Could subcutaneous rifampicin administration be an effective approach for reducing episiotomy infections?

OBJECTIVE

The aim of this prospective cross-sectional study was to investigate whether cleaning the episiotomy line with rifampicin solution before suturing will reduce infection and wound dehiscence in women who had vaginal delivery with episiotomy.

PATIENTS AND METHODS

A prospective cross-sectional study was conducted with a total of 400 primigravida patients. In the study group, irrigation with rifampicin of the subcutaneous tissue of the episiotomy incision was applied, and in the control group, there was no irrigation. Patients were evaluated for infection at the 1st, 3rd week, and 1-month controls. The groups were compared according to episiotomy infection and wound dehiscence rates.

RESULTS

The episiotomy infection rate of the whole group was 8.5%, the wound dehiscence rate was 3.75%, and the average time of occurrence of the infection was 5.35±2.21 days. The most common infection findings were local pain and purulent discharge at 4.75%. In the control group, where the infection occurred earlier, the infection and wound dehiscence rates were significantly higher [11.5% vs. 5.5%; 6.0% vs. 1.5% (p<0.05)]. Purulent discharge was the most common finding in the control group, and local pain in the study group, but no significant difference was found between the two groups in terms of findings (p<0.05). When only the patients who developed episiotomy infection were evaluated among themselves, the only significant difference was found in wound dehiscence, which was higher in the control group (p<0.05).

CONCLUSIONS

Considering the high rates of episiotomy in our country, subcutaneous irrigation with rifampicin is a good option that can be kept in the foreground due to its low cost and ease of application.

Can restless legs be a sign of something else? A case report of spondyloarthritis presenting with restless legs syndrome and a review of the literature

Restless legs syndrome (RLS) is a chronic movement disorder characterized by an urge or need to move the limbs, usually associated with uncomfortable sensations in the legs and sleep disorders. In general, two clinical forms of RLS are described: primary and secondary. Although primary RLS has a familial component, the underlying mechanism is still not fully understood but seems to be related to abnormalities in the dopaminergic and glutamatergic pathways of the central nervous system. The secondary forms of the syndrome are associated with iron deficiency, renal failure, pregnancy, diabetes mellitus, peripheral neuropathy, and several rheumatologic disorders such as rheumatoid arthritis and Sjögren's syndrome. In a few clinical trials, an increased frequency of RLS has been reported in patients with spondyloarthritis. In this report, a case of coexistence of spondyloarthritis and RLS is presented, showing satisfactory improvement with conservative treatment and additionally adding naproxen. Anemia of chronic disease occurring in rheumatic diseases, and associated iron deficiency may contribute to the development of RLS.

Determination of distress, emotional eating and internalized weight bias levels of Turkish pregnant women

This study was conducted to determine the stress, emotional eating and weight bias levels of Turkish pregnant women. The study sample was composed of 210 pregnant women, who met the research inclusion criteria and admitted to the obstetrics and gynaecology outpatient clinics of Bingol Hospital for Obstetrics and Gynaecology. Research data were collected between December 2018 and June 2019, using face-to-face interview technique. Personal Information Form, Tilburg Pregnancy Distress Scale (TPDS), Internalised Weight Bias Scale (IWBS), and Emotional Eating sub-scale items of the Netherlands Eating Behaviour Questionnaire used to collect data. In our study, 47.9% of pregnant women were found to be overweight or obese according to the pre-pregnancy body mass index (BMI) average. Pregnant women experience a moderate level of stress, emotional eating and weight bias. It was found that there was a statistically significant relationship between the weight bias score averages and the emotional eating and stress score averages of the pregnant women (p < .05). In our study, stress, emotional eating and weight bias score averages of pregnant women in the 3rd trimester were found to be higher than that of the pregnant women in the 2nd trimester (p < .05). It has been determined that nearly 1in 2 pregnant women was overweight or obese, when BMI level of the women increased, weight stigma and emotional eating of them also increased.IMPACT STATEMENTWhat is already known on this subject? To be overweight or obese pre-pregnancy is risk for pregnancy complications and adverse birth outcomes.What do the results of this study add? It is important to inform nurses about the relationship between stress, weight bias, eating disorders, and obesity; moreover, care should be providing with the awareness that pregnant women with obesity are at greater risk in terms of these factors. It is of great importance to provide the necessary training and counselling by nurses to ensure the psychological adaptation of pregnant women to childbirth and the postpartum period. Besides, any disadvantage or disparity between overweight and obese pregnant women in the care process should be eliminated, and all pregnant women, regardless of their body size, should have equal access to supportive prenatal and postnatal care.What are the implications of these findings for clinical practice and/or further research? It is of great importance to providing training and consultation by nurses on coping with stress and stigma and eating during pregnancy in order to ensure psychological adjustment of the pregnant women to childbirth and the postpartum period, which are at risk in terms of stress, emotional eating and weight bias factors.

