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We question the perspective that curiosity and creativity stem from a shared novelty-seeking process. We emphasize that creativity has two distinct dimensions: Novelty and usefulness, each involving separate cognitive processes. These dimensions may not necessarily mutually reinforce each other. We contend that a more comprehensive model that encompasses the full scope of the creativity construct is needed.
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Creatividad , Conducta Exploratoria , Conducta Exploratoria/fisiología , Humanos , Cognición/fisiologíaRESUMEN
BACKGROUND: With the increased legalization of cannabis, a new unknown emerges for orthopaedic surgeons and their patients. This systematic review aimed to (1) evaluate complications of cannabis use; (2) determine the effects of cannabis on pain and opioid consumption; and (3) evaluate healthcare utilizations associated with cannabis use among patients undergoing total joint arthroplasty (TJA). METHODS: A systematic review was performed. A search of the literature was performed in 5 databases. We included studies between January 2012 and July 2022 reporting cannabis use and complications, pain management, opioid consumption, length of stay, costs, or functional outcomes following TJA. A meta-analysis of odds ratios (ORs) and continuous variables was performed. A total of 19 articles were included in our final analysis. RESULTS: Cannabis use was associated with higher odds for deep vein thrombosis (DVT) (OR: 1.46, 95% Confidence Interval [CI]: 1.13 to 1.89) and revisions (OR: 1.47 [95% CI: 1.41 to 1.53]) in total knee arthroplasty (TKA). Cannabis use was associated with similar odds for DVT in total hip arthroplasty (THA) (OR: 1.30 [95% CI: 0.79 to 2.13]), pulmonary embolus in both TKA (OR: 1.29 [95% CI: 0.95 to 1.77]), THA (OR: 0.55 [95% CI: 0.09 to 3.28]), and cardiovascular complications in TKA (OR: 1.97 [95% Cl: 0.93 to 4.14]). Cannabis use did not alter pain scores, opioid consumption, or cost of care in THA (estimate: $2,550.51 [95% CI: $356.58 to $5,457.62]) but was associated with higher costs in TKA (estimate: $3,552.46 [95% CI: $1,729.71 to $5,375.22]). There was no difference in lengths of stay or functional outcomes; however, there may be a potentially increased risk for prosthetic complications, pneumonia, and cerebrovascular accidents among cannabis users. CONCLUSION: Cannabis use may be associated with an increased risk of DVTs, revisions, pneumonia, cerebrovascular accidents, and cardiac complications after TJA. Higher-level studies are needed to ascertain the impact of cannabis use for patients undergoing TJA.
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Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Cannabis , Neumonía , Accidente Cerebrovascular , Humanos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Analgésicos Opioides/efectos adversos , Factores de Riesgo , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Cadera/efectos adversos , Neumonía/complicaciones , Accidente Cerebrovascular/etiología , Dolor/etiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: In this study, we aimed to evaluate quality of life and parental attitudes in children who underwent an atrial septal defect closure procedure with a transcatheter or surgical method in childhood and whether they continued their lives with similar activities to their healthy peers by comparing the two groups. METHODS: Patient forms to define sociodemographic and clinical features, the Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents (KINDL) to measure the quality of life of children, and the Parent-Child Relationship Test (Parental Attitude Research Instrument) to measure parental attitudes were used. RESULTS: The groups were similar in terms of age and sex. The mean quality of life scale scores were high in all groups, and there was no statistically significant difference between the scores. Parents of the patients who underwent closure received higher scores from the demographic attitudes and recognition of quality subdimension compared to the parents of the healthy group. CONCLUSIONS: The quality of life of children with atrial septal defect closure was found to be similar to their healthy peers. Additionally, the effects of surgical or percutaneous closure of atrial septal defect on quality of life are similar. Children with atrial septal defect closure perceive their health status as well as their healthy peers, and this perception does not cause any difference in the attitudes and behaviours of families.
