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 < 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

Ectrodactyly with a case of cornelia de lange syndrome: Case report

Cornelia de Lange sendromu (CDL) karakteristik yüz özellikleri prenatal ve postnatal büyüme geriliği, mental retardasyon ile karakterizedir. Fasiyal özellikleri (synophrys, uzun kirpikler ve kaşlar ) muhtemel doğru tanıyı koymaya yardımcı olur. Kliniğimize getirilen bir aylık dismorfik yüz özellikleri olan CDL sendromlu bir kız çocuğu olgu olarak sunuldu. Klasik CDL sendromuna farklı olarak olguda sağ elde ektrodaktili, sol elde basit sindaktili vardı. Bu çalışmada CDL sendromunun klinik özellikleri ile olgumuzdaki bulgular literatür eşliğinde gözden geçirildi.The Cornelia de Lange syndrome (CDL) is recognized on the basis of characteristic facies in association with prenatal and postnatal growth retardation and mental retardation. Facial abnormalities most likely to lead to a diagnosis are hypertrichosis, and bushy eyebrows. A one month old female with the dismorphic features of Cornelia de Lange syndrome presented to our clinic. The case had simple syndactyly in the left hand, and ectrodactyly of the right hand, which was differed from the classical presentation of CDL syndrome. In this report, clinical features of CDL syndrome reviewed in the light of current literature with the unique features of ectrodactyly of the right hand in the present case

Ectrodactyly with a case of cornelia de lange syndrome: Case report

Cornelia de Lange sendromu (CDL) karakteristik yüz özellikleri prenatal ve postnatal büyüme geriliği, mental retardasyon ile karakterizedir. Fasiyal özellikleri (synophrys, uzun kirpikler ve kaşlar ) muhtemel doğru tanıyı koymaya yardımcı olur. Kliniğimize getirilen bir aylık dismorfik yüz özellikleri olan CDL sendromlu bir kız çocuğu olgu olarak sunuldu. Klasik CDL sendromuna farklı olarak olguda sağ elde ektrodaktili, sol elde basit sindaktili vardı. Bu çalışmada CDL sendromunun klinik özellikleri ile olgumuzdaki bulgular literatür eşliğinde gözden geçirildi.The Cornelia de Lange syndrome (CDL) is recognized on the basis of characteristic facies in association with prenatal and postnatal growth retardation and mental retardation. Facial abnormalities most likely to lead to a diagnosis are hypertrichosis, and bushy eyebrows. A one month old female with the dismorphic features of Cornelia de Lange syndrome presented to our clinic. The case had simple syndactyly in the left hand, and ectrodactyly of the right hand, which was differed from the classical presentation of CDL syndrome. In this report, clinical features of CDL syndrome reviewed in the light of current literature with the unique features of ectrodactyly of the right hand in the present case

Çocuklarda artrit ve artralji ile human parvovirüs B19 arasındaki ilişki

TEZ2954Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 1998.Kaynakça (s. 47-52) var.vi, 52 s. ; rnk. res. ; 30 cm.

Evaluation of microrna, CCN2 and TGF-β expression levels in patients with idiopathic pulmonary fibrosis

