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Effect of malpractice claims on orthopedic and traumatology physicians in Turkey: A survey study
No full textObjective: This study aimed to investigate the malpractice claims experienced by orthopedic and traumatology physicians andto determine their effects on burnout, job satisfaction, and clinical practice.Methods: A questionnaire survey was conducted on orthopedic and traumatology specialists between May 2019 and February2020. Data collection was carried out via e-survey at “turk-ortopedi” mail group, which is an electronic communication networkof orthopedic and traumatology physicians. For data collection, sociodemographic data forms were used including the generalcharacteristics, working conditions, and the malpractice claim events along with the Maslach Burnout Inventory scale to evaluate burnout and the Minnesota Satisfaction Questionnaire to investigate job satisfaction.Results: In total, 353 orthopedic and traumatology physicians (348 men, 5 women), including 37 professors, 41 associate professors,and 275 surgeons, completed the questionnaire. In total, 65.4% of the participants (231 physicians and 471 relevant dossiers) statedthat they were currently facing a malpractice claim. Emotional burnout and hesitant behavior in medical practices were significantlyhigher among the physicians who had undergone an investigation/trial with the claim of malpractice (p<0.05), whereas intrinsic jobsatisfaction was significantly lower (p<0.05). It was determined that orthopedic and traumatology physicians dealing with arthroplasty, vertebral surgery, hand surgery, and foot/ankle surgeries had undergone significantly more trials (p<0.05). In the evaluationof the burnout levels and job satisfaction scores of the physicians according to the age, academic title, seniority, and institution, itwas determined that burnout level decreased with age, those between the ages of 25 and 34 years were exhausted the most, and jobsatisfaction increased with age. It was also found that burnout level decreased and job satisfaction increased as the academic titlebecame higher, and attending physicians were the most exhausted. Moreover, burnout level decreased as seniority increased, themost senior ones were the ones most exhausted, and job satisfaction increased with seniority.Conclusion: Evidence from this study has revealed that malpractice claims cause emotional burnout, low intrinsic job satisfaction, and a hesitant behavior in medical practice for the orthopedic and traumatology physicians. The concept of malpracticealone may result in unnecessary analyses/examinations for patients.Level of Evidence: Level IV, Diagnostic Stud
MIDTERM OUTCOMES OF LIVE KIDNEY TRANSPLANTATION FROM ELDERLY DONORS
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A new approach for leptomeningeal metastases: chemotherapy administered through lumbar intrathecal port
No full textBackground: Intrathecal chemotherapy is a local therapeutic modality used for treatment of leptomeningeal metastases. However, the techniques currently used, i.e. repeated lumbar puncture and Ommaya reservoir, have certain disadvantages. Lumbar intrathecal port (LIP) placement is a relatively novel technique, which has been used for pain management in cancer patients. Objective: To investigate the use of LIP for intrathecal administration of chemotherapeutic agents in patients with leptomeningeal metastases. Methods: Retrospective study of 13 patients treated with intrathecal chemotherapy for secondary leptomeningeal involvement of a primary solid tumor were included in this retrospective study. The patients received intrathecal chemotherapy through a LIP. Results: The patients received a total of 123 intrathecal chemotherapy doses. No grade 3-4 toxicity, technical problem or severe complication developed. During a median of 136 days of follow-up (range, 67-376 days), 12 patients died (92.3%). The treatment resulted in symptom improvement in all patients and self-rated overall health and quality of life improved, compared with baseline. Conclusions: The LIP system, which has been used for intrathecal pain management for decades, appears to offer a safe alternative for intrathecal chemotherapy in patients with leptomeningeal metastases. Further studies are warranted to clarify its potential use in this setting
Does the FT3-to-FT4 ratio easily predict the progression of NAFLD and NASH cirrhosis?