Effectiveness of Interventions in Reducing Substance-Related Stigma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The purpose of this study was to undertake a quantitative analysis to determine the effectiveness of interventions designed in reducing different types of stigma (self-stigma, social stigma, and structural stigma) for the substance use. This study followed the Cochrane Handbook for Systematic Reviews of Interventions guideline. This study followed the Cochrane Handbook for Systematic Reviews of Interventions guideline. Systematic searches were conducted in PubMed, Science Direct, Web of Science, Scopus, and MEDLINE. These electronic databases were searched research published in English from date of their inception to July 15, 2021. Randomized controlled trials that evaluated interventions on stigma associated with substance use were included. Studies should include at least one stigma outcome involving self-stigma, social stigma, or structural stigmatization. Ten randomized controlled studies were included. The overall Hedges'g for the interventions' impact on reducing stigma was 0.301, 95%CI = [-0.154- 0.755], p = 0.195, that there was no statistically significant difference. However, the meta-analysis showed that interventions had no significant impact on self-stigma [0.682, 95% CI=(-0.015-1.380), p = 0.055] and social stigma [0.198, 95% CI=(-1.271-0.876), p = 0.718] but had a small but significant impact in favor of the experimental group on reducing structural stigma [0.360 (95% CI= 0.156-0.564), p = 0.00]. According to subgroup analyses, there was no difference in the effects of stigma according to the type of intervention, the number of sessions, or the type of group. The interventions for reducing stigma related to substance use are promising. It seems to have a small but significant positive impact on structural stigma.

Cold-pressed milk thistle seed oil: physico-chemical properties, composition and sensory analysis

Cold pressed oil was produced from milk thistle seeds, and its composition and sensorial properties were determined. The seeds were found to contain 14.98% oil, 17.31% protein and 4.14% ash. The peroxide value of the oil (11.39 meqO2/kg oil) was within acceptable limits according to codex, but the free fatty acidity value (3.45%) exceeded the limit. The oil melted at -20.18 °C and crystallized at -3.71 °C. Linoleic acid (51.97%), β-sitosterol (67.56 mg/100 g oil) and γ-tocopherol (53.60 mg/kg oil) were determined as the main components, respectively. Six sensory descriptive terms (sweet, spicy, raw vegetable, straw, roasted and throat-catching) were described for the oil. Consumer tests proved that cold-pressed milk thistle seed oil had intermediate acceptance scores and consumer satisfaction was moderate. In conclusion, it is thought that milk thistle seeds could be used for the production of edible gourmet oil. Further studies regarding the composition of the bio-active molecules in the oil are anticipated.

Physical, structural, and rheological properties of γ-cyclodextrin metal-organic framework emulgels

This study aimed to develop and characterise emulgels based on aqueous γ-cyclodextrin metal-organic framework (γ-CD-MOF) solutions with sunflower oil in the presence of Tween 20, 40, and 60 emulsifiers. The main physical, structural, and rheological properties of γ-CD-MOF emulgels were investigated. The emulgels prepared with 5% and 10% γ-CD-MOF were durable. The X-ray diffraction patterns proved the existence of β polymorph type lipid crystals. The rheological analyses showed that the gel strength increased with increased γ-CD-MOF concentration, and thixotropic behaviour was observed depending on the gel strength at 10 °C. In addition, the samples were heat resistant proved by rheological temperature ramp tests. Finally, addition of the emulsifiers did not cause any change in the centrifuge stability and colour properties of the emulgels. These samples could be used to prepare different emulsion type food products.

Endometrial carcinoma detection with 3.0 Tesla imaging: which sequence is more useful

OBJECTIVE

Detection of endometrial cancer (EC) is crucial in pre-operative EC management. The study aimed at determining the most reliable sequence in magnetic resonance imaging (MRI) evaluation at the EC. Different sequences were compared using histopathological results as the gold standard.

PATIENTS AND METHODS

In this retrospective study, 62 women diagnosed with EC were examined using 3 Tesla MR and post-hysterectomy histopathological examination. The MRI protocol included diffusion-weighted imaging (DWI), T2 weighted images, Dynamic Contrast T1 weighted images, and ZOOMit DWI. Apparent diffusion coefficient (ADC) maps were also obtained. ADC maps were calculated for both DWI and ZOOMit DWI. All serial images were analyzed by endometrial distance to account for myometrial invasion and tumor size. All sequences and histopathological results were compared using the paired sample t-test.

