Informed consent in surgical practice with patients’ experiences: A cross-sectional study

This study aims to evaluate patients\u27 experiences and perspectives regarding informed consent in surgical practice. Data for this cross-sectional study were collected from 276 patients using a questionnaire developed by Falagas et al. Descriptive statistics were employed for all questions. Statistical tests such as the Mann-Whitney U test, Kruskal-Wallis test, and Spearman\u27s rank correlation analysis were performed, and Cohen\u27s effect sizes were reported. IBM SPSS 23.0 was used for all analyses, and p\u3c0.05 was considered statistically significant. A high score on both The Delivered Information Index and The Patient-Physician Index represents a positive informed consent process. Among the participants, 65.2% indicated that they understood all parts of the consent form. Of all patients, 92.8% reported that information about the specific surgical procedure was provided by physicians. However, 47.5% of the patients reported that they did not feel comfortable with their surgeons. The mean score of the Delivered Information Index was 5.63 (2.38). The mean patient-physician relationship score was 14.38 (3.31). There was a moderate positive correlation between the delivered information index and the patient-physician relationship (r=0.50; p\u3c0.001). In addition, there was a moderate positive correlation between the delivered information index and the time spent on the informed consent process, as well as between the patient-physician relationship and the time spent on the informed consent process (r=0.52; r=0.40, respectively). The study emphasized the lack of communication between patients and physicians, the limitation of information on treatment risks, adverse effects, and alternative treatment options. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Optik atrofi, maküler incelme ve arkuat skotom gibi atipik klinik bulgular gösteren çoklu geçici beyaz nokta sendromu olgusu

A 57-year-old man presented with a sudden loss of vision, central scotoma, and photopsia in the left eye. Grayish-white spots localized in the deep retina around the macula and optic disc were observed in the left eye on funduscopic examination. We observed a hyperfluorescence in a wreath-like pattern with late staining in retinal lesions during the early stage of fundus fluorescein angiography. Disruption was observed in an ellipsoid zone in optical coherence tomography. Multiple evanescent white dot syndrome was diagnosed based on findings and followed up without medication. The visual acuity of the left eye improved from 1/20 to 6/10 after a 7-week follow-up. Dilated fundus examination showed optic atrophy, and visual field examination revealed an arcuate scotoma.Elli yedi yaşında erkek hasta, sol gözde ani görme kaybı, santral skotom ve fotopsi şikâyetleri ile kliniğimize başvurdu. Funduskopik muayenesinde, sol gözde makula ve optik disk etrafında, retinanın derin katlarında lokalize olmuş grimsi beyaz lezyonlar gözlendi. Fundus floresan anjiyografi erken dönemi boyunca retinal lezyonlarda gözlenen çelenk benzeri hiperfloresans, geç boyanma ile devam etti. Optik koherens tomografide, fotoreseptör iç ve dış segment tabakasında harabiyet görüldü. Mevcut bulgular eşliğinde hastaya, çoklu geçici beyaz nokta sendromu teşhisi kondu ve ilaçsız takip edildi. Yedi haftalık takip sonrası hastanın görme keskinliği 1/20’den 6/10’a yükseldi. Dilate fundus muayenesinde, optik atrofi ve görme alanında arkuat skotom oluştuğu gözlendi

Increased serum concentration of netrin-1 after intravitreal bevacizumab injection: is it a compensatory mechanism to counteract drug side effects?

