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Tuominen A, Saavalainen L, Niinimäki M, Gissler M, But A, Härkki P, Heikinheimo O. First live birth before surgical verification of endometriosis-a nationwide register study of 18 324 women. Hum Reprod 2023:dead120. [PMID: 37403272 PMCID: PMC10391315 DOI: 10.1093/humrep/dead120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
STUDY QUESTION Do women with endometriosis have lower first live birth rate before surgical diagnosis than women without verified endometriosis? SUMMARY ANSWER Compared to reference women, the incidence of first live birth was lower in women prior to surgical verification of endometriosis irrespective of the type of endometriosis. WHAT IS KNOWN ALREADY Endometriosis is associated with pain and reduced fertility. The mechanism of infertility is partly explained by anatomical, endocrinological, and immunological changes. Over the past decades, the treatment of both endometriosis and infertility has evolved. Knowledge of fertility far before surgical diagnosis of endometriosis in large cohorts and of different types of endometriosis has been lacking. The diagnostic delay of endometriosis is long, 6-7 years. STUDY DESIGN, SIZE, DURATION Retrospective population-based cohort study focused on the time period before the surgical verification of endometriosis. All women with surgical verification of endometriosis in 1998-2012 were identified from the Finnish Hospital Discharge Register and the reference cohort from the Central Population Register. Data on deliveries, gynecological care, and sociodemographic factors before the surgical diagnosis were gathered from Finnish national registers maintained by the Finnish Institute for Health and Welfare, the Digital and Population Data Services Agency, and Statistics Finland. PARTICIPANTS/MATERIALS, SETTING, METHODS All women aged 15-49 years at the time of surgical verification of endometriosis (ICD-10: N80.1-N80.9) in Finland during 1998-2012 were identified (n = 21 620). Of them, we excluded women born in 1980-1999 due to the proximity of the surgical diagnosis (n = 3286) and women left without reference (n = 10) for the final endometriosis cohort of 18 324 women. From the final cohort, we selected sub-cohorts of women with isolated diagnosis of ovarian (n = 6384), peritoneal (n = 5789), and deep (n = 1267) endometriosis. Reference women were matched by age and residence and lacked registered clinical or surgical diagnosis of endometriosis (n = 35 793). The follow-up started at the age of 15 years and ended at the first birth, sterilization, bilateral oophorectomy, hysterectomy, or until the surgical diagnosis of endometriosis or corresponding index day-whichever came first. Incidence rate (IR) and the incidence rate ratio (IRR) of first live birth before the surgical verification of endometriosis with corresponding CIs were calculated. In addition, we reported the fertility rate of parous women (the number of all children divided by the number of parous women in the cohort) until the surgical verification of endometriosis. The trends in first births were analysed according to the women's birth cohort, type of endometriosis, and age. MAIN RESULTS AND THE ROLE OF CHANCE Surgical diagnosis of endometriosis was set at the median age of 35.0 years (IQR 30.0-41.4). Altogether 7363 women (40.2%) with endometriosis and 23 718 (66.3%) women without endometriosis delivered a live born infant before the index day (surgery). The IRs of the first live birth per 100 person-years were 2.64 (95% CI 2.58-2.70) in the endometriosis cohort and 5.21 (95% CI 5.15-5.28) in the reference cohort. Between the endometriosis sub-cohorts, the IRs were similar. The IRR of the first live birth was 0.51 (95% CI 0.49-0.52) between the endometriosis and reference cohorts. Fertility rate per parous woman before the surgical diagnosis was 1.93 (SD 1.00) and 2.16 (SD 1.15) in the endometriosis and reference cohorts (P < 0.01). The median age at the first live birth was 25.5 (IQR 22.3-28.9) and 25.5 (IQR 22.3-28.6) years (P = 0.01), respectively. Between the endometriosis sub-cohorts, women in the ovarian sub-cohort were the oldest at the time of surgical diagnosis with the median age of 37.2 years (IQR 31.4-43.3), (P < 0.001). Altogether 44.1% (2814) of the women with ovarian, 39.4% (2282) with peritoneal, and 40.8% (517) with deep endometriosis delivered a live born infant before the diagnosis. IRRs between the endometriosis sub-cohorts did not differ. Fertility rate per parous woman was lowest, 1.88 (SD 0.95), in the ovarian sub-cohort compared to 1.98 (SD 1.07) in the peritoneal and 2.04 (SD 0.96) in deep endometriosis (P < 0.001). Women with ovarian endometriosis were oldest at first live birth compared to women in other sub-cohorts with a median age of 25.8 years (IQR 22.6-29.1) (P < 0.001). Cumulative distributions of first live birth were presented according to age at first live birth and birth cohorts of the participants. LIMITATIONS, REASONS FOR CAUTION The increasing age at first live birth, increasing practice of clinical diagnostics, conservative treatment of endometriosis, a possible effect of coexisting adenomyosis, and use of artificial reproductive treatments should be considered when assessing the results. In addition, the study is limited due to possible confounding effects of socioeconomic factors, such as level of education. It should be noted that, in this study, we assessed parity only during the years preceding the surgical verification of endometriosis. WIDER IMPLICATIONS OF THE FINDINGS The need for early diagnosis and relevant treatment of endometriosis appears clear given the impairment of fertility prior to its surgical verification. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Hospital District of Helsinki and Uusimaa and by Finska Läkaresällskapet. The authors report no conflicts of interest. All authors have completed the ICMJE Disclosure form. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Tuominen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, Finland
| | - L Saavalainen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Niinimäki
- Department of Obstetrics and Gynecology, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostobothnia, Oulu, Finland
| | - M Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Academic Primary Health Care Center, Stockholm, Sweden
| | - A But
- Department of Biostatistics, University of Helsinki, Helsinki, Finland
| | - P Härkki
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - O Heikinheimo
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Lemma A, Tolonen M, Vikatmaa P, Mentula P, Kantonen I, But A, Leppäniemi A, Sallinen V. Epidemiology, Diagnostics, and Outcomes of Acute Occlusive Arterial Mesenteric Ischaemia: A Population Based Study. J Vasc Surg 2023. [DOI: 10.1016/j.jvs.2022.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Toffol E, Partonen T, Latvala A, But A, Heikinheimo O, Haukka J. Use of hormonal contraception and attempted suicide: a nested case-control study. Eur Psychiatry 2022. [PMCID: PMC9564136 DOI: 10.1192/j.eurpsy.2022.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
In Finland more than 40% of fertile aged women used some type of hormonal contraception (HC) in the period 2010-2013. A proportion of women using HC complains of side effects, including mood symptoms. The relationship between the use of HC and the risk of attempted suicide (AS) is still a matter of debate.