RESULTS

In all 32 women, post-hysterectomy histopathological confirmation was obtained. Mean myometrial invasion values were not significantly different after comparing DWI, ZOOM it DWI, and Dynamic contrast enhancement (DCE)-T1WI (p=0.054, p=0.039). The first strong correlation was found between DWI and ZOOMit DWI (0.943). The second was between ZOOMit DWI and DCE-T1 WI (0.949). Comparing each set of sequences, no statistically significant differences in tumor size (p > 0.05) were found. Also, no statistically significant differences between images and histopathological size were found. The ADC values of ZOOMit DWI indicated that this method detected significant differences between EC histological subtypes.

CONCLUSIONS

Each sequence is essential and valuable, whereas priorities may vary depending on the desired information. The most valuable sequences for the myometrial invasion were ZOOMit and conventional DWI. T2WI and DCE T1 WI were more valuable sequences the size of EC.

Application of MOFs and natural clays for removal of MCPD and GEs from edible oils

The aim of this study was to investigate the removal of 3-monochloropropane-1,2-diol (3-MCPD) and glycidyl esters (GEs) from edible oils by using Metal Organic Frameworks (MOF) and natural clays. First, the model oil was treated with adsorbents and titanium (IV) butoxide-terephthalate MOF (Ti-MOF) and kaolin were selected as the best performing MOF along with natural clay, respectively, for the removal of 3-MCPD and GEs. The effects of treatment conditions were also investigated, 6.0% adsorbent level, 120 min treatment time and 95 ºC temperature were determined to be the best treatment parameters. Finally, palm oil samples were treated with Ti-MOF and kaolin under the selected conditions and removal of 3-MCPD and GEs was obtained at up to 27% and 58%, respectively. In conclusion, MOFs and natural clays showed good potential for the removal of 3-MCPD and GEs, and the efficiency of the treatment can be improved by modifying the adsorbents.

Frequency of fragmented QRS on ECG and relationship with left ventricular dysfunction in patients with subclinical hypothyroidism

OBJECTIVE

Subclinical hypothyroidism (SH) is a biochemical definition that has been proven to be associated with cardiovascular diseases. Fragmented QRS (fQRS) is defined as an electrocardiographic (ECG) reflection of cardiac fibrosis. It is associated with increased cardiovascular mortality and morbidity. In this study, we aim to evaluate the presence and frequency of fQRS in SH patients and determine the relationship between fQRS presence and left ventricular dysfunction by using the myocardial performance index (MPI).

PATIENTS AND METHODS

Our study included 50 newly diagnosed SH and 50 healthy participants with similar demographic characteristics. We compared demographic characteristics, laboratory findings, electrocardiographic and echocardiographic measurements of the study population. SH patients were evaluated as two groups in the subgroup analysis: [fQRS(+) SH] with fQRS and [fQRS(-) SH] without fQRS. We analyzed the correlation of thyroidstimulating hormone (TSH) levels with demographic characteristics, electrocardiographic and echocardiographic data. Independent predictors of fQRS presence were evaluated by logistic regression analysis.

RESULTS

The mean age of SH patients was 44 ± 8 years, and 46% (n = 23) of the patients were women. In the control group, the mean age was 45 ± 11 years, and 52% (n = 26) of the participants were women. MPI was found to be significantly higher in the SH group compared to the control group (0.53 ± 0.07 vs. 0.41 ± 0.08, p< 0.001). fQRS was found to be significantly higher in the SH group compared to the control group (p= 0.004). In echocardiographic measurements, isovolumic relaxation time (IVRT) was found to be significantly longer in the fQRS(+) SH group (105.6 ± 21.8 ms vs. 91.1 ± 24.4 ms, p < 0.001), while isovolumic contraction time (IVCT) was not significantly different between the groups. Ejection time (ET) was significantly longer in the fQRS (-) SH group (286.9 ± 32.1 ms vs. 274.2 ± 30.6 ms; p = 0.011). MPI was 0.57 ± 0.12 in the fQRS (+) SH group and 0.48 ± 0.06 in the fQRS (-) SH group, which was significantly higher (p = 0.001). TSH was found to be 8.82 ± 4.58 in fQRS (+) SH group and 5.73 ± 3.10 in fQRS (-) SH group (p = 0.003). It was found that MPI (r = 0.302, p < 0.001) and fQRS (r = 0.321, p < 0.001) were significantly positively correlated with TSH. TSH levels [OR = 1,645, 95% CI = 1,322 to 2,067 (p = 0.001)], IVRT [OR = 1,502, 95% CI = 1,119 to 95% (p = 0.003)], and MPI [OR = 1,408, 95% CI = 0.989 - 1.806 (p = 0.001)] were found to be independent predictors of the presence of fQRS.

CONCLUSIONS

The frequency of fQRS in SH patients was found to be higher than in the healthy population. MPI values were higher in fQRS (+) SH patients compared to fQRS (-) SH patients, resulting indirectly having a higher risk of tendency to left ventricular systolic/diastolic dysfunction. MPI and fQRS had a significant positive correlation with TSH. TSH, IVRT, and MPI were found to be independent predictors of the presence of fQRS in SH patients.

