Clinical Outcomes and Effectiveness of Renal Artery Stenting in Patients With Critical Atherosclerotic Renal Artery Stenosis: Does it İmprove Blood Pressure Control and Renal Function Assessed by Estimated Glomerular Filtration Rate?

INTRODUCTION: Atherosclerotic renal artery stenosis (ARAS) is associated with uncontrolled hypertension and chronic renal failure. AIM: To evaluate the influence of gender and presence of chronic renal failure on the outcomes of percutaneous transluminal renal artery stenting (PTRAS) due to atherosclerosis. MATERIAL AND METHODS: A total of 28 ARAS patients underwent PTRAS and 36 stents were placed. Basal characteristics, laboratory data and blood pressure of patients were recorded. The differences between genders and improvement/deterioration of renal functions and blood pressure were analyzed. The predictors of outcomes were determined. RESULTS: Baseline characteristics were similar between men and women. Significant improvement of systolic and diastolic blood pressure control was achieved after PTRAS (153.04 ±17.07 mm Hg vs. 124.75 ±11.40 mm Hg, p = 0.001 and 92.50 ±10.76 mm Hg vs. 77.54 ±8.23 mm Hg, p < 0.001, respectively). Although mean estimated glomerular filtration rate (eGFR) and creatinine levels did not significantly improve at the 6-month follow-up visit compared to baseline values, of the 28 patients 13 (46.4%) patients had improvement of renal functions. CONCLUSIONS: Our results suggest that PTRAS is a safe procedure and may offer blood pressure control but beneficial effects of PTRAS on renal function may be anticipated in a selected group of patients, especially those with a low eGFR

Splenectomy in patients with idiopathic thrombocytopenic purpura: Analysis of 109 cases

Objectives: Splenectomy is performed in order to provide the treatment in the patients with severe idiopathic thrombocytopenic purpura, refractory to medical treatment. In this study, we aimed to investigate the postoperatif and longterm outcomes in the patients who underwent splenectomy with the diagnosis of idiopathic thrombocytopenic purpura.Materials and Methods: Between 2001-2010 at Dicle University Medical Faculty, General Surgery Department, a retrospective review of the 109 patients who had undergone splenectomy for ITP was reviewed. Age, gender, presence of accessory spleens and location, duration of the operation, number of preoperative platelet tranfusion, number of preoperative and postoperative blood transfusion, length of hospital stay, long-term outcomes, morbidity and mortality were recorded.Results: The mean age was 37.10 ± 16.62 (16-72), and there were 88 (80.7%) female and 21 (19.3%) male patients. The mean operation time was 44.87 ± 10:32 (30-120) minutes. The average postoperative blood and preoperative platelet transfusion were 1.63 ± 0.85 (0-3) and 2.01 ± 0.71 (1-3) units, respectively. The accessory spleens were encountered in 20 (18.3%) patients at the ultrasonographic examination. And also the accessory spleens were encountered in 23 (21.1%) patients during operation and confirmed with histopathologic examination. The most common localization of accessory spleens were splenic hilus. The postoperative complications were occurred in 16 patients (14.7%) and the most complication was atelectasia. The mean length of hospital stay was 4:56 ± 2:45 (2-12) days. Patients were followed for an average of 28 (9-48) months. At the follow-up period, 1 (0.9 %) patient had died.Conclusion: Splenectomy can be performed safely in the treatment of the patients with idiopathic thrombocytopenic purpura unresponsive to medical treatment. Long-term good results can be obtained with splenectomy in these patients. The accessory spleens should not be overlooked to prevent recurrences

Evaluating functional capacity, and mortality effects in the presence of atrial electromechanical conduction delay in patients with systolic heart failure

Objective: Atrial functions are relatively suppressed in heart failure (HF). We aimed to investigate the associations of intra- and inter-atrial electromechanical conduction delay (EMCD) with functional class and mortality over a 12-month follow-up period. Methods: The prospective study included 65 patients with systolic HF and 65 healthy subjects with normal sinus rhythm. Left ventricular (LV) systolic functions and left atrial (LA) dimensions and volumes were evaluated by transthoracic echocardiography. Tissue Doppler imaging (TDI) signals at the lateral border of the mitral annulus (lateral PA’), septal mitral annulus (septal PA’), and tricuspid annulus (tricuspid PA’) were measured. Intra- and inter-atrial EMCD were calculated. Results: Mitral inflow velocities were studied using pulsed-wave Doppler after placing the sample volume at the leaflets’ tips. The peak early (E wave) and late (A wave) velocities were measured. The septal annular E/E’ ratio was relatively higher and lateral, septal, and right ventricular S, E’, and A’ waves were significantly lower in the HF group than in the control group (12.49±6.03 - 7.16±1.75, pE/E’ <0.0001). Intra-atrial EMCD was detected as 117.5 ms and inter-atrial EMCD as 127.5 ms in patients with prolonged atrial EMCD. A significant increase was found in prolonged intra- and inter-atrial EMCD according to functional capacity increase (p=0.012 and p=0.031, respectively). The incidence of mortality was significantly higher in patients with prolonged atrial EMCD (p=0.025), and 5 patients in the HF group died during the study over the 12-month follow-up period. Conclusions: In this study, we found a relationship between prolonged atrial conduction time and increased functional class and mortality in patients with systolic HF. © 2016 by Turkish Society of Cardiology