No full textBackground Factors causing progression from nonalcoholic fatty liver to nonalcoholic steatohepatitis (NASH) and liver cirrhosis remain relatively unknown. We aimed to evaluate the power and effectiveness of the free triiodothyronine (FT3)-to-free thyroxine (FT4) ratio to predict non-alcoholic fatty liver disease (NAFLD)/liver fibrosis and NASH cirrhosis severity. Methods Patients (n = 436) with NASH-associated liver cirrhosis (n = 68), patients with liver biopsy-proven NAFLD (n = 226), or healthy participants (n = 142) were enrolled between January 2010 and January 2020. The aspartate aminotransferase-to-thrombocyte ratio (APRI), NAFLD fibrosis score, albumin-bilirubin score (ALBI), aspartate aminotransferase (AST)-to-alanine aminotransferase (ALT) ratio, FT3-to-FT4 ratio, and Fibrosis-4 (FIB-4) were calculated and evaluated. Results All parameters were significantly higher in NASH cirrhosis than in the healthy group. Body mass index, ALT, fasting insulin, homeostatic model assessment for insulin resistance, and triglyceride levels were significantly higher in liver biopsy-proven NAFLD than in the healthy group. The APRI, NAFLD fibrosis score, ALBI, AST-to-ALT ratio, FT3-to-FT4 ratio, and FIB-4 were significantly higher in the NASH cirrhosis group than in the healthy group. In patients with biopsy-proven NAFLD, the FT3-to-FT4 ratio was significantly lower than in the healthy group. Conclusion The FT3-to-FT4 ratio is an effective and useful indicator to predict NAFLD/liver fibrosis and NASH cirrhosis severity
Investigation of the effect of chemotherapy on cytomegalovirus reactivity in patients with solid organ tumors
No full textObjectives: Chemotherapy induces an immunosuppressive state in patients with solid organ tumors. Cytomegalovirus (CMV) reactivation as a result of immunosuppression causes a severe clinical manifestation. However, in this group, CMV infections developing due to reactivation were not adequately discussed in the literature. The aims of this study were to determine the incidence of CMV reactivation after chemotherapy, to evaluate the contribution of chemotherapy to reactivation, to determine the incidence of asymptomatic and symptomatic infections and to investigate the results of the treatment.Methods: A total of 93 patients with solid tumors were included in the study. Weekly blood samples were collected from the patients for three weeks before and after chemotherapy. Quantitative analysis of DNA was detected using CMV PCR kit (GeneProof CMV PCR kit, Bruno, Czech Republic). Diagnosis and treatment of patients were retrospectively reviewed.Results: Of the patients, 65.6% were female and 34.4% were male. The mean age was 55 ± 12 years. The most common cancer types among the patients were breast cancer in 45.2%, lung cancer in 15.1%, and colon cancer in 12.9%. The mean leukocyte count of the patients was 7,647/mm3. CMV DNA was not detected in any patient. According to this result, none of the patients had CMV reactivation after chemotherapy. Conclusions: In this study including patients with solid organ tumors with mild to moderate level of immunosuppression CMV DNA was not detected in any patient. Based on this finding no standard prophylaxis was required for CMV in this group of patients
Assessment of subclinical atherosclerosis with ankle-brachial index in psoriatic arthritis: A case-control study
No full textObjectives: This study aims to evaluate subclinical atherosclerosis using the Ankle-Brachial Index (ABI) in patients with psoriatic arthritis (PsA).Patients and methods: This case-control study included 51 PsA patients (24 males, 27 females; median age 47; range, 41 to 52 years) recruitedat our hospital’s outpatient clinics between October 2016 and January 2017 and 50 healthy controls (24 males, 26 females; median age: 48.5;range, 40.7 to 56 years). Anthropomorphic measurements and laboratory results were recorded. In patients, the 66 swollen/68 tender joints count,dactylitis score, Leeds Enthesitis Index, Health-related Quality of Life, the Psoriasis Area and Severity Index, and Dermatology Life Quality Index wereevaluated. Ankylosing Spondylitis Quality of Life and Bath Ankylosing Spondylitis Disease Activity