The Patient Perspective of Telemedicine in the Context of COVID-19 Pandemic.

COVID-19 Pandemic might be considered as a catalyst for transformation in healthcare experience via the use of video consultation as a method for telemedicine. The aim of our qualitative study is to understand the patient perception of video consultations in telemedicine, which has been used by a single pulmonologist in only one university hospital in Turkey since the first three months of the pandemic. Research findings are essential when it comes to a more effective and widespread future use of telemedicine, as it focuses on patient experience about a medical technology that is newly introduced. Totally 30 patients were randomly chosen and interviewed who get healthcare support via telemedicine. A semi-structured questionnaire was used to learn the experiences and opinions of the interviewees. The expressions of the patients highlight some advantages of using telemedicine such as being free from risk of contagion caused by exposure in the hospital, being able to save time and money while reaching to the physician online whenever needed, and success in technical details even though they were experiencing it for the first time. A very few of the patients are feeling discomfort to be in front of the screen. Almost all patients are applicants to suggest to other individuals the system they used, in conditions to be appropriate, and continuity after the pandemic period. Since the pandemic has propagated from one patient, the worldwide implementation of telemedicine might be catalyzed by following in the footsteps of the sporadic examples of decisiveness nourished from patient experiences.

"Maternal/Neonatal" iodine status in patients with prolonged physiological jaundice.

BACKGROUND: The increasing knowledge indicated that borderline hypothyroidism may cause neurodevelopmental disorders. Borderline compensated congenital hypothyroidism could caused by iodine deficiency or iodine overload. One of the most important etiological factors causing prolonged jaundice in the neonatal period is congenital hypothyroidism. Aimed of this study is to investigate the frequency of borderline or overt hypothyroidism in a group of newborn with prolonged physiological jaundice, and to evaluate iodine status of these babies and their mothers. METHODS: Fifty-five apparently healthy newborn were evaluated. Twenty-five of them showed borderline thyroid dysfunctions. Remained 30 babies had normal thyroid function, considered as euthyroid group. Iodine status was evaluated by measuring urinary iodine excretion. RESULTS: According to UIE, maternal iodine deficiency (55%) associated with neonatal iodine overload (65%) had came to attention. Although mean urinary iodine levels in both mother groups were similar, the mean urinary levels of borderline hypothyroidic and euthyroid groups were 432+/-129 microg/l and 271.5+/-137 microg/l, respectively. Iodine overload was also presence in newborn with normal thyroid function tests. CONCLUSION: We considered that individual sensitivity to iodine overload could make the differentiation on thyroid function. Iodine overload in important degree seen in borderline hypothyroidic babies emphasize the harmful effect of topical antiseptic iodine application that given to mothers during labor. This application could also mask possible prenatal iodine deficiency.

Combination of hypoosmotic swelling/eosin Y test for sperm membrane integrity evaluation: correlations with other sperm parameters to predict ICSI cycles.

The objective of our study was to evaluate the accuracy of the combination of hypoosmotic swelling (HOS) and eosin Y (Ey) exclusion tests to predict the ICSI cycles' outcome and its correlations with other sperm parameters. The functional and structural integrity of sperm membrane was evaluated with the combined HOS/Ey test in 95 ICSI cycles and the results were correlated with other sperm parameters, including concentration, motility, strict morphology, and total motile sperm count. The combined HOS/Ey test was evaluated for the prediction of the ICSI cycles' outcome parameters including fertilization, cleavage, and pregnancy rates. The HOS/Ey test presented significant relationships with concentration, motility, and strict morphology (p < 0,0001) but it couldn't predict the fertilization, cleavage, and pregnancy outcomes of ICSI cycles. The combined HOS/Ey test has strong correlations with motility and strict morphology parameters of sperm samples but is not sufficiently sensitive to estimate the outcome of ICSI cycles.

Objective risk definition for endometrial lesion spectrum: a diagnostic algorithm.

OBJECTIVE: Investigations for risk definition in endometrial lesion spectrum still go on. In this study, molecular, morphometric, immunohistochemical techniques were combined with conventional morphology to realize whether an algorithm is definable for risk assessment to progress an invasive carcinoma in endometrial glandular lesion spectrum is possible. METHODS: The study was carried out on 20 benign endometria, 35 hyperplasias, and 20 adenocarcinoma cases. Clonality of glandular cells, the volume percent of endometrial stroma (VPS), PTEN inactivation, and proliferative index (PI) were evaluated. Statistical analysis was evaluated to set an objective algorithm. RESULTS: All benign tissues had polyclonal (PC), whereas all malignant tissues had monoclonal (MC) glandular epithelium. Of hyperplasias, 19 were MC, and 16 were PC. VPS value of 55% had 100% sensitivity, and 80% specificity (n=67) to distinguish MC from PC. Neither PTEN nor PI data augmented the specificity or the sensitivity of clonal distinction. CONCLUSION: Clonality and VPS values were found to be significant in differential of endometrial lesions. With this rationale, a diagnostic algorithm for endometrial risk lesions was set. This algorithm is based on HE morphology, VPS and clonality findings, and has 100% sensitivity and specificity to discriminate neoplastic endometrium from hyperplasia.

