18 research outputs found

    Investigation of aggression in adolescents according to sex and gender roles

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    Cinsiyet, tek başına saldırganlığı anlamaya ve açıklamaya çalışan araştırmacılar arasında oldukça popüler ve çok sık kullanılan bir değişken olmasına rağmen, bu popülerliği saldırganlığı açıklayabilme gücünden daha büyük gibi durmaktadır. Bu çerçevede mevcut çalışma, cinsiyet ve cinsiyet rollerine göre ergenlerin saldırganlık türlerini incelemeyi amaçlamıştır. Çalışmanın verileri, 1870‟i erkek, 2228‟i kadın toplam 4098 ergenden (yaş ort: 16.51, ss: 1.02) toplanmıştır. Ergenlerin saldırganlık puanlarını belirleyebilmek için „Buss-Durkee Saldırganlık Ölçeği‟ ve cinsiyet rollerini belirleyebilmek için „BEM Cinsiyet Rolleri Envanteri‟ kullanılmıştır. Verilerin analizinde SPSS 22 paket programından yararlanılmıştır. İstatistiksel olarak, iki faktörlü MANOVA analizi kullanılmıştır. Araştırma verilerinden elde edilen sonuçlara göre, ergenlerin cinsiyetlerine göre dolaylı saldırganlık ve toplam saldırganlık puanları kızlar lehine farklılaşırken; fiziksel saldırganlık, sözel saldırganlık, öfke ve düşmanlık puanları farklılaşmamaktadır. Cinsiyet rolleri açısından değerlendirildiğinde, ergenlerin fiziksel saldırganlık, dolaylı saldırganlık, sözel saldırganlık, öfke, düşmanlık ve toplam saldırganlık puanlarının farklılaştığı görülmüştür. Son olarak, cinsiyet/cinsiyet rolleri etkileşimine göre ergenlerin saldırganlık toplam puanları ve saldırganlık türleri açısından anlamlı bir fark elde edilememiştir. Elde edilen bulgular alan yazını doğrultusunda tartışılmış, yorumlanmış ve önerilerde bulunulmuştur.Although sex alone is a very popular and frequently used variable among researchers trying to understand and explain aggression, its popularity seems to be greater than its power to explain aggression. In this context, the present study aimed to examine the aggression types of adolescents according to sex and gender roles. The data of the study were collected from a total of 4098 adolescents (mean age: 16.51, SD: 1.02), 1870 males and 2228 females. „The Buss-Durkee Aggression Scale‟ was used to determine the aggression scores of the adolescents and the „BEM Gender Roles Inventory‟ was used to determine the gender roles. SPSS 22 package program was used to analyze the data. According to the findings of the study, while the indirect aggression and total aggression scores of the adolescents differed in favor of the girls according to their gender; physical aggression, verbal aggression, anger and hostility scores do not differ.When evaluated in terms of gender roles, it was observed that the physical aggression, indirect aggression, verbal aggression, anger, hostility and total aggression scores of the adolescents differed. Finally, no significant difference was found in terms of aggression total scores and aggression types of adolescents according to gender/gender role interaction. The findings were discussed, interpreted and suggestions were made in the light of the literature

    Modified pectoral nerve block versus bi-level erector spinae plane block for postoperative analgesia after radical mastectomy surgery: a prospective, randomized, controlled trial

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    Background Regional anesthesia techniques constitute an important part of successful analgesia strategies in the perioperative care of patients undergoing breast surgery. The advent of ultrasound-guided regional anesthesia has led to the development of fascial plane blocks. The large array of blocks available for postoperative analgesia in breast surgery has increased the accessibility of regional anesthesia but has also created a dilemma of choice. This study compared the analgesic efficacy of the ultrasound-guided modified pectoral nerve (PECS) block and erector spinae plane block (ESPB) in patients undergoing radical mastectomy. Methods Seventy women were enrolled in this prospective, double-blind, randomized control trial. After exclusion, 67 female patients who underwent radical mastectomy were finally analyzed. Ultrasound-guided PECS blocks and ESPBs were performed with 30 ml 0.25% bupivacaine. Postoperative morphine and pain scores were compared between the groups. Results Postoperative total morphine consumption in the first 24 h was significantly higher in the PECS group (P < 0.001). The ESPB group exhibited significantly reduced morphine consumption at all postoperative time points. Numeric rating scale scores were lower in the ESPB group at 6, 12, and 24 h postoperatively at rest and when coughing. Conclusions Ultrasound-guided bi-level ESPBs provided better postoperative analgesia than PECS blocks after radical mastectomy surgery