Preparation and characterization of oleogels with tallow and partially hydrolyzed tallow as organogelators

The aim of this study was to evaluate the organogelation potential of tallow fat (TF) and partially hydrolyzed tallow fat (HTF) against saturated monoglyceride (MG) and a saturated monoglyceride + diglyceride mixture (MDG) as the organogelators. TF itself created oleogel at a 30% addition level, while HTF, MG and MDG oleogels were prepared at 10% addition levels. Fatty acid composition data showed that the oleogel of HTF (HTFO) was quite similar to those of MG and MDG oleogels. Solid fat content, free fatty acidity and peroxide values were found to be in acceptable ranges for HTFO. Thermal properties, crystal morphology and X-ray diffraction patterns were also evaluated. Rheological analyses indicated that all oleogels had higher storage modulus (G´) than loss modulus (G´´). The time-sweep test showed that after applying higher shear rates, the gels re-formed at rest. Further, all oleogels maintained their gelled consistency until around 54 °C. The results suggest that HTF could be a cheap, efficient, fast melting, safe and readily available organogelator.

Efficacy and quality of life assessment in the use of subcutaneous immunoglobulin treatment for children with primary immunodeficiency disorder

Summary

Introduction. Most patients with primary and secondary immunodeficiencies need regular Intravenous Immunoglobulin (IVIG) or Subcutaneous Immunoglobulin (SCIG) treatment. This study aimed to evaluate the serum IgG trough levels, frequency of mild and severe infections, frequency and duration of hospitalization, duration of absence of school, and quality of life in patients switching their IVIG therapy to SCIG administration. Materials. Twenty-nine patients with immunodeficiency on regular IVIG treatment and who agreed to receive SCIG treatment were included. Seven patients discontinued treatment after the first SCIG administration. We collected data regarding serum IgG levels, annual numbers of infections, hospital admissions, and adverse events prior to and following SCIG initiation. PedsQL tests such as Scale Total Score (STS), Physical Health Total Score (PHTS), Psychosocial Health Total Score (PsyHTS), emotional functionality, social functionality, school/work problems score were calculated separately for all patients and their parents. Results. In twenty-two cases who were diagnosed as primary immunodeficiency, the most common indication for initiation of SCIG treatment was the long transfusion period of IVIG treatments and the difficulty of access to the hospital. No systemic side effects were noted except local redness, pain, and swelling on the injection site. The median IgG value was 588.9 mg/dl during IVIG treatment and 872 mg/dl one year after SCIG treatment. Annual frequency of infections and absence to school/work decreased significantly in the SCIG group while the annual number of hospitalizations and hospital stay time did not change significantly. There was a significant increase in the "quality of life" scores of the patients and their families. Conclusions. SCIG treatment provides ideal and protective immunoglobulin levels and offers the comfort of treatment in their home environment, thus increasing the patient's satisfaction and quality of life.

The effect of psychoeducation given to psychiatry nurses on level of knowledge, attitudes, and practices regarding physical restraint: A randomized controlled study

PURPOSE

This study aims to determine the effect of psychoeducation, given to nurses working in a psychiatry clinic, on level of knowledge, attitudes, and practices regarding physical restraint.

DESIGN AND METHODS

This study was conducted with a randomized-controlled-study design. A total of 111 nurses were recruited and randomly assigned to experimental (n = 53) and control (n = 58) groups. The experimental group received psychoeducation, while no intervention was applied to the control group. This study was conducted in a psychiatric hospital located in the Eastern Anatolia of Turkey. A Descriptive Form and the Levels of Knowledge, Attitudes, and Practices of Nurses Regarding Physical Restraints Questionnaire were used to collect data.

FINDINGS

Statistically significant differences were found between the pretest and posttest total mean scores on the level of knowledge (P = .000), attitudes (P = .000), and practices (P = .000) of the nurses in the control group and the study group.

PRACTICE IMPLICATIONS

An increase in the level of knowledge and positive improvement in attitudes and practices were observed in the nurses who received psychoeducation. Providing nurses with psychoeducation on physical restraint can positively contribute to improving their level of knowledge and to eliminating their negative attitudes and practices on this subject.

Purification of degummed crude sunflower oil with selected metal-organic frameworks as adsorbents

The aims of this study were to investigate the effectiveness of seven metal-organic frameworks (MOFs) as adsorbents for the purification of crude degummed sunflower oil, and to compare their effectiveness with three natural clays. The oil was treated with two different addition levels (0.05% and 0.3%, w/w), and two different treatment times (0.5 h and 3.0 h) under constant temperature (25 °C). The results indicated that all adsorbent treatments improved the oil’s physico-chemical properties. Most importantly, the oil’s free fatty acid, peroxide and p-anisidine values were significantly reduced by Ti-MOF and γ-CD-MOF in comparison with the control sample. The oil showed no contamination by the metals during the MOF treatments. There were no significant changes in the fatty acid or sterol composition of the treated oil, while α-tocopherol contents decreased to some extent. This study proved the possibility of MOF as adsorbents for crude oil purification, and showed the great potential of Ti-MOF and γ-CD-MOF as promising adsorbents.

