Does patient education increase antimuscarinic treatment persistence in overactive bladder syndrome?

Overactive bladder syndrome (OAB) is a chronic condition that requires long‐term management. Patient education may have role in decreasing the unfavourable effects of long‐term treatment of OAB. The aim of the study was to evaluate the effect of detailed patient education on the patients' persistence with antimuscarinic treatment for OAB. A total of 140 patients with the diagnosis of OAB were included in this study. Patients were randomly divided into two groups. Patients in Group 1 were given information by the same urology doctor about the disease and treatment. Patients in Group 2 were given information by a urology nurse. Patients were recalled in the first, third and sixth months of treatment. The treatment persistency was evaluated in the whole study population and between the groups. The persistency rates of the whole group were 88·6% in the first month, 65·7% in the third month and 45·7% in the sixth month. At the end of the sixth month, 42·8% of males and 47·1% of females were taking antimuscarinics (p = 0·580). The persistence rate of Groups 1 and 2 were 82·8 and 94·3% at the first month. (p = 0·034). It decreased to 31·4% in the first and 60% in the second group at the sixth month (p = 0·001). The persistence rate of antimuscarinic treatment is low. Patient education is simple and effective way of increasing persistence. Clinicians must pay attention to inform their patients about the disease and possible side effects of treatment. An educated health provider may be very helpful in educating patients for OAB.     

Prediction of infarct-related coronary artery of patients with acute inferior myocardial infarction by a predischarge exercise test index

The predictive accuracy of electrocardiographic markers in identifying the infarct-related artery of myocardial infarctions has been a subject of extensive investigation. The present study was designed to test whether the index L II/L III ratio adapted to exercise electrocardiograms could be utilized as a marker to distinguish right coronary and left circumflex arteries as culprit coronaries in acute inferior myocardial infarctions. For this purpose, 82 patients with a positive-symptom-limited and/or submaximal treadmill exercise test with modified Bruce protocol after an acute inferior myocardial infarction were studied. Those patients with ST segment elevation during the stress test were included in the study. ST segment index was defined as the ratio of exercise-induced ST elevation amplitude in L II/L III. Patients were classified as having an index > 1 (n=24) and < 1 (n=58), and the findings were compared with the findings on coronary angiography. The groups were comparable with respect to age, gender, peak exercise level, and double products achieved. Circumflex artery was the infarct-related one in the majority (21/24; 88%) of patients with an index > 1, whereas most (51/58; 88%) patients with an index < 1 had the culprit lesion in their right coronary artery (p<0.001). The ratio of exercise-induced ST elevations in leads L II and L III has a significantly high ability to discriminate the infarct-related coronary artery in patients with uncomplicated inferior myocardial infarction. Considering the prognostic importance of the type of coronary involvement, this index could be a part of predischarge evaluation in this patient group.     

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES:

To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis.

METHODS:

We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed.

RESULTS:

Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival.

CONCLUSIONS:

Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis.     

Effect of ankle proprioceptive training on static body balance

[Purpose] This study aimed to investigate the effect of ankle proprioceptive training on static body balance. [Subjects and Methods] In this randomized-controlled, single-blind study, 59 university students (35 females, 24 males) were randomized into study (n=29) and control (n=30) groups. The study group received a foot and ankle proprioceptive exercise program including stretching, strengthening (plantar and dorsi-flexors, invertor and evertor muscles), and balance board exercises, each with 10 repetitions per session, 5 days a week, for a total of 10 sessions. The control group did not receive any intervention. Static body balance was evaluated by a kinesthetic ability trainer, which showed the balance index scores under both single foot and both feet conditions. This evaluation was repeated at the end of two weeks for both groups. [Results] Outcome measures of the groups were similar at the baseline. Balance index scores of both groups improved at the end of two weeks, and the study group had significantly lower index scores than those of the control group, indicating better balance. [Conclusion] Ankle proprioceptive training had positive effects on static body balance parameters in healthy individuals, and it is worth investigating the effects of this type of training in patients with balance disorders.Key words: Ankle proprioception, Static balance, Sport KAT     

The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients

[Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation.Key words: Acute stroke, Mirror therapy, Upper extremity     

Therapeutic plasma exchange in pediatric intensive care: Indications,results and complications

Therapeutic plasma exchange (TPE) is an effective treatment method in selective indications. Secondary to access and technical features, it is more difficult to apply in pediatric population than adults. The aim of this study is investigate safety, clinical indications, and results of this method in critically ill pediatric patients who need TPE treatment. All of the TPE procedures performed in a pediatric intensive care unit providing tertiary care during 4 years (2015–2019) were evaluated retrospectively. TPE procedures (635) were performed for 135 patients. Median age was 34 months (10‐108). Ninety‐seven patients had mechanical ventilation support. Sepsis with multiple organ failure was the most frequent indication and accounted for 44.4% (n = 60) of the indications followed by hematological and neurological diseases (19.2% and 9.6% respectively). TPE was performed alone in 469 cases (73.9%), in combination with continuous renal replacement therapy in 154 cases (24.2%), and additional to extracorporeal membrane oxygenation in 12 cases (1.9%). Hematological disease and sepsis subgroups had the highest intubation rate, mechanical ventilation period, PRISM score, organ failure count, and mortality. Fresh frozen plasma (FFP) was the most frequently used replacement fluid in 90.4% of the procedures. The most frequent anticoagulant used in TPE was acid citrate dextrose solution (79.3%). Procedural complications were detected in 104 cases (16.3%) and occurred during TPE sessions. Overall survival rate was 78.5%. We found that the non‐survivor group had significantly higher rates of organ failures (P = 0.0001), higher PRISM scores on admission (P = 0.0001), and higher rates of invasive ventilation support needed (P = 0.012). TPE is a treatment method which can be safely provided in healthcare facilities with necessary medical and technical requirements. Although it is riskier to provide such treatment to critically ill children, complications can be minimized in experienced healthcare facilities. Overall results are good and can vary depending on indication.     

Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome

Purpose

Retina is a unique part of the central nervous system (CNS) for visualizing the processes of axonal and neuronal degeneration. Optical coherence tomography (OCT) allows direct visualization and measurement of retinal nerve fiber layer (RNFL) thickness, macular volume, and optic disc (OD) parameters. One of the disorders associated with atrophy in different brain regions is obstructive sleep apnea syndrome (OSAS). In the present study, we aimed to determine OD and RNFL changes measured by OCT for investigating the progress of neurodegeneration development in OSAS, excluding all the other conditions that can directly affect RNFL thickness and optic nerve parameters.

Methods

Both eyes of 101 patients with OSAS and 20 controls were investigated by OCT. Full-night polysomnography (PSG) and ophthalmologic examination including automated visual field (VF) examination and OCT were performed in all of the patients.

Results

According to the OSAS grading, patients were grouped as mild (n?=?15), moderate (n?=?27), and severe (n?=?59). We found significant decrease in RNFL thickness only in the patients with severe OSAS compared with the other groups and decreased macular ganglion cell thickness in the severe OSAS group compared with the control group. VF parameters were significantly worsened in all the OSAS subgroups compared to the control group. We found different data such as normal or increased optic nerve parameters as result of subtle OD edema, which may mask possible peripapillar axonal loss.

Conclusions

We think that evaluation of neurodegeneration in OSAS is not always possible by examining OD and RNFL because there are difficulties due to the confounding issues of cerebral atrophy and OD edema.