Comparison of artificial intelligence-assisted informed consent obtained before coronary angiography with the conventional method: Medical competence and ethical assessment.

Objective: At the time of informed consent (IC) for coronary angiography (CAG), patients' knowledge of the process is inadequate. Time constraints and a lack of personalization of consent are the primary causes of inadequate information. This procedure can be enhanced by obtaining IC using a chatbot powered by artificial intelligence (AI). Methods: In the study, patients who will undergo CAG for the first time were randomly divided into two groups, and IC was given to one group using the conventional method and the other group using an AI-supported chatbot, chatGPT3. They were then evaluated with two distinct questionnaires measuring their satisfaction and capacity to understand CAG risks. Results: While the satisfaction questionnaire was equal between the two groups (p = 0.581), the correct understanding of CAG risk questionnaire was found to be significantly higher in the AI group (<0.001). Conclusions: AI can be trained to support clinicians in giving IC before CAG. In this way, the workload of healthcare professionals can be reduced while providing a better IC.

Xenophobia and medicine (profession of a doctor): can the two coexist in the 21st century? / Xenofobia y medicina (profesión del médico): ¿pueden ambas coexistir en el siglo XXI? / Xenofobia e medicina (profissão de um doutor): podem os dois coexistirem no Século 21?

Abstract: This study was conducted to reveal how physicians view the access of refugees, who have difficulties in accessing health services and who may experience various health rights violations, to health services and to discuss the case in terms of medical ethics and deontology. Xenophobia, which is one of the main causes of discrimination in health, needs to be evaluated. In this context, quantitative research methods were used to measure the xenophobia levels of physicians working in Eskişehir province. Stratified sampling method was used to evaluate the views of the physicians. The study data were collected through the Xenophobia Scale developed by Kees Van Der Veer et al. and a questionnaire created by the researchers. The age distribution of the physicians in the study was 38,069±10,337. The distribution of the scores obtained from the xenophobia scale was found to be high (56.20±11.54). Of the physicians in the study, 34.3% stated that they would not want to provide health services for refugees if they were given the right to choose. They mainly thought that health services should not be provided free of charge for refugees and should be provided in separate places, refugees affected the access of the citizens of the Turkish Republic to health services negatively, the number of children should be limited, refugees would increase violence in health and public health problems, and that there should be an interpreter in health institutions. "Refugees do not deserve discrimination in health services" in terms of medical ethics. "Physicians should reach a common consensus against all kinds of discrimination while carrying out their profession." When xenophobia shows its effect in the field of health, it turns into a phenomenon that damages human dignity, causes all kinds of inequality, and moves medicine away from its deontology.

Resumen: Se realizó este estudio para revelar cómo ven los médicos el acceso de refugiados con dificultades para acceder a servicios de salud y que sufren violaciones a sus derechos de salud, y para discutir el caso desde la ética médica y la deontología. La xenofobia es una de las principales causas de discriminación en cuidados de salud, por lo que necesita ser evaluada. En este contexto, se usaron métodos de investigación cuantitativa para medir los niveles de xenofobia de médicos que trabajan en la provincia de Eskişehir. Se usó un método de muestra estratificada para evaluar los puntos de vista de los médicos. Los datos del estudio fueron recolectados mediante la escala de Xenofobia desarrollada por Kees Van Der Veer y colaboradores, y mediante un cuestionario creado por los investigadores. La distribución de la edad de los médicos que participaron en el estudio fue de 38,069±10,337. Se encontró que la distribución de los puntajes obtenidos de la escala de xenofobia fue alta (56.20±11.54). De los médicos del estudio, 34.3% manifestó que no proporcionarían servicios de salud a los refugiados si se les diera el derecho a elegir. Principalmente pensaban que los servicios de salud no debieran proporcionarse gratis a los refugiados, debiera hacerse en lugares separados, los refugiados restringen el acceso a los servicios de salud de los ciudadanos de la República de Turquía, debiera limitarse el número de niños, los refugiados incrementan los problemas de violencia y salud pública y debiera haber intérpretes en las instituciones de salud. De acuerdo con la ética médica, "los refugiados no merecen ser discriminados en los servicios de salud". "Los médicos debieran llegar a un consenso común en contra de toda clase de discriminación mientras que cumplen con su profesión". Cuando la xenofobia muestra sus efectos en el campo de la salud, se transforma en un fenómeno que daña la dignidad humana, causa toda clase de desigualdades y lleva a la medicina a apartarse de su deber.

