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The prevalence of Burnout Syndrome among Turkish Urologists: Results of a Nationwide Survey
No full textMustafa Suat Bolat, FEBU and Assoc Prof in Urology/0000-0002-4650-2271; cinar, onder/0000-0002-0107-5843WOS: 000489555600008PubMed: 30475702Objective: To investigate the prevalence of Burnout syndrome (BS) with its emotional exhausting (EE), depersonalization (DP), and personal accomplishment (PA) dimensions among Turkish urologists. Material and methods: A total of 2,259 certified Turkish urologists were invited by e-mail to participate in this cross-sectional survey-based study. An online survey was conducted to evaluate three dimensions of BS ie: -EE, DP and PA-and their association with socio-demographic variables of Turkish urologists using the Maslach Burnout Inventory (MBI). Results: of the 2259 urologists contacted, 362 (with a mean age of 44 +/- 9.9 years) completed the survey. the mean EE, DP and PA scores were 16.8 +/- 8.7, 6.6 +/- 4.6 and 8.2 +/- 5.6, respectively. Cronbach's a reliability co-efficiencies were 0.920 for EE, 0.819 for DP and 0.803 for PA. Antidepressant drug usage was quite prevalent among participants (21.9%), and the most common comorbidity was hypertension (13%). the academic title, age, smoking status, monthly income and relationships between colleagues and employers were associated with BS (p<0.05). Conclusion: the prevalence of BS among Turkish urologists is quite prevalent in terms of EE and DP subscales and may negatively affect the psychosocial status and well-being of the urologists. in this study, a high prevalence of BS has been reported among Turkish urologists. in conclusion the BS could become an important occupational and health problem, if it is not properly managed
Comparison of long-term follow-up in patients with single or dual chamber pacemakers: is downtrodden or take its rightful place?
No full textusalp, songul/0000-0001-9572-5431;WOS: 000517761900004BACKGROUND: in this study, at a median follow-up of 7.9 years (3-22), the patients who had implanted either single chamber (VDD) or dual chamber (DDD) pacemakers were compared according to the changes in left ventricular function, pacemaker-related complications, and mortality. METHODS: in between January 1985 and August 2016, a total of 1238 patients, who presented with a diverse set of clinical situations and had implanted a single or double chamber pacemaker were retrospectively included in the present study. Age, prior history of hypertension, diabetes mellitus, heart failure and coronary artery disease did not differ between the groups (P>0.05). RESULT S: When pre-implantation echocardiographic data was compared to the post-implantation values, in both groups, there were a significant decrease in LVEF (P0.05). the comparison of the two pacemaker groups according to the decline in LVEF (<=% 40) did not show any significant difference (P=0.122). CONCLUSIONS: Patients with VDD or DDD pacemakers have both a decline in LVEF and an increase in LV diameter during the long-term follow-up. Mortality and complication rates were not different between the two groups. When compared to the DDD group, left ventricular dimensions and functions were better preserved in VDD group
The Elephant in the Room: Sudden Unexplained Death in Epilepsy Patients
No full textEpilepsi, tekrarlayan nöbetlerle karakterize bir hastalıktır. Epilepsi hastalarında ani beklenmedik ölüm (sudden unexplained death in epilepsy: SUDEP) nadir olmasına karşın büyük öneme sahip bir komplikasyondur. Bu geri dönüşümsüz ve yıkıcı komplikasyona karşı alınabilecek tüm önlemler oldukça kıymetlidir. Bu derlemede, SUDEP’in ne olduğu, risk faktörleri ve korunmak için alınabilecek önlemler tartışılmıştır. Epilepsi hastalarının tedavisinde yer alan tüm nöroloji uzmanlarının ve aile hekimlerinin bu konuya özellikle eğilmesi gerekmektedir. SUDEP konusunda ve alınabilecek koruyucu önlemlerle ilgili tüm epilepsi hastaları ve yakınları bilgilendirilmelidir. Epilepsinin