The impact of a videoconferencing-ımplemented program on older adults' psychosocial health in the COVID-19 pandemic: an experimental study

BACKGROUND

Social distancing and 'stay-at-home' orders are essential to contain the coronavirus outbreak; however, it has affected older adults very negatively psychosocially. The present study explored the impact of a videoconferencing-implemented program on older adults' psychosocial health during the COVID-19 pandemic.

METHODS

We carried out this experimental research with pretest-posttest and control groups between November 02 to December 26, 2020 on individuals aged 60 years and over who were enrolled at Fethiye Refreshment University (60+ FRU). While the intervention group consisted of 40 people, we recruited 52 participants in the control group. Unlike the control group, the intervention group participated in a structured videoconferencing program held there days a week for 8 weeks. We collected the data using the Fear of COVID-19 Scale (FCV-19S), the Multidimensional Scale of Perceived Social Support (MSPS), the Depression Anxiety Stress Scale (DASS-21), and the Loneliness Scale for Elderly (LSE). The data were then analysed on the SPSS 22.0 program.

RESULTS

The participants had a mean age of 66.13 ± 5.13 years; 65.2% were females, 58.7% were married, 55.4% held a university degree and 93.5% had a regular income. Following the intervention, we found the experimental group to have significantly a lower posttest FCV-19S score (p < 0.05) and a higher posttest MSPS score than the control group (p < 0.05). Besides, the experimental group had significantly lower posttest scores on the DASS-21 and the anxiety and stress subscales than the control group (p < 0.05). Moreover, the posttest score of the experiential group on the emotional loneliness subscale (LSE) was found to be significantly lower than that of the control group (p < 0.05); nevertheless, we could not conclude significant differences between the groups' pretest and posttest LSE scores and their scores on the other LSE subscales (p > 0.05).

CONCLUSION

Overall, the videoconferencing program was found to be efficient in providing older adults with psychosocial support amid social isolation.

Environmental impact of a 290.4 kWp grid-connected photovoltaic system in Kocaeli, Turkey

ABSTRACT

This paper examines the environmental impact of a grid-connected PV system in Kocaeli, Turkey, supported by East Marmara Development Agency to contribute local economic and environmental sustainability goals. For this purpose, energy payback time and greenhouse payback time analysis is carried out in terms of calculated total embodied data and measured annual operation data. The results indicate that the system spends approximately 12.68% of its lifetime to payback its total embodied energy and 10.67% to save its total embodied greenhouse gas emissions.

Complete Resolution of the Left Ventricular Pedunculated Thrombus with Tirofiban Infusion in a Patient with Severe Left Ventricular Dysfunction

A 28-year-old man was admitted with symptoms of heart failure. Echocardiography revealed severe left ventricular dysfunction, apical aneurysm, and a 40 × 11 mm sized mobile thrombus attached to apical septum with a narrow stalk. The patient had anterior myocardial infarction two years ago. Heparin infusion was started at 1000 IU/hour for 48 hours. There was no detected change on the size of the thrombus. Surgery recommended to the patient was refused by him because of the procedural risks. Tirofiban infusion was started. Repeat echocardiography showed significant reduction in thrombus size after 24 hours, and complete resolution of the thrombus after 48 hours. To our knowledge, this is the first case with left ventricular mobile thrombus treated successfully with tirofiban infusion.

Epithelioid hemangioendothelioma of the nasal septum

Epithelioid hemangioendothelioma of the nasal septum.

BACKGROUND

Epithelioid hemangioendothelioma is a tumour of vascular origin and unknown aetiology, which occurs in all age groups. The most common locations are the liver, bone, lungs, and brain, with less common occurrence in head and neck regions, and no prior reports of origination from nasal septum.

