The Efficacy of Biofeedback Treatment in Patients with Fecal Incontinence

Background: The initial treatment for fecal incontinence (FI) includes supportive treatment and medical treatment. If the initial treatment fails, biofeedback therapy (BFT) is recommended. However, there are limited and conflicting results in the literature supporting the beneficial effect of BFT for FI. The aim of the study is to analyze the efficacy of BFT in 126 patients who have FI due to several causes.Methods: The data of 126 patients (88 females (69.8%) and 38 males (30.2%)) were collected retrospectively. Colonoscopy, anorectal manometry (ARM), and 3D-Endoanal ultrasonography (EAUS) were performed for all patients before applying BFT. In addition, all patients received toilet training instruction and training in Kegel and other pelvic floor strengthening exercises from an experienced nurse, before BFT.Results: The median age of participants was 54 years (range 18-75 years). While 80 patients (63.5%) had clinical and manometric benefit from BFT, 46 patients (36.5%) did not respond to BFT. According to the EAUS and ARM findings, BFT was beneficial in patients who had partial external sphincter failure, and was unsuccessful in patients who had both internal and external sphincter failure, both internal and external sphincter tears, and external sphincter tear rates of more than 25%. After BFT, significant increases in squeeze pressures were observed, with this increase being higher in the positive-response group.Conclusion: The results suggest that BFT is effective in the treatment of FI for specific patient populations.     

Papel dos Níveis de Sódio na Fibrilação Atrial na Insuficiência Cardíaca: Jogador Ativo ou Bystander?

BackgroundThe coexistence of hyponatremia and atrial fibrillation (AF) increases morbidity and mortality in patients with heart failure (HF). However, it is not established whether hyponatremia is related to AF or not.ObjectiveOur study aims to seek a potential association of hyponatremia with AF in patients with reduced ejection fraction heart failure (HFrEF).MethodsThis observational cross-sectional single-center study included 280 consecutive outpatients diagnosed with HFrEF with 40% or less. Based on sodium concentrations ≤135 mEq/L or higher, the patients were classified into hyponatremia (n=66) and normonatremia (n=214). A p-value <0.05 was considered significant.ResultsMean age was 67.6±10.5 years, 202 of them (72.2%) were male, mean blood sodium level was 138±3.6 mEq/L, and mean ejection fraction was 30±4%. Of those, 195 (69.6%) patients were diagnosed with coronary artery disease. AF was detected in 124 (44.3%) patients. AF rate was higher in patients with hyponatremia compared to those with normonatremia (n=39 [59.1%] vs. n=85 [39.7%), p= 0.020). In the logistic regression analysis, hyponatremia was not related to AF (OR=1.022, 95% CI=0.785–1.330, p=0.871). Advanced age (OR=1.046, 95% CI=1.016–1.177, p=0.003), presence of CAD (OR=2.058, 95% CI=1.122–3.777, p=0.020), resting heart rate (OR=1.041, 95% CI=1.023–1.060, p<0.001), and left atrium diameter (OR=1.049, 95% CI=1.011–1.616, p=0.002) were found to be predictors of AF.ConclusionAF was higher in outpatients with HFrEF and hyponatremia. However, there is no association between sodium levels and AF in patients with HFrEF.     

Relations Between Depression Level and Conflict Resolution Styles,Marital Adjustments of Patients With Major Depression and Their Spouses

The objective of this study was to determine to relations between the depression level and the conflict resolution styles, marital adjustments of the depressed patients and to analyze the conflict resolution styles, marital adjustments of both the patients and their spouses as the possible predictors of depression levels. The research comprised 113 patients with major depression and their spouses. While there was a negative correlation between depression scores and positive and subordination conflict resolution styles subscales of the patients, there was a positive correlation between the depression scores and negative conflict resolution style subscale. Negative correlation was observed between the depression and marital adjustment scores of patients (p < 0.05). The conflict resolution styles and marital adjustment of depressed patients and their spouses are predictors of depression in patients.     

The effectiveness of Pilates for partial anterior cruciate ligament injury

Purpose

This study explored the effects of Pilates on the muscle strength, function, and instability of patients with partial anterior cruciate ligament (ACL) injuries in situations in which a non-surgical treatment option is preferred.

