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Does prior lower abdominal surgery prevent laparoscopic hernia repair (totally extraperitoneal or transabdominal preperitoneal)? a prospective observational study
No full textObjective: Totally extraperitoneal (TEP) surgeries were considered contraindicated in patients who underwent lower abdominal surgery until recently. However, in recent surgeries, it has been reported that they can be performed safely in those cases. Our aim in this study is to investigate the effectiveness of laparoscopic hernia repair methods in patients who have and have not had lower abdominal surgery before. Patients and Method: This study was a prospective observational study between May 2018 and May 2023. Two hundred eighty-eight patients were included in the study. The operation was started with the TEP technique in all patients. Patients, classified in two groups who had not previously undergone abdominal surgery (n = 216) (Group I) and who had surgery (n = 72) (Group II). Demographic characteristics of patients, intraoperative and postoperative complications were determined. In addition to descriptive statistical methods (mean, standard deviation), Shapiro-Wilk normality test, independent t test, and chi-square test were used to evaluate the data. Logistic regression analysis was performed to determine the factors affecting the presence of Previous Surgery and Peritoneal Tear. Results were evaluated at the significance level of P < .05. Results: Two hundred fifty-nine patients were operated with TEP method. TEP method was converted to transabdominal preperitoneal (TAPP) in 9 patients from Group I and 20 patients from Group II. Intraoperative and postoperative complications were recorded. Conclusion: With increasing experience in laparoscopic hernia surgery, it is now possible to perform hernia surgeries with preperitoneal (TEP) and abdominal approaches (TAPP) in patients who have previously undergone lower abdominal surgery
Rolle der oralen eisenbehandlung bei der behandlung schwerer dilatativer kardiomyopathie bei einem 18 monate alten kleinkind: ein fallbericht
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Noninvasive approach to postoperative bleeding in patients undergoing septorhinoplasty surgery
No full textObjectives:In this study, we retrospectively examined the bleeding that occurred in the 5-year patient series.Materials and Methods:One thousand seven hundred seventy-five patients who underwent septorhinoplasty surgery between 2019 and 2023 were included in the study, and 28 of these patients who presented with bleeding complications were examined. All patients underwent open-technique septorhinoplasty surgery with or without concha intervention and were discharged the next day after overnight hospitalization.Results:Of the 1775 patients included in the study, 1415 (79.7%) were female and 360 (20.3%) were male. Bleeding was observed in a total of 28 cases (1.6%). There was no difference regarding age or sex in patients with bleeding. It was also observed that concha intervention did not make a difference in terms of bleeding. The bleeding period ranged from 1 to 9 days, with an average period of 5.53 +/- 2.36 days and a median bleeding period of 6 days. All bleeding patients were followed up with supportive treatment and were discharged after a 24-hour bleeding-free period. There was no need for interventions in the operating room or blood transfusions in for any patient.Conclusion:Patients who present with bleeding after rhinoplasty can be observed, and their bleeding can be controlled without further intervention with supportive treatment and sufficient time
Postoperative corneal remodeling after corneal allograft intrastromal ring segment (cairs) implantation for keratoconus: an oct study
No full textObjectives: To demonstrate corneal remodeling after corneal allograft intrastromal ring segment (CAIRS) with an anterior-segment optical coherence tomography (AS-OCT). Design: A prospective observational single-center study. Methods: This observational study included keratoconus patients who underwent CAIRS implantation into a stromal tunnel. Topographical, refractive, and visual changes were obtained from the patient records. Epithelial thickness (ET), anterior stromal thickness (AST), allograft corneal ring thickness (ACRT), and posterior stromal thickness (PST) were measured on the first day and 1, 3, 6, and 12 months postoperatively using AS-OCT. Results: The study included 35 eyes of 27 patients with advanced keratoconus. The mean keratometry decreased from 48.26 ± 4.78 D to 44.50 ± 4.42 D at 1-year postoperatively (P = 0.004), mean corrected distance visual acuity increased from 0.29 ± 0.18 to 0.70 ± 0.24 (P < 0.001), and spherical equivalent (SE) decreased from -6.94 ± 4.32 D to -1.44 ± 4.44 D (P < 0.001). The mean AST decreased by 17.39 ± 5.78 μm in the postoperative 1 st month compared to 1 st day after surgery (P = 0.040). No statistically significant variations were observed in AST after the first month. There was no statistically significant difference in the mean ET, ACRT, and PST measurements between follow-up times. Significant negative correlations were found between SE change and ET (r = -0.543, P = 0.023) and between K1 change and ACRT (r = -0.548, P = 0.008). Conclusion: CAIRS is an effective treatment method to improve visual acuity and keratometry measurements and does not cause significant changes in graft thickness or recipient corneal epithelial and stromal thicknesses during the 1-year follow-up period. The observed correlations between SE, keratometry, and corneal thickness suggest that epithelial and stromal remodeling play crucial roles in postoperative outcomes of CAIRS
Analysing the financial innovation-based characteristics of stock market efficiency using fuzzy decision-making technique
