Effects of postgraduate emergency training among general practitioners working in emergency units in Denizli,Turkey

INTRODUCTION: Emergency medicine is characterised by rapid decisionmaking to help patients in life-threatening situations. For this purpose, special qualifications are necessary. The aim of our study was to evaluate the emergency medicine knowledge obtained during an obligatory postgraduate emergency medicine training programme that has been recently applied among Turkish physicians. METHODS: The training targeted all general practitioners (GPs) working in emergency units in the city hospitals, city-wide primary healthcare centres, public health offices, emergency services and private hospitals. Over an 8-month period between September 2004 and April 2005, seven individual groups of approximately 45 physicians were formed. Each group undertook an identical 5-day training programme and every participant completed identical pre-and post-training tests. RESULTS: Two-hundred and ninety-eight physicians participated in the training programme. The majority of participants were male (n=224, 75.2%), aged between 35 and 39 years (n=127, 42.6%), had been in the medical professional for 11 to 15 years (n=121, 40.7%), and were employed in city hospitals (n=102, 34.2%). Surprisingly, the majority of GPs had never participated in a postgraduate training programme before (n=166, 55.7%). Mean post-test scores of the participants were significantly higher than the pre-test scores (89.70%+/-12.41% vs 43.15%+/-10.47%, respectively; P<0.001). Mean pretest scores were significantly higher in the emergency services subgroup (51%, P=0.001) and in the subgroup of participants that had previously undertaken two or more postgraduate training courses (47.9%, P=0.004) compared with the mean pre-test scores of the other subgroups. However post-test scores were not statistically different between the groups. CONCLUSIONS: This postgraduate emergency medicine training programme appears to be effective in improving physicians' knowledge regarding emergencies. Any developing emergency medicine system in Turkey should include continuous, up-to-date, standardised educational programmes for emergency professionals. These may include postgraduate workshops to improve the knowledge and skill levels of emergency professionals.     

Amlodipine-induced gingival hyperplasia in chronic renal failure: a case report

Amlodipine is a dihydropyridine calcium channel blocker that is used in the management of both hypertension and angina. Amlodipine induced side effects are headache, dizziness, edema, flushing, palpitations, and rarely gingival hyperplasia. The exact reason of amlodipine-induced gingival hyperplasia is not known. We presented a case with chronic renal failure (CRF) that developed gingival hyperplasia due to amlodipine use, which improved after ceasing the drug.     

Cockayne syndrome: Review of 25 cases

Clinical and laboratory findings of 25 patients with classical Cockayne syndrome (CS) are reviewed. A history of consanguinity was present in 21 patients, and 15 patients had at least 1 affected sibling. Apart from the cardinal features of dwarfism, microcephaly, and mental retardation, the most consistent clinical features included photosensitivity (84%), gait disturbances (84%), progeroid appearance (84%), and ocular abnormalities (88%). The most consistent laboratory findings comprised abnormal nerve conduction (slowed conduction in 13 of the 16 cases with an ENMG), and an abnormal brainstem auditory evoked response (BAER) and/or audiometry (abnormal in 13 of the 17 cases in whom either one of them were available). Cerebral atrophy and calcification of the basal ganglia were the next more common laboratory findings. Clinical criteria are useful in most instances in the diagnosis of CS. In patients in whom the clinical features are controversial for a diagnosis of Cockayne syndrome, studies directed to disorders of myelination involving both peripheral and central nervous systems in conjunction with audiometry may aid in the diagnosis.     

Anterior segment optical coherence tomography evaluation of corneal epithelium healing time after 2 different surface ablation methods

Objectives:

To compare epithelial healing time following laser epithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) with anterior segment optic coherence tomography (AS-OCT).

Methods:

This prospective interventional case series study comprised 56 eyes of 28 patients that underwent laser refractive surgery in the Department of Ophthalmology, Medipol University Medical Faculty, Istanbul, Turkey, between March 2014 and May 2014. Each patient was randomized to have one eye operated on with PRK, and the other with LASEK. Patients were examined daily for 5 days, and epithelial healing time was assessed by using AS-OCT without removing therapeutic contact lens (TCL). Average discomfort scores were calculated from ratings obtained from questions regarding pain, photophobia, and lacrimation according to a scale of 0 (none) to 5.

Results:

The mean re-epithelialization time assessed with AS-OCT was 3.07±0.64 days in the PRK group, 3.55±0.54 days in the LASEK group, and the difference was statistically significant (p=0.03). Mean subjective discomfort score was 4.42±0.50 in the PRK eyes, and 2.85±0.44 in the LASEK eyes on the first exam day (p=0.001). The score obtained on the second (p=0.024), and third day (p=0.03) were also statistically significant. The fourth (p=0.069), and fifth days scores (p=0.1) showed no statistically significant difference between groups.

Conclusion:

The PRK showed a statistically significant shorter epithelial healing time, but had a statistically significant higher discomfort score until the postoperative fourth day compared with LASEK.Anterior segment optical coherence tomography (AS-OCT) is a valuable, non-invasive and non-contact method to evaluate anterior segment structures quantitatively. It provides high resolution images by using a long wavelength (1.310 nm) of light; it offers rapid quantitative analysis of various structures. AS-OCT has demonstrated good repeatability and reproducibility with low intra-observer and inter-observer variability.1-3 Since laser in situ keratomileusis (LASIK) was introduced in the mid-1990’s, it has become the predominant refractive surgery for the correction of myopia, hyperopia, and astigmatism.4 However, LASIK has unique risks, including problems related to corneal flap creation and iatrogenic ectasia. Despite these factors, where possible, surface ablation procedures still advised by most refractive surgeons. Photorefractive keratectomy (PRK) is one of the surface ablation procedures, performed for treat refractive errors in patients not candidates for LASIK. However, eyes with PRK have some notable adverse effects like severe pain, discomfort and prolonged visual recovery due to the process of epithelial wound healing, which usually starts on the day of surgery and may last up to 4 days after surgery. In 2003, Camellin introduced a new technique called laser-assisted sub-epithelial keratectomy (LASEK) which would minimize discomfort, speed visual recovery time and reduce the incidence of corneal haze with PRK by preserving the epithelium as a flap and replacing it following the laser treatment.5,6 Faster re-epithelialization decreases the risk factor for postoperative infections and facilitates earlier visual rehabilitation, and reduces patient discomfort. Several studies report conflicting results in epithelial healing time after LASEK versus PRK because the different methods were used. Some comparative studies about epithelial healing time have reported no benefits of LASEK over PRK. There are also some clinical studies have demonstrated controversial results.7-9 The aim of the current study is to document the healing process of the cornea after LASEK and PRK quantitatively using a non-invasive, non-contact, and a more sophisticated method AS-OCT without removing therapeutic contact lenses (TCL).