Ferhan Elmali

The Effects of Training on Inhaler Technique and Quality Of Life in Patients with COPD

OBJECTIVES This experimental study was conducted to determine the effects of training on inhaler technique and quality of life in patients with chronic obstructive pulmonary disease (COPD). METHODS Among the patients who applied at the outpatient clinic of chest diseases between March 2009 and May 2010, a total of 69 with COPD who complied with the criteria of the study were recruited; of these, 34 subjects were put in the intervention group and 35 in the control group. The intervention group was educated on using an inhaler by verbal training, demonstration movie, and leaflet. A follow-up after 3 months was carried out in both groups. RESULTS Of the intervention group, 82.4% used the inhaler correctly; however, in the follow-up, all of the controls used it incorrectly (p<0.05). The number of attacks (p<0.001), emergency applications, and hospitalizations (p>0.05) of the intervention group was lower at the follow-up than in the control. Promotion in all areas of quality of life was determined in the intervention group (p<0.001). CONCLUSION Consequently, a planned inhaler training given to the patients with COPD was found to decrease attack frequency and dyspnea, and improve quality of life.

Does ampicillin-sulbactam cause false positivity of (1,3)-beta-D-glucan assay? A prospective evaluation of 15 patients without invasive fungal infections*

The purpose of this study was to investigate the interaction between intravenous ampicillin‐sulbactam treatment and (1,3)‐beta‐D‐glucan (BDG) assay. Fifteen patients with a median age of 60 (16–81) without known risk factors for invasive fungal infections who received a daily dose of 3 × 2 g ampicillin‐sulbactam monotherapy from different batches were included in the study. Thirteen patients had soft tissue infections. The 5 of 13 patients who went under surgery had surgical dressings. Serum samples were obtained both before and after antibiotic infusion on the first, third, seventh and tenth days of an ampicillin‐sulbactam treatment course. BDG was assayed using the Fungitell kit (Associates of Cape Cod, East Falmouth, MA, USA) according to manufacturers’ specifications. All serum samples were also tested for galactomannan (GM) antigenemia by Platelia Aspergillus ELISA (Bio‐Rad Laboratories, Marnes‐la‐Coquette, France). A total of 37 of 117 serum samples were positive for BDG at a threshold of 80 pg ml−1. Seven of 37 BDG positive serum samples had a GM index ≥0.5. When a cutoff value of ≥0.5 was used for GM positivity, 16 (13.3%) serum samples were positive. For a cutoff value of ≥0.7, eight (6.6%) serum samples were positive. There were no statistically significant differences in the median BDG levels (P = 0.47) or median GM indices (P = 0.28) of the various sampling times. None of the SAM vials tested positive for BDG or GM. After ruling out fungal infections and all known potential causes of false BDG positivity, environmental contamination remained possible cause of BDG reactivity. We did not observe any significant association of ampicillin‐sulbactam administration and positive assays for BDG or GM.

The endocrine disruptor bisphenol A may play a role in the aetiopathogenesis of polycystic ovary syndrome in adolescent girls

Experimental in vitro studies have shown that bisphenol A affects steroidogenesis, folliculogenesis and ovarian morphology. The aim of this study was to investigate the role of the endocrine disruptor bisphenol A in the aetiopathogenesis of polycystic ovary syndrome (PCOS) in adolescents and its relationship with metabolic parameters, insulin resistance and obesity in this population.

The risk analysis of arm fat area in Turkish children and adolescents.

Aim: The study examined the risk factors associated with arm fat area (AFA) in Turkish children and adolescents. Methods and samples: This study was conducted with 5358 (2621 boys, 2737 girls) children and adolescents aged 6–17 years. Height, weight, waist circumference, mid-upper arm circumference and triceps skinfold thickness were measured. Body mass index, fat percentage, waist-to-height ratio, and AFA were calculated. A questionnaire was used to obtain socio-demographic data. For age- and gender-specific AFA, three groups were created by percentiles (underweight<5th, healthy weight≥5–84.99th, overweight≥85th percentiles). Multinomial logistic regression analyses were performed to determine the risk factors. Results: For the entire group, underweight and overweight prevalences were 4.7% and 14.9%, respectively. The body-size variables increased across age in Turkish boys and girls. The most significant risk factors for AFA were shown to be appetite, sleep duration, household income, and elevator use. Conclusion: AFA can be a significant index, in combination with other well-known anthropometric indices, in determining nutritional status.