Evaluation of plasma agmatine level and its metabolic pathway in patients with bipolar disorder during manic episode and remission period

Objectives: Agmatine is a cationic amine resulting from the decarboxylation of l-arginine. Agmatine has neuroprotective, anti-inflammatory, anti-stress, and anti-depressant properties. In this study, plasma agmatine, arginine decarboxylase, and agmatinase levels were measured during manic episode and remission period in patients with bipolar disorder. Methods: Thirty healthy volunteers and 30 patients who meet Bipolar Disorder Manic Episode diagnostic criteria were included in the study. Additionally, the changes in the patient group between manic episode and remission period were examined. We evaluated the relationship between levels of l-arginine and arginine decarboxylase in the agmatine synthesis pathway, and level of agmatinase that degrades agmatine. Results: Levels of agmatine and l-arginine were significantly increased than control group during manic episode (p < .01). All parameters were increased during manic episode compared to remission period (p < .05). Agmatinase was significantly decreased both during manic episode (p < .01) and remission period (p < .05) in comparison to the control group. Arginine decarboxylase levels did not show a significant difference between the groups (p > .05). Conclusions: This study indicate that there may be a relationship between bipolar disorder and agmatine and its metabolic pathway. Nonetheless, we believe more comprehensive studies are needed in order to reveal the role of agmatine in etiology of bipolar disorder. Key points Agmantine, agmatinase, l-arginine and arginine decarboxylase levels in BD have not been explored before. Various neuro-chemical mechanisms act to increase agmatine in BD; however, agmatine could have elevated to compensate agmatine deficit prior to the manifestation of the disease as in schizophrenia. Elevated agmatine degradation resulting from excess expression of agmatinase which is suggested to be effective in pathogenesis of mood disorders was compensated by this way. Elevated agmatine may be one of the causes which play a role in mania development. Elevated agmatine levels are also suggested to trigger psychosis and be related with the etiology of manic episode and lead to BD.

Effect of occlusal splint on interleukin 6, malondialdehyde and 8-hydroxydeoxyguanosine levels in the synovial fluid of patients with temporomandibular disorders

The actual role of splint therapy in preventing excessive loading of the temporomandibular joint (TMJ) is still debated. Lower intra-articular pressure levels have been measured in patients wearing occlusal splints, which may also reduce oxidative stress in the articular spaces. The aim of this study was to determine whether splint therapy reduces oxidative stress and inflammation in TMJ internal derangement patients by measuring interleukin 6 (IL-6), malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHdG) levels in the synovial fluid (SF). Twenty-four patients with a temporomandibular disorder (TMD) were included in the study. TMJ SF samples were obtained prior to arthrocentesis. Twelve patients used a 2-mm hard acrylic, maxillary stabilization-type splint for 3 months after arthrocentesis. Twelve patients had no treatment after the SF aspiration. Second SF samples were obtained from all patients at 3 months post arthrocentesis. IL-6, MDA, and 8-OHdG levels in the samples were evaluated. All patients showed a significant symptomatic improvement after treatment (P < 0.005). No statistical correlation was found between the two groups concerning pre-treatment and 3-month SF levels of MDA, 8-OHdG, and IL-6. Although splint therapy was found to be successful in eliminating clinical symptoms of TMD, the results showed no beneficial effect on inflammation and oxidative stress markers in the synovial fluid.

Infertility Stigma Scale: A psychometric study in a Turkish sample

PURPOSE

The purpose of the present study is to conduct the Turkish validity and reliability study of the Infertility Stigma Scale (ISS).

DESIGN AND METHODS

This methodological study was conducted in an infertility polyclinic in Turkey. The sample consisted of 178 infertile women.

FINDINGS

The validity of the four-factor structure of the scale and the appropriateness of its fit indices were confirmed. The analyses of internal consistency indicated that the total score correlations of items were sufficient; test-retest, r = 0.948;P < 0.001; Cronbach's α = 0.93.

PRACTICE IMPLICATIONS

ISS could be used as a useful assessment instrument in investigating the stigma concerning infertility and making efficient related interventions.

Skeletal muscle loss during anti-EGFR combined chemotherapy regimens predicts poor prognosis in patients with RAS wild metastatic colorectal cancer

PURPOSE

We aimed to assess whether anti-EGFR combined chemotherapy regimens are related with loss of skeletal muscle mass and to compare cetuximab and panitumumab therapies in the aspect of skeletal muscle area change as well as to assess whether skeletal muscle mass loss has prognostic significance in the RAS wild mCRC patients.

