Goal: 16 - Barış, Adalet ve Güçlü Kurumlar
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Diagnostic value of electroencephalography inpatient patients: Effect on clinical decision-making Yatan hastalarda elektroensefalografinin tanısal değeri: Klinik karar verme üzerine etkisi
© 2020, Istanbul Universitesi. All rights reserved.Objective: To evaluate the efficiency of electroencephalography (EEG) requested at the consul-tation. Methods: EEGs for which consultation was requested in one year were analyzed retrospectively. Neurology consultation notes, EEG forms, compliance with EEG findings were examined for each pa-tient. Demographic data, requested unit, pre-diagnosis, final diagnosis were recorded. EEG results were divided into 3 groups:1)normal, 2)EEG with epileptiform anomaly (EEG-EA),3)EEG with nonepilepti-form anomaly (EEG-NE). EEGs were also evaluated for their indications and contribution to diagnosis. Results: A total of 261 EEG recordings of 239 patients (133 men, average age 56.44 (18-90)) were examined. 30.5% of the registered patients had a history of neurological diseases. EEGs were requested from 36.4% intensive care units and emergency departments, 51.5% internal branches, 12.3% surgical branches. Preliminaries were seizures in 42.5%, alertness/encephalopathy in 17.2%, syncope in 5.7%, nonconvulsive status epilepticus (NCSE) in 10.3%. 55% of EEGs were considered nor-mal. 37.5% were in EEG-NE, 8.4% in EEG-EA. 91.6% of patients were imaged, 52.5% were pathological. Focal imaging pathology and EEG findings were compatible in 63% of patients with pathological EEG findings. EEG was pathological in 64.5% of the 127 patients requested with appropriate indications. 80% of EEG was thought not to contribute to the definitive diagnosis. Discussion: Male and advanced elderly people with neurological disease were preferred for EEG. Appropriate indication with a desired high probability of detection of pathological EEG. It is important that the doctor who evaluates the inpatient patient makes more careful decisions in terms of unneces-sary process, resource and time wasting.
Inflammation, Frailty and Cardiovascular Disease
Chronic inflammation, which is called -inflamm-aging-, is characterized by an increased level of inflammatory cytokines in response to physiological and environmental stressors, and causes the immune system to function consistently at a low level, even though it is not effective. Possible causes of inflammaging include genetic susceptibility, visceral obesity, changes in gut microbiota and permeability, chronic infections and cellular senescence. Inflammation has a role in the development of many age-related diseases, such as frailty. Low grade chronic inflammation can also increase the risk of atherosclerosis and insulin resistance which are the leading mechanisms in the development of cardiovascular diseases (CVD). As it is well known that the risk of CVD is higher in older people with frailty and the risk of frailty is higher in patients with CVD, there may be relationship between inflammation and the development of CVD and frailty. Therefore, this important issue will be discussed in this chapter.
Serum endocan levels in women with restless legs syndrome.
Background: Endocan is a recently introduced marker of endothelial dysfunction. The objective of this study was to compare serum endocan levels in patients with restless legs syndrome (RLS) and control subjects in order to elucidate whether RLS is associated with endothelial dysfunction. Methods: A total of 31 drug naïve female patients with RLS and 31 age- and BMI-matched women were included in the study. Patients with pathological or physiological conditions or with a history of medication use that could potentially influence endothelial functions were excluded, as well as those with alcohol or drug abuse history. The two groups were compared with routine blood tests and serum endocan levels. Results: Patients with RLS had lower serum endocan levels than the controls (P=0.037). There was a negative bivariate correlation between RLS severity score and serum endocan levels (r=-0.406, P=0.023). While white blood cell count was significantly higher in RLS group, 25-hydroxy vitamin D3, vitamin B12, transferrin saturation rate, and HDL-cholesterol were significantly lower. Creatininemia and diastolic blood pressure were also marginally insignificantly lower in RLS group. Due to the presence of differences between two groups in these variables, a linear regression analysis was performed that showed a positive association between endocan and creatininemia (β=0.310, P=0.022), and a negative association between endocan and RLS (β=-0.502, P,0.001). Conclusion: The results of this study seem to suggest that patients with RLS may have better endothelial functions when compared with the general population and that these patients may be better protected against atherosclerosis
Workplace violence against medical student- A Turkish perspective
Background: Workplace violence against healthcare providers including the medical students being an important issue all over the World. The aim of this study is to survey the medical students about exposure to workplace violence (WPV) while they are doing their medical training in private tertiary hospitals. Methods: This was a cross-sectional study carried out among all medical students (4th, 5th, and 6th class) attending a teaching hospital at Bezmialem Vakif University (BVU), Istanbul, Turkey. A total of 150 students in the 2017-2018 academic year were recruited in this study. Data were collected using a modified questionnaire through a face to face interview. Data were analyzed using SPSS 16. Results: About one-third of the surveyed students (54, 36.0%) exposed to violence and 71.3% of them witnessed incidents of violence against healthcare providers at the workplace. The prevalence of physical violence and verbal abuse among medical students was reported at 5.5% and 92.6% respectively. About 81.5% were females compared to 18.5% of their counterparts. Patients (38.9%) and their relatives (61.1%) were the main sources of the violence respectively. More than half (57.0%) of students exposed to violence at outpatient services and 25.9% at the emergency room and 16.7% at inpatient wards. Few of them (22, 14.7%) thought that they will get support if they make a complaint. Conclusion: Being a medical student and has direct contact with patients and their relative is not always safe practice. Our results suggested a high prevalence of verbal and physical abuse against medical students. Health sector authorities should adopt a restrictive and clear strategy to protect medical students and other healthcare providers.
