Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

THE EVALUATION CHEMICAL AND MICROBIOLOGICAL PARAMETERS OF TOTAL MIXED RATION (TMR) IN DAIRY FARM

Araştırma toplam rasyon karışımı (TMR) sistemi uygulanan bir süt sığırcılığı işletmesinde 10 aylık dönemde yürütülmüştür. Araştırmanın materyalini işletmede hazırlanan TMR yemlerinden mikser vagon ve yemliklerden alınan örnekler oluşturmuştur. Araştırmanın yürütüldüğü işletmenin mikser vagon kapasitesi ortalama 1 ton olup TMR kompozisyonunu ise çayır otu, saman, tritikale, ayçiçeği küspesi, mısır silajı, melas, tuz, vitamin mineral karması ve süt yemi oluşturmaktadır. TMR örneklerinde pH, kuru madde (KM), suda çözünebilir karbonhidrat (SÇK) mikrobiyolojik analizler laktik asit, maya ve küf analizleri yapılmıştır. Her numune alım döneminde ortam sıcaklığı, yemliklerdeki sıcaklık değişimleri de kaydedilmiştir. Araştırma sonucunda özellikle çevre sıcaklığının yüksek olduğu dönemlerde yemlik kontrollerinin çok daha önemli olduğunu ortaya koymaktadırThe research was conducted in a 10 month period in a dairy cattle farm which has a total mixed ration (TMR) system. The material of the study consisted of samples taken from mixer wagons and feeders from TMR feed prepared in the enterprise. The mixer wagon capacity of the enterprise where the research is carried out is 1 ton and the composition of TMR is formed of meadow grass, straw, triticale, sunflower meal, corn silage, molasses, salt, vitamin mineral mixture and milk feed. pH, dry matter (DM), water soluble carbohydrate (WSC) microbiological analysis, lactic acid, yeast and mold analysis were performed. In each sampling period, ambient temperature and temperatures changes in feeders were recorded. As a result of the research, it is seen that feeder controls are more important especially during periods of high environmental temperatur

The effect of career job motivations of X and Y generations on expectations: a study on the banking sect or

Günümüzde çalışma hayatında bir arada olan kuşakların iş motivasyonları için uygulanması gereken politikalar değişmektedir. Çalışma hayatında motivasyon kaynaklarından birisi de çalışanların kariyer beklentisidir. Bu araştırmanın da amacı; X Kuşağı ve Y Kuşağı’nın iş motivasyonunun kariyer beklentilerini ne ölçüde etkilediğinin tespit edilmesidir. Araştırmada, X Kuşağı ve Y Kuşağı çalışanlarının yoğun olduğu bankacılık sektöründe çalışanlara yönelik bir araştırma gerçekleştirilmiştir. Bu bağlamda Antalya’da faaliyet gösteren özel sermayeli bir bankada görevli çalışanların iş motivasyonlarının kariyer beklentilerine etkisi incelenmiştir. Araştırmada Çok Boyutlu İş Motivasyonu Ölçeği ve Kariyer Geleceği Ölçeği kullanılarak kolayda örnekleme yöntemiyle bankacılık sektöründe çalışan 315 kişiye anket uygulanmıştır. Çok Boyutlu İş Motivasyonu Ölçeği’nde amotivasyon, dışsal sosyal etkilenme, dışsal maddi etkilenme, içe yansıtılmış etkilenme, tanımlanmış etkilenme ve içsel motivasyon olmak üzere toplam altı faktör, Kariyer Geleceği Ölçeği’nde kariyer uyumluluğu, kariyer iyimserliği ve bilgi olmak üzere üç faktör bulunmaktadır. Sonuçlara göre X kuşağının iş motivasyonları kariyer beklentilerini etkilememektedir. X kuşağı için içe yansıtılmış etkilenme, tanımlanmış etkilenme ve içsel motivasyon boyutlarında anlamlı etki bulunmaktadır. Ancak diğer boyutlarda iş motivasyonu, X kuşağı için kariyer beklentilerini anlamlı bir şekilde etkilememektedir. Y kuşağında dışsal maddi etkilenme, tanımlanmış etkilenme ve içsel motivasyon boyutları anlamlı ve pozitif etkilerken, motive olmamanın kariyer beklentisi üzerinde etkisi bulunmamaktadır.Today, the policies that should be implemented for the work motivation of the generations who are together in working life are changing. One of the sources of motivation in working life is the career expectation of the employees. The aim of this resear ch is; It is to determine to what extent the work motivation of Generation X and Generation Y affects their career expectations. In the research, a research was conducted on the employees of the banking sector, where X Generation and Y Generation employees are concentrated. In this context, the effect of job motivations of employees working in a privately owned bank operating in Antalya on career expectations was examined. In the research, a questionnaire was applied to 315 people working in the ba nking sector by using the Multidimensional Job Motivation Scale and the Career Future Scale using the convenience sampling method. In the Multidimensional Work Motivation Scale, there are six factors in total: amotivation, external social influence, extern al material influence, introjected influence, defined influence and intrinsic motivation, and three factors in the Career Future Scale: career adaptability, career optimism and knowledge. According to the results, the work motivations of the X generation d o not affect their career expectations. For the X generation, there is a significant effect in the dimensions of introjected affect, defined influence and intrinsic motivation. However, in other dimensions, work motivation does not significantly affect car eer prospects for Generation X. While external financial influence, defined influence and intrinsic motivation dimensions affect the Y generation significantly and positively, not being motivated has no effect on career expectation.No sponso

