Northern clinics of Istanbul最新文献

Objective: Chronic spontaneous urticaria is characterized by recurrent hives and/or angioedema that persists for more than six weeks, with unknown triggers. This study aimed to gather and analyze real-world data from adult patients diagnosed with chronic spontaneous urticaria who were receiving omalizumab treatment.

Methods: This retrospective observational study included adults who received omalizumab between September 2022 and February 2024.

Results: A total of 64 patients were included in the study, with a mean age of 44.3 years. Among them, 40 (62.5%) were female, and 24 (37.5%) were male. The mean duration of urticaria diagnosis was 46.6 months, with a mean omalizumab use of 23.6 months. Prior to omalizumab treatment, the most commonly used treatments were the highest dose of second-generation antihistamines (60.9%), and combination therapy with antihistamines and oral corticosteroids (31.3%). All patients received omalizumab 300 mg once every four weeks from the start of treatment and continued using antihistamines. No significant correlation was observed between the antihistamine dosage and treatment response (p=0.06). An observed interval extension and/or dose increase was noted in 23.4% of the patients. The mean Urticaria Control Test (UCT) score, weekly Urticaria Activity Score (UAS7), and Dermatology Life Quality Index (DLQI) scores significantly improved from the first visit before omalizumab treatment to the last visit after treatment (all p<0.001). Of the patients, 98.4% responded moderately or above to the treatment, 26.6% responded thoroughly, and 46.9% responded well. Only three patients (3.1%) experienced myalgia as a side effect of omalizumab therapy, with no severe adverse events reported.

Conclusion: Combination therapy with antihistamine and omalizumab is a reliable and beneficial therapy for managing chronic spontaneous urticaria.

Objective: Tracheal intubation out-of-operation theatre has a higher risk than intubation inside the theatre, and studies on this topic are sparse. Safety interventions during tracheal intubation can reduce adverse events. This study aims to assess current practices, compliance with tracheal intubation bundle guidelines, and the incidence of adverse events during out-of-operating-theatre intubations in our hospital.

Methods: A prospective observational study was conducted over a 6-month period on all tracheal intubations occurring outside the operating theatre. Data were collected through discussions with the anaesthesia duty team and review of hospital records, using a standardized proforma based on intubation bundle guidelines and adverse events. The variables were summarized using counts and percentages.

Results: Thirty-two patients required out-of-operating-theatre tracheal intubation, with the most common indication being respiratory failure in 13 (40.6%) cases. Airway assessment was performed in 21 (65.6%) cases, and nil per oral status was confirmed in 26 (81.3%) cases. Role planning by the team leader occurred in 27 (84.4%) cases. Fluid loading was administered in 24 (75%) cases, Ryle's tube aspiration in 29 (90.6%) cases, and pre-oxygenation in 30 (93.8%) cases. Rapid sequence induction was used in 26 (81.3%) cases, with first-attempt endotracheal tube placement in 22 (68.8%) cases, aided by a stylet in 21 (65.6%) cases. Capnography was not used in 29 (90.6%) cases to confirm intubation. Alternative airway securing methods (supraglottic airway) were present in 29 (90.6%) cases. Overall, 13 patients (40.6%) experienced adverse events during tracheal intubation.

Conclusion: Adverse airway events can be decreased by adhering to the intubation bundle, and staff training should be provided for effective implementation of guidelines. The use of a stylet as an intubation aid helps achieve successful first-attempt intubation and should be incorporated into the bundle. Capnography should be routinely used to confirm endotracheal tube placement.

Objective: The aim of this study is to determine the iodine deficiency status of school-age children in Canakkale, whose data were not known before.

Methods: The population of the research was created from students in the 7-11 age group studying in primary schools. 316 students were selected for the study group by multi-stage stratified sampling method. Physical examinations and anthropometric measurements of the children were performed. A survey was conducted on their families regarding the use of iodized salt. Iodine level was measured spectrophotometrically from the collected spot urine sample.