Amaç: MiRNA’lar biyolojik süreçlerde ve İPF gibi fibrotik hastalıklarda rol alan küçük RNA molekülleridir. Son yıllarda yapılan çalışmalar; vücut sıvılarında tespit edilebileceğini, hastalıkların tanı ve takiplerinde belirteç olarak kullanılabileceğini göstermektedir. Bu projede amaç; İPF hastalarında fibrotik süreçten sorumlu olabilecek CCN2 ve TGF-β genlerinin ve 21 miRNA’nın ekspresyon düzeylerinin periferik kanda qPCR yöntemiyle değerlendirilmesidir. Yöntem: Göğüs hastalıkları ana bilim dalı multidisipliner interstisyel akciğer hastalıkları konseyinde değerlendirilmiş ve İPF tanısı almış 20 kişilik hasta grubu ile 20 sağlıklı gönüllüden alınan periferik kan örneklerinde qPCR ile CCN2, TGF-β ve miRNA ekspresyon analizleri yapıldı. Bulgular: CCN2, TGF-β genlerinin ve miR’lerin ekspresyon düzeyleri belirlenerek hasta ve kontrol grubu arasındaki fark istatistiksel yöntemler ile incelendi. TGF-β, miR29a/29b/29c-3p, miR-19a, miR-130a-3p, miR-140-5p, miR-320a, miR-155-5p, miR-21-5p, miR-205-5p ekspresyonları hasta grubunda downregüle bulundu, miR-143-3p ekspresyonu ise upregüle bulundu. CCN2, miR-145, miR-30a/30b/30d/30e-5p, miR-26a-5p, miR-32-5p, miR-19b-1, miR-133 ve let-7d gruplar arasında ekspresyon farkı göstermedi. Hastalarda miR-29a-3p ve miR-140-5p’nin sigara kullanımı ile; miR-155-5p, miR-140-5p ve miR320a’nın cinsiyete göre ekspresyon farkı sergilediği saptandı. miR-29a ve miR-143 ile lojistik regresyon modeli oluşturuldu, ROC analizi ile miR-29a ve miR-143’ün hasta ve kontrol grubunu ayırt etme gücü istatistiksel olarak yüksek bulundu. Sonuç: Çalışmamızda, gen ve miRNA disregülasyonunun İPF hasta serumlarında RTqPCR gibi kolay ve rutin bir yöntemle tespit edilebileceği gösterilmiş; tanı, takip ve ilaç yanıtı değerlendirmede kullanımının mümkün olabileceği tartışılmıştır. Literatüre katkı sağlayacak yeni bulgular tespit edilmiş olup, bu bulgular ışığında yapılacak yeni çalışmalara yön verecektirBackground/Aim: MiRNA’s are small RNA molecules that participate many biological processes and fibrotic diseases like IPF. Studies carried out in recent years; shows that it can be detected in body fluids and can be used as a marker in the diagnosis and follow-up of diseases. Aim in this project is evaluation of expression levels of CCN2 and TGF-β genes and 21 miRNA’s that can be responsible for the fibrotic process of IPF, using RTqPCR in peripheral blood samples. Methods: CCN2, TGF-β and miRNA expression levels were analyzed using qPCR in peripheral blood samples of 20 patients and 20 healthy volunteers. All of the patients were diagnosed of IPF in the multidiciplinary interstitial pulmonary diseases counsil of the chest diseases department. Result: Any alteration of the expression levels of CCN2, TGF-β genes and miRNA’s were statistically analyzed. It is revealed that; TGF-β, miR-29a/b/c-3p, miR-19a, miR-130a-3p, miR-140-5p, miR-320a, miR-155-5p, miR-21-5p, miR-205-5p expression levels were downregulated in the patients; in contrast to miR-143-3p expression, which was upregulated. CCN2, miR-145, miR-30a/b/d/e-5p, miR-26a-5p, miR-32-5p, miR-19b-1, miR-133 and let-7d showed no statistically significant difference between patient and control groups. It was demonstrated; miR-29a and miR-140 expressions were altered due to whether the patient was a smoker, while miR-155, miR-140 and miR-320a expressions showed gender differences. Logistical regression model with miR-29a and miR-143 expression profiles were created. It was demonstrated that; strength of differentiating case and control groups were statistically higher in miR-29a and miR-143, with ROC analysis. Conclusion: In this study; we demonstrated that, gene and miRNA dysregulations in blood samples of IPF patients could easily be detected by routinely used RT-qPCR method. The potentiality of them being used in diagnosis, follow-up and drug responsiveness was discussed. Our project will contribute to the literature with new findings and guide the other invetigators in this field

The role of MTHFR C677T and A1298C Polymorphysms in the Ethiopathogenesis of Diabetic Neuropathy

Amaç: Bu çalışmada MTHFR geni C677T ve A1298C polimorfizmlerinin diyabetik periferik polinöropati patogenezine katkısı olup olmadığını araştırdık. Gereç ve Yöntem: Hasta grubu, Selçuk Üniversitesi Meram Tıp Fakültesi İç Hastalıkları Anabilim Dalı Endokrinoloji Polikliniğine başvuran, en az 10 yıldır Tip 2 DM tanısı nedeniyle takip edilen ve ENMG tetkiklerinde Diabetik Periferik Polinöropatisi olan 103 hastadan oluşturuldu. Kontrol grubu ise 2010 yılında Konya ilinde yaşayan rastgele seçilmiş 100 sağlıklı gönüllüden seçildi. Hasta ve kontrol grubundan yazılı onay alındıktan sonra kanları alındı. Pyrosequence tekniği ile MTHFR geni C677T ve A1298C polimorfizmleri araştırıldı. Bulgular: Araştırmamızda diyabetik nöropatili bireyler ile sağlıklı kontrol grubu karşılaştırıldığında MTHFR geni C677T ve A1298C polimorfizmlerinin genotip ve allel frekansları için istatistiksel olarak anlamlı bir farklılık bulunamadı. Bununla birlikte 2 ve daha fazla mutant alleli olan bireylerin, 1 ve daha az mutant alleli olan bireylerle karşılaştırıldığında diyabetik nöropati grubunda kontrol grubuna göre anlamlı bir şekilde (P 0.01) yüksek olduğu tespit edildi. Sonuç: Tip 2 DM hastalarında MTHFR geni C677T ve A1298C polimorfizmleri, polimorfik allel sayısı arttıkça diyabetik periferik polinöropati gelişimine yatkınlık sağlayabilir. Ancak diyabetik periferik polinöropatilerin poligenik doğası ve çevresel faktörlerden etkilenmesi, MTHFR gen polimorfizmlerinin tek başına etkisini ortaya koymayı zorlaştırmaktadır. Bu nedenle hasta ve kontrol gruplarının daha fazla sayıda olduğu, farklı etnik grupları içeren, çok merkezli daha geniş ölçekli araştırmalarla diyabetik periferik polinöropatilerin genetik nedenleri aydınlatılabilir.Objective: In this study, we investigated whether MTHFR gene C677T and A1298C polymorphisms contribute to the etiopathogenesis of diabetic peripheral neuropathies. Materials and Methods: The patients group was constituted 103 individuals with diabetic peripheral polyneuropathy diagnosed by electrophysiological techniques who were followed the diagnosis of type 2 DM at least 10 years at the Selçuk University Meram Medical School, Department of Internal Medicine. The control group was constituted 100 healthy volunteers randomly selected and living in Konya. Blood samples were collected after written consent from patients and control group. MTHFR gene C677T and A1298C polymorphisms was investigated using pyrosequence technique. Results: In our study, there was not found any statistically significant diffrences allele and genotype frequencies of MTHFR gene C677T and A1298C polymorphisms when patient and control groups were compared. Nevertheless, the number of individuals who had 2 or more the mutant allele in the patients group were significantly higher than the control group, compared with the number of individuals who had 1 and less than the mutant allele (P 0.01). Conclusion: As the number of polymorphic alleles of MTHFR gene C677T and A1298C polymorphisms in type 2 DM patients may predispose to the development of diabetic peripheral polyneuropathy. But, polygenic nature of diabetic peripheral polyneuropathy and influenced of environmental factors makes it difficult to reveal the effect of MTHFR gene polymorphisms in diabetic peripheral polyneuropathy. Thus the genetic causes of diabetic peripheral polyneuropathies may be elucidated by large-scale multi-center studies containing different ethnic groups and consisting of more individuals