No full textNecessary actions should be taken to ensure stock market efficiency; thus, financial innovation-based criteria that affect stock market efficiency should be improved. However, simultaneously improving all criteria is difficult; therefore, performing priority analysis is important for carrying out this process effectively and efficiently. Accordingly, this study aims to evaluate the financial innovation-based characteristics of stock market efficiency. This study’s main research question within this framework is identifying which factors should be prioritized to improve the stock market. In this scope, we created a novel fuzzy decision-making model consisting of two stages. First, selected criteria for the financial innovation-based characteristics of stock market efficiency are weighted. In this process, quantum spherical fuzzy sets based on DEMATEL are considered. In the second stage, selected economies are ranked using the technique for order of preference by similarity to ideal solution (TOPSIS) approach. This study’s main contribution is that the DEMATEL technique in calculating criterion weights in the decision-making analysis process provides some advantages. With the help of this situation, the causal directions between these items can be considered; thus, it is possible to determine the most accurate strategies. The findings demonstrate that providing tax advantages is the most important factor in ensuring stock market efficiency. Moreover, the excellence of the financial system is critical in ensuring stock market efficiency. In this context, it is possible to provide tax advantages, especially for long-term investments. Thus, long-term investments can be increased, significantly increasing the market’s stability
Determinants of brain drain among physicians in Turkey: Findings from a national exploratory study
No full textBackground: The shortage of physicians in Turkey is a highly critical emergency. In fact, physicians’ migration to developing or high-income countries, defined as brain drain, threatens the sustainability of the national healthcare system. Aims: This study explored the driving factors associated with Turkish Physicians’ brain drain, including high-economic inflation, social-politics, poor-living, equity, violence, and the desire to practice medical activity abroad. Methods: A cross-sectional survey of 1,861 Turkish physicians aged 25 to 65 years old was conducted employing the Brain Drain questionnaire, the Depression Anxiety Stress Scale (DASS-21), the Patient Health Questionnaire 9 (PHQ-9), and the Fatigue Assessment Scale (FAS). Results: Significant differences were observed among physicians staying in Turkey versus considering migration to Western countries, regarding their age, gender, marital status, educational level, occupational status, work years, hospital night shifts, income, and cigarette/nargileh smoking habits (all p ⩽.018). The main reasons for brain drain included transport problems, harassment, low salary, malpractice, bad environment, job insecurity, workload, burnout, treating difficult patients, inadequate postgraduate systems, peer-pressure, health safety concerns, and favoritism in the workplace, as well as stress and depression caused by work overload. In fact, depression, anxiety, stress, fatigue, and burnout varied significantly among the different groups of physicians (all p ⩽.013). Additionally, key predictors of brain drain were better job opportunities, poor hospital management (in Turkey), job-related stress, dealing with difficult patients, research deficiencies, workload, burnout, transportation issues, short consultation time, low salary, and fatigue. Among the general factors contributing to the brain drain in the Turkish Health System, we identified significant issues related to research deficiencies, compulsory working duties, poor quality of postgraduate, inadequate medical-schools, poor hospital management, and shortage of consultants. Conclusion: Physicians’ migration is a major global public health concern, leading to substantial risks for healthcare services, especially in Turkey. Many physicians decide to migrate to work in Western countries
Patients' attitudes toward artificial intelligence in dentistry and their trust in dentists
No full textObjectives: This study intended to evaluate patients’ attitudes toward the use of AI in dental radiographic detection of occlusal caries and the impact of AI-based diagnosis on their trust in dentists. Methods: A total of 272 completed questionnaires were included in this study. In the first part of the study, approval was obtained from the patients, and data were collected about their socio-demographic characteristics. In the second part the 11-item Dentist Trust Scale was applied. In the third and fourth parts, there were questions about two clinical scenarios, the patients’ knowledge of attitudes toward AI, and how the AI-based diagnosis had affected their trust. Evaluation was performed using a Likert-type scale. Data were analyzed with the Chi-square, one-way ANOVA, and ordinal logistic regression tests (p < 0.05). Results: The patients believed that “AI is useful” (3.86 ± 1.03) and were not afraid of the use of AI in dentistry (2.40 ± 1.05). Educational level was considerably related to the patients’ attitudes to the use of AI for dental diagnostics (p < 0.05). The patients stated that “dentists are extremely thorough and careful” (4.39 ± 0.77). Conclusions: The patients displayed a positive attitude to AI-based diagnosis in the dental field and appear to exhibit trust in dentists. The use of Al in routine clinical practice can provide important benefit to physicians as a clinical decision support system in dentistry and understanding patients’ attitudes may allow dentists to shape AI-supported dentistry in the future
Universal depressive symptom screening in middle schools in Istanbul: an epidemiologic study