Results: One hundred forty-nine of the study group (47.2%) were male and 167 (52.8%) were female. Mean age was 8.74±1.09 years, mean height SDS was 0.45±1.09, mean weight SDS was 0.62±1.27. Iodine deficiency was detected in 25% (79) of the study group, and most of them (20.5%) had mild iodine deficiency and 51.8% of the children. The mean iodine level in Canakkale was 15.8±8.43 μg/dL.

Conclusion: In our study, we showed that the average urinary iodine level in school-age children in Canakkale was sufficient. However, we showed that Canakkale is an endemic region for iodine deficiency due to its high rate of mild urinary iodine deficiency.

Objective: The aim of this study was to investigate the effects of the February 6 earthquake on the bacteria grown in urine cultures and antibiotic resistance of patients admitted to the urology outpatient clinic.

Methods: In this study, 11,397 urine samples requested by the urology outpatient clinic between January 2022 and December 2023 were examined. We evaluated the urine cultures and antibiotic resistance profiles of the pathogens in patients' clinic in the years 2022 and 2023 separately and post-earthquake year 2023 as two separate periods, as the first 6-month period immediately after the earthquake. The pathogens grown in urine cultures and antibiotic resistance profiles were examined retrospectively. Only one of the same strains isolated in consecutive repeated growths in the urine cultures of the patients was included.

Results: Of the 11,397 urine cultures, 6,914 were requested in 2022 and 4,483 were requested in 2023. There was no statistical difference in the growth rate between the years (13.1-14.1%). When the demographic data of the first and last 6 months of 2023 were compared, statistical differences were found between the first and last six months of 2023 in terms of the number of patients for whom culture was requested, the number of culture positives, the reproduction rate, and the number of male and female patients. The total number of patients for whom urine culture was requested was 4483 (1471 in the first six months - 3012 in the last six months) (p=0.008) and the number of culture-positive patients was 630 (184-446) (p=0.007). The reproduction rates were found to be 12.5% and 14.8%, respectively (p=0.047). It was found that the resistance rates of Escherichia coli (E. coli) to gentamicin (GN), cefuroxime (CXM), cefixime (CFM) and ceftazidime (CAZ) groups of antibiotics were higher in the first six-month period of 2023 (p<0.05). Similarly, the resistance rate of Klebsiella spp. to CXM and CAZ groups of antibiotics was found to be higher in the first six-month period of 2023 (p<0.05).

Conclusion: The results of our study show that the conditions in communal living areas after the February 6 earthquake had an increasing impact on antibiotic resistance rates and antibiotic resistance rates of certain groups of antibiotics, especially the Enterobacterales group were higher in the first half of 2023.

Objective: The unfavorable effects of air pollution on respiratory health have been shown in many studies. Exposure to air pollution can lead to developing asthma and losing control over existing asthma. In this study, we aimed to evaluate the investigation of indoor air pollution in children with asthma.

Methods: 130300 measurement data obtained from all participants' home environments (29 patients diagnosed with asthma and 13 controls) were compared. The BLATN BR-SMART Multi-function Air Quality Monitor measured PM_2.5, CO₂, and formaldehyde (HCHO) levels.

Results: The age and sex distributions of the patients and controls were similar. The median age of asthmatic patients was 14 years (IQR: 9), and the median age of controls was 13 years (IQR: 9). The number of household members in the homes of asthmatic patients (median: 4, IQR: 1) was significantly higher than the controls (median: 3, IQR: 1) (p=0.035). Asthmatic patients' houses were closer to the highway than the controls (p=0.019). The frequency of homes being closer than 100 meters to the main road was higher in asthmatics (n=17, 65.4%) than in controls (n=3, 23.1%) (p=0.019). Based on all measurements, indoor CO₂ and HCHO levels in the asthmatic patient group were higher than in the controls. Although the PM_2.5 levels were also higher in asthmatic patients, this difference was statistically insignificant. According to indoor air pollution parameters throughout the day, PM_2.5 levels were found to be higher in asthmatic patients, especially between 18.00 and 06.00, when the number of people in the house was the highest.

