Türkiye’de stoma açılan hastaların kesitsel değerlendirilmesi

Aim: Despite recent technological developments, a stoma formation is needed for the treatment of many diseases, especially in colorectal surgery. Due to the radical principles of cancer treatment, the number of patients living with stoma is increasing. However, there is no study that quantitatively evaluates the stoma patients nationally. In this study, it was aimed to retrospectively evaluate the demographic data, indications, preferred types of stoma and the outcomes of patients who had a stoma formation in our country in the last three years. Method: In our country, there are 3 companies that operate in the field, provide materials for 95% of stoma patients. The data of patients who had a stoma between 2017 and 2019 were collected from these companies retrospectively by protecting personal privacy of patients. The distribution of indications and type of stoma acording to indications were determined. Average age, stoma closure rates and mortality rates were calculated. All data are presented as numbers and percentages and categorical variables are shown as median (minimum-maximum), continuous variables are shown as ± standard deviation. Results: The most common indication for stoma creation was colorectal malignancy (58.4%) and followed by mechanical bowel obstructions (29.6%). Other malignancies (4.16%), inflammatory causes (4.58%), traumatic causes (1.88%) and congenital anomalies (1.17%) constituted a total of 11% stoma indications. It was observed that. ostomies opened due to colorectal malignancy,were closed in 40% of patients with loop ileostomy, 30.1% of patients with loop colostomy, and only 13% of patients with end colostomy. Conclusion: We aimed to obtain a national perspective by evaluating the patients who had a stoma in the last 3 years and to show up the distribution of stoma formation indications in our country. We have determined the demographic data of patients with stoma and calculated the stoma closure and mortality rates according to stoma types. Although this study is a cross-sectional evaluation of patients in the whole country, weak point of our study is there are deficiencies in our evaluation due to the lack of retrospective data. We think that prospective studies should be planned by detailing subgroups.Amaç: Ülkemizde stomalı bireyleri niceliksel olarak inceleyen çalışma henüz bulunmamaktadır. Bu çalışmada ülkemizde son üç yıl içinde stoma açılmış olan hastaların demografik verilerinin, endikasyonlarının, tercih edilen stoma tiplerinin ve hastaların akıbetlerinin retrospektif olarak değerlendirilmesi amaçlanmıştır. Yöntem: Ülkemizde stoma alanında faaliyet göstermekte olan ve stoma hastalarının stoma malzemelerini sağlayan 3 firmanın 2017-2019 yılları arasında, malzeme temin ettiği stoma hastalarının bilgileri, kişisel verilerin gizliliği kurallarına dikkat edilerek retrospektif olarak derlenmiştir. Endikasyona göre hastalara hangi tip stoma açıldığı, bu hastaların cinsiyete göre dağılımı (minimum-maksimum), yaş ortalamaları, stoma kapatılma oranları, ölüm oranları hesaplanmıştır. Bulgular: En sık stoma oluşturma endikasyonunun kolorektal malignite olduğu ve tüm stomaların %58,4’ünü oluşturduğu görüldü. Bunu mekanik barsak tıkanıklıkları (%29,6) takip etmekte idi. Diğer maligniteler (%4,16), enflamatuvar sebepler (%4,58), travmatik sebepler (%1,88) ve doğumsalanomaliler (%1,17) toplamda yaklaşık %11 oranında stoma açılmasına endikasyon oluşturmaktaydı. Kolorektal malignite nedeni ile açılan stomalar değerlendirildiğinde loop ileostomi uygulanan hastların %40’ının, loop kolostomi uygulanan hastaların %30,1’inin stoması kapatılabilmişken, uç kolostomi uygulanan hastaların sadece %13’ünün stomasının kapatıldığı görülmüştür. Sonuç: Ülkemizde son 3 yıl içinde stoma açılmış olan hastaları değerlendirerek ulusal anlamda geniş bir perspektif elde etmeyi amaçladık. Stoma ile yaşamak durumunda olan hastaların demografik verilerini, kaçının stomasının kapatılabildiğini ve stoma tiplerine göre stoma kapatılma ve ölüm oranlarını tespit ettik. Stomalı bireylerin analizini gerçekleştirdiğimiz bu çalışma, ulusal anlamda gerçekleştirilen ilk çalışma olmasına rağmen, retrospektif verilerdeki eksiklikler nedeni ile değerlendirmemizde yetersizlikler mevcuttur. Alt grupların detaylandırılarak, prospektif özellikte çalışmaların planlanması gerektiğini düşünüyoruz

