Research Hospital Research Articles

Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques (PREVENT): a multicentre, open-label, randomised controlled trial

Acute coronary syndrome and sudden cardiac death are often caused by rupture and thrombosis of lipid-rich atherosclerotic coronary plaques (known as vulnerable plaques), many of which are non-flow-limiting. The safety and effectiveness of focal preventive therapy with percutaneous coronary intervention of vulnerable plaques in reducing adverse cardiac events are unknown. We aimed to assess whether preventive percutaneous coronary intervention of non-flow-limiting vulnerable plaques improves clinical outcomes compared with optimal medical therapy alone. PREVENT was a multicentre, open-label, randomised controlled trial done at 15 research hospitals in four countries (South Korea, Japan, Taiwan, and New Zealand). Patients aged 18 years or older with non-flow-limiting (fractional flow reserve >0·80) vulnerable coronary plaques identified by intracoronary imaging were randomly assigned (1:1) to either percutaneous coronary intervention plus optimal medical therapy or optimal medical therapy alone, in block sizes of 4 or 6, stratified by diabetes status and the performance of percutaneous coronary intervention in a non-study target vessel. Follow-up continued annually in all enrolled patients until the last enrolled patient reached 2 years after randomisation. The primary outcome was a composite of death from cardiac causes, target-vessel myocardial infarction, ischaemia-driven target-vessel revascularisation, or hospitalisation for unstable or progressive angina, assessed in the intention-to-treat population at 2 years. Time-to-first-event estimates were calculated with the Kaplan-Meier method and were compared with the log-rank test. This report is the principal analysis from the trial and includes all long-term analysed data. The trial is registered at ClinicalTrials.gov, NCT02316886, and is complete. Between Sept 23, 2015, and Sept 29, 2021, 5627 patients were screened for eligibility, 1606 of whom were enrolled and randomly assigned to percutaneous coronary intervention (n=803) or optimal medical therapy alone (n=803). 1177 (73%) patients were men and 429 (27%) were women. 2-year follow-up for the primary outcome assessment was completed in 1556 (97%) patients (percutaneous coronary intervention group n=780; optimal medical therapy group n=776). At 2 years, the primary outcome occurred in three (0·4%) patients in the percutaneous coronary intervention group and in 27 (3·4%) patients in the medical therapy group (absolute difference -3·0 percentage points [95% CI -4·4 to -1·8]; p=0·0003). The effect of preventive percutaneous coronary intervention was directionally consistent for each component of the primary composite outcome. Serious clinical or adverse events did not differ between the percutaneous coronary intervention group and the medical therapy group: at 2 years, four (0·5%) versus ten (1·3%) patients died (absolute difference -0·8 percentage points [95% CI -1·7 to 0·2]) and nine (1·1%) versus 13 (1·7%) patients had myocardial infarction (absolute difference -0·5 percentage points [-1·7 to 0·6]). In patients with non-flow-limiting vulnerable coronary plaques, preventive percutaneous coronary intervention reduced major adverse cardiac events arising from high-risk vulnerable plaques, compared with optimal medical therapy alone. Given that PREVENT is the first large trial to show the potential effect of the focal treatment for vulnerable plaques, these findings support consideration to expand indications for percutaneous coronary intervention to include non-flow-limiting, high-risk vulnerable plaques. The CardioVascular Research Foundation, Abbott, Yuhan Corp, CAH-Cordis, Philips, and Infraredx, a Nipro company.

Isolated Transverse Process Fractures: Should We Offer Lumbar Corset or Not?

Background The aim of this study is to emphasize the need to be careful in terms of internal organ injuries in patients with isolated transverse process fracture (ITPF), and to investigate the effectiveness of corset use in controlling acute pain. Methods This is a retrospective study including 72 patients with only transverse process fractures secondary to trauma, who were admitted to the Emergency Department of Sakarya University Research and Training Hospital between January 2020 and October 2022. The radiological diagnoses were collected from spinal vertebral computed tomography images. Twelve patients were excluded from the study due to exclusion criteria. Sixty patients with ITPF were included in the comparison group. All patients were divided into two groups. The groupwith no lumbar corset (LC) included those who were discharged with analgesic and muscle relaxant treatment without a brace (n = 33). The LC+ group (n = 27) included those who received rigid lumbosacral orthosis in addition to analgesic and muscle relaxant treatment. Pain levels of all cases in both groups were evaluated with Visual Analog Scale scores on the day of trauma, the first week, the first month, and the sixth month. Results A total of 25 cases had one ITPF, 25 had two, 17 had three, and five patients had four or more ITPFs. The hospitalization rate was the highest among patients with four or more ITPFs (40%). Although the hospitalization rates according to the number of ITPFs were not statistically significant (p = 0.528), there was a clinical significance regarding increasing hospitalization rates with the increasing number of ITPFs. The hospitalization rates were 12%, 16%, 17.6%, and 40% in patients with one, two, three, and four or more ITPFs, respectively. Conclusion ITPFs should be treated conservatively. Concomitant organ injuries must be ruled out before treatment. Medical treatment without a lumbar corset could be used as a cost-effective choice.