Objectives
To assess the association of the use of HC with the risk of AS during 2017-2019.
Methods
Data were retrieved from the Prescription Centre, Care Register of Health Care, Register of Primary Health Care Visits and Statistics Finland. A total of 587 823 women, aged 15-49 years, using and not using HC in 2017 were analysed in the initial incidence study. All incident AS cases during 2018-2019, and their 4:1 age-matched controls (1 174 346 person-years) were analysed in a nested case-control setting via conditional logistic regression models.
Results
Altogether 818 AS cases occurred during the follow-up (incidence rate: 0.70/1000 person-years, 95% CI 0.65–0.75), with an IRR of HC vs. no-HC use of 0.73 (0.63–0.83). Current use (in the 180 days before the event) of estradiol- or ethinylestradiol-containing HC was associated with a lower risk of AS (0.53, 0.33–0.87; 0.49, 0.37–0.64, respectively) compared to non-use of HC. After controlling for covariates (marital and socioeconomic status, education level, use of psychotropic medications), only current use of HC containing ethinylestradiol remained significant (0.39, 0.23–0.65).
Conclusions
A lower risk of AS is associated with the use of HC, and specifically of ethinylestradiol-containing
HC.
Disclosure
No significant relationships.
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Sari S, Aksoy SM, But A. The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors. Int J Clin Pract 2021; 75:e14103. [PMID: 33616248 DOI: 10.1111/ijcp.14103] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/18/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Unintended perioperative hypothermia, defined as core body temperature less than 36°C, is closely related to many complications such as cardiovascular diseases, peroperative hemorrhagic diathesis and impairment of drug metabolism. Determination of the incidence of perioperative hypothermia and examination of risk factors may help to prevent hypothermia and its complications. METHODS We conducted a prospective, observational study of 2015 patients who underwent various operations under general anesthesia, and the risk factors of developing hypothermia were analysed. RESULTS The incidence of perioperative hypothermia was 78.6%. The incidence of hypothermia within 2 hours was 56.6%, and after 2 hours, it was 100%. Mean age was 49.36 ± 16.10, and 17.8% were over 65 years old. The mean body mass index (BMI) was 27.96 ± 3.94 kg/m2 ; 60.8% of the patients had American Society of Anesthesiologists (ASA) I score, 33.4% had ASA II and 5.8% had ASA III; 35.8% of the patients had co-morbidities. Intravenous and irrigation fluids were unwarmed; 99.9% of the patients were warmed passively, and only 0.1% of patients received active heating intraoperatively. The incidence of hypothermia was higher in overweight (BMI ≥ 25 kg/m2 ), elderly (>65 years) patients and those with co-morbidities. High American Society of Anesthesiologists (ASA) scores, grade 3-4 surgery, endoscopic surgery, duration of anesthesia >2 hours, infusion or irrigation >1000 mL significantly increased the incidence of hypothermia. CONCLUSION The incidence of perioperative hypothermia found was high. Important risk factors were found as prolonged duration of anesthesia and surgery, advanced age, overweight, high ASA scores, major surgeries, endoscopic operations and unwarmed fluid administration. High incidence may be reduced by raising awareness, considering fossible risk factors and following the recommendations of the guidelines on prevention of perioperative hypothermia.
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Affiliation(s)
- Suleyman Sari
- Department of Anesthesiology and Reanimation, Ministry of Health Yozgat City Hospital, Yozgat, Turkey
| | - Semsi Mustafa Aksoy
- Department of Anesthesiology and Reanimation, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
| | - Abdulkadir But
- Department of Anesthesiology and Reanimation, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara, Turkey
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Sahap M, Gulec H, But A, Gulec S, Ozcan AD. Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities. APIC 2021. [DOI: 10.35975/apic.v25i2.1475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The higher incidence of comorbidities in advanced age causes difficulties in anesthesia management. When choosing the anesthesia technique in old aged patients, our target must be to avoid aggravating the existing systemic diseases and avoid disturbing the hemodynamics to ensure their rapid return to routine life. In this case report, we present our choice of infraclavicular nerve block accompanied with spinal anesthesia in a patient with advanced age and several comorbidities, who sustained multiple trauma. The surgery of the patient was successfully performed with minimal effects on the hemodynamics, and he was transferred to the clinic. We stress careful selection of the most appropriate anesthesia technique according to the existing state of the patient, and opting for appropriate nerve blocks even to the patients with respiratory problems.
