Knowledge and Attitudes of Turkish Physicians About Organ Donation After Circulatory Death

Objective: Organ donation (OD) still cannot reach the desired level in our country. A new form of OD is being implemented in the world. OD can be performed with family consent from patients with circulatory death (CD). This study was conducted to measure the attitudes and knowledge levels of Turkish physicians about organ donation after circulatory death (DCD). Materials and Methods: Three-part survey questions were sent to specialist physicians via e-mail. In the first part, their sociodemographic characteristics, in the second part their attitudes and behaviors about OD, and in the third part, their knowledge levels about DCD were measured. Results: 51.9% of the 258 participants were female and 48.1% were male. 52.3% specialized in surgery, 47.7% specialized in internal medicine. 39.1% were working in the intensive care unit, 25.9% were working in the emergency room, and 21.3% were working in the operating room. All physicians agreed on the importance of OD. Although OD rates were low, this rate was found to be significantly higher in surgical branches compared with internal branches (p=0.02). Most organ donors shared this situation with their families (respectively, surgical physicians 83.3%, internal physicians 66.6%). The percentage of surgical branches receiving education on brain death or organ transplantation was high. However, the definition of DCD in both groups was little known (2.9%, 0.8%, respectively). When their knowledge levels were examined, only five questions (these were propositions about OD and donor care) were higher for the surgical physicians to answer correctly. Theoretical knowledge propositions about CD were answered incorrectly in both groups. Conclusion: To increase the awareness of Turkish physicians about DCD, which has been known since 1995, there is a need for new research and medical education to include current issues. Therefore, as soon as the legislation is enacted in our country, the number of ODs will increase

Cervical epidural hematoma and headache developing after epidural anesthesia in a patient with type 1 arnold chiari malformation

Spinal anestezinin en yaygın komplikasyonlarından biri baş ağrısıdır. Sıklığı yıllar içerisinde % 0,2 ile % 24 arasında değişiklik göstermiştir. Akut baş ağrısı yapan diğer nedenlerden dikkatli bir anamnez ve fizik muayene ile ayrılması gerekmektedir. Biz bu olgu sunumunda travma sonrası ortopedi tarafından spinal epidural anestezi ile operasyona alınan, sonrasında başağrısı ve ense sertliği şikayeti olan, postoperatif tetkiklerde servikal epidural hematom tespit edilen Tip 1 Arnold Chiari Malformasyonlu bir hastayı tartıştık.One of the most common complications of spinal anesthesia is headache. Its frequency changed between the values of 0,2 % and 24 % through the years. It should be differentiated from other reasons of acute headache by physical examination and a serious anamnesis.In this essay, we examined a patient who was operated by orthopedics with spinal epidural anesthesia after trauma. The patient had post operative headache and nape hardness, also in postoperative examination cervical epidural hematoma Type 1 Arnold Chiari Malformation was identified in patient

Evaluation of patients admitted to the emergency department with the suspect of acute renal colic with the modified STONE score

Aim: Renal colic pain is one of the most common agonizing forms of pain that is frequently treated in emergency departments. Computed tomography (CT), which is used for the detection of kidney stones, is a costly application. Therefore, scoring systems that predict stone have been developed. This study was conducted to investigate the diagnostic accuracy of the Modified STONE Score (MSS) to predict stones. Materials and Methods: Among those who applied to the emergency department with renal colic pain, patients with CT were examined. Three hundred and thirty-seven patients included in the study were divided into two groups as those with and without kidney stones. It was examined whether there was a difference between these two groups in terms of personal, seasonal, laboratory findings and MSS. Results: We found that ureteral stone history, pain duration less than 6 hours, presence of hematuria and nausea/vomiting, C-reactive protein (CRP) value below 0.5 mg/dL, The MSS above 9, age <= 50 years were factors that increase stone. The MSS was significantly high in the stone-detected group. When the STONE score is calculated for all patients and divided into three groups (low, moderated, and high modified STONE scores), the prevalence of ureteral stones increases towards the high MSS group. Conclusion: We found that the modified STONE score was quite successful in predicting ureteral stones. We determined that emergency physicians can diagnose stones using this score and avoid unnecessary CT. The diagnostic value of this score may increase when nausea/ vomiting factor is added

Evaluation of the Relationship of PD-L1 and FOXP3 Expressions With Clinicopathological Parameters in Gastric Carcinomas