MATERIALS AND METHODS

A total of 56 patients (30 patients in cetuximab arm and 26 patients in panitumumab) who had computed tomography images were retrospectively evaluated at the diagnosis and follow up during the treatment period before progression.

RESULTS

During treatment period 24 patients (42.8%) had muscle loss. Of these, 7 (29.2%) patients were treated at first-line and 17 (70.8%) patients were treated at second-line setting. There was no significant difference in the aspect of skeletal muscle loss among cetuximab and panitumumab combined treatment regimens. Median PFS was 9.1 (8.6-9.6) months in muscle loss group and 13.9 (7.2-20.6) months in muscle stable group (p = 0.001). Median OS was 23.4 (95% CI 15.8-31.0) months in muscle stable group and 19.1 (95% CI 17.0-21.3) months in muscle loss group (p = 0.57) at first-line setting. For second-line, median OS was 21.2 (14.7-27.7) months in muscle stable group and 14.4 (6.0-22.4) months in muscle loss group (p = 0.003).

CONCLUSIONS

Decrease in skeletal muscle mass before progression on CT imaging is an independent indicator for shorter PFS value in RAS WT mCRC patients who received anti-EGFR combined chemotherapy regimens at both the first and second-line settings. Beside that shorter overall survival values also were significantly seen in patients who had muscle loss during anti-EGFR therapy in the second-line setting.

Effects of Mindfulness-Based Psychoeducation on the Internalized Stigmatization Level of Patients With Schizophrenia

The aim of this study was to determine the effects of mindfulness-based psychoeducation on internalized stigma in patients with schizophrenia. The patients were recruited from the community mental health centers. This quasiexperimental study was conducted using pretests and posttests with a control group. The participants were 69 patients with schizophrenia; 34 were part of the experimental group and 35 were part of the control group. The patients in the experimental group participated 2 days a week for 6 weeks in a total of 12 sessions which were given in the form of face-to-face group training. The difference between the scale mean posttest scores of the patients in the experimental and control groups was found to be statistically significant (p < .05). In the intragroup comparisons, a significant difference was found between the stigma mean scores in the experimental group (p < .05). It was concluded that mindfulness-based psychoeducation was effective in reducing stigma in patients with schizophrenia.

Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections

This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality.

Cold pressed versus refined winterized corn oils: quality, composition and aroma

The aims of this study were to characterize and compare cold pressed and fully refined winterized corn oils. Free fatty acidity (FFA), peroxide (PV) and p-anisidin (p-AV) values, saponification number, total carotenoid and phenolic contents of cold pressed corn oils were higher than that of the refined winterized corn oils. Linoleic and oleic acids (approximately 53-54% and 30-31%, respectively) were detected as the major fatty acids in both oil samples. Fifteen different sterols with a majority of β-sitosterol, campesterol, and stigmasterol were quantified in both oil samples. Although phenolic compounds were not quantified in the refined winterized oil samples, some flavonoids (hesperidin, rutin) and phenolic acids (gallic, syringic, rosmaniric and trans-ferulic) were detected in the cold pressed oil samples. This study concludes that cold pressed corn oils could be superior in terms of bioactive compounds but still need some quality improvements for sensory attributes.

Test of Mindfulness-Based Psychosocial Skills Training to İmprove Insight and Functional Recovery in Schizophrenia

This study was conducted with two groups (training and control) using a pretest/posttest design to determine the effect of mindfulness-based psychosocial skills training for improving insight and functional recovery levels in patients with schizophrenia. The study sample included 45 patients with schizophrenia (21 were in the training group/mindfulness-based psychosocial skills training and 24 were in the control group/standard drug medication). The data were collected using a Personal Information Form, Functional Remission of General Schizophrenia (FROGS) scale, and Beck Cognitive Insight Scale (BCIS). The training group was divided into two groups of 10 to 12 persons on average. Training was given as a group training for a total of 16 sessions, two sessions a week for 8 weeks. The training group scored significantly higher in functional recovery and insight levels than the control group after training ( p < .05). The study determined training has an effect on increasing the levels of insight and functional recovery in schizophrenia.

The Effect of Internalized Stigma on the Self Esteem in Patients with Schizophrenia

AIM

This study has been conducted to determine the relationship between internalized stigma and self-esteem in patients with schizophrenia.

MATERIALS AND METHODS

This study was conducted using 60 patients with schizophrenia who were diagnosed as schizophrenic according to the DSM-IV diagnostic criteria in the psychiatric clinics of hospitals in Erzurum. The data were collected using the "Questionnaire on Internalized Stigma of Mental Illness Scale" (ISMI) that determines the socio-demographic characteristics of patients, and the "Short Form of Self-Esteem Scale" (SF-SES).