Postmenopozal Romatoid Artritli Hastalarda Bifosfonat Tedavisinin Hastalik Aktivitesi Üzerine Etkisi

INTRODUCTION: Bisphosphonates therapy may be potentialadjunctive therapy agents of synthetic disease modifying antirheumaticdrugs in rheumatoid arthitis patients who have contraindications andwho are intolerant to biologics. The aim of this retrospective study wasto evaluate the effects of adjunctive Bisphosphonates on disease activityof our patients with rheumatoid arthitis who underwent the syntheticdisease modifying antirheumatic drugs therapy.MATERIAL AND METHOD: Retrospective data were collectedfrom patient records of our Rheumatology department outpatientclinic. Files of 207 patients who are over 45 years old and whose bonemineral density were evaluated in the previous year were screened forthe study. Patients demographics, medications, disease duration, theage of disease onset, anti-Cyclic Citrullinated Peptid, Rheumatoid factorpositivily, Disease activity scores positivity were recorded. Bone mineraldensitometry analyses were performed in patients by Dual EnergyX-ray Absorptiometry. 106 patients (89 women, 17 men) who receivedbisphosponates therapy for 1 year constituted group1 and 101 patients (81women 20 men) who did not receive bisphosponates constituted group 2.RESULTS: The mean age of group 1 was 65.02 11.14 years and group2 was 63.649.1 years (p 0.05). There was no statistically significantdifference between groups in terms of age, gender and disease durationparameters. There were no statistically significant difference according todisease modifying antirheumatic drugs type and dosages between groups(p 0.05) but in group 1, prednisolone users were more than group 2(p 0.001). The mean tender joint count changes were -0.640.63 ingroup 1 and 0.420.62 in group 2 (p0.001). There were no significantdifference according to bone mass density values of prednisolone usersand nonusers at baseline and after 1 year.DISCUSSION: For patients who cannot be treated with biological agents,effective prevention of focal bone damage and generalized bone losswill require new treatment strategies, like concomitant administrationof drugs with specific effects on bone metabolism. Bisphosponates canprevent generalized bone loss and therapies may yield both medical andeconomic benefits in patients with rheumatoid arthritis.CONCLUSION :We think that adjunctive bisphosponates may provideadditional benefits in older rheumatoid arthritis patients with systemicand regional bone loss. However, further studies are needed to determinewhether bisphosphonate therapies must be administered routinely with thedisease modifying antirheumatic drugs and biologics.GİRİŞ: Bifosfonat tedavileri, biyolojik ajanlara intoleransı veyakontreendike durumu olan romatoid artrit hastaları için sentetikhastalık modifiye edici ajanların etkisini tamamlayan ajanlar olabilir. Buretrospektif çalışmanın amacı bifosfonat tedavisinin sentetik modifiyeedici ajan kullanan romatoid artrit hastalarındaki hastalık aktivitesiüzerine etkisini incelemektir.MATERYAL VE METHOD: Veriler kliniğimizin romatolojidepartmanındaki hasta kayıtlarının retrospektif olarak incelenmesiile elde edilmiştir. Çalışma için, 45 yaş üstü ve ardışık yıllarda kemikmineral yoğunluğu değerlendirilen 207 hasta dosyası tarandı. Hastalarındemografik bilgileri, ilaçları, hastalık süreleri, hastalığa yakalandıklarıyaş, anti-siklik sitrullin peptit, romatoid faktör pozitifliği, hastalık aktiviteskorları gibi bilgiler kayıt edildi. Kemik mineral dansitesi analizleri dualenerji x-ray absorptiometri ile yapıldı. Bir yıldır bifosfonat tedavisi alan106 hasta (89 kadın, 17 erkek) grup1, bifosfonat tedavisi almayan 101hasta (81 kadın, 20 erkek) ise grup 2 olarak ayrıldı.BULGULAR: Grup 1 hastaların yaş ortalaması 65.02 11.14 yıliken, grup 2 hastalarınki 63.649.1 yıl idi (p0.05). Gruplar arasındayaş, cinsiyet, hastalık süresi açısından istatistiksel olarak anlamlı farkyoktu. Gruplar arasında kullanılan hastalık modifiye edici ilaç tipleri vedozajları arasında istatistiksel olarak anlamlı fark yoktu (p0.05), fakatgrup 1'de prednizolon kullanımı grup 2'den daha fazlaydı (p0.001).Ortalama hassas nokta sayısındaki değişimler grup 1'de -0.640.63,grup 2 ise 0.420.62 idi (p0,001). Bir yıl sonunda prednizolon kullananve kullanmayan hastalar arasında kemik mineral dansitesi değerleriaçısından istatistiksel olarak anlamlı fark yoktu.TARTIŞMA: Biyolojik ajanlarla tedavi edilemeyen hastalar için, fokalkemik hasarının ve genel kemik kaybının etkili bir şekilde önlenmesi,kemik metabolizması üzerinde belirli etkilere sahip ilaçların eşzamanlıuygulanması gibi yeni tedavi stratejileri gerekmektedir. Bisfosfonatlar,jeneralize kemik kaybını önleyebilir ve romatoid artritli hastalarda hemtıbbi hem de ekonomik yararlar sağlayabilir.SONUÇ: Bifosfonatların, sistemik ve bölgesel kemik kaybı olandaha yaşlı romatoid artritli hastalarda ek yararlar sağlayabileceğinidüşünüyoruz. Bununla birlikte, bifosfonat tedavilerinin, rutin olarakantiromatizmal ilaçlar ve biyolojik maddeleri modifiye eden hastalıklarlabirlikte uygulanmasının gerekip gerekmediğini belirlemek için daha ileriçalışmalara ihtiyaç vardır