Objective: At the time of diagnosis, gastric cancers are generally at an advanced stage and the survival rates are very low. The aim of this study is to determine the prognostic values of PD-L1 expression in gastric carcinomas and to detect the presence of FOXP3- positive Treg cells in tumor microenviroment. Method: In this study, PD-L1 and FOXP3 expressions were evaluated in 125 patients with gastric carcinoma who had undergone gastrectomy between 2011, and 2015. Results: The mean age of the patients was 64.18+-12.3 years and the patients were followed up for a mean period of 29.6+-26.4 months. In only 2 (1.6%) cases there were weak membranous expressions of PD-L1 in tumor cells. PD-L1- positive inflammatory cells were also seen in tumors of 2 (1.6%) cases. There was no significant relationship between PD-L1 expression and survival times (p= 0.690). In 57(45.6%) cases, FOXP3- positive lymphocytes were detected. The number of FOXP3-positive cells ranged between 1 and 55/HPF. There was no statistically significant correlation between the survival times and presence of Tregs (p=0.793). Twenty-two cases (17.6%) were evaluated as HER2-positive. There was a statistical relationship between HER2-positivity and perineural invasion (p=0.006). Statistical significance between survival and some prognostic factors such as nodal metastasis (p=0.004), pT stage (p&lt;0.01) and presence of perineural invasion (p=0.010) was determined. Conclusion: This study has demonstrated that the PD-L1 positivity was not effective on gastric tumorigenesis. We have found a positive correlation between the presence of Treg inflammatory cells and PD-L1 expression. But this relationship could not be proved by statistical analyses. However since PD-L1 expression was detected in only 4 cases, these findings should be confirmed in larger series

Sociodemographic characteristics and clinical results of the patients of Adnan Menderes University Algology Policlinic

Geçmişte sadece çeşitli hastalıkların bir bulgusu olarak kabul edilen ağrı, özellikle de kronik ağrı artık başlı başına bir hastalık, bir sendrom olarak ele alınmaya başlanmıştır. Günümüzde, sayıları gittikçe artan ağrı merkezleri ve poliklinikleri ile daha fazla hastaya ulaşabilmek, doğru tanı koymak, tedavileri uygun düzenlemek ve dolayısıyla bireylerin yaşam kalitelerini arttırabilmek hedeflenmektedir. Adnan Menderes Üniversitesi Tıp Fakültesi Hastanesi Algoloji Bilim Dalı, dünyadaki ve Türkiye'deki ağrı bilimiyle ilgili gelişmeleri yakından izlemeyi ve çalışmalarına yansıtmayı amaçlayarak 2001 yılında poliklinik hizmetine başlamış, 20 Ocak 2004 tarihinden beri Bilim dalı olarak çalışmalarına devam etmektedir. Başvuran bütün hastalarımıza önceden hazırlanmış olan 'Ağrı Değerlendirme Formu' bünyesindeki sorular yöneltilmekte ve alınan bilgiler mevcut form üzerine kaydedilmektedir. Hastaların klinik tablolarını değerlendirebilmek amacıyla hastalarla yüz yüze yapılan ayrıntılı anamneze özen gösterilmekte, hastaların yaş, cinsiyet, meslek, medeni hal, öğrenim ve ekonomik durumu gibi demografik özellikleri forma işlenmektedir. Detaylı ağrı anamnezi için ağrının yeri, niteliği, başlangıç zamanı, şiddeti, ağrıya eşlik eden semptomlar, bu ağrılı hastalık nedeniyle daha önce aldığı ilaçlar ve uygulanan tedaviler, başvuran her hastada sorgulanmakta ve ağrı değerlendirme formuna kaydedilmektedir. Çalışmamız 1 Ocak 2006 ' 31 Aralık 2007 tarihleri arasında algoloji polikliniğimize başvuran 772 yeni hastanın sonuçlarını içermektedir. Yaptığımız çalışmanın sonucunda 41 ile 69 yaş arasındaki özellikle bayan hastaların ağrı çektiğine rastladık. En sık ağrı şikâyetinin bel, omuz ve baş bölgesinden kaynaklandığı görüldü. Hastalarımıza konan en sık üç tanı; bel, muskuloskeletal ve baş ağrısıydı. Ağrılı hastaların ev hanımı veya emekli olan, evli, ilköğretim düzeyinde eğitime sahip, orta gelirli toplum kesiminden oluştuğunu saptadık. Hastaların ortalama VAS değerinin 7,3 gibi yüksek bir değer olduğu, ağrılarının genellikle sızlama, zonklama niteliğinde olduğu ve hastalarımızın %73'lük büyük kısmında üç aydan uzun süren kronik ağrının mevcut olduğu bulundu. Ağrının yanında en sık görülen yakınma halsizlik, bulantı-kusma ve uykusuzluk idi. Hastaların %58'i önceden ilaç tedavisi almaktaydı. En sık uygulanan tedavileri ise ilaç tedavisi ve beraberinde uygulanan invazif girişimler oluşturuyordu.Pain was considered to be a sign of illness in the past; but nowadays especially chronic pain is considered as an illness itself. Nowadays, the aims of Pain Centers and Pain Clinics are to reach more number of patients, to diagnose correctly and to apply correct medical treatments; and therefore to increase the life quality of individuals. Algology Division of Hospital of Adnan Menderes University Medicine Faculty aims to follow throughly the improvements in the science of pain and implement these progresses in its own studies. In order to give better and regular service to its patients within Aydın and its suburbs, Algology Polyclinic of Adnan Menderes University Hospital was established in 2001. Algology Science Branch continues its studies since 20th January 2004. This branch is a sub-branch of Adnan Menderes University Medicine Faculty, Anesthesiology and Reanimation Branch. All the patients who come to our clinic are kindly requested to fill in the 'Pain Assessment Form' before diagnosis. Face to face interviews with the patients are done with extreme care in order to assess the clinical situation of them. Their demographic characteristics such as age, gender, occupation, marital status, education and economical status are written on the forms. In addition, their consumption characteristics of smoke and alcohol are also recorded. For the detailed pain anamnesis, following factors are recorded in the pain assessment form: The location, quantity and starting time of pain, its duration, the symptoms associated with pain, any kind of prior medication that was taken for the treatment of pain. Our study includes the diagnosis, treatment and long term results of 772 patients who applied to our algology clinic between 1st January 2006 and 31st December 2007. We found that those who were between ages 41 and 69 and those who are women suffered from pain more compared to others. We saw that the pain sufferers were mainly from the group of married, with primary education level housewives and retired females. The most frequent complaints were from low back pain, shoulder pain and headaches. VAS value was found to be 7.3. The patients classified their pains mostly as stingy ache or as trobbing. 73% of our patients had been suffering chronic pain of 3 months or more. The pain of patients was increasing with activities such as walking and standing. And this increasing pain was accompanied in many patients by weakness, muscle weakness, nausea and vomiting. 58% of patients were taking medical treatment previously. The most frequent three diagnosis were low back pain, musculoskeletal pain and headache. The most frequent reason of low back pain was disc hernias whereas the most frequent headache was tension type headache. Among the most frequent source of cancer pains were lungs, prostates and rectum cancers. The most frequent treatments were medical treatments along with invasive interferences. Invasive interferences were mostly applied on low back pain patients, among them transforaminal steroid injection outnumbered others. Cancer patients were most frequently applied stationary epidural catheter. With the student t test we applied, we found that the first VAS value was significantly higher in female patients. We found that VAS values were significantly getting less after invasive interferences, which shows that the treatment had been successful. When we examined the risk factors of low back pain (which was the most common pain) we saw that the risk increased in those who are workers, who smoke and who has a low educational level as well as low economic conditions