Elli-altmış beş yaş arasındaki postmenopozal Türk kadınlarda, vücut kompozisyonu ve el kavrama gücünün, aksiyal kemik mineral yoğunluğuna etkisi: Yağsız vücut kitlesi belirleyici midir?

Amaç: Postmenopozal kadınlarda, vücut kitle indeksi (VKİ), yağsız vücut kütlesi, yağ kütlesi, ve el kavrama gücü, kemik mineral yoğunluğunun (KMY) belirleyicileridir. Bu çalışmanın amacı, 50 yaş ve üstü kadınlarda, VKİ, vücut kompozisyonu, ve el kavrama gücünün, lomber ve femoral boyun bölgesi KMY üzerine etkisini araştırmaktır. Gereç ve Yöntem: Yaşları 50-65 (55,6±3,9) arasında olan 161 kadın hasta çalışmaya alındı. Kemik mineral yoğunluğu ve vücut kompozisyonu DEXA ile ölçüldü (Norland XR-46). El kavrama gücü JAMAR el dinamometresi ile değerlendirildi. Spearman korelasyon katsayıları hesaplandı. Çeşitli değişkenlerin KMY ile olası ilişkisi açısından multipl lineer regresyon analizi uygulandı. Bulgular: Yağsız vücut kitlesiyle yaş arasında negatif korelasyon saptandı. Yağsız vücut kitlesi lomber ve femur boyun bölgesi ile korele idi. Yağsız vücut kütlesi aynı zamanda el kavrama gücü ve VKİ ile korele idi. El kavrama gücü, yaş ve menopoz süresi ile negatif olarak korele idi. Sonuç: Yağsız vücut kitlesi ve el kavrama gücünün yaşa bağlı olarak azalması, 50-65 yaş arası kadınlarda KMY azalması ile ilişkilidir. Bu yüzden, bu hastalarda, egzersiz ile yağsız vücut kitlesi arttırılmalıdır.Objective: Body mass index, lean mass, fat mass and peripheral muscle strength are often found the determinants of bone mineral density (BMD) in postmenopausal women. The aim of the present study is to investigate the effect of body mass index, body composition and hand grip strength on femoral neck and lumbar spine in postmenopausal women aged 50-65 years. Materials and Methods: We studied 161 women aged 50-65 (55.6&plusmn;3.9) years. Bone mineral density and body composition were measured by DEXA (Norland X-R 46). Hand grip strength was measured by JAMAR hand held dynamometer. Spearman's correlation's coefficients were calculated. Multiple linear regressions were performed using all variables possibly associated with BMD. Results: Lean mass was correlated negatively with age. Lean mass was correlated with lumbar spine and femoral neck BMD. It was also correlated with hand grip strength and body mass index. Hand grip strength was correlated negatively with age and years since menopause. Conclusion: These results suggest that, age related decline of lean mass and grip strength are associated with the decline of BMD in postmenopausal women aged 50-65 years. Therefore, we encourage these patients to increase lean mass by exercise

Predisposing factors for musculoskeletal symptoms in intensive care unit nurses

IntroductionIntensive care unit nurses have more ergonomic risks than nurses working in other units in hospital