Care Self-Efficacy and Related Factors in Mothers with 1-3 Year Old Children in a Training and Research Hospital

Care Self-Efficacy and Related Factors in Mothers with 1-3 Year Old Children in a Training and Research Hospital

The effects of using heel protectors on the prevention of heel pressure injuries and plantar flexion contractures.

Immobilization in the intensive care unit can lead to pressure injuries and plantar flexion contractures. This study was conducted to evaluate the effectiveness of heel protectors applied for the prevention of heel pressure injuries and plantar flexion contractures in intensive care units. This study was conducted as a randomized controlled trial in two adult intensive care units of a teaching and research hospital. The study sample consisted of 84 patients admitted to intensive care units between January 2022 and December 2022. Patients who had been in the intensive care unit for at least 5 days, scored 16 or less on the Braden Pressure Ulcer Risk Assessment Scale and scored 4 or more on the Ramsey Sedation Scale, were included in the study. Heel protector boots were applied to the heels of the patients in the intervention group, while standard positioning with a pillow and ROM exercises were continued in the control group. A sociodemographic data form, the Ramsey Sedation Scale and the Braden Pressure Ulcer Risk Assessment Scale were used to collect data. While pressure injuries were evaluated with the International NPUAP-EPUAP Pressure Ulcer Classification System, goniometric measurements were made to evaluate joint ROM. In the intervention group, heel pressure injuries did not develop during the study, whereas five patients in the control group developed heel pressure injuries. The risk of pressure injury development that was seen in the control group was 1.7 times higher compared with the risk for the intervention group (log 95% CI: 0.91-2.59). There were significant differences between the right foot (99%; F = 99.229; p = .000) and left foot (99%; F = 100.519; p = .000) in range of motion measurement values of the patients in the intervention group according to the measurement times. According to the results of the multiple comparison test (Bonferroni) performed to determine the range of motion measurement periods showing significant differences, it was observed that each measurement for both feet yielded lower results than the previous measurement (seven measurements from day 1 to day 13). The use of heel protector boots was found to be effective in preventing the development of heel pressure injuries and plantar flexion contractures in intensive care unit patients. This study provides evidence that intensive care nurses can use heel protector boots to prevent the development of heel pressure injuries and plantar flexion contractures.

Erythroferrone and hepcidin levels in children with iron deficiency anemia.

Iron deficiency anemia remains a significant public health issue in developing countries. The regulation of iron metabolism is primarily controlled by hepcidin, a key regulatory protein. During erythropoiesis, erythroferrone (ERFE), a hormone produced by erythroblasts in response to erythropoietin (EPO) synthesis, mediates the suppression of hepcidin. In this study, it was aimed to determine the correlation between erythroferrone (ERFE) and hepcidin levels in children with iron deficiency anemia. This is a case-control study conducted at Kırşehir Ahi Evran University Training and Research Hospital Pediatrics Clinic between 1 and 31 September 2020. The study included 26 healthy children and 26 children with iron deficiency anemia. In order to evaluate iron status,whole blood count, serum iron, total iron binding capacity (TIBC), and ferritin levels were analyzed. The study measured the levels of hepcidin and erythroferrone in the serum of children diagnosed with iron deficiency before and after one month of iron treatment, as well as in a control group, using the ELISA method. Correlation between whole blood count, initial ferritin, hepcidin, ERFE and ferritin in the iron deficiency group was evaluated. Compared with healthy controls, the iron-deficient group had significantly lower haemoglobin (p < 0.001), MCV (p = 0.001), MCH (p < 0.001), MCHC (p < 0.001), iron (p < 0.001), ferritin (p < 0.001) and hepcidin (p = 0.001). Ferritin and hepcidin levels increased while erythroferrone levels remained unchanged after iron deficiency treatment. There was no correlation between hepcidin and ferritin levels in treatment group. The study found a strong and positive correlation between ferritin and hepcidin levels in iron-deficient children, but not between ERFE levels, suggesting that hepcidin is largely regulated by iron deposition levels. In addition, there was an increase in ferritin and hepcidin levels after iron treatment. The study found no significant difference in erythroferrone levels between the iron-deficient group and the control group. It is thought that this may be due to the short duration of iron treatment given to the patients with iron deficiency anemia included in the study.