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BACKGROUND: Succinate (SI) is a citric acid cycle metabolite that accumulates in tissues during hemorrhagic shock (HS) due to electron transport chain uncoupling. Dimethyl malonate (DMM) is a competitive inhibitor of SI dehydrogenase, which has been shown to reduce SI accumulation and protect against reperfusion injury. Whether DMM can be therapeutic after severe HS is unknown. We hypothesized that DMM would prevent SI buildup during resuscitation (RES) in a swine model of HS, leading to better physiological recovery after RES. METHODS: The carotid arteries of Yorkshire pigs were cannulated with a 5-Fr catheter. After placement of a Swan-Ganz catheter and femoral arterial line, the carotid catheters were opened and the animals were exsanguinated to a mean arterial pressure (MAP) of 45 mm. After 30 minutes in the shock state, the animals were resuscitated to a MAP of 60 mm using lactated ringers. A MAP above 60 mm was maintained throughout RES. One group received 10 mg/kg of DMM (n = 6), while the control received sham injections (n = 6). The primary end-point was SI levels. Secondary end-points included cardiac function and lactate. RESULTS: Succinate levels increased from baseline to the 20-minute RES point in control, while the DMM cohort remained unchanged. The DMM group required less intravenous fluid to maintain a MAP above 60 (450.0 vs. 229.0 mL; p = 0.01). The DMM group had higher pulmonary capillary wedge pressure at the 20-minute and 40-minute RES points. The DMM group had better recovery of cardiac output and index during RES, while the control had no improvement. While lactate levels were similar, DMM may lead to increased ionized calcium levels. DISCUSSION: Dimethyl malonate slows SI accumulation during HS and helps preserve cardiac filling pressures and function during RES. In addition, DMM may protect against depletion of ionized calcium. Dimethyl malonate may have therapeutic potential during HS.
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Choque Hemorrágico , Animales , Calcio , Modelos Animales de Enfermedad , Humanos , Lactatos , Malonatos , Resucitación , Ácido Succínico , PorcinosAsunto(s)
COVID-19 , Médicos , Ansiedad , Estudios Transversales , Humanos , Medicina Interna , Pandemias , SARS-CoV-2 , Centros de Atención TerciariaRESUMEN
BACKGROUND: The aim of the study was to compare the effects of rosmarinic acid and dexpanthenol in a rat experimental wound model. MATERIALS AND METHODS: Twenty-four Wistar albino rats weighing 200-250 g were randomly divided into three groups. After 2-cm full-thickness skin defects were created, the wounds were washed with sterile 0.9% NaCl solution. After washing, the control group was left untreated, the second group received 5% dexpanthenol cream, and the third group received 10% rosmarinic acid cream. Before excision, the skin was evaluated macroscopically by measuring the reduction in wound size; after excision, histological examination (epithelisation, inflammation, fibrosis, granulation) was performed. RESULTS: Macroscopic comparison of the wound sizes showed that group 3 showed a statistically significant difference in wound size reduction compared to the other two groups. Histopathological examination showed that there was no statistically significant difference between the groups. We found that the rosmarinic acid group had greater wound size reduction than the other two groups. However, epithelialisation was detected in fewer cases. CONCLUSIONS: We believe that rosmarinic acid can be used as a topical cream for wound healing, as it leads to significant reduction in wound size, resulting in fewer scars.
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Ácido Pantoténico , Cicatrización de Heridas , Animales , Cinamatos , Depsidos , Ácido Pantoténico/análogos & derivados , Ácido Pantoténico/farmacología , Ratas , Ratas Wistar , Piel , Ácido RosmarínicoRESUMEN
Extracorporeal shock wave lithotripsy (ESWL) is considered a safe technique, but not without complications, though the vast majority are minor complications. We describe a rare case of splenic injury after ESWL. A 33-year-old male presented to the emergency department (ED) after three weeks experiencing severe intermittent left-sided flank pain that he contributed to a previous motor vehicle accident. Then computerized tomography (CT) revealed a left renal stone. ESWL was performed after three weeks. After being discharged home, he returned the same day to the ED with persistent, worsening abdominal pain, hypotension, and multiple syncopes. CT demonstrated the presence of active contrast extravasation from the spleen likely due to active bleeding. Initial resuscitation was with intravenous fluids and blood products. The following day, the embolization of the splenic artery was done. The patient was discharged home after nine days of conservative management. After one month, he had shortness of breath due to a large left-sided pleural effusion and lung collapse managed with thoracocentesis and thoracoscopic surgery. Subsequent follow-up reveals much improvement and successful conservative management. Splenic injury is a rare complication of ESWL, and all of the 11 reported cases in the literature were managed with splenectomy. Our case is unique in being successfully managed conservatively.
