Integration of Traditional and Complementary Medicine into Evidence-Based Clinical Practice

Traditional and complementary medicine regains popularity not only in developing countries but also in developed countries. Modern medicine often fails to cure and just tries to alleviate the symptoms. The patient feels better as long as the effect of the drug continues but his/her symptoms reappear after the elimination of the drug. In this way, instead of healing the patients, we turn them into life-time drug dependent. Traditional and complementary medicine, being turned scientifically into evidence-based medicine, will change the medical philosophy and treatment such as individualized and holistic approach. Complementary interventions are used together with conventional treatments, whereas alternative interventions are used instead of conventional medicine

Hypnosis and Hypnotherapy: Emerging of Science-Based Hypnosis

Hypnosis, which has been used for centuries in different forms, has to be reevaluated in the light of modern medicine and science by biological, psychological, sociological and spiritual approach. Hypnosis has been regaining its popularity in the trend of personalized and holistic medicine without any drug, injection or side effects

Effect of waist circumference and body mass index on the level of spinal anesthesia

Background: We aimed to determine the effects of waist circumference and body mass index on spinal anesthesia levels. In total, 120 surgical patients who were between 18 and 65 years old and in the American Society of Anesthesiologists' (ASA) I-III risk groups enrolled in this study. Patients were classified into three groups, depending on their weight. After a spinal block, we noted the time needed for the sensory block to reach the T10 level, the maximum sensory block level, the time needed for the sensory block to reach the maximum sensory block level, the time needed before the start of the motor block, and the Bromage scale for each patient. Results: We observed no significant demographic differences in age, gender, or ASA risk class between the groups; however, we found a statistically significant difference between the groups' BMIs and waist circumferences. For the time needed for the spinal block to reach the T10 level, we observed a statistically significant difference between groups I, II, and III, and we also found a statistically significant difference between the groups' comparing Bromage scales. Moreover, we found a statistically significant difference between the groups' time needed (in minutes) for the block to reach the maximal upper dermatomal block level and, as BMIs and waist circumferences increased, the time needed to reach the maximal upper dermatomal block level. We also noted a statistically significant difference in waist circumference variability. Conclusions: This study shows that body mass index and waist circumference can be used and interpreted as independent parameters reflecting the increasing incidence of obesity

COVID-19 Pandemi Sırasındaki Acil Cerrahi Bakım ve Ameliyathane Uygulamalarında Perioperatif Uygulama ve Rehberlik; Deneyimlerimiz

Aim: The novel coronavirus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE). We aimed to review the latest data on the COVID-19 pandemic and essential information for practice in emergency surgery and the operating room.Materials and Methods: An interventional platform (operating room, interventional suite, and endoscopy) with our committee formed with our doctors consisting of different branches, we developed our guidelines based on potential patterns of spread, risk of exposure, and conservation of PPE. We aimed to share our experiences with 128 patients who were taken into operation in a 2-month period.Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in Medical Faculty of Namık Kemal University.Results: A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on the urgency of operation, anticipated viral burden at the surgical site, the opportunity for a procedure to aerosolize virus, and the likelihood a patient could be infected based on symptoms and testing.Conclusion: Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm for the interventional platform teams, we can ensure optimal healthcare worker safety.Amaç: Yeni koronavirüs SARS-CoV-2 (COVID-19) sağlık çalışanlarını enfekte edebilir. COVID-19 salgını sırasında ameliyathane ekip üyelerini korumak ve rasyonel olarak kişisel koruyucu ekipman (KKE) için kurumsal bir algoritma geliştirdik. Acil cerrahi ve ameliyathanede COVID-19 salgını ile ilgili en güncel bilgileri gözden geçirmeyi amaçladık. Materyal ve Metot: Farklı branşlardan oluşan doktorlarımızla oluşturduğumuz komitemiz ile girişimsel bir platform (ameliyathane, girişimsel ve endoskopi), potansiyel yayılma örüntüleri, maruz kalma riski ve KKE'nin korunmasına dayanan kılavuzlarımızı geliştirdik. Deneyimlerimizi 2 aylık bir sürede ameliyat edilen 128 hasta ile paylaşmayı amaçladık. 2019-nCoV şüphesi olan hastalar için acil durum prosedürleri için anestezi yönetimi ve enfeksiyon kontrol kılavuzları Namık Kemal Üniversitesi Tıp Fakültesi'nde hazırlanmış ve uygulanmıştır. Bulgular: Ameliyathane ekibi üyelerine yönelik önlemler için kurumsal yönergelerimizi açıklayan bir karar algoritması oluşturuldu. Bu algoritma ameliyatın aciliyetine, cerrahi bölgede beklenen viral yüke, virüsü aerosol haline getirme prosedürü fırsatına ve hastanın semptomlara ve testlere dayanarak enfekte olma olasılığına dayanır. Sonuç: COVID-19'un yeni bir tehdit olmasına rağmen, girişimsel platform ekipleri için izlemesi kolay bir karar algoritması geliştirerek, optimum sağlık çalışanı güvenliğini sağlayabildiğimizi gösterdik

