Northern clinics of Istanbul最新文献

Objective: In our study, the protective effect of dodder plant extract against encephalopathy induced by cholestatic liver disease model was investigated.

Methods: Spraque Dawley rats were used in the study. For the cholestatic liver disease model, the bile duct ligation (BDL) was applied. The groups were determined as control, Cuscuta sp. (CUS), BDL and BDL + CUS. Double ligation was performed in the bile duct in the BDL groups. For the applications, saline (SF) was administered to the control and BDL groups for 28 days while 250 mg/kg of Cuscuta sp. extract was given by oral gavage to the CUS and BDL + CUS groups. At the end of the experiment, cognitive evaluations were made by applying new object recognition and Morris water maze tests. After these tests, blood-brain barrier (BBB) measurements were made in half of the groups. In the other half of the groups, brain tissue samples were taken by decapitation and transforming growth factor-beta (TGF-β), 8-hydroxydeoxyguanosine (8-OHdG) and sodium-potassium adenosine triphosphatase (Na⁺/K⁺-ATPase) measurements were made in the tissues. Histological examinations of the tissues were also performed.

Results: Cognitive performance was low, and BBB permeability was found to be increased in the group with bile duct ligation. In addition, TGF-β and 8-OHdG levels were increased in tissues, while Na⁺/K⁺-ATPase enzyme activity was suppressed. Treatment with Cuscuta sp. increased cognitive performance and decreased BBB permeability. Other biochemical parameters examined were significantly (p<0.05-0.001) reversed and supported by histological findings.

Conclusion: Our findings in the study suggest that dodder plant may be beneficial for the protection of cognitive performance and brain tissue in encephalopathy caused by cholestasis.

Objective: The purpose of this study is to assess the postoperative physical activity limitations and balance changes in patients who have been operated on for breast cancer. Some physical activity limitations and balance disorders can be expected after breast cancer surgery.

Methods: From 2008 to 2016, 112 patients who underwent breast cancer surgery were included in this study. The patients who have some neurological, physical, pulmonary or cardiac diseases were not included. Patients were invited to the hospital. Lack of balance and physical activity limitations were evaluated with a questionnaire including 17 questions.

Results: On the postoperative frequency distribution of physical activities criteria out of 112 patients %33.1 (n=37) people got 4 points and over while %66.9 (n=75) people got less than 4 points. After the operation, since more than 75 people got less than 4 points, it is accepted as inadequate in terms of physical activity. Looking at balance changes, in patients with breast-conserving surgery (BCS)were approximately 5.94-0.82 where as average modified radical mastectomy (MRM)was 5.94-0.41. According to criteria on postoperated patients' balance changes, the value of f was 3.162, contrary to this, as the value of p was found 0.078. Differences between operation and balance changes were not significant.

Conclusion: The patients who have had breast cancer surgery, physical activities were limited and life quality was down after the operation. On the other hand, there was no significant difference on balance changes depending on the operations.

Objective: Cyclin D1 (CDDN1) is an important protein for mitotic cell cycle advancement through the G1 phase and contributes to the control of the cyclin-dependent kinases CDK4 and CDK6. We evaluated the relationship between CDDN1 expression and clinicopathological features in prostate cancer (PCa) cases and whether CDDN1 could be used as a prognostic biomarker for PCa cases in this study.

Methods: This study comprised ninety cases; seventy-five had PCa and fifteen had benign prostatic hypertrophy (BPH) diagnoses (as the control group). The pathological specimens were stained immunohistochemically and categorized as a 'low' (L) or a 'high' (H) group for CDDN1 expression. The cases' clinicopathological features and survival rates were evaluated statistically, within a 95% confidence interval, p<0.05, retrospectively.

Results: The median follow-up time was 75 (17-96) months, and the median overall survival (OS) was 87 months (CI 95%: 74.74-99.25). While the OS was 66 months (CI 95%: 49.61-82.38) in the H-CDDN1 group, the OS of the L-CDDN1 group was not yet reached. The OS of the L-CDDN1 group was longer in statistical significance (p=0.011). A Cox regression analysis revealed that the levels of CDDN1 expression, the values of lactate dehydrogenase, and post-treatment prostate specific antigen were found to be prognostic factors for OS in PCa cases (p<0.05).

Conclusion: Our results suggest the overexpression of CDDN1 is a potentially useful but poor prognostic biomarker for PCa cases.

Objective: In our study, we attempted to determine the accreditation process experience of hospital senior managers accredited by the Turkish Health Care Quality and Accreditation Institute (TUSKA). Along with the institutions' accomplishments through the accreditation program, the major challenges they faced during the accreditation process were revealed.