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The navigation is a substantial issue in the field of robotics. Simultaneous Localization and Mapping (SLAM) is a principle for many autonomous navigation applications, particularly in the Global Navigation Satellite System (GNSS) denied environments. Many SLAM methods made substantial contributions to improve its accuracy, cost, and efficiency. Still, it is a considerable challenge to manage robust SLAM, and there exist several attempts to find better estimation algorithms for it. In this research, we proposed a novel Bayesian filtering based Airborne SLAM structure for the first time in the literature. We also presented the mathematical background of the algorithm, and the SLAM model of an autonomous aerial vehicle. Simulation results emphasize that the new Airborne SLAM performance with the exact flow of particles using for recursive state estimations superior to other approaches emerged before, in terms of accuracy and speed of convergence. Nevertheless, its computational complexity may cause real-time application concerns, particularly in high-dimensional state spaces. However, in Airborne SLAM, it can be preferred in the measurement environments that use low uncertainty sensors because it gives more successful results by eliminating the problem of degeneration seen in the particle filter structure.
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Robótica , Aeronaves , Algoritmos , Sistemas de Información GeográficaRESUMEN
BACKGROUND: The aim of the study was to investigate the protective effects of rosmarinic acid in rats exposed to hepatic ischaemia/reperfusion (I/R) injury. MATERIALS AND METHODS: Thirty-two rats were randomly classified into four groups of 8 rats each: laparotomy without medication, rosmarinic acid (dose of 50 mg/kg via oral gavage) followed by laparotomy, laparotomy followed by hepatic I/R, and hepatic I/R with rosmarinic acid. Serum aspartate aminotransferase, alanine aminotransferase, and malondialdehyde levels and total oxidant activity and total antioxidant capacity levels of the liver, lung, and kidney were assessed. The histopathologic assessment was also performed. RESULTS: Rosmarinic acid significantly reduced liver function test parameters and decreased oxidative stress and abnormal histopathologic findings in the liver. The oxidative stress in the lung significantly increased in the I/R group but significantly decreased in the I/R + rosmarinic acid group due to the addition of rosmarinic acid. Rosmarinic acid led to no reduction in oxidative stress in kidney following hepatic I/R injury. There were no statistically significant differences among the groups regarding histopathologic changes in kidney and lung sections. CONCLUSIONS: Rosmarinic acid has antioxidant properties and is an effective hepatoprotective agent. However, although rosmarinic acid provides useful effects in the lung by increasing antioxidant capacity and reducing oxidative stress after I/R injury, it does not ameliorate histopathologic changes. These findings suggest that rosmarinic acid is likely to provide favourable outcomes in the treatment of hepatic I/R injury.