A comparison of the clinical features of molar pregnancy in adolescents and adults

Objective: To compare the age-specific clinical features of molar pregnancy and to describe the risk factors associated with this situation.&#x0D; Method: This retrospective case-control study was conducted at the Department of Obstetrics and Gynecology. Tepecik Education and Research Hospital, Izmir, Turkey. The participants included both adolescents (≤ 19 years) and adults with histologically confirmed hydatidiform moles in our institution between January 2015 and January 2022. The interventions and main outcome measures of this study involved evaluating the clinical and ultrasonographic features, as well as the risk factors, associated with molar pregnancies in adolescents.&#x0D; Results: This study of 137 patients with molar pregnancy found that adults had a higher incidence of partial molar pregnancy (20 patients versus seven patients) and lower beta-hCG levels than adolescents (176.890.71 mIU/ml versus 253.734.47 mIU/ml). Adolescents had a higher likelihood of hyperthyroidism (25.4% versus 9.2%). bleeding on admission (4.2% versus 1.51%),. longer hospital stays (5.44 ± 2.73 days versus 3.59 ± 3.08 days). Higher rates of uterine enlargement and postoperative bleeding (15.5% versus 1.5%). Adolescents also required more analgesia (97% versus 89.4%).&#x0D; Conclusions: Adolescents with Gestational trophoblastic diseases (GTD) may present with more severe symptoms compared to adults, which can lead to delayed diagnosis and treatment. Further research is needed to better understand the underlying mechanisms and risk factors for GTDs in this population. Increased awareness and education can help improve recognition and management of GTDs in adolescents and improve their overall health outcomes.&#x0D; doi: https://doi.org/10.12669/pjms.40.5.8383&#x0D; How to cite this: Ozer M, Ozer PT, Karaca I, Karaca S, Ileri A, Budak A. A comparison of the clinical features of molar pregnancy in adolescents and adults. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8383&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Persistent Conjunctival Chemosis after Lower Lid Blepharoplasty: A Comparison of Different Surgical Techniques.

Background: Conjunctival chemosis, a complication of lower blepharoplasty, can cause persistent discomfort and functional disturbances with worsening in the postoperative period following surgery. Methods: A review of the records of the lower blepharoplasty procedures carried out at the Humanitas Research Hospital, Rozzano, Milan, Italy was performed. Patients were categorized into two groups depending on the procedure performed: (1) transconjunctival blepharoplasty with the removal of the fatty lodges with canthopexy and (2) transcutaneous blepharoplasty with the removal of the fatty lodges with lateral canthoplasty. Each group was further divided into two more groups based on the surgical method used, that is either (a) cold blade and disposable cautery or (b) radiofrequency cut and coagulation and colorado tip (respectively 1a, 1b, 2a and 2b). All patients underwent a postoperative follow-up up to 24 months, which included an evaluation of cosmetic appearance, eyelid scarring and the severity of chemosis. The aim of the study was to investigate which of the surgical procedures causes a lower incidence of persistent type 3 conjunctival chemosis. Results: A total of 1047 patients who underwent lower lid blepharoplasty were included in the study. A total of 512 patients underwent transcutaneous blepharoplasty and 535 underwent the transconjunctival procedure. Among the first group of patients, 266 belong to group 1a and 246 to group 1b. In the second group, 264 were categorized as group 2a and 271 as group 2b. The incidence of type 3 chemosis in the transcutaneous blepharoplasty procedure with lateral canthoplasty was statistically significantly higher than in the transconjunctival approach, considering both the cold blade and the radiofrequency (p = 0.012, 0.010, 0.006, 0.004, respectively). Conclusions: A higher incidence of persistent type 3 conjunctival chemosis is associated with lateral canthus surgery and with the use of radiofrequency.

