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Acil serviste troponin yükselmesini tahmin etmede lökosit, trombosit sayıları ve nötrofil/lenfosit oranının yararı / The benefit of leukocyte and platelet counts and neutrophil/lymphocyte ratio for predicting elevated troponin levels in emergency department
(Bezmialem Vakıf University, 2015) Uğurlu, Yusuf; SÖNMEZ, Ertan
Objective: We aimed to find out whether the number of leukocyte, platelet and neutrophil / lymphocyte ratio of the patients, who were admitted to the emergency department with the complaints suggestive of acute coronary syndrome (ACS) and who requires troponin monitorization, at admission had positive predictive value in identifying the patients in whom troponin value becomes positive and who are considered as non-st-segment elevation myocardial infarction (NSTEMI). Materials And Methods: Three hundred twenty-eight patients who were admitted to the emergency department with chest pain and the complaints suggestive of ACS and whose electrocardiograms (EKG) did not reveal ST elevation were examined retrospectively. A total of 163 patients whose troponin values were elevated and who were diagnosed with NSTEMI were included as the study group while 165 patients in whom ACS was excluded according to the American Heart Association (AHA) 2014 Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) management guideline and who were discharged from the emergency department with the diagnosis of non-cardiac chest pain were included as the control group. The leukocyte count, platelet count, neutrophil / lymphocyte ratio and routine tests were compared among groups by the Statistical Package for Social Sciences (SPSS) for Windows 22.0 program. Results: When the patients of the study and control groups were compared in terms of cardiovascular risk factors, the parameters of age, gender distribution, family history, and history of coronary artery disease (CAD) did not show statistical difference between the two groups (p ˃ 0.05) whereas diabetes mellitus, hypertension, hyperlipidemia and smoking rates were found to be significantly higher in the study group compared to the control group (p = 0.006, p = 0.0.009, p = 0.011, p = 0.009). The leukocyte value and neutrophil / lymphocyte ratio were found to be significantly higher in the study group compared to the control group (p <0.001) while the platelet count was found to be significantly lower in the study group compared to the control group (p <0.001). In the Receiver operating curve (ROC) curve analyses, the cutoff value, sensitivity and specificity were determined to be 9.10 * 3 / uL, 74%, 70.8% for leukocyte, 235.10 * 3 / uL, 71.3%, 72% for platelet and 2.5, 84.8%, 71.9% for the neutrophil / lymphocyte ratio, respectively. Conclusion: Having leukocyte value over 9.10 * 3 / uL and neutrophil / lymphocyte ratio over 2.5 and having platelet value below 235.10 * 3 / uL in the initial blood samples of the patients, who were admitted to the emergency department with the complaints suggestive of ACS, predict the patients with troponin increase during monitorization. We suggest that these parameters may be used in conjunction with other cardiac parameters for the diagnosis of NSTEMI in the patients who are admitted to the emergency department with chest pain or the complaints suggestive of ACS and who require troponin monitorization. Keywords: Emergency Room, Acute Coronary Syndrome, Leukocyte, Neutrophil / Lymphocyte ratio, Platelet, Troponin
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Acil Tıp Çalışanlarının (KBRN) Kimyasal, Biyolojik, Radyolojik, Nükleer Kazalara Karşı İlgi, Bilgi ve Tutum Durumu Araştırması
(2019) Dönmez, Akif Mehmet
Emergency services, the initial recourse point at all traumatic events that affect the public, will be faced in a CBRN sourced event inevitably new and complicated loads to be added to its existing chaotic structure. In our thesis, evaluating the emergency medicine workers' (emergency physician, emergency medicine resident, paramedic, emergency medicine technician and nurses) prepareadness levels intended for probable CBRN (Chemical, Biologic, Radiologic and Nuclear) threats sourced from accidents, disasters, sabotage and terror events.. In addition to emergency medicine workers' attention, notion and attitude against CBRN threats and accidents, determining physical structures of hospitals and emergency services and present coordinations between emergency service-hospital administration and hospital-relevant institutions (AFAD, Ministry of Health, UMKE etc.) will attribute overcoming the deficiencies in CBRN prepareadness and determining the road map. The survey with 23 questions applied to university, state and private hospitals' emergency medicine workers face to face and electronically. Three questions about demografic informations and twenty questions were concerning CBRN threats awareness, emergency services' present CBRN prepareadness capacity(decontamination, personal protective equipment, education and exercise status, coordinations between intra-organizational b2b and interacademic institutions. 436 emergency medicine workers participated to our study. 42% (n=183) of participants were emergency physician, 17.4 % (n=76 ) ; emergency medicine resident, 8.3 % (n=36) emergency medicine technician, 11.5 % (n=50) paramedic, 20.9 % (n=91) nurses. 46.6 % (n=203) of emergency medicine workers mentioned their request towards enhancing advance in CBRN incidences, 39% (n=170) of them although not yet prioritizing CBRN issues, are sure in importance and delicacy of the matter. Primarily encountered CBRN incidents are 39,9 % (n=174) chemicals and afterwards 12,4 % (n=54) hazardous materials. Emergency medicine workers participated in the survey stated in the rate of 61,8 % (n=268) that have not received any CBRN education toward clinicians. Trainees about 88,3% (n=145) had received a baseline level of theoretical CBRN education. The total of miscognizants about CBRN exercises and nonparticipants were 87,6 %(n=382). Only 12,4 (n=54) participated CBRN exercise hosted by hospital or emergency service. Survey answerers about 13,4 % (n=60) expressed active liaison with hospital coordination authority due to CBRN prepareadness. Those who have not determined task framework for incoming CBRN incidents to emergency department are at the rate of 81% (n= 353) and knowledgelesses about taking the proper procedures in a probable CBRN event correspond to 77,3 % (n=337). Emergency medicine workers' rate about wearing personal protective equipment (availability information and place knowledge) in case of a doubtful CBRN event has been seen as 33,7 % (n=147). Declaratives about presentness and availability of detection and identification equipments in hospital and emergency department for CBRN incidents are at the rate of % 13,5 (n=59). Chiefs of the emergency departments nearly 7,1 % (n=8) declared a fair amount of CBRN service support (allocation of funds, education, education materials, exercise support etc.) to hospital/emergency department by public enterprises (AFAD, CoHE, Ministry of Health). In terms of CBRN Incident Command System, 17,2 % (n=20) rate of emergency departments chiefs mentioned that hospital has a determined role in province-wide and a present protocol with the public enterprises liable for CBRN service support. CBRN accidents and events are serious threats to be prepared. Emergency medicine workers, assured conscious of the importance of CBRN prepareadness, have to be supported with education and exercises, CBRN coordination between intra-organizational and interacademic institutions must be improved. Keywords: Emergency service, Emergency medicine workers, hospital, accidents, CBRN threats.
