Türk hekimlerinin fibromiyalji tedavisindeki tutumları; pregabalinofobi ağrı tedavisinin yeni gerçeği mi?

OBJECTIVES: This study aims to determine the treatment preferences of physicians interested in fibromyalgia treatment and to investigate their hesitations about prescribing pregabalin. METHODS: Our survey study was conducted between February 5 and 20, 2021. The survey forms were sent to the known email addresses and phone numbers of 1569 physical medicine and rehabilitation (PMR), algology, and rheumatology physicians. The replies to the surveys were checked for possible resubmissions. The pooled data were evaluated with the SPSS 22.0 statistical package program. Frequency distributions were calculated and presented as n, %. RESULTS: Four hundred and six PMR, rheumatology, and algology specialists fulfilled the study forms. About 59.0% of physicians stated that they prefer duloxetine as the first-line agent of fibromyalgia syndrome (FMS) treatment. Pregabalin was only 6.0% of the physicians' first choice for FMS. About 35.0% of the participating physicians stated that the PMR department should follow up FMS patients. About 44.3% of the participants noted that they refer FMS patients to other departments which interested in FMS treatment and do not want to follow-up FMS patients. About 81% agreed that pregabalin causes addiction. About 36.7% stated that at least 20% of the patients could abuse pregabalin and 97.8% of physicians stated that they were prejudiced about prescribing pregabalin to prisoners. Approximately two of the three physicians experienced an act of violence in their hospital regarding pregabalin prescribing. CONCLUSION: These data showed that the 'Pregabalinophobia' should be accepted. This condition is associated with life safety concerns of the physician not only from unreliability of the drug. It seems that the doctors have valid reasons to develop this prejudice.Amaç: Bu çalışma, fibromiyalji tedavisi ile ilgilenen hekimlerin tedavi tercihlerini belirlemek ve pregabalin reçetelemek konusundaki tereddütlerini araştırmayı amaçlamaktadır. Gereç ve Yöntem: Anket çalışmamız 5 Şubat 2021–20 Şubat 2021 tarihleri arasında gerçekleştirildi. Fiziksel tıp ve rehabilitasyon, algoloji ve romatoloji hekimlerinden oluşan 1569 kişinin bilinen e-posta adreslerine ve telefon numaralarına anket formları gönderildi. Anketlere verilen yanıtlar olası yeniden gönderimler açısından kontrol edildi. Veri havuzu SPSS 22.0 istatistik paket programı ile değerlendirildi. Frekans dağılımları hesaplandı ve n, % olarak sunuldu. Bulgular: Dört yüz altı fiziksel tıp ve rehabilitasyon, romatoloji ve algoloji uzmanı çalışma formlarını tamamladı. Hekimlerin %59’u fibromiyalji tedavisinde birinci basamak ajan olarak duloksetin tercih ettiklerini belirtti. Pregabalin, hekimlerin fibromi-yalji için ilk tercihinin sadece %6'sıydı. Çalışmaya katılan hekimlerin %35'i fibromiyalji hastalarının fiziksel tıp ve rehabilitasyon bölümlerinde takip edilmesi gerektiğini belirtti. Katılımcıların %44,3’ü fibromiyalji hastalarını, fibromiyalji tedavisi ile ilgilenen ve fibromiyalji hastalarını takip etmek isteyen diğer bölümlere sevk ettiklerini belirtti. Katılımcıların %81'i pregabalinin bağımlılığa neden olduğunu kabul etti. Katılımcıların %36,7'si fibromiyalji hastalarının en az %20'sinin pregabalini kötüye kullanabileceğini belirtti. Hekimlerin %97,8'i mahkumlara pregabalin reçete edilmesi konusunda ön yargılı olduğunu belirtti. Üç hekimden yaklaşık ikisi hastanelerinde pregabalin reçete edilmesi ile ilgili bir şiddet olayına maruz kaldığını belirtti. Sonuç: Bu veriler “pregabalinofobi”nin kabul edilmesi gerektiğini göstermektedir. Bu durum, yalnızca ilacın güvenilmezliğinden değil, hekimin can güvenliği endişeleriyle de ilişkilidir. Görünüşe göre doktorlarda bu ön yargının oluşmasında geçerli nedenler vardır

