Issues in cross‐cultural validity: Example from the adaptation,reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire

Objective

Guidelines have been established for cross‐cultural adaptation of outcome measures. However, invariance across cultures must also be demonstrated through analysis of Differential Item Functioning (DIF). This is tested in the context of a Turkish adaptation of the Health Assessment Questionnaire (HAQ).

Methods

Internal construct validity of the adapted HAQ is assessed by Rasch analysis; reliability, by internal consistency and the intraclass correlation coefficient; external construct validity, by association with impairments and American College of Rheumatology functional stages. Cross‐cultural validity is tested through DIF by comparison with data from the UK version of the HAQ.

Results

The adapted version of the HAQ demonstrated good internal construct validity through fit of the data to the Rasch model (mean item fit 0.205; SD 0.998). Reliability was excellent (α = 0.97) and external construct validity was confirmed by expected associations. DIF for culture was found in only 1 item.

Conclusions

Cross‐cultural validity was found to be sufficient for use in international studies between the UK and Turkey. Future adaptation of instruments should include analysis of DIF at the field testing stage in the adaptation process.

     

Lingual angioedema after alteplase treatment in a patient with acute ischemic stroke

BACKGROUND: In recent years, thrombolytic therapy has become the main treatment of ischemic stroke. But the increasing use of alteplase in ischemic stroke has made some complications more evident. Angioedema is a rare but potentially life-threatening complication of alteplase treatment. Only a few studies have examined the incidence of angioedema after treatment with alteplase for stroke.METHODS: A 75-year-old man complaining of right hemiparesis was admitted to our emergency department. He was diagnosed as having acute ischemic stroke, and alteplase infusion was given two hours after the onset of stroke symptoms. Immediately after the completion of infusion he was noted to have a large swollen tongue.RESULTS: His neurological symptoms resolved gradually within 4 hours, whereas his upper extremity strength improved to 4/5 and lower extremity 5/5. Lingual edema resolved within 16 hours without any complication. He died from presumed nosocomial infection 5 days later.CONCLUSIONS: Lingual angioedema may appear as a possible complication in patients who were treated with alteplase. The management of these patients should be very careful.     

Association of matrix Gla protein gene allelic polymorphisms (G?7→A,T?138→C and Thr83→Ala) with acute coronary syndrome in the Ukrainian population

BACKGROUND:

Several allelic variants of matrix γ-carboxyglutamic acid protein (MGP) can differentially affect the development of certain forms of ischemic heart disease depending on specific characteristics of each population.

OBJECTIVE:

To study the distribution of allelic variants of MGP promoter T⁻¹³⁸→C (rs1800802) and G⁻⁷→A (rs1800801), and Thr₈₃→Ala exon 4 (rs4236) polymorphisms in a Ukrainian population of patients with acute coronary syndrome (ACS).

METHODS:

Polymerase chain reaction and restriction fragment length polymorphism (RFLP) analysis were used to detect the above-mentioned variants of the MGP gene in 115 patients with ACS and in 140 essentially healthy individuals.

RESULTS:

The distribution of homozygous carriers of a major allelic variant, and heterozygous and homozygous minor allele variants of the T⁻¹³⁸→C MGP promoter polymorphism in patients with ACS were 59.8%, 32.7% and 7.5%, respectively. The corresponding distributions of variants in the control group were 54.0%, 41.0% and 5.0%, respectively (P>0.05 [χ² test]). With respect to the G⁻⁷→A polymorphism, the respective distributions were 42.1%, 45.6% and 12.3%, compared with 50.7%, 45.0% and 4.3% in the control group, respectively (P<0.05). Finally, the respective distributions according to the Thr₈₃→Ala exon 4 polymorphism were 42.6%, 43.5% and 13.9%, respectively, compared with 45.3%, 43.0% and 11.7% in the control group. Using logistic regression analysis, it was estimated that the A/A genotype (G⁻⁷→A polymorphism) was significantly (P=0.02) associated with ACS (OR 4.302 [95% CI 1.262 to 14.673]).

CONCLUSION:

The allelic A/A promoter variant of MGP G⁻⁷→A polymorphism can be considered a risk factor for ACS in the Ukrainian population.     

