Acıbadem Üniversitesi Açık Erişim Sistemi
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Comparison of perioperative outcomes among robot-assisted, conventional laparoscopic, and abdominal/open myomectomies
No full textObjective: To compare the perioperative results of myomectomy performed by robotic surgery (RM), laparoscopic surgery (LM), and open/abdominal surgery (OM). Material and Methods: We included 227 patients who underwent either robotic (n=66), laparoscopic (n=88), or abdominal (n=73) myomectomy at our hospital between 2016 and 2020. Retrospective medical records, including fibroid characteristics, demographic findings, and surgical outcomes, were compared. Results: The RM group had a significantly lower body mass index and significantly larger uterine size, myoma diameter, and myoma weight than the other groups. However, the OM group had the highest number of myoma. Moreover, the RM group had higher operative time and blood loss but significantly lower maximum visual analog scale values than the OM and LM groups. Hospitalization duration was significantly different among the groups. The rate of 1-day hospitalization was 56.2\%, 64.8\%, and 37.9\% in the OM, LM, and RM groups, respectively. Furthermore, blood transfusion requirement was significantly higher in the OM group (12.3\%) than in the LM and RM groups (0.0\% and 4.5\%, respectively). Conclusion: Minimally invasive myomectomy may be preferable, particularly for women of reproductive age. In women with large uterine size and myoma, robot-assisted LM is recommended.4DEC312-3182
Integrating patient management, reflective practice, and ethical decision-making in an emergency medicine intern boot camp
No full textBackground Integration of clinical skills, ethical decision-making, and reflection skills have emerged as cornerstones of clinical teaching in medical schools. This study aimed to detect whether a multimodal learning environment approach consisting of lectures, a drill, post-drill video debriefing, and written reflection in an emergency medicine rotation boot camp improves interns' patient management skills, ethical decision-making, and reflection skills. Methods A multimodal learning environment was created by the collaboration of emergency medicine, ethics, and medical education specialists. Multiple educational techniques involving lectures, case discussions, and role-playing a crisis scenario were applied. Pre-test and post-test, debriefing on performances on video records, video-recorded performance assessment, and reflective essays about their own and group's performances were used to assess various aspects of the student performances. Additionally, a meeting was organized with the presence of the authors to create qualitative data obtained through the program evaluation meeting conducted on three themes: influences of teaching methods, students' performances, and common achievements and mistakes of students. Results 133 students participated. Post-test multiple-choice question (MCQ) test scores were slightly higher than pre-test. A low and medium correlation was detected among pre-test and post-test patient management problem (PMP) and reflection scores, which was more prominent for female students. Multiple linear regression showed that pre-test and post-test PMP scores significantly contributed to reflection scores. These results might support that better patient management predicts more robust reflective practice. Teachers observed that students appreciated being inspired by well-performing peers, particularly noting the empathic needs of patients, companions, and other health professionals. However, students overlooked summoning forensic or social services and were inhibited by the pressure of the contextual traits of the drill. Conclusion The multimodal learning environment created by multidisciplinary collaboration contributed to the improvement of components of situational awareness of the interns: patient management skills, ethical decision-making, and reflective practice. During this research, we created a toolbox better to capture the richness and diversity of student interactions. Considering the scarcity of context-specific assessment methods and widespread use of MCQs or generic scales for higher-order thinking skills in medicine, this study might be regarded as a step forward in that context.1OCT 222
The role of Intraoperative cholangiography (IOC) and methylene blue tests in reducing bile leakage after living donor hepatectomy
No full textAim: Liver transplantation remains the only curative treatment in end stage liver disease. Biliary complications remain the most common major morbidity causes in hepatic resection. We aimed to determine and eliminate the bile leakage in donor hepatectomy of LDLT. Material and methods: This study was conducted retrospective and one center study. The study population included 110 consequential liver donors with major liver resection (more than three segments). The population was divided into three groups for data analyses. Primary study groups included 40 donors subjected to methylene blue test starting in April 2013 and 40 donors subjected to intraoperative cholangiography started in March 2014. Results: A total of 110 liver donors (42.7\% women) were included in the study. Postoperative biliary