MRONJ approach of medical doctors who prescribing antiresorptive drug

Amaç: Diş çekimi gibi çene üzerinde cerrahi işlem uygulandığında, kemik iyileşmesinin bozulmasıyla çenenin bifosfonat ilişkili nekrozu meydana gelebilir. Bifosfonat kullanan hasta sayısının her geçengün artması ve çenelerin ilaçlara bağlı gelişen osteonekrozu (MRONJ)olgularındaki yükseliş, hekimlerin bu komplikasyonla karşılaşma ihtimalîni artırmaktadır. Hekimler, diş hekimleri ve hastalar tarafındanMRONJ farkındalığı; erken teşhis, tedavi ve önlenmesi açısındanönemlidir. Bu çalışmada, antirezorptif ve antianjiyojenik ilaçları reçeteeden tıp doktorlarının, ciddi bir komplikasyon olan MRONJ ile ilgilifarkındalıklarını ve yaklaşımlarını değerlendirmek amaçlanmıştır.Gereç ve Yöntemler: Araştırmaya bazı üniversite hastaneleri, eğitimve araştırma hastaneleri ve özel sağlık kurumlarında çalışan; ortopedi,dahiliye, romatoloji, fizik tedavi ve rehabilitasyon ve onkoloji uzmanları dâhil edilmiştir. Katılan hekimlere, bifosfonatlar ve MRONJ hakkındaki bilgileri, tedavi sürecindeki yaklaşımları ile ilgili 15 sorudanoluşan bir anket formunu yanıtlamaları istenmiştir. Bulgular: Çalışmayakatılan hekimlerin %46'sı asistan, %54'ü uzman doktordur. Hekimlerin%74'ü bu ilaçları osteoporoz tedavisi için reçete ederken, %47'si alendronatı tercih ettiklerini belirtmişlerdir. Hekimlerin %21’i tedavi öncesidental muayeneyi önerirken, %51’i dental tedaviyi hastanın şikâyeti olduğunda önerdiğini bildirmiştir. Hekimlerin %22’si bifosfonat grubuMRONJ ile karşılaştığını bildirmiştir. Ayrıca hekimlerin uzmanlık alanları arasında, bifosfonata bağlı çene nekrozu hakkında bilgi durumudağılım oranları açısından istatistiksel olarak anlamlı farklılık bulunmaktadır. Bununla beraber hekimlerin %16’sı bifosfonat grubu ilaç kullanımına bağlı çene nekrozu hakkında bilgisinin olmadığını bildirmiştir.Sonuç: Bifosfonat grubu ilaçları reçete eden tıp hekimlerinin, çenelerdegelişen MRONJ hakkındaki farkındalıklarının artması için bifosfonatlarve MRONJ ile ilgili eğitim stratejileri oluşturulmalıdır.ABS TRACT Objective: The number of patients using bisphosphonates is increasing day by day and the increase in medication-related osteonecrosis of the jaw (MRONJ) cases increases the possibility of physicians to encounter this complication. In this study, it is aimed to evaluate the awareness and approaches of medical doctors who prescribe antiresorptive and antiangiogenic drugs about MRONJ, which is a serious complication. Material and Methods: Some researchers working in university hospitals, education and research hospitals and private health institutions; orthopedics, internal medicine, rheumatology, physical therapy-rehabilitation and oncology specialists are included in this study. To the attending physicians; they were asked to answer a questionnaire consisting of 15 questions about their knowledge about bisphosphonates and MRONJ and their approach to the treatment process. Results: Fourty six percent of the physicians participating in the study were residents and 54% were specialists. Seventy four percent of the physicians prescribed these drugs for osteoporosis treatment, while 47% preferred alendronate. While 21% of the physicians recommended dental examination before treatment, 51% reported that they recommended dental treatment when the patient complained. 22% of physicians reported that they encountered jaw necrosis due to drug use in the bisphosphonate group. In addition, there is a statistically significant difference between the specialties of the physicians in terms of knowledge distribution of jaw necrosis due to bisphosphonate. However, 16% of physicians reported that they did not know about chin necrosis related to the use of bisphosphonate drugs. Conclusion: Training strategies about bisphosphonates and MRONJ should be developed in order to increase the awareness of the physicians who prescribe bisphosphonate group drugs about the developing MRONJ

Single-center Experiences of Ovarian Sex Cord Stromal Tumors

Objective:The aim of this study is to examine the sex cord stromal tumors of the ovary operated in our clinic in the last 4 years and to contribute to the literature on this rare tumor.Method:The clinical and laboratory findings of 34 patients with pathological diagnosis of ovarian sex cord stromal tumor, who were operated in our obstetrics and gynecology clinic between 2016 and 2020, were evaluated retrospectively. Pathological diagnoses were classified and other accompanying pathologies and complaints were evaluated for each type.Results:Ovarian sex cord stromal tumors usually attract attention with the peripheral effects of the hormones produced by the tumor tissue. They rarely come to very large sizes. They are mostly benign. When the hormone estrogen is produced, accompanying endometrial pathologies should not be overlooked. Hormonal complaints in patients improve dramatically after surgery both clinically and laboratory. Oncological follow-up is required following diagnosis in some malignant types.Conclusion:If ovarian sex cord stromal tumor is suspected, preoperative blood androgen levels, inhibin A, and alpha feto protein (AFP) should be evaluated. In addition, ultrasonographic and, if necessary, endometrial histopathological evaluations are important for patient follow-up as well as diagnosis. The patient's fertility desire and age should be considered during treatment