Relative erythrocytosis of patients with end stage renal failure undergoing CAPD

BACKGROUND AND AIM: Although the majority of patients with end stage renal failure have anemia, some have relative erythrocytosis. Patients treated with continuous ambulatory peritoneal dialysis (CAPD) having relative erythrocytosis were studied in order to determine the factors that would be responsible. METHODS: Nine out of 89 CAPD patients (10%) were identified as having relative erythrocytosis. Age-, sex- and duration of disease-matched eight patients undergoing CAPD were taken as control. Beside factors of etiologies of renal failure, smoking, renal cysts, viral hepatitides, residual renal function, the adequacy of CAPD, nutritional status, hypertension, serum levels of erythropoietin, IL-1, IL-6, TNF-, and IGF-1 levels were also investigated. RESULTS: Relative erythrocytosis occurred most often in diabetic and amyloidosis patients. None of the parameters studied were found to be significantly different between groups. During 2-year follow-up, although statistically non-significant, patients having relative erythrocytosis seemed to have higher mortality rate due to vascular complications. CONCLUSION: No single factor seemed to explain erythrocytosis in patients undergoing CAPD. Being diabetic or with amyloidosis may increase the risk.     

A schwannoma mimicing hypopharyngeal carcinoma

Hypopharyngeal schwannoma is quite rare, with only nine cases presented in the literature to our knowledge. The presentation itself requires a distinction from malignant hypopharyngeal disease, which is usually the initial diagnosis. A transcervical approach and laryngomicrosurgery are two possible operating methods for the treatment of hypopharyngeal schwannoma. The selection of the surgical method depends on the size of the tumor. For this case, we preferred the transcervical approach without tracheotomy. In contrast to previous case reports, we were unable to trace the original nerve.     

High conformality radiotherapy in Europe: thirty-one centres participating in the quality assurance programme of the EORTC prostate trial 22991

Today, conformality in radiotherapy is at the centre of many investments in equipment and staffing. To estimate the current situation within the European Organisation for Research and Treatment of Cancer (EORTC) conformal radiotherapy trial for prostate cancer, a technology questionnaire was designed to assess whether participating centres can comply with the required radiotherapy procedures of EORTC trial 22991, where a high dose is prescribed to the prostate. Questions covered various items of computed tomography, data acquisition, treatment planning, delivery and verification. All centres (n=31) replied to the questionnaire. All generate beam's eye views and dose volume histograms. All, but two, centres use digitally reconstructed radiographs to display images. The vast majority of the centres perform at least weekly treatment verification and half have access to individual in vivo dosimetry. The results of the questionnaire indicate that participating centres have access to the equipment and apply the procedures that are essential for conformal prostate radiotherapy. The technology questionnaire is the first step in the extensive quality assurance programme dedicated to this high-tech radiotherapy trial.     

Nasomaxillary frame translocation in medial maxillectomy

Medial maxillectomy is the standard operation for en bloc resection of the lateral nasal wall with portions of the maxillary and ethmoid sinuses. Although most reports comment on good to excellent cosmetic results, nasal collapse is a possible complication of the procedure and is best explained by the loss of lateral nasal wall support. To overcome this problem, we describe a technique with temporary mobilization of a bone frame around the ipsilateral pyriform aperture, including one nasal bone, and fixing it to its original position at the end of the operation.     

The prevalence and clinical features of tuberculous peritonitis in CAPD patients in Turkey, report of ten cases from multi-centers

OBJECTIVE: To determine the rate, risk factors and outcome of Tuberculous Peritonitis (TBP) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) in our units. DESIGN: Retrospectively, we reviewed the medical data of all CAPD patients from 12 centers for TBP, covering the period between 1986 and December 2002. SETTING: All patients were from 12 renal clinics at tertiary-care university hospitals. RESULTS: Ten cases of TBP were identified among the CAPD patients in our centers. There were five male and five female patients with a mean age of 37.2 years. None of the patients had tuberculosis history, 6 patients had predominance of PNL. One patient had coincidental bacterial peritonitis. Two patients were successfully treated without the removal of the Tenckhoff catheter. CONCLUSION: TBP in CAPD patients is a very rare complication. In contrast to predominance of lymphocytes in nonuremic patients with tuberculous peritonitis, CAPD patients with tuberculous peritonitis may have predominance of PNL on examination of the peritoneal fluid. Since TBP has high morbidity and mortality, early diagnosis and treatment of disease are extremely important for improving outcome.