    Evaluation of Emergency Interhospital Patient Transfers from Province of Mardin to Out-of-Province Hospitals in a Year

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    Abstract Objective: This study aimed to assess patients who were transferred from emergency services throughout the province of Mardin to out-of-province hospitals by ambulance in a year. Material and Methods: In this study, all patients transferred from emergency services in the province of Mardin to out-of-province hospitals via ambulances by the Patient Referral Assessment Committee, founded under the Provincial Directorate of Health, between the dates of December 31, 2010 and December 31, 2011 were evaluated retrospectively. No exclusion criteria were used. Patients were grouped and analyzed according to their demographic characteristics, transport properties, and reasons for referral. Results: The total number of the patients included in the study was 1518 (55.8% males, 41±27 mean age). Of all, 621 patients (40.9%) were transferred from the center of Mardin province, and the other patients were transferred from 8 district hospitals and two private hospitals. It was found that the patients were transferred to 37 hospitals in 8 provinces, and a total of 562 patients (37%) were transferred to private hospitals. Cardiology (23.3%), pediatrics (11.5%), and obstetrics and gynecology (8.8%) departments were the first three clinics that patients were transferred to frequently, respectively. In total, 274 patients (18.1%) were transferred inappropriately. There was a statistically significant difference between patients&apos; transfer hospitals (state hospital/private hospital) and the age of the patients (younger than 18 years/18 years or older) (p&lt;0.001). In addition, the rate of adult patients&apos; transfers to tertiary healthcare centers was significantly higher (p&lt;0.001). Conclusion: In Mardin, cardiology, pediatrics and obstetrics and gynecology patients are the most common group of emergency patients transferred by 112 ambulances to out-of-province hospitals. Approximately 40% of the patients were transferred to private hospitals. Inappropriate patient transfers seem to be a major problem in this study, as in other studies conducted in Turkey. (JAEM 2014; 13: 62-6

    The importance of head-thrust test in differential diagnosis of peripheral and central vertigo in patients presenting to emergency service with dizziness