Uso de la medicina complementaria y alternativa y enfoques para hacer frente al estrés en las mujeres con cáncer de mama: un estudio transversal

ObjectiveThe study aimed to reveal the approaches to coping with stress of women with breast cancer and the factors predicting these approaches, to determine the prevalence and characteristics of Complementary and Alternative Medicine (CAM), and to examine the relationship between use of CAM and approaches to coping with stress. MethodsA descriptive and cross-sectional study was conducted among 328 women with breast cancer at a training and research hospital in Türkiye. Data were collected with the Descriptive Information Form and the Stress Coping Styles Scale (SCSS). ResultsWomen's SCSS score was 47.26±6.39 (effective) and 37.76±6.33 (ineffective). The SCSS score were not significantly different between CAM users and non-CAM users (P>.05). The prevalence of CAM use was 36%, the most common types of CAM were herbal products (55.1%) and prayer (33.8%) and the reasons for using CAM were for relaxation (symptomatic) (43.2%). As a result of multivariate logistic regression analysis, level of income, working, number of living children, receiving chemotherapy, receiving surgery, having a family history of cancer, and the interest of their partner after the disease were associated with effective coping with stress (P<.05, adjusted R2=.08, .05, and .33 respectively). Working, receiving chemotherapy, receiving surgery, stage of cancer, and having a history of cancer in a social environment were associated with ineffective coping with stress (P<.05, adjusted R2=.14 and .11 respectively). ConclusionsOne-third of women were using CAM and had a good level of approaches to coping with stress. Healthcare providers, especially gynecology-oncology nurses, should provide counseling on CAMs and develop strategies for coping with stress for women with breast cancer.

Investigation of Parents' Awareness of Early Orthodontic Evaluation and Treatment in Paediatric Patients: A Cross-Sectional Study.

This study aims to gauge the level of awareness among parents about the importance, timing, and benefits of early orthodontic assessments for their children. A questionnaire consisting of 12 questions was created through Google Forms to measure the knowledge about early orthodontic treatment and consultation with the parents of 1821 patients aged 6-11 years admitted to the paediatric service of a training and research hospital and filled out by the parents. The distribution of variables was examined with the Shapiro-Wilk normality test; the independent t test was used in the comparison of paired groups of normally distributed variables; and the chi-square test was used in the comparison of qualitative data. A stepwise logistic regression analysis was performed to determine the effective factors for consultation with the orthodontist. The present study found a positive relationship between parents' education and monthly financial income and their knowledge of malocclusions for early orthodontic treatment. Conversely, there was a negative correlation between the number of children parents had and their awareness of malocclusions. The early identification of malocclusions allows orthodontic problems to be corrected with less complex treatment methods.

The use of complementary and alternative medicine and approaches to coping with stress in women with breast cancer: a cross-sectional study

ObjectiveThe study aimed to reveal the approaches to coping with stress of women with breast cancer and the factors predicting these approaches, to determine the prevalence and characteristics of Complementary and Alternative Medicine (CAM), and to examine the relationship between use of CAM and approaches to coping with stress. MethodsA descriptive and cross-sectional study was conducted among 328 women with breast cancer at a training and research hospital in Türkiye. Data were collected with the “Descriptive Information Form” and the “Stress Coping Styles Scale (SCSS)”. ResultsWomen's SCSS score was 47.26±6.39 (effective) and 37.76±6.33 (ineffective). The SCSS score were not significantly different between CAM users and non-CAM users (p>0.05). The prevalence of CAM use was 36%, the most common types of CAM were herbal products (55.1%) and prayer (33.8%) and the reasons for using CAM were for relaxation (symptomatic) (43.2%). As a result of multivariate logistic regression analysis, level of income, working, number of living children, receiving chemotherapy, receiving surgery, having a family history of cancer, and the interest of their partner after the disease were associated with effective coping with stress (p<0.05, adjusted R2=0.08, 0.05, and 0.33 respectively). Working, receiving chemotherapy, receiving surgery, stage of cancer, and having a history of cancer in a social environment were associated with ineffective coping with stress (p<0.05, adjusted R2=0.14 and 0.11 respectively). ConclusionsOne-third of women were using CAM and had a good level of approaches to coping with stress. Healthcare providers, especially gynecology-oncology nurses, should provide counseling on CAMs and develop strategies for coping with stress for women with breast cancer.