CASE REPORT

Here we report a case of epithelioid hemangioendothelioma of the nasal septum. A 62-year-old male patient attended our clinic with epistaxis and congestion in his left nasal cavity. Endoscopic examination revealed a mass within the left nasal passage. Clinical and histopathological examinations showed that the mass was a septum-originated epithelioid hemangioendothelioma. The mass was removed endoscopically using a transnasal approach.

CONCLUSIONS

No recurrence was observed over 36 months of follow-up. Here we discussed this uncommon case along with a literature review.

Using oxidant and antioxidant levels to predict the duration of both acute peripheral and mesenteric ischemia

OBJECTIVE

The aim of this study was to determine the relationship between oxidative stress markers and the duration of ischemia in rat mesenteric and peripheral ischemia models.

METHODS

Forty rats were divided into five equal groups, as follows: rats in Group I (control group) were sacrificed to determine the baseline characteristics of the serum markers; the superior mesenteric artery was clamped via a simple laparotomy to induce mesenteric ischemia in Groups II and III; the right common femoral artery was clamped to induce peripheral ischemia in Groups IV and V. Blood samples were taken at 2 (Groups II and IV) and 6 (Groups III and V) hours after these procedures. The serum total oxidative status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and paraoxonase-1 (PON-1) enzyme activities were evaluated in the samples obtained from each group.

RESULTS

The OSI level of the control group was 91.00±5.46 (mean ± SD). The OSI levels taken 2 hours after the induction of mesenteric ischemia and peripheral ischemia were significantly higher (194.50±11.16 and 301.75±19.98, respectively (p<0.05)). However, these levels decreased to 151.88±17.02 (mesenteric ischemia) and 108.88±9.46 (peripheral ischemia) after 6 hours. The PON-1 levels of Group III (mesenteric ischemia at 6 hours) (99.75±7.26), Group IV (peripheral ischemia at 2 hours) (96.88±4.09), and Group V (peripheral ischemia at 6 hours) (111.25±10.33) were slightly elevated over that of the control group (87.38±5.31). However, the PON-1 level of Group II (mesenteric ischemia at 2 hours) (42.88±3.14) was lower than that of the other groups (p<0.05).

CONCLUSION

Despite the increment of oxidative markers in early periods of ischemia (2(nd) hour), which was a hypoxic response of ischemic cells, they have decreased markedly in prolonged ischemia. This might have been caused by the opening of some collateral circulation or the destruction of the ischemic cells.

Iloprost reduces myocardial edema in a rat model of myocardial ischemia reperfusion

OBJECTIVE

Myocardial ischemia severely reduces myocyte longevity and function. Extensive interstitial edema and cell damage occur as a result of myocardial reperfusion injury. Current therapies are directed at prevention of ischemia-induced damage to cardiac tissue. Iloprost is a novel pharmaceutical agent for the treatment of ischemia.

METHODS

Twenty rats were segregated into four experimental groups. The procedure control group consisted of four rats undergoing a sham operation. The remaining 16 rats were divided into two equal groups. The first group (control group) received a continuous intravenous infusion of physiological serum immediately prior to the procedure. Iloprost was administered by a continuous intravenous infusion into the right jugular vein at an infusion rate of 100 ng/kg/min for 30 minutes prior to reperfusion in the experimental group (study group). Following the infusion treatments, ligation of the left coronary artery was conducted for 30 minutes to induce myocardial ischemia. The rats were euthanized 24 hours after reperfusion and cardiac tissue was harvested from all specimens for analysis.

RESULTS

Histological examination revealed three myocardial tissue specimens with grade II damage and five myocardial tissue specimens with grade III reperfusion injury in the control group. However, the study group consisted of two grade III myocardial tissue specimens, five grade II myocardial tissue specimens and one grade I myocardial tissue specimen. Moreover, a statistically significant reduction in myocardial edema was observed in the study group (p=0.022).

CONCLUSION

Our results support the hypothesis that iloprost enhances protection against cardiac ischemia reperfusion injury. This protective effect may be associated with vasodilation, antioxidant or anti-edema mechanisms.