Comparison of Pediatric and Adult Tonsillectomies Performed by Thermal Welding System

Objective. To compare pediatric and adult age groups in terms of postoperative bleeding and pain following tonsillectomy performed by thermal welding system (TWS). Method. The study consisted of 213 patients, of whom 178 were children and 35 were adults. The mean age of the pediatric patients (81 girls and 97 females) was 6.7±2.4 years (range 3–13 years) and the mean age of the adults (20 males and 15 females) was 21.8±7.07 years (range 15–41 years). All of the patients were evaluated in terms of postoperative bleeding and pain following tonsillectomy performed by TWS. Results. Bleeding was detected in the late postoperative period in 11 pediatric and 7 adult patients and of them 2 pediatric and 3 adult patients controlled under general. Postoperative bleeding was significantly less prevalent in the pediatric age group compared to the adult age group (P=0.04). Likewise, postoperative pain was significantly less prevalent in the pediatric age group as compared to the adult age group (P<0.001). Conclusion. Both postoperative bleeding and pain following tonsillectomy performed by TWS were more prevalent in the adult age group compared to the pediatric age group

A Rare Combination of Mosaic Ring Y Chromosome and Shox Gene Deletion in an Infertile Male

Y kromozomunun yapısal anomalileri sıklıkla testiküler disfonksiyon ile ilişkilidir. Bu anomaliler Y kromozomunun uzun ya da kısa kolununun delesyonları, izokromozom Y, izodisentrik Y kromozomu, ve ring Y kromozomu olabilir. Ring Y kromozomuna sahip hastalar Turner sendromu, ambiguus genitalya, kısa boy, infertilite gibi birçok farklı fenotiple karşımıza çıkabilmektedir. SHOX (short stature homeobox-containing) geni X ve Y kromozomlarının psödootozomal 1 (PAR1) bölgelerinde yer alır ve bir kopyasında görülen fonksiyon kaybı boy kısalığı ile ilişkilidir. Bu çalışmada infertilite nedeniyle polikliniğimize başvuran ve konvansiyonel sitogenetik analiz sonucunda 46,X,r (Y)/45,X mozaikliği tespit edilen hastada, Y kromozomunda ring yapıya ek olarak SHOX geni delesyonunun nadir görülen birlikteliği sunulmuştur.Structural rearrangements of the Y chromosome are frequently associated with testicular dysfunction. These anomalies may be long or short arm deletions of Y chromosome, isochromosome Y, isodicentric Y chromosome, and ring Y chromosome. Patients with ring Y chromosome can present with many different phenotypes, such as Turner's Syndrome, ambiguous genitalia, short stature and infertility. The SHOX (short stature homeobox-containing) gene is located in the pseudoautosomal 1 (PAR 1) region of the X and Y chromosomes and loss of function of one copy is associated with short stature. In this study, we present a rare combination of SHOX gene deletion in addition to the ring structure of Y chromosome in a patient who was referred to our clinic with infertility and having 46,X,r (Y) /45,X mosaicism as a result of conventional cytogenetic analysis