Henri Temianka Correspondence; (spivakovsky)

https://digitalcommons.chapman.edu/temianka_correspondence/2868/thumbnail.jp

Impact of Reducing Irritative Symptoms in Non-Muscle Invasive Bladder Cancer During BCG Instillation: A Pilot Study

INTRODUCTION: We evaluated use of anticholinergics, mirabegron, and combination of anticholinergics with mirabegron during Bacillus Calmette-Guérin (BCG) instillation for reducing irritative symptoms in patients with non-muscle invasive bladder cancer (NMIBC). METHODS: Prospectively recorded data of NMIBC patients receiving BCG were retrospectively evaluated between August 2015 and April 2019. Patients with low-grade T1 solitary papillary lesions <4 cm were included in the study. Validated questionnaires (OAB-V8) for irritative symptoms adapted to Turkish language, and QoL index forms were filled out by the study participants. OAB-V8 scores of ≥8 were considered as an indication to start medical treatment for irritative symptoms. Groups were formed according to daily used anticholinergic drugs and combinations as follows: Group 1, tolterodine; Group 2, solifenacin 5mg; Group 3, mirabegron, and Group 4, mirabegron with solifenacin 5 mg. RESULTS: Mean follow- up period was 20.4+-6.8 months. There were 132 patients [110 men (83%) and 22 (17%) women] with irritative symptoms and NMIBC. Mean age of the study population was 59.7+-12.4 years. The OAB-V8 scores and QoL indexes significantly improved with all drugs. However, in subgroup analyses, Group 4 provided the most dramatic improvement in OAB-V8 and QoL index scores (P=0.02 for both). The longest in time to micturition was recorded in Group 4 (P=0.04). Tumour recurrence was similar for groups 12 months after BCG instillation (P=0.9), however the least recurrence was observed in Group 4. DISCUSSION AND CONCLUSION: Combination of solifecacin and mirabegron can reduce irritative symptoms, improve QoL, and prolong time to micturition, during BCG instillation in selected NMIBC patients. This combination may also decrease recurrence rates in this patient population

Metabolik Sendromu Olan Hastalarda Visseral Yağlanma Oranı ve Boyun Çevresi Arasındaki İlişki

Amaç: İnsanların yaşadığı çevre, davranışları ve yaşam tarzı, dramatik bir şekilde değişmektedir. Bu değişimlere bağlı olarak, obezite ve tip 2 diyabet sıklığında ciddi bir artış görülmektedir. Obezite ve diyabetin görülme sıklığındaki artışa paralel, her geçen gün daha fazla insanı etkilemekte olan ve multi faktöriyel risk etmenlerinin bir araya gelmesi sonucu oluşan metabolik sendrom, kardiyovasküler hastalık riskini de beraberinde getirdiği için 21. yüzyılın önemli sağlık sorunlarından biridir.Gereç ve Yöntem: Bu araştırmada, kilo yakınması ile başvuran hastalarda, boyun çevresi ölçümlerini bazı metabolik ve antropometrik ölçümlerle karşılaştırmayı ve özellikle metabolik sendromu olan hastalarda, visseral yağlanma oranları ile boyun çevresi ölçümleri arasındaki korelasyonu göstermeyi amaçladık. Araştırmamıza, 01.02.2009 – 01.02.2011 tarihleri arasında, Başkent Üniversitesi Ümitköy Semt Polikliniği, diyabet ve obezite polikliniğine, kilo yakınması ile başvuran 179 hasta alınmıştır. Bu çalışma retrospektif bir vaka – kontrol çalışmasıdır.Araştırmanın verileri, SPSS 16.0 versiyonu istatistik programına aktarılmış, veri kontrolü ve analizler bu programda yapılmıştır. Hipoteze yönelik analizlerde Pearson Ki-kare testi kullanılmış, verilerin anlamlılık düzeyleri Ki-kare testi ile saptanmıştır.Bulgular: Çalışmamıza alınan 179 hastadan % 77’si n=137 kadın, % 23’ü n=42 erkektir K:E oranı=3,26 . Hastalarımızın yaş ortalaması 37±13,15’dir. Hastalarımızdan 40’ına % 22,3 metabolik sendrom tanısı konmuştur. Metabolik sendromu olmayanların boyun çevresi ortalaması 35,15±3,48 cm, metabolik sendromu olanların ise 38,40±4,13 cm saptanmıştır. Metabolik sendromu olan hastalarda, boyun çevresi ile visseral yağlanma oranları arasında istatistiksel olarak anlamlı pozitif korelasyon gösterilmiştir r=0,71; p=0,01 .Sonuç: Çalışmamız, metabolik sendromda boyun çevresi ölçümünün, NCEP ATP III kriterlerinden biri olan bel çevresi ölçümü gibi değerli ve istatistiksel olarak anlamlı pozitif korelasyon gösteren bir ölçüm olduğunu ortaya koymuştu