Resumo: Esse estudo foi realizado para mostrar como médicos veem o acesso de refugiados -que tem dificuldades em acessar serviços de saúde e que podem experimentar diversas violações em direitos à saúde- a serviços de saúde e para discutir o situação em termos de ética médica e deontologia. Xenofobia, que é uma das principais causas de discriminação na saúde, necessita ser avaliada. Nesse contexto, métodos de pesquisa quantitativa foram utilizados para medir os níveis de xenofobia de médicos trabalhando na província de Eskisehir. Métodos de amostragem estratificada foram utilizados para avaliar o ponto de vista dos médicos. Os dados do estudo foram coletados através da Escala de Xenofobia desenvolvida por Kees Van Der Veer et al. e um questionário criado pelos pesquisadores. A distribuição etária dos médicos no estudo foi 38,069±10,337. A distribuição dos escores obtidos na escala de xenofobia foi alta (56.20±11.54). Dos médicos no estudo, 34,3% afirmaram que eles poderiam não querer prestar serviços de saúde para refugiados se fosse dado a eles o direito de escolher. Eles principalmente pensam que serviços de saúde não deveriam ser fornecidos gratuitamente para refugiados e que deveriam ser fornecidos em lugares separados, que refugiados afetam negativamente o acesso de cidadãos da República Turca a serviços de saúde, que o número de crianças deveria ser limitado, que os refugiados poderiam aumentar a violência na saúde e os problemas de saúde pública, e que deveria haver um intérprete nas instituições de saúde. "Refugiados não merecem ser discriminados em serviços de saúde" em termos de ética médica. "Médicos deveriam alcançar um consenso contra todas as formas de discriminação quando no exercício de sua profissão". Quando a xenofobia mostra seus efeitos no campo da saúde, ela se transforma em um fenômeno que danifica a dignidade humana, causa todas as formas de desigualdades e afasta a medicina para longe de sua deontologia.

A giant cystic echinococcosis of the lung in East Turkey.

INTRODUCTION: Hydatid cyst disease is a zoonosis provoked by Echinoccocus. PRESENTATION OF CASE: 17 year old male applied to our clinic with complaints of fatigue, lassitude, right chest pain and spitting of watery expectoration proceeding in 6 months. Computed tomographic scan indicated a 130*110 mm smooth contoured cavitary lesion located in the right middle lobe of the lung. Treatment with cystotomy and capitonnage successfully. Histopathologic examination confirmed hydatid cyst. The patient recovered from all his complaints postoperatively and he was discharged from the hospital in 7 days. Albendazole was implemented for 3 months postoperatively. He was observed to be healthy in his three month follow-up visit. DISCUSSION: Pulmonary hydatid cysts are generally treated with surgery. Cystotomy and capitonnage, pericystectomy and enucleation are the commonly used surgical techniques. CONCLUSIONS: Surgery is the treatment regimen for pulmonary hydatid cysts and antihelmintic therapy is adviced to eliminate recurrences postoperatively.

Surgical reconstruction of traumatic flail chest with titanium plaques.

INTRODUCTION: Multiple rib fractures exposes serious respiratory disorders and they are generally treated with non surgical methods. Nevertheless, in cases of long term pain despite medical treatment, parenchymal injury, hematoma, posture disorder and flail chest, surgery is needed. Flail chest, as the most critical form of blunt chest trauma, can disturb the hemodynamic of patient significantly and threaten life. This work has been reported in line with the SCARE criteria. PRESENTATION OF CASE: A 32 year old male patient referred to our hospital with flail chest in intubated status due to industrial accident. In physical examination, there was displaced dissociation in lower 1/3 of sternum and pericardium was palpated in the subcutaneus tissue. In thorax CT, there was fracture both in the right 7-8. costochondral and in the left 8. costochondral joints. Additionally, crepitation was palpated in these joints. There was flail chest in the right anterior hemithorax and in the lower sternum. Patient was treated with chest wall reconstruction with titanium plaques. DISCUSSION: In cases of flail chest, after a few days mechanical ventilation, implementing stabilization provides a rapid healing. CONCLUSIONS: We believe there is significant place of surgery for stabilization in proper cases.

Expression of Egfl7 and miRNA-126-5p in Symptomatic Carotid Artery Disease.