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Antioxidantes/farmacología , Cinamatos/farmacología , Depsidos/farmacología , Riñón/efectos de los fármacos , Hígado/efectos de los fármacos , Pulmón/efectos de los fármacos , Daño por Reperfusión/patología , Animales , Hepatopatías/etiología , Hepatopatías/patología , Masculino , Estrés Oxidativo/efectos de los fármacos , Ratas , Ratas Wistar , Ácido RosmarínicoRESUMEN
INTRODUCTION: Vaccination against influenza on an annual basis is widely recommended, yet recent studies suggest consecutive vaccination may reduce vaccine effectiveness (VE). PURPOSE: To assess whether when examining the entirety of existing data consecutive influenza vaccination reduces VE compared to current season influenza vaccination. DATA SOURCES: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 26, 2017; citations of included studies. STUDY SELECTION: Randomized, controlled trials (RCTs) and observational studies of children, adults and/or the elderly that reported laboratory-confirmed influenza infection over 2 or more consecutive influenza seasons were eligible. DATA EXTRACTION: Data related to study characteristics, participant demographics, cases of influenza infection by vaccination group and risk of bias assessment was extracted in duplicate. DATA SYNTHESIS: Five RCTs involving 11,987 participants did not show a significant reduction in VE when participants vaccinated in two consecutive seasons (VE 71%, 95% CI 62-78%) were compared to those vaccinated in the current season (VE 58%, 95% CI 48-66%) (odds ratio [OR] 0.88, 95% CI 0.62-1.26, pâ¯=â¯0.49, I2â¯=â¯39%). Twenty-eight observational studies involving 28,627 participants also did not show a reduction (VE for two consecutive seasons 41%, 95% CI 30-51% compared to VE for current season 47%, 95% CI 39-54%; OR 1.14, 95% CI 0.98-1.32, pâ¯=â¯0.09, I2â¯=â¯63%). Results from subgroup analyses by influenza type/subtype, vaccine type, age, vaccine match and co-morbidity support these findings; however, dose-response results were inconsistent. Certainty in the evidence was assessed to be very low due to unexplained heterogeneity and imprecision. LIMITATIONS: The inclusion of studies with relatively small sample sizes and low event rates contributed to the imprecision of summary VE and OR estimates, which were based on unadjusted data. CONCLUSION: Available evidence does not support a reduction in VE with consecutive influenza vaccination, but the possibility of reduced effectiveness cannot be ruled out due to very low certainty in this evidence. FUNDING SOURCE: CIHR Foundation Grant (PROSPERO: CRD42017059893).
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Inmunogenicidad Vacunal , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Vacunación/métodos , Adulto , Anciano , Sesgo , Niño , Humanos , Esquemas de Inmunización , Gripe Humana/epidemiología , Gripe Humana/inmunología , Estudios Observacionales como Asunto , Oportunidad Relativa , Riesgo , Estaciones del Año , IncertidumbreRESUMEN
Van fish is a fish that can live in soda water at pH 9-10. Van fishing area is a very important source of protein for the people. The variations in tissue metal levels according to gender and weight in Van fish (Alburnus tarichi, Güldenstadt 1814) were studied. This study was conducted for the first time in Van fish. Which it is very important for living organisms Calcium(Ca), magnesium(Mg), sodium(Na), potassium(K), cobalt(Co), chromium(Cr) and lithium(Li) elements levels in the muscle, liver, gill, gonad, and brain tissues of Van fish were investigated by using inductively-coupled plasma-optic emission spectroscopy (ICP-OES). The results were evaluated in two groups as macro-elements(Ca, Mg, Na, K) and trace-elements(Co, Cr, Li). Cobalt concentration in brain tissue was found to be higher than those in other tissues. Also, male fish had higher metal concentrations than female fish and their metal levels in brain and gonad tissues varied with their weight (P<0.05). This study shows that consumption of Van fish can be consumed to supply some necessary minerals required for a healthy nutrition.(AU)
Peixes van são a única espécie de peixe vivendo em pH 9-10 no mundo. A área de pescaria Van é uma fonte importante de proteína para a população. As variações de niveis de metal nos tecidos de acordo com sexo e peso do peixe Van (Alburnus tarichi, Güldenstadt 1814) foram estudadas. Esse é o primeiro estudo conduzido com peixes Van. São importantes para organismos vivos o Calcio (Ca), magnésio (Mg), sódio (Na), potássio (K), cobalto (Co), cromio (Cr), e lítio (Li) e foi investigado o nível desses elementos no músculo, fígado, brânquia, gônada, e tecido cerebral dos peixes Van utilizando espectrometria de emissão atômica por plasma acoplado indutivamente (ICP-OES). Os resultados foram avaliados em dois grupos como macro-elementos (Ca, Mg, Na, K) e traços (Co, Cr, Li). Concentração de cobalto em tecido cerebral foi mais alto que em outros tecidos. Peixes machos tinham concentração mais alta de metais que fêmeas e os níveis de metal no cérebro e gônadas variava com seu peso (P<0.05). Esse estudo mostra que o consumo de peixe Van pode suplementar alguns minerais necessários para uma nutrição saudável.(AU)
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Animales , Análisis Espectral , Tejidos/anatomía & histología , Peces/anatomía & histologíaRESUMEN
Prolactinomas are the most common pituitary tumors but rarely seen in adolescent males. There is no indication for surgery both in micro- and macro-adenomas unless an urgent treatment is necessary. First line treatment is always medical with dopamine agonists. In this report, we presented a patient with pubertal arrest and giant prolactinoma that disappeared in a short time with cabergoline treatment.
