Tıbbi müdahalede danışım(konsültasyon)

21. yüzyılda tıp bilimi ve teknolojisi, geçmiştekiler ile kıyaslandığında çok büyük ilerlemeler göstermiş ve tıbbi süreçler gelişmiştir. Bu gelişme ve ilerleme beraberinde sağlık alanında çalışan insan yapısında da değişiklikler yaratmış ve tüm tıp meslekleri içinde daha fazla uzmanlaşma ihtiyacına yol açmıştır. Bu durum hekimler arasında daha fazla işbirliği yapma ihtiyacını doğurmuştur. İşbirliği, taraflar arasındaki hiyerarşiyi gösteren dikey işbirliği şeklinde olabileceği gibi, aralarında hiçbir şekilde hiyerarşik ilişki bulunmayan yatay işbirliği şeklinde de olabilmektedir. Danışım (konsültasyon) adını verilen işbirliği, yatay işbirliğine dahildir. Danışım farklı uzmanlık alanlarından birden fazla hekimin, hastaya beraber teşhis koyması veya tedavi etmesi anlamına gelmektedir. Bu çalışmada danışım kavramı, bunun nasıl yapılması gerektiği, bu aşamada ortaya çıkabilecek sorunlar ve bu sorunlardan kimin sorumlu olacağı incelenmiştir. Özellikle danışım sebebiyle yapılan bir tıbbi kötü uygulamadan dolayı hasta zarar görürse, bu zarardan müdavi hekimin mi yoksa danışılan (konsültan) hekimin mi sorumlu olacağı konusu ile müteselsil sorumluluk üzerinde durulmuştur

Reactions of anthocyanin rich in maize genotypes to low temperature treatments according to photosynthesis, gas exchange properties, and bio-active compounds

Low temperatures during the early growing stages limit the productivity of maize considerably. Investigating responses of different coloured corns (Zea mays L.) to chilling may reveal alternative genotypes which can be preferred under early sowing conditions of water-shortage farming areas. The aim of this study is determining whether the color factor affects the tolerance to chilling in maize and which properties are effective on the low temperature tolerance. We exposed corns with different colours (white, yellow, red, purple) to different temperatures [8°C, 12°C, 16°C, 25°C (control)] and analysed the effects of temperature on morphological, physiological, bio-active properties and stress indicators. Using 14-day old seedlings, we noted that purple corn had the highest seedling length, seedling weight, chlorophyll content, stomatal conductance, chlorophyll B and total phenolic content in the 8°C and followed by white (photosynthesis rate, chlorophyll fluorescence, chlorophyll A and carotenoids), yellow (transpiration rate, sub stomatal CO2, and total antioxidant activity) and red corns (water use efficiency, total anthocyanin content and proline). On the other hand, white corn maintained its superiority in other treatments, receiving the highest values in 9 of 17 characteristics at 12°C, in 8 of 17 at 16°C and in 10 of 17 in the control. Performance of purple corn in the 8°C was the most remarkable one in all genotypes and treatments. Based on our results, it has been concluded that white and purple corns are more chilling tolerant genotypes and may be alternative for early sowing conditions in drought farming areas

Interrupted inferior vena cava and partial anomalous pulmonary venous return with atrial septal defect in a 38-year-old adult: a case report

We present a woman having congenital anomalies of the inferior vena cava and partial anomalous pulmonary venous return from the right lung with atrial septal defect in a 38-year-old. Congenital anomalies of inferior vena cava are rare. They are seen more often in young males. If there are not other anomalies, they are latent for a long time. Peripheral venous thrombosis, chronic venous insufficiency, dyspnea and fatigue are often the first symptoms of these anomalies. Surgical repair of atrial septal defect with partial anomalous pulmonary venous return include provision of durably unobstructed systemic and pulmonary venous pathways, closure of the atrial septal defect, and avoidance of arrhythmias. The diagnosis has been determined by compression ultrasonography with color doppler assessment, multidetector computed tomography angiography and echocardiography