No full textIstanbul Medipol University Scientific Research CommissionIntroduction: Depression is a significant public health concern, with severe adolescent morbidity and mortality. Promoting adolescents' mental health is increasingly recognized, and schools are proposed as screening and preventive intervention sites. This cross-sectional study aimed to screen self-reported elevated depressive symptom prevalence among secondary school students in Istanbul, Turkey. The secondary objectives were determining behavioral problems, resilience, positive attitudes, and risk factors associated with depressive symptoms. Methods: Data collection was conducted between April–June 2022. Six thousand one hundred ten students from nine randomly selected schools from different city districts were approached. Depression was screened by the Centre for Epidemiological Studies Depression Scale for Children (CES-DC). The Strengths and Difficulties Questionnaire (SDQ) was used for screening behavioral problems and positive attitudes. Resilience was evaluated by the Child and Youth Resilience Measure (CYRM). Results: The final study sample comprised 2780 participants (response rate 47.7 %) with a mean age of 12.4 ± 1.1 years (females:52.7 %). Elevated depressive symptoms were detected in 31.2 % of the students. Female students exhibited higher scores in CES-DC and total difficulties but lower resilience scores in CYRM than male students. In a multiple regression analysis, female gender, higher total difficulties score, lower resilience score, and lower perceived academic performance significantly predicted CES-DC [F(6,2279) = 421, p < 0.01]. Discussion: Our findings showed high rates of elevated self-reported depressive symptoms in a city sample among Turkish adolescents at middle schools, in addition to coexisting behavioral difficulties and decreased resilience indicating poor psychosocial functioning. Given the prevalent depressive symptoms, screening and intervention programs involving resilience promotion may involve school systems to prevent adolescent depression
Risk factors for noninvasive ventilation failure in preterm infants at less than 30 weeks of gestation with respiratory distress syndrome
No full textThis study aimed to identify risk factors for noninvasive ventilation (NIV) failure in <30 weeks’ gestation preterm neonates and compare morbidity in patients with and without NIV failure. This study included preterm neonates <30 weeks’ gestation who received NIV support for respiratory distress syndrome (RDS). Demographic and clinical characteristics were compared between infants with and without NIV failure within the first 72 hours after birth. Of 443 preterm neonates, NIV failure occurred in 101 (22.8%). Of these, initial respiratory support was nasal continuous positive airway pressure (nCPAP) in 76 infants (75.2%) and nasal intermittent positive pressure ventilation (NIPPV) or bilevel positive airway pressure (BiPAP) in 25 infants (24.8%). Gestational age, birth weight, and antenatal steroid exposure were significantly lower in patients with NIV failure. Grade III-IV intraventricular hemorrhage, moderate/severe bronchopulmonary dysplasia, and retinopathy of prematurity requiring laser photocoagulation were significantly more common in the NIV failure group. Multivariate logistic regression analysis showed that antenatal steroid therapy reduced NIV failure [odds ratio (OR): 0.53, 95% confidence interval (CI): 0.29–0.94; P = .03], while nCPAP (OR: 2.61, 95% CI: 1.53–4.48; P < .001), surfactant requirement (OR: 2.40, 95% CI: 1.36–4.25; P = .003), and ≥2 doses of surfactant need (OR: 3.57, 95% CI: 1.89–6.74; P < .001) were associated with greater NIV failure. The results of this study indicated that administering antenatal steroids and using NIPPV or BiPAP instead of nCPAP as initial respiratory support reduced the likelihood of NIV failure in preterm infants with RDS
Using an algorithm for reconstruction of low-energy blast injuries of the hand
No full textBackground: Low-energy blast injuries caused by fireworks and other small explosives are a significant source of hand trauma resulting in fractures, amputations, and soft-tissue defects. In this study, we aimed to present a comprehensive clinical algorithm for managing these injuries and to share our experience in treating hand trauma resulting from low-energy blasts. Materials and Methods: A retrospective study was conducted on 37 patients who presented to the emergency services at two university hospitals between 2015 and 2018 with isolated hand trauma due to low-energy blasts. Upon arrival, the patients underwent tetanus prophylaxis and were stabilized before evaluation. All patients underwent surgery on the same day as the injury. Demographics, type of explosives, and reason for the explosion were noted, and treatment modalities were meticulously documented. Results: Of the 37 patients, 29 were injured by firecrackers and 8 by fireworks. Among the patients, 7 presented with total amputations, 3 had circulation problems before the operation, and 24 required bone fixation. Soft-tissue reconstruction was necessary in 30 patients, and vacuum-assisted closure therapy, skin grafting, or flap reconstruction was performed in seven patients. Delayed complications were observed in 12 patients during the postoperative period. Conclusion: Low-energy blast injuries of the hand require a multidisciplinary treatment approach. Our clinical algorithm provides an efficient treatment modality that emphasizes early exploration and aggressive debridement. We recommend managing soft-tissue defects by approximating existing tissues without tension. Furthermore, our findings suggest that legal and sales regulations are effective in reducing firework-related hand injuries, highlighting the importance of their consideration