ölümcül bir komplikasyonu olan SUDEP konusunda daha çok bilgilendirilme ve araştırmaya gereksinim duyulmaktadır.Epilepsy is a disease characterized by recurring seizures. Sudden unexpected death in epilepsy patients (SUDEP), however rare, is very important. Precautions taken against this devastating and irreversible complication have substantial value. This review is a discussion of the definition of SUDEP, possible risk factors, and preventative measures. All neurologists and family medicine practitioners participating in the care of epilepsy patients should be well informed and very aware of this risk and preventative measures, as well as epilepsy patients and their caregivers. More research and programs to raise awareness of SUDEP, a deadly complication of epilepsy, are urgently needed
Comparison of the Effect of Phytohemagglutinin and Interleukin-2 on Human-T-Cells
No full textAmaç: Bu çalışmada, CD3+T-hücrelerini fitohemaglutinin (phytohemagglutinin,PHA), İnterlökin-2(interleukin-2,IL-2) ve PHA+IL-2 ile birlikte uyararak, farklı uyarıcılarla uyarılmanın CD3+T-hücre çoğalım ve aktivasyon molekülleri ekspresyonuna etkisinin belirlenmesi amaçlandı. Gereç ve Yöntem: Sağlıklı 15 kadının herbirinden 6 mL periferik kan örneği alınarak RosetteSep yöntemiyle 3x106 adet CD3+T-hücre izole edildi. CD3+T-hücreleri faz-kontrast mikroskopta sayıldı ve izolasyon saflıkları immunfloresan ve akım sitometrik yöntemlerle belirlendi. 12 kuyucuklu kültür kabının 3’er kuyucuğuna 2x105 adet paylaştırılan hücrelere 10 ?g/mL PHA, 13?L/mL IL-2 ve 10 ?g/mL PHA+13?L/mL IL-2 uygulanarak 24 saat inkübatörde inkübe edildi. Uyarıcıyla uyarılmamış CD3+T-hücreleriyle (kontrol grubu) karşılaştırılan uyarılmış CD3+T–hücre gruplarının; çoğalımları spektrofotometrik yöntemle WST-1 testi ve akım sitometride CFSE testi ile aktivasyon moleküllerinin ekspresyonları CD25,CD38,CD69,CD71 ve HLA-DR antikorları ile akım sitometride ölçüldü. Bulgular: WST-1 ve CFSE test değerleri gruplar arasında istatistiksel olarak karşılaştırıldığında; PHA-CD3+T-hücrelerinin (p <0.001) ve PHA+IL- 2-CD3+T-hücrelerinin (p <0.001) IL-2-CD3+T-hücrelerinden anlamlı olarak daha fazla çoğaldıkları yani uyarıldıkları tespit edildi. Akım sitometride ölçülen aktivasyon moleküllerinin düzeyleri gruplar arasında istatistiksel olarak karşılaştırıldığında; IL-2-CD3+T-hücrelerine kıyasla, PHA-CD3+Thücrelerinde ve PHA+IL-2-CD3+T-hücrelerinde CD25 (p <0.001), CD38 (p <0.001), CD71 (p <0.001) ve HLA-DR (p <0.001) % ekspresyon düzeylerinde anlamlı artış tespit edildi. Sonuç: PHA ve PHA+IL-2 ile uyarılan CD3+T-hücrelerinde hücre proliferasyonunun ve aktivasyon molekülleri düzeylerdinin benzer olduğu ve IL-2 ile uyarılan hücrelere kıyasla fazla olduğu tespit edildiğinden, invitro çalışmalarda CD3+T-hücre uyarıcısı olarak PHA kullanılmasının başka bir uyarıcıya gerek duyulmaksızın tek başına etkin olduğu ve CD3+T-hücrelerde IL-2’ye kıyasla daha fazla çoğalımı ve uyarılmayı sağladığı sonucuna varıldı.Objective: In this study, it is aimed to determine the effect of stimulation with different stimuli on CD3+T-cells proliferation and activation molecules by stimulating phytohemagglutinin (PHA), Interleukin-2 (IL-2) and PHA+IL-2 together. Material and Method: Six mL peripheral blood samples were obtained from each 15 healthy women and their 3x106 CD3+T-cells were isolated by the RosetteSep method. CD3+T-cells were counted on a phase-contrast microscope and their isolation purity were determined by immunofluorescence and flow cytometric methods. 