Serum ischaemia-modified albumin level is an irrelevant predictive factor for ischaemic duration in mesenteric ischaemia

BACKGROUND

Acute mesenteric ischaemia is an emergency condition that requires urgent and expeditious diagnosis and immediate surgical or medical intervention. The initial hours are critical for the recovery of the affected bowel segment. Thus, its clinic diagnostic biomarkers are important when it comes to reducing mortality and morbidity rates.

METHODS

Twenty-four male Sprague-Dawley rats were included in the study. The rats were divided into three equal groups. Those in Group I were sacrificed to determine the basal serum values of ischaemia-modified albumin (IMA) after a simple laparotomy. The superior mesenteric artery (SMA) was clamped in a simple laparotomy in Groups II and III; blood samples were taken at 120 minutes in Group II and 360 minutes in Group III. The serum IMA levels were identified from the blood samples and the results obtained were compared statistically.

RESULTS

The serum IMA levels were determined to be 22±6 (22) μ/L, 34±7 (34) μ/L and 36±4 (37) μ/L in Groups I, II and III, respectively. The differences between the groups were not statistically significant.

CONCLUSION

Our results showed that the serum IMA level is not an appropriate biomarker for acute mesenteric ischaemia. Additionally, the IMA level is not an appropriate biomarker for the detection of ischaemia duration. However, future studies should be conducted to clarify the efficacy of serum IMA levels under different ischaemic conditions.

The predictors of poor outcomes in patients with femoral artery injuries

PURPOSE

This study investigated the predictors of poor outcomes, including limb loss and death, in patients with femoral artery injuries.

PATIENTS AND METHODS

The study included 158 patients aged 2-82 (mean age 28.4 ± 16.5) with femoral arterial injury (common, deep, and superficial femoral artery) that were treated surgically between 2000 and 2010. Isolated venous injuries were excluded. Demographic and clinical data of the patients, including age, gender, admission time, pulse rate and blood pressure, hematocrit value, reason of injury, associated injury, and Mangled Extremity Severity Score (MESS) were recorded.

RESULTS

Of the 158 patients, the death and amputation rates were 5.7% (9) and 5.1% (8), respectively. In logistic regression analysis, four variables (pulse rate, MESS, hematocrit, and bone trauma) were found to be independent predictors for poor outcomes. The Odd's ratios and confidence interval values of these variables were as follows: 7.24 (1.94-26.92), 21.75 (5.41-87.48), 5.93 (3.04-11.54) and 7.46 (2.09-9.56), respectively.

CONCLUSIONS

The MESS value, presence of bone fracture, hematocrit, and pulse rate on admission are predictive risk factors for poor outcomes in patients with femoral artery injury. Therefore, in these patients, prompt intervention by experienced surgeons is crucial for limb salvage and decreased mortality.

Asymptomatic and isolated accessory mitral valve tissue in adult population: three case reports and review of the literature

Accessory mitral valve tissue is a rare congenital cardiac anomaly and commonly it may cause left ventricular outflow tract obstruction (LVOTO). This anomaly occurs as a part of other congenital cardiac anomalies. However, it may be seen isolated. Structures in LVOT such as tumor, vegetation, cysts may have attention for differential diagnosis. The number of cases is increasing with the routinely using of two-dimensional echocardiography. Accessory mitral valve tissue is detected first early in children with symptoms of LVOT and is very rarely diagnosed in adults. One third of cases may asymptomatic, but commonly significant left ventricular outflow tract gradient can be detected in these cases, especially adult period. Optimal treatment of this anomaly is surgery if there is a significant LVOTO. In this report, we presented the three asymptomatic adult cases with accessory mitral valve tissue, without increased gradient in LVOT. Surgical excision was recommended to the first case in another hospital with diagnosis of cardiac cyst. Two cases are presented.