Overseas Experience and Requests in Intensive Care Doctors

Objective: To evaluate the overseas experiences of our intensive care unit doctors and to determine out the reasons for our doctors who couldnot go and what support they wanted. Materials and Methods: The created questionnaire was delivered to the doctors via the internet. The survey consisted of three main parts. They were asked in the first part, sociodemographic characteristics; in the second part, how long they went abroad, how they choose the center, from whom they received support; in the third part, the reasons why our physicians who donot have been abroad experienced could not go, on which subject/center they want to gain professional experience, and how to get support in this regard. Results: 31.4% of the 156 participants had professional abroad experience. 55% of those who went stated that they found the center with their own efforts, and very few (13 people, 26%) stated that they received support from the education/administrative unit of the institution they worked during the admission. In academically titled physicians, the level of foreign language and the importance given to education abroad were quite high. It was determined that the frequency of reading articles was correlated only with the duration of the profession. The most common reasons for physicians who couldnot get a chance to go was not being able to find a clinic/scholarship program to go to/not being informed (63.5%) and high accommodation/living fees (48.4%). Conclusion: Professional overseas experience has a high contribution to our physicians and our health system. The biggest obstacle for our physicians who cannot attend is not being able to find a center/clinic to go to. We think that the institutions/associations to which they are affiliated can support this issue

Effectiveness of pericapsular nerve group block with ultrasonography in patients diagnosed with hip fracture in the emergency department

Hip fractures (HF) are among the most common fractures present in the emergency department and are very painful. Pericapsular nerve group block (PENG) is a new regional anesthesia technique developed for analgesia in total hip arthroplasties. We aimed to determine the effectiveness of PENG block used to reduce pain in patients with HF in the emergency department. METHODS: This single-center, randomized, and prospective study was carried out in the emergency department. The patients included in the study were selected according to the suitability of the personnel who will perform the procedure. The sealed envelope system was used for randomization. RESULTS: Statistical analysis was performed with 39 patients (18 patients in the PENG group, 21 patients in the control group). Thirteen (33.3%) of the patients were female and 26 (66.7%) were male. The mean age was 75.3. At rest post-procedure, the mean Numeric Rating Scale (NRS) scores of the patients at the 30th min, 2nd, 6th, and 24th h were 1.78??1.83, 0.00??0.00, 0.00??0.00, and 1.28??1.41 in the PENG group. On the other hand, it was 3.38??1.86, 0.05??0.22, 2.86??2.37, and 4.95??1.47 in the control group, respectively. The mean NRS scores of the patients at 15?? elevation of the leg at the 30th min, 2nd, 6th, and 24th h were 3.06??1.80, 0.06??0.24, 0.22??0.43, and 2.44??1.50 in the PENG group and it was 5.24??1.81, 1.05??0.92, 4.29??2.35, and 7.14??1.24 in the control group, respectively. CONCLUSION: PENG block can reduce pain and the need for systemic analgesics as a practical option in patients with HF