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  • Comparative analysis of patients hospitalized for severe transaminase elevation according to etiology and laboratory findings

    Objective: The aim of this study is to investigate the etiological, epidemiological, clinical and laboratory findings of patients hospitalized in internal clinics with elevated transaminases and to create a point of view with clinical cues for acute hepatitis.

    Methods: A total of 102 patients who were hospitalized in Internal Medicine and Infectious Diseases Clinics between January 2010 and September 2013 and whose transaminase levels were at least five times higher than the upper limit were included in the study. Patients’ age, sex, etiology, laboratory findings, length of stay in the clinic, and duration of liver enzymes normalizations were examined retrospectively. ANOVA, Kruskal-Wallis and chi-square tests were used in the analysis of qualitative and quantitative data.

    Results: Of the 102 patients with acute liver injury, 58 (56.9%) were female and 44 (43.1%) were male. The average age is 46 years. The study group consisted of three main groups: toxic hepatitis (34.3%), acute viral hepatitis (25.5%) and ischemic hepatitis (17.6%). This was followed by acute nonbiliary pancreatitis (6.9%), autoimmune hepatitis (4.9%) and other (10.8%) groups. Transaminase and bilirubin values ​​were higher in acute viral hepatitis than other groups. Acute viral hepatitis group hospitalized for the longest time. The group which the liver enzymes recovered at the latest was toxic hepatitis. The two most common causes of toxic hepatitis were nonsteroidal anti-inflammatory drugs and herbal products. In the ischemic hepatitis group, the mean age was significantly higher. Alcohol use was not effective on the duration of hospitalization and normalization of liver enzymes.

    Conclusion: Rapid determination of etiology, shortening hospitalization periot, and proper use of laboratory tests are important in patients with elevated transaminases. The purpose of this study is to enable the clinician to have an effective approach to acute liver damage.

  • Depression and anxiety symptom severity in a group of children with epilepsy and related factors].

    OBJECTIVE:

    The aim of this study was to assess the anxiety and depression symptom severity in a group of epileptic children and compare the results to healthy controls. Additionally, the frequency of psychiatric disorders in epileptic children was also assessed.

    METHOD:

    The study compared 30 children, ranging in age from 8 to 16 years with epileptic disorder who attended a children’s neurology clinic, with healthy controls using the State-Trait Anxiety Inventory and Children’s Depression Inventory scores and suicidal ideation. The MINI was administered to epileptic patients to determine the frequency of psychiatric disorders in this clinical group.

    RESULTS:

    State anxiety scores of the epilepsy group were significantly higher compared to controls. No significant differences were found between patients and controls in terms of trait anxiety and depression scores. In all 3 scales boys scored significantly higher than girls. No significant relationships were found between symptom severity, duration of epilepsy, age of seizure onset and depression and anxiety scores. Psychiatric assessments with the MINI identified psychiatric disorders in 26.7% of epileptic patients. Two epileptic patients reported past suicidal attempts however, only 2 patients were receiving psychiatric treatment.

    CONCLUSION:

    Psychiatric disorders were frequently observed in the group of epileptic patients. Psychiatric disorders occurred more frequently in boys compared to girls in this group. Clinicians should be more aware of accompanying psychiatric symptoms in epileptic patients and take the necessary precautions in the early period of the illness in an effort to prevent future mental health problems.

  • Sociodemographic and clinical factors associated with compliance to methylphenidate treatment in children with attention deficit hyperactivity disorder].

    OBJECTIVE:

    The present study aimed to determine the rate of treatment compliance in children with attention deficit hyperactivity disorder (ADHD) that were newly prescribed methylphenidate, and to evaluate the associated clinical and sociodemographic factors, as well as parental concerns about drug treatment.

    METHOD:

    The sample of this prospective and observational study consisted of 238 children aged 7-18 years with ADHD diagnosed according to DSM-IV criteria. At the end of the first year, the study sample was splitted into 2 groups; compliant and non-compliant. Parental attitudes toward drug therapy, and clinical and sociodemographic characteristics of the 2 groups were compared. A clinician rated parental concerns about drug treatment 4-6 weeks after the interview that was conducted in order to inform them about methylphenidate therapy. Regarding a minimum requirement of 5 days weekly dosage and drug holidays, cases that took more than 70% of the recommended methylphenidate dose at the end of the first year were described as compliant.

    RESULTS:

    At the end of the first year of treatment, the drug compliance rate was 80.3% (n= 191). The non-compliant group consisted of older children. A significant difference was observed between the compliant and non-compliant groups in terms of parental approach toward drug treatment. Children in the non-compliant group had parents that had doubts about pharmacotherapy and these children were less compliant with methylphenidate treatment.

    CONCLUSION:

    Parental concerns about methylphenidate treatment in ADHD may influence treatment compliance. Additionally, it is suggested that developmental psychological characteristics associated with adolescence may also be important.

  • Psychiatric symptoms and health-related quality of life in children and adolescents with psoriasis.