Methods: One of the qualitative research designs used was interpretive phenomenological analysis, which was carried out through semi-structured interviews with hospital senior managers.

Results: In the study conducted with eight participants, 55 sub-themes emerged under 12 main themes. The participants expressed their opinions on a wide range of topics, from the achievements related to the accreditation process to the difficulties they encountered, from their strengths to the dissemination of accreditation throughout the country.

Conclusion: It has been understood that the national hospital accreditations carried out in our country provide important gains to the institutions in management and clinical activities, while the expectations on incentives and other similar issues have not yet been met.

Objective: This retrospective study was conducted in a tertiary hospital in Turkiye, it was aimed to evaluate the results of kidney and bladder ultrasonography, uroflowmetric study and volume frequency chart in children diagnosed with bedwetting at night.

Methods: This study focused on patients aged 5-17 years who were treated for nocturnal enuresis in the single-center pediatric urology clinic of a tertiary hospital between 2017-2021. Patients' comorbidities, surgical history, urinary ultrasonography findings, uroflowmetry examination results, and two-day voiding diary were requested.

Results: The number of pediatric patients diagnosed with enuresis nocturna was 956. Abnormal ultrasonography findings were observed in 13.9% of patients. Almost half of the patients had a positive family history, and 13.4% had a history of previous surgical procedures. While the voiding diary indicated that 54.2% of patients had bladder volumes equivalent to the expected bladder capacity, uroflowmetry examination revealed low bladder capacity in 65% of patients.

Conclusion: This study underscores the significance of comprehensive evaluations, including detailed ultrasonography and voiding diary measurements, in pediatric patients with monosymptomatic enuresis nocturna. Our study suggests that bladder volume measured through a two-day weekend voiding diary may provide more effective information for estimating optimal bladder capacity compared to measurements obtained through uroflowmetry.

Objective: Information regarding pregabalin use is limited. We aimed to assess the outcome of the patients who have taken pregabalin at a certain time during their pregnancies.

Methods: 31 patients used pregabalin treatment during pregnancy and 93 control patients were included in the study who applied to hospital between the years 2013-2022. In this multicenter case-controlled study, the outcome of the pregnancies and the health condition of the newborn in the pregabalin and control groups were evaluated.

Results: Preterm delivery rates (5/27 (18.5%) vs. 5/87 (5.7%); OR 0.26, 95% CI 0.07-1.01, p=0.04) and lower birth weight (6/27 (22.2%) vs. 5/81 (6.6%); OR 4.34, 95% CI 1.20-15.65, p=0.016) were found higher in the pregabalin group compared to the control group. However, significant difference was not found between the birth dates of babies in pregabalin and control groups with the log-rank test (p=0.30). Spontaneous abortion rates were not significantly different (2/31 (6.4%) vs. 4/93 (4.3%); OR 1.52, 95% CI 0.26-8.72, p=0.63). Although major malformation rates in pregabalin were higher than those in controls (3/27 (11%) vs. 4/88 (4.5%); OR 0.38, 95% CI 0.07-1.82, p=0.21) the outcomes were statistically insignificant.

Conclusion: Preterm delivery rates and lower birth weight were higher in pregabalin group. Also, it should not be ignored that chronic diseases of the pregnant women in pregabalin group may affect the outcomes poorly.

Objective: To compare one-year anatomical and functional results of switching to an on-label intravitreal anti-vascular endothelial growth factor (anti-VEGF) agent (intravitreal ranibizumab [IVR] or aflibercept [IVA]) after treatment failure with three loading doses of off-label intravitreal bevacizumab (IVB), which is mandatory in the treatment of neovascular age-related macular degeneration (nAMD) to get reimbursement from Social Security Institution in Turkiye.

Methods: This comparative, real-life, retrospective cohort study included treatment-naïve nAMD patients treated starting with three loading doses of IVB, switched to three loading doses of IVR and IVA due to treatment failure after IVB loading, and followed up one year with a treat-and-extend (T&E) protocol with 2-week extension/shortening intervals. The primary outcomes were changes in best-corrected visual acuity (BCVA; logMAR) and central macular thickness (CMT, µm) one year after the switch, and the secondary outcomes were maximum treatment intervals, number of injections, and disease activity rates.

