Evaluation of the North Star Ambulatory Assessment scale and cardiac abnormalities in ambulant boys with Duchenne muscular dystrophy

Aim We evaluated ambulatory patients with Duchenne muscular dystrophy from the cardiovascular standpoint and studied the correlation between the results of electrocardiographic (ECG) findings, left ventricular ejection fraction (LVEF), troponin T and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels and patients' North Star Ambulatory Assessment scores. Methods: Fifty patients of ages 6–12 (8.9 ± 2.8) were enrolled in this cross‐sectional study. Cardiac evaluation included electrocardiography, echocardiography and cardiac enzyme tests. Results North Star scores ranged from 6/34 to 34/34. Twenty‐eight patients (56%) had ECG changes. The most frequently seen ECG abnormalities were short PR interval (14%, n= 7), right ventricular hypertrophy (16%, n= 8), prolonged QTc interval (10%, n= 5), prominent Q wave (10%, n= 5) and T wave inversion (44%, n= 22). In 10 patients (20%), LVEF was below 55%, troponin T and NT‐proBNP levels were significantly elevated (P= 0.003 and P < 0.001, respectively). When North Star scores were compared to patients' age, enzyme levels, ECG and echocardiographic results, we discovered negative correlation with age (P < 0.001) and troponin T levels (P= 0.02) and positive correlation with LVEF (P= 0.02). Conclusion Patients with North Star scores of ≤16 are more at risk of developing cardiomyopathies. Troponin T is a cardiac index that can be used for evaluating myopathic patients and it seems to be correlated with the proBNP levels and LVEF values.     

The Effects of Instrumental Touching on Infant Pain Perception and the Effects of Eutectic Mixture of Local Anesthetics (EMLA) on the Reduction of Pain

Background:

Premature infants, who have to spend the first week of their lives in neonatal intensive care units (NICUs), experience pain and stress in numerous cases, and they are exposed to many invasive interventions. The studies have shown that uncontrolled pain experienced during early life has negative and long-term side effects, such as distress, and such experiences negatively affect the development of the central nervous system

Objectives:

The purpose of the study was to examine the effects of touching on infant pain perception and the effects of eutectic mixture of local anesthetic (EMLA) on the reduction of pain.

Patients and Methods:

Data for the study were collected between March and August 2012 from the neonatal clinic of a university hospital located in eastern Turkey. The population of the study consisted of premature infants who were undergoing treatment, completed the first month and who were approved for Hepatitis B vaccine. The study consisted of two experimental groups and one control group. Information forms, intervention follow-up forms, and Premature Infant Pain Profile (PIPP) were used to collect the data. EMLA cream was applied on the vastus lateralis muscles of the first experimental group before the vaccination. The second experimental group was vaccinated by imitation (placebo), without a needle tip or medicine. Vaccination was carried out using instrumental touch in this group. A routine vaccination was applied in the control group.

Results:

Mean pain scores of the group to which EMLA was applied were lower in a statistically significant way (P < 0.05) compared to the pain scores of the other groups. Moreover, it was determined that even though invasive intervention was not applied to the newborns, the touching caused them to feel pain just as in the placebo group (P < 0.005).

Conclusions:

The results demonstrated that EMLA was an effective method for reducing pain in premature newborns, and the use of instrumental touch for invasive intervention stimulated the pain perception in the newborns.     

Prenatal ultrasonographic diagnosis of generalized arterial calcification of infancy

A healthy 19‐year‐old nulliparous pregnant woman was referred to our clinic because of fetal pericardial effusion and ascites. The sonographic examination performed at 28 weeks' gestation revealed scalp edema, severe skin edema, bilateral hydrocele, ascites, and pleural and pericardial effusion. Fetal echocardiographic examination showed that both ventricles were dilated with severely depressed contractility. The aortic annulus, ascending aorta, aortic arch, descending aorta, common iliac arteries, main pulmonary artery, tricuspid valve, and mitral chordae tendinae were hyperechogenic. Right ventricular outflow tract was narrow with decreased blood flow. There was tricuspid and mitral valve regurgitation and tricuspid valve stenosis. On the basis of these findings, we made the diagnosis of generalized arterial calcification, which is characterized by extensive calcification of internal elastic lamina and intimal proliferation of medium‐sized and large arteries. This diagnosis was confirmed histologically after the termination of pregnancy. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43 :50–54, 2015     