Background To evaluate alterations in the serum concentrations of vascular endothelial growth factor (VEGF) and netrin-1 after intravitreal bevacizumab (BCZ) injection for the treatment of diabetic macular edema (DME). Methods This prospective case-control study included a total of 50 participants assigned to one of three groups, including 10 individuals with DME and non-proliferative diabetic retinopathy (NPDR), 13 with DME, and proliferative diabetic retinopathy (PDR), and 27 healthy individuals as a control group. Serum VEGF and netrin-1 concentrations were measured by enzyme-linked immunosorbent assays (ELISAs) immediately before, as well as 1 week and 1 month after, intravitreal BCZ injection. Results The mean VEGF serum concentrations in the PDR and NPDR groups were 388.4 and 196.9 pg/mL at baseline, respectively. After 1 week, these concentrations changed to 193.41 and 150.23 pg/mL, respectively (P = 0.001 and P = 0.005, respectively); after 1 month, the concentrations were 97.89 and 76.46 pg/mL, respectively (P = 0.001 and P = 0.009, respectively). The mean netrin-1 serum concentrations in the PDR patients and NPDR groups were 318.2 and 252.7 pg/mL at baseline, respectively. After 1 week, these concentrations increased to 476.6 and 416.3 pg/mL, respectively (P = 0.033 and P = 0.005, respectively), and after 1 month, they were 676.6 and 747.5 pg/mL, respectively (P = 0.001 and P = 0.005, respectively). The correlation analysis revealed a significant inverse relationship between changes in serum VEGF and netrin-1 concentrations in both the PDR and NPDR groups (r = - 0.685, P = 0.029). Conclusions Intravitreal BCZ injections work systemically to significantly decrease serum VEGF levels, leading to a significant upregulation in the concentration of another angiogenic mediator, netrin-1

Larinks skuamöz hücreli karsinom kökenli optik disk ve koroid metastazlı bir olgu

A 67-year-old male patient was presented with loss of vision, which he noticed in his left eye one week ago. He had undergone total laryngectomy due to laryngeal squamous cell carcinoma 3 years ago. His fundus examination revealed an elevated yellow mass on the optic disc. Magnetic resonance imaging (MRI) and computed tomography (CT) were performed with suspicion of laryngeal cancer metastasis. The MRI showed metastatic lesions in the brain, optic disc, and the surrounding choroid. The CT demonstrated diffuse metastasis in both lungs. The patient received radiotherapy for the brain, optic disc, and choroidal metastases. Unfortunately, the patient died within 2.5 months after the diagnosis because of systemic complications that developed due to extraocular causes. Metastasis of laryngeal cancer to the optic disc and choroid is rare. Although the majority of optic disc tumors are primary, a systemic investigation should be performed in cases of a mass on the disc with the suspicion of distant organ metastasis, albeit rare.T Altmış yedi yaşında erkek hasta, 1 hafta önce sol gözünde fark ettiği görme kaybı şikâyeti ile başvurdu. Üç yıl önce laringeal skuamöz hücreli karsinom nedeniyle total larenjektomi geçirdiği öğrenildi. Fundus muayenesinde, optik diskte sarı bir kitle görüldü. Larinks kanseri metastazı şüphesi ile manyetik rezonans görüntüleme (MRG) ve bilgisayarlı tomografi (BT) yapıldı. MRG’de beyin, optik disk ve çevreleyen koroidde, metastatik lezyonlar tespit edildi. BT’de her iki akciğerde yaygın metastaz saptandı. Hasta beyin, optik disk ve koroid metastazları için radyoterapi aldı. Ekstraoküler nedenlere bağlı gelişen sistemik komplikasyonlar nedeniyle tanı konulduktan sonraki 2,5 ay içinde ne yazık ki hasta kaybedildi. Larinks kanserinin, optik disk ve koroide metastazı nadirdir. Optik disk tümörlerinin çoğunluğu primer olmakla birlikte, nadir de olsa uzak organ metastazı şüphesi ile diskte kitle olması durumunda sistemik inceleme yapılmalıdır

Demir yükü artmış karaciğerde i̇nce i̇ğne aspirasyon sitolojisi (IIAS) ve tru-cut biyopsisi: deneysel bir çalışma