2x105 cells were apportioned in a 3-well dish of a 12-well culture dish, applied 10?g/mL PHA, 13?L/mL IL-2 and 10?g/mL PHA+13 ?L/mL IL-2 and incubated in incubator for 24 hours. Cells groups of stimulated CD3+T-cells compared with CD3+T-cells(control group) not stimulated with any stimulants; their proliferations measured by spectrophotometric method using WST-1 test and flow cytometry by CFSE test, their expressions of activation molecules measured by flow cytometry with CD25, CD38, CD69, CD71 and HLA-DR antibodies. Results: When WST-1 and CFSE test values were compared statistically between groups; It was determined that PHA-CD3+T-cells (p <0.001) and PHA + IL-2-CD3+T-cells (p <0.001) were significantly more proliferated, in other words activated than IL-2-CD3+T-cells. When levels of activation molecules evaluated by flow cytometry were compared statistically between groups; in comparison to IL-2-CD3+T-cells, significantly increased % expression values of CD25 (p <0.001), CD38 (p <0.001), CD71 (p <0.001) and HLA-DR (p <0.001) were detected in PHA-CD3+T-cells and PHA+IL-2-CD3+T-cells. Conclusion: Since the proliferation and activation molecule levels in CD3+T-cells stimulated by PHA and PHA + IL-2 were similar and more than than stimulated by IL-2, it was concluded that the use of PHA as a CD3+T-cell stimulant in invitro studies alone was effective with no need for other stimulants and provided more proliferation and stimulation compared to IL-2 in CD3+T-cells
Therapeutic effect of adenosine on experimentally induced acute ulcerative colitis model in rats
No full textWOS: 000516602500001PubMed: 32074166Purpose: To examine the therapeutic effect of external adenosine on an acetic acid-induced acute ulcerative colitis model in rats. Methods: Thirty male mature rats were divided into three groups as control, acute colitis (AC) and AC+adenosine group (AC+AD). AC was induced by rectal administration of 4% acetic acid (AA). 5mg/kg/day adenosine was performed i.p for 4 weeks to AC+AD group. Rectum and colon were excised for microscopic and histopathological histopathologic evaluations, and immunohistochemical analysis of nuclear factor kappa B (NF-kB). Blood samples were collected for biochemical detection of TNF-alpha, Pentraxin-3 and malondialdehyde (MDA) levels. Results: AC group had generalized hyperemia and hemorrhage with increased macroscopic and histopathological scores compared with control (P <0.0001) while adenosine treatment decreased these scores significantly (P <0.001), with reduced distribution of disrupted epithelium, leukocyte infiltrates, and focal hemorrhage. AC group showed significantly increased immunoexpression of NF-kB in rectum, plasma and tissue levels of TNF-alpha, plasma Pentraxin-3 and MDA levels (P <0.0001) while adenosine reduced these levels (P < 0.05). Conclusion: Adenosine appears to promote healing of colon and rectum exposed to AA-induced AC, suggesting a boosting effect of adenosine on the intestinal immune system to cure ulcerative colitis
Allogeneic Hematopoietic Cell Transplantation (AHCT) in Post Infusion Cyclophosphamide (PIC) Era: The Switch from Anti-Thymocyte Globulin (ATG) to PIC for Graft Versus Host Disease (GVHD) Prophylaxis in AHCT from Alternative Donors
No full textWOS:000577164607109[No Abstract Available]5720Amer Soc Hemato
The drug adherence and lifestyle factors that contribute to blood pressure control among hypertensive patients
No full textObjectives: To investigate drug adherence and lifestyle behaviors affecting the blood pressure (BP) control among hypertensive patients that have uncontrolled and controlled BP. Methods: Seventy-eight uncontrolled BP and 98 controlled BP hypertensive patients matched on age, gender, time since hypertension diagnosis and the number of antihypertensive drugs used were investigated using a standardized questionnaire to evaluate lifestyle behaviors, drug adherence, the use of complementary and alternative medicine, and health related quality of life. Drug-drug interactions were evaluated with an electronic drug reference software. Results: Not taking therapy when feeling better was observed significantly more frequently in the uncontrolled hypertensive group (OR: 0.297, %95 CI: 0.115-0.770). Uncontrolled BP hypertensive patients live more frequently in extended family settings (p = 0.043), they sleep less controlled BP hypertensive patients (OR: 0.749, %95 CI: 0.605-0.929). The groups did not differ statistically in terms of Complementary and Alternative