Key words: Advanced age; Trauma; Spinal anesthesia; Infraclavicular block
Citation: Sahap M, Gulec H, But A, Gulec S, Ozcan AD. Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities. Anaesth. pain intensive care 2021;25(2):222-224. DOI: 10.35975/apic.v25i2.1475
Received: 1 December 2020, Reviewed: 7 February 2021, Accepted: 23 February 2021
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Gulec H, Piskinel Y, Sahap M, Balci CA, Erkilic E, But A. Femoral venous catheter: intraperitoneal placement. APIC 2021. [DOI: 10.35975/apic.v25i2.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Central venous cannulation through femoral veins is known to be associated with various complications. Early complications include extravasation and collection of blood, fluid, and/or contrast material in the retroperitoneal spaces or the peritoneal cavity, whereas late complications include abdominal compartment syndrome (ACS).
A 30-year-old patient was admitted to the emergency department and brought into the operating room with a preliminary diagnosis of pelvic fracture and acute abdomen. An intravenous catheter was placed into the peripheral vein and a central venous catheter in the femoral vein, in the emergency room through which blood was transfused. At the start of the operation, it was found that intraperitoneal bleeding was caused by a perforation associated with the femoral catheter.
We conclude that in the case of acute abdomen, if the femoral venous catheter was already placed in the emergency room, proper placement should be confirmed with ultrasound imaging.
Key words: Central venous catheterization; Femoral vein; Complications; Acute abdomen; Ultrasound imaging; Emergency care
Citation: Piskinel Y, Sahap M, Balci CA, Gulec H, Erkilic E, But A. Femoral venous catheter: intraperitoneal placement. Anaesth. pain intensive care 2021;25(2):203-205. DOI: 10.35975/apic.v25i2.1466
Received: 23 November 2020. Reviewed: 10 February 2021, Accepted: 1 February 2021
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Whipp AM, Vuoksimaa E, Korhonen T, Pool R, But A, Ligthart L, Hagenbeek FA, Bartels M, Bogl LH, Pulkkinen L, Rose RJ, Boomsma DI, Kaprio J. Ketone body 3-hydroxybutyrate as a biomarker of aggression. Sci Rep 2021; 11:5813. [PMID: 33712630 PMCID: PMC7955062 DOI: 10.1038/s41598-021-84635-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 02/09/2021] [Indexed: 01/05/2023] Open
Abstract
Human aggression is a complex behaviour, the biological underpinnings of which remain poorly known. To gain insights into aggression biology, we studied relationships with aggression of 11 low-molecular-weight metabolites (amino acids, ketone bodies), processed using 1H nuclear magnetic resonance spectroscopy. We used a discovery sample of young adults and an independent adult replication sample. We studied 725 young adults from a population-based Finnish twin cohort born 1983-1987, with aggression levels rated in adolescence (ages 12, 14, 17) by multiple raters and blood plasma samples at age 22. Linear regression models specified metabolites as the response variable and aggression ratings as predictor variables, and included several potential confounders. All metabolites showed low correlations with aggression, with only one-3-hydroxybutyrate, a ketone body produced during fasting-showing significant (negative) associations with aggression. Effect sizes for different raters were generally similar in magnitude, while teacher-rated (age 12) and self-rated (age 14) aggression were both significant predictors of 3-hydroxybutyrate in multi-rater models. In an independent replication sample of 960 adults from the Netherlands Twin Register, higher aggression (self-rated) was also related to lower levels of 3-hydroxybutyrate. These exploratory epidemiologic results warrant further studies on the role of ketone metabolism in aggression.
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Affiliation(s)
- A M Whipp
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
| | - E Vuoksimaa
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - T Korhonen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - R Pool
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health (APH) Research Institute, Amsterdam, The Netherlands
| | - A But
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - L Ligthart
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F A Hagenbeek
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health (APH) Research Institute, Amsterdam, The Netherlands
| | - M Bartels
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health (APH) Research Institute, Amsterdam, The Netherlands
| | - L H Bogl
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Epidemiology, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - L Pulkkinen
- Department of Psychology, University of Jyvaskyla, Jyvaskyla, Finland
| | - R J Rose
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - D I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health (APH) Research Institute, Amsterdam, The Netherlands
| | - J Kaprio
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
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Turan M, Kaya S, Tas S, Bas A, Gulec H, Sahap M, Erkilic E, But A. Spinal anesthesia and infraclavicular brachial plexus block for upper extremity reconstruction requiring grafting. APIC 2020. [DOI: 10.35975/apic.v24i4.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Combined use of upper limb blocks in the same surgery with lower limb central blocks is rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in such surgeries. However, the use of ultrasound provides reliable anesthetic accumulation around the nerves, thereby reducing the need for local anesthetics, furthermore local anesthetic is used in spinal anesthesia compared to epidural anesthesia is much less.
