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Objective: To compare the safety and efficacy of two misoprostol regimens for mid-trimester pregnancy terminations., Methods: Retrospective analysis of 263 cases of pregnancy terminations with misoprostol between 12 and 24 weeks was performed. Group 1 (total 129 patients) consisted of patients who were given 200 mcg vaginal misoprostol every 4 h until the abortion, whereas Group 2 patients (total 134 patients) were given misoprostol as in International Federation of Gynecology and Obstetrics's (FIGO) 2012 recommendation. In case of a previous cesarean section doses were halved in both groups. Primary outcomes of the study were the time to abortion and the total drug dose used. Secondary outcome was the rate of complications., Results: Total dose and time to abortion did not differ between the groups. As for complications, one patient (%0.8) in group 1 developed HELLP syndrome and had hysterotomy. One patient (%0.8) in group 2 had uterine rupture and had total hysterectomy. Two patients in both groups considered failure of induction and terminated with surgery (hysterotomy). Groups did not show difference in induction failure rates., Conclusions: We respect the presence of dose recommendation stated by the FIGO and found similar results with our recent protocol. Other misoprostol regimens used worldwide should also be compared with this guideline in order to improve its efficacy.

Background: Mastalgia is a debilitating disorder, which has serious effects on one's daily life and causes significant medical costs., Aim: Mastalgia patients determine the overall approach and improve the quality of life of patients., Methods: In this study, the outcomes of psychoeducation on anxiety and pain in a group of patients with mastalgia without an organic etiology have been investigated. 88 patients were included in this study. The socio-demographic data form, the Symptom Checklist 90 (SCL-90), the Toronto Alexithymia Scale-20 (TAS-20), the Hamilton Anxiety Scorer (HAM-A), the State-Trait Anxiety Inventory (STAI-I, STAI-2) and the Visual Analogue Scale (VAS) were all applied to the patients. 64 randomly selected patients (Group 1) were given psychoeducation while the remaining 24 (Group 2) were not. All patients were called back after 1 month for repeats of the HAM-A, STAI-I, STAI-2 and VAS tests., Results: The results of this study demonstrated that psychoeducation has positive impacts on the perception of pain besides stationary, contemporary and total anxiety scores., Conclusions: It is concluded that the administration of psychoeducation is a good choice in the degradation of anxiety symptoms and pain.

The aim of this study was to determine the frequency and etiology of altered mental status in adults at an Emergency Department. Medical records of 790 patients with altered mental status were reviewed. Out of 790 patients, 414 (52.3%) were male, 376 (47.7%) were female. Mean age was 45.65 +/- 15.5 years. Etiologic factors were neurological (n = 566; 71.6%), head trauma (n = 82; 10.4%), endocrine/metabolic (n = 48; 6.1%), cardiovascular/pulmonary (n = 49; 6.2%), infectious (n = 30; 3.8%), gynecologic and obstetric (n = 2; 0. 4%), toxicologic (n = 12; 1.5%). Of patients, 40% were in deep coma, 11% were confused, 20% were in agitated confusion, 15% were lethargic, and 14% were in stupor. Eighteen percent of were hypertensive. Total mortality rate was 20.1% (n = 159). Common causes of death were cerebrovascular disease and trauma. Most patients presenting with altered mental status seem to be elderly with the most frequent cause being cerebrovascular accidents. Fatality rate is very high.

Objective: Cardiovascular complications due to atherosclerosis (AS) are the major cause of mortality in hemodialysis (HD) patients. Inflammation may play an important role in the development of AS. Several studies have demonstrated an association between AS and acute-phase proteins and cytokines in the general population and in HD patients. Interleukin-10 (IL-10) is an anti-inflammatory cytokine. The aim of this study was to compare serum levels of inflammatory and anti-inflammatory indicators in HD patients according to the presence or absence of AS., Material and Methods: A total of 33 HD patients were studied. AS was defined as the presence of plaques as detected by Doppler ultrasonography. The patients were subgrouped according to the presence or absence of plaques. Serum levels of IL-1, -2, -6 and -10, C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) were measured. Risk factors for AS, such as age, gender, hypertension, hyperlipidemia and duration of HD, were also evaluated., Results: Patients with AS had significantly higher high sensitivity (hs)-CRP and lower IL-10 levels. Blood pressure was also elevated in patients with AS. There was an inverse correlation between CRP and IL-10 levels in patients with AS., Conclusion: Patients with AS undergoing HD had low serum levels of the anti-inflammatory cytokine IL-10 and high serum levels of hs-CRP. These results may suggest that limitation of the anti-inflammatory response in atherosclerotic uremic patients is a triggering or contributory factor for AS.

Arteriosclerosis is characterized by stiffening of arteries. The incremental elastic modulus (Einc) measurement is a good marker of arterial wall stiffness. Metabolic, inflammatory and hemodynamic alterations cause structural changes and vascular complications in end stage renal disease. The aim of the present study was to evaluate the factors that may affect the development of arteriosclerosis by measurement of Einc in hemodialysis (HD) patients. Thirty-two patients (16 men; 16 female) on chronic HD with a mean age of 42.2 +/- 19.3 (range: 15-80) were included in the study. The carotid Einc was measured to determine arteriosclerosis by high-resolution echo-tracking system (Acuson Aspen, Acuson Corp., Mountain View, California, USA). Einc measurement was calculated from transcutaneous measurements of common carotid arterial (CCA) internal diameter and wall thickness and carotid pulse pressure. Common carotid compliance and distensibility were determined from changes in carotid artery diameter during systole and simultaneously measured carotid pulse pressure. Common carotid artery stuffiness (Einc) was influenced by age, systolic blood pressure (SBP), pulse pressure (PP), calcium (Ca) and alkaline phosphatase (ALP). The distensibility of CCA was correlated with age, SBP, diastolic blood pressure (DBP), PP, Ca, ALP, and parathormone (PTH). The inflammatory parameter, hs-CRP, was increased with Einc. The mean Einc measurement was found significantly increased in patient receiving vitamin D. In conclusion, the stiffening of carotid artery in HD patients is related not only to hemodynamic changes (increased SBP, PP) but also to metabolic (increased Ca) and to inflammation (increased hs-CRP). Carotid Einc is accepted independent risk factor for cardiovascular mortality. Because of the positive correlation between Einc and serum Ca, vitamin D and Ca containing phosphorus (P) binders should be used carefully.