Successful embolectomy in a femoral artery thrombosis caused by femoral artery catheterization in a infant

In infants, the most common cause of femoral artery is thrombosis and iatrogenic arterial injuries usually occur after femoral artery catheterization procedures. Management of this complication includes heparin infusion, thrombolytic agents, interventional radiologic procedures, surgical thrombectomy and by-pass surgery. Signs of arterial thrombosis developed after femoral artery catheterization procedure in the right lower extremity of 9-month-old female infant with methyl malonic acidemia. Heparin infusion was started after confirming the diagnosis of femoral artery thrombosis by ultrasonography. Because of there was no response to heparin treatment, thrombolytic therapy (t-PA) was started after 24 hours. Again, because of there was no response to all medication, surgical thrombectomy was performed. Was entered right common femoral artery with 3.0 F Fogarty catheter and fresh thrombus material was removed from the proximal and distal segments of the femoral artery. Antegrade and retrograde blood flow was achieved. After the procedure clinical signs and the symptoms of the thrombosis were resolved rapidly. There were no any complications in the postoperative period.This case encouraged us for using surgical thrombectomy in the treatment of femoral artery thrombosis in infants who do not respond to medication.

Effect of hypoglycemic drugs on aspirin resistance in patients with diabetes mellitus

BACKGROUND

Aspirin reduces the odds of an arterial thrombotic event in high-risk patients. However, 10%-20% of patients with an arterial thrombotic event who are treated with aspirin have a recurrent arterial thrombotic event during long-term followup. Aspirin resistance has been described in some patient populations such as those with an acute coronary syndrome, ischemic stroke, percutaneous coronary intervention with drug-eluting stent, stent re-stenosis, and diabetes mellitus (DM). The aim of this study was to assess aspirin resistance and to compare it to the use of oral anti-diabetic drugs and insulin in patients with diabetes.

METHODS AND RESULTS

Platelet aggregation was measured after aspirin treatment in 101 diabetic patients undergoing percutaneous coronary intervention. Two patient populations were included in the investigation: use of insulin (group 1) and use of oral anti-diabetic agents (OAD) (group 2) in diabetic patients. Platelet aggregation was determined using a multichannel Multiplate analyzer. Among group 1 patients, 4.7% were aspirin non-responders and among group 2 patients, 8.6% were aspirin non-responders. Statistical differences were not found between the groups (p = 0.359).

CONCLUSIONS

This study demonstrated that there was no significant difference in aspirin resistance between type 2 diabetes mellitus patients on insulin treatment and type 2 diabetes mellitus patients on OAD treatment.

The medical approaching to a pellet injury of the heart

A 55-year-old man with multiple pellet injuries was brought to the Emergency room. In his physical examination, there were multiple wounds in face, neck, shoulders, arms, thorax and upper abdomen. The therapeutic options include pericardial drainage, conservative treatment, and surgical removal of the pellet. But, he was successfully managed with conservative medical treatment. This case showed that the treatment of heart injuries due to shotgun pellet should be individualized.

Evaluation of pulmonary vein variations in the middle pulmonary lobe with 64-slice multidetector computed tomography

PURPOSE

To evaluate the multi detector computed tomographic (CT) depiction of middle lobe vein variation of the right pulmonary vein and create a diagram for cardiologist and cardiovascular surgeons.

MATERIALS AND METHODS

According to hospital records, between January 2009 and April 2010, 314 consecutive patients underwent pulmonary CT angiography (CTPA) and coronary CT angiography. The CT films from these patients were retrospectively analyzed.

RESULTS

Under normal conditions, the middle pulmonary vein (MPV) drains into the left atrium either by the "direct" or "indirect" route. Direct (37 patients, 11.8%) drainage means that the MPV does not drain into the upper or lower pulmonary veins but instead drains directly into the right pulmonary vein system. In contrast, indirect (276 patients, 87.9%) drainage occurs when the MPV drains into the upper or lower pulmonary veins. In this study, 12 different variations in drainage patterns were found.