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    Giriş: Baş dönmesi ayaktan hasta başvurularının en sık sebeplerinden biridir[3] ve acil servis (AS) başvurularının %1.3-2.5 ini oluşturur.[4,5] Şikayetin hasta tarafından tarifi zor, fizik muayene bulguları ile uyumsuz veya güvenilmez olabilir.[1,2] Uygulaması kolay, ucuz, non invaziv, fazla zaman almayan yatakbaşı testlerin özellikle santral vertigo ayırıcı tanısı için acil tıp hekimi için önemi büyüktür. Çalışmada, AS ye baş dönmesi şikayeti ile başvuran hastalarda, periferik ve santral vertigo ayırıcı tanısında head-thrust (baş çevirme) testinin (HTT) yerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Prospektif gözlemsel klinik bir çalışma olarak dizayn edilmiş, acil servisimizde 01.02.2011-31.07.2011 tarihleri arasında yapılmıştır. Periferik vertigo grubundaki tüm hastalara odyovestibüler testler, santral vertigo grubundaki hastaların hepsine nörogörüntüleme yapılmıştır. Bulgular: AS başvurularının %0.78 ini baş dönmesi/vertigo hastaları oluşturmaktadır. Santral vertigo grubu hastalar istatistiksel anlamlı olarak daha yaşlı (Mann-Whitney U, p=0.007), özgeçmişinde HT ve antiagregan kullanımına sahip (Fisher in kesin testi, sırasıyla p=0.026 ve p<0.001), baş dönmesi baş hareketleri ile &#8243;tetiklenmeyen&#8243; (Pearson &#967;² testi, p<0.001), vertikal nistagmus paternine sahip (Pearson &#967;² testi, p<0.001), HTT sonuçları normal (Pearson &#967;² testi, p<0.001), tandem yürüyüş, Romberg ve diz-topuk testleri bozuk olan (Fisher in kesin testi, sırasıyla p<0.001, p<0.001 ve p=0.026) hastalardır. HTT nin normal olmasının santral vertigo için duyarlılığı %95, özgüllüğü ise %75.6 olarak saptanmıştır. Yine bu hastalarda hastane yatışı, AS de nörogörüntüleme oranları ve ortalama SKB değerleri daha yüksek bulunmuştur. Periferik vertigo grubunda en sık üç tanı BPPV, meniere hastalığı ve vestibüler nörittir. Sonuç: HTT nin acil tıp hekimlerince kullanılması ayırıcı tanı açısından önem taşıyabilir. Testin kolay uygulanabilirliği, kısa sürmesi, ek ekipman gerektirmemesi, tekrar edilebilirliği ve hastanın tedavisini geciktirmemesi gibi avantajları da düşünülürse AS de vertigo başvurularında kullanılması uygun görünmektedir.Introduction: Dizziness is among the most common reasons that patients present for an evaluation[3] and its presentation at the emergency room (ER) with an incidence of 1.3-2.5%.[4,5] The report of symptoms can be vague, inconsistent, or unreliable.[1,2] Non-invasive, inexpensive, not time consuming, and easy to apply bedside testing is important for emergency medicine physician especially for the differential diagnosis of central vertigo. We aimed to investigate the role of the head-thrust test (HTT) in the differential diagnosis of peripheral and central vertigo in patients presenting to the ER with complaint of dizziness. Material and Method: This prospective observational clinical study has been carried out between 01.02.2011 to 31.07.2011 in Gazi University, Faculty of Medicine, Department of Emergency Medicine. Audiovestibular tests were performed in all patients in peripheral vertigo group and neuroimaging studies were performed in all patients in central vertigo group. Results: Dizziness/vertigo presentations have constituted 0.78% of all ER presentations. Patients in central vertigo group were significantly older (Mann-Whitney U, p=0.007) and with a diagnosis of hypertension and using antiagregant (Fisher s exact test, respectively p=0.026 and p<0.001) compared with those in peripheral vertigo group. Their vertigo complaints were not significantly triggering with head movements (Pearson &#967;² test, p<0.001) compared with peripheral vertigo group. They also had vertical nystagmus pattern (Pearson &#967;² test, p<0.001) and normal HTT results (Pearson &#967;² test, p<0.001) significantly. Patients in central vertigo group were also had significantly more deficits in neurological examination (Fisher s exact test, respectively p<0.001, p<0.001, and p=0.026 for tandem walking, Romberg, and knee-heel tests). Furthermore hospitalization rates, number of neuroimaging studies performed in the ER, and mean systolic blood pressure values were higher in central vertigo group. Benign paroxysmal positional vertigo, Meniere disease, and vestibular neuritis were the first three most frequent diagnosis in peripheral vertigo group. Conclusion: Using of the HTT by emergency medicine physicians may be important in terms of differential diagnosis. HTT is easy applicable, repeatable, and short duration test. This test does not require additional equipment or delay the patient s treatment. Given the advantages of the HTT, it seems to be appropriate for the use of vertigo presentations in the ER