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Volanen SM, Lassander M, Hankonen N, Santalahti P, Hintsanen M, Simonsen N, Raevuori A, Mullola S, Vahlberg T, But A, Suominen S. Healthy learning mind - Effectiveness of a mindfulness program on mental health compared to a relaxation program and teaching as usual in schools: A cluster-randomised controlled trial. J Affect Disord 2020; 260:660-669. [PMID: 31546105 DOI: 10.1016/j.jad.2019.08.087] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial. METHODS Finnish school children and adolescents (N = 3519), aged 12-15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26). RESULTS Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (β=1.18, SE 0.57, p = 0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (β=-0.49, SE 0.21, p = 0.02) and improved socio-emotional functioning at T9 (β=-1.37, SE 0.69, p = 0.049) and at T26 (β=-1.71, SE 0.73, p = 0.02) among 7th graders as compared to relaxation. LIMITATIONS The inactive control group was smaller than the intervention and active control groups, reducing statistical power. CONCLUSIONS A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects.
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Affiliation(s)
- S-M Volanen
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; Clinicum, Department of Public Health, University of Helsinki, Finland.
| | - M Lassander
- Institute of Behavioural Sciences, University of Helsinki Finland
| | - N Hankonen
- Social Psychology Unit, Faculty of Social Sciences, University of Helsinki, Finland
| | - P Santalahti
- National Institute for Health and Welfare, Finland
| | - M Hintsanen
- Unit of Psychology, University of Oulu, Oulu, Finland
| | - N Simonsen
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; Clinicum, Department of Public Health, University of Helsinki, Finland
| | - A Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Finland; Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - S Mullola
- Institute of Behavioural Sciences, University of Helsinki Finland; Department of Teacher Education, University of Helsinki, Finland
| | - T Vahlberg
- Department of Biostatistics, University of Turku, Finland
| | - A But
- Clinicum, Department of Public Health, University of Helsinki, Finland
| | - S Suominen
- Department of Public Health, University of Skövde, Sweden; Department of Public Health, University of Turku, Finland
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Toffol E, But A, Heikinheimo O, Latvala A, Partonen T, Haukka J. Nation-wide profile of women using hormonal contraception in Finland in 2017. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Up to 69% of European women use contraception. Nordic countries have traditionally high levels of contraception use, of welfare and social equality. However, the uneven population distribution across the Finnish territory makes the easiness of access to health care structures and trained professionals an important issue in relation to effective contraception use. Understanding the patterns of contraception prescription and their underlying determinants is crucial to guarantee the best contraceptive option for each woman.
Methods
In Finland, users of hormonal contraception (HC) can be identified from register records only starting from 2017. This nationwide, register-based study includes all women with at least one HC prescription in 2017, and a reference cohort of non-users, matched by age and municipality. Through linkages to Finnish National Registers we retrieved sociodemographic data. We calculated national and regional rates and distributions, and compared distributions with t-test, Kruskal Wallis or Chi-squared test.
Results
The HC cohort included 294445 women aged 15-49 years (mean 28.9, SD 8.6), 25.8% of Finnish women of that age range. The majority of them were unmarried (71.8%) and employed (71.6%). Compared to non-users, HC users were more often unmarried, a cohabiting couple without common children, employed, had upper secondary or bachelor level education, and higher annual income (p < 0.001). Differences between HC users and non-users were non-homogenous across 70 Finnish regions.
Conclusions
These preliminary results show different sociodemographic correlates of HC use across Finnish regions. Our findings will guide public health strategies aimed at guaranteeing the best contraceptive option for each woman across the whole country.
Key messages
Sociodemographic correlates of HC use differ across Finnish regions. These differences may reflect differences in access to health care services, in prescribers’ characteristics and in HC methods.
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Affiliation(s)
- E Toffol
- University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - A But
- University of Helsinki, Helsinki, Finland
| | - O Heikinheimo
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Latvala
- University of Helsinki, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki, Finland
| | - T Partonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - J Haukka
- University of Helsinki, Helsinki, Finland
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Saavalainen L, But A, Tiitinen A, Härkki P, Gissler M, Haukka J, Heikinheimo O. Mortality of midlife women with surgically verified endometriosis—a cohort study including 2.5 million person-years of observation. Hum Reprod 2019; 34:1576-1586. [DOI: 10.1093/humrep/dez074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/18/2019] [Accepted: 04/25/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
STUDY QUESTION
Is all-cause and cause-specific mortality increased among women with surgically verified endometriosis?
SUMMARY ANSWER
The all-cause and cause-specific mortality in midlife was lower throughout the follow-up among women with surgically verified endometriosis compared to the reference cohort.
WHAT IS KNOWN ALREADY
Endometriosis has been associated with an increased risk of comorbidities such as certain cancers and cardiovascular diseases. These diseases are also common causes of death; however, little is known about the mortality of women with endometriosis.