Objective: Fine needle aspiration cytology (FNAC) is safer, simpler, faster and cost effective, compared to tru-cut biopsy, and patient compliance is generally better. There is not much data on the use of FNAC, which is used in many organs and lesions, in parenchymal diseases in the liver. Therefore, in this study, the benefit of FNAC in showing iron deposition and injury of liver is evaluated. Methods: There were 2 control groups in the study. At the end of the study, FNAC and tru-cut biopsy samples were taken from these groups, where no administration was performed. FNAC and tru-cut biopsy procedures were also performed to the study groups after the iron overload was created by intraperitoneal iron dextran (88 mg/kg) administration for 28 days. Hepatocyte injury, inflammation and iron deposition were evaluated histopathologically in the preparations. The sensitivity, specificity, positive and negative predictivity and diagnostic accuracy of both methods were calculated based on the hepatectomy material. Results: In hepatocyte injury; sensitivity (60%), diagnostic accuracy (66.7%) and negative predictivity (50%) were found to be significantly higher in tru-cut group. It was observed that the methods were not superior to each other in the evaluation of inflammation, and FNAC almost approached tru-cut biopsy rates (100%) with a sensitivity of 83.3% and diagnostic accuracy in iron deposition. Conclusion: In iron-induced liver damage, the gold standard should be tissue examination, so tru-cut biopsy must be the first choice. However, based on the present study results, it is suggested that FNAC may be preferred over more invasive options in cases where tru-cut biopsy can not be used in terms of susceptibility to bleeding, situations where surgical accessibility is not available, patient orientation and cooperation is poor, or in presence of different accompanying diseases

Evaluation of serum vascular endothelial growth factor and netrin-1 levels in patients with neovascular age-related macular degeneration: case-control study

Amaç: Bu çalışmanın amacı, neovasküler yaşa bağlı makula dejenerasyonu (n-YBMD) hastalarında serum vasküler endotelyal büyüme faktörü [vascular endothelial growth factor (VEGF)] ve netrin-1 düzeyini sağlıklı kontrol grubu ile karşılaştırarak, bu vasküler belirteçlerin düzeyindeki değişikliğin sistemik problemlerin belirtisi olup olmadığını araştırmaktır. Gereç ve Yöntemler: Kliniğimizde n-YBMD teşhisi almış ve intravitreal enjeksiyon planlanan 37 hasta ve kontrol grubu olarak katarakt cerrahisi planlanan 34 hasta dâhil edildi. Çalışma ve kontrol grubu hastalarında serum VEGF ve netrin-1 düzeyi enzime bağlı immünosorbent deney yöntemi kullanılarak ölçüldü. Bulgular: Çalışma grubunun medyan yaş değeri 77 (61-84) kontrol grubunun ise 75 (50-87) idi. N-YBMD grubunda serum netrin-1 ve netrin-1/VEGF oranı kontrol grubuna göre anlamlı olarak düşük ve serum VEGF oranı anlamlı olarak yüksek bulundu (tümü p<0,001). Alıcı işletim karakteristiği [receiver operating characteristic (ROC)] analizine göre netrin1 seviyesi n-YBMD’yi tahmin etmek için orta düzeyde bir kesinliğe sahipti. ROC eğrisi altında kalan alan %83,78 [%95 GA (güven aralığı), 68-93,8)] duyarlılık ve %85,29 (%95 GA, 68,9-95) özgüllük ile 0,883 (%95 GA, 0,797-0,970) olarak bulundu. Netrin-1 seviyeleri için en iyi kesim değeri ≤485,1 mg/mL idi ve bu istatistiksel anlamlı olarak değerlendirildi (p<0,001). Sonuç: N-YBMD hastalarında bulunan yüksek VEGF ve düşük netrin-1 serum düzeyi bu hastalığın sistemik ve inflamatuar bir hastalık olduğunu göstermektedir. Düşük serum netrin1/VEGF oranı ise bu hastalıkta birbiri ile ilişkili anjiyogenik mediyatörlerin sistemik dengesinin bozukluğunun göstergesidir.Objective: To compare serum vascular endothelial growth factor (VEGF) and netrin-1 levels in patients with neovascular age-related macular degeneration (n-AMD) with a healthy control group, to investigate whether changes in the level of these vascular markers are a sign of systemic problems. Material and Methods: In our clinic, 37 patients who were diagnosed with n-AMD and were scheduled for intravitreal injection, and 34 patients who were scheduled for cataract surgery as the control group were included in the study. Serum VEGF and netrin-1 levels were measured using the enzymelinked immunosorbent assay method in the study and control group. Results: The median age of the study group was 77 (61-84) and the control group was 75 (50-87). Serum netrin-1/VEGF ratio and netrin1 levels were significantly lower and VEGF levels were significantly higher in n-AMD patients compared to the control group (p<0.001 for all). According to the receiver operating characteristic (ROC) analysis, the netrin-1 level had a moderate precision to predict n-AMD. The area under the ROC curve was 0.883 [95% confidence index (CI), 0.797- 0.970] with a sensitivity of 83.78% (95% CI, 68-93.8) and a specificity of 85.29% (95% CI, 68.9-95). For netrin-1 levels, the best cut-off value was ≤485.1 mg/mL, with a statistically significant difference (p<0.001). Conclusion: Low serum netrin-1 and high VEGF levels detected in patients with neovascular AMD indicate a manifestation of systemic inflammatory disease. The low serum netrin-1/VEGF ratio indicates that the systemic balance of these biomarkers is impaired in this disease