    Meme kanserinde siklooksijen az-2 ekspresyonu artışının sağkalım üzerine etkisi

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    ÖZETMeme kanseri kadınlarda görülen en sık kanserdir. Bu kanserin görülme hızı hergeçen gün daha da artmaktadır. Prostaglandin sentezinde görevli ana enzim olansiklooksijenaz-2 (COX-2) enziminin bir çok kanser tipinde olduğu gibi memekanserinde de ekspresyonunun arttığı gösterilmiĢtir. Günümüzde meme kanserinindeğerlendirilmesinde ve tedavisinde kullanılan bazı prognostik ve prediktif faktörlervardır. ÇalıĢmalar COX-2’nin meme kanseri sağkalımını da tahmin ettirebilecekprognostik ve prediktif bir faktör olabileceği konusunda iĢaretler ortaya koymuĢtur.Bu çalıĢmanın amacı meme kanseri sağkalımı ile COX-2 ekspresyonundakiartıĢ arasındaki iliĢkiyi göstermektir. ÇalıĢmanın hipotezi, COX-2 ekspresyonundakiartıĢın meme kanseri sağkalımı ile ters orantılı olduğudur.ÇalıĢmada COX-2 ekspresyonunun genel sağkalım (GS), hastalıksız sağkalım(HS) ve meme kanserine özgün sağkalım (MKÖS) üzerine etkileri ortayakoyulmuĢtur. COX-2 ekspresyonu ile meme kanserinin prognostik faktörleriarasındaki iliĢki, GS, HS ve MKÖS’yi etkileyen bağımsız faktörler ve moleküler altgruplarda COX-2 ekspresyonunun GS, HS ve MKÖS üzerine etkileri gösterilmeyeçalıĢılmıĢtır.ÇalıĢmanın sonucunda COX-2 ekspresyonunun GS, HS ve MKÖS üzerineanlamlı bir etkisinin olmadığı gösterilmiĢtir. Buna rağmen takip süreleri ilerledikçeGS ve MKÖS için COX-2 ekspresyonu pozitif olan hastaların sağkalımlarının dahakötüye gittiği görülmüĢtür. COX-2 ekspresyonu ile Ki67 ekspresyonu arasındaanlamlı bir iliĢki olduğu, Ki67’si pozitif hastaların COX-2 ekspresyon düzeyinin deyüksek olduğu gösterilmiĢtir. Sadece progesteron reseptör pozitifliğinin GS veMKÖS’yi etkilediği, PR negatif olmasının GS ve MKÖS’yi azalttığı gösterilmiĢtir.Tümör çapının artmasının ve moleküler alt gruplandırmada luminal B tip ve bazal tipolmanın HS’yi azalttığı gösterilmiĢtir. Moleküler alt gruplar değerlendirmesinde iseher alt grup içinde COX-2 ekspresyonunun negatif veya pozitif olmasının o altgrubun sağkalımı üzerine etkisinin olmadığı görülmüĢtür.ANAHTAR SÖZCÜKLER : meme kanseri, sağkalım, siklooksijenaz-2 enzimi,prognostik faktör, prediktif faktörSUMMARYBreast cancer is the most common cancer in Turkish women and its incidence isincreasing in time. Overexpression of cyclooxygenase-2 (COX-2), a major enzymefor prostaglandin synthesis, is also found in breast cancer. There are currentpredictive and prognostic factors of breast cancer which are taken underconsideration for treatment assignment. Previous data revealed that COX-2expression is also a promising predictive and prognostic factor for breast cancer.Aim of this present study is to assess the impact of COX-2 expression onbreast cancer survival. Hypothesis was determined as COX-2 overexpression isrelated with poor prognosis in breast cancer patients.The study assessed rates of overall (OS), disease free (DFS) and breast cancerspecific survival (BCSS) in patients with and without COX-2 overexpression inretrospective manner. In addition, relation between COX-2 expression and otherconventional prognostic factors such as tumor size, grade and hormone receptorexpression for breast cancer was assessed. Independent factors for OS, DFS andBCSS and the impact of COX-2 expression on OS, DFS as well as BCSS wasanalyzed in each molecular subgroup of breast cancer.As result, OS, DFS and BCSS rates were not different in patients with COX-2negative and positive breast cancer. Ki67 expression was significantly increased inCOX-2 overexpressed patients. Progesteron receptor expression was found to be theindependent factor for both OS and BCSS, in which progesteron receptor negativepatients had significantly poorer survival rates. Additionally, increasing tumor sizeand molecular subtypes of luminal B and basal types were the independent predictivefactors for poorer DFS. Survival rates were also similar within each molecularsubgroup irrespective of their COX-2 overexpression.KEY WORDS : breast cancer, survival, cyclooxygenase -2 enzyme, prognosticfactors, predictive factor