Open Access
Açık açılı glokom olgularında minimal invaziv cerrahi tekniği olarak jel stent implantasyonunun etkinlik ve güvenilirliğinin değerlendirilmesi / Evaluation of efficiency and safety of gel stent implantation as minimal invasive surgery technique in open angle glaucoma
(Bezmialem Vakıf University, 2018) HAMZAYEV, Igbal; UMURHAN AKKAN, Jülide Canan
Purpose : To evaluate the performance and safety of an ab interno gel stent, a minimally invasive glaucoma surgery device, in open angle glaucoma Materials and Methods : Medical records of 18 eyes of 15 patients undergone gel implantation with the same surgeon and same technique between June 2016 and April 2017 in the glaucoma unit of our clinic were evaluated retrospectively. Complete success was defined as intraocular pressure (IOP) reduction ≥20% from preoperative baseline without any glaucoma medications while partial success as IOP reduction of ≥20% with medications. Failure was defined as vision loss of light perception or worse, need for additional glaucoma surgery, or <20% reduction of IOP from baseline. Results : Mean intraocular pressure dropped from 20.4±4.1 (15-30) mmHg pre-op to 11±4.1(5-18), 12.6±3.9 (7-20), 13.3±2.7 (8-18), 13.5±3.1 (8-19), and 14.2±3.2 (8-21), 14.2±2.3 (11-17) mmHg at 1 week, 1, 3, 6, and 12 months (p < 0.001, Wilcoxon signed ranks) consecutively. Mean number of medications dropped from 2.2±0.7 preoperatively to 0.5±0.6 (p <0.001) at 1-year follow-up. 46.6% of eyes achieved complete success and 86.6% qualified success. Complications included hyphema in 2 eyes, and implant extrusion in 1 eye, and 1 eyes underwent trabeculectomy. Conclusion : Gel implant was an effective surgical treatment for open-angle glaucoma and a significant reduction in intraocular pressure and glaucoma medication was observed at with an average follow-up of 10.7 ± 2.4 months . Key Words : Ab interno implantation; Gel implant; Minimally invasive glaucoma surgery; Open-angle glaucoma
Open Access
Adheziv kapsülitli hastalarda ağrının fonksiyonellik, kinezyofobi, uyku kalitesi ve yaşam kalitesine etkisi
(Bezmialem Vakıf University, 2017) Bilge, Ceren; Özyılmaz, Semiramis
50 patients who had adhesive capsulitis diagnosed and shoulder pain complained were included in our study to investigate the relationship between pain, functionality, kinesiophobia, quality of sleep and quality of life. Visual Analog Scale (VAS) was used to determine the pain level, The Disabilities of the Arm, Shoulder and Hand (DASH) was used to assess functionality, Tampa Scale of Kinesiophobia (TSK) was used to determine the kinesiophobia level, Pittsburgh Sleep Quality Index (PSQI) was used assess the sleep quality and quality of life was assessed by the Nottingham Health Profile (NHP). There was a significant correlation between pain severity and TSK, DASH total score, some sub-parameters of PSQI and NHP (p<0,05). There was a significant correlation between DASH score and some sub-parameters of PSQI scores (p<0,05). Also, there was a significant correlation between DASH score and all quality of life sub-parameters except NHP sleep (p>0,05). There was a significant correlation between TSK score and all sub-parameters of NHP except NHP pain and some sub-parameters of PSQI (p<0,05). Also, there was a significant correlation between PSQI and some sub-parameters of NHP (p<0,05). As a result, this study showed that the common symptom of pain in adhesive capsulitis patients had a negative effect on functionality, kinesiophobia, quality of sleep and quality of life.
Open Access
Adölesan idiopatik skolyoz'lu hastalarda inspiratuar kas eğitiminin solunum kas gücü, solunum fonksiyonları ve fonksiyonel kapasiteye etkisi / The effect of the inspiratory muscle training on respiratory muscle strength, respiratory function and functional capasity in adolescents with idiopatic scoliosis
(Bezmialem Vakıf University, 2018) Başbuğ, Gözde; Gürses, Hülya Nilgün
Scoliosis is defined as a lateral flexion of the spine greater than 100 in the anteroposterior radiograph. However, in reality, a 3-dimensional structural deformity involving a curvature in the coronal plane, a change in the curves in the sagittal plane, and a rotation in the transverse plane. Scoliosis deformity is usually progressive and can cause chronic pain, cosmetic problems, decreased quality of life, and activity participation in patients. This three dimensional deformity also causes various respiratory dysfunctions. In this context, scoliosis brings about findings such as decreased respiratory function, inadequate functional capacity and low respiratory muscle strength. The adverse consequences of scoliosis when the angle of the curve exceeds 40 -50 degree usually last for life. Adolescent idiopathic scoliosis (AIS) is defined as "a structural curvature of the spinal cord with lateral flexion and rotation components that occur around the puberty period in healthy children". AIS is the most common type of scoliosis with a 2% incidence in the general population. AIS accounts for 80% of scoliosis cases. Risk of progress of AIS; natural history, skeletal maturity, sex, and curve size. In girls, the curvature is more likely to progress and more likely to need treatment. The size of the curveture increases with the skeletal growth; therefore, a patient who is not yet skeletally immature is at greater risk for progression of the disease. The relationship between scoliosis and altered pulmonary functions has long been known and studied in the literature. Impairment of pulmonary function and functional capacity seen on the AIS are tought depends on spinal curvature, rotation, thoracic kyphosis and lordosis, and chest deformation. Possible disabilities for untreated AIS, such as back pain and pulmonary limitations affect the functional capacity and self-esteem of the person. There are very few studies in this area. From a literary perspective; a significant proportion of the conservative treatment parameter of scoliosis is exercises training for increasing respiratory functions and functional capacity. Assessing respiratory function, determining the risk of restrictive lung disease, identifying respiratory problems of patients with scoliosis, and adding respiratory exercises to their treatment program have great importance for the rehabilitation of patients with scoliosis. In this context, studies are needed to develop the scoliosis specific parameters of respiratory rehabilitation. In our study, we aimed to increase respiratory muscle strength, respiratory functions and functional capacities by providing respiratory training to children with mild to moderate scoliosis. The study included patients who applied to the Faculty of Medicine, Department of Orthopedics and Traumatology of the Bezmialem Vakif University. Patients were directed by the orthopedic surgeon to the Department of Physiotherapy and Rehabilitation of the Faculty of Health Sciences at Bezmialem Vakif University with the diagnosis of AİS. Thirty-four patients were included in the study and randomized into control and training groups. During the first visit of all patients, an evaluation form was filled in which included demographic and clinical features. A 6-min walk distance (6MWD) was calculated for all cases in the training and control groups by applying the 6-min walk test (6MWT). Beside this, pulmonary function test (PFT), respiratory muscle strength (MIP: maximal inspiratory pressure, MEP: maximal expiratory pressure) was assessed and the results is recorded. Angle of trunk rotation (ATR) has evaluated by the same physiotherapist with a scoliometer and were recorded in the patient evaluation form, as well as the demographic information of the patients, as Risser classification, Cobb angle evaluation determined by the orthopedic surgeon. After the initial evaluation, all patients (training and control group) were given a home-based exercise program by the physiotherapist, consisting of deep diaphragmatic respiratory exercises, resistive respiratory exercises to weak zones on the concave sides of the scoliosis, spinal stabilization exercises, strengthening of interscapular muscles and stretching exercises. In the training group, the same home based exercise program as well as inspiratory muscle training (IMT) were given. Inspiratory muscle training was performed with Threshold IMT for 8 weeks, 30% of MIP value, 7 days a week, 15 minutes per set and twice a day. Patients in the training group were taken into control once a week to reevaluate the MIP values and 30% of the measured MIP was identified as the new training workload. In both control and training groups, during weekly controls, home based exercise program has repeated with physiotherapist accompanied by intraoral pressure measurements. At the end of the 8-week training period, the patients were reevaluated. The evaluations at the end of treatment showed statistically significant improvements in respiratory function test parameters including FEV1 (% predictive) and PEF (% predictive) and MIP, MEP values of respiratory muscle strength parameters in both control and training groups (p<0.05). The training group also showed a significant improvement in the value of forced vital capacity (FVC) (% predicted) (p <0.05). We think that home based exercise training, given in both groups with AIS in our study are very useful in terms of development of respiratory muscle power, respiratory functions and functional capacities. In addition to these gains, there was a statistically significant decrease in the ATR of the both patient group after 8 weeks of exercise training (p <0,05). We think that the exercise program we have applied was based on spinal stabilization and 3D breathing exercises, has been very beneficial on trunk rotation. When we look at the results obtained at the end of the 8-week training period, the increases in FVC (% predictive), MIP, MEP and 6MWD were found to be statistically higher than the increases in the control group (p <0,05). In this case, as we have already mentioned in our hypothesis, we can say that IMT has a positive effect especially on FVC, which is a sign of lung volumes, in pulmonary function test parameters. In addition, we think that IMT has a developmental effect on respiratory muscle strength and functional capacity, which is lower in children with AİS than healthy age groups. As a result of our study, the exercise program, consisted of spinal stabilization exercises, interscapular strengthening exercises, stretching exercises and respiratory exercises including diaphragmatic deep breathing exercises and resistive local expansion exercises to the concave regions of the scoliosis were performed throughout the patient group with AIS, is effective by the development of respiratory muscle power, the improvement of respiratory functions, the development of functional capacity and the reduction of trunk rotation caused by scoliosis. In addition to this, according to data of our study, IMT is quite effective at removing the deficits and achieving significant cardiorespiratory gains in mild to moderate AIS cases with inadequate respiratory muscle strength and functional capacities, apart from respiratory dysfunction arising from the likely natural course of the disease. In the light of findings obtained from our study, we would like to inform that a comprehensive exercise program in addition with IMT is a very effective method for cardiopulmonary physiotherapy and rehabilitation of AİS and it is useful for this patient group to disseminate its usage.
Open Access
Adölesan İdiyopatik Skolyozlu Çocuklarda Core Stabilizasyon Eğitiminin Solunum Parametreleri, Periferik Kas Gücü, Denge, Fonksiyonel Kapasite ve Yaşam Kalitesi Üzerine Etkisi
(Bezmialem Vakıf University, 2019) Yıldırım, Sefa; Özyılmaz, Semiramis
The three-dimensional deformity of the vertebrae with lateral flexion in the frontal plane of 10 ° and in the axial plane and the flattening components in the physiological curve in the sagittal plane is defined as scoliosis. 80% of the structural scoliosis is idiopathic scoliosis. Adolescent idiopathic scoliosis (AIS) is a variant of idiopathic scoliosis occurring from the onset of puberty (above 10 years of age) until the growth plates are closed. Conservative and surgical treatment options have been reported in the treatment of AIS. Conservative treatment includes observation, exercise and orthotic options. The primary purpose of conservative treatment in AIS is to correct secondary damage including back pain, respiratory problems, balance problems and cosmetic deformations by preventing progression of the curve and improving quality of life. Specific exercise methods are used in conservative treatment. Core Stabilization exercises are also one of these methods. The aim of this study was to investigate the effects of Core Stabilization training on respiratory parameters, peripheral muscle strength, balance, functional capacity and quality of life in AIS patients. The study included 30 children aged 10-20 years with AIS who were randomly assigned to experimental and control groups. Pulmonary function test (PFT), respiratory and peripheral muscle strength measurement, 6 min walk test (6 MWT) and Biodex Balance System® device and postural stability and stability limits were applied to all patients. Exercises given to the experimental and control groups were administered under the supervision of a physiotherapist for 1 week, in the home 6 days a week for 8 weeks. Traditional scoliosis exercises were given to the control group. In addition to the traditional scoliosis exercises, the core exercise program was included for training group. At the end of eight weeks, evaluations were repeated. SPSS Statistics 21.0 program was used for data analysis. The significance level was accepted as p <0.05 for all analyzes. At the end of the 8th week, in the training group, trunk rotation angle, forward and side tilt angles, respiratory function test parameters % FVC and% FEV1 values, respiratory muscle strength values (MIP, MEP), some parameters in the stability test stability parameters, hand grip and quadriceps muscle strength, functional capacity, cosmetic deformity perception score and some parameters of quality of life. In the control group, statistically significant improvement was found in forward and side bending angles, MIP values, stability parameters in stability test, quadriceps muscle strength, functional capacity and some sub-parameters of quality of life. When the training and control groups were compared, some improvement was observed in the education group in some respiratory parameters and in the perception of cosmetic deformity. Considering the literature and the results of our study, it was concluded that Core Stabilization exercises could be applied to AIS patients and added to routine physiotherapy program. keywords: adolescent idiopathic scoliosis, core stabilization exercises, pulmonary function test, respiratory muscle strength, peripheral muscle strength, cosmetic deformity perception, quality of life
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AFAD İstanbul Arama Kurtarma Birliğinin Ekip Çalışmasına Yatkınlığı
(2019) Demirbaş, Elif; Erdoğan, Özcan
The AFAD search and Rescue Association is based on volunteering and dedication in terms of working conditions. The human factor has an important place in the success of this institution. AFAD employees, who have a sense of commitment to their institutions, take great responsibility in providing superior services to organizations. It was also thought that the satisfaction of the employees, their commitment to their organization and the support of the organization will increase the quality and efficiency of the service the organization aims to provide. This research was carried out on a descriptive and cross-sectional basis in order to determine the relationship between AFAD Istanbul search and Rescue union employees and organizational commitment and to take necessary measures against the problems present in the institution. The research was carried out with 71 employees working in search and rescue unit of Disaster and Emergency Directorate in Istanbul between 02.11.2018 - 01.01.2019. Data were collected using Descriptive Information Form and Organizational Commitment Scale. Descriptive statistics were used to evaluate the data. The average age of the participants was 38.89 ± 6.32 years and 91.5% were male. 23.9% of them have associate degree and 67.6% of them have bachelor's degree. 81.7% are married. 50.7% have been working in the current institution for less than 10 years. Total working time of 46.5% is less than 12 years. 14.1% graduated from agriculture. 63.3% are employed as search and rescue technicians. Employees considered their organizational commitment to be 25.4% very good and 22.5% good. 54.9% said they faced a problem related to organizational commitment. The average point of the Organizational Commitment Scale was determined 3.07 ± 0.20. The average point of Organizational Commitment Scale of those whose total working period is 12 years or more was found to be statistically higher than those with a total working time of under 12 years (p:0,048; p<0,05). The average point of Organizational Commitment Scale of those who did not encounter a problem about organizational commitment was found to be statistically higher than those who encounter a problem about organizational commitment (p:0,015; p<0,05). It wasn't determined statistically significant difference between Organizational Commitment and age, gender, marital status, education level and working time in the current institution. It was found that the employees evaluated the status of having organizational commitment as good but faced with problems related to organizational commitment. At the same time, it was concluded that employees with a high level of organizational commitment can respond to the situation in a prepared and effective without stress manner in the event of a disaster.