BRAF V600E mutation in papillary thyroid cancer is correlated with adverse clinicopathological features but not with iodine exposure

Introduction: BRAFV600E activating mutation is the most frequent genetic abnormality in the pathogenesis of papillary thyroid carcinoma. We aimed to evaluate the association between BRAFV600E mutation and well-established prognostic clinicopathological characteristics as well as iodine exposure. Material and methods: From 2000 to 2012, the data of PTC patients admitted to Dr. Lutfi Kirdar Kartal Education and Research Hospital in Turkey were reviewed retrospectively. Clinicopathological parameters were collected. BRAFV600E mutation was analysed by DNA sequencing method in tumour specimens. We hypothesised that BRAFV600E mutation prevalence is positively correlated with prolonged iodine exposure and expected to be higher in the second half of the recruitment period due to the increment in time spent from the iodisation process of the table salt in our country. Thus, iodine exposure was categorised as short-term (2000–2006) and long-term (2006–2012). Results: A total of 197 patients were accrued. The study population predominantly consisted of conventional variant. A statistically significant relationship was observed between BRAFV600E mutation presence and age (p = 0.03), conventional variant PTC (p = 0.00002), T4 stage (p = 0.002), vascular invasion (p = 0.036), thyroid capsule invasion (p &lt; 0.00001), extrathyroidal tissue invasion (p &lt; 0.00001), and lymph node metastasis (p &lt; 0.00001). When categorised as long-term and short-term, iodine exposure was not statistically significantly related with BRAFV600E mutation; however, there were far more PTC cases in the long-term group (86.3% vs. 13.7%). Conclusion: We revealed that BRAFV600E mutation is associated with adverse clinicopathological parameters. There appeared to be no relation between long-term iodine exposure and BRAFV600E.

DRD4 genotyping may differentiate symptoms of attention-deficit/hyperactivity disorder and sluggish cognitive tempo

Objective: Studies to reduce the heterogeneity of attention-deficit/hyperactivity disorder (ADHD) have increased interest in the concept of sluggish cognitive tempo (SCT). The aim of this study was to investigate if the prevalence of two variable-number tandem repeats (VNTRs) located within the 30 -untranslated region of the DAT1 gene and in exon 3 of the dopamine D4 receptor (DRD4) gene differ among four groups (31 subjects with SCT but no ADHD, 146 individuals with ADHD but no SCT, 67 subjects with SCT + ADHD, and 92 healthy controls). Methods: We compared the sociodemographic profiles, neurocognitive domains, and prevalence of two VNTRs in SCT and ADHD subjects versus typically developing (TD) controls. Results: The SCT without ADHD group had a higher proportion of females and lower parental educational attainment. Subjects in this group performed worse on neuropsychological tests, except for psychomotor speed and commission errors, compared to controls. However, the ADHD without SCT group performed significantly worse on all neuropsychological domains than controls. We found that 4R homozygosity for the DRD4 gene was most prevalent in the ADHD without SCT group. The SCT without ADHD group had the highest 7R allele frequency, differing significantly from the ADHD without SCT group. Conclusion: The 7R allele of DRD4 gene was found to be significantly more prevalent in SCT cases than in ADHD cases. No substantial neuropsychological differences were found between SCT and ADHD subjects

Turner syndrome and associated problems in turkish children: A multicenter study

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population. Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014. Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosi) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto’s thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%. Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan. © Journal of Clinical Research in Pediatric Endocrinology

Evaluation of nucleolin, nucleophosmin, PTN levels in patients with non small cell cancer