Yaşa Bağlı İşitme Kaybı Olan Hastalarda Retina Sinir Lifi Kalınlığının Değerlendirilmesi

Introduction: To perform retinal nerve fibre layer (RNFL) analysis in patients with age-related hearing loss (ARHL) using optical coherence tomography (OCT). Materials and Methods: Sixty-five patients with ARHL and 36 healthy controls were included in this prospective study. Patients with ARHL were divided into two groups—one with mild (33 patients) and one with moderate (32 patients) impairment. A complete ophthalmological examination was applied to all subjects and included best-corrected visual acuity, slit lamp examination, Goldmann applanation tonometer, visual field testing and dilated fundus examination. The RNFL thickness of all participants was measured using an OCT device. Pure tone audiometry tests were performed on the patients using headphones and AC40 audiometry in a silent cabin. Results: The mean age was 70.39, 70.55 and 71.22 in the control, mild and moderate hearing loss groups, respectively. A statistically significant difference was observed between the control group and patients with moderate ARHL, between inferior quadrant thicknesses(p=0.011) and between mean RNFL thicknesses(p=0.025). The superior, nasal and temporal quadrant RNFL thicknesses were similar across the whole study group, with no statistically significant difference (p values: 0.104, 0.650, 0.470, respectively). Conclusion: The average RNFL was significantly thinner in the patients with moderate ARHL compared to the controls. As age and the degree of hearing loss inc reases, RNFL thicknesses decreases.Amaç: Yaşa bağlı işitme kaybı (YBİK) olan hastalarda optik koherens tomografi (OKT) kullanarak retina sinir lifi tabakası (RSLT) kalınlığı analizi yapmak. Gereçler ve Yöntem: Bu prospektif çalışmada YBİK olan 65 hasta ve 36 sağlıklı kontrol vardı. YBİK olan hastalar hafif (33 hasta) ve orta (32 hasta) olarak iki gruba ayrıldı. Her hastaya en iyi düzeltilmiş görme keskinliği, yarıklı lamba muayenesi, Goldmann aplanasyon tonometresi, görme alanı testi ve dilate fundus muayenesi dahil olmak üzere tam bir oftalmolojik muayene yapıldı. Tüm katılımcıların RSLT kalınlığı OKT cihazı kullanılarak ölçüldü. Hastaların saf ses odyometri testleri sessiz bir kabinde kulaklık ve AC40 odyometri kullanılarak yapıldı. Bulgular: Kontrol, hafif ve orta işitme kaybı gruplarında ortalama yaş sırasıyla 70.39, 70.55 ve 71.22 idi. Kontrol grubu ve orta derecede YBİK olan hastalarda inferior kadran kalınlıkları arasında(p = 0.011) ve ortalama RSLT kalınlıkları arasında(p = 0.025) istatistiksel olarak anlamlı bir fark vardı. Üst, nazal ve temporal kadran RSLT kalınlıkları tüm çalışma gruplarında benzer bulundu ve istatistiksel olarak anlamlı bir fark yoktu (sırasıyla p =0.104, 0.650, 0.470). Sonuç: Orta derecede YBİK olan hastalarda kontrollere kıyasla ortalama RSLT kalınlıkları anlamlı derecede daha ince bulundu. Yaş ve işitme kaybı derecesi arttıkça RSLT kalınlıkları azalır

