and TGF-beta1 were higher. CONCLUSION: It may be concluded from these results that VZV, HSV-1, CMV, EBV, and mumps virus play a significant role in the etiology of idiopathic peripheral facial palsy and activate the cellular immunity.

Comparative analysis of serum homocysteine, folic acid and Vitamin B12 levels in patients with noise-induced hearing loss.

OBJECTIVE: The aim of the present study was to determine the levels of homocysteine, folic acid, and Vitamin B12 in subjects with noise-induced hearing loss. Furthermore, possible links between these parameters and noise-induced hearing loss were aimed to be evaluated. METHODS: In the present study, blood samples were obtained from all subjects after overnight fasting for biochemical analysis. We examined the levels of homocysteine, Vitamin B12 and folic acid levels in subjects with noise-induced hearing loss. Twenty-eight male patients with noise-induced hearing loss (mean age 37 +/- 5 year) were included in the study group whereas the control group was composed of 32 healthy male volunteers (mean age 36 +/- 4 year). RESULTS: It was found that homocysteine levels of subjects with noise-induced hearing loss as significantly high compared to healthy controls (P < 0.05). On the other hand, Vitamin B12 and folic acid levels of patients with noise-induced hearing loss were determined to be significantly low compared to the controls (P < 0.05 and < 0.01, respectively). CONCLUSION: Our findings indicate that there might be a link between increased homocysteine levels and noise-induced hearing loss. Since increased homocysteine levels cause elevated levels of free radicals in addition to its atherogenic and thrombogenic effects. Further experimental studies are needed to decipher how this relationship is linked.

[The levels of vitamins A, E, B12 and folic acid in noise-induced hearing loss]. / Gürültüye bagli isitme kayipli hastalarda vitamin A, E, B12 ve folik asit düzeyleri.

OBJECTIVES: To investigate the levels of vitamin A, E, B12, folic acid in employees with hearing loss due to noise. PATIENTS AND METHODS: Employees in a local hydroelectric powerhouse who suffered from hearing loss due to noise were included in the study. Study and control groups were composed of 28 employees (mean age 37+/-5 years) and 30 voluntary subjects (mean age 36+/-4 years), respectively. All the subjects in patient and control groups were males. Blood samples were obtained from all subjects and vitamin A, E, B12 and folic acid levels were measured. RESULTS: Level of vitamin B12 was found low in the patient group and normal in the control group and these were found statistically significant (p<0.005). There were no significant differences between vitamin A, E and folic acid levels. CONCLUSION: We think that measurement of vitamin B12 in routine control of the people who are working in noisy environment may be useful.

Early stage impacts of tonsillectomy on immune functions of children.

OBJECTIVE: The purpose of this study was to investigate the changes in the humoral and cellular immunity of patients with chronic tonsillitis before and 1 month after tonsillectomy. PATIENTS AND METHODS: 37 patients scheduled for tonsillectomy were enrolled in this study. The levels of CD3+, CD4+, CD8+, CD19+, CD25+ and CD16+ + 56+ were measured for cellular immunity, and levels of IgG, IgA, IgM, C3 and C4 were measured for humoral immunity in blood samples taken from these patients before and 1 month after the operation. RESULTS: The levels of CD3+, CD8+ and CD19+ were reduced in post-operative period as compared to pre-operative period but this was not statistically significant (P > 0.05). However it was found that the level of CD4+ was significantly increased while the level of CD25+ was reduced (P < 0.05) in the post-operative period. There were statistically significant differences between pre- and post-operative levels of immunoglobulins, C3 and C4, which were decreased after tonsillectomy (P < 0.05), but these levels were comparable with those of the control group. CONCLUSION: The results from the present study indicate that humoral and cellular immunity of patients undergoing tonsillectomy were decreased in the early period and came to normal later. The cellular and humoral immune responses are stimulated in patients with tonsillitis, and tonsillectomy removes this stimulus without negatively affecting the patient's immune functions.

Ectopic thyroid and Hashimoto's thyroiditis arising from a thyroglossal duct cyst: a case report.

A seventy-five-year-old male patient presented with a palpable smooth mass that moved upwards on swallowing, extending from the hyoid bone to the cricoid cartilage. Ultrasonography, scintigraphy, and thyroid hormone measurements showed the mass free from the thyroid gland. Following a diagnosis of infected thyroglossal duct cyst by fine needle aspiration biopsy, the mass was removed by surgery. Histopathologic diagnosis was Hashimoto's thyroiditis that developed from the ectopic thyroid tissue on the wall of thyroglossal duct cyst.