Medicine (CAM) use (p = 0.795) and informing doctors about the use of CAMs (p = 0.910). The EuroQol five-dimensional 3 level (EQ5D3L) questionnaire Visual Analogue Scale (VAS) score was significantly higher in the control group (p = 0.011). In both groups over 70% of patients should be monitored for therapy due to drug interactions evaluation. Conclusions: Our study shows that increasing the drug adherence and sleeping hours and living in the nuclear family is associated with improvement in blood pressure control and health related quality of life. A comprehensive approach and good patient-physician communication and trust are essential for well-managed hypertension
The Evaluation of Complementary Health Approaches and Affecting Factors in Breast Cancer Patients with Ongoing Chemotherapy Treatment
No full textAmaç: Bu çalışmada, meme kanserli hastaların tamamlayıcı sağlık yaklaşımları kullanım durumları ve ilişkili faktörlerin araştırılması amaçlanmıştır. Yöntem: Çalışmaya bir eğitim ve araştırma hastanesinin onkoloji klinik/polikliniğinde takip edilen 71 meme kanseri hastası dâhil edildi. Çalışmaya katılmayı kabul eden hastaların sosyo-demografik, klinik özellikleri ve tamamlayıcı sağlık yaklaşımları kullanım durumları kaydedildi. Hastaların ilaç tedavisine inanç durumları “İlaçlar Hakkında İnançlar Anketi” ile değerlendirildi. Bulgular: Hastaların %21.1’i (n=15) bir tamamlayıcı sağlık yaklaşımları yöntemi kullandığını, kullananların tamamı, bu uygulamaların tıbbi tedavisine yararı olabileceğini düşündüğü için kullanmak istediğini, %9.9’u aile ve akrabaların tavsiyesi, %8.5’i medyanın etkisi nedeniyle tamamlayıcı sağlık yaklaşımları uygulamalarını kullandığını belirtti. Uzak organ tutulumu olan ve hastalık süresi daha uzun olan hastaların tamamlayıcı sağlık yaklaşımları uygulamalarını daha çok kullandıkları ve bunun istatistiksel olarak anlamlı olduğu bulundu (sırasıyla p=0.006, p=0.004). Tamamlayıcı sağlık yaklaşımları uygulamalarını kullanmayan hastaların ilaçların genel olarak zararlı olduğuna inandıkları (p=0.004) saptandı. Sonuç: Çalışmamızda hastaların yaklaşık beşte birinin başta doğal ürünler olmak üzere tamamlayıcı sağlık yaklaşımları uygulamalarından en az birini kullandıkları saptandı. Tamamlayıcı sağlık yaklaşımları uygulamalarını; uzak organ tutulumu ve hastalık süresi daha uzun olan hastaların daha çok, ilaçların daha çok zararlı olduğunu düşünen hastaların ise daha az kullandıkları tespit edildi.Aim: The purpose of this study is to evaluate complementary health approaches and related factors in breast cancer patients. Methods: A total of 71 breast cancer patients who were followed-up at an oncology and outpatient clinic of a training and research hospital were included in the study. Sociodemographic characteristics, clinical characteristics, and the use of complementary health approaches were recorded for the patients who agreed to participate in the study. The patients’ beliefs about medicinal treatments were evaluated by the “Beliefs About Medicines Questionnaire.” Results: The patients reported that 21.1% of them (n=15) used a complementary health approaches method; all mentioned that they used it because they believed it may be beneficial for their medical treatment, 9.9% used it by taking into account the recommendation of family and relatives, and 8.5% used it due to the influence of the media. It was found that patients with distant organ metastasis and longer disease duration were more likely to use complementary health approaches, which is statistically significant (p= 0.006, p= 0.004, respectively). Patients who did not use complementary health approaches were found to believe that drugs are generally harmful (p= 0.004). Conclusion: In our study, it was determined that approximately one out of five patients used at least one of the complementary health approaches, particularly natural products. It was found that patient
Results of Prompt Surgical Intervention in Hemodialysis Radiocephalic Fistula Secondary Dysfunction