The Impact of Patient and Parents’ Education by Nurses on Serum Ferritin Levels in Children with Beta-Thalassemia Major

Background: Through education and information, nurses can help patients learn more about their health status and can contribute to improvement in patient drug adherence, clinical and laboratory outcomes. The aim of this study was to assess the impact of patient and their family education by nurses on serum ferritin levels. Methods: The study included 85 children with transfusion-dependent beta-thalassemia aged between 2.4 to 17 (mean 7.6 ± 3.3) years, 44 (52%) of whom were male. All patients received deferasirox doses ranged from 12 to 40 mg/kg/day. Patients and their families were requested for education intervention provided by nurses. Seventeen patients (group 1) (11 male, 6 female) refused to receive education or not compliant with the study protocol. Sixty-eight (33 male, 35 female) patients (group 2) and their parents educated by nurses, including drug instructions, telephone interviews and home visits for 12 months. Results: Mean deferasirox dose at the 24th and 36th months of the study were 31.6 ± 7 and 32 ± 8 mg/kg/day in group 1, and were 32.7 ± 8 and 33.6 ± mg/kg/day in group 2, respectively. Mean serum ferritin levels at the 24th and 36th months of the study were reduced from 4424 ± 2305 ng/mL to 3425 ± 1661 ng/mL (the mean difference was 662 ng/mL) (P =0.044) in group 1, and were reduced from 3177 ± 1645 to 2748 ± 1343 ng/mL (the mean difference was 274 ng/mL) (P = 0.033) in group 2, respectively Conclusion: Our study’s results suggested that patient and parents’ education by nurses have no significant impact in reducing ferritin levels in children with beta-thalassemia major. Deferasirox dose was the only significant predictor that contributed to reduction in ferritin levels

Adjuvant Corticosteroid Therapy in Hepatosplenic Candidiasis-Related Iris

Candida infections are the most frequent infections in neutropenic patients. Hepatosplenic candidiasis (HSC) is a part of disseminated Candida infection that occurs most commonly in patients with hematologic malignancies treated with chemotherapy and requires protracted antifungal therapy. During invasive mycosis with rapid resolution of immunosuppression, immune reconstitution inflammatory syndrome (IRIS) which mimics treatment failure, drug toxicity or breakthrough infections may occur. Manifestation period, histopathologic findings and favorable effect of steroids to its inflammatory symptoms strongly suggest that HSC belongs to the invasive fungal infection induced IRIS. We present a child with B cell-acute lymphoblastic leukemia who developed HSC and addition of corticosteroid therapy to antifungal treatment achieved rapid resolution of the clinical symptoms and laboratory findings

Sustainability Organic Agriculture and Livestock Production with Respect to European Union in Eastern Anatolia and East Black Sea Regions

The majority of farm households in Turkey and especially the Eastern Anatolia are still based on low-input semi subsistence agriculture and livestock production. Despite a slow decline in recent years, agriculture and livestock production remains a major employer in Turkey and it is a significant contributor to the country’s gross domestic product, GDP. Whist Turkey is one of the EU candidate countries, is self sufficient in food production and Turkish agriculture is poorly structured inefficient, with farming in the Eastern Anatolia being mainly subsistence farming. Yet, these traditional rural structures combined with poor access to low level of education and low level of off-farm unemployment problem makes the situation more complicated and unsustainable. The best way to promote sustainability, better and higher production of Eastern Anatolian and rural Turkey is to invest in the local people, villages through improved, continuing and effective agricultural and livestock programs in particular. Investment in human capital especially in the rural areas leads to more employment opportunities through entrepreneurship and innovation in organic agriculture and livestock production. A holistic approach to developing and improving supply chains could unlock the potential for sophisticated, state-of-the-art organic agriculture and livestock producers and businesses in the region to become EU and global players. Eastern Anatolian livestock producers and the farmers have the ambitions to take part in future progress because the region is naturally organic not by design but default. It is for sure that present potential of the region has not been fully determined and utilized. EU has greatly benefited from previous enlargements economically, politically and socially. When European Union (EU) and Turkish Government relations considered and accession of Turkey to EU would be the logical consequence of the previous accessions. The screening on chapter 11 (Agriculture and rural development) is one of the important criteria and Turkey is working on to meet these benchmarks

Remembering the Occam’s Razor: Could simple electrocardiographic findings provide relevant predictions for current hemodynamic criteria of pulmonary hypertension?

