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Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study
No full textWOS: 000561377700019PubMed: 32904611Introduction: Interventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. the most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential. Aim: To compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP. Material and methods: Forty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 mu g/kg for 10 min) in group D. Propofol was used for maintenance. the sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded. Results: the hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 +/- 80.0 vs. 154.5 +/- 66.7 mg; p = 0.011). the recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 +/- 2.1 vs. 6.6 +/- 1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups. Conclusions: We found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients
Evaluation of the eating habits of breast cancer patients
No full textWOS: 000580048400023PubMed: 33235575Objective: To determine the relationship between the dietary characteristics of breast cancer patients. Methods: Patients with breast cancer whose treatments have finished and are in remission formed the study group and healthy people formed the control group. Demographic, anthropometric characteristics, food consumption frequency form and exercise status were recorded with all groups. Data analysis was done by SPSS 22. Results: in the study group, mean carbohydrate percentage was lower, while fat, fat percentage, monosaccharide, glucose, fructose, omega3( n3), saturated fatty acids(SFA), monounsaturated fatty acids (MUFA), vitamin A, C, E, B6, biotin and copper values were significantly higher (p<0.05). Recurrence was observed in seven patients (7.1%) during the follow-up period, hormone receptor levels (ER) and vitamin B2 intake (accuracy 93.9%) were inversely related to the recurrence of the disease (p=0.02). Conclusions: While the percentage of carbohydrate taken was lower in study group; total fat, n3, SFA, MUFA, monosaccharide, glucose, fructose, water-soluble fiber, B6, biotin and copper values were higher. Further studies are needed for vitamin B2 deficiency in patients with recurrence
Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes
No full textWOS: 000586632300001Study Design: Retrospective study. Objective: the aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: the mean age was 49 years (range 22-83 years). the mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. the mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). the mean LKA improved from 34.7 degrees to 4.9 degrees (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures
A MULTICENTER STUDY OF THE CLINICAL, LABORATORY CHARACTERISTICS AND POTENTIAL PROGNOSTIC FACTORS IN PATIENTS WITH AA AMYLOIDOSIS ON HEMODIALYSIS
No full text57th ERA-EDTA Congress -- JUN 06-09, 2020 -- ELECTR NETWORKWOS: 000562392100332[No abstract available]ERA, EDT
Tacrolimus-induced gingival hyperplasia and recovery from tacrolimus to everolimus switching
No full text[Özet Yok
Comparison between Chest CT and X-ray Under 15 Years Old: Has Technological Progress Lead to Higher Radiation Exposure?
No full textObjectives: PA chest X-ray is the first choice for evaluation of the lung pathologies in children. The use of computedtomography (CT) has been increasing due to defensive medicine approaches and diagnostic advantages such as multiplanar imaging. The most important situation in childhood imaging is avoiding high radiation exposure, which is thedisadvantage of CT. In this study, diagnostic coherence between chest X-ray and CT and the necessity of chest CT wereevaluated.Methods: 644 patients under 15 years old who had admitted to emergency room and underwent chest CT betweenJanuary 2017 and January 2019 were enrolled in this retrospective study. 348 of 644 patients had just chest CT withoutchest X-ray. All pathologies in chest CT and chest X-ray were examined by two radiologist (F.E.U, B.O). Lung pathologieswere classified as radiologically. Statistical Package for the Social Sciences (SPSS, version 21 for windows) was used forthe statistical analysis. The coherence between chest X-ray and CT was evaluated with Cohen’s kappa test. P<0.05 wasconsidered.Results: Chest CT was performed only in 0.9% of under 15 years old patients who had chest X-ray between January 2017 and January 2019. Normal radiological findings were found in 288 of 348 patients (83%) who had only CTscanning. There were coherence for all radiological findings (atelectasis, consolidation, ground glass opacity, nodularinfiltration, pneumothorax, pleural effusion, bone fracture, mass and cavitary lesions) in between two methods. In 8patients who had