Electrocardiographic and echocardiographic findings in street children known to be substance abusers

Substance abuse is prevalent in adolescent street children, and death is reported as secondary to aspiration, accidental trauma, asphyxia, cardiac arrhythmia, anoxia, vagal inhibition and respiratory depression. In this study, we examined electrocardiographic and echocardiographic findings from 53 street male adolescents, comparing our findings to those obtained from 61 controls in the same age group. The street children smoked cigarettes (98.1%) and had used, or were using, thinner (73.6%), glue (75.5%), hashish (79.2%), morphine or its products (24.5%), ecstasy (37.7%), anti-emetics (13.2%) and alcohol (60.4%). On examination, their blood pressures were lower than the control group. Electrocardiographically, PR, QRS, QT were found to be longer (p less than 0.05) than the values for healthy controls. Although it was not statistically significant, QTc duration was also longer than the control group. Echocardiography revealed increased diameters of the left ventricle and atrium, the aorta, and the coronary arteries as compared to the healthy children (p less than 0.05).     

CT Angiography Evaluation of Unusual Transorbital Penetrating Injury: A Toothbrush

Orbital penetrating injuries may cause significant harm to optic nerves and eyeball as well as to the brain and cerebral vasculature. Defining surrounding neurovascular structures by CT angiography (CTA) is important for surgical removal. We present an uncommon case of a 3‐year‐old child with a penetrating orbital injury caused by a toothbrush. To the best of our knowledge, there is no report orbital injury with a toothbrush so far.     

The relation of the subjective dyspnoea perception with objective dyspnoea indicators,quality of life and functional capacity in patients with COPD

Aims and objectives. The study was conducted to determine the relationship between the subjective dyspnoea perception and objective dyspnoea indicators, quality of life and functional capacity. Background. Even though dyspnoea severity is generally assessed through objective parameters such as respiratory functions and arterial blood gases, studies indicate that subjectively perceived dyspnoea is not always consistent with objective dyspnoea indicators. For that reason, it is necessary to assess the changes caused by dyspnoea on quality of life and on functional capacity in addition to objective dyspnoea indicators to assess subjective dyspnoea in the most accurate way in patients with COPD. Design. A correlational study. Methods. The subjective dyspnoea was evaluated via the Basal Dyspnea Index and Visual Analog Scale, whereas objective dyspnoea was evaluated through respiratory function tests and arterial blood gases, which are physiological measurements. The quality of life was assessed with SF‐36 and St. George’s Respiratory Diseases Questionnaire. Functional capacity was evaluated with the six‐minute walking distance test. Results. Basal Dyspnea Index score was associated with respiratory functions (FEV₁, FVC, FEV₁/FVC), arterial blood gases (SaO₂, PaO₂, pH), the quality of life and functional capacity, while Visual Analog Scale score was not associated with these measurements. Conclusions. Subjective dyspnoea severity assessed by Basal Dyspnea Index is related to the objective dyspnoea indicators, quality of life and functional capacity. In the assessment of dyspnoea, Basal Dyspnea Index is an appropriate measure, whereas Visual Analog Scale is not. In the light of these results, we recommend that Basal Dyspnea Index should be used in the assessment of dyspnoea in patients with COPD. Relevance to clinical practice. We conclude that dyspnoea will be evaluated in the most accurate and short way with the Basal Dyspnea Index. In addition, the effects of dyspnoea on quality of life and functional capacity will be predicted by Basal Dyspnea Index.     

The effect of the design of a mandibular implant-supported zirconia prosthesis on stress distribution