Index were applied to patients with axial disease.Then, Composite Psoriatic Disease Activity Index was determined. A Doppler probe and a standard blood pressure cuff were used to calculate theABI values for each participant.Results: Patients had lower right ABI (median, 1.05 vs. 1.1, p<0.01), lower left ABI (1.04 vs. 1.09, p<0.01) and lower overall ABI (1.03 vs. 1.09, p<0.01)compared with healthy subjects. Twelve (23.5%) patients had borderline ABI, but none of the controls (p<0.01). Patients with borderline ABI had alonger duration of psoriasis (25 vs. 15 years, p=0.03). The distribution of borderline ABI value was statistically significant between patients with axialdisease and peripheral disease only (42.1% vs. 12.5%, p=0.02). Disease activity was found as an independent risk factor for borderline ABI in a binarylogistic regression (odds ratio 6.306, 95% confidence interval 1.185 to 33.561, p=0.031).Conclusion: Lower ABI was found in PsA patients than healthy controls even in those matched with traditional cardiovascular risk factors. Allparticipants with borderline ABI were in the patient group. Borderline ABI was associated with disease activity and disease duration
Motor skills, language development, and visual processing in preterm and full-term infants
No full textLanguage development is intertwined with motor development. This study examined how visual processing might mediate the relation between language development and motor skills in preterm (PT, n = 34, Mean gestational age = 30 weeks) and full-term infants (FT, n = 35, Mean gestational age = 38.9 weeks) at 13 months of age. Infants' visual processing, fine and gross motor skills were tested using the Mullen Scales of Early Learning. Parents reported on infants' language skills (word comprehension and early communicative behavior), using the Turkish version of CDI (TCDI). Results showed that PT infants performed worse than their FT peers on gross motor skills and visual processing, but not on language. When controlling for age and neonatal condition (being preterm or not), visual processing mediated the relation between gross motor skills and word comprehension as well as early communicative behavior. However, for fine motor skills, visual processing mediated the relation between fine motor skills and early communicative behavior but not word comprehension. The relations between motor skills and visual processing were more robust for the PT group than the FT group. Following developmental cascades, these findings suggest that motor skills contribute to language development through visual processing. These relations are prominent for preterm infants who have delays in motor skills. PT children's limited interactions with their environment due to problems in motor skills can be connected to delays in visual processing.James S. McDonnell Foundation Scholar Award [220020510]This work was supported by the James S. McDonnell Foundation Scholar Award (Grant no: 220020510) to Tilbe Goksun. We thank everyone at the Language and Cognition Lab at Koc University for their invaluable contributions to this project. Special thanks to Cerebral Palsy Turkey Metin Sabanc Center for Family Counseling for the institutional support, Dr. Nihan Hande Akcakaya, Banu Bingol, and Rahime Gokboa from Cerebral Palsy Turkey to their support for the project, El Bebek Gul Bebek Foundation for Premature Birth and Gymboree Classes for helping us reach out the families Special thanks to Feyza Nur Dik, pek Bahar Ungan, Merve Duran, ozge Eser, Rengim Lal Klavuz, layda Deringor, and lke Uysal who assisted with data transcription coding, and reliability. We are grateful to the children and parents who participated in the study. The data that support the findings of this study are available from the corresponding author upon reasonable request
The Influence of Human Leukocyte Antigens in Graft Versus Host Disease and Survival After Hematopoiet ic Stem Cell Transplantation in Pediatric Patients with Leukemia