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AFAD İstanbul Arama Kurtarma Birliğinin Örgütsel Bağlılığı
(2019) Özkar, Yalım; Erdoğan, Özcan
This research was conducted descriptively and cross-sectionally in order to determine the relationship between AFAD Istanbul Search and Rescue Association employees and teamwork tendency. The research was carried out with 67 employees working in Search and Rescue Association of Disaster and Emergency Directorate in Istanbul between 02.11.2018- 01.01.2019. Data were collected by using the Descriptive Information Form and the Teamwork Tendency Scale. Descriptive statistics were used to evaluate the data. The average age of the participants was 39.58 ± 5.81 and 89.6% were male. 23.9% of them have associate degree and 70.1% of them have bachelor degree. 77.6% are married. 52.2% have been working in the current institution for more than 15 years. 53.7% of the total working time is over 15 years. 19.4% are graduates from agriculture department. 58.2% are employed as search and rescue technicians. 29.9% of the employees evaluated their own teamwork as very good and 31.3% as good. 53.7% said they had a problem with teamwork. The average point of the trust subscale of those aged 40 and under, was significantly determined higher than those over 40 years of age (p:0,020; p<0,05). Average point of sub-dimension of diagnosing and analyzing the problem of high school / associate degree graduates was found to be statistically higher than bachelor's and above graduates (p:0,039; p<0,05). High internal motivation subscale average point of high school / associate degree graduates were found to be statistically higher than those of bachelor's and above graduates (p:0,024; p<0,05). The average point of responsibility subdimension of those who think that teamwork is very good was found to be significantly higher than those who think that it is medium and lower (p:0,015; p<0,05). The average point of cooperation and teamwork sub-dimension of those who think that teamwork is very good, was found to be significantly higher than those who think that teamwork is moderate and under (p: 0.001) and good (p: 0.020). (p<0,05; p<0,01). High internal motivation subscale point of those who think that teamwork is very good, was found to be significantly higher than those who thought that the teamwork was moderate and below (p: 0.019) and good (p: 0.029). (p<0,05). The average point of leadership, persuasion, perseverance sub-dimension of those who think that teamwork is very good, was found to be significantly higher than those who thought that teamwork was was moderate and below (p: 0.001) and good (p: 0.01). (p<0,01). The average point of cooperation and teamwork subscale scores of those who encountered problems during the teamwork was found to be significantly higher than those who did not encounter the problem (p:0,017; p<0,05). It was found that the employees evaluated the status of being a team member as good but encountered problems during the team working. xiv In this study, it is concluded that teamwork is vital for the measures to be taken in case of disasters and emergencies and for interventions to be made at the event.
Open Access
Afet Tıbbı Açısından KBRN Müdahale Sistemi: Suriye’deki Kimyasal Silah Yaralılarının Yönetimi Örneği
(2019) Öztürk, İlhan; Güneren, Ethem
Today, as Chemical, Biological, Radiological and Nuclear (CBRN) weapons are generally used to cause terror and havoc, they are also used to bring about mass destruction and breach of the capacity. Since CBRN weapons are easily procurable, they became an untrammeled power supply in the hands of weak states. Despite all international judgments, treaties and pressures preventing production, storage and usage of chemical weapons, uncontrolled usage still has not been averted. Dual-use feature of some chemicals provides convenience in their trading permissions and their passing through customs. Because chemical detections are difficult and early warning systems are not prevalent in border crossings and customs entries, there is an increasing danger. Disregard of the agencies and institutions meant to be responsible from protecting human health and health of other species, jeopardizes the situation more. In terms of disaster medicine, management of injuries with chemical warfare agents and injured peoples require a multi-disciplinary approach, study and coordination. Unfortunately, academic studies regarding standard procedures and algorithms of rescue and health services provided to the injured peoples as from the initial contact, - especially in the case of injuries with chemical weapons- have a very limited availability. On the purpose of removing this uncertainty and remedying the current deficiency; scientists, forensic science experts, health care providers, chemists, engineers, search and rescue experts, firefighters, members of the managerial disciplines, legists, logistics specialists and experts related to the security field urgently need to determine required standard algorithms of prevention and response. The objective of this cross-sectional study is, review of the medical care processes provided to the victims of chemical weapons from 2011 until today; their comparison with the health care processes applied to the victims of chemical weapons in the Iran – Iraq War and World War I and putting forward proposals about these processes. In line with this objective, highlighting the gap in academic studies related to the medical care processes of the victims of chemical weapons and making contribution to the literature are aimed. Not only the cases either injured in attacks by the chemical weapons which has been used as weapons of chemical mass destruction in Syria from 2011; but also the victims who were passed through the border gates in Hatay and Kilis; whose first responses and transports were provided in ambulances of Emergency Health Presidencies of Kilis, Hatay and Gaziantep and also the cases whose medical cares were maintained in the same provinces are investigated. In this study, acute stage medical cares of the cases exposed to the attacks of chemical agents actualized by two different chemical agents (SM and Chlorine Gas) in two different places are examined. 13 blister agent of Sulfur Mustard (SM) cases whose medical cares were provided in Gaziantep Şehitkâmil State Hospital by being passed through Kilis – Oncupinar Bordergate are all male. Their ages vary between 16 and 48 (average age 29.31 ± 9.87 years) and length of their treatment period vary between 8 and 23 days (average 12.91 days). While 12 of these cases were discharged from the hospital with recovery, one of them was died (%7,69) in the intensive care unit in consequence of cardiopulmonary arrest. While 10 of the 23 cases by exposure to the pulmonary agent Chlorine Gas were male (%43,4), 13 of them were female (%56,6). Both lungs were auscultated; coarse crackles and rhonchus (80%), respiratory distress (100%) and infiltration parts in the lungs (60%) were diagnosed. Despite the oxygenotherapy and supportive care, one of the cases were intubated as a consequence of the decrease of the saturation; and was died after the occurrence of (%4,34) acute respiratory distress syndrome (ARDS) in the intensive care unit. As a consequence, medical care of the all cases exposed to chemical weapons is a process, demanding a great importance and notice. It has a vital importance that, all of the medical personnel, -especially doctors- and everyone actively assigned in the field need to be trained about the influences of chemical weapons on health; protection methods; antidotes; personal decontamination ways and decontamination ways of injured people; field case management and medical care processes for hospitals and fields in accordance with the type of agent and also active exercises need to be conducted for these people regularly.