both chest CT and X-ray, cavitary lesion was not detected in chest X-ray (Kappa: 0.490, p=0.002).Conclusion: Patients had mostly normal findings when they were examined by just CT before not underwent chest X-ray.There was a coherence between two examinations in all lung pathologies. Radiation exposure significantly decreaseswhen the patients examined firstly with PA chest X-ray. There are problems such as positioning and inspirium sufficiencyin chest X-ray in children, but it is usually enough for evaluating lung pathologies, as seen in our study. We think that it isappropriate to perform chest X-ray firstly in stable patients. Further, we think that it is also appropriate to perform chest Ctwhen clinical findings was not regress or for excluding additional pathologies
How Did Influence Establishment of the National Donor Registry (TURKOK) Our Unrelated Donor Hematopoietic Stem Cell Transplantation Activity? A Retrospective Single Center Analysis
No full textAmaç: Allojeneik hematopoietik kök hücre nakli (AHKHN) erişkin hematolojik malignitelerde tedavi edici bir hücresel yöntemdir. Türkiye Kök Hücre Koordinasyon Merkezi (TÜRKÖK), 2015 yılında T.C. Sağlık Bakanlığı tarafından kurulan yeni bir donör kayıt sistemidir. Aktif ve 600’den fazla AHKHN deneyimi olan bir transplant merkezi olarak hipotezimiz, lojistik açıdan daha hızlı erişim ve HLA uyumsuzluğunda kendi vatandaşlarımızın donör olabilmesi dolayısıyla TÜRKÖK’ün nakil kinetiği ve kayıt sistemi temelli sonuçlar üzerinde olumlu etkileri olduğu yönündedir.Hastalar ve Yöntem: Çalışmaya 2015-2019 yılları arasında HLA-uyumlu akraba dışı donör (MUD) kullanarak AHKHN uygulanan 127 yetişkin (18-65 yaş) hasta dahil edildi. Hastaların tıbbi kayıtları retrospektif olarak incelendi. MUD kullanılan AHKHN faaliyetimiz 2012 yılında başlamıştır. MUD nakil gerçekleştirilen 127 AHKHN sırasıyla, Alman Kemik İliği Kayıt Sistem (DKMS) (n= 80), TÜRKÖK (n= 38) ve diğer ulusal kayıtlardan (DKMS olmayan) (n= 9) sağlandı.Bulgular: Donörler sadece sitomegalovirüs (CMV) seropozitifliği üzerinde önemli farklılıklar gösterirken, TÜRKÖK’te pozitiflik %90’dan fazla, diğer sistemlerde ise %55’ten az bulunmuştur. Eşleşme oranı, 9/10 ve 10/10 için DKMS, TÜRKÖK ve DKMS dışı gruplarında sırasıyla %60-40, %66.7-33.3 ve %55.3-44.7 idi ve neredeyse aynıydı. Merkezimizde 2015 yılında MUD AHKHN’nin sadece %20’si TÜRKÖK tarafından sağlanmış, 2018’de bu oranın %55’ten fazla olduğu görülmüştür. DKMS, TÜRKÖK ve DKMS dışı için donör araştırmasının başlamasından kök hücre infüzyonuna kadar geçen ortalama süre (SD1) sırasıyla 176, 92 ve 123 gün olarak hesaplanmıştır. İki yıllık genel sağkalım oranları istatistiksel olarak anlamlı bir farklılık göstermemiştir (p= 0.24).Sonuç: TÜRKÖK, yerel bağışçı adayları ve kolaylaştırılmış lojistik sayesinde beklendiği gibi daha hızlı hizmet vermektedir. HLA uyumsuzluğu üç grupta da hemen hemen aynı idi ve sağkalım analizlerine yansıyan bir farklılık yoktu. Sonuç olarak, TÜRKÖK’ün uluslararası kayıtlara kıyasla alternatif donör AHKHN faaliyetimiz üzerinde daha hızlı ve benzer bir etkiye sahip olduğu sonucuna varılmıştır.Objective: Allogeneic hematopoietic stem cell transplantation (AHSCT) is currently a curative cellular therapy approach in hematological malignancies of adults. TURKOK is a new donor registry, established by Turkish Ministry of Health in 2015. As a single active center, having performed more than 600 AHSCT, we analyzed the impact of TURKOK on our transplant kinetics and registry based outcome, hypothesiz?ing faster kinetics for logistics and better survival using own citizens, who may have less disparity on HLA immunogenetics basis. Patients and Methods: One hundred and twenty seven adult (18-65 years) patients who underwent AHSCT using matched unrelated donors (MUD) between 2015 and 2019 were included in this study. Our AHSCT activity using MUD started in 2012, among 127 AHSCT performed MUD were provided from German Bone Marrow Registry (DKMS) (n= 80), TURKOK (n= 38), from other national registries (non?DKMS) (n= 9). Results: The donors differ significantly only on cytomegalovirus (CMV) seropositivity, in TURKOK more than 90%, whereas in others less than 55%. Matching rate (%) 9/10-10/10 was nearly the same for DKMS, TURKOK and non-DKMS, 60-40%, 66.7-33.3% and 55.3-44.7%, respectively. In 2015 only 20% of the MUD AHSCT were facilitated by TURKOK in our center whereas in 2018 more than 55%. Mean dura?tion from start of the donor search to infusion of HSC for DKMS, TURKOK and non-DKMS was 176, 92 and 123 days, respectively. The overall survival analysis at two years showed no statistical difference (p= 0.24). Conclusion: Turkish national donor registry, TURKOK is serving faster as expected due to native donor candidates and facilitated logistics. The CMV donor positivity is clearly different in TURKOK. The HLA disparity is nearly the same on all three groups and survival analysis did not any significance. We concluded that TURKOK is serving faster and with similar impact on our alternative donor AHSCT activity in comparison with international registries