The Association of Skinfold Anthropometric Measures, Body Composition and Disease Severity in Obese and Non-obese Fibromyalgia Patients: A Cross-sectional Study

Objectives: This study aims to determine the effects of obesity and obesity related anthropometric and body composition determiners on the severity of fibromyalgia syndrome (FS) and to compare obese, overweight and normoweight FS patients according to general health and psychological status. Patients and methods: The study included 42 obese (mean age 48.8±11.6; range 24 to 65 years), 27 overweight (mean age 47.3±3.4; range 24 to 61 years) and 32 normoweight (mean age 47.1±7.8 years; range 31 to 60 years) female FS patients. Widespread pain scores and symptom severity scores were noted. Pain pressure thresholds of tender points and control points were measured and total myalgic score (TMS) was calculated. The anthropometric assessments and skinfold measurements of all participants were recorded. Quality of life was evaluated by Health Assessment Questionnaire while psychological status was evaluated using Beck Depression Inventory. Results: Control points, TMS values and hand grip strength values of obese FS patients were significantly lower, while disease duration, symptom severity, widespread pain scores, visual analog scale and Health Assessment Questionnaire scores were significantly higher than normoweight and overweight FS patients. Fat free mass, fat mass, body fat percentage and waist/hip ratio values were significantly higher in obese FS patients than overweight and normoweight FS patients (p<0.001 for all values). Stepwise linear regression analysis showed that increased body mass index, decreased fat free mass (R2=0.11) and increased disease duration (R2=0.13) were associated with lower TMS. Conclusion: We found that obesity had significant negative effects on pain, disease severity and quality of life in patients with FS

Association of granulomatous appendicitis and simple laboratory tests. Controlled observational study.

Aim: Granulomatous appendicitis (GA) is evaluated as different clinical situation from specific causes, and very rare. It is defined as the presence of granulomatous inflammation in the appendix. Its etiology can be infectious, or noninfectious. However its differentiation from tumor can be challenging with macroscopic appearance in the operation. In this study, we aimed to present a case series of GA cases, evaluate prediction and association of GA before surgery. Material and methodsA descriptive study is designed. All appendectomies between 2007 and 2015 were reviewed. The patients who diagnosed with GA by histopathological evaluation constituted study group. The rest constituted the control group.  Demographic data, complete blood count parameters (22 parameters for each) were recorded. Categorical variables were expressed as frequencies and percentages. Baseline characteristics were compared using the t-test and Mann-Whitney U test. Fisher’s exact test was used to compare categorical variables. The differences were considered statistically significant if the p value was less than 0.05 at a 95% confidence interval.ResultsDuring study period, 4570 patients were operated for acute abdomen with the presumptive diagnosis of acute appendicitis. Eight (0.2%) patients constituted study group. For control group sample size was calculated as 527 cases (95% power to show a 50% difference in the rate of the primary outcome, with a 2-sided type I error rate of 5%. Additional 142 to decrease errors). Demographic findings like age and gender didn’t show difference between the groups (p=0.499 and p=0.477, respectively). EOS# and EOS% were higher in study group than control group (p&lt;0.0001 and p&lt;0.0001, respectively). Logistic regression analysis showed that EOS% effect was significant with p of &lt;0.0001, odds ratio of 0.522 and Nagelkerke R2 of 0.191.ConclusionDiagnosis of GA with macroscopic appearance in operation is a challenging for a surgeon. We found that EOS# and EOS% are associated with GA