Background: We evaluated the predictive value of electrocardiographic (ECG) findings for pulmonary hemodynamics assessed by right heart catheterization (RHC). Methods: Our study population comprised 562 retrospectively evaluated patients who underwent RHC between 2006 and 2022. Correlations between ECG measures and pulmonary arterial systolic and mean pressures (PASP and PAMP) and pulmonary vascular resistance (PVR) were investigated. Moreover, receiver operating characteristic (ROC) curve analysis assessed the predictive value of ECG for pulmonary hypertension (PH) and precapillary PH. Results: The P-wave amplitude (Pwa) and R/S ratio (r) in V1 and V2, Ra in augmented voltage right (aVR), right or indeterminate axis, but not P wave duration (Pwd) or right bundle branch block (RBBB) significantly correlated with PASP, PAMP, and PVR (P 0.16 mV, Ra in aVR > 0.05 mV, QRS axis > 100° and R/Sr in V1 > 0.9 showed the highest area under curve (AUC) values for PAMP > 20 mm Hg. Using the same cutoff value, Ra in aVR, Pwa, QRS axis, and R/Sr in V1 showed highest predictions for PVR > 2 Wood Units (WU). Conclusion: In this study, Pwa, Ra in aVR, right or indeterminate axis deviations, and R/Sr in V1 and V2 showed statistically significant correlations with pulmonary hemodynamics, and Ra in aVR, R/Sr in V2 and V1, QRS axis, and Pwa contributed to variance for PASP, PAMP, and PVR, respectively. Moreover, Pwa, Ra in aVR, QRS axis, and R/Sr in V1 seem to provide relevant predictions for PH and precapillary PH

Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy

Background: There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). Methods: A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. Results: The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0–14.0) months in the ET arm of group A, and 5.3 (3.9–6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8–7.7) months in the ET arm of group B, and 5.7 (4.6–6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5–8.0) months in the ET arm of group C and 4.0 (3.5–4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. Conclusion: Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.Breast Cancer Consortiu

Comparison of different bronchial closure techniques following pneumonectomy in dogs

The comparison of the histologic healing and bronchopleural fistula (BPF) complications encountered with three different BS closure techniques (manual suture, stapler and manual suture plus tissue flab) after pneumonectomy in dogs was investigated for a one-month period. The dogs were separated into two groups: group I (GI) (n = 9) and group II (GII) (n = 9). Right and left pneumonectomies were performed on the animals in GI and GII, respectively. Each group was further divided into three subgroups according to BS closure technique: subgroup I (SGI) (n = 3), manual suture; subgroup II (SGII) (n = 3), stapler; and subgroup III (SGIII) (n = 3), manual suture plus tissue flab. The dogs were sacrificed after one month of observation, and the bronchial stumps were removed for histological examination. The complications observed during a one-month period following pneumonectomy in nine dogs (n = 9) were: BPF (n = 5), peri-operative cardiac arrest (n = 1), post-operative respiratory arrest (n = 1), post-operative cardiac failure (n = 1) and cardio-pulmonary failure (n = 1). Histological healing was classified as complete or incomplete healing. Histological healing and BPF complications in the subgroups were analyzed statistically. There was no significant difference in histological healing between SGI and SGIII (p = 1.00; p > 0.05), nor between SGII and SGIII (p = 1.00; p > 0.05). Similarly, no significant difference was observed between the subgroups in terms of BPF (p = 0.945; p > 0.05). The results of the statistical analysis indicated that manual suture, stapler or manual suture plus tissue flab could be alternative methods for BS closure following pneumonectomy in dogs

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