Conclusion: Indoor PM_2.5, CO₂, and formaldehyde levels in patients with asthma were higher than controls. Management of environmental factors along with medical treatment is also essential to achieve better asthma control.

Objective: The Gleason Score is the most widely used grading system for prostate adenocarcinoma and it is the strongest predictor of the patient's clinical outcome similar to other grading systems, and plays a key role in determining the most effective treatment strategy for the patient. The Gleason scoring system is subject to both intraobserver and interobserver variability. This study aims to assess the interobserver agreement for prostate adenocarcinoma within the Gleason grading system at our center, as well as identify contributing factors.

Methods: A total of 119 cases diagnosed with prostatic adenocarcinoma at Giresun Training and Research Hospital were included in the study. Tissue samples from the cases had been subjected to routine laboratory procedures; three-micron sections were obtained from formalin-fixed paraffin blocks and stained H&E. Statistical investigation was conducted on the agreement between Gleason pattern, Gleason sum score, and grade group data among three observers.

Results: In the evaluation, interobserver agreement was found to be minimal (Gleason pattern k=0.285, total Gleason sum score k=0.309, Grade group k=0.313). The assessment indicated higher agreement in determining low grade compared to high grade, with a decrease in interobserver agreement as the grade increased. Moreover, interobserver agreement demonstrated an increase over the years (p<0.001).

Conclusion: The findings underscore the ongoing inadequacy of interobserver agreement in the Gleason scoring system. Improvement suggestions involve conducting studies to ascertain in-clinic interobserver agreement enhancing training, facilitating information sharing, and employing accessible and easily applicable artificial intelligence-supported programs.

Objective: Understanding the health system and the clinical and learning experiences from the perspective of complexity theory requires a reflective and contextual approach. The context in which experience takes place consists of multidimensional elements that influence each other, such as sociocultural environment, work/educational climate, stakeholders, educational/healthcare system. In this framework, it is important to read and analyze the parties' experiential narratives within their contexts. The aim of this study is to analyze the narratives of the team working in a surgical clinic about their clinical education and healthcare experiences in terms of the "institutional, clinical and national system" as one of the contextual elements in which the experience is lived. In line with this purpose, the research problems were identified as follows: (1) what are the experiences and narratives of the team regarding the system in clinical education and healthcare processes, (2) how do the parties relate to the system, and (3) what are the outcomes of different ways of relating?

Methods: This narrative study was conducted in the surgical clinic of a university hospital. The voluntary participant group consisted of 31 participants, including clinical instructors (n=5), surgical residency students (n=5), medical students/interns (n=15) and nurses (n=6) working as a team in the clinic. The narratives obtained through in-depth interviews were analyzed using the "Three-Stage Contextual Theme Analysis" created for this study.

Results: The themes that emerged from the analysis were grouped under three contextual categories: "clinical system: structure, functioning and workload", "clinical environment, climate and culture", "national, social environment and extra challenging situations". The themes related to the consequences of these contextual experiences were grouped under two categories: "ways of coping/not coping" and "consequences/effects".

Conclusion: The contextual dimension of the experience can cause parties to live experiences in their own way and to focus more on their context and not see enough of what others experience. This points to the importance of planning, conducting and evaluating clinical education, research and healthcare processes within their context, including the system.

Clinical decision support (CDS) tools play a crucial role in assisting healthcare professionals in making informed decisions. However, the full potential of CDS systems has not been realized due to various usability issues. This paper provides an overview of usability issues identified in CDS tools, including graphical user interface issues, user experience problems, terminology clarity, and user control problems. Several usability assessment methods, such as heuristic evaluation, think-aloud testing, cognitive walk-through, and surveys, are employed to evaluate CDS tool usability. These methods reveal strengths and weaknesses in CDS tool design, guiding improvements to enhance usability. The findings of this review emphasize the importance of incorporating user feedback, employing iterative processes, and addressing interface design challenges to optimize the usability and acceptance of CDS tools in healthcare settings. By addressing these usability issues, healthcare professionals can leverage CDS tools effectively to improve patient outcomes.