YÖK Tez No: 668037Amaç: Akciğer kanseri tüm dünyada kanserlerden ölümlerin en sık sebebidir. Akciğer kanserlerinin yaklaşık %85ini küçük hücreli dışı akciğer kanserleri (KHDAK) oluşturmaktadır. Bu çalışmada Serum pleitropin(PTN), nükleolin(NCL), nükleofosmin(NPM) düzeylerinin akciğer kanserinde tanı, takip ve tedavide, prognoz tayinini ve tedavi yanıtı değerlendirilmesinde belirteç olarak kullanılabilirliği araştırılırmıştır. Gereç ve Yöntemler: Düzce Üniversitesi Tıp Fakültesi Hastanesi Tıbbi Onkoloji bölümüne başvuran, tanıları histopatolojik olarak doğrulanmış Küçük Hücreli Dışı akciğer kanseri tanılı 34 hasta ve İç Hastalıkları polikliniğine başvuran, herhangi bir malignite tanısı olamayan 35 hasta; dışlanma ve dahil edilme kriterlerine göre çalışmaya alındı. Kontrol grubunun, akciğer kanseri tanılı hastaların kemoterapi öncesinde ve 3-4 kür kemoterapi sonrasında alınan serum örneklerinden NCL, NPM, PTN düzeyleri elisa yöntemiyle çalışıldı. Sonuçlar SPSS v.22 paket programı ile değerlendirilmiş, anlamlılık düzeyi 0,05 olarak kabul edilmiştir. Bulgular: Hastaların %97'si erkek, %3'ü kadın cinsiyete sahipti. Yaş ortalaması 63,9 saptandı. Hastaların %56'si skuomöz hücreli karinom tanılı iken, %44'ü adenokarsinom tanılı ve %53'ü evre 3 iken %47'si evre 4 idi. Hastaların ortanca genel sağ kalım süresi 13,7±8,1 ay, ortanca PS süresi 9,3±4,9 ay olarak saptandı. Hasta ve kontrol grubu analizlerinde serum NCL, NPM, PTN düzeyleri hasta grubunda anlamlı olarak yüksek saptandı. Histopatolojik tipe göre adenokarsinomda skuomöz hücreli karsinoma göre anlamlı olarak yüksek saptandı. Kemoterapötik ajanların tedavi yanıtlarına bakıldığında kemoterapi öncesi ve kemoterapi sonrası değerler arasında farklılık vardı ancak istatistiksel anlamlılığa ulaşılamadı. Hasta grubu alt grup analizlerinde serum NCL, NPM, PTN düzeylerinde istatistiksel anlamlılığa ulaşılamadı. Sonuç: Çalışmamız KHDAK hastalarında serum NCL ve NPM düzeylerinin bakıldığı ilk çalışmadır. Yüksek serum NCL, NPM, PTN düzeylerinin kötü prognoz, kötü tedavi yanıtı ve düşük sağkalımı ile ilişkili bulundu. Akciğer kanseri tanılı hastalarda serum NCL, NPM, PTN düzeylerinin değerlendirilmesi sayesinde sağlık personelinin iş gücü kaybını azalacağını, görüntüleme sıklığının azalacağını, prognoz göstergesi olabileceğini, tedavi değişimi veya devamı konusunda klinisyene yardımcı olabilecek ve yol gösterici bir belirteç olabileceğini düşünmekteyiz.Objective: Lung cancer is the most common cause of cancer deaths all over the world. Approximately 85% of lung cancers are non-small cell lung cancers (NSCLC). In this study, the usability of serum pleitropin (PTN), nucleolin (NCL), nucleophosmin (NPM) levels as markers in the diagnosis, follow-up and treatment of lung cancer, determination of prognosis and evaluation of treatment response was investigated. Material and Methods: 34 patients with a diagnosis of non-small cell lung cancer whose diagnosis was histopathologically confirmed and 35 patients who were admitted to the Internal Diseases outpatient clinic without any malignancy diagnosis; NCL, NPM, PTN levels were studied by ELISA method from serum samples of patients with lung cancer before and after 3-4 cycles of chemotherapy and control group. The results were evaluated with the SPSS v.22 package program, and the significance level was accepted as 0.05. Results: 97% of the patients were male and 3% were female. The average age was 63.9 years. While 56% of the patients were diagnosed with squamous cell carinoma, 44% were diagnosed with adenocarcinoma and 53% were stage 3 and 47% were stage 4. The median overall survival of the patients was 13,7 ± 8,1 months, and the median PS duration was 9,3 ± 4.9 months. Serum NCL, NPM, PTN levels were found to be significantly higher in the patient group. According to histopathological type, molecules levels were found to be adenocarsinoma significantly higher than squamous cell carcinoma. When the treatment responses of chemotherapeutic agents were examined, there was a difference between the values before and after chemotherapy, but statistical significance could not be reached. In the patient group subgroup analyzes, no statistical significance was found in serum NCL, NPM, PTN levels. Conclusion: Our study is the first study investigating serum NCL and NPM levels in NSCLC patients. High serum NCL, NPM, and PTN levels were found to be associated with poor prognosis, poor treatment response and low survival. Evaluation of serum NCL, NPM, and PTN levels in patients with lung cancer will reduce the workforce loss of healthcare professionals, decrease the frequency of imaging, may be an indicator of prognosis, and change the treatment. We think that it can be a guiding marker that can help the clinician about or its continuation