All India Institute of Medical Sciences (AIIMS), Delhi: Cyberattack Puts Digitalisation Under Scanner

‘I Dream of a Digital India where cyber security becomes an integral part of National Security’—Narendra Modi Fulling this dream one as to realise the fact ‘Cyber Security is not easy. But it comes down to three basic principles—PROTECT, DETECT AND RESPOND as early as possible’—Advent from AIIMS Case The All India Institute of Medical Sciences (AIIMS), a top public medical research facility and hospital with headquarters in New Delhi, India, announced a sophisticated cyber-incident on its servers on 23 November 2022. Several patient care services were rendered unavailable as a result of the incident, including registration, admission, billing and discharge. Several news sources claim that this cyber event, which affected the e-services of the AIIMS (New Delhi) starting at 7:00 a.m. on 23 November 2022, was of the ransomware variety. The testing runs of the e-hospital server were successful, and the majority of the lost data had been recovered during the previous few days, according to AIIMS authorities’ confirmation on 6 December 2022. The case provides background on the healthcare industry and a brief analysis of the incident, along with the measures taken to prevent such attacks in the future.

The Relationship of the Traumatic Birth Perception of Women with Birth Memories and Recall.

A traumatic childbirth experience can have both short- and long-term health and well-being consequences for the woman and her family. If a woman experiences traumatic childbirth and retains negative memories for a long time, this may impact her future childbirth experience, mother-infant bonding and breastfeeding problems, and her relationship with other family members. The research was conducted to evaluate the relationship between women's traumatic birth perception and birth memory and recall. This descriptive study was conducted at Erzurum Research Hospital between August 16 and October 2021. Two hundred sixty women who met the inclusion criteria were included in the study sample. The personal information protocol, "Traumatic Childbirth Perception Scale," and "Birth Memories and Recall Questionnaire" were used to collect data. The participants' mean age was 30.13 ± 5.85, and 43.4% had their first birth. Of the participants, 45% had one living child, 72.9% had a planned pregnancy, and 62.8% had a normal birth. Whereas more than a third of women in the study perceived childbirth and childbirth processes as moderately traumatic, another third had a high and very high perception. The birth memories and recall mean scores of the mothers within the scope of the study were 81.09 ± 22.69. According to the study results, it was determined that women's birth memories and recall were negatively affected as their traumatic childbirth perceptions increased. It is possible to reduce traumatic childbirth perception with the continuous care and support provided by midwives during childbirth. Improving women's traumatic childbirth perception will also positively impact women's long-term memories of childbirth experience.

Comparison of salpingectomy and tubal detorsion procedures after experimental ischemia-reperfusion injury in a rat fallopian tube model: biochemical and histopathological evaluation

To compare salpingectomy and detorsion procedures and investigate the biochemical and histopathological changes in fallopian tubes in the experimentally isolated fallopian tube torsion model in rats. Experimental study. Experimental surgery laboratory in a training and research hospital ANIMAL(S): Twenty-seven Sprague-Dawley rats in the reproductive period INTERVENTION(S): Group 1: Control group (n=6); Group 2: bilateral total salpingectomy group after 4 hours of tubal ischemia (n=7); Group 3: 4 hours of bilateral tubal ischemia plus one week of reperfusion (n=7); Group 4: 4-hour period of bilateral tubal ischemia plus 30-days of reperfusion (n=7). A 22-gauge catheter was administered before and after surgery using methylene blue through the uterine horn of the rat to evaluate tubal patency. Preoperative and postoperative serum AMH levels; histopathologic examination of rat tuba uterine and histopathologic damage scores; antioxidant compounds (superoxide dismutase, catalase, glutathione peroxidase); and oxidative stress end product levels (malondialdehyde and 8-hydroxy-2-deoxyguanosine). While a significant difference was observed in tissue SOD (p<0.001), GPx (p=0.002), MDA (p=0.001), and 8 OHdG (p<0.001) values, no significant difference was observed between the groups in serum samples (p>0.05). Tissue SOD and tissue GPx levels in group 2 significantly decreased, and a significant increase was observed in tissue MDA and 8-OHdG values in group 2. Among the histopathological parameters, epithelial changes (p<0.001), vascular congestion (p = 0.001), and the total fallopian tube mean damage score of 4 (p = 0.003) showed a significant decrease in group 4. When the methylene blue transitions before and after ischemia-reperfusion (I/R) injury were compared, the value of the methylene blue transition after I/R injury in groups 2 (p = 0.008), 3 (p = 0.025), and 4 (p = 0.014) decreased significantly. When serum AMH levels are analyzed, the postoperative AMH value significantly increases in group 2 (p = 0.028). This study reveals that biochemical and histopathological improvement is observed in the fallopian tube tissues gradually when the detorsion procedure is performed for the necrotized tubal tissue instead of salpingectomy. Although there is a restoration in epithelial integrity after reperfusion, tubal passage remains absent.