STUDY DESIGN, SIZE, DURATION
A nationwide retrospective cohort study of women with surgically verified diagnosis of endometriosis was compared to the reference cohort in Finland (1987–2012). Follow-up ended at death or 31 December 2014. During the median follow-up of 17 years, 2.5 million person-years accumulated.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Forty-nine thousand nine hundred and fifty-six women with at least one record of surgically verified diagnosis of endometriosis in the Finnish Hospital Discharge Register between 1987 and 2012 were compared to a reference cohort of 98 824 age- and municipality-matched women. The age (mean ± standard deviation) of the endometriosis cohort was 36.4 ± 9.0 and 53.6 ± 12.1 years at the beginning and at the end of the follow-up, respectively. By using the Poisson regression models the crude and adjusted all-cause and cause-specific mortality rate ratios (MRR) and 95% confidence intervals (CI) were assessed. Calendar time, age, time since the start of follow-up, educational level, and parity adjusted were considered in the multivariate analyses.
MAIN RESULTS AND THE ROLE OF CHANCE
A total of 1656 and 4291 deaths occurred in the endometriosis and reference cohorts, respectively. A lower all-cause mortality was observed for the endometriosis cohort (adjusted MRR, 0.73 [95% CI 0.69 to 0.77])—there were four deaths less per 1000 women over 10 years. A lower cause-specific mortality contributed to this: the adjusted MRR was 0.88 (95% CI 0.81 to 0.96) for any cancer and 0.55 (95% CI 0.47 to 0.65) for cardiovascular diseases, including 0.52 (95% CI 0.42 to 0.64) for ischemic heart disease and 0.60 (95% CI 0.47 to 0.76) for cerebrovascular disease. Mortality due to alcohol, accidents and violence, respiratory, and digestive disease-related causes was also decreased.
LIMITATIONS, REASONS FOR CAUSATION
These results are limited to women with endometriosis diagnosed by surgery. In addition, the study does not extend into the oldest age groups. The results might be explained by the characteristics and factors related to women’s lifestyle, and/or increased medical attention and care received, rather than the disease itself.
WIDER IMPLICATIONS OF THE FINDINGS
These reassuring data are valuable to women with endometriosis and to their health care providers. Nonetheless, more studies are needed to address the causality.
STUDY FUNDING/COMPETING INTEREST
This research was funded by the Hospital District of Helsinki and Uusimaa and The Finnish Medical Foundation. None of the authors report any competing interest in relation to the present work; all the authors have completed the disclosure form.
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Affiliation(s)
- L Saavalainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A But
- Biostatistics Consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Härkki
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Gissler
- National Institute for Health and Welfare (THL), Information Services Department, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - J Haukka
- Biostatistics Consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - O Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Ozcan ATD, Doger C, Ozturk L, Yungul A, Kurtsahin M, Neselioglu S, Ergin M, But A. Comparison of the Effects of Sevoflurane and Desflurane on Thiol-Disulfide Homeostasis in Patients Undergoing Laparoscopic Cholecystectomy. Eurasian J Med 2019; 51:70-74. [PMID: 30911261 DOI: 10.5152/eurasianjmed.2019.18299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective This study aims to compare the effects of different inhalation anesthetics on oxidative status by measuring thiol-disulfide homeostasis in laparoscopic cholecystectomy surgeries. The effect of inhaler agents on thiol-disulfide homeostasis that shows the oxidative status in laparoscopic cholecystectomy is unknown. Materials and Methods In this study, 71 patients planned to undergo laparoscopic cholecystectomy under general anesthesia were included. They were divided into two groups: desflurane (group D, n: 35) and sevoflurane (group S, n: 36). Blood samples were taken before induction (T1), at 30th minute of insufflation (T2) (30th min of ischemia), and at 30th min postdeflation (T3) (30th min of reperfusion). The native thiols (-SH) and total thiols (-SH+ -SS) were determined. The amounts of disulfide (-SS), disulfide/native thiol percent ratios (-SS/-SH), disulfide/total thiol percent ratios (-SS/-SH+-SS), and native thiol/total thiol percent ratios (-SH/-SH+ -SS) were calculated. Results In the sevoflurane group, preoperative values and intraoperative 30th-minute SS-SH ratio were significantly reduced (p=0.017). In the desflurane group, intraoperative native thiol values and postdeflation levels significantly decreased compared to those in the preoperative values (p<0.001). Conclusion We think that the usage of sevoflurane was more protective in terms of the oxidative damage occurring during laparoscopic surgery.