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Antineoplásicos/uso terapéutico , Agonistas de Dopamina/uso terapéutico , Ergolinas/uso terapéutico , Neoplasias Hipofisarias/tratamiento farmacológico , Prolactinoma/tratamiento farmacológico , Cabergolina , Humanos , Masculino , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/patología , Prolactinoma/complicaciones , Prolactinoma/patología , Pubertad Tardía/etiología , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the effects of temporal lobe epilepsy (TLE) on corpus callosum (CC) morphometry in patients with TLE. METHODS: This retrospective study was conducted at the Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey between November 2010 and December 2013. The epileptic syndrome diagnosis was based on International League Against Epilepsy criteria, and this study was conducted on the MRIs of 25 epilepsy patients and 25 control subjects. We classified the patients according to their duration of epilepsy: <10 and >/=10 years. The projection area length (PAL) of the CC was also estimated. Total brain volumes (TBV) were measured on CT images. RESULTS: The mean values of TBV for patients with TLE and the control group were not statistically different, but the CC PAL values were statistically different. The mean CC PAL values of under and over 25 years of age in patients with TLE were statistically different. The mean values of TBV of under and over 10 years duration of TLE were small statistically, but the CC PAL values were statistically different. CONCLUSION: The results indicate a clear influence of TLE on the structure of the CC rather than TBV.
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Cuerpo Calloso/patología , Epilepsia del Lóbulo Temporal/patología , Adolescente , Adulto , Animales , Epilepsia del Lóbulo Temporal/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: Difficulties in the detection of pancreatic damage result in morbidity and mortality in cases of pancreatic trauma. This study was performed to determine factors affecting morbidity and mortality in pancreatic trauma. METHODS: The records of 33 patients who underwent surgery for pancreatic trauma between January 2004 and December 2013 were analyzed retrospectively. RESULTS: The types of injury were penetrating injury and blunt abdominal trauma in 75.8 and 24.2 % of all cases, respectively. Injuries were classified as stage 1 in 6 cases (18.2 %), stage 2 in 18 cases (54.5 %), stage 3 in 5 cases (15.2 %), and stage 4 in 4 cases (12.1 %). The average injury severity scale (ISS) value was 25.70 ± 9:33. Six patients (18.2 %) had isolated pancreatic injury, 27 (81.2 %) had additional intraabdominal organ injuries and 10 patients (30.3 %) had extraabdominal organ injuries. The mean length of hospital stay was 13.24 ± 9 days. Various complications were observed in eight patients (24.2 %) and mortality occurred in three (9.1 %). Complications were more frequent in patients with high pancreatic damage scores (p = 0.024), additional organ injuries (p = 0.05), and blunt trauma (p = 0.026). Pancreatic injury score was associated with morbidity, while the presence of major vascular injury was associated with mortality. CONCLUSIONS: Complications were significantly more common in injuries with higher pancreatic damage scores, additional organ injuries, and blunt abdominal trauma. Pancreatic injury score was associated with morbidity, while the presence of major vascular injury was associated with mortality.