No full textKosem, Mesut/0000-0002-7913-6730WOS:000610242600005Radiocephalic fistula (RCF) dysfunction is a common problem due to low maturation and patency rates of these fistulas. The most common procedure in such cases is to place a temporary catheter for the dialysis. Temporary catheter placement and undergoing dialysis with this catheter cause complications, reduce the chance for fistula, and deteriorate the quality of life. The aim of this study was to demonstrate that immediate intervention in RCF dysfunctions can increase fistula success for the patient and can reduce the need for a catheter. Furthermore, the hemodialysis treatment can continue without affecting the quality of life. A total of 295 patients who were admitted for RCF dysfunction and who underwent early surgical intervention without any catheter placement were evaluated for postoperative complications, patency rates, and rates and durations of temporary catheter use over a mean time of 47 months of follow-up (range: 4-79 months). Of the patients, 77.2% (n = 228) underwent new proximal anastomosis (NEO; the radial artery and cephalic vein were reached with an incision created proximal to the previous anastomosis), 14.2% (n = 42) underwent brachiocephalic arteriovenous fistula (AVF), 8.4% (n = 25) underwent side-to-side brachiobasilic AVF thorn super-ficialization of the basilic vein. In 88.8% (n = 262) of the patients, successful cannulations were performed within the first 24 to 48 hours without any catheter requirement or complications. Temporary catheter was used for 15.1 6 10.7 days in 11.2% (n = 33) of the patients. In RCF dysfunctions, early surgical interventions performed in the forearm and elbow provide early cannulation and thus decrease the catheter requirement, also prevent the complications of temporary catheters (infection, decreasing the fistula success, vascular injuries, etc.), increase the autogenous fistula success, and allow for the continuation of dialysis without disturbing the quality of life
SPECIAL DESIGNED ROUTING DEVICE TO EASE ENDOSCOPİC TRANSFORAMINAL LUMBAR DISC SURGERY: A CADAVERIC STUDY
No full textBackground Data: Fully endoscopic lumbar disc (FELD) surgery via transforaminal (TF) approach may be more demanding to adopt for surgeons experienced with conventional microdiscectomy, due to the necessity of a new anatomic orientation and understanding. We designed a routing device to facilitate access to safe anatomic triangle defined by Kambin at the level of foramen in cadavers. Purpose: To show that the transforaminal route for endoscopic lumbar disc herniations is safely applicable with the aid of a new routing device. Materials and Methods: Ten cadavers between the ages 18-75, with no history of lumbar spinal surgery or trauma, with previous abdominal computed tomography (CT) scans included in our study. Postmortem abdominal CT scans were performed. Images were examined and transforaminal entrance angles without causing damage to retroperitoneal structures for each lumbar disc space and anatomical differences were recorded. TF approach was performed in cadavers using the angles measured from abdominal CTs and the entry point determined with the help of routing device. Results: L1-L2, L2-L3, L3-L4, L4-L5 disc spaces were operated in ten cadavers. Kambin’s triangle was successfully reached with help of routing device using data obtained from CT (X’, ?) and C-arm fluoroscopy (X, Y, Y’). Y’ marker with protractor on routing device, and the metal rod on this Y’ marker with an opening through which only the punction needle could pass were very important in reaching the target. The metal bar horizontal movement and fixation to this mechanism contributed to operation of device. Entrance points and angles calculated with the help of CT scans were found to be compatible with the images obtained from fluoroscopy and endoscopy during operation. Conclusions: In this study, it has been showed that TF approach can be safely performed with help of the new designed routing device