    Senkopta nadir tanı: tip 2 Brugada sendromu

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    Brugada syndrome (BS) is an autosomal-dominant inherited genetic disorder characterized by mutations in cardiac sodium-channel genes, characteristic changes in electrocardiography (ECG) and associated with increased risk of ventricular arrhythmia and sudden cardiac death. BS mostly affects Asian races and its prevalence varies in different societies. Although it is a rare disease, it should be considered in patients admitted to the emergency department (ED) with the complaint of syncope. In a study, it was revealed that the main complaint in 28% of patients with BS was syncope. Here, we present a 19-year-old male patient who admitted to ED with the complaint of syncope and was diagnosed with BS.Brugada Sendromu (BS), kardiyak sodyum kanal genlerindeki mutasyonlar, elektrokardiyografide (EKG) tipik değişiklikler ile karakterize ve artmış ventriküler aritmi ve ani kardiyak ölüm riski ile ilişkili otozomal-dominant kalıtsal bir genetik hastalıktır. Brugada Sendromu çoğunlukla Asya ırklarını etkiler ve toplumdan topluma görülme sıklığı farklılıklar gösterir. Nadir bir hastalık olmasına rağmen acil servise (AS) senkop şikayeti ile başvuran hastalarda akılda tutulmalıdır. Yapılan bir çalışmada BS’li hastaların %28’inde ana şikayetin senkop olduğu ortaya konmuştur. Burada AS’ye senkop şikayeti ile başvuran ve BS tanısı konan 19 yaşındaki erkek hastayı sunuyoruz

    Second Kidney Transplant in a Patient with Artificial Urinary Sphincter

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    Artificial urinary sphincter (AUS) is regarded as the gold standard treatment for post-prostatectomy urinary incontinence. Kidney transplantation is gold standard treatment for end stage renal disease. Since both AUS implantation and renal transplant surgeries are relatively common, a co-occurrence is likely and a patient with AUS may need a kidney transplant. Herein, we report a patient with an AUS who underwent second kidney transplantation. Since the iliac fossa ipsilateral to the AUS parts had to be preferred for the second kidney transplant, risks of AUS damage and infection were higher. This report illustrates the precautions taken to minimize these risks

    Cost of Inpatient Treatment of Patients with Status Epilepticus in Turkey

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    Objectives:Status epilepticus (SE) is a neurological emergency with high mortality. As there are no data on the cost of treatment of SE in this country, the aim of this study was to investigate and analyze these costs.Methods:Patients who were hospitalized in the neurology intensive care unit between January and August 2018 were retrospectively evaluated. Demographic data, SE type, etiological factors, antiepileptic drugs used, duration of hospitalization, total cost of hospitalization, and the cost of medication(s) were recorded.Results:The records of 15 patients (male/female: 4/11) with a mean age of 46.73 years were examined. Seven patients had no previous history of epilepsy and their first seizure was SE-like. The seizures were classified as primary generalized convulsive (n=5), focal onset generalized convulsive (n=6), focal motor (n=1), and non-convulsive (n=3) SE. Medication mismatch (n=4), systemic infection (n=4), previous stroke (n=2), acute stroke (n=3), metabolic causes (n=1), and iatrogenic causes (n=1) were found in the seizure etiology. Two patients died during followup. The mean length of time of hospitalization in the neurology service and intensive care unit was 5.7 and 13.2 days, respectively. The mean total cost of the treatment per patient was TL 22,202.86 and the mean drug cost was TL 4,630.73.Conclusion:The presence of an acute central nervous system etiology and advanced age of the patient are 2 important factors that significantly increased the cost. More comprehensive data are needed to investigate the risk factors that contribute to the cost of larger patient numbers in our country

    Acil Servise Başvuran 7423 Olgu Üzerinden Hayvan-İlişkili Yaralanmaların İncelenmesi