Which Unicondylar Prosthesis Has Better Mid-Term Results: Fixed or Mobile?
Objective: Osteoarthritis, which is one of the most common causes of pain and motion loss, is an important medical disease that particularly affects elderly people. Unicondylar knee arthroplasty treatment is still a challenge for obese and/or ACL deficient patients. In addition, surgeons face a challenge of deciding whether to perform either fixed or mobile insert design prosthesis. The objective of this study was to evaluate the effect of fixed or mobile insert design prosthesis on the mid-term results of patients that we followed up for 8 years or more.
Discordance between Serum Neutralizing Antibody Titers and the Recovery from COVID-19
The recent pandemic of COVID-19 has caused a tremendous alarm around the world. Details of the infection process in the host have significant bearings on both recovery from the disease and on the correlates of the protection from the future exposures. One of these factors is the presence and titers of neutralizing Abs (NAbs) in infected people. In the current study, we set out to investigate NAbs in the recovered subjects discharged from the hospital in full health. Serum samples from a total of 49 documented consecutive COVID-19 subjects were included in the study. All the subjects were adults, and serum samples collected during the discharge were tested in viral neutralization, enzyme immunoassay (EIA), and Western immunoblot tests against viral Ags. Even though a majority of the recovered subjects had raised significant NAb titers, there is a substantial number of recovered patients (10 out of 49) with no or low titers of NAbs against the virus. In these cohorts as well as in patients with high NAb titers, viral Ag binding Abs were detectable in EIA tests. Both NAb titers and EIA detectable Abs are increased in patients experiencing a severe form of the disease, and in older patients the Ab titers were heightened. The main conclusion is that the recovery from SARS-CoV-2 infection is not solely dependent on high NAb titers in affected subjects, and this recovery process is probably produced by a complex interplay between many factors, including immune response, age of the subjects, and viral pathology.
Global overview of health systems oversight and financing for kidney care
Reliable governance and health financing are critical to the abilities of health systems in different countries to sustainably meet the health needs of their peoples, including those with kidney disease. A comprehensive understanding of existing systems and infrastructure is therefore necessary to globally identify gaps in kidney care and prioritize areas for improvement. This multinational, cross-sectional survey, conducted by the ISN as part of the Global Kidney Health Atlas, examined the oversight, financing, and perceived quality of infrastructure for kidney care across the world. Overall, 125 countries, comprising 93% of the world's population, responded to the entire survey, with 122 countries responding to questions pertaining to this domain. National oversight of kidney care was most common in high-income countries while individual hospital oversight was most common in low-income countries. Parts of Africa and the Middle East appeared to have no organized oversight system. The proportion of countries in which health care system coverage for people with kidney disease was publicly funded and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis (63%), and kidney transplantation (57%), but was much less common in lower income countries, particularly Africa and Southeast Asia, which relied more heavily on private funding with out-of-pocket expenses for patients. Early detection and management of kidney disease were least likely to be covered by funding models. The perceived quality of health infrastructure supporting AKI and chronic kidney disease care was rated poor to extremely poor in none of the high-income countries but was rated poor to extremely poor in over 40% of low-income countries, particularly Africa. This study demonstrated significant gaps in oversight, funding, and infrastructure supporting health services caring for patients with kidney disease, especially in low- and middle-income countries.
