Employment and Other Income Sources Among Homeless Youth

Homeless youth report high rates of unemployment. While homeless serving agencies usually offer employment services, most homeless youth are disengaged from homeless service agencies, and a limited number of studies have examined employment and other income sources among service disconnected youth. Our study examined income sources and change in income among service disconnected youth, all of whom received Strengths-Based Outreach and Advocacy (SBOA, N?=?79). Findings revealed that over time employment and legal income from non-survival behaviors increased (e.g., governmental assistance and receiving income from friends and relatives), while income from survival behaviors decreased (e.g., prostitution, stealing, selling possessions, selling blood or plasma). Although unemployment among these youth remained high (62%), income from survival behaviors reduced most drastically. Findings also suggest that employment is linked to housing stability and mental health, as is substance use and income, which suggests that mental health, housing, and substance use treatment services are important components in income stabilization for homeless youth.     

Behcet’s disease and cardiovascular involvement: our experience of asymptomatic Behcet’s patients

Behcet’s disease is generally defined by oral and genital ulcers and uveitis. It is also known as a recurrent multisystemic and inflammatory disease. It is mostly seen in Mediterranean countries and the Far East.The aetiology of Behcet’s disease is associated with viral, toxic, bacterial and immunological factors. It was defined in 1963 as an auto-immune disease caused by auto-antibodies against the oral mucosa. Vascular involvement is 2–7% and it is usually seen in patients between the ages of 20 and 40 years.Behcet’s disease is a non-specific arterial and venous vasculitis.1-8 Proximal and distal anastomotic aneurysm formation after surgery is not rare one to 12 months postoperatively. Recurrent surgical interventions increase the risk of mortality and morbidity.9,10 Cardiovascular involvement in Behcet’s disease includes pericarditis, coronary arterial disease, cardiomyopathy and valvular dysfunction.11 The aim of this study was to report our experience of cardiovascular involvement with asymptomatic Behcet’s disease.     

A Study on Olfactory Dysfunction in Turkish Population with using Survey Method and Validated Olfactory Testing

The aim of this study was to evaluate the effect of olfactory dysfunction on quality of life (QOL), and to investigate olfactory dysfunction related self-reported clinical features in Turkish population. The participants were questioned about the presence of any olfactory dysfunction. Participants with a complaint of olfactory dysfunction were asked to fill out a survey and then a validated olfactory test was performed. We asked 2,824 volunteers whether they had olfactory dysfunctions or not. A total of 199 (6.7 %) people mentioned that they had, and filled out the questions in our survey. The mean age of the surveyed population was 44 ± 15 years. The current investigation produced four major findings (1) the feeling of inadequacy due to olfactory dysfunction was more common among females than males (2) there was a significant correlation between subjective olfactory complaints and objective olfactory testing (3) problems in QOL issues are typically reported primarily in the areas of safety and nutrition (4) the possible reasons for the olfactory dysfunction according to the volunteers were upper respiratory infections including rhinosinusitis (46 %), allergic rhinitis (27 %), severe face and head trauma (6.5 %). The effect of subjective olfactory dysfunctions on QOL among the Turkish population was investigated for the first time. Problems in daily life issues are typically reported primarily in the areas of safety and nutrition.     

Orally disintegrating tablets and orally disintegrating mini tablets – novel dosage forms for pediatric use

The oral administration route is considered to be the most widely used route because of its convenience of administration and manufacturing. Dosage forms, like orally disintegrating tablets (ODTs), mini tablets, and orally disintegrating mini tablets (ODMTs), are recognized as promising for use in pediatric patients. ODTs are known to be suitable drug delivery systems, especially for pediatric patients, because of their rapid disintegration properties, use without water, and no swallowing problems. In addition, in recent years, a new formulation approach has been developed. ODMTs, are the newest drug delivery systems. They combine the advantageous properties of ODTs and the small size of mini tablets, aimed for pediatric use. These tablets, which can be formulated as 2–4?mm in diameter, are known as drug delivery systems that have children acceptability age as low as 6-months old. The fact that the ODTs and the ODMTs can be formulated with acceptable flavors for children further increases the importance of these carrier systems in the treatment. The objective of this article is to highlight the development of ODTs and mini-ODTs, their significance, ideal characteristics, various techniques, and aspects related to design and formulation, marketed preparations, and future perspectives, especially for the pediatric patients.     

Low Pulse Pressure as a Predictor of Death in Patients with Mild to Advanced Heart Failure