Carbapenem-resistant Klebsiella pneumoniae sepsis in corticosteroid receipt mice: tigecycline or colistin monotherapy versus tigecycline/colistin combination

Abstract This study compared the effect of monotherapy of colistin, tigecycline, and their combination in sepsis model of mice. OXA-48 producing Carbapenem-resistant Klebsiella pneumoniae (CRKP) strain was used in Balb/c mice. The mice were divided into competent and Methylprednisolone acetate (MPA)-treated groups. Each group was sub-divided into (1) colistin or (2) tigecycline monotherapy and (3) colistin/tigecycline combination therapy. After 3 hours of intraperitoneal bacterial inoculation, antimicrobials were administered, and mice were sacrificed at 24 and 48 hours Time-kill curve study demonstrated that colistin sulphate had early bactericidal activity following re-growth. In competent and MPA-treated groups of mice at 24 hours, bacterial counts in liver samples significantly lowered compared to control, however, there were no statistically differences between monotherapy and combination therapy subgroup. Bacterial count in lung samples of competent group was significantly lesser than control for all three antimicrobial subgroups at 24 hours Colistin plus tigecycline combination therapy was not superior against colistin or tigecycline monotherapy.

Health promoting lifestyle behaviour in medical students: a multicentre study from Turkey.

BACKGROUND The aim of this study was to determine the predictors of health promoting lifestyle behaviour among medical students attending seven of the medical schools in Turkey. MATERIALS AND METHODS This cross- sectional descriptive study was performed during the second semester of the first and last (sixth) years of study from March to May 2011. A questionnaire with two sections was specifically designed. The first section contained questions on demographic characteristics; the second consisted of the Health Promoting Lifestyle Profile II (HPLP) Scale. From a total of 2,309 medical students, 2,118 (response rate 91.7%) completed the questionnaire. Data were analyzed using descriptive statistics, t, Anova, Tukey test and binary logistic regression analysis. The research was approved by the Ethics Committee of Erciyes University. RESULTS The mean age was 20.7±2.9 years and it was found that 55.1% were men, 62.3% were in the first year. The overall prevalence of smoking was 19.1%, and for drinking alcohol was 19.4%. HPLP point averages of the first year students were 129.2±17.7, and for last year 125.5±19.0. The overall mean score for the HPLP II was 2.5±0.4. They scored highest on the spiritual growth subscale (2.9±0.5), interpersonal relations (2.8±0.5), health responsibility subscale (2.3±0.5), nutrition subscale (2.3±0.5), stress management subscale (2.3±0.4), and the lowest subscale physical activity (2.0±0.5). It is established that students grade, educational level of parents, economic status of family, marital status, smoking and general health perception of the students resulted in a significant difference in HPLP Scale total score average and the mean score of majority of subscales.There was no statistically significant difference between the total HPLP when evaluated for gender, chronic disease, alcohol drinking status and BMI. CONCLUSIONS Based on these results, particularly in the curriculum of medical students in order to increase positive health behaviours including physical activity, health promotion issues, and giving more space to aim at behaviour change in these matters is recommended.

Increasing hepatic arteriole wall thickness and decreased luminal diameter occur with increasing age in normal livers