RESULTS

The mean Internalized Stigma of Mental Illness Scale score was high; the mean of the positive dimension of the self-esteem scale score was lower than negative dimension. A negative significant relationship was found (r=-.758, p<0.01) between the ISMI and SF-SES when we examined the relationship between the mean scores of self-esteem and internalized stigma levels of the patients. There is a significantly positive relationship between the mean scores of the stigma resistance and SERS-SF (r=.339, p<0.01).

CONCLUSION

The findings show that the patients' self-esteem decreases with the increasing levels of internalized stigma. In particular, the high level of accepting stereotyped judgments and the low stigma resistance can be associated with low self-esteem. Based on these results, increasing psychoeducation and counseling services for patients with schizophrenia, and increasing the public awareness of this issue are recommended. Advanced quantitative studies should be conducted to determine the factors related to fighting stigma.

Effects of Relaxation Exercises and Music Therapy on the Psychological Symptoms and Depression Levels of Patients with Schizophrenia

PURPOSE

This study aims to identify the effects of relaxation exercises and music therapy on the psychological symptoms and depression levels of patients with chronic schizophrenia.

MATERIALS AND METHODS

This semi-experimental study was conducted using pre- and post-tests with a control group. The study population consists of patients with schizophrenia who regularly attended community mental health centers in the Malatya and Elazığ provinces of Turkey between May 2015 and September 2015. The study's sample consists of 70 patients with schizophrenia (n=35 in the control group; n=35 in the experimental group) who were selected randomly based on power analysis. The "Patient Information Form," the "Brief Psychiatric Rating Scale (BPRS)" and the "Calgary Depression Scale for Schizophrenia (CDSS)" were used for data collection. Patients in the experimental group participated in relaxation exercises and music therapy 5 times a week for 4 weeks. The experimental group of 35 persons was divided into three groups of approximately 10-12 individuals in order to enable all participants to attend the program. No intervention was applied to the patients in the control group. The data were evaluated using percentage distribution, arithmetic means, standard deviations, Chi-square and independent samples t-tests.

RESULTS

The study found that patients in the experimental group showed a decrease in total mean scores on the BPRS and CDSS; the difference between the post-test scores of the experimental group and the post-test scores of the control group was statistically significant (p<0.05). The practice of relaxation exercises and music therapy was proven to be effective in reducing schizophrenic patients' psychological symptoms and levels of depression.

CONCLUSION

Relaxation exercises and music therapy can be used as a complementary therapy in the medical treatment of patients with chronic schizophrenia.

Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality

This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.

Relationship of hemoxygenase-1 and prolidase enzyme activity with oxidative stress in papillary thyroid cancer

AIM

Recent studies associate thyroid cancer with oxidative stress. We aim to clarify the relation between papillary thyroid cancer, oxidative stress, hemoxygenase-1, prolidase enzymes and investigate the availability of these enzymes as markers for diagnosis, success of treatment, and follow-up.

METHODS

Thirty-one patients with papillary thyroid carcinoma and 25 healthy control subjects were included in this study. Hemoxygenase-1, prolidase (oxidant stress indicator), malondialdehyde, protein carbonyl, and superoxide dismutase (an indicator of antioxidant defense system) were measured pre-operatively and 30 days after thyroidectomy.

RESULTS

There was a significant decrease in serum levels of malondialdehyde and superoxide dismutase (p <0.001 for both) after thyroidectomy in papillary thyroid carcinoma group. In addition, there was a significant difference in the postoperative serum levels of prolidase, malondialdehyde, protein carbonyl, and superoxide dismutase between papillary thyroid carcinoma and control groups (p =0.024, p <0.001, p =0.002, and p =0.016, respectively) beside significant difference of malondialdehyde, protein carbonyl, hemoxygenase-1, and superoxide dismutase pre-operative serum levels (p <0.001, p =0.003, p =0.006, and p =0.025, respectively).

CONCLUSION

When the unquestionable role of oxidative stress in the pathogenesis of cancer is considered, in the future it is expected to associate parametric changes in the serum of patients caused by oxidative stress to papillary thyroid cancer. Hippokratia 2016, 20(1): 55-59.

The Effect of Internalized Stigma on the Adherence to Treatment in Patients With Schizophrenia

This study was conducted to determine the effect of internalized stigma on the adherence to the treatment of patients with schizophrenia. The population of the study consisted of patients who were diagnosed with schizophrenia according to the DSM IV diagnostic criteria and compatible with the study criteria. The study was completed with 63 patients overall. The researcher used Demographics Questionnaire, Morisky Medication Adherence Scale, Drug Attitude Inventory and Internalized Stigma of Mental Illness Scale to gather data. Among the patients, 11.1% adhered to the treatment, and 54.0% did not. The mean score for the internalized stigma level of patients was 76.39±14.30. A positive significant relationship was found among the scales (p<0.05). The level of internalized stigma of patients with schizophrenia was determined to be high, and the internalized stigma had a negative impact on the adherence and attitude toward the treatment.