The prognostic value of pulse pressure has been investigated in heart-failure patients. Low pulse pressure in advanced heart failure and high pulse pressure in mild heart failure have been separately linked to increased mortality rates. We prospectively investigated an association between pulse pressure and 2-year cardiovascular death in an entire heart-failure population.We prospectively enrolled 225 heart-failure patients (New York Heart Association [NYHA] functional class, I–IV; mean age, 56.5 ± 12.3 yr; 188 men). The patients'' blood pressures were measured in accordance with recommended guidelines. Pulse pressures were calculated as the difference between systolic and diastolic blood pressure values. The patients were monitored for a mean period of 670 ± 42 days for the occurrence of cardiovascular death.All patients were divided into quartiles according to their pulse pressures (<35, 35–45, 46–55, and >55 mmHg). Pulse pressure decreased as NYHA class worsened (P <0.001). Patients in the <35-mmHg quartile had the lowest plasma sodium concentrations, left ventricular ejection fractions, and systolic myocardial velocities upon echocardiography; and the highest left ventricular dimensions, early diastolic/late diastolic filling velocity ratios, and peak early/peak late diastolic myocardial velocity ratios. Pulse pressure independently predicted death in the patients with advanced heart failure and in the entire population. Upon receiver operating characteristic analysis, a 30-mmHg cutoff value for pulse pressure predicted death with 83.7% sensitivity and 79.7% specificity.Pulse pressure is easily calculated and enables the prediction of cardiovascular death in patients with mild to advanced heart failure. Pulse pressure can be used reliably as a prognostic marker in clinical practice.Key words: Blood pressure/physiology, cardiovascular diseases/mortality/physiopathology, epidemiologic methods, heart failure/epidemiology/etiology/physiopathology, multivariate analysis, predictive value of tests, prospective studies, pulse/physiology, reference values, risk factorsPulse pressure (PP) is the difference between systolic and diastolic blood pressure (BP) values. Pulse pressure markedly rises after the 5th decade of life, due to arterial stiffening with increasing age.^1,2 Several studies have shown a close relationship between high PP and the occurrence of cardiovascular (CV) death.^3-5 Furthermore, high PP is a risk factor for the development of coronary heart disease, myocardial infarction, and heart failure in normotensive and hypertensive persons.^6-10Data regarding the prognostic value of PP in patients with heart failure are limited and controversial. The importance of PP was investigated in 2 large studies. The SAVE¹¹ (Survival and Ventricular Enlargement) trial revealed a worse prognosis in patients with high PP and symptomatic or asymptomatic left ventricular (LV) systolic dysfunction. The SOLVD¹² (Studies of Left Ventricular Dysfunction) trial found that high PP independently predicted total and CV death in mild heart failure. However, in both studies, patients in New York Heart Association (NYHA) functional classes I and II constituted most of the population, and few patients had advanced heart failure (NYHA classes III and IV). In other studies involving patients with advanced heart failure, low PP was associated with high CV mortality rates.^13-16 We believed that further study was warranted in order to elucidate the prognostic value of PP in an entire heart-failure population. Accordingly, we investigated the association between PP and 2-year CV death in patients in whom the severity of heart failure ranged from mild to advanced.     

Effects of metoprolol therapy on cardiac troponin-I levels after elective percutaneous coronary interventions.

AIMS: Beta-blockers (BBs) have been shown to improve survival and reduce the risk of re-infarction in patients following myocardial infarction. There are conflicting data about the effects of BB therapy on cardiac biomarkers after percutaneous coronary interventions (PCIs). The aim of the study was to investigate the effects of BB use on cardiac troponin-I (cTnI) levels in patients who had undergone elective PCI. METHODS AND RESULTS: In this prospective study, 287 patients with coronary artery disease were included. Patients were randomized either to BB or control groups prior to the intervention. Blood samples for cTnI were obtained before and at 6, 24, and 36 h after the procedure. Of the 287 patients included, 143 received metoprolol succinate 100 mg/day, and 144 received no BB and served as the control group. Baseline clinical characteristics of both groups, except for history of coronary artery bypass graft surgery, were similar. We observed no significant difference in the elevation of cTnI levels between the two groups after PCI (BB group, 17 patients, 11.9%; control group, 10 patients, 6.9%; P=0.2). CONCLUSION: Metoprolol succinate therapy seems to have no cardioprotective effect in limiting troponin-I rise after PCI.     

Coronary and systemic stent embolization during percutaneous coronary interventions: a single center experience

OBJECTIVE: In this study, we attempted to analyze the incidence and outcomes of systemic and coronary stent embolizations during percutaneous coronary interventions and have described the treatment and retrieval methods used. METHODS: We retrospectively studied 24,038 consecutive coronary angiography procedures carried out at The Baskent University Adana Hospital from 1998 to present to determine the total number of stent embolization events. RESULTS: Among them, 4,797 were consecutive coronary stent operations and embolization was encountered in 14 cases (0.29%; 95% CI = 0.14-0.44%, P < 0.0001). The mean age of the patients was 61 +/- 8 years and 78% were men. Stent embolization occurred more frequently in cases with significant proximal angulation. Calcified lesions were not noted in any of the cases. In 7 out of 14 cases, stent embolization occurred at an unknown location and the clinical course was uneventful thereafter. Treatment and retrieval methods of the other 7 cases included the following: 1. Emergency cardiac bypass surgery (3 cases, 43%) 2. Advancement of a low profile delivery balloon through the stent, inflating the balloon, and replacing the stent at the lesion site (3 cases, 43%) 3. Crushing the stent against the coronary wall using another stent (1 case, 14%) 4. 4-loop snare (1 case, failed) None of the cases had bleeding that required transfusion. The stent was not crushed or deployed in the coronary artery causing major cardiac complication in any case. CONCLUSION: Systemic and coronary embolizations of stent procedures are rare. Consequences of coronary stent embolization can lead to prompt cardiac bypass surgery if the retrieval or deployment methods fail. Stent deployment or crushing techniques may be attempted before retrieval in patients who do not suffer from coronary thrombosis and myocardial infarction due to stent embolization.     

Echocardiographic diagnosis of a giant thrombus passing through a patent foramen ovale from right atrium to the left atrium

Pulmonary embolus sourced by right atrial thrombus trapped in a patent foramen ovale is an unusual, rare condition. Thus in suspicion of massive pulmonary thromboembolus, echocardiographic examination carries great importance evaluate right ventricular functions and diagnose right sided intracardiac thrombus. We report a 76-year-old female with massive pulmonary embolism caused by a gigantic thrombus trapped in a patent foramen ovale. The echocardiography was the diagnostic procedure to display the source of the thromboembolism and urgent cardiac surgery was successful and life-saving treatment in this case.     

Prevalence and short-term mortality of acute-on-chronic liver failure: A national cohort study from the USA

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