No full textObjective: Hematopoietic stem cell transplantation (HSCT) is an important therapy for hematological diseases. One of the most significant complications of HSCT is graft versus host disease (GVHD), and major histocompatibility complex (MHC) is well known to affect GVHD and graft rejection. This study aimed to examine the effect of human leukocyte antigens (HLA) on the incidence of GVHD development in patients with leukemia. Methods: The association between HLA and GVHD formation was evaluated in 57 patients with HSCT with HLA-identical sibling donors, of whom 37 were boys and 20 were girls with a mean age of 10.11 years. All patients were diagnosed with leukemia; acute myeloid leukemia (n=33), acute lymphoblastic leukemia (n=15), and chronic myeloid leukemia (n=9). Transplantation pairs were worked for HLA-A, -B, -C, and -DRB1 alleles. Class I HLA antigens were investigated using Terasaki microlymphocytotoxicity, whereas class II HLA alleles with polymerase chain reaction - sequence-specific amplification method. Results: The frequency of developing GVHD in patients with HSCT was found to be 17.5% (n=10). HLA-DRB1?04 allelic frequency [p=0.024, odds ratio (OR): 4.87] was found to be higher in patients who developed GVHD. However, the HLA-DRB1?11 allelic frequency (p=0.031, OR: 0.12) was lower in patients who developed GVHD compared to patients who did not develop GVHD. Furthermore, HLA-B38 (p=0.002) and HLA-B41 (p=0.002) antigens were found only in patients who developed GVHD. The frequencies of the HLA-A26 allele (p=0.12) and the HLADRB1?11 allele (p=0.037, OR: 4.0) were higher in patients with relapse after HSCT; however, the frequencies of the HLA-A2 allele (p=0.033, OR: 0.19) was lower in patients who relapsed after HSCT. Conclusion: This study assessed the relationship of HLA class with GVHD, relapse, and survival in children after HSCT in pediatric patients with leukemia. © 2021 Galenos Publishing House. All rights reserved
Relationship of Patellofemoral Angles and Tibiofemoral Rotational Angles With Jumper's Knee in Professional Dancers: An MRI Analysis
No full textPubMed: 33796584WOS:000629761300001Background: Jumper's knee is a type of tendinopathy affecting the distal insertion of the quadriceps tendon (25% of cases) or the patellar tendon. It has been shown that frontal-plane measurements, such as genu valgum, genu varum, an increased quadriceps angle, a protuberant tibial tuberosity, patella alta, and short hamstring muscles, may be related to jumper's knee. Purpose: To investigate the effects of tibiofemoral rotational angles and patellofemoral (PF) angles on the development of jumper's knee in professional folk dancers. Study Design: Case-control study; Level of evidence, 3. Methods: We examined 26 dancers (16 male, 10 female) with knee pain using magnetic resonance imaging (MRI), for a total of 32 knees. Of the knees, 21 with quadriceps tendinopathy (QT) and 7 with patellar tendinopathy (PT) were detected. Using MRI scans, we measured PF angles (PF sulcus angle, lateral PF angle, patellar tilt angle, lateral trochlear inclination angle, lateral patellar tilt angle, and PF congruence angle) and tibiofemoral rotational angles (condylar twist angle, posterior condylar angle, femoral Insall angle, tibial Insall angle, posterior tibiofemoral angle, and angle between the Whiteside line and posterior femoral condylar line) and noted specifics such as patella alta, patella baja, and the Wiberg classification of the patellar shape between the patients with versus without QT and between patients with versus without PT to understand if there was any relationship with tendinopathy. Results: No statistically significant difference was observed in age, sex, patella alta, or the Wiberg classification between the QT groups (with vs without) and between the PT groups (with vs without) (P > .05). Having QT was found to be significantly associated with the PF sulcus angle (P = .009), and having PT was found to be significantly associated with the femoral Insall angle (P = .029). Conclusion: Jumper's knee was found to be associated with anatomic variations of the PF sulcus angle and rotation of the patellar tendon in relation to the femur (femoral Insall angle) on axial MRI scans in professional dancers. Unlike those of other athletes, dancers' knees are exposed more to external rotation forces because of turnout, and this can be the cause of jumper's knee