Open Access
Afet Tıbbı Açısından Yeraltı Hastaneleri Modelinin Geliştirilmesi: Bezmialem Vakıf Üniversitesi Araştırma ve Uygulama Hastanesi Örneği
(Bezmialem Vakıf University, 2020) Karakoç, Miraç Nevzat; Elmalı, Nurzat; Erdoğan, Özcan
Disaster management can be considered as a plan that covers multiple disciplines, requires special areas of expertise and involves proper use of the resources. One of the most important steps in these disciplines is the health services during disasters, which have direct effect on minimizing the loss of lives. The purpose of this research is to develop and apply the underground hospital model for uninterrupted operation of medical responses and increasing capacities of the hospitals in case of mass injuries to arise from any natural disaster or war. It is intended to create a guideline for design and development of an underground hospital regarding existing or future hospitals in the event of disasters and emergencies. Therefore, underground hospital model has been designed and suggested for new hospital project of the Bezmialem Vakif University Faculty of Medicine Hospital. Design is based on the field hospitals that provide and use the fastest and modular health services in case of natural disaster or war. SWOT analysis and SWOT matrix studies were performed for the Underground Hospital Model and Field Hospital. Then, data has been collected to define a standard for the field hospitals by holding face to face meetings with the companies that generate and conceptualize projects for field hospitals and scanning the relevant literature. With the data obtained, standard levels as Standard Level I, Standard Level II, Standard Level III and Standard Level IV were defined for field hospitals and Area I, Area II, Area III and Area IV as their corresponding underground hospital area standards. These standard areas provided a basis for underground hospital models to be applied for parking lot and reserve areas for the future or existing hospitals. Ideal utilization matrix was developed by the xvii Level/Area standards via specified standard levels and area standards, and it is intended to evaluate the efficiency of the planned underground hospital model. For the underground hospital project to be suggested for application in the new hospital project of the Bezmialem Vakif University Faculty of Medicine Hospital, the project of the parking lot area to work on was obtained from Bezmialem Vakif University Directorate of Construction, which carries out project studies on the new faculty of medicine hospital to be built. A procedure containing 6 items was created to be followed while creating the underground hospital area model. Applying this procedure, two project studies as Project-1 and Project-2 were performed on the relevant area. The project called "Project-1" suggested application of the all units included, self contained Area IV model underground hospital. The project called "Project-2" stipulated and suggested that the medical care and medical care infrastructural capacity of the existing hospital can cover the underground hospitals if certain modifications are made on the Area IV model underground hospital, including the entire medical care service, and a study was performed by changing the Health Service unit placement. Underground Hospital Disaster Plan (YAHAP) has been prepared for Bezmialem University Faculty of Medicine Underground Hospital that was offered to be conceptualized for a project. Keywords: Disaster, Disaster Medicine, Disaster Management, Underground Hospital, Field Hospital.
Open Access
Ağır Vasıta Sürücülerinde Ağrı, Postür, Uyku Kalitesi, Yorgunluk, Stres ve Yaşam Kalitesinin Değerlendirilmesi
(2019) Yavuz, Yavuzhan; Özyılmaz, Semiramis
In our country, freight and passenger transport is largely used as a result, truck and bus drivers face an extreme workload. As a result of this intensive workload, drivers face a high risk of musculoskeletal problems, stress, fatigue and sleep quality. This study was carried out to investigate the differences between pain, postural changes, sleep quality, fatigue, stress and quality of life in urban and intercity heavy vehicle drivers. A total of 76 drivers 42 of them in cities including 17 (%40) of them are trucks, 25 (%60) of them are buses, 34 of them in intercities including 12 (%35) of them are trucks, 22 (%65) of them are buses participated in the study for at least 5 years, using 5-8 hours per day, without surgery and without spinal problems. The individuals pain assessments with McGill Melzack pain survey and visual analogue scale, postural changes by New York posture method, manual muscle tests and elasticity evaluations, hand grip forces with Baseline Smedley Digital Hand Dynamometer® device, sleep quality by Pitsburgh Sleep Quality Index, daytime sleepiness levels by Epworth sleepiness scale, fatigue severities by Fatigue Severity Scale, stress levels by Perceived Stress Scale and quality of life assestments by Nothingham Health Profile. SPSS v.20.0 program was used for data analysis. The results were considered significant with P-values<0,05. There was no statistically significant difference between the groups when the postural changes, pain complaints and pain severity of the drivers who used urban and urban heavy vehicles were compared (p>0,05). While our drivers had similar sleep quality, intercity drivers had higher daytime sleepiness compared to city drivers (p = 0,034). It was found that intercity drivers felt more severe than urban drivers (p <0,05). It was observed that the perceived stress level of urban drivers was higher (p <0,05) and this was related to cigarette consumption (p = 0,010) and food consumption (p = 0,015). When we look at the quality of life in urban and intercity drivers there is no difference but was found to be worse emotional reaction sub-parameter in city drivers (p <0.05) and to be worse to be worse energy sub-parameter in intercity (p = 0.004) drivers. As a result of our study, it was observed that both urban and intercity heavy vehicle drivers had similar problems with musculoskeletal system, the drivers who were driving by city were exposed to more stress, and the drivers who were by intercity felt more tired. Keywords; truck, bus, quality of life, pain, posture, sleep, fatigue, stress
Open Access
Ameliyathane hemşirelerinin delici kesici aletler ile yaralanma durumu, nedenleri ve önlemleri
(Bezmialem Vakıf Uniersity, ) Dağcı, Mahmut; Sayın, Yazile
Introduction: Penetrators and sharps injuries, PSI is a factor affecting the healthcare workers, is seen high among operating room nurses. This research was planned and conducted to examine the conditions and precautions that operating room nurses cause to PSI. Method: The descriptive and cross-sectional study was conducted between January 2017-May 2018 in istanbul european side with 463 volunteer nurses in 27 different hospitals. Operating rooms had at least 10 nurses and were compliance with the Turkish Standards Institute Clean Rooms Standard. The data collected with two data forms which prepared with knowledge of literature. IBM SPSS 22.0 used for data analysis and P<0.05 was significance value. Findings: Participants were 18-61 years old, (avg.35.9 ± 0.84), 63.7% had bachelor degree and above, 80.8% had nurse title, 68.9% said they had PSI. There were significantly different for PSI (p<0.05) women, married and had low educational level, working in university hospitals with deep invasive intervention and using protective equipment. Participants reported that 54.8% of the injuries were performed in the right hand and primary cause was exchanging instruments between nurse and surgeon, secondary was assisting surgeon. Most of the participants (37.1%)were injured by the suture material.After the injury, 83.0% of the participants were made right attempt to the wound. 26.6% of the participants, come across to infected PSI, while only 60.2% reported it. 71.4% who didn't report said, reporting wasn't working and wasn't significant. Conclusion: Personal and occupational characteristics of health workers working as nurses with inadequate physical and environmental factors of the operating theater are effective in the high PSI rate.