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    Amaç: Hayvan-ilişkili yaralanmalar tüm dünyada olduğu gibi ülkemizde de önemli bir halk sağlığı sorunudur. Bu yaralanmalarda ciddi enfeksiyonlar gibi komplikasyonlar oluşabilmektedir. Çalışmamızda hayvan-ilişkili yaralanmalar nedeni ile acil servise başvuran hastalarda sosyo demografik özellikleri, kuduz riskli temas niteliklerini ve profilaksi yaklaşımlarını, temas sonrası profilaksinin uygunluğunu incelemeyi amaçladık. Yöntem: Bu çalışma 2010-2011 yılları süresince Ankara Eğitim ve Araştırma Hastanesi acil servisine hayvan-ilişkili yaralanma nedeni ile başvuran 7423 hastanın dosya kayıtlarının retrospektif olarak değerlendirilmesiyle yapılmıştır. Çalışmada elde edilen veriler SPSS 11.5 paket programında değerlendirilmiştir. Bulgular: Çalışmaya 7423 hasta alındı. Hastaların %66.4'ü erkek, ortalama yaşları 3118'dir. Hayvan-ilişkili yaralanmaların bahar ve yaz aylarında arttığı, bireylerin %80.8'inin ısırılma yolu ile temasa uğradığı belirlendi. Hastaların %69.8'inde etken köpekler, %27.5'inde kediler, %0.2'sinde ise vahşi hayvanlardı. Hastaların %51.6'sı üst ekstremite, %39.7'si alt ekstremite, %4.6'sı baş ve boyun, %2.4'ü göğüs ve %1.7'si sırt bölgesinden yaralanmıştı. En çok izlenen yaralanma tipi laserasyondu. Hastaların %43.6'sına 211 kuduz aşısı şeması uygulandığı, %7.1'ine 211 kuduz aşısı ve immunglobülin uygulandığı, %12.9'una 5 doz aşı şeması uygulandığı belirlendi. Hastaların %34.4'ünün ise kuduz profilaksisi uygulanmadan 10 gün izleme alındığı tespit edildi. Sonuç: Hayvan-ilişkili yaralanmalara en sık köpekler neden olmaktadır. Mekanizma köpekler için daha çok ısırma, kediler için tırmalamadır. Sıklıkla ekstremite bölgelerinde yaralanmaların oluştuğu, çocukluk yaş grubunda ise baş boyun bölgesindeki yaralanmaların diğer yaşlara göre yüksek olduğu görülmüştür. Hayvanın sahipli ve aşılı olması veya lezyonun mevcu t olup olmamasına göre kuduz profilaksisi uygulamasının değişiklikler gösterdiği belirlenmiştir.Objective: Animal-related injuries are major issues of public health in all over the world and in our country as well. These animal-related injuries may result in serious complications like infections. In our s tudy we aimed to investigate the sociodemographic characteristics, the features of contact related to animal bites or exposure to rabies risk, prophylactic treatment strategies and appropriateness of post-exposure prophylaxis in patients with animal-related injuries. Method: This study was retrospectively designed by collecting data of the patients with animal related and bite wound injuries admitted to the emergency department of Ankara Training and Research Hospital during the years of 2010 and 2011. The data was analysed by using SPSS 11.5 software programme. Results: The study was consisted of 7423 patients. Animal related injuries were mostly seen in male patients (66.4%) and the mean age of the patients was 31±18. These injuries were mostly during spring and summer. In 80.8% of the patients the injuries were due to animal bites. Of the 7423 patients; 69.8% were injured by dogs, 27.5% by cats and 0.2% by wild animals. The location of the bite wounds were in the upper extremities in 51.6%, lower extremit ies in 39.7%, head and neck in 4.6%, chest in 2.4% and back in 1.7% of the patients. Lacerations were the most common type of injury. Of the patients 43.6% received 211 rabies vaccination schedule, 7.1% received 211 rabies vaccination schedule and immunoglobulin, 12.9% received 5 dosage vaccination schedule. Of the patients 34.4% followed up for 10 days without any rabies prophylaxis. Conclusions: According to the results of our study; most of the animal related injuries are caused by dogs. Dogs mostly cause bite injuries whereas cats cause scatch injuries. Wounds are located generally in the extremities. Head and neck injuries are more common in pediatric group compared with other age groups. Rabies prophylaxis application strategies were changed if the dogs were owned or not and according to the existence of the lesion
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