Pain Perception Within Consciousness

As a psychological state, pain is perceived by the affected individual and it corresponds to a form of conscious awareness as a subjective conscious experience mediated in part by beliefs or emotions. Regardless of its 'physical' origins, pain, like all other perceptions, is a mental experience at different degrees of consciousness. The experience of pain requiring a stimulus, a feeling or emotion, and an effect or result, consists of an intermingling of chemical, biological, psychological, physiologic, socioeconomic, cultural, ethnic backgrounds, and emotional and cognitive factors. Not only the activation but also the connections are involved in conscious pain perception. Moreover, interconnectivity between the periaqueductal matter and orbitofrontal cortex is the key to cognitive-emotional responses associated with pain. Thus, the central pain control processes arising from interactions among the cognitive-evaluative, motivational-affective, and sensory-discriminative systems characterize the pain response, being also influenced by both noxious input and cognitive self-regulation. Neuroimaging studies (Davis et al., 2015) in healthy volunteers showed that pain cannot be localized in an isolated pain center in the brain, but it rather encompasses a neural circuitry

Medical treatment in the low back pain (Review)

Kronik bel ağrısı baş ağrısından sonra ikinci sırada en sık görülen nörolojik bir sorundur. 45 yaşından daha genç breylerde aktivite kısıtlamasının en sık nedenidir. Genellikle, kronik bel ağrısı daha çok omurganın travmatik, dejeneratif ve malign hastalıklar sonucu gelişir. Travmatik ya da omurganın dejeneratif durumları kronik bel ağrısı en sık görülen nedenleri olmakla birliklte bilgisayarlı tomografi (BT) ve manyetik rezonans(MR) değerlendirmelerinde disk protrüzyonu ve hernisi, siyatik nedenlere de rastlanmaktadır. Bel ağrısının tahmini yıllık gö- rülme sıklığı ABD'de %5-20 ve Avrupa'da ise 25-45% dır. Ağrı tipine göre diskojenik, radiküler, sakroiliak, kas ve faset eklem ağrısı olarak sınıflandırılır. Epidemiyolojik olarak risk faktörleri arasında sigara, morbid obezite, özellikle öne eğilme ve bükülme pozisyonları, tekrarlayan ağır kaldırma sayılabilir. Kronik bel ağrısında, akut alevlenmelerde trisiklik antidepresanlar, antikonvülzan ilaçlarla paroksismal veya nöropatik ağrı azaltıbilir. Kalsiyum kanal blokerleri ve alfa-adrenerjik antagonistler kompleks bölgesel ağrı sendromu ile ilişkili olduğu bel ağrısı tedavisinde yararlıdır. Acetaminofen, nonsteroid antiinflamatuvar ilaçlar, opioidler kronik ağrıda fonksiyon ve hareketliliği sağlamak için kullanılabilirChronic low back pain (LBP) is the second most common neurological problem after headache. Chronic LBP is the most common cause of activity limitation in persons younger than 45 years.. Generally, Chronic LBP is results from traumatic and degenerative and malign diseases conditions of the spine. Traumatic or degenerative conditions of the spine are the most common causes of chronic LBP. Although disk protrusion and herniation have been popularized as causes of LBP and sciatica, asymptomatic disk herniations on CT and MRI are common. The estimated yearly prevalence of LBP is 5-20% in the United States and 25-45% in Europe. It is classificated by the type of pain as discogenic, radicular, sacroiliac, muscular and facet- joint pain. Epidemiologic data suggest that risk factors include cigarette smoking; morbid obesity; occupations that require repetitive lifting, especially in forward bending and twisting positions. Principles for medical management in the chronic stages of LBP and disability differ in several ways from those in the acute phase. Tricyclic antidepressants are useful in chronic LBP Anticonvulsant medications may reduce paroxysmal or neuropathic pain. Calcium channel blockers and alpha-adrenergic antagonists are useful for treating LBP when it is associated with a complex regional pain syndrome. Acetaminofen, nonsteroidal antiinflamatuar drugs, narcotics may be used to maintain function and mobility in the chronic pain