Gingival fibromatosis, short stature, border-line IQ, facial dysmorphism and hepatomegaly.

Gingival fibromatosis, short stature, border-line IQ, facial dysmorphism and hepatomegaly: Gingival fibromatosis is a rare and benign disorder. The enlarged gingivae are firm and may interfere with speech, closure of the lips, and mastication. We report a thirteen years old girl, with gingival fibromatosis referred to the periodontics clinics. Full mouth gingivectomy and gingivoplasty were performed. Medical investigation showed short stature, low-borderline IQ, facial dysmorphism, and hepatomegaly. Histological analysis revealed hyperplasia in the epithelial area and fibrotic appearance of gingival connective tissue with dense collagen fibre clusters. Pedigree analysis confirmed that mode of inheritance is autosomal recessive. According to the combination of clinical findings, this case report may represent a previously unreported syndrome.

Regressed retinopathy of prematurity in children aged 5-8 years in Sivas, Turkey.

In this present study regressed retinopathy of prematurity has been investigated in children born prematurely (< 2300 g birth weight and < 34 weeks gestational age) in Sivas, Turkey during January 1989-January 1992. At the age of 5-8 years, 55 children born prematurely were examined; eye fundus information could be obtained by indirect ophthalmoscopy in all of them. The frequency of regressed retinopathy of prematurity was 35.45 percent for the whole group. Severe forms with optic atrophy, dragged optic disk, vitreoretinal scarring, retinal traction and temporal avascular retina were seen in 13.63 percent of cases. Moderate forms with pigmentary changes, vitreoretinal interphase changes and lattice degeneration were seen in 21.81 percent of cases. While the severe and moderate regressed premature retinopathy findings in premature children with gestational ages of 30-34 weeks were observed to be 12.0 and 14.0 percent, respectively, those in the 25-29 week-gestational-aged premature children were determined to be 5.0 and 28.33 percent, respectively. Although the incidence of both severe and moderate regressed premature retinopathy was higher in the 25-29 week gestational-aged group when compared to that of the 30-34-week-gestational-aged group, the difference was not found to be statistically significant (p > 0.05). In conclusion, premature retinopathy should not only be followed up in the early stage with active changes but also later in infancy and childhood because of regressed premature retinopathy findings that may require treatment.

Serum-free carnitine levels in children with heart failure.

The serum-free carnitine (SFC) levels of 91 children with heart failure (HF) and of a control group consisting of 30 healthy children were measured. Twenty-four of 91 children with HF were administered oral L-carnitine. The mean SFC level of children with HF (20.16 +/- 0.30 nmol/l) was significantly lower than that of the control group (38.98 +/- 0.79 nmol/ml) (p < 0.01). Mean SFC levels of 24 patients, after L-carnitine administration, increased significantly (p < 0.01). Patients administered L-carnitine displayed a marked difference in time taken for clinical improvement compared with those not given oral L-carnitine.

Prophylaxis of the occurrence of hyperbilirubinemia in relation to maternal oxytocin infusion with steroid treatment.

This study was carried out to investigate the steroid prevention on the occurrence and the severity of red blood cell destruction by the effect of oxytocin usage for labor induction. Venous cord blood was collected from the pregnancies who had oxytocin-induced or augmented labors (20), oxytocin-infused deliveries with steroid use (20), deliveries without oxytocin use (20) and cesarean sections (20). Evaluation of the data showed significant increase in serum bilirubin level, serum lactic dehydrogenase activity, erythrocyte fragility and reticulocyte count (p < 0.0083), and a significant decrease in hemoglobulin concentration, packed red cell volume fraction (p < 0.01) in groups with labor induction or augmentation with oxytocin in comparison to deliveries with oxytocin plus steroid use and the two other methods of delivery. Moreover, with regard to the above data, no significant difference was observed between the deliveries other than oxytocin-only use. Mean corpuscular volume in the oxytocin group was apparently (not significant) higher than the steroid group. The results of this study suggest that the use of 16 mg dexamethasone 21-phosphate at the beginning of the induction or augmentation of labor with oxytocin, followed by an additional 4-mg dose 4 h later intravenously, is advantageous for the prevention of erythrocyte destruction.

Clomiphene citrate-resistant polycystic ovary syndrome. Preventing multifollicular development.