complications were less in methylene blue and intraoperative cholangiography (IOC) groups. Bile leakage was significantly higher in control group (23.3\%) compared to methylene blue (5\%) and IOC groups (2\%) Average duration of hospital stay and duration of operation were significantly higher in control group compared to methylene blue and IOC groups. Conclusion: In our study we conducted to establish biliary leakage in living donor hepatectomy which intraoperative cholangiography test was used to determine. Many intraoperative methods have been introduced to prevent biliary leakage and development of complications. We have showed that IOC test used in the present study could be easily applied in both living liver donor hepatectomy and other major hepatectomy cases. IOC test reduced postoperative biliary leakage incidence and did not increase incidence of other complications. (C) 2020 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.1JAN147-1524
Simulation of pandemics in real cities: enhanced and accurate digital laboratories
No full textThis study develops a modelling framework for simulating the spread of infectious diseases within real cities. Digital copies of Birmingham (UK) and Bogota (Colombia) are generated, reproducing their urban environment, infrastructure and population. The digital inhabitants have the same statistical features of the real population. Their motion is a combination of predictable trips (commute to work, school, etc.) and random walks (shopping, leisure, etc.). Millions of individuals, their encounters and the spread of the disease are simulated by means of high-performance computing and massively parallel algorithms for several months and a time resolution of 1 minute. Simulations accurately reproduce the COVID-19 data for Birmingham and Bogota both before and during the lockdown. The model has only one adjustable parameter calculable in the early stages of the pandemic. Policymakers can use our digital cities as virtual laboratories for testing, predicting and comparing the effects of policies aimed at containing epidemics.2245JAN 2747
Prediction of Mortality in Patients with Sepsis Due to Gram-negative Bacteremia: Pitt Bacteremia Score, qSOFA, SIRS
No full textIntroduction: Sepsis is a syndrome of physiologic, biochemical and pathologic abnormalities induced by infection and has been associated with high mortality and morbidity. This study aimed to compare Systemic Inflammatory Response Syndrome (SIRS) criteria, Pitt bacteremia score and quick Sequential Organ Failure Assessment (qSOFA) for the prediction of mortality in patients with sepsis due to Gram-negative bacteremia. Materials and Methods: Patients with sepsis due to Gram-negative bacteremia admitted to emergency medicine clinic were observed retrospectively from March 2016 to March 2018. Clinical data, laboratory results, co-morbidities, antimicrobial treatment, Pitt bacteremia score, qSOFA score, SIRS criteria of patients were evaluated. Results: A total of 106 patients with sepsis due to gram-negative bacteremia according to Sepsis-2 definition were included. Thirty-day mortality was 20.8\%. Multivariate analysis determined Pitt bacteraemia score (OR:1.63, 95\% CI 1.29-2.05, p< 0.001) as predictors of mortality among septic patients. The area under the ROC curve was 0.885 (95\% CI 0.737-0.933) for Pitt bacteremia score 0.808 (95\% CI 0.713-0.904) for qSOFA and 0.623 (95\% CI 0.492-0.753) for SIRS. Pitt bacteremia score showed the highest specificity (\%71.4) and positive predictive value (\%40.0) as compared to other scores. Conclusion: As the result of the analyses, the mortality rate in patients with sepsis due to gram-negative bacteremia was better predicted with the Pitt bacteremia score than qSOFA score and SIRS criteria.4663-6692
Derece II ve III meningiomların preoperatif prediktif faktörleri
No full textÖZET
Amaç: Meningiomlar en sık görülen primer intrakranyal patolojilerdir. Patolojik olarak üç dereceleri vardır. Cerrahi ile total
rezeksiyon belirleyici tedavi olmakla beraber, özellikle asemptomatik ve insidental vakalarda, yakın takip veya stereotaktik
radyocerrahi tercih edilebilmektedir. Cerrahi tedavi ile konservatif tedavi arasında karar verebilmek açısından, daha agresif
klinik seyir gösterebilen Derece II ve III meningiomların, ön görülebilmesi önem taşımaktadır. Çalışmamızda, meningiom
serimizde kayıtlı hastaların klinik, radyolojik ve yerleşim özelliklerine göre patolojik derecelerinde prediktif olabilecek
etkenleri araştırdık.
Hastalar ve Yöntem: İntrakranyal meningiom veri tabanımıza kayıtlı, Eylül 1986 ile Temmuz 2019 arasında opere
edilen hastaların klinik, radyolojik, cerrahi ve patolojik raporları retrospektif olarak tarandı. Yaş, cinsiyet, tümör yerleşimi,
peritümöral ödem olup olmaması, patolojik derecesi not edildi. Patoloji dereceleri açısından yaşın, cinsiyetin, ödemin ve
tümör yerleşiminin prediktif olup olmadığı istatistiki yöntemler ile araştırıldı.
Bulgular: Veri tabanımızda 1401 intrakranyal meningiom hastası tespit edildi. Hastaların 1015’i kadın, 386’sı erkekti
(kadın/erkek= 2,6). Ortalama yaşları 52,2 yıl idi. Bin iki yüz on dokuz Derece I, 164 Derece II, 18 Derece III meningiom
vardı. Erkek cinsiyeti ve/veya kafa tabanı dışı yerleşim Derece II ve III meningiomlar için prediktif olarak tespit edildi.