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Affiliation(s)
- Ayca Tuba Dumanlı Ozcan
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Cihan Doger
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Levent Ozturk
- Department of Anesthesiology and Reanimation, Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Aysun Yungul
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Muge Kurtsahin
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Salim Neselioglu
- Department of Biochemistry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Merve Ergin
- Department of Biochemistry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Abdulkadir But
- Department of Anesthesiology and Reanimation, Yildirim Beyazit University School of Medicine, Ankara, Turkey
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13
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Dumanlı Özcan AT, Kesimci E, Balcı CA, Kanbak O, Kaşıkara H, But A. Comparison between Colloid Preload and Coload in Bone Cement Implantation Syndrome under Spinal Anesthesia: A Randomized Controlled Trial. Anesth Essays Res 2019; 12:879-884. [PMID: 30662124 PMCID: PMC6319061 DOI: 10.4103/aer.aer_127_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Bone cement implantation syndrome (BCIS) is characterized by hypoxia hypotension cardiac arrest. There is not any research that investigated the hemodynamic effects of colloid use during and before cement implantation regarding BCIS development. Aims: We aimed to compare the effects of colloid preloading before or coloading simultaneously at cement implantation on BCIS development and hemodynamic parameters in patients who underwent total knee arthroplasty. Settings and Design: This is a prospective, randomized, clinical trial with the participation of 109 patients over 60 years of age and patients physical status American Society of Anesthesiologists Classes I and II to undergo knee surgery. The patients were administered spinal anesthesia, divided into three groups. Subjects and Methods: The patients in Group I were infused 8 mL/kg hydroxyethyl starch (130/0.4) 20 min before the cement implantation, those in Group II were infused the same simultaneously during cement implantation. Group III was infused 8 mL/kg/h sodium chloride during the anesthesia management. Hemodynamic parameters of the patients were recorded at before and after cement implantation and once the tourniquet was removed. Statistical Analysis Used: The descriptive statistics were presented as the mean ± standard deviation for normally distributed variables, as the median for nonnormally distributed variables, and as the number of cases and (%) for nominal variables. Pearson's Chi-square test and Fisher's exact test were used in the analysis of categorical variables. Results: Compared to the control group, Groups I and II were hemodynamically more stable. The development of moderate hypoxia during cement implantation was significantly different between the study groups (P < 0.05). Conclusions: We suggest that avoiding intravascular volume depletion by using the colloids, particularly in elderly patients, is important for preventing from the BCIS.
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Affiliation(s)
- Ayça T Dumanlı Özcan
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Elvin Kesimci
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Cemile Altın Balcı
- Department of Anesthesiology and Reanimation, Yildirim Beyazit University, Ankara, Turkey
| | - Orhan Kanbak
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Hülya Kaşıkara
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Abdulkadir But
- Department of Anesthesiology and Reanimation, Yildirim Beyazit University, Ankara, Turkey
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14
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Lemmetyinen RE, Karjalainen JV, But A, Renkonen RLO, Pekkanen JR, Toppila-Salmi SK, Haukka JK. Higher mortality of adults with asthma: A 15-year follow-up of a population-based cohort. Allergy 2018; 73:1479-1488. [PMID: 29461632 DOI: 10.1111/all.13431] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Higher all-cause mortality in asthmatics has been shown previously. Polysensitization is associated with higher morbidity among asthmatic children, and allergic rhinitis and/or allergic conjunctivitis (AR/AC) are associated with higher morbidity in adult asthmatics. Little is known about the effect of AR/AC and other factors on mortality among adult asthmatics. The aim was to study mortality and its risk factors in adults with and without asthma. METHODS We randomly selected 1648 asthmatics with age over 30 years from national registers and matched the asthma sample with one or two controls. Baseline information was obtained by a questionnaire in 1997, and the study population was linked with the death certificate information of Statistics Finland from 1997 to 2013. Overall and cause-specific survival between the groups was compared in several adjusted models. RESULTS During a mean follow-up period of 15.6 years, 221 deaths among 1052 asthma patients and 335 deaths among 1889 nonasthmatics were observed. Cardiovascular diseases were the main cause of death in both groups. Asthma was associated with increased all-cause mortality (adjusted HR 1.25; 95% CI 1.05-1.49, P = .011) as well as mortality from chronic obstructive pulmonary disease (HR 12.0, 4.18-34.2, P < .001) and malignant neoplasms of respiratory organs (HR 2.33, 1.25-4.42, P = .008). Among asthmatics, smoking was associated with increased all-cause mortality, and self-reported AR/AC was associated with decreased mortality. Among nonasthmatics, smoking, and obesity were associated with increased all-cause mortality, whereas female gender showed an association with a decreased risk. CONCLUSIONS Increased mortality among adult asthmatics was largely explained by the development of COPD, malignant respiratory tract neoplasms, and cardiovascular diseases. Smoking cessation is important for reduction in total mortality in both asthmatic and nonasthmatic adults. AR/AC was associated with decreased mortality only in asthmatics. Thus, studies in other populations of larger size are needed to explore further the nature of this association.