Open Access
Anti-oksidan doğal bileşiklerin kemoterapi ajanı paclitaxel ile birlikte nano misellere yüklenmesinin etkinlik ve toksisite profili açısından in -vitro ortamda gözlenen olası değişiklikler
(2019) Öztenekeci, Burcu; Bahadori, Fatemeh
Chemotherapeutic agents used in chemotherapy treatment not only affect cancer tumors, but also can cause toxic effects in healthy areas. These substances show side effects from time to time due to their oxidation effect. From this point of view, it is sometimes recommended that patients consume antioxidant natural products during chemotherapy in cancer treatment. However, these antioxidant substances may reduce the oxidation effect of the chemotherapy agent at the cancer tumor site and prevent the chemotherapy agent from acting fully. This issue should be clarified. From this point, the antioxidant effect of curcumin, quercetin and rosmarinic acid compounds were applied to cancer cells together with chemotherapy agent paclitaxel and the effect of this agent was investigated. For this purpose, the natural antioxidants compounds were loaded into nano-carriers and the effect of paclitaxel on breast cancer cells was investigated. The reason for the loading of natural antioxidants in the nano-carrier is that these substances can be applied to the cells at a high rate by removing their low solubility property in water. To this end, poly lactide co-glycolide (PLGA) nano-micelles were used. The water-soluble commercial form of Paclitaxel was applied to the cells. The nano-formulation of each antioxidant was prepared separately using the o/w method. Briefly, the antioxidant and PLGA were dissolved together in acetone and slowly dropped into water containing the surfactant. The organic solvent was removed at room temperature by stirring overnight. The size of the nanofomulations obtained were determined by Dynamic Light Scattering (DLS) method. The antioxidants were loaded into the nao-carrier with increasing concentrations, and the highest concentration with no aggregate, ie the formulation in which the entire compound was loaded into the micelle, was considered as the optimized formulation. The concentration of paclitaxel equal to the IC 50 value was applied to MCF-7 human breast cancer cells with various concentrations of nano-antioxidants and changes in cell viability were observed. Cell viability was measured by Sulforhodamine B assay. In addition, nano-anti-oxidant was applied to the cells together with paclitaxel, 1 hour before paclitaxel and 1 hour after paclitaxel, and the effect of time of administration on the results was investigated. In conclusion, it was observed that curcumin significantly reduced the anti-tumor effect of Paclitaxel. Quercetin reduced the anti-tumor effect of paclitaxel in a dose-dependent manner. There was no significant effect of rosmarinic acid. It was observed that the application time had no function on the change of these effects. Ultimately, the bioavailability of antioxidant and its concentration in the blood will remain unknown unless the concentration of the antioxidant in the blood circulation is known. This will cause the unknown direction of the natural antioxidant on affecting the effect of chemotherapy on the tumor site. From this it can be clearly concluded that antioxidants should not be used during cancer treatment unless the xiv effect of the anti-oxidant on the chemotherapy agent and ultimately its negative impact on the growth of the cancer tumor is fully understood
Open Access
Asbest ile ilişkili hastalıkların gelişiminde çevresel ve mesleki asbest maruziyetinin değerlendirilmesi / Evaluation the enviromental and occupational asbetos exposures in the development of asbestos related diseas
(Bezmialem Vakıf University, 2017) ÖZKAN, Didem; BAYRAM, Mehmet
Aim: While there are many studies related to environmental asbestos exposure in our country, there is no information about occupational exposure. In this study we aimed to determine the environmental and occupational exposures and occupations with high risk in disease development in patients with asbestos related diseases. Materials and Method: 139 patients older than 18 years of age who had thorax computerized tomography and diagnosed for asbestos related diseases (pleural plaque, pleural calcification, mesothelioma etc.) in the registry of radiology or pathology departments between 01.01.2006-01.07.2016 at Bezmialem Vakıf University Medical Faculty Hospital were included to the study. All subjects were questioned for age, gender, birth place, living environment and period, occupations and periods. Occupations were classified according to Work-Related Lung Disease Surveillance Report 2002 as high, intermediate and low risk. Birth places of the subjects were marked at the geological maps showing ophiolitic units and the distance were measured as kilometers. Results: The distribution of the subjects according to the occupation was 31(22.3%), 29 (20.9%), and 79 (56.8%) in the high, intermediate and low risk groups, respectively. Although all female subjects were in the low risk group; 31%, 29% and 41% of the male subjects were in high, intermediate and low risk groups, respectively. While 90 subjects (71.2%) were close (<10 km) to ophiolites, 40 subjects (28.8%) were far (>10 km) from ophiolites. Mean age of the male subjects was 65.05±11.9 and female subjects was 63.03±13.1. Age distribution and distance to environmental asbestos exposure were significantly different in the high risk group than the rest of the subjects. However, there was no significant difference between low and intermediate risk groups. Optimal safety distance for environmental asbestos exposure was identified as 13-14,5 km. We have identified risky occupations and generated a map of Turkey for risk groups. Also, we have determined 10, 9, 6, 1 and 1 cases from Kastamonu-Taşköprü, Adıyaman-Gerger, Erzurum-Oltu, Niğde-Ulukışla and Sinop-Boyabat, respectively which were never reported at the literature. Conclusion: In our study, we determined that at least 20% of the asbestos related disease were related to occupational exposures. Also, we have identified new areas for environmental exposure. During the evaluation of the asbestos related diseases, occupational exposure should be questioned in accordance environmental exposures assessment.