Methods

Fifty participants 20–45 years of age who were diagnosed with isolated ACL injuries were included in the study. The participants were randomly assigned to either the Pilates exercise group (n = 24) or the control group (n = 26). The subjects in the Pilates exercise group performed basic mat exercises that focused on the muscle strength and flexibility of the lower limbs and core muscles during each class session, which met three times per week for 12 weeks. The control group did not receive any treatment or home exercise programme. All patients were evaluated using the Lysholm Knee Scale, the Cincinnati Knee Rating System, and isokinetic quadriceps and hamstring strength. Patient satisfaction regarding improvement in knee stability was assessed using the Global Rating of Change scale.

Results

The Pilates group experienced significant improvement over the control group as measured by the difference in quadriceps strength at 12 weeks (p = 0.03). Both groups showed some clinical change over time, but the Pilates group improved for all outcome measurements at the 12-week follow-up, and the control group only improved for functional outcomes. Patient satisfaction with the level of knee stability based on the Global Rating of Change scale was higher in the Pilates group than in the control group.

Conclusion

Although both groups exhibited improvements in knee strength and functional outcomes, the results suggest that Pilates is a superior management approach over a control treatment for increasing quadriceps strength in participants with partial ACL injury. Pilates may provide clinicians a novel option when choosing a treatment for a partial ACL injury. Further study is needed to determine whether certain subgroups of individuals might achieve an added benefit with this approach.

Level of evidence

II.

     

Application of classical and model-based spectral methods to ophthalmic arterial Doppler signals with uveitis disease

In this study, Doppler signals recorded from ophthalmic artery of 75 subjects were processed by PC-computer using classical and model-based methods. The classical method (fast Fourier transform) and three model-based methods (Burg autoregressive, moving average, least-squares modified Yule–Walker autoregressive moving average methods) were selected for processing ophthalmic arterial Doppler signals with uveitis disease. Doppler power spectra of ophthalmic arterial Doppler signals were obtained by using these spectrum analysis techniques. The variations in the shape of the Doppler spectra as a function of time were presented in the form of sonograms in order to obtain medical information. These Doppler spectra and sonograms were then used to compare the applied methods in terms of their frequency resolution and the effects in determination of uveitis disease.     

Spectroelectrochemical and Photovoltaic Characterization of a Solution‐Processable n‐and‐p Type Dopable Pyrrole‐Bearing Conjugated Polymer

D‐A‐D‐type polymers are of high interest in the field of photovoltaics and electrochromism. In this study we report the synthesis and electrochemical properties of PPyBT along with its photophysical properties and photovoltaic performance. PPyBT is soluble in common organic solvents and both n‐ and p‐type dopable, which is a desired property for conjugated polymers. During electrochemistry studies, the onset potentials of the polymer were determined as +0.2 V for oxidation and ?1.4 V for reduction. Using these values, HOMO and LUMO energy levels were calculated. The photovoltaic properties of PPyBT were also studied. PL studies showed that there is a charge transfer between PPyBT (donor) and PCBM (acceptor).

     

Frequency of Mycoplasma pneumoniae among atypical pneumonia of childhood

We aimed to investigate the frequency of Mycoplasma pneumoniae among atypical pneumonia of childhood that is acquired from the community and to determine a practical approach to the diagnosis of these patients. In this prospective study, 55 patients (31 male and 24 female) with atypical pneumonia were investigated with conventional laboratory and radiological methods as well as culture and polymerase chain reaction (PCR) on throat swab. In addition, serum of the patients was tested for M. pneumoniae specific IgM. The patients were reevaluated clinically at 3-5 days and 3-4 weeks and serologically at 3-4 weeks. The data on patients with M. pneumoniae pneumonia were compared with the other patients with atypical pneumonia and controls. All patients were treated with macrolide antibiotics. The mean age of the patients was 7.8+/-2.9 years. The frequency of M. pneumoniae by this method was 34.5%. Neither clinical, laboratory, or epidemiological data nor response to macrolide antibiotics was useful in detecting the etiology of atypical pneumonia. Diagnostic sensitivity and specificity of IgM+IgG antibodies plus PCR on throat swab were estimated as 100%. M. pneumoniae was an important microorganism in the etiology of atypical pneumonia of childhood in our community. In order to prevent loss of time with beta-lactamase antibiotics, which are usually started in severe pneumonia, serologic tests and PCR must be done during the initial evaluation of the patient for the reliable diagnosis of M. pneumoniae, which will increase the chance of early and appropriate therapy.