Results: The mean age (72.9±8.2 and 72.2±6.7, p=0.677) and gender (60.0% and 47.4% females, p=0.398) were similar among the IVR (35 eyes/patients) and IVA (38 eyes/patients) groups. The median BCVA and CMT were significantly improved during the study period (p<0.001) with no significant intergroup differences. The ratio of 4-, 6-, 8-, 10-, and 12-week maximum treatment intervals were 28.6%, 17.1%, 14.3%, 8.6%, and 31.4% in the IVR, and 13.2%, 15.8%, 21.1%, 15.8%, and 34.2% in the IVA group (p=0.492). The median (IQR) number of injections in the IVA group (8 [7-9]) was significantly lower than the IVR group (9 [8-12]) during the one-year T&E period (p=0.026). The disease activity rates were 34.3% and 26.4% one month (p=0.610) and 37.1% and 21.1% one year (p=0.195) after the switch in IVR and IVA groups.

Conclusion: This real-life comparison study indicates that, after the treatment failure with three loading doses of IVB, switching to either on-label anti-VEGF agent can be regarded as comparable considering functional and anatomical results. However, although maximum treatment intervals were not significantly different, fewer injections were required with aflibercept during the one-year T&E follow-up period.

Objective: The purpose of this study is to demonstrate the potential effects of thymoquinone, a well-known antioxidant agent, on random flap viability and thus to improve the clinical use of these flaps.

Methods: In this study, 24 Sprague Dawley female albino rats weighing between 200-250 grams were used. Three groups consisting of randomly selected 8 rats were formed, as study, sham and control groups. Modified McFarlane flap model sized 3x9 cm. was used. In control group, only local wound care was carried out for ten days after flap elevation. In sham group, daily intraperitoneal dimethyl sulfoxide (DMSO) solution was injected in the post-operative 10-day period. In the study group thymoquinone and DMSO solution were injected intraperitoneally together. 10 days later, the study was terminated and flaps were photographed for necrotic area measurements, tissue and blood samples were taken out for biochemical and histopathological studies. In biochemical studies, tissue and serum total antioxidant capacity (TAC) and thiobarbituric acid reactive substrates (TBARS) levels were measured. Histopathological studies included inflammatory cell infiltration, collagen, fibroblast formation and angiogenesis.

Results: There was significant decrease in the necrotic areas of flaps in the study group. Serum and tissue antioxidant levels were significantly high and TBARS levels were significantly low. Histopathological examination showed no significant difference in inflammatory cell infiltration, fibroblast formation or angiogenesis between the groups. However, collagen density in the study group was found to be more than the other groups and the structure was better formed.

Conclusion: Thymoquinone increases the flap viability due to its antioxidant properties and it has a positive contribution to wound healing, although it has no significant anti-inflammatory or anjiogenetic activity. In the future, we think that it can be clinically useful for preventing distal flap necrosis in patients with high risk.

Objective: The aim of this study was to determine the effectiveness of a virtual service/patient-based program (vSPBP) developed for nursing education and its effect on the development of care plan preparation and clinical decision-making skills.

Methods: The study was conducted in a quasi-experimental design with a sample of fourth-year nursing students. Participants were assigned to the intervention group (n=44) and control group (n=51). The intervention group participated in a full-day vSPBP in addition to clinical training, whereas the control group received only the clinical training. Both groups were evaluated at the end of the intervention for care planning skills and at the beginning, middle, and end of the academic year for clinical decision-making skills. The Modified Simulation Effectiveness Tool (mSET) and focused group interview were used to evaluate the effectiveness of the vSPBP; nursing students' Clinical Decision-Making in Nursing Scale (CDM-NS) and Care Plan Evaluation Form were used to evaluate learning outcomes. Quantitative data were analyzed using the t-test and ANOVA. Qualitative data were analyzed by three researchers, and themes were identified. Ethical permissions were obtained from the relevant units.

Results: The total score of the Turkish Version of the mSET was 84.39±12.08 (51-95) and the education program was found to be highly effective. The mean care plan preparation skills scores of the intervention and control groups were 44.84±2.77 and 27.75±4.28 (0-50), respectively, and the total scores of the CDM-NS (at the last measurement) were 147.90±11.28 and 146.42±12.21. While there was a significant difference between the intervention and control groups in the ability to prepare a care plan (p=0.001), there was no difference between the groups in clinical decision-making skills over time (p=0.433), between the second and third measurements over time (p>0.05), but both measurements increased significantly compared with the first measurement (p=0.000).

Conclusion: The vSPBP was determined to be an effective learning activity for the development of care plan preparation and clinical reasoning skills, as well as effective in closing the gap between theoretical and clinical knowledge and adaptation to the nursing process when applied in an integrated manner with the existing nursing program.