Relationship between Gambling Motivation and InternalExternal Locus of Control
No full textAmaç: Bu çalışmada iç-dış kontrol odağı ile kumar oynama motivasyonları arasındaki ilişkinin incelenmesihedeflenmiştir.Yöntem: Çalışmanın evrenini, İstanbul’da ikamet eden ve kumar oynayan 18 ile 55 yaş arasındaki bireyleroluşturmaktadır. Çalışmanın katılımcıları ise İstanbul’da ikamet eden ve kumar oynayan 121 bireydenmeydana gelmiştir. Çalışmada demografik bilgi formu, kumar oynama nedenleri ölçeği ve iç-dış kontrolodağı ölçeği kullanılmıştır.Bulgular: Analizler sonucu elde edilen bulgulara göre kumar oynama motivasyonun ve alt boyutları olaneğlenme/heyecanlanma, kazanma, sosyalleşme ve kaçınma) motivasyonlarının kontrol odağına göreistatiksel olarak anlamlı şekilde farklılaştığı görülmüştür. Ayrıca regresyon analizi sonucuna göre kontrolodağı, kumar oynama motivasyonunu (R²=0,327), eğlenme/heyecanlanma (R²=0,305), para kazanma(R²=0,205), sosyalleşme (R²=0,090) ve kaçınma (R²=0,154) motivasyonlarını anlamlı olarakyordamaktadır.Sonuç: Kontrol odağı ile kumar oynama motivasyonu arasında saptanan ilişki, kontrol odağının önemli birfaktör olduğunu göstermiştir. Ayrıca kumara başlama davranışının motivasyonu ile devam etmedavranışının altında daha farklı motivasyonlar olduğu anlaşılmıştır.Objective: The aim of this study is to examine the relationship between the focus of internal and external control and gambling motivations. Method: The universe of the study consists of individuals between the ages of 18 and 55 who live and gamble in Istanbul. The participants of the study consisted of 121 individuals residing and gambling in Istanbul. In the study, demographic information form, gambling causes scale and internal-external control focus scale were used. Results: The gambling motivation and its sub-dimensions fun / excitement, monetary, socialization and avoidance motivations were statistically significantly different based on the locus of control. In addition, according to the results of the regression analysis, the control focus significantly predicted gamble motivation (R² = 0.327) and sub-dimensions which are fun / excitement (R² = 0.305), monetary (R² = 0.205), socialization (R² = 0.090) and avoidance (R² = 0.154) motivations. Conclusion: The relationship between locus of control and gambling motivation showed that the locus of control is an important factor. In addition, it was understood that the start of gambling behavior and continuation gambling behavior affected from different motivations than each other
ICD detected patient activity is associated with arrhythmic events in heart failure patients
No full textPubMed: 332217902-s2.0-85096631730Background: Although implantable cardioverter-defibrillator (ICD) reduces mortality in heart failure patients with reduced left ventricle function, arrhythmic episodes are related with increased mortality. Aim: The aim of this study was to investigate whether low patient activity predicts arrhythmic events in the heart failure patients with primary prevention ICD. Methods: We examined 206 heart Failure (HF) patients (mean age: 61.3 ± 10.9 years, 77.7% male) with primary prevention implanted ICD who referred to our outpatient clinic for pacemaker control. After pacemaker (PM) controls, the overall study group was categorized into three distinct subgroups: Activity less than 2 h, activity 2-4 h, and activity 4-8 h in a day. Results: Activity less than 2 h had a substantially higher level of arrhythmic episodes in comparison to other groups (P < 0.05). In addition, appropriate shock or ATP (antitachycardia pacing) was detected higher in patients whose activity was less than 2 h in a day than other groups (P < 0.001). Conclusions: Detected low patient activity in ICD control may be a predictor of arrhythmic episodes and appropriate therapies. Increasing physical activity may potentially protect these patients from unwanted events
Akne Klinik
No full textWOS:000614646600002The clinical symptoms of acne are of polymorphic nature and its lesions can be investigated in two groups, primary and secondary. The primary acne lesions include open and closed plugged pores, papules, pustules, and nodules. Developing mostly from primary lesions, the secondary lesions include abscesses, cysts, post-inflammatory hyperpigmentation, signs of excoriation, and scars. The severity of primary lesions determines the disease activity