Open Access
Asemptomatik sağlıklı gönüllülerde kardiyak MRG ile sağ ventrikül myokardiyal yağ araştırılması: Cinsiyet, yaş ve vücut-kitle indeksi ile ilişkisi / Right ventricular fat imaging with cardiac MRİ in asymptomatic healthy volunteers: Relationship with age, gender and bmi
(Bezmialem Vakıf University, 2018) TOKDEMİR ŞİŞMAN, Sevil; ÖZDEMİR, Hüseyin
Purpose: To demonstrate the relationship between right ventricular myocardial fat and gender, BMI and age in healthy and asymtomatic individuals. Materials and Methods: 107 healthy and asymptomatic subjects evaluated for right ventricular intramyocardiyal fat infiltration. ECG triggered cardiac MRI performed with Siemens Avanto 1,5 T in all subjects. Intramyocardial T1W hyperintense fat foci confirmed with fat saturated T1W images. Each subject evaluated for myocardial fat, number of involved segments, most frequent involved segments, associated wall motion abnormalities. Right ventricular and RVOT end diastolic diameters and right ventricle ejection fraction measured to assesment of right ventricular dysfunction. Relationship between all obtained data and gender, age and BMI was investigated. Results: Intramyocardial fat was detected in 65 of 107 subjects. 49 of subjects with fat were female. Fat was detected %45,7 of male and %68,1 of female subjects. There is statiscally significant positive relationship between rihgt ventricular myocardial fat deposition and female gender. BMI <30 was in 34, >30 was in 73 subjects. %38.2 of BMI<30 group and %71.2 of BMI>30 group has fat in myocardium. There is statiscally significant positive relationship between right ventricular myocardial fat deposition and obesity. Fat was observed most frequently in midventricular lateral, apicoanterior, midventricular anterior segments, and less frequently seen in RVOT. There is statiscally significant positive correlation between number of infiltrated segments and BMI. There was no difference in EF, RV ED and RVOT ED diameters between subjects with and without fat. Also RV ED and RVOT ED diameters were normal in both groups. Conclusion: Compared to CT assesment for myocardial fat content, MRI is more consistent with histopathologic results of autopsy series. Thus, MRI is more sensitive to fat content than CT. BMI and female gender have significant positive relationship with right ventricular myocardial fat. However, right ventricular functional measurements were normal. Therefore, in subjects with right ventricular myocardial fat, diagnosis of ARVD or other pathologic fat infiltration causes should be avoided unless accompanied by wall motion abnormalities or functional impairment.
Metadata only
Bariatrik cerrahinin obezite ile ilişkilendirilmişmikrorna düzeylerine etkisi / Bariatric surgery effect on associated with obesity microrna levels
(Bezmialem Vakıf University, 2020) YIĞMAN, Samet; YARDIMCI, Erkan
Objective: In this study, it was aimed to evaluate the relationship between miRNA expression levels associated with obesity and weight loss, to predict how much weight patients can lose postoperatively and to get maximum benefit from planned surgery. Materials and Methods: Between May 2017-July 2018, 17 patients who were indicated for bariatric surgery and planned laparoscopic sleeve gastrectomy at Bezmialem Vakıf University, Faculty of Medicine, Department of General Surgery, Obesity and Metabolic Surgery Polyclinic were included in this study. The study was approved by Bezmialem Vakıf University Faculty of Medicine Ethics Committee. Preoperative and postoperative 6th month blood samples and intraoperative adipose tissue samples were obtained. The expression levels of miRNA (miR27b-3p, miR122-5p, miR223-3p) associated with obesity were examined. The miRNAs were isolated from blood and adipose tissue and quantitated and analyzed by real-time polymerase chain reaction (RT-PCR) method. Postoperative 6th month excess weight loss rates (%EWL) were evaluated in three groups as %0-50 (group-1), %50-70 (group-2), %70-90 (group-3) respectively. The differences of miRNA expressions between blood and adipose tissues, gender, excess weight loss rates, and relationship with diabetes mellitus were examined. Results: 4 of the patients were male (%23.5), 13 were female (%76.4), male/female ratio 0.3, average age 41±11,6, average body mass index 49,1±7,6 kg/m2. Diabetes mellitus was present in 6 patients (35.2%) and their mean glucose and HbA1c values were 133 ± 59.4 mg / dl and 6.4 ± 1.3 %, respectively. The sixth month EWL rate was an average of %62.7±17. There were 4, 7 and 6 patients in groups 1, 2 and 3, respectively. The expression of miR223-3p was found significantly higher among all preoperative groups (p = 0.0046 for group-1; p <0.0001 for group-2; p = 0.0017 for group-3). MiR223-3p gene expression levels evaluated in preoperative and postoperative blood samples in group-2 and group-3 were found to be statistically significantly higher than miR27b-3p and miR122-5p gene expressions (p values for group-2 are p = 0.0335 and p = 0.0328 respectively, p values for group-3 are p=0.0446 and p = 0.0441 respectively). In addition, miR122-5p gene expression in fatty tissue was found to be less expressed than other miRNAs in patients with diabetes mellitus (p = 0.0062). Conclusion: Expression of miR223-3p has been shown to correlate with morbidly obese patients, particularly with patients with an EWL of 50% and above. For this reason, miR223-3p gene can be used as a possible biomarker in predicting weight loss after bariatric surgery. Thus, the group of patients who will benefit more from surgery can be determined in advance and the effectiveness of surgery can be increased. In addition, groups that will not benefit from surgery can be identified and combined (restrictive + malabsorbtive) or malabsorbtive surgical procedures may be preferred instead of restrictive bariatric surgery procedures in these patients. However, further studies with high number of cases, more types of miRNA and applied different bariatric surgery procedures are needed.
Open Access
Baş ağrısıyla gelen çocuklarda demografik özellikler ve PEDMIDAS, MIDAS ölçeklerinin kullanımı / Demographic characteristics and use of PEDMIDAS, MIDAS scales in children with headache
(Bezmialem Vakıf University, 2018) Kırmacı, Çiğdem; İÇAĞASIOĞLU, Dilara Füsun
Pediatric headache is one of the most common causes of pediatric outpatient clinics. It is important to recognize the classification and treatment of headache by the physician because of the high incidence, high quality of life and high economic burden. The World Health Organization has realized this situation and has initiated a global campaign to reduce the headache burden in the world. Considering the negative effects of headache on the social and school life of children, detailed history should be taken, differential diagnosis should be made and appropriate treatment should be determined in order to reach the correct diagnosis. The headache classification in adults was made in accordance with the diagnostic criteria published by the International Headache Society (IHS) in 2005. These criteria, which were not suitable for pediatric patients, have been adapted to children and adolescents in later years. Headaches affect daily activity and may impair the work or school performance of the patients and cause decrease in quality of life, family and social activities. This situation was evaluated by the WHO as disability. Various scales have been developed to measure the quality of life and disability related to headache in order to plan the treatment and evaluate the response to treatment. One of the most commonly used scales to measure disability in adult migraine patients is the Migraine Disability Assesment Scale (MIDAS). The MIDAS scale was adapted to the children and the PedMIDAS scale was prepared. In our retrospective and prospective study; we aimed to determine the demographic characteristics of the children with headache, the frequency of headaches and the type of IHS according to the criteria, by using the MIDAS and PedMIDAS scales, we focused on planning the treatment and evaluating the response to treatment. The study include 680 children aged 6-18 years, who were admitted to Bezmiâlem Vakıf University Hospital general pediatrics, pediatric emergency and pediatric neurology outpatient clinics with a headache between August 2017 and January 2017. Demographic findings and headache characteristics of the patients were noted. Prospective study was started in December 2017. MIDAS and PedMIDAS scales were applied to these patients. PedMIDAS scale was reapplied to patients who were called for control in February 2018 and their responses to treatment were evaluated. Nearly fifty five percent of the patients were female and nearly 45% were male. The most common presentation with headache was the pediatric neurology outpatient clinic. The most common type of headache in all diagnoses was tension-type headache. Nearly thirty of the patients in the prospective study felt pain 2 or 3 times a month and 40% of the patients had pain for 1-4 hours. Suppressive, compressive character pain was the most common type of pain. The most common localization was in the frontal region. Stress was the most common triggering factor for pain. It was observed that 50% of the patients provided relaxation with sleep and rest. Forty-four point three percent primary headaches were diagnosed with 25.2% tension headache and 18.6% migraine. Forty-one point six percent of the patients were diagnosed with secondary headache. MIDAS and PedMIDAS scales were applied to the patients and no statistically significant difference was found between the stages. The response to treatment was observed as a result of the PedMIDAS scale applied to patients diagnosed with migraine. These results have demostrated that the PedMIDAS scale can be used in children and adolescents with headache. The importance of preventive medicine in pediatric medicine is well-known in the light of this, in addition to reducing the concerns of the family and the child, the ways of coping with pain should be explained to family and the child.