    Information about the relationship between psoriasis and psychiatric morbidity and quality of life in children and adolescents is limited. We aimed to examine the symptoms of depression and anxiety and health-related quality of life levels in children and adolescents with psoriasis. Forty-eight outpatients with psoriasis aged 8 to 18 years are included in this study. Child Depression Inventory (CDI), State-Trait Anxiety Inventories for Children (STAI-C) and Pediatric Quality of Life Inventory Parent and Child Versions (PedQL-P and C) were applied to both patient and control groups. Psoriasis symptom severity was measured by the Psoriasis Area Severity Index (PASI). Both study and control groups were divided into two age groups, child (8-12 yrs) and adolescent (13-18 yrs), to exclude the effect of puberty on psychological condition. The mean CDI score was higher, and PedQL-C psychosocial and total scores were lower in the children compared with controls. Duration of psoriasis had an increasing effect on physical-health and total scores of PedQL-C in the child group and all PedQL-C scores in the entire sample. Psoriasis severity showed a negative correlation with psychosocial and total scores of PedQL-P in the adolescent group and PedQL-P physical-health scores in the entire sample. Psoriasis is related to depression and impaired quality of life in children. The depressive symptoms in children with psoriasis should not be overlooked and psychiatric assessment of these children should be provided.

  • The relationship between psychological symptoms, lung function and quality of life in children and adolescents with non-cystic fibrosis bronchiectasis.

    OBJECTIVES:

    The aim of this study was to evaluate the relationship between psychological symptoms and quality of life (QOL) and clinical variables in a cohort of children and adolescents with non-cystic fibrosis (non-CF) bronchiectasis.

    METHODS:

    Seventy-six patients (aged 8-17years) participated in this study. Questionnaires were used to evaluate the psychological status and QOL of the patients and healthy controls. The patient and control groups were divided into child and adolescent groups to exclude the effect of puberty on psychological status.

    RESULTS:

    No significant difference was found between patient and control groups for mean depression and trait anxiety scores. Only the child-rated physical health QOL scores were significantly lower for patients than the controls. Also, excepting physical health scores in adolescent group, all of the parent-rated QOL scores were significantly lower in both group and total subjects. Regarding determinants of QOL, age of children and FEV1/FVC percent predicted had positive effects, while dyspnea severity and trait anxiety had negative effects, for the sample as a whole.

    CONCLUSIONS:

    Non-CF bronchiectasis is associated with poorer QOL in childhood. The impact of the disease on QOL occurs through both clinical and psychological variables.

  • Clinical effects of vitamin d ın children with asthma

    Clinical Effects Of Vitamin D In Children With Asthma

    Abstract

    Objective: Both asthma and vitamin D deficiency are common among children. The results from studies examining the relationship between them are contradictory. The aim of this study is to determine the relationship between the clinical parameters of asthma and vitamin D status in children.

    Materials and Methods: One hundred and twenty children diagnosed with asthma and followed up in our hospital were included in the study. The control group included seventy-four children with no evidence of allergic disease. The eosinophil counts, immunoglobulin E levels and serum 25 OH cholecalciferol (25OHD) levels were measured.

    Results: This study consisted of 73(60.8%) males with a mean age of 4.4±1.2 years in the patient group. There was no significant difference between the patient and control groups with respect to gender and age. The mean 25OHD level was 21.49±7.74ng/mL in the study group and 23.94±8.97 ng/mL in the control group. The difference was not significant (p=0.094). The patients with asthma were grouped according to their vitamin D status as “deficient (Group-1)”, “insufficient (Group-2)” and “normal (Group-3)”. The sociodemographic features, duration of illness, number of hospitalizations, number of sensitivity to allergens, eosinophil count, and the serum IgE levels were not found to be different between the groups. However, the total number of the exacerbations, asthma severity, and systemic glucocorticoid need in the previous year were significantly higher in deficiency group (p<0.05).

    Discussion: Vitamin D levels were not significantly different in patients with asthma. Vitamin D deficiency was common in the study group as well as the control group. Clinical severity of disease, the number of exacerbations, and the systemic glucocorticoid need were related to the vitamin D level.

  • Comparison of warm fluid and cold fluid resuscitation during uncontrolled hemorrhagic shock model in rats

    BACKGROUND: This study was designed to compare the e ects of resuscitation with cold and warm fluid on survival time, rate and volume of hemorrhage, hemodynamics, hypothermia, coagulopathy, acid-base balance, hematocrit, lactate, and base deficit during uncontrolled hemorrhagic shock (HS) model in rats.

    METHODS: HS model was created with splenic vascular and parenchymal injury in 29 rats under ketamine and xylazine anesthesia. Thirty minutes after the hemorrhage, the rats were randomized to receive 14.5 mL/kg 0.9% sodium chloride solution at either 24oC (Group 1; n=9) or 4oC (Group 2; n=10) for 20 minutes. Groups 1 and 2 were compared with group that did not receive fluid (Group 3; n=10). Statistical data were represented as mean±SD. SPSS for Windows, Version 15.0 (SPSS, Inc., Chicago, IL, USA) software, Bonferroni-adjusted Mann-Whitney U test and Kaplan-Meier procedure were used to perform statistical data analysis. P value of ≤0.05 was considered statistically significant.

    RESULTS: Cold fluid resuscitation decreased survival time due to increased rate and volume of hemorrhage, acidosis, hypothermia, lactate, and base deficit and decreased blood pressure and hematocrit.

    CONCLUSION: There is a great need for further experimental and clinical trials on fluid resuscitation in trauma in order to define which fluid should be administered, temperature of the fluid, quantity to be delivered, and duration.

    Keywords: Fluid resuscitation; hemorrhagic shock; intravenous cold fluid; rat.