On the Use of Homogeneous Polynomial Yield Functions in Sheet Metal Forming Analysis

Sheet metal forming techniques are a major class of stamping and manufacturing processes of numerous parts such as doors, hoods, and fenders in the automotive and related supplier industries. Due to series of rolling processes employed in the sheet production phase, automotive sheet metals, typically, exhibit a significant variation in the mechanical properties especially in strength and an accurate description of their so-called plastic anisotropy and deformation behaviors are essential in the stamping process and methods engineering studies. One key gradient of any engineering plasticity modeling is to use an anisotropic yield criterion to be employed in an industrial content. In literature, several orthotropic yield functions have been proposed for these objectives and usually contain complex and nonlinear formulations leading to several difficulties in obtaining positive and convex functions. In recent years, homogenous polynomial type yield functions have taken a special attention due to their simple, flexible, and generalizable structure. Furthermore, the calculation of their first and second derivatives are quite straightforward, and this provides an important advantage in the implementation of these models into a finite element (FE) software. Therefore, this study focuses on the plasticity descriptions of homogeneous second, fourth and sixth order polynomials and the FE implementation of these yield functions. Finally, their performance in FE simulation of sheet metal cup drawing processes are presented in detail

Evaluation of the Cases Admitted to the Disability Board After A Traffic Accidental Head Trauma, in Terms of Neuropsychiatric Sequelae

Objective:Trauma is the most important cause of death in underdeveloped and developing countries. Although the brain has protective layers such as the cranium and scalp, it can be damaged as a result of various traumas, causing permanent neurological and psychiatric sequelae. In our study, we aimed to evaluate the demographic data of patients who applied to our department to be evaluated in terms of disability after head trauma due to a traffic accident, and to emphasize that objective data criteria are required in the evaluation of neuropsychiatric sequelae.Methods:Sociodemographic characteristics, neuropsychiatric complaints, neuropsychological testing results and disability rate/duration of patients evaluated in the disability board of our department between 01.01.2019-31.12.2020.Results:It was observed that 579 of the patients investigated during the study period had head trauma. It was observed that 173 of 579 patients had intracranial injury and neuropsychiatric sequelae and a related disability rate was determined. 79.2% of the cases were male, 20.8% were female, the mean age was 29.6±15.6. Most common symptoms were dementia in 113 cases (65.3%), headache in 60 cases (34.6%) and psychiatric complaints in 48 cases (27.7%).Conclusion:As a result of the study, it was seen that neuropsychiatric sequelae due to head trauma are quite common and varied. The severity of the trauma and clinical situation should be determined by objective criteria. Detailed examination, neuropsychological testing and radiological examinations will prevent such cases from being overlooked

Morphometric Evaluation of Coccyx with Microcomputed Tomography (Micro CT) and Computed Tomography (CT) Technology

Aim%253A We investigated the coccyx anatomy accurately in detail by microcomputed tomography (micro CT) and computed tomography (CT) to contribute to the data related to the coccyx anatomy and the potential clinical contribution of these datas in the treatment of coccyxs pathologies. Material and Methods%253A Twenty coccyges from embalmed cadavers were examined with a micro CT device. The inferior part of the sacrum and coccyx together with the surrounding soft tissue was removed safely. The tissue was scanned with a micro CT device, and all parameters were measured with micro CT image viewer programs. CT images of 29 patients without coccyx pathology were measured with OsiriX programs. Measured morphometric parameters with micro CT and CT were evaluated using statistical methods. Results%253A Generally, the morphometric parameters as mean values were larger in males than in females. Mean values for vertical length and coccyx width were higher for CT compared with micro CT images. Coccyx was more flat in the frontal plane in females. There were statistically significant differences between the micro CT and CT images regarding mean vertical length, width, lateral deviation angle, and sacrococcygeal angle and length of the vertebrae (p lt%253B 0.05). There were no statistically significant differences in number and width of the vertebrae (p gt%253B 0.05). Conclusion%253A We suggest that examining the normal coccyx morphology will help to better understand and treat the pathologic conditions of the coccyx. We believe our findings will contribute to the data related to the coccyx anatomy