Primary Retroperitoneal Mucinous Cystadenocarcinoma: 5th Male Case in the Literature
Retroperitoneal primary mucinous tumor is an extremely rare malignancy. To date, only 52 cases of primary retroperitoneal mucinous cystadenocarcinoma (PRMC) have been reported in the literature, with the majority being women. Our patient is the 5th known male case. A 57-year-old male patient presented with a two year history of an undefined abdominal pain. Computed tomography demonstrated a 12 x 9.5 cm cystic mass lesion extending superiorly from right iliac fossa, while localizing below the abdominal wall and close to the psoas muscle. According to the laparotomy, iliopsoas muscle was infiltrated by the mass in the retroperitoneal region. Pathological diagnosis was mucinous cystadenocarcinoma. The asymptomatic patient was followed up without applying an adjuvant chemotherapy, since the clinical course of the tumor is known to be slow and postoperative therapy is not recognized as a standardized treatment. The clinical course of PRMC is generally indolent, however, it may manifest an aggressive course, as well. It has no definitive and clear pathogenesis. The treatment is contentious, as well. Diagnosis and treatment require surgical excision but data on adjuvant chemotherapy is limited.
Administration of rectal cytotec versus rectal buscopan before hysteroscopy
Introduction:Our objective was to compare the effect of rectal misoprostol (Cytotec) versus rectal hyoscine-n-butyl bromide (Buscopan) on patients undergoing hysteroscopy. We hypothesised that HBB may have a role in cervical priming. Material and methods:This trial was conducted at Bezmialem Vakif University Hospital. Women of reproductive age between 18-50 years who were scheduled for operative hysteroscopy indicated by type 1 submucous myoma or endometrial polyps were recruited for the study. Ninety patients were divided randomly into three groups. Group 1 received placebo treatment. Group 2 received rectal 200 mcg misoprostol and Group 3 received rectal 20 mg hyoscine-n-butyl bromide two hours before the procedure. Procedures were performed using a bipolar 26 F (9 mm) continuous-flow rigid resectoscope with a 30 degrees lens. The outcome measures included cervical dilation width and time, ease of cervical dilation, procedure time and operative complications. Postoperative self-rated pain was assessed one hour after the procedure. Results:Thirteen patients (43. 3%) in the placebo treatment group, 11 patients (36.7%) in the misoprostol group and four patients (13.3%) in the hyoscine-n-butyl bromide group needed analgesics postoperatively (p = .02). The mean duration of cervical dilation time was longest in Group 1 and shortest in Group 3, however this difference did not reach statistical significance (p=.11). There was no difference with regard to other studied parameters. Summary:HBB reduced the need for pain medication compared to placebo. Larger studies are needed to further investigate the role of HBB in facilitating pre-operative cervical priming.
Violence related behaviours among adolescent students and factors affecting thereto
© 2015 Eker HH, et al.Background: Violence among young people is an important public health problem in society. Act of violence seen in schools is disturbing students- learning processes and inhibiting their developments generally results in emotional abuse, physical injury and death. Objectives: This study is conducted in order to find out the prevalence of and exposure to violence, which is an important public health problem, in schools and to determine the factors affecting thereto. Specific factors investigated were exposure to violence, gender, age, type of school, economic status of families and level of education of mothers. Method: This cross-sectional study was performed between March 2012 and May 2012. The population is 1575 students from 9th grade and the study is completed with 1405 students accepting to participate therein. A study questionnaire form established based on the -Youth Risk Behaviour Survey (YRBS)- prepared by CDC (Center for Disease Control and Prevention) is used as data collecting tool. Results: The ratios of each violence-related behaviour are 35.8% and 14.1%, respectively for boys whereas 20.4% and 6.4% for girls. These behaviours are statistically more common among boys than girls (p < 0.05). It was found out that there is a significant relationship between the students- family income level and getting involved in a physical fight in school (p < 0.05).Though no significant relationship is detected between mother-s educational level and getting involved in a physical fight and carrying weapons, ratios of gang membership is 6.2% for students whose a mother is illiterate and is 14.3% for student whose mother-s educational level is high school and above (p < 0.05) Conclusions: It is observed that each violence-related behaviour is more common among boys and with the increase in the mother-s education, tendency of being a member of a gang and getting involved in a physical fight accordingly increases.