Video ile Bilgi Verilmesinin Total Diz Protezi Operasyonu Hastalarında Preoperatif Anksiyete Düzeyine Etkisi

Objective: The preoperative anxiety rate in patients waiting for elective surgery varies between 60% and 80%. We aimed to reduce preoperativeanxiety in patients undergoing total knee replacement using a video demonstration of combined spinal-epidural anesthesia on a tablet computer.Methods: Fifty adult patients, scheduled to undergo total knee replacement, were enrolled in a randomized controlled study. Anxiety levels wereassessed using the State-trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information scale. The assessment was basedon questionnaires completed by the patients. Patients were randomly divided into two groups: video and control groups. In the video group, a videodemonstration of combined spinal-epidural anesthesia was provided, along with verbal information about the procedure. On the day of surgery, thesame questionnaires were again completed for the assessment of anxiety levels.Results: There were no significant differences between groups regarding age, sex, occupation, education, and previous history of anesthesia andsurgery. The STAI scale scores were found to be significantly lower in the video group than in the control group (p=0.000; p<0.005). The AmsterdamPreoperative Anxiety and Information scale scores were found to be significantly lower in the video group compared to the control group (p=0.000;p<0.05).Conclusion: New devices and technologies may be used in daily anesthetic practice to offer patient information more efficiently. This may helpreduce preoperative anxiety levels among patients undergoing elective surgery.Amaç: Elektif ameliyat için bekleyen hastalarda preoperatif anksiyete oranı %60 ile %80 arasında değişmektedir. Çalışmamızda hastalara bir tablet bilgisayar ile daha önceden gerçekleştirilmiş bir kombine spinal epidural anestezi işlemi videosu izleterek hastaların preoperatif anksiyetelerini azaltmayı amaçladık. Yöntemler: Kombine spinal epidural anestezi ile total diz protezi ameliyatı olacak 50 hasta çalışmamıza dahil edildi. Hastalar randomize olarak video ve kontrol olarak iki gruba ayrıldı. Video grubunda hastalara daha önceden hazırlanmış olan kombine spinal epidural anestezi işlemi videosu işlem hakkında sözel bilgi verilirken izletildi. Kontrol grubunda ise anket formaları doldurulduktan sonra vizit sona erdi. Ameliyat günü Durumluk-sürekli Anksiyete ölçeği (STAI) ve Amsterdam Preoperatif Anksiyete ve Bilgi ölçeği formları cerrahiden bir önceki gibi dolduruldu. Bulgular: Kontrol grubunda STAI skorları artmış bulunurken video grubunda azalmış bulundu ve bu azalma istatistiksel olarak anlamlıydı (p=0,000; p<0,005). Amsterdam Preoperatif Anksiyete ve Bilgi ölçeği kontrol grubunda artmış bulunurken video grubunda istatistiksel olarak anlamı olarak azalmış bulundu (p=0,000; p<0,005). Sonuç: Yeni cihazlar ve teknolojilerin kullanımı günlük anestezi uygulamalarımızda bizlere kolaylık sağlayabilir ve hastaların preoperatif dönemdeki anksiyetelerini gidermek amacıyla daha verimli bilgilendirmekte kullanılabilir

Status of High-risk Oncogenic Human Papillomavirus Subtypes Harbored in the Prepuce of Prepubertal Boys

OBJECTIVE To evaluate whether the high-risk human papillomavirus (HPV) subtypes that are strongly related to cervical cancer are harbored in the prepuce of the circumcised tissue of prepubertal boys in the period just before active sexual life. METHODS The present study enrolled 30 healthy boys (age range 4-11 years, mean age 8.1 +/- 1.6) who underwent a standard circumcision procedure, with hypospadias repair in 3 patients. All prepuceal samples were studied using real-time polymerase chain reaction and grouped according to HPV subtype prevalence as groups 1 (types 16 and 18), 2 (types 31, 33, 45, 52, and 58), and 3 (types 35, 39, 51, 56, 59, 66, and 68). RESULTS HPV DNA was reported in 25 (83.3%) of the 30 subjects. All samples showed a negative result for group 2. Although most of the positive findings were for group 3 (25 [83.3%] of 30), a positive result was reported for only 1 subject for group 1 (3.3%). CONCLUSION The results of the present study have shown that the prepuce harbored the rarest HPV types, including types 35, 39, 51, 56, 59, 66, and 68 in preadolescence boys with a high rate (83%). These findings are in contrast to the common knowledge of HPV prevalence in adults that points to the dominance of HPV subtypes 16 and 18. UROLOGY 80: 423-426, 2012. (c) 2012 Elsevier Inc