Guideline for the diagnosis and management of multiple myeloma-related renal impairment (2024 version)

Renal impairment is a common complication of multiple myeloma (MM). All patients with MM should be assessed for the presence and severity of renal impairment. The clinicopathological manifestations of MM-related renal impairment are diverse and complex; accordingly, except for light-chain nephropathy, which can often be diagnosed without biopsy based solely on clinical criteria, a renal biopsy is needed for an accurate diagnosis. Supportive care, such as adequate hydration, is required for all patients with MM-related renal impairment. The guideline provide the principles for dose adjustment of the drugs used for MM with renal impairment, including proteasome inhibitors, immunomodulators, monoclonal antibodies, small molecule inhibitors, and alkylating agents, as well as those used for myeloma bone disease. Autologous stem cell transplantation (ASCT) and chimeric antigen receptor T-cell immunotherapy (CAR-T) are effective in patients with moderate renal impairment and are tolerated by the patients. The Chinese Hematology Association; the Chinese Geriatrics Association, Society of Hematology; and the Chinese Research Hospital Association, Society of Nephrology asked experts to collate information on current progress in clinical research relating to MM with renal impairment. This guideline was developed based on the gathered data combined with the latest international consensus and clinical practice guidelines.

Literature review and protocol for a prospective multicentre cohort study on multimodal prediction of seizure recurrence after unprovoked first seizure

IntroductionEpilepsy is a common neurological disorder characterised by recurrent seizures. Almost half of patients who have an unprovoked first seizure (UFS) have additional seizures and develop epilepsy. No current predictive...

Sonographic Association between Hepatic Steatosis Disease and Polycystic Ovarian Syndrome in Swabi Women

Background: Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, with significant implications for their fertility and metabolic health. Non-Alcoholic Hepatic Steatosis Disease (NAHSD), or fatty liver disease, has been increasingly recognized as a comorbidity in women with PCOS, suggesting a possible interrelation between these conditions that warrants further investigation. Objective: This study aimed to explore the association between NAHSD and PCOS among women in the Swabi district of Khyber Pakhtunkhwa, Pakistan, with an emphasis on understanding the prevalence and sonographic characteristics of these conditions in the affected population. Methods: A cross-sectional study was conducted at the Department of Radiology, Mahaban Medical and Research Hospital, Swabi, KP, Pakistan. The study included 86 women with a history of irregular menstrual cycles or amenorrhea. Sonographic examinations were performed using a Toshiba prime ultrasound machine with convex (3.0—5.0 MHz) and linear (7.0—14.0 MHz) transducers. Clinical and sonographic data pertaining to PCOS and NAHSD were collected, including ovarian volume and liver echogenicity grading. Statistical analysis was conducted using SPSS version 25. Results: The mean age of participants was 27.5 ± 4.8 years. The mean ovarian volumes were 11.52 ml (right ovary) and 10.80 ml (left ovary). The prevalence of NAHSD in our study cohort was 46.5%. Furthermore, hirsutism was observed in 22.1% of the patients. A significant association between the presence of NAHSD and PCOS was identified, with higher rates of hepatic steatosis observed among the PCOS patients compared to those without PCOS. Conclusion: The findings from this study underscore a significant association between NAHSD and PCOS among women in the Swabi district, suggesting that women with PCOS are at an increased risk of developing fatty liver disease. This association highlights the need for comprehensive screening and management strategies to address these comorbid conditions effectively.