BACKGROUND: Neoangiogenesis inside the atherosclerotic plaques has been linked to progression of the disease. Egfl7, a key player in adult angiogenesis, was found to be upregulated in response to vascular injury in rats. Egfl7 encodes for miR-126-3p and miR-126-5p. Specific information about miRNA-126-5p and its expression in cardiovascular disease is scarce in comparison to that of miR-126-3p. OBJECTIVES: A gene expression study was conducted to investigate the levels of Egfl7 and miRNA126-5p in human carotid artery atherosclerotic plaques aiming to gain a better understanding of the role of neoangiogenesis within plaques and the mechanisms causing atherosclerosis progression. METHODS: Egfl7 and miR-126-5p levels were studied in 14 plaque samples and 14 control samples using real-time PCR. The fold change between the carotid artery plaque tissue and control tissue was calculated using the 2(-ΔΔCT) method. RESULTS: Egfl7 was upregulated in the 11 plaque samples compared to controls, while expression levels of miR-126-5p was higher in eight of the plaque samples and lower in six as compared to control samples. Upregulation of miR-126-5p expression was correlated with high low-density lipoprotein (LDL) cholesterol (p = 0.023). CONCLUSIONS: Our findings suggest that the upregulation of Egfl7 promotes neoangiogenesis within the plaques, contributing to disease progression.

Morphine is a reasonable alternative to haloperidol in the treatment of postoperative hyperactive-type delirium after cardiac surgery.

OBJECTIVES: Patients who undergo cardiac surgery have an increased risk of delirium. Currently, there are few choices of treatment for postoperative hyperactive delirium in cardiac surgical patients. The aim of this study was to assess the effect of morphine compared with a haloperidol-based regimen in hyperactive-type delirium in patients after cardiac surgery. DESIGN: A prospective, randomized clinical study. SETTING: A single community hospital. PARTICIPANTS: Fifty-three consecutive, adult, delirious patients. INTERVENTIONS: Patients were randomized into 2 groups; in group 1, patients received 5mg of haloperidol intramuscularly and in group 2, patients received 5mg of morphine sulfate intramuscularly to control delirium symptoms. MEASUREMENTS AND MAIN RESULTS: During the second and third hour of the morphine treatment, statistically low Richmond Agitation and Sedation Scale scores were found and the target Richmond Agitation and Sedation Scale scores percentages were statistically higher than those of the haloperidol group (p = 0.042 and p = 0.028, respectively). The number of patients requiring additive sedatives was significantly more in the haloperidol group when compared with the morphine group (p = 0.011). CONCLUSION: During the treatment of patients, it was determined that the patients who were receiving morphine treatment responded more quickly compared with the patients receiving haloperidol treatment. Morphine was found to be a reasonable alternative to haloperidol in the treatment of postoperative hyperactive delirious patients after cardiac surgery.

Effect of body mass index on early morbidity and mortality after isolated coronary artery bypass graft surgery.

OBJECTIVES: Obesity is a risk factor for morbidity after isolated coronary artery bypass grafting. This study aimed to analyze the sole effect of body mass index (BMI) on early morbidity and mortality in patients after isolated coronary artery bypass grafting. DESIGN: This study was retrospective and used an electronic database of anesthesia information management. SETTING: A single community hospital. PARTICIPANTS: The data of 803 consecutive patients after isolated on-pump coronary artery bypass grafting were analyzed retrospectively; off-pump cases were excluded. INTERVENTION: According to measured BMI, patients were divided into 5 groups: underweight (BMI <20 kg/m(2)), normal weight (BMI 20.0-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)), obese (BMI 30.0-34.9 kg/m(2)), and morbidly obese (BMI >34.9 kg/m(2)). Early postoperative morbidity and mortality were evaluated using logistic regression analysis. MEASUREMENTS AND MAIN RESULTS: Early cumulative postoperative mortality was 3.9% (32 of 803 patients). Mortality was recorded in 3 underweight (n = 15, 20%, odds ratio [OR] 6.54, p = 0.001), 9 normal-weight (n = 159, 5.7%, OR 1.62, p = 0.228), 12 overweight (n = 371, 3.2%, OR 0.68, p = 0.314), 6 obese (n = 199, 3.0%, OR 0.69, p = 0.421), and 2 morbidly obese (n = 59, 3.4%, OR 0.83, p = 0.808) patients. Prolonged intensive care unit stay (p < 0.001), prolonged hospital stay (p < 0.001), and mortality (p = 0.01) were significantly more common in patients in the underweight group than in the other groups. Univariate and multivariate logistic regression analyses showed that underweight, hypertension, and chronic renal failure were independent risk factors for mortality. CONCLUSIONS: Underweight patients with a BMI <20 kg/m(2) are at increased risk of postoperative complications and mortality compared with normal-weight or overweight subjects.

Aortic root aneurysm after off-pump reduction aortoplasty.

We present a patient with aortic root aneurysm and severe aortic regurgitation who had a previous off-pump reduction ascending aortoplasty and external wrapping with concomitant coronary bypass grafting. Preliminary aortic dissection and erosion of the aortic intima were detected during the operation. This complication warrants the re-evaluation of the indications for reduction ascending aortoplasty and emphasizes the necessity for close follow-up.