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Objective: The objective was to investigate the incidence, indications, and risk factors of peripartum emergent hysterectomy. Method: Fifty-nine cases of emergent peripartum hysterectomy performed at Zeynep Kamil Women and Children's Education and Research Hospital during a 13-year period between January 1990 and January 2003 were evaluated retrospectively. Emergent peripartum hysterectomy was defined as that performed for haemorrhage unresponsive to other therapeutic interventions within the first 24 h of delivery. Result: Emergent peripartum hysterectomy was performed in 59 cases of 234,958 women (25.1/100,000). Total and subtotal hysterectomy was performed in 25 and 34 cases respectively. The rates of emergent penpartum hysterectomy after vaginal and caesarean deliveries were 8.7/100,000 and 104.5/100,000 respectively. Uterine atony was the most frequent indication (62.7%). The rates of emergent peripartum hysterectomy due to uterine atony in primiparous and multiparous women were 61.1 and 65.2% respectively. The rate of maternal mortality was 8% (5 cases). Conclusion: Uterine atony was the most common indication for emergent peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

The increasing preference for indoor exercise spaces highlights the relationship between indoor thermal environments and physiological responses, particularly concerning thermal comfort during physical activity. Determining the metabolic heat production rate during exercise is essential for optimizing the thermal comfort, well-being, and performance of individuals engaged in physical activities. This value can be determined during the activity using several methods, including direct calorimetry measurement, indirect calorimetry that uses analysis of respiratory gases, or approximations using collected data such as speed, body mass, and heart rate. The study aimed to calculate the metabolic heat production rate by infrared thermal evaluation (ITE) based on the body's thermal balance approach and compare it with the values determined by indirect calorimetry (IC). Fourteen participants volunteered for the study, using a cycling ergometer in a controlled climatic chamber. After the familiarization sessions, maximal O 2 intake levels (VO 2max ) were determined through maximal graded exercise tests. Subsequently, constant work rate exercise tests were performed at 60% of VO 2max for 20 min. The metabolic heat production rates were calculated by IC and ITE for each athlete individually. Respiratory gases were used to determine IC, while body skin and core temperatures, along with physical environmental data, were applied to calculate ITE using the human body thermal balance approximation of ASHRAE. According to the results, heat storage rates were misleading among the body's heat transfer modes, particularly during the first 8 min of the exercise. ITE showed a moderate level of correlation with IC (r: 0.03-0.86) with a higher level of dispersion relative to the mean (CV%: 12-84%). Therefore, a new equation (ITE new ) for the heat storage rates was proposed using the experimental data from this study. The results showed that ITE new provided more precise estimations for the entire exercise period (p > 0.05). Correlations between ITE new and IC values were consistently strong throughout the exercise period (r: 0.62-0.85). It can be suggested that ITE new values can predict IC during the constant work rate steady-state exercise., (© 2024. The Author(s) under exclusive licence to International Society of Biometeorology.)

Purpose: This study aims to review all published cases on the association between thyrotoxicosis and Takutsubo Syndrome by describing clinical characteristics, diagnostic work-up, treatment, and outcome., Methods: We searched PubMed and Embase databases from inception to the 17th of February 2022 for case reports or series reporting the above-mentioned association. We extracted data on demographic characteristics, clinical features, diagnostic work-up, treatment, and clinical outcomes. Cases were stratified into groups based on the presumed cause of the thyrotoxicosis (iatrogenic vs non-iatrogenic and Graves' diseases vs non-Graves' disease, respectively)., Results: We identified 25 cases from 24 articles. The mean age was 61.7 years (+/- SD 14.5). Most patients were women (88%). Graves' disease (52%) was the leading cause of thyrotoxicosis. Previous cancer was significantly more common in patients with iatrogenic thyrotoxicosis (P = 0.03). The most common symptoms were respiratory symptoms (68%), chest pain (56%), and palpitations (40%). The most common ECG characteristics were T-wave abnormalities (48%) and ST-elevations (36%). Elevated troponin levels were found in 92% of the cases. Patients with Graves's disease and Takutsubo Syndrome had higher plasma levels of serum thyroxine (P = 0.03) and were more often treated with beta-blockers (P = 0.01) compared to patients with thyrotoxicosis of other origins. Notably, 40% of cases experienced in-hospital complications. No deaths were reported. All patients had improved cardiac function within a median follow-up of 42 days., Conclusion: Evidence-based on current case reports suggests an increased risk of Takutsubo Syndrome and subsequently increased risk of in-hospital complications in patients with thyrotoxicosis., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

For decades, diuretics have been the cornerstone in the treatment of patients with chronic heart failure with reduced ejection fraction (HFrEF) presenting with congestion. However, evidence guiding the use of diuretics is generally lacking. Adequate dosing and evaluation of diuretic effect are important for treatment success. Measuring the concentration of sodium in urine in addition to urinary output has been suggested as a good marker to guide the use of diuretics. This review summaries the current knowledge on the use of diuretics in patients with HFrEF presenting with congestion.

Rapid identification of acute myocardial infarction (MI) is important for the early initiation of evidence-based therapy. In the European Society of Cardiology (ESC) 0/1h-algorithm (also called early-rule-out algorithm) high-sentivity cardiac troponin is measured at admission and one hour later. By using assay-specific cut-off levels patients are triaged to three different groups; "rule-out", "observation" or "rule-in" of acute MI. The ESC 0/1h-algorithm has high diagnostic accuracy and safety to rule out MI. This review summaries the current knowledge and practical use of the new early-rule-out algorithm.

This study is aimed to compare the clinical and radiological differences between classic locked intra- medullary nailing (LIN) and blade expandable intra- medullary nailing (BEIN) at tibia shaft fractures. Operation time, exposing of radiation time and fracture healing times were recorded. Pain visual anolog scale (VAS), shortening of tibia and angulation of fracture line were compared. All patients healed. In LIN group operation time, exposing of radiation time was longer (statistically significant). Because of shorter operation time and lower radiation exposure we recommend the BEIN technique as a preferable technique in tibia intramedullary nailing.

In this study, thermal behaviours of the athletes were investigated with respect to thermal comfort and exercise intensity. The relationship between an index for analysing thermal comfort (Predicted Mean Vote: PMV) and Rating of Perceived Exertion (RPE) which shows exercise intensity and exhaustion level was evaluated. Eleven moderately trained male athletes ( V ˙ O 2max 54 ± 9.9 mL∙min -1 ∙kg -1 ) had volunteered for the study (age: 22.2 ± 3.7 years; body mass: 73.8 ± 6.9 kg; height: 181 ± 6.3 cm; Body surface area (BSA): 1.93 ± 0.1 m²; body fat: 12.6% ± 4.2%; V ˙ O 2max : 54 ± 9.9 mL∙min -1 ∙kg -1 ). Experiments were carried out by using a cycle ergometer in an air-conditioned test chamber which provided fresh air and had the ability to control the temperature and relative humidity. The study cohort was divided into two groups according to maximal oxygen consumption levels of the participants. Statistical analyses were conducted with the whole study cohort as well as the two separated groups. There was a moderate correlation between PMV and RPE for whole cohort ( r : -0.51). When the whole cohort divided as low and high aerobic power groups, an average correlation coefficient at high oxygen consumption cohort decreased to r : -0.21, while the average correlation coefficient at low oxygen consumption cohort increased to r : -0.77. In conclusion, PMV and RPE have a high correlation in less trained participants, but not in the more trained ones. The case may bring to mind that thermal distribution may be better in high aerobic power group in spite of high RPE and thus the relation between PMV and RPE is affected by exercise performance status., Competing Interests: The authors declare no conflict of interest.

Objective: The purpose of the present study was to determine whether the vaginal preparation with povidone-iodine prior to caesarean delivery decreased the incidence of postpartum endometritis., Methods: The present study was a prospective randomized controlled trial in which subjects received a vaginal preparation with povidone-iodine solution immediately prior to caesarean delivery or received no vaginal preparation. The primary outcome measure was the rate of postpartum endometritis., Results: A significant decrease in post-caesarean endometritis was noted in the group that received the povidone-iodine vaginal preparation (n = 334) compared with the control group (n = 336) [6.9 vs. 11.6%; RR = 1.69; 95% CI = 1.03-2.76]. No statistically significant differences in the incidence of endometritis were noted between the experimental and control groups among women who were not in labor at the time of the caesarean delivery [9.2 vs. 8.6%; RR = 1.05; 95% CI = 0.58-1.90], and no differences were found between groups when women with ruptured membranes were excluded from the analysis [9.6 vs. 6.7%; RR = 1.39; 95% CI = 0.78-2.47]., Conclusions: Vaginal preparation with povidone-iodine solution immediately prior to a caesarean delivery reduces the risk of post-operative endometritis. This preemptive measure was only found to be beneficial in women whose membranes had ruptured and those who were in labor prior to caesarean surgery.

Objective: To examine the effect of metformin therapy on ovarian response in clomiphene-resistant PCOS patients., Design: Randomized prospective study., Setting: Zeynep Kamil Hospital IVF Center., Patients: Thirty-two female PCOS patients with clomiphene citrate resistance., Interventions: Test group A received 2x850 mg/day metformin therapy for 8 weeks, followed by gonadotropin induction. Only gonadotropin induction was applied to Control group B., Main Outcome Measures: Total gonadotropin dosage, duration of gonadotropin therapy, estradiol level on HCG-day, number of follicles with >or=16 mm diameter, number of cases with hyperstimulation development, number of cancelled cycles, endometrial thickness on HCG-day, pregnancy outcome, multiple pregnancy rate., Results: The total gonadotropin doses given to metformin-study group was significantly lower than the control group. In addition, duration of therapy, HCG level, plasma estradiol level on HCG-day in the study group was significantly lower than in the control group., Conclusions: Metformin therapy has led to a higher pregnancy outcome, as well as to a decrease in hyperstimulation risk, cycle cancellations, and multiple pregnancy rates with a lower gonadotropin dosage.