Evaluation of potential salivary acetaldehyde production from ethanol in oral cancer patients and healthy subjects

BACKGROUND

Acetaldehyde has been implicated as a major factor in oral carcinogenesis associated with alcohol consumption. In this study, saliva samples from oral cancer patients and healthy individuals were incubated in vitro with ethanol in order to investigate factors which can influence salivary acetaldehyde production.

MATERIALS AND METHODS

A total of 66 individuals (40 males and 26 females, mean age 52 years) participated in the study. Participants were classified into three groups: Group 1 (oral cancer patients [n = 20]); Group 2 (poor dental health status [n = 25]) and Group 3 (good dental health status [n=21]). Every patient chewed a 1g piece of paraffin chewing gum for 1 minute then saliva samples were collected from all individuals. After in vitro incubation of the samples with ethanol, the levels of salivary acetaldehyde production was measured by head space gas chromatography. Kruskal-Wallis and Mann-Whitney tests and Spearman's Correlations analysis were performed for statistical analyses.

RESULTS

The salivary acetaldehyde production was significantly higher (p <0.0001) in both group 1 and group 2 when compared to group 3. However, there was no significant difference between group 1 and group 2. Poor dental health status, infrequent oral hygiene habits and dental visits, smoking and presence of a dental prosthesis were significant parameters for increased levels of salivary acetaldehyde production from alcohol. The evaluation of salivary acetaldehyde production after in vitro incubation with ethanol may be useful for early detection of oral cancer.

CONCLUSION

According to the results of this study, the significantly higher levels of salivary acetaldehyde production in oral cancer patients and individuals with poor dental health status may suggest a possible link between increased salivary acetaldehyde production and oral cancer. Improved oral hygiene can effectively decrease the level of salivary acetaldehyde production in oral cavity. Hippokratia 2014; 18 (3): 269-274.

A mucormycosis case treated with a combination of caspofungin and amphotericin B

Mucormycosis is a rare, invasive and fatal disease that occurs mainly in diabetes mellitus patients with uncontrolled blood glucose levels or in immunocompromised patients. The mortality rate of this disease is as high as 25 to 80%, despite aggressive surgical treatment and antifungal therapy. This high mortality requires alternative treatment approaches. The accepted treatment modality of invasive mucormycosis are amphotericin B lipid formulations. Although echinocandins generally show no activity against Mucorales, it was shown that Rhizopus oryzae expressed the target enzyme for echinocandins, 1,3-beta-glucan synthase. Additionally, there are some experimental studies in a diabetic mouse model and case reports regarding the effects of caspofungin. In this report, we present a rhinocerebral mucormycosis case treated with liposomal amphotericin B and caspofungin. There was regression of the patient's clinical and radiological condition with the addition of caspofungin, but she died due to discontinuation of her treatment and reasons other than mucormycosis.

Skin tag and acanthosis nigricans: do they have a predictive value for gestational diabetes mellitus?

BACKGROUND

Gestational diabetes mellitus (GDM) is a metabolic condition that can cause severe fetal and maternal morbidity. Early diagnosis and treatment of GDM can significantly prevent maternal and perinatal morbidity.

OBJECTIVE

To investigate and compare the prevalence of gestational diabetes mellitus in pregnant women with skin tag (ST) and/or acanthosis nigricans (AN) and a control group.

METHODS

This cross-sectional study was conducted at Adana Numune Educational and Research Hospital, Seyhan Practice Center, Dermatology and Obstetrics Clinics between March, 2006 and July, 2008. All 249 pregnant women without risk factors for GDM examined dermatologically in terms of AN and ST in the first antenatal visit. A 50 g glucose screening test and, if test positive, 100 g oral glucose tolerance test was performed between theirs 24 and 28 weeks of pregnancy. GDM was diagnosed according to American Diabetes Association (ADA) criteria. AN and ST prevalence were compared in women with GDM and without GDM.

RESULTS

35.8% of the pregnant women with AN had GDM, while the same ratio was 9.2% for the women without AN. The probability of pregnant women with AN having GDM is 5.5 (95%CI: 2.6-11.6) times more than the pregnant women without AN. Among the pregnant women with both ST and AN, 40.0% of them had GDM, while the same ratio was 12.3% for the women free of both ST and AN. In this instance, the difference between the ratios was found statistically significant (p=0.001). Based on the results, the probability of pregnant women with both ST and AN having GDM is 4.8 (95%CI: 1.9-11.7) times more than the pregnant women without ST and AN.

CONCLUSIONS

AN or AN with ST may be a risk factor for GDM. If this supported with large case-control study, early screening for GDM to prevent serious complications of disease should be done in pregnant women with AN.