Magnetic resonance ımaging of the sacroiliac joints in ankylosing spondilitis before and after therapy with anti-tumor necrosis factor alpha

AMAÇ: Çalışmanın amacı, dirençli AS'li hastalarda, anti-TNF-alfa ilaçların etkinliğini ve güvenirliğini yanısıra, manyetik rezonans (MR) görüntüleme ile tedavi öncesi ve sonrası sakroiliak eklem değişiklerini tespit etmektir. GEREÇ ve YÖNTEM: Modifiye New York tanı kriterlerine göre AS tanısı almış, 27 hasta çalışmaya dahil edildi. Sakroiilitis bulguları, anti-TNF-alfa tedavi öncesi ve sonrası, Gd-MR ile tespit edildi. Sekiz hastaya, 4 haftada bir İnfliximab 4 mg/kg i.v. infüzıon verildi. Diğer 19 hastaya ise Etanercept 2x25 mg/hafta s.c. verildi. Değerlendirilen klinik ve laboratuvar parametreler; BASDAı, BASFı, ağrı (VAS skoru), Schöber testi, göğüs ekspansiyonu, C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH). BULGULAR: Hastaların çoğu, anti-TNF-alfa tedavilerine iyi yanıt verdi. 24. haftanın sonunda, takip edilen tüm parametrelerde iyileşme gözlendi. MR görüntüleme çalışmalarında, anti-TNF-alfa tedavi sonrası sadece 3 hastanın sakroiliak eklem inflamasyonunda gerileme gözlendi. SONUÇ: Aktif AS'li hastalarda, 24. hafta sonunda anti-TNF-alfa ilaçları güvenilir ve etkin bulundu. BASDAı, BASFı, ağrı skorlarında belirgin düşüş gözlendi. Fakat, sakroiliak eklemin akut inflamatuvar bulgularında, MR görüntüleme ile herhangi bir gerileme tespit edilmedi.OBJECTIVE: The goal of this study is to assess the changes in the sacroiliac joints (Sİ) by magnetic resonance imaging (MRI) in a 24-week follow-up period and to determine the efficacy and safety of anti-TNF-α therapies for refractory AS. MATERIALS and METHODS: Twenty-seven patients who met the modified New York criteria for AS were enrolled in this study. Activity of sacroiliitis was determined by Gd-MRI scan before and after anti-TNF-α treatment. Eight patients received infliximab at a dose of 4mg/kg by intravenous infusion over 2 hours at every 4 week. Other 19 patients were treated with 25mg subcutaneous etanercept twice weekly. Total observational period was 24 weeks. The clinical and laboratory variables included: Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), pain on a visual analog scale, Schober's index, chest expansion, C-reactive protein(CRP), erythrocyte sedimentation rate (ESR). RESULTS: Most patients responded well to treatment of anti-TNF-α antagonists. At 24 weeks, there was an improvement in all of the following measures. Imaging studies showed decreased inflammation of the SI joints after 24 weeks of treatment with anti-TNF-α therapies in only 3 patients. CONCLUSION: The anti-TNF-α therapy was safe and effective in treating patients with active AS during 24-week study period. The BASDAI, BASFI, VAS of pain were decreased well. But we could not determine any regression of acute inflammatory changes of the SI joints as depicted by MR

Examination of Nursing Students\u2019 Medical Error Attitudes within Three Different Educational Models

Objective: A cross-sectional comparative study was exposed within three Turkish public universities. This study aims to examine nursing students' attitudes towards medical errors who are trained within three different education models and to determine factors that affect these attitudes

Aspava Lokantaları ve Ankara yemek kültürüne etkileri

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2015.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Özer, Abdürrahim

Second-line gemcitabine-based chemotherapy regimens improve overall 3-year survival rate in patients with malignant pleural mesothelioma: a multicenter retrospective study

In the present study, we aimed to evaluate the effectiveness of second-line gemcitabine-based chemotherapy regimens on overall survival (OS) in malignant pleural mesothelioma (MPM) patients receiving first-line pemetrexed-based regimens. A total of 73 patients with MPM from Akdeniz University, Acibadem Kayseri Hospital, Kayseri Training and Research Hospital, and Erciyes University were analyzed and evaluated retrospectively as two groups: second-line gemcitabine-based chemotherapy and no second-line chemotherapy. The median OS of patients who received second-line gemcitabine-based chemotherapy was 11.3 (5.1-17.5) months, while it was 9.9 (2.1-17.7) months in the patients who did not receive chemotherapy in the second-line setting (p = 0.056). When we evaluated the survival rate at the 6th, 12th, 18th, 24th, and 36th month, the OS rate of the 36th month was significantly higher in patients who received gemcitabine-based second-line chemotherapy (p = 0.041). When evaluating the OS from diagnosis to death, the median OS values were 20.8 (17.5-24.1) months for first-line pemetrexed-based regimens then second-line gemcitabine alone and 13.1 (9.0-17.1) months supportive care after first-line pemetrexed-based regimens (p = 0.005). According to our results, we may consider gemcitabine-based regimens as second-line chemotherapy after treatment with pemetrexed plus platinum in patients with MPM

Investigation of hemorheological parameters at the diagnosis and follow up of children with iron deficiency anemia and mixed anemia

OBJECTIVE:We aimed to investigate the effects of iron deficiency anemia (IDA) and vitamin B12 deficiency coexisting with IDA which is called as mixed anemia (MA) on hemorheological parameters, to compare them with each other and healthy controls, and to assess the changes in hemorheological parameters after treatment. MATERIALS AND METHODS: 32 IDA patients (mean age:6.3±5.3 years), 30 MA patients (mean age:7.2±5.4 years), and 31 healthy controls (mean age:7.1±5.2 years) were enrolled. Erythrocyte deformability and aggregation were determined by an ectacytometer, plasma and whole blood viscosities by a cone-plate rotational viscometer. Differences between IDA and MA, and healthy controls were compared. Hemorheological parameters were repeated in the patient groups after treatment and compared with the initial results. RESULTS: In both of the patient groups, erythrocyte deformability, whole blood and plasma viscosities were found to be significantly decreased before treatment, compared with the controls. After treatment these parameters were found to be increased significantly. There were no significant differences in these parameters between the IDA and MA group. Additionally, no statistically significant alteration was found in erythrocyte aggregation measurements of both patient groups. CONCLUSION: This study indicates that IDA andMAhave similar effects on hemorheological parameters. When vitamin B12 deficiency accompanies IDA which is called as MA, no further alterations occur in hemorheological parameters. The adequate treatment of these anemias not only corrects the hematological parameters, but also by helping to normalize the hemorheological parameters, may contribute to the regulation of microvascular perfusion. © 2015 - IOS Press and the authors