Melatonin Attenuates LPS-Induced Acute Depressive-Like Behaviors and Microglial NLRP3 Inflammasome Activation Through the SIRT1/Nrf2 Pathway.

peer reviewedInflammation is a crucial component of various stress-induced responses that contributes to the pathogenesis of major depressive disorder (MDD). Depressive-like behavior (DLB) is characterized by decreased mobility and depressive behavior that occurs in systemic infection induced by Lipopolysaccharide (LPS) in experimental animals and is considered as a model of exacerbation of MDD. We assessed the effects of melatonin on behavioral changes and inflammatory cytokine expression in hippocampus of mice in LPS-induced DLB, as well as its effects on NLR Family Pyrin Domain Containing 3 (NLRP3) inflammasome activation, oxidative stress and pyroptotic cell death in murine microglia in vitro. Intraperitoneal 5 mg/kg dose of LPS was used to mimic depressive-like behaviors and melatonin was given at a dose of 500 mg/kg for 4 times with 6 h intervals, starting at 2 h before LPS administration. Behavioral assessment was carried out at 24 h post-LPS injection by tail suspension and forced swimming tests. Additionally, hippocampal cytokine and NLRP3 protein levels were estimated. Melatonin increased mobility time of LPS-induced DLB mice and suppressed NLRP3 expression and interleukin-1β (IL-1β) cleavage in the hippocampus. Immunofluorescence staining of hippocampal tissue showed that NLRP3 is mainly expressed in ionized calcium-binding adapter molecule 1 (Iba1) -positive microglia. Our results show that melatonin prevents LPS and Adenosine triphosphate (ATP) induced NLRP3 inflammasome activation in murine microglia in vitro, evidenced by inhibition of NLRP3 expression, Apoptosis-associated speck-like protein containing a CARD (ASC) speck formation, caspase-1 cleavage and interleukin-1β (IL-1β) maturation and secretion. Additionally, melatonin inhibits pyroptosis, production of mitochondrial and cytosolic reactive oxygen species (ROS) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling. The beneficial effects of melatonin on NLRP3 inflammasome activation were associated with nuclear factor erythroid 2-related factor 2 (Nrf2) and Silent information regulator 2 homolog 1 (SIRT1) activation, which were reversed by Nrf2 siRNA and SIRT1 inhibitor treatment

Divergent effects of first-generation and second-generation antipsychotics on cortical thickness in first episode psychosis

BACKGROUND: Whether there are differential effects of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) on the brain is currently debated. Although some studies report that FGAs reduce grey matter more than SGAs, others do not, and research to date is limited by a focus on schizophrenia spectrum disorders. To address this limitation, this study investigated the effects of medication in patients being treated for first-episode schizophrenia or affective psychoses. METHOD: Cortical thickness was compared between 52 first-episode psychosis patients separated into diagnostic (i.e. schizophrenia or affective psychosis) and medication (i.e. FGA and SGA) subgroups. Patients in each group were also compared to age- and sex-matched healthy controls (n = 28). A whole-brain cortical thickness interaction analysis of medication and diagnosis was then performed. Correlations between cortical thickness with antipsychotic dose and psychotic symptoms were examined. RESULTS: The effects of medication and diagnosis did not interact, suggesting independent effects. Compared with controls, diagnostic differences were found in frontal, parietal and temporal regions. Decreased thickness in FGA-treated versus SGA-treated groups was found in a large frontoparietal region (p < 0.001, corrected). Comparisons with healthy controls revealed decreased cortical thickness in the FGA group whereas the SGA group showed increases in addition to decreases. In FGA-treated patients cortical thinning was associated with higher negative symptoms whereas increased cortical thickness in the SGA-treated group was associated with lower positive symptoms. CONCLUSIONS: Our results suggest that FGA and SGA treatments have divergent effects on cortical thickness during the first episode of psychosis that are independent from changes due to illness

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication