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The relationship between obesity, sex difference, and fatigue in patients with multiple sclerosis

Aim: Obesity is a risk factor for autoimmune disorders and worsens the disease process. The purpose of this study was to investigate the association between

the body mass index (BMI), sex differences and fatigue in MS patients compared to healthy controls. Material and Method: Our study consisted of 59 MS

patients (37 females, 22 males) and 45 healthy controls. Medical history of MS patients, including the duration of illness, BMI, Fatigue Severity Scale (FSS)

number of annual episodes, demographic data (sex, age) and BMI and fatigue severity of healthy control group were recorded. Results: The female MS patients

had a significantly higher mean BMI than the control group and a significant positive correlation between BMI and Extended Disability Scale Score (EDSS)

and fatigue. There was no significant difference between the male MS patients’ BMI and that of controls. Obese MS patient group had a significantly higher

mean fatigue level than the normoweight and overweight ones and significantly higher mean annual attack number than the normoweight MS group. In the

female MS patients group, the mean BMI and EDSS of Fatigue Severity Scale (FSS) ≥4 group were significantly higher than of FSS <4 group but there was no

significant correlation between the FSS ≥4 and FSS <4 groups in the male MS patients. Discussion: These findings suggest that being obese in MS patients

may affect attacks via inflammatory pathway as well as disability, particularly so in women; they also show the necessity of approaches encouraging weight

loss for MS treatment

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Epidural analgesia for labor pain: what has changed in the last 1 year? Literature review and clinical results our experience in labor analgesia

Aim: The technique of epidural analgesia is the most accepted method of labor analgesia in the contemporary world because it allows the mother to participate

both in the physical and emotional aspects of the delivery as well as eliminating the pain that occurs during labor. The aim of our study is to investigate the

effects of epidural analgesia on mother, fetus, and labor. Material and Method: Files of pregnancies underwent epidural labor analgesia were reviewed retrospectively.

Demographic data, hemodynamic parameters, Activity, Pulse, Grimace, Appearance, Respiration scores (APGAR scores), durations of first and second

stages of labor, side effects, drug doses and amounts, VAS and VRS scores, maternal satisfaction ratings were examined. Results: In the primiparous group

there is a moderate positive correlation between the total dose and Verbal Rating Scale 2 (VRS 2) and Visual Analog Scale 2 (VAS 2), (p-values are p<0.001,

p<0.001 respectively). In the multiparous group, there is a strong positive correlation between VRS 2 and VAS 2 (p-values are p<0.001, p<0.001 respectively).

There is also a moderate positive correlation between the total dose and VRS 2 and VAS 2 when all pregnant women are examined (p-values are p<0.001,

p<0.001 respectively). It was observed that epidural analgesia had no effect on the 1st and 5th minute APGAR scores. There was a significant moderate positive

correlation between total dose and duration of labor (p<0.001). Discussion: The use of epidural analgesia, during labor that generates intensive maternal

pain and stress, when done by specialists, allows a highly satisfactory and comfortable labor by reducing pain of the mother.

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Use of multiple artery grafts to ensure long-term graft patency in coronary bypass surgeries

Aim: When selecting a graft for coronary artery bypass surgery (CABG), it is necessary to consider the quality of life and life expectancy of the patient besides

ensuring complete revascularization. Use of multiple artery grafts confers the advantage over venous grafts because of their longer patency rates. The aim

of this study is to evaluate our experiences in the use of arterial grafts and draw attention to the use of multiple artery grafts. Accordingly, coronary bypass

surgeries that we have performed by using multiple arterial grafts were reviewed in our study. Material and Method: Between January 2017 and December

2017, 10 patients (8 males average age: 52.75 2 females average age: 61) had undergone CABG surgery by using multiple arterial grafts. We used the left

internal mammary artery (LIMA) and radial artery (RA) in 2 patients, LIMA and right internal mammary artery (RIMA) in 6 patients and LIMA-RIMA and radial

artery in 2 patients. In 2 of these patients, a T-graft was constructed by anastomosing the proximal end of the free RIMA to the side of the attached LIMA. In all

cases, the radial artery was proximally anastomosed to the aorta. All patients were followed up in the intensive care unit for 2 days. Patients were discharged

from the hospital in 5-6 days on average. Results: Patients were evaluated in terms of operative mortality, cross clamp time, intensive care and hospitalization

period, pain in the incision area, management of post-extubation saturation levels, postoperative complications, recurrent angina, myocardial infarction

(MI) and reoperation. No complications were reported during the early period of our evaluations. Although low levels of saturation were detected during this

time in patients for whom bilateral IMA was used, saturation increased in the following days with no complications. No sternal dehiscence or infections were

observed in patients. Non-steroidal anti-inflammatory (NSAI) and paracetamol anti-analgesics were given to all patients. For measurement of incision area

pain, a pain index test was implemented. Discussion: In patients, whose venous grafts are used following CABG, early period graft thromboses lead to repetitive

interventional operations and increase in re-operations. Although the superiority of CABG operation versus stent operation is accepted for multiple vein

patients, many cardiologists and patients carry objections against the repetitive interventional operations that may arise due to early graft failure and the

consequent increase in early period mortality and morbidity risk. We believe that we can overcome these risks by use of multiple artery grafts which allow for

a higher patency rate over the long term.

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