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Affiliation(s)
- R. E. Lemmetyinen
- Haartman Institute; Medicum; University of Helsinki; Helsinki Finland
- Department of Public Health; University of Helsinki; Helsinki Finland
| | | | - A. But
- Department of Public Health; University of Helsinki; Helsinki Finland
| | - R. L. O. Renkonen
- Haartman Institute; Medicum; University of Helsinki; Helsinki Finland
- HUSLAB; Helsinki University Hospital; Helsinki Finland
| | - J. R. Pekkanen
- Department of Public Health; University of Helsinki; Helsinki Finland
- Living Environment and Health Unit; National Institute for Health and Welfare; Kuopio Finland
| | - S. K. Toppila-Salmi
- Haartman Institute; Medicum; University of Helsinki; Helsinki Finland
- Skin and Allergy Hospital; Hospital District of Helsinki and Uusimaa; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - J. K. Haukka
- Department of Public Health; University of Helsinki; Helsinki Finland
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15
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But A, Arffman M, Sund R, Haukka J. Comorbidities and mortality in persons with type 1 diabetes: the vantage point of multiple time scales via Bayesian intensity model. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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16
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Ozcan ATD, Altin CB, Erdogan S, Ergin M, Çiftçi A, Kara H, Aksoy SM, But A. The effects of Desflurane and Sevoflurane on Nesfatin-1 levels in laparoscopic Cholecystectomy: a randomized controlled trial. BMC Anesthesiol 2018; 18:23. [PMID: 29452603 PMCID: PMC5815222 DOI: 10.1186/s12871-018-0484-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Nesfatin-1 is involved in cardiovascular regulation, stress-related responses. The objective of this study is to investigate the impact of volatile anesthetics on Nesfatin-1 levels. Method Fourty-two patients aged 30–65 years with the American Society Anesthesiology (ASA) Class I-II who were scheduled for laparoscopic cholecystectomy were included in the study Patients were randomized into two group; desflurane administered group (Group I, n = 21) and sevoflurane administered group (Group II, n = 21). For anesthesia maintenance, the patients received 6% desflurane or 2% sevoflurane in 40% O2 and 60% air. The patient’s heart rate (HR), mean, systolic and diastolic arterial pressures (MAP, SAP, DAP), peripheral O2 saturation (SpO2) were monitored and recorded before induction, after induction, after intubation, and during extubation. Blood samples were collected before induction (T1), and after extubation when aldrete score was 10 (T2). Results Demographic data were similar between the groups. The preoperative levels of nesfatin were similar in the two groups (p = 0.715). In desflurane group, post-operative nesfatin levels were similar compared to preoperative levels (p = 0.073). In sevoflurane group, post-operative nesfatin levels were similar (p = 0.131). The nesfatin levels (postoperative vs preoperative) were similar between the groups (p = 0.900). Conclusion In conclusion, this study results suggest that nesfatin-1 levels are not affected by the use of sevoflurane or desflurane in patients undergoing laparoscopic cholecystectomy. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617001023347, retrospectively registered on 17 July 2017.
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Affiliation(s)
- A T D Ozcan
- Atatürk Training and Research Hospital, Anesthesiology and Reanimation Department, Atatürk Training and Research Hospital, Bilkent, Ankara, Turkey.
| | - C B Altin
- Yıldırım Beyazıt University Anesthesiology and Reanimation Department, Ankara, Turkey
| | - S Erdogan
- Atatürk Training and Research Hospital, Biochemistry Department, Ankara, Turkey
| | - M Ergin
- Atatürk Training and Research Hospital, Biochemistry Department, Ankara, Turkey
| | - A Çiftçi
- Atatürk Training and Research Hospital, Anesthesiology and Reanimation Department, Atatürk Training and Research Hospital, Bilkent, Ankara, Turkey
| | - H Kara
- Yıldırım Beyazıt University Pharmacology Department, Ankara, Turkey
| | - S M Aksoy
- Yıldırım Beyazıt University Anesthesiology and Reanimation Department, Ankara, Turkey
| | - A But
- Yıldırım Beyazıt University Anesthesiology and Reanimation Department, Ankara, Turkey
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17
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Arıkan M, Aslan B, Arıkan O, Horasanlı E, But A. Comparison of the effects of magnesium and ketamine on postoperative pain and morphine consumption. A double-blind randomized controlled clinical study. Acta Cir Bras 2016; 31:67-73. [PMID: 26840358 DOI: 10.1590/s0102-865020160010000010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/23/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare the effects of magnesium sulfate and ketamine on postoperative pain and total morphine consumption in a placebo-controlled design. METHODS One hundred and twenty women scheduled for total abdominal hysterectomy were included in this prospective, randomized, double-blind study. Postoperatively, when the Numeric Pain Rating Scale (NPRS) was four or more, IV-PCA morphine was applied to all patients. The patients were randomized into three groups: Group K ketamine, Group M magnesium, and Group C saline received as infusion. Total morphine consumption for 48h, pain scores, adverse effects, and patients' satisfaction were evaluated. RESULTS Total morphine consumption was significantly lower in Group K (32.6±9.2 mg) than in Group M (58.9±6.5 mg) and in Group C (65.7±8.2 mg). The satisfaction level of patients in Group K was higher than the other two groups (p<0.05). Pruritus and nausea were observed more frequently in Group C. CONCLUSİON: The addition of ketamine to IV-PCA morphine reduces the total consumption of morphine without psychotic effects; however, magnesium did not influence morphine consumption.
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Affiliation(s)
- Müge Arıkan
- School of Medicine, Karabuk University, Turkey
| | - Bilge Aslan
- Department of Anesthesiology, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey
| | | | - Eyüp Horasanlı
- School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Abdulkadir But
- School of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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18
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Arikan M, Aslan B, Arikan O, But A, Horasanli E. Comparison of propofol-remifentanil and propofol-ketamine combination for dilatation and currettage: a randomized double blind prospective trial. Eur Rev Med Pharmacol Sci 2015; 19:3522-3527. [PMID: 26439052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the propofol-remifentanil combination and propofol-ketamine combination for Dilatation and Curettage (DC) procedure. PATIENTS AND METHODS This prospective, double blind, and randomized study comprised 81 female patients undergoing diagnostic DC. Patients were randomly allocated to one of two groups; propofol-remifentanil (Group PR, n= 44) or propofol-ketamine (Group PK, n= 37). The level of sedation was assessed with the Ramsay Sedation Score (RSS). The patients' RSS scores were maintained at 4-5 with an additional 0.5 mg/kg bolus dose of propofol. Heart rate (HR), mean blood pressure (MBP), peripheral oxygen saturation (SpO2), and RSS were recorded. The Modify Aldrete Score (MAS) was used for postoperative recovery evaluation, and the time to reach MAS score of 10 was recorded. Total dose of propofol, procedure time, side effects, and satisfaction scores of patient and surgeon were also recorded. RESULTS The mean HR and MBP values of Group PR were lower than those of Group PK, at all recording times. Sedation levels were significantly higher in Group PK. The total dose of propofol consumed was significantly higher in Group PR. The recovery time of Group PK was significantly longer than that of Group PF (p<0.05). Nausea-vomiting and bradycardia were more frequent in the Group PR. There was no difference in patient and surgeon satisfaction between the two groups. CONCLUSIONS Ketamine-propofol combination provides better hemodynamic stability and better quality of sedation than propofol-remifentanil combination. Ketamine still seems as an advantageous and safe drug for such procedure.