Styles of attachment to parents and evaluation of interpersonal relations

İstanbul Bilim Üniversitesi, Florence Nightingale Hastanesi Hemşirelik Yüksekokulu.Farklı kişilik örüntülerine sahip bireyler, özel yaşamda ve iş yaşamında kaçınılmaz bir şekilde birbirlerini etkiler. Bu etkileşim, kişilerarası ilişkiler olarak adlandırılmaktadır. Bakım vereniyle yaşadığı ilk deneyimler bebeğin kişilerarası ilişkilerinin çekirdeklerini oluşturmaktadır. Sağlıklı ve uyum sağlayabilen bir zihinsel gelişim anne/baba ya da birincil bakım verenle olan etkileşime bağlıdır. Anne-babaya bağlanma biçimleri, kişilerarası ilişkiler ve bu ilişkilerin uyum içinde sürdürülebilmesinde döngüsel bir etki yaratmaktadır. Uyum, sağlığın bir göstergesi olmasının yanı sıra sağlık bakımı için büyük önem taşımaktadır. Sağlık bakımının etkin bir biçimde sağlanabilmesi, amaçlı ve tedaviye yardım edici iletişim olarak tanımlanabilen terapötik ilişkiyle mümkündür. Kaliteli ve etkin bir sağlık hizmeti sunmada bakım alan bireylerin ve sağlık ekibinin terapötik ilişkide başarılı olması gerekmektedir. Bu başarı, sağlık profesyonellerinin bağlanma ilişkisi ve kişilerarası ilişkilere yönelik bilgi, beceri ve içgörülerinin artmasıyla elde edilebilir.Individuals with different personality patterns inevitably influence each other in private and business life. This interaction is called interpersonal relations. First experiences with the caregiver constitute the very core of a baby's interpersonal relations. A healthy and cohesive mental development depends on the interaction with the mother/father or primary caregiver. Styles of attachment to parents create a cyclical effect for interpersonal relations and for sustaining these in harmony. Compliance, as well as being an indicator of health, is of great importance for healthcare. It is only possible to provide healthcare effectively through therapeutic relationship that can be described as purposive and contributive communication to treatment. In order to provide a high-quality and efficient healthcare service, there should be a sound therapeutic relationship between healthcare staff and the individuals receiving the care. This soundness can be achieved via improvement of healthcare professionals’ knowledge, skills and insights on attachment relationships and interpersonal relations

The changes which come with the model upon metropolitan municipality within the provincial administrative boundaries

Türkiye’de kentlerin nüfus ve mekânsal olarak büyümesi, toplumun belediyelerden hizmet beklentilerinin artması, belediye yasalarında yeni düzenlemeler yapma ihtiyacını doğurmuştur. 1982 Anayasasındaki büyük yerleşim birimleri için özel yönetim biçimleri getirebilir hükmüne dayanılarak 1984 yılında büyükşehir belediyeleri kurulmuştur. Son olarak 2012 yılında 6360 sayılı büyükşehir belediye yasası çıkarılmıştır. Bu yasa ile büyükşehir olan illerde belediye sınırı il mülki sınırları ile örtüştürülmüş, böylece kentsel alanlar yanında kırsal yerleşmelere de hizmet vermeye başlayan büyükşehir belediyeleri ortaya çıkmıştır. Büyükşehir belediyelerinin hizmet alanının il mülki sınırları olarak belirlenmesiyle görev, yetki, sorumluluk, temsil ve katılım açısından önemli değişiklikler ortaya çıkarabileceği ifade edilmektedir. Bu çalışmada, yerel yönetimler içinde önemli bir yeri olan büyükşehir belediye sisteminin analizi yapılacaktır.The growing cities in Turkey by the population and spatial terms and the increase of societies ' own expectation about services have revealed the basic needs on upcoming amendments f or available municipality laws. The constitution act in 1982 brought new and specif ic management f orms f or big settlements in Turkey, then the metropolitan municipalities were f irstly f ounded in 1984. Consequently, the metropolitan municipality law 6360 has been f inally accepted in 2012. Besides, the area management principle was also accepted f or metropolitan municipalities which gave services f or rural areas as well as the urban ones. Equaling the service area of metropolitan municipalities to the provincial administrative boundaries open the debates on some important changes upon duties, responsibility, representation and participation concepts. In this study the case of metropolitan municipalities ' own available system which has an important place in local governance will be analyzed