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Traumatismos Abdominales , Páncreas , Pancreatectomía , Enfermedades Pancreáticas , Pancreatoyeyunostomía , Heridas no Penetrantes/complicaciones , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/mortalidad , Traumatismos Abdominales/cirugía , Adulto , Drenaje/métodos , Drenaje/estadística & datos numéricos , Femenino , Humanos , Masculino , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico , Evaluación de Procesos y Resultados en Atención de Salud , Páncreas/lesiones , Páncreas/cirugía , Pancreatectomía/métodos , Pancreatectomía/estadística & datos numéricos , Enfermedades Pancreáticas/diagnóstico , Enfermedades Pancreáticas/epidemiología , Enfermedades Pancreáticas/etiología , Pancreatoyeyunostomía/métodos , Pancreatoyeyunostomía/estadística & datos numéricos , Estudios Retrospectivos , Índices de Gravedad del Trauma , Turquía/epidemiología , Heridas no Penetrantes/diagnóstico , Heridas Penetrantes/complicaciones , Heridas Penetrantes/diagnósticoRESUMEN
CONTEXT: With more studies investigating effects of high serum lipid levels, new findings are emerging regarding the damage these biomolecules may cause. AIM: In this study we aimed to find a relation between neuropathy and hypertriglyceridemia in patients with metabolic syndrome (MS). MATERIAL AND METHODS: One hundred and twenty subjects (Ninety subjects with metabolic syndrome and 30 healthy controls) were included in the study. Subjects with MS were divided into three groups. HbA1C levels of the subjects were < 5.7% in group A, ≥ 5.7% - < 6.5% in group B, and ≥ 6.5% - < 8.0% in group C. Pin-Prick test and Semmes- Weinstein Monofilament were used for neurological examination. Electromyography was performed to patients with neuropathy to support the diagnosis. RESULTS: Neuropathy prevalence was found to be higher in the subjects with metabolic syndrome compared to control group. (9.9 %; 16.65 %; 23.31 % vs. 3.3%; in group A, group B, group C vs. healthy control group respectively) (p=0.003 for group A, p=0.0002 for group B, p=0.0002 for group C). There was an association between triglyceride levels and neuropathy in group C. CONCLUSION: Patients with MS may have more neuropathy risk than we estimate.
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Neoplasias de la Mama/patología , Mama/patología , Neoplasias Pulmonares/patología , Invasividad Neoplásica/patología , Adolescente , Anciano , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/secundario , Niño , Preescolar , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Invasividad Neoplásica/diagnóstico por imagenRESUMEN
AIM: Fetuin-A levels are reported to be low as a negative acute phase reactant in systemical inflammatory situations. Hashimoto thyroiditis is characterized with inflammation. In this study, we hypothesised that the serum fetuin A levels could be found to be low due to inflammation in patients with Hashimoto thyroiditis. For this purpose, serum fetuin A levels in patients with Hashimoto thyroiditis were compared with those in healthy subjects. METHODS: A total of 85 participants (11 male, 74 female, mean age: 38.60±10.14 years) were included. The patient group consisted of 44 Hashimoto thyroiditis patients with subclinical hypothyroidism (7 male, 37 female) and the control group consisted of 41 healthy subjects (4 male, 37 female). Groups were compared according to their demographic, anthropometric and biochemical data and serum fetuin-A levels. Correlation analysis was used for determining the relation between fetuin A levels and clinical parameters. RESULTS: Fetuin-A levels of the patient group were found lower than those of the control group (0.58±0.50 g/L versus 1.53±1.60 g/L, P=0.001). Fetuin-A levels were not correlated with clinical parameters such as TSH, C-reactive protein, body mass index, waist circumference, blood pressure, glucose, and lipids. CONCLUSION: These findings supported the hypothesis that serum fetuin A levels could be found to be low as a negative acute phase reactant in patients with Hashimoto thyroiditis. Fetuin A can be considered as an indicator of inflammation in Hashimoto thyroiditis.