CONCLUSION

Increasing the number of patients may have led to the identification of additional variants. However, clinically important variations are rarely seen. Correct mapping of the MPV is very important for cardiologists and for surgeons in order to provide the best treatment and avoid complications.

A case of a diaphragmatic rupture complicated with lacerations of stomach and spleen caused by a violent cough presenting with mediastinal shift

INTRODUCTION

Diapraghmatic rupture is a clinical case that is mostly seen following a blunt thoracoabdominal trauma or is rarely reported as spontaneously induced by various factors.

CLINICAL PICTURE

A 28-year-old man presented as an emergency with shortness of breath and severe abdominal pain following a violent cough. His chest radiography and computed tomography demonstrated left diaphragmatic rupture, mediastinal shift and herniation of gastric fundus into the pleural cavity.

TREATMENT

Left thoracotomy for the replacement of herniated gastric fundus and median laparotomy for the repair of serosal layer of gastric fundus and a diaphragmatic gap were performed.

OUTCOME

He made an uneventful recovery.

CONCLUSIONS

Diaphragmatic ruptures may be caused by violent coughing with serious life-threatening complications.

Laparoscopic repair of acquired lumbar hernia

Lumbar hernias are rare; approximately 300 cases have been described in the literature since their first description. They are typically subdivided by categories such as congenital or acquired and by their location. Acquired lumbar hernias may follow trauma, poliomyelitis, loin incision, and the use of iliac crest as a donor site for bone grafting. Although they tend to grow in size and have a 25% risk of incarceration and 8% risk of strangulation, surgery is indicated once the lesion is confirmed. Many techniques have been described for surgical repair of lumbar hernias, including primary repair, local tissue flaps, and conventional mesh repair. All these open techniques require a large incision plus extensive dissection to expose the area. The first laparoscopic repair of lumbar hernia was described in 1996. The laparoscopic approach for lumbar hernia has significant advantages: it enables exact localization of the anatomic defect, the mesh can be placed deep into the defect allowing intraabdominal pressure to hold it in position, and it also has all the well-known advantages of the laparoscopic approach. We present two cases of laparoscopically repaired acquired lumbar hernias.

Reversal of cerebral vasospasm by the nitric oxide donor SNAP in an experimental model of subarachnoid haemorrhage

The constant release of nitric oxide (NO) is essential to maintain basal cerebrovascular tone. Oxyhaemoglobin, liberated by lysis of red blood cells after subarachnoid haemorrhage binds NO and prevents its entry into vascular smooth muscle cells. While endothelium-dependent vasoconstriction is preserved, decreased levels of NO inhibit endothelium-dependent relaxation and may cause vasospasm. S-nitrosothiols are potent vasodilators and precursors of NO. The authors' aim was to determine whether S-nitroso-N-acetylpenicillamine (SNAP), a stable S-nitrosothiol compound, could reverse vasospasm in an experimental vasospasm model in rabbit. Experimental subarachnoid haemorrhage (SAH) was induced in 37 New Zealand white rabbits. The animals were divided into four groups. Control (no SAH), SAH only, SAH plus saline and SAH plus SNAP. SNAP (15 micrograms/kg/min) or 0.09% saline (equal volume) was infused 46 hours after induction of SAH. All animals were killed by perfusion fixation 48 hours after SAH occurred. Basilar arteries were removed, sectioned and their cross sectional areas were evaluated in a blind manner, by light microscopy and by using computer assisted morphometry. Experimental SAH elicited vasospasm in all animals of SAH only and SAH plus saline group. In animals treated with SNAP, arterial narrowing was markedly attenuated without producing systemic hypotension. This widening achieved statistical significance when compared to the arteries of the SAH only and SAH plus saline group (p < 0.01). This study indicates that the NO donor SNAP is a potentially useful drug to reverse cerebral vasospasm due to SAH.