Hülya Akdur

Comparison of the mobilization and proprioceptive neuromuscular facilitation methods in the treatment of shoulder impingement syndrome

AbstractThe aim of this study was to compare the effectiveness of the mobilization and proprioceptive neuromuscular facilitation methods in the treatment of shoulder impingement syndrome.Forty patients were included in the study and they were divided into two groups: Group 1 was treated by mobilization and Group 2 by proprioceptive neuromuscular facilitation (PNF). All findings were scored using a visual analogue scale, joint range of motion, and University of California at Los Angeles criteria, before and after treatment.It was observed that mobilization and proprioceptive neuromuscular facilitation methods are both similarly effective, but mobilization was painless and better tolerated than PDF.

The Effect of Exercise to P Wave Dispersion and Its Evaluation as a Predictor of Atrial Fibrillation

Aim: Prolongation of P wave time and increase of its dispersion as an independent predictor of atrial fibrillation. In patients with paroxysmal atrial fibrillation (PAF) as in healthy people, exercise augments sympathetic activity and therefore can cause the development of atrial fibrillation. The aim of this study is to evaluate the effect of exercise on P wave dispersion and to predict the development of atrial fibrillation.

Prospective evaluation of platelets prepared by single and random methods during 5 days of storage: aspects related to quality and quantity

Platelets, which have an important role in hemostatic mechanisms and which were prepared by single and random methods were investigated to measure quantity, and aggregation response during 5 days of storage. The aggregation response and quantitative values of platelet concentrates (PCs), 60 of which were prepared by a single donor method and 62 by a random method were investigated during the 1st, 3rd, and 5th days of storage. The single donor platelets (SDP) were obtained by using the MCS Plus apheresis device and the random donor platelets (RDP) were obtained by two-phase centrifugation in the Heraeus 8500i centrifuge device (during the first phase, platelet rich plasma was obtained then platelet concentrate was obtained from this product) and were stored at 22 degrees C on a circular agitator. In addition, pH, PO2, PCO2, glucose and lactate values were measured in order to evaluate the effects of storage. The aggregation response was measured using adenosine diphosphate (ADP), epinephrine (EPN), collagen (COLL) and ristocetin (RIST). The cell count in mm3 and the total cell count were also measured. The total cell counts and cells in mm3 of the PCs which were prepared by the single donar method on the 1st, 3rd and 5th days, were: 3.11 x 10(11), 3.09 x 10(11), 3.07 x 10(11) and 292 x 10(3), 290 x 10(3), 289 x 10(3) and of those prepared by the random method were: 5.71 x 10(10), 5.69 x 10(10), 5.66 x 10(10) and 156 x 10(3), 153 x 10(3), 151 x 10(3). The mean aggregation responses of the PCs prepared by the two methods on the 1st, 3rd and 5th days, expressed as a % were: ADP: 94.8-93.2, 81.6-78.7, 44.3-8.2; COLL: 91.7-89.6, 79.2-74.2, 29.8-11.1; EPN: 88.5-91.3, 64.2-62.7, 39.4-4.5 and RIST: 89.4-89.4, 76.5-73.6, 14.4-3.2. Other data related to platelet storage were obtained by measuring the pH, PO2, PCO2, glucose and lactate levels of the PCs. In our study, it was determined that in spite of the optimal storage conditions, the aggregation response of the PCs decreased significantly, whereas, the numerical values changed little during the storage period.

Investigation of Various Antibiotic Combinations Using the E-Test Method in Multiresistant Pseudomonas aeruginosa Strains

Background: Antibiotic combinations are frequently used in order to obtain wide-spectrum effects in the treatment of serious infections such as septicemia and endocarditis, and also to produce an in vivo effect against strains which are defined as resistant to the known inhibiting or fatal dose of one antibiotic. The synergistic effects of combinations such as aminoglycoside + beta-lactam, aminoglycoside + quinolone and quinolone + beta-lactam on Pseudomonas aeruginosa have been revealed in different studies. The multiple resistance rate of nosocomial P. aeruginosa strains isolated from intensive care units (ICUs) has been reported as high in many studies. Methods: In this study, the effects of various combinations of antibiotics (aminoglycoside + beta-lactam and aminoglycoside + quinolone) against 101 multiresistant P. aeruginosa strains which were isolated from the ICUs of three different hospitals in İstanbul were investigated using the E-test method. The combinations for which the highest synergistic effects were determined by the E-test method were also tested with the checkerboard method, i.e. in addition to the E-test method, in 19 of a total of 23 strains. Results: When the synergistic results which were obtained with the combinations of aminoglycoside + beta-lactam were compared with those of the aminoglycoside + quinolone combinations, they were determined to be higher for the two aminoglycosides gentamicin (GM) and tobramycin (TM). We determined the synergistic rates to be 23, 21, 19, 18, 16, 14, 10 and 10% for GM + ceftriaxone (TX), GM + piperacillin (PP), GM + ceftazidime (TZ), TM + PP, TM + TX, TM + TZ, GM + ciprofloxacin (CI) and TM + CI, respectively. The GM + TX combination – for which the highest synergistic effects were determined with the E-test stripes – was also determined as synergistic with the checkerboard method in 19 of a total of 23 strains (23%), and the agreement rate between the two methods was 100% (ĸ > 0.7). The highest synergistic effects against strains which were sensitive to both of the antibiotics which constitute the combinations were found for the GM + TX combination, as 50%, whereas for strains which were resistant to both of the antibiotics, this was found for the TM + PP combination, also as 50%. Conclusions: We consider that the minimal inhibitory concentration values of antibiotics are not sufficient alone in order to constitute a combination for multiresistant strains and it would be advisable to begin a treatment by applying a combination study. The E-test method has been evaluated as a good alternative for combination investigations because of its ease both of application and evaluation and also for its good agreement with the standard checkerboard method.

The evaluation of microbial contamination in platelet concentrates prepared by two different methods

The microbial contamination of platelet concentrates (PCs) prepared by two different methods both with a high risk of bacterial contamination during preparation and storage were evaluated. For apheresis platelets, the concentrates were obtained using the Haemonetics MCS 3P device. For the random method, platelets were obtained by two phase centrifugation, in the Heraeus Cryofuge 8500 I device using the Kansuk 3-way bags which permit storage for five days. 1620 plateletpheresis units prepared by apheresis, and 9838 units prepared by the random method, were included in the study. Of the 11,458 PCs studied. 32 (0.27%) were false positives and 24 (0.2%) were real positives. All of the positive results occurred in platelets prepared by the random method. C. xerosis and S. epidermidis, S. hominis, Alpha-hemolytic streptococci, all flora of the skin, were isolated in the contaminated concentrates. The risk of microbial contamination of PCs, prepared both by apheresis and from whole blood, continues at a low rate although the products were collected into specific bags following rules including appropriate disinfection of the skin, correct centrifugation collection time and optimal storage conditions including temperature and agitation. These results again emphasize the importance of: obeying phlebotomy rules and hand disinfection of the person who collects the blood as well as the need for careful skin decontamination of the donor, during donation.