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Enfermedad de Hashimoto/sangre , alfa-2-Glicoproteína-HS/análisis , Adulto , Consumo de Bebidas Alcohólicas/sangre , Biomarcadores , Glucemia/análisis , Presión Sanguínea , Índice de Masa Corporal , Proteína C-Reactiva/análisis , Femenino , Humanos , Hipotiroidismo/sangre , Inflamación/sangre , Lípidos/sangre , Masculino , Persona de Mediana Edad , Fumar/sangre , Tirotropina/sangre , Tiroxina/sangre , Circunferencia de la CinturaRESUMEN
BACKGROUND: Prosthetic valve thrombosis (PVT) is serious complication of valvular replacement surgery, and increased levels of anticardiolipin antibodies (aCL) are associated with thrombosis. The aim of this study was to evaluate the role of aCL in the development of PVT. PATIENTS AND METHODS: We studied the aCL IgM and IgG levels in 114 patients with PVT and 80 healthy patients with prosthetic valves without PVT or a history of thrombosis. All patients underwent detailed transthoracic, transesophageal echocardiographic and clinical examinations. Blood samples were obtained after transesophageal echocardiography. Tests were repeated 12 weeks apart in patients with aCL IgM or IgG positivity. RESULTS: The mean age, sex, presence of atrial fibrillation and cardiovascular risk factors, elapsed time after surgery, and prosthetic valve type and location were similar between patients with PVT and those without. Ineffective anticoagulation was significantly higher among patients with PVT (p < 0.001). The aCL IgM values were significantly higher and positive (> 40 MPL) in the PVT group compared with the control group (10.58 ± 15.90 MPL to 3.70 ± 2.30 MPL, p < 0.001; 7.0 to 0 %, p = 0.016, respectively). The aCL IgG values were significantly higher and positive (> 40 GPL) in the PVT group compared with the control group (12.04 ± 17.58 GPL to 3.83 ± 2.56 GPL, p < 0.001 and 7.9 to 0 %, p = 0.01, respectively). According to international consensus documents, 16 patients had antiphospholipid syndrome. Ineffective anticoagulation and aCL IgM and IgG positivity were independent predictors of PVT in logistic regression analysis (multivariate r(2)= 0.648; p < 0.001, OR= 21.405, 95 %CI= 8.201-55.872; p = 0.008, OR= 1.322, % 95CI= 1.076-1.626; p = 0.005, OR= 1.288, 95 %CI= 1.079-1.538). CONCLUSION: Since the presence of aCL IgM and IgG positivity may cause a tendency toward PVT, these values should be examined in all patients with PVT.
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Anticuerpos Anticardiolipina/inmunología , Síndrome Antifosfolípido/inmunología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Trombosis/inmunología , Adulto , Biomarcadores/sangre , Estudios Transversales , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Trombosis/diagnóstico , Trombosis/etiología , Resultado del TratamientoRESUMEN
PURPOSE: This study evaluated levels of metabolic control, resource use and quality of life in Turkish patients with type 2 diabetes initiated on insulin in routine care. PATIENTS AND METHODS: The prospective, observational TREAT study evaluated patients from five different countries who were initiated on insulin and followed for 24 months. In this paper, we present the results of a cohort analysis specific to Turkish patients from the study. RESULTS: A total of 211 patients in the Turkish multicenter cohort [male patients 50.2%, age 56.5 year±8.9 SD, body mass index (BMI) 30.6 kg/m2±5.4 SD, diabetes duration 9.7 year±5.9 SD] initiated insulin at baseline. Oral antidiabetic drugs had been used by 93.4% of patients prior to insulin initiation, and 65.9% had used more than one regimen. Pre-existing metformin therapy was continued by 68.7% of patients after insulin initiation. In the three most common insulin regimens, glycosylated haemoglobin (HbA1C) declined over 24 months from 10.27% to 7.82% (long/intermediate acting), from 10.82% to 7.52% (premixed) and from 10.42% to 7.67% (basal-bolus). Less than 25% achieved a glycaemic goal of HbA1C≤7.0% and changes in insulin dose or regimen rarely occurred. Premixed insulin regimens were associated with greatest weight gain. Hypoglycaemic episodes were reported by more patients at 3, 6 and 12 months than at baseline or at 18 or 24 months. Healthcare use increased over baseline levels in the first 6 months, but was closer to baseline levels at subsequent assessments. Patient recorded health profiles improved after initiating insulin, particularly quality of life scores related to psychological distress and pain/discomfort. Morisky scores predictive of medication adherence and treatment persistence also improved. CONCLUSIONS: In Turkish patients with type 2 diabetes, metabolic control remained suboptimal after initiating insulin as part of routine care even after 24 months of insulin treatment. Apparent shortcomings in routine care in most patients included a high baseline HbA1C because of delayed insulin initiation and an unwillingness to individualise insulin regimens.