Open Access
Behçet tanılı olgularda kognitif fonksiyonlar ile beyin difüzyon tensor görüntüleme bulguları arasındaki ilişkinin değerlendirilmesi
(Bezmialem Vakıf University, 2018) ATASOY BADUR, Bahar; TOPRAK, Hüseyin
Objective: To investigate the relationship between the DTG parameters obtained from the different brain localizations and the neurocognitive function test results. Material and Method: 35 adults with Behcet's disease and 21 healthy controls were participated in this study. Neurocognitive functions of the patients and the controls were evaluated with the Brief Battery Test which comprises the PASAT, Selective reminding test. Spatial recall test, Symbol digit modalities test and Word list generation test. In both of the patients and the controls, FA, ADC, MR and RD values were calculated at the 19 different localizations in the brain and the obtained values were compared with each other. Also, the correlation between the DTI parameters and the neurocognitive function test results were investigated. In addition, the effect of the presence of neurological symptoms and Neurobehcet diagnosis on the DTG parameters and neurocognitive functions were evaluated. Results: In Behcet's disease, at the cingulum and the splenium of the corpus callosum, the measured FA values were significantly lower compared with the controls. The ADC values of the corona radiata were significantly higher than the controls. Significant differences were found at the different brain localizations in patients with or without neurological symptoms and Neurobehcet. Also, between the neurocognitive functon test results and the DTI parameters, significant correlations were detected. Conclusion: Our results suggested that these findings could be an early indication of the detriment to the myelinated fibers, existence of the axonal dejeneration and the local cellular damage due to Behcet's disease and the secondary impairment of the neurocognitive functions. In addition to that, these DTI findings could be an early sign of the microstrucrural changes before the appearance of the neurologic symptoms and the conventional brain MRI findings. Our results suggested that in this patients, brain injury have been started at the cellular level due to the disease and the secondary impairment of the neurocognitive functions could be developed.
Open Access
Beta talasemi minörde serum ürotensin II düzeyi incelenmesi
(Bezmialem Vakıf University, 2017) BURHAN, Şebnem; KISKAÇ, Muharrem
Introduction and Purpose: Beta Thalassemia Minor (BTM) is a chronic hemolytic anemia due to impaired hemoglobin structure due to poor production of beta globulin chain in hemoglobin structure. Cerebrovascular and cardiovascular events in BTM have been shown in studies performed less frequently. Mechanism has not been fully elucidated. Urotensin is the most potent known vasoconstrictor. Studies have shown that Urotensin II is elevated in essential hypertension, congestive heart failure, metabolic syndrome, and carotid artery stenosis. We also thought that the possible low UII levels in BTM might be a minor effect of cerebrovascular and cardiovascular pathologies in our study and we aimed to investigate serum urotensin II level in BTM patients. Material and Methods: The subjects included in the study were divided into two groups, the BTM group (Group 1-n: 45) and the healthy controls (Group 2-n: 46). Comorbidities and drug use that are known to affect the level of urotensin II and drug use have been identified as exclusion criteria for the study. Urotensin II measurements were performed using ELISA kits. Results: In the BTM group (Group 1), 46 people were included in the study group (Group 2). There was no difference between the two groups in terms of gender, age, and BMI (p: 0.69, p: 0,166, p: 0,145). Plasma UII level averages were 352.65 ± 130.46 ng / L in Group 1 and 222.88 ± 80.44 ng / L in Group 2. Group 1 was statistically significantly higher (p <0.001). UII levels were significantly correlated with HbA2 in the positive direction (p: <0.001, r: 0.482). There was no relationship between UII levels, age, sex, and BMI. Conclusion: In our study, we had the opposite result of our hypothesis. We expected to find the UII molecule low in Group 1. We think that high UII levels in the BTM group are highly detected as hemolysis and anemia secondary to ineffective erythropoiesis in BTM. The correlation of UII level with HbA2 supports this. We think that more comprehensive studies on the effect of other protective factors should be made in less frequent ischemic vascular pathologies in BTM.
Open Access
Bezmialem Vakıf Üniversitesi Hastanelerinde Çalışan Hemşirelerin Afetlere Hazır Oluşluluk Durumları
(2019) Zeren, Hasret; Erdoğan, Özcan
This study was accomplished descriptively and cross-sectionally to determine the preparedness of the nurses working in Bezmialem Vakif University Hospitals. The study was carried out with a total of 430 nurses including 360 nurses working at Bezmialem Vakif University Medical Faculty Hospital (Vatan Campus) and 70 nurses working at Bezmialem Vakif University Dragos Hospital between the dates of 01.11.2018 - 01.02.2019. Data were collected using the Descriptive Information Form and the Basic Competence Scale of Nurses in Preparedness to Disasters. Descriptive statistics were used to evaluate the data. The average age of the nurses participating in the study was found to be 26,06±6,05 and the average duration of the study was 6,24±5,86. It was found that 76.8% of the nurses were female, 64.8% of them were single, 38% of them were high school graduates, 31.7% were associate degree graduates and 28.2% were bachelor graduates. It was determined that 53.5% of the nurses were working as service nurses and 60.6% of them did not receive any training on disasters. 69% of nurses before the disaster, 90.1% of them during the disaster, 93.7% of them after the disaster stated that nurses have a role after disaster. The average point of the nurses' preparedness for disasters was 5,03±2,38 (min-max: 0-10). Hospital disaster plan knowledge status perception point average was found to be 4,27±2,53 (. (Min-max: 0-10). It is determined that disasters which the nurses see as highly probable as earthquakes and traffic accidents with 63.4% and disaster preparedness course is the most necessary course with 47.9% as disaster management course. It is found that the average point of Basic Competence Scale of Nurses in Preparedness to Disasters was 141.46 ± 32.48, the lowest subscale point was 11.49 ± 3.42 with critical thinking skills and the highest subscale point was 48.23 ± 12.21 with technical skills. It is found a positive and weak correlation between critical thinking skills and disaster preparedness (r = 0.170). A positive and weak correlation was found between special diagnostic skills and disaster preparedness (r = 0.197). The median values of occupational groups were found to differ from the bachelor graduate nurses according to the critical thinking skills sub-dimension (p = 0.027). In the study, the preparedness level of the nurses for disasters was found to be "moderate".

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