Sonuç: Asemptomatik, insidental olarak tespit edilen meningiomlarda, konservatif tedavi (yakın takip veya stereotaktik
radyocerrahi) tercih edildiğinde, erkek ve/veya kafa tabanı dışı yerleşimli olanların, daha agresif davranışlı olan Derece II
veya III olma ihtimalinin daha yüksek olduğu unutulmamalıdır
Gestasyonel diabetes mellitus tanısı almış gebelerde akdeniz diyetine bağlılığın değerlendirilmesi
No full textEvaluation of optimal urine screening and confirmation cut-off values for opiates, at a national reference laboratory
No full textObjectives: To obtain optimal immunoassay screening and LC-MS/MS confirmation cut-offs for opiate group tests to reduce false positive (FP) and false negative (FN) rates. Methods: A total of 126 urine samples, -50 opiate screening negative, 76 positive according to the threshold of 300 ng/mL by CEDIA method - were confirmed by a full-validated in-house LC-MS/MS method. Sensitivity, specificity, FP, and FN rates were determined at cut-off concentrations of both 300 and 2,000 ng/mL formorphine and codeine, and 10 ng/mLfor heroinmetabolite 6-mono-acetyl-morphine (6-MAM). Results: All CEDIA opiate negative urine samples were negative for morphine, codeine and 6-MAM. Although sensitivity was 100\% for each cut-offspecificity was 54.9\% at CEDIA cut-off 300 ng/mL vs. LC-MS/MS cut-off 300 ng/mL and, 75\% at CEDIA cut-off 2,000 ng/mL vs. LC-MS/MS cut-off 2,000 ng/mL. False positive rate was highest (45.1\%) at CEDIA cut-off 300 ng/mL. At CEDIA cut-off 2,000 ng/mL vs. LC-MS/MS cut-off 300 ng/mL, specificity increased to 82.4\% and FP rate decreased to 17.6\%. All 6-MAM positive samples had CEDIA concentration >= 2,000 ng/mL. Conclusions: 2,000 ng/mL for screening and 300 ng/mL for confirmation cut-offs are the most efficient thresholds for the lowest rate of FP opiate results.5OCT593-6024
Doubly charged vector tetraquark Z(++) (V) = [cu][sd]
No full textWe explore properties of the doubly charged vector tetraquark ZV++= {[}cu]{[}sd] built of four quarks of different flavors using the QCD sum rule methods. The mass and current coupling of ZV++ are computed in the framework of the QCD two-point sum rule approach by taking into account quark, gluon and mixed vacuum condensates up to dimension 10. The full width of this tetraquark is saturated by S-wave Z++ V -> pi+Ds1(2460)+, rho+D{*}s0(2317)+, and P-wave Z++ V -> pi+Ds+, K+D+ decays. Strong couplings required to find partial widths of aforementioned decays are calculated in the context of the QCD light-cone sum rule method and a soft-meson approximation. Our predictions for the mass m = (3515 +/- 125) MeV and full width Pfull =156+56-30 MeV of ZV++ are useful to search for this exotic meson in various processes. Recently, the LHCb collaboration discovered neutral states X0(1)(2900) as resonance-like peaks in D-K+ invariant mass distribution in the decay B+ -> D+D-K+. We argue that mass distribution of D+K+ mesons in the same B decay can be used to observe the doubly charged scalar ZS++ and vector Z ++ V tetraquarks. (c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Funded by SCOAP3.SEP 1082
The effect of topical ocular moxifloxacin on conjunctival and nasal mucosal flora
No full textTo determine the short-term effect of topically administered ocular moxifloxacin on conjunctival and nasal bacterial mucosal flora. The study included 20 patients with newly diagnosed age-related macular degeneration. Each patient's diseased eye was selected as the treatment eye and the fellow eye was selected as the control eye. All treatment eyes constituted the treatment group and all controls eyes constituted the control group. All patients received intravitreal injection of ranibizumab. Cultures were obtained from the inferior conjunctival fornix and the nostrils in all patients. Patients were instructed to administer moxifloxacin eye drops to the treatment eye 4 times daily for 1 week. The patients were instructed to come for a follow-up exam 1 week post intravitreal injection. The bacterial culture positivity rate and the bacteria isolated from the conjunctiva and nostrils were recorded in the 2 groups before and after use of topical ocular moxifloxacin. Mean age of the patients (12 female and 8 male) was 64.9 years. Before use of topical ocular moxifloxacin the conjunctival and nasal culture positivity rates in the treatment group were both 100\%, versus 90\% and 95\%, respectively, in the control group. At the follow-up exam the conjunctival and nasal mucosa culture positivity rates in the treatment group decreased to 20\% (4/20) and 30\% (6/20), respectively (P<0.001), versus 85\% (17/20) and 80\% (16/20), respectively, in the control group (P=0.68 and P=0.72 for conjunctival and nasal). This is the first study to show that moxifloxacin applied to the ocular surface topically has a significant effect on nasal flora. Daily administration of topical ocular moxifloxacin for 1 week significantly reduces the nasal bacterial flora in addition to conjunctival flora.1JUL 21