Determination of Burnout Level and Associated Factors in Research Assistants of Düzce University Faculty of Medicine

Amaç: Tükenmişlik, sağlık çalışanlarında, özellikle de işyerinde yüksek düzeyde strese maruz kalan hekimlerde çok sık görülmektedir. Bu çalışmada Düzce Üniversitesi Tıp Fakültesi’nde uzmanlık eğitimini almakta olan asistan hekimlerde tükenmişlik düzeylerinin ve ilişkili olabilecek faktörlerin değerlendirilmesi amaçlanmıştır. Yöntem: Çalışmamız tanımlayıcı-kesitsel tipte olup, 01.01.2018-01.04.2018 tarihleri arasında Düzce Üniversitesi Tıp Fakültesi Hastanesi’nde uzmanlık eğitimini almakta olan toplam 89 asistan hekim çalışmaya alınmıştır. Veri toplama aracı olarak araştırma görevlilerinin sosyo-demografik özelliklerini değerlendiren 21 sorudan oluşan anket formu ve araştırma görevlilerinin tükenmişlik düzeylerinin belirlenmesi için 22 sorudan oluşan Maslach Tükenmişlik Ölçeği yüz yüze görüşme tekniği ile uygulandı. Bulgular: Katılımcıların yaş ortalaması 28,653,03’tür; 46'sı (%51,7) erkek, 57'si (%64) bekar hekimlerden oluşmaktadır. Maslach Tükenmişlik Ölçeği duygusal tükenme ortalama puanları 27,787,80; duyarsızlaşma ortalama puanları 12,764,15 ve kişisel başarıda azalma ortalama puanları 27,695,04’tür. Duygusal tükenme durumu ile meslek sevgisi ve seçilen branş sevgisi arasında; duyarsızlaşma durumu ile cinsiyet arasında; kişisel başarıda azalma durumu ile gelir durumu, kronik hastalık varlığı, meslek sevgisi arasında istatistiki olarak pozitif yönde anlamlı ilişki saptanmıştır. Sonuç: Çalışmamızın sonuçlarına göre asistan hekimlerde tükenmişlik bulunmaktadır. Asistanların gelir düzeyi durumunun düzenlenmesi, adaletsiz dağılımların önlenmesi, kronik hastalığı olan hekimlere bazı durumlarda ayrıcalık tanınması, mesleki doyumlarının artmasına yönelik motivasyonel teşvik aktivitelerinin yapılması, gerekirse ödüllendirmelerin yapılmasının, hekimlerde tükenmişlik sendromunun önlenmesinde olumlu etki edeceği düşünülmektedir.Aim: Burnout is very common among health care workers, especially in physicians exposed to high levels of stress in the workplace. We aimed to evaluate burnout levels and related factors in residents in specialist training at Düzce University Faculty of Medicine. Methods: Our study was a descriptive cross-sectional type study and 89 resident assistants who were receiving specialist training at Düzce University Medical Faculty Hospital between January 1st and April 1st, 2018 were taken into the study. A 21-questions questionnaire was used to evaluate the socio-demographic characteristics and Maslach Burnout Questionnaire was used to determine the burnout level of the research assistants. Results: The mean age of participants was 28.653.03; 46 (51.7%) were male and 57 (64%) were single. Maslach Burnout Scale emotional exhaustion mean score was 27.787.80; the mean score of depersonalization was 12.764.15 and the mean score of the individual decrease was 27.695.04. The relationship between emotional exhaustion and occupational love and selected branch love, the relationship between depersonalization and gender, the relationship between personal achievement decrease with income status, the presence of chronic illness and the occupational love were positively statistically significant. Conclusion: According to the results of our study, there is burnout among resident doctors. Regulation of income levels of residents, prevention of unjust distribution, in some cases giving privilege to physicians with chronic diseases and making motivational incentive activities to increase their occupational satisfaction are thought to have a positive effect on the prevention of burnout syndrome among physicians

A new prognostic-predictor marker of cardiovascular disease for obstructive sleep apnea: Pentraxin 3