BACKGROUND & AIMS There is no data to suggest that the size of bile ducts, portal venules, and hepatic arterioles varies according to age in the normal human liver. We sought to examine whether hepatic arteriolar size, wall thickness, and luminal diameter change with increasing age. METHODS Histologically normal liver specimens from 90 live and deceased donors were separated into three groups of thirty: donor age<30, 31-60, and>60years old. Trichrome-stained slides were de-identified and assessed by a liver pathologist blinded to donor age. Morphometric measurements were taken of the hepatic arteriole, the cross-sectional diameter, and its wall thickness. The arteriole was measured at its widest diameter, the arteriolar wall at its thickest portion, and the luminal diameter between its widest points. RESULTS There was no difference in number of arterioles or bile ducts or in arteriolar cross-sectional diameter among the groups and no correlation with age was found. An increasing arteriolar wall thickness and a decrease in luminal diameter with advancing age were noted; no difference in bile duct size among the groups was found. There was a significant difference in wall thickness/total cross-sectional diameter with extremes in age (21-30 age group vs. 71-80 age group, p=0.0009) with an accompanying significant decrease in luminal diameter/cross-sectional diameter between the same groups (p=0.00002). CONCLUSIONS Increasing hepatic arteriolar wall thickness and decreased arteriolar cross-sectional diameter occur with increasing age in the normal human liver.

Fatty liver is a good indicator of subclinical atherosclerosis risk in obese children and adolescents regardless of liver enzyme elevation

To investigate the presence of association between nonalcoholic fatty liver disease (NAFLD) and subclinical atherosclerosis using carotid intima media thickness (c‐IMT) in obese children and adolescents. Additionally, we wished to investigate the relationship between fatty liver and elevated liver enzymes.

Efficacy of sulbactam and its combination with imipenem, colistin and tigecycline in an experimental model of carbapenem-resistant Acinetobacter baumannii sepsis.

Background: In recent years, multidrug-resistant Acinetobacter baumannii has been reported as an important nosocomial pathogen, and treatment options are limited. The aim of this study was to investigate the additional effect of sulbactam on monotherapy with colistin, tigecycline and imipenem in experimental sepsis with carbapenem-resistant A. baumannii in mice. Methods: Sepsis was developed in 8- to 10-week-old BALB/c mice by an intraperitoneal injection of A. baumannii. Antibiotic was given intraperitoneally 2 h after bacterial inoculation. Each experimental group had 15 mice and was divided into 3 subgroups. Mice were sacrificed at 24, 48 or 72 h. Lung, liver, heart and spleen samples were cultured, and homogenates of lung and liver were used to detect the number of colony-forming units per gram. Bacterial clearance was compared in lung and liver at different time points. Results: Imipenem did not decrease the bacterial load, but the other antibiotics showed significant bactericidal activity compared with the control group, and the combination of imipenem with sulbactam decreased the bacterial load in lung and liver. However, the addition of sulbactam to colistin and tigecycline had no significant effect on bacterial counts. Only the addition of sulbactam to imipenem showed better bactericidal activity compared to imipenem alone. Conclusions: These results suggested that combining sulbactam with tigeycline or colistin does not increase the efficiency of these antibiotics.

Sexual lives of women with diabetes mellitus (type 2) and impact of culture on solution for problems related to sexual life

AIMS AND OBJECTIVES To examine sexual lives of women with diabetes mellitus (type 2) (DM) and impact of culture on solution for problems related to sexual life. BACKGROUND DM has long been considered a risk factor for sexual dysfunction in men and women, although the evidence in women is less clear. This study was conducted to emphasise the effect of DM and culture on sexual life. DESIGN A descriptive and qualitative study. METHODS Planned as descriptive and qualitative, this study was conducted with 38 women who matched with the following inclusion criterion: living in a neighbourhood with low socio-economic status in the province of Kayseri, Turkey. The Participant Information Form, Diabetes Control Form, the Arizona Sexual Experiences Scale (ASEX), Sexual Life Definition Form and Semi-Structured Interview Form for revealing problems lived in sexual life, besides the results of laboratory tests, were used for data collection. RESULTS Mean age of the participating women was 51·34 ± 5·85 years. Total score of ASEX was found to be correlated with the type of DM treatment, duration of DM diagnosis, complications of DM, relation with her husband, level of HbA1c and systolic-diastolic blood pressure (p < 0·05). Of the participating women, 47·4% expressed that they had problems with sexual relation. CONCLUSION Most of the women with DM were determined to have problems in sexual functions besides the disease, and the impact of culture on the solution for problems lived within sexual life was effective. RELEVANCE TO CLINICAL PRACTICE These findings can help guide to raise the health of Turkish women with diabetes and to plan appropriate nursing interventions.