Extension in Shelf Life of Fresh Food Using Nanomaterials Food Packages

In this study, the use of nanocomposite polyethylene films to extend shelf life of food products and to enhance its barrier and mechanical properties was investigated. Nanocomposite was designated 80% wt LLDPE, 14.28% wt PE-g-MA, and 5.72% wt organoclay and package films were prepared on the "cast-film" line. The physical and chemical properties of these films were determined and evaluated. The results showed that an "exfoliated/intercalated" mixture was obtained, with un pronounced change in mechanical properties and transparencies, while oxygen permeability is decreased by 42% and the shelf-lives of foods extended up to twofold

Influence of Process Parameters on the Mechanical and Foaming Properties of PP Polymer and PP/TALC/EPDM Composites

In this study, PP and Talc/EPDM/PP composite materials are used. Foaming process is achieved by a conventional injection molding method. The influence of injection pressure and melting temperature on the average cell dimension, cell number, skin layer thickness, foam density and mechanical properties of investegated foam materials were evaluated. It is observed that cell density is increased by the increment of injection pressure. However, the values of skin layer thickness, density, cell diameter and charpy impact strength are decreased. In addition, the values of skin layer thickness, cell density, density and impact strength are increased with the increment of melting temperature

Evaluation of tear parameters and meibomian gland morphology in keratoconus patients after epithelial-on corneal cross-linking

Purpose To evaluate the variations in tear parameters and meibomian gland morphology after epithelial-on (epi-on) corneal collagen cross-linking (CXL) in keratoconus (KC) patients. Methods This prospective observational study included 38 KC eyes that underwent epithelium-on CXL. Thirty-three eyes of 33 stable KC patients with no prior CXL treatment formed the KC group and 35 eyes of 35 healthy volunteers were recruited as the control group. All participants were evaluated by Schirmer I test, first and average noninvasive tear break-up time (NITBUT), ocular surface disease index (OSDI) questionnaire, and meibography scores. The CXL patients were evaluated preoperatively and at the 1st, 3rd, and 6th months, and participants without any intervention (KC and control groups) were evaluated initially, at 1st, 3rd, and 6th months. Results The KC patients had significantly lower average NITBUT, higher OSDI scores, and impaired meibomian gland morphology than healthy individuals (NITBUT(seconds): KC, 12.8(2.4-17.6), healthy group (HG), 17.1(6.8-17.6); p = 0.012, OSDI: KC, 27.5(0.0-87.5), HG, 7.5(0.0-55.0); p < 0.001, p < 0.001, respectively). A significant difference was found in Schirmer values of the CXL group at 0-1st months, first NITBUT values at 1-6 months, and average NITBUT values at 1-3 and 1-6 months (p = 0.003, p = 0.001, p = 0.003, p = 0.001, respectively). All meibography parameters remained unchanged after CXL over a 6-month follow-up compared to initial measurements. Conclusions Even though the KC patients had lower NITBUT, higher OSDI scores, and increased meibomian gland disfunction, the CXL treatment did not significantly affect tear quantity, dry eye symptoms, and meibomian gland morphology