Evaluation and Categorization of Femur Morphometry with Digital Measurement Method

BACKGROUND Variational differences of the femur between populations like clinical, anthropological and forensic anthropology are important. These morphometric differences are influenced by factors such as race, heredity, climate and diet. METHODS With the descriptive and cross-sectional design of this study, we aimed to investigate the femur morphometry with digital image analysis program. In this study, 105 femur bones belonging to Cukurova University, Medicine Faculty, Anatomy Department, were used. This study which has a descriptive and crosssectional design, was carried out in April 2018. For statistical analysis, "Statistical Package for Social Sciences for Windows 20.0" program was used. RESULTS The mean and standard deviation values of the parameters measured in femur were as follows- maximum femur length 431.42±36.2, physiological femur length 428±36.15, physiological trochanter length 403.3±34.3, anterior, posterior, superior and inferior aspects of collum femoris length 28±5.30, 25.5±5.4, 26.2±5.4, 39±7.5, caput femoris diameter 44±4, collum femoris width 34.2±7.15, collum femoris axis length 95.2±10, transverse and sagittal aspects of subtrochanteric diameter 30±3, 25.01±3, linea intertrochanterica length 68.1±8.22, transverse and sagittal aspects of mid-body diameter 27.03±3, 27.22±3, maximum proximal and distal width 86.1±13, 76.3±8, intercondylar width and depth 18.3±3.32, 25±4, condylar width and depth were 70.14±7.2, 57.4±7, midbody circumference was 85.5±9.03 mm. The mean weight of the femur was determined as 292.4±68.04 gr. Robustness, platymeria, pilastric, intercondylar width and depth indexes were calculated. Averages values of these indexes respectively were 13±2, 84.15±10, 101.22±10.4, 0.3±0.04, 0.43±0.05. CONCLUSIONS Although the mean morphometric data of the right femurs obtained from our study were higher than the left femurs, there was no significant difference (p> 0.05); There was a statistically significant difference between the right and left femurs in the intercondylar depth average (p <0.05). When the studies in the literature were compared with our results, it was found that the nearest average values were the maximum femur length and physiological femur length. Studies suggest that differences in femur geometry may be caused by race-dependent characteristics. The anatomical structure and morphometric measurements of the femur are clinically important for femoral fractures and pathologies. In addition, the data obtained from this study will be used by anthropologists for various determinations in the field of forensic medicine. We think that the results of our study will help clinicians in surgical interventions

How long do oral and maxillofacial surgery patients talk in first examination?

Amaç: Hastaların ilk muayene sırasında sözleri kesilmeden şikayetlerini aktarma süreleri tıbbın belli alanlarında incelenmiştir ancak bu konuda Ağız Diş ve Çene Cerrahisi bölümünde yapılmış bir araştırma bulunmamaktadır. Bu çalışmanın amacı Ağız, Diş ve Çene Cerrahisi kliniklerine ilk defa başvuran hastaların total konuşma zamanlarının değerlendirilmesidir. Gereç ve Yöntem: Çalışmaya 400 hasta dahil edilmiştir. Hastalar şikayetlerine göre; dentoalveolar cerrahi, temporomandibular eklem, dental implant, oral patoloji, dentofasiyal deformite ve travma olmak üzere 6 gruba ayrılmıştır. Bulgular: Çalışma sonucunda hastaların ortalama konuşma zamanının 27.6 saniye olduğu tespit edilmiştir. En uzun konuşma zamanı 42.3 sn (TME grup), en kısa konuşma zamanı ise 13.5 sn (travma grup) olarak ölçülmüştür. Yaş, cinsiyet ve ortalama konuşma zamanı arasında istatistiksel olarak anlamlı bir fark gözlenmemiştir. Sonuç: Daha ayrıntılı bilgi alabilmek ve hasta memnuniyetini arttırmak için; hastalar şikayetlerini anlatırken sözleri kesilmeden sonuna kadar dinlenmelidir.How long do oral and maxillofacial surgery patients talk in first examination? Öz (İngilizce):Introduction: Talking time of the patient without interruption during initial examination was evaluated in a few specialties but unknown in Oral and Maxillofacial Surgery (OMS) clinics. The aim of this study is to evaluate total talking time of the OMS patient in their first visit. Material and Methods: Four hundred patients were included in this study. The patients were analyzed in five groups; dentoalveolar, TMJ, pathology, dental implants and trauma. Results: The mean talking time of the patients was 27.6 seconds. The longest talking time was 42,3 seconds (TMJ patients) and the shortest time was 13,5 seconds (Trauma). There was no significant relation between age, sex and mean talking time. Conclusion: Clinicians should let the patient talk without interruption in order to get detailed information and possibly improve patient satisfaction