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Affiliation(s)
- M Arikan
- Department of Anesthesiology, Faculty of Medicine, Karabuk University, Karabuk, Turkey.
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Bakır M, Gözel MG, Köksal I, Aşık Z, Günal Ö, Yılmaz H, But A, Yılmaz G, Engin A. Validation of a severity grading score (SGS) system for predicting the course of disease and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF). Eur J Clin Microbiol Infect Dis 2014; 34:325-30. [PMID: 25213721 DOI: 10.1007/s10096-014-2238-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/25/2014] [Indexed: 11/26/2022]
Abstract
We aimed to validate a severity grading score (SGS) system for predicting the course of disease and fatality in Crimean-Congo hemorrhagic fever (CCHF). This SGS was established using several variables that were assumed to be associated with mortality and had clinical importance. We included patients diagnosed with CCHF from different centers. Patients who had symptoms of CCHF for <5 days were included. The patients were grouped into three categories according to mortality risk. An SGS ≤4 showed no association with mortality [n = 323 (79.9 % of the total study population), and all survived]. An SGS between 5 and 8 points was classified into the intermediate risk group (20 %), and 14 of 70 patients in this group died. An SGS ≥9 was classified as the high risk of mortality group and 11 of 11 patients in this group died (p = 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for an SGS >9 points at admission were 96, 100, 97, 100, and 44 %, respectively. This SGS system may help appropriate the triage of patients, decrease the cost of treatment, and improve the functionality of healthcare staff. The present study is the first investigation about the validation of an SGS system in patients with CCHF.
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Affiliation(s)
- M Bakır
- Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University, School of Medicine, Sivas, 58140, Turkey,
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20
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Sen P, Izdes S, But A. Effects of sevoflurane and propofol anaesthesia on cerebral oxygenation during normocapnia and mild hypercapnia: a pilot study. Br J Anaesth 2013; 110:318-9. [DOI: 10.1093/bja/aes489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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İzdeş S, Defne Altıntaş N, Karaaslan G, Uygun R, But A. Akut Miyokard Enfarktüsünü Taklit Eden Akut Miyoperikardit. tybdd 2011. [DOI: 10.4274/tybdd.09.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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22
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Erdil F, Demirbilek S, Begec Z, Ozturk E, But A, Ozcan Ersoy M. The effect of esmolol on the QTc interval during induction of anaesthesia in patients with coronary artery disease. Anaesthesia 2009; 64:246-50. [DOI: 10.1111/j.1365-2044.2008.05754.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Oztürk E, Demirbilek S, Köroğlu A, But A, Begeç ZO, Gülec M, Akyol O, Ersoy MO. Propofol and erythropoietin antioxidant properties in rat brain injured tissue. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:81-6. [PMID: 17764798 DOI: 10.1016/j.pnpbp.2007.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 07/13/2007] [Accepted: 07/13/2007] [Indexed: 01/27/2023]
Abstract
So far, several treatment modalities have been attempted to brain protection in cases such as brain trauma, stroke or brain hemorrhage. However, a treatment method that the effect begins immediately and definitely helpful has not been discovered yet. In this study, we aimed to compare the effects of propofol and erythropoietin (Epo) on brain injury caused by oxidative stress and antioxidant properties of these agents after closed head injury (CHI) in rats. For this study, female Wistar Albino rats were divided into five groups: non-traumatic control group, trauma performed group CHI, trauma with propofol (100 mg/kg) intraperitoneally (i.p.), trauma with Epo (5000 U/kg) i.p. and trauma with propofol and Epo performed study groups. Twenty-four hours after CHI, rats were sacrificed and the brains were removed. Superoxide dismutase (SOD), catalase (CAT), xanthine oxidase (XO), nitric oxide (NO), and malondialdehyde (MDA) levels were measured in brain tissue. MDA and NO levels were decreased significantly in Groups Epo, Propofol and Epo+Propofol than Group CHI (p<0.01). XO activity was significantly lower in Group Epo than Group CHI (p<0.05). Epo and propofol decreased oxidative stress by decreasing MDA and NO level in brain tissue after CHI. However, combination of Epo and propofol has no significant beneficial advantage than Epo or propofol alone.
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Affiliation(s)
- Erdoğan Oztürk
- Inonu University, Faculty of Medicine, Department of Anesthesiology, Turkey.
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