Effectiveness of Acupressure Therapy in Cancer Patients with Constipation

Background: Constipation in cancer patients on chemotherapy is common (31.7%), worsened by medication side effects. Laxatives worsen symptoms, prompting exploration of alternative therapies like acupressure, particularly in pediatric cases. Indonesian National Hospital research assesses acupressure's effectiveness in managing chemotherapy-induced constipation. This study aims to identifying the effectiveness of acupressure therapy in pediatric cancer patients with constipation. Methods: experimental research methods on cancer children with the health problem of constipation. Results: Before receiving acupressure therapy, the average patient had not defecated for 81 hours. Changes occurred after therapy, namely patients experienced defecation an average of 9.2 hours. Conclusions: The changes show that acupressure therapy is very significant in reducing constipation.

Multicenter Study on Breast Cancer in the Geriatric Population: Insights for Effective Treatment Strategies.

Breast cancer is common among women aged 65 and over. There is a significant lack of evidence regarding the treatment of breast cancer in patients in this age group due to the rare inclusion of these patients in clinical studies. However, it is known that survival in elderly patients with breast cancer is significantly reduced in those not receiving standard therapy. Several factors, including patients' comorbidities, performance status, life expectancy, and tumor pathological and molecular characteristics, can affect the outcomes of treatment. In this study, we aimed to update the knowledge in this field by assessing these factors among the geriatric population in our multicenter dataset. This retrospective study analyzed data from 335 breast cancer patients aged 65 and over who received adjuvant radiotherapy at five oncology centers (Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul,Meram Medical Faculty - Necmettin Erbakan University, Konya,Prof. Dr. Cemil Tascioglu City Hospital, Istanbul,Umraniye Training and Research Hospital, Istanbul, andIstanbul Oncology Hospital, Istanbul) between May 2010 and September 2022. Demographic, clinical, and pathological data were collected, including age, gender, clinical symptoms, tumor characteristics, treatment approaches, and outcomes. Statistical analyses, including descriptive statistics, Kaplan-Meier analysis, log-rank test, and Cox regression analysis, were performed using IBMSPSSStatistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States), with a significance level of p < 0.05. The tumor characteristics and survival time of 335 breast cancer patients were examined. In the results, performance status, T stage, and perineural invasion were found to be factors affecting the survival of elderly breast cancer patients. In multivariate analysis, it was seen that performance status played an important role as an independent prognostic factor. The treatment of breast cancer in the geriatric age group necessitates a personalized approach, taking into account the patient's overall health status, life expectancy, and comorbidities.

Preventing Bone Loss in Breast Cancer Patients: Designing a Personalized Clinical Pathway in a Large-Volume Research Hospital.

We assess the impact of bone health clinical management in breast cancer (BC) patients receiving adjuvant endocrine therapy and design a personalized clinical pathway to reduce bone loss in an Italian research hospital. The primary endpoint was to assess (through the process improvement organizational method) the clinical pathway that post-surgical BC patients prescribed with endocrine therapy undergo to prevent bone loss. The secondary endpoint was to design a personalized clinical pathway for a prompt implementation of guidelines, to assess and possibly prescribe antiresorptive therapy. During the first year of the execution of the new Diagnostic Therapeutic Assistance Pathway, a 60% increase in Dual-Energy X-ray Absorptiometry evaluations within 30 days and a 39.5% increase in antiresorptive therapy prescription within 90 days (since the prescription of endocrine therapy) were shown, thus increasing patients' compliance. Case managers and bone health specialists in this context can improve patients' adherence to therapies and bone health, helping physicians to expand their collaboration.

Determinants of distress levels in high-risk pregnant women – cross-sectional study

Introduction and aim. Global and national care recommendations indicate that women with high-risk pregnancies should receive personalized and qualified care during this period. This study was conducted to determine the distress levels in high-risk pregnant women and affecting factors. Material and methods. The cross-sectional this study was conducted with total of 416 high-risk pregnant women who met the inclusion criteria in the obstetrics clinic of a training and research hospital. The study data were collected with data collection form and “Tilburg Pregnancy Distress Scale (TPDS).” Results. The mean TPDS total score of high-risk pregnant women was 18.25±6.85. It was found that planning pregnancy, gravida, and diagnosis of gestational hypertension, systemic diseases, and gestational diabetes in the present pregnancy was asso ciated with pregnancy-specific distress (p&lt;0.05; β=0.291, β=0.158, β=0.272, β=0.137, β=0.116, respectively). Conclusion. It is advised that health professionals assess the distress levels of high-risk pregnant women and give personalized care during prenatal period.