Statement of problemProsthetic complications have been frequently reported in implant-supported complete-arch prosthesis. Prosthetic restorations designed with an all-on-four treatment concept and fabricated from zirconia ceramic may be used to overcome these problems.PurposeThe purpose of this biomechanical study was to evaluate the effects of cantilever length and inclination of implant on the stress distribution in bone tissue, implant, and a monolithic zirconia ceramic-lithium disilicate glass-ceramic superstructure for all-on-four prosthesis.Material and methodsAll-on-four mandibular prosthesis fabricated from a zirconia and lithium disilicate glass-ceramic (LDGC) superstructure was designed with cantilever lengths of either 5 mm or 9 mm and posterior implants with a distal tilt of either 15 or 30 degrees. Stresses were evaluated with a simulated application of a static load of 600 N.ResultsIncreasing implant inclination from 15 to 30 degrees led to a decrease in maximum principal stress (MaxPS) values of approximately 4 to 7 MPa in cortical bone around all implants except the right anterior implant in the designs with short cantilevers and an increase in MaxPS values (approximately 3 to 19 MPa) in the same places in the designs with the long cantilevers. Increasing cantilever length from 5 to 9 mm resulted in an increase in minimum principal stress (MinPS) values of approximately 3 to 13 MPa in the cortical bone surrounding all posterior implants. In the designs with the long cantilever, MaxPS values increased approximately 3 to 4 MPa in spongy bone adjacent to the right posterior implant. An increase in cantilever length also led to higher vMS values at the first and second implant grooves in the right posterior implant in the design with the 15-degree implant tilt. An increase in implant inclination in the design with the short cantilever resulted in lower vMS values at the apex and all grooves of the left posterior implant, whereas in the design with the long cantilever, an increase in implant inclination resulted in lower stress values in the first and second grooves of the same implant. An increase in implant inclination led to in an increase in vMS values in the core structure.ConclusionsIn zirconia ceramic restorations by using an all-on-four design with an LDGC superstructure, short cantilevers may be preferable because they result in a more favorable distribution of stress than long cantilevers. An increase in implant angulation from 15 to 30 degrees decreased MaxPS values in cortical bone.     

Cost of illness among patients with diabetic foot ulcer in Turkey

AIMTo evaluate the annual cost of patients with Wagner grade 3-4-5 diabetic foot ulcer (DFU) from the public payer’s perspective in Turkey.METHODSThis study was conducted focused on a time frame of one year from the public payer’s perspective. Cost-of-illness (COI) methodology, which was developed by the World Health Organization, was used in the generation of cost data. By following a clinical path with the COI method, the main total expenses were reached by multiplying the number of uses of each expense item, the percentage of cases that used them and unit costs. Clinical guidelines and real data specific to Turkey were used in the calculation of the direct costs. Monte Carlo Simulation was used in the study as a sensitivity analysis.RESULTSThe following were calculated in DFU treatment from the public payer’s perspective: The annual average per patient outpatient costs $579.5 (4.1%), imaging test costs $283.2 (2.0%), laboratory test costs $284.8 (2.0%), annual average per patient cost of intervention, rehabilitation and trainings $2291.7 (16.0%), annual average per patient cost of drugs used $2545.8 (17.8%) and annual average per patient cost of medical materials used in DFU treatment $735.0 (5.1%). The average annual per patient cost for hospital admission is $7357.4 (51.5%). The average per patient complication cost for DFU is $210.3 (1.5%). The average annual per patient cost of DFU treatment in Turkey is $14287.70. As a result of the sensitivity analysis, the standard deviation of the analysis was $5706.60 (n = 5000, mean = $14146.8, 95%CI: $13988.6-$14304.9).CONCLUSIONThe health expenses per person are $-PPP 1045 in 2014 in Turkey and the average annual per patient cost for DFU is 14-fold of said amount. The total health expense in 2014 in Turkey is $-PPP 80.3 billion and the total DFU cost has a 3% share in the total annual health expenses for Turkey. Hospital costs are the highest component in DFU disease costs. In order to prevent DFU, training of the patients at risk and raising consciousness in patients with diabetes mellitus (DM) will provide benefits in terms of economy. Appropriate and efficient treatment of DM is a health intervention that can prevent complications.     

Fungal peritonitis among the peritoneal dialysis patients of four Turkish centres

This study evaluates the clinical findings and treatment of continuous ambulatory peritoneal dialysis (CAPD) patients with fungal peritonitis in Istanbul from 2000 to 2010. The clinical records of 15 patients with fungal peritonitis among the total 795 patients were reviewed for the clinical and laboratory data. The mean duration of dialysis from the initiation of treatment until the development of fungal peritonitis was 41.14 months. Fungal peritonitis was the primary episode of infection in eight patients. In five other patients previous intensive antibiotherapy was documented. The isolated mircoboes were Candida albicans in six, non-C. albicans in eight and Aspergillus fumigatus in one patient. Tenckoff catheters were removed in all cases and antifungal treatment was given for a minimum of three weeks. Two patients died in the hospital due to the fungal infection whereas others were transferred to haemodialysis. This study highlights the importance of removing the catheter and initiating antifungal therapy as soon as possible in cases of fungal peritonitis because it is responsible for high morbidity and mortality.