OBJECTIVE: To determine the efficiency and comparison of two different protocols, human menopausal gonadotropin (hMG) plus gonadotropin-releasing hormone analog (GnRH-a) and low-dose hMG to reduce multifollicular development in clomiphene-resistant polycystic ovary syndrome (PCOS) patients. STUDY DESIGN: Prospective comparative and pilot study in 20 patients for 31 cycles. The first group (n = 10) was treated with buserelin acetate, 600 micrograms/d, for six weeks before ovulation induction with hMG in conventional doses for 14 cycles. The other group (n = 10) was treated only with low-dose hMG for 17 cycles. All cycles were compared in terms of the number of follicles per cycle, cycles human chorionic gonadotropin withheld, estradiol level on ovulation day, treatment duration and number of ampules used per cycle. In addition, the outcome of cycles and complications of multifollicular development, ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy were determined. RESULTS: As compared with the GnRH-a + hMG protocol, the low-dose hMG protocol yielded less multifollicular (57.1% vs. 17.6%) and more monofollicular (35.7% vs. 70.6%) development. Consequently, less OHSS (21.4% vs. 0%) and multiple pregnancy (10% vs. 0%) occurred in the low-dose group. CONCLUSION: Low-dose hMG therapy has distinct advantages in eliminating multifollicular development and related complications in clomiphene citrate-resistant PCOS patients. The addition of GnRH-a to gonadotropins does not change the incidence of multifollicular development.

Prenatal diagnosis of an uncommon syndrome: thrombocytopenia absent radius (TAR).

The prenatal diagnosis of the thrombocytopenia absent radius (TAR) syndrome using ultrasound and cordocentesis at the 34th week of gestation is established. Two basic components of the syndrome, bilateral absence of radius and thrombocytopenia at a level 12.000/mm3 were detected. No complication during the cordocentesis and delivery occurred due to thrombocytopenia. This case report, to our knowledge, is one of a limited number of cases emphasized on prenatal diagnosis of TAR syndrome in the world.

Color Doppler sonographic features of uterine arteriovenous malformations: report of two cases.

We describe the color Doppler sonographic features of uterine arteriovenous malformations in two cases. In both cases color Doppler imaging demonstrated hypervascularity throughout the arteriovenous malformation. The dominance of pale shades during both systole and diastole represented low-impedance, high-velocity flow within the lesion and a colored mosaic pattern representing turbulent flow was noted. Spectral analysis of the vessels within the lesion confirmed high-velocity flow during both systole and diastole, and a low resistance index. The spectral waveform trace also showed spectral broadening consistent with turbulence and the spectral envelope was irregular. These findings indicated the presence of numerous arteriovenous shunts and marked turbulence within the arteriovenous malformation. Spectral analysis of the venous flow revealed high flow velocities and systolic velocity peaks similar to an arterial pattern. The uterine artery velocity waveforms were characterized by high flow velocity and a low resistance index. The diagnosis of uterine arteriovenous malformation was confirmed by histological examination in both cases. The findings of these two cases suggest that color Doppler sonography may play an important role in the diagnosis of uterine arteriovenous malformations.

Serum free carnitine levels in children with recurrent pulmonary infections.

The serum free carnitine levels of 33 children with recurrent pulmonary infection and 30 healthy children were measured and found to be 26.12 +/- 0.98 nmol/mL and that of the control group 38.98 +/- 0.79 nmol/mL on the average. The mean free carnitine level was statistically determined to be significantly lower when compared with that of the control group (P < 0.01). The results indicate that oral L-carnitine therapy is recommended for pediatric patients with recurrent pulmonary infection.

Does vancomycine increase aminoglycoside nephrotoxicity?

Vancomycine and amikacin combined is an effective antibiotic combination used in the treatment of serious Gram-positive bacteremia in childhood. However, both drugs may have a potential nephrotoxic effect when used individually. The present study investigates whether the nephrotoxicity of these drugs that display a nephrotoxic effect when used separately increases when used in a combined manner. Ten 2-month-old rats were subjected to intraperitoneal injections of vancomycine (100 mg/kg) and amikacin (80 mg/kg) and ten other 2-month-old rats were administered amikacin (80 mg/kg) for a period of 15 days. The control group of animals consisting of five 2-month old rats were untreated. The renal tissues obtained by laparotomy were processed for both light and electron microscopy. Paraffin sections and ultrathin sections were evaluated in order to determine the renal structure of the control and the experimental groups. In addition, serum creatinine and blood, urea and nitrogen (BUN) levels were measured in blood samples obtained from the rats. In the amikacin and combined amikacin-vancomycine treatment groups, renal morphological changes were observed at the glomerular and tubular levels when compared to the control group, and the serum creatinine and BUN levels were also higher in these groups. Although both experimental groups were different from the control group, they had similar morphological and biochemical features. It was concluded that vancomycine did not influence the nephrotoxic effect of amikacin and both drugs could be used in a combined manner.