Obstructive sleep apnea syndrome (OSAS) is characterized by intermittent complete or partial upper airway obstruction during sleep causing hypoxia, sleep disruption, daytime sleepiness, mental and physical effects is the second most common respiratory condition; affecting 0.3- 4% of the middle- aged population (1). OSAS is strongly associated with cardiovascular morbidity and mortality, including an increased risk of endothelial dysfunction and atherosclerosis (2). The increased prevalence of hypertension and atherogenesis among OSAS patients has been attributed to sympathetic activation and endothelial dysfunction, likely resulting from initiation and propagation of inflammatory responses within the microvasculature (3). There is increasing evidence that OSAS associated with inflammatory cytokines and markers such as C-reactive protein (CRP), interleukin-6, fibrinogen, tumor necrosis factor alpha which are closely-involved in atherosclerosis, plaque formation and rupture (4). OSAS, a potent activator of inflammation, inreases CRP which has been used as an inflammatory biomarker for prediction of cardiovascular events;CRP is named as classical short pentraxins and is a acute phase protein produced from the liver in response to inflammatory mediators (5). Pentraxin 3 (PTX3), a new defined member of the pentraxin family, is produced from the major cell types involved in atherosclerotic lesions, including vascular endothelial-smooth muscle cells, macrophages, and neutrophils in response to inflammatory stimuli, however CRP is produced only from liver (6,7). Furthermore, CRP represents a systemic response to local inflammation, whereas PTX3 is rapidly produced directly from damaged tissues and directly reflects only the inflammatory state of the vasculature. The last but not the least PTX3 levels have been reported to be significantly elevated in acute myocardial infarction (7). In the light of these knowledge, PTX3 is able to reflect ACS condition better than CRP, it is highly possible that PTX3 is a superior biomarker to predict future cardiovascular events. Therefore, we speculate that OSAS, directly or indirectly, induces a persisting systemic and vascular inflammation and may cause PTX3 secretion. Since high PTX3 level is a sign of vascular inflammation which is the trigger point for many diseases that may occur secondary to OSAS, might also be a good marker of cardiovascular disease in OSAS. Screening of PTX3 level in OSAS patients may be a useful marker for evaluating the prognosis of OSAS. To address this hypothesis, further prospective studies are warranted to evaluate the role of PTX3 in patients with OSAS

Impact of using thiocolchicoside during endoscopic ureteral calculi removal: A preliminary study

Ates, Erhan/0000-0002-9677-5673;WOS: 000366731000005PubMed: 26174074

The prevalance of atopy and allergic rhinitis in asthma Astimda atopi ve alerjik rinit sikliǧi

Purpose: The aim of the present study was to determine the prevalence of atopy and allergic rhinitis by prick skin test with multi-test II applicator in patients with asthma. Material and Methods: In this study, 200 patients who were admitted to the Medical Faculty, Department of Pulmonary Disease and who was diagnosed asthma were evaluated prospectively. Pulmonary function test and twelve aeroallergens skin test were applied to patients. Total IgE levels and blood eosinophil counts were also measured. Atopic asthma was defined as the history of asthma with positive skin test. Results: Mean age of patients was 42.4±13.2 years old. 152 (76%) were women; 48 (24%) were men. 120 (60%) were skin test positive. Allergy to pollens (%69.2) was the most prevalent sensitization, followed by allergy to house dust mites, cockroach and molds (%56.7, %41.7, %7.5). Ninety-seven patients (48%) were allergic rhinitis. Conclusion: The results showed that asthma in 60% of the patients had an atopic background in Kayseri. Less than half of the asthmatic patients had associated rhinitis. The most frequent sensitization allergens that were determined by prick skin test with multi-test II applicator in patients with or without rhinitis were pollens in Kayseri. The frequency of house dust mite was second highest, of cockroach was third highest In patients with atopic asthma and allergic rhinitis, prevention should be provided against pollens and house dust mite to control the disease

Gemcitabine induced pulmonary toxicity with late onset

Gemcitabine is a nucleoside analog that has been increasingly used in the chemotherapy of solide tumors, including breast, pancreas ovary and non small cell lung cancer. It is generally well tolerated and has few side effects. Gemcitabine induced pulmonary complications range from mild dyspnea to death from ARDS. A 57- year- old man was treated with six cycles of gemcitabine because of pancreatic carcinoma in July, 2004.The patient had self limiting weakness, lack of appetite, nausea and no dyspnea in treatment period. One year later, he was admitted to a local hospital with exercises induced dyspnea. He had been given levofloxacin for 14 days. On admission to our hospital, his complaint kept on. A few inspiratory crackles were present at right base. CXR demonstrated interstitial infiltrations in the right lung lower zone. HRCT showed grand glass opacity and mild reticular patterns in right lung middle and lower lobes. Bronchoscopy was performed. Transbronchial biopsy revealed nonspecific interstitial pneumonia. Following the administration of oral corticosteroid, he had complete resolution of all signs and symptoms of gemcitabine toxicity