The role of the family in attributing meaning to living with HIV and its stigma in Turkey

Stigma attached to HIV/AIDS remains a global problem, with severe negative consequences for people living with HIV (PLHIV). Family support is fundamental for PLHIV’s psychological and physical well-being. HIV-related stigma is high in Turkey, where HIV/AIDS prevalence is low and the epidemic is not considered a priority. Based on qualitative data generated with HIV-positive women and men, this article explores the process of stigmatization, as experienced and perceived by PLHIV in Turkey, focusing on the institution of the family. Results indicated that enacted stigma from family members is lower than anticipated. While most participants’ narratives showed patterns of support rather than rejection from families, the strong expectations around the cultural value attributed to “the family” are found to be the main facilitators of internalized stigma. The article critically discusses the meaning and implications of family support, addressing the role of patriarchal values attributed to womanhood, manhood, and sexuality in Turkey

Neurogenic bladder in patients with traumatic spinal cord injury: Treatment and follow-up

Study design:Multi-center, cross-sectional study.Objectives:Our aim was to evaluate the treatment methods and follow-up of neurogenic bladder in patients with traumatic spinal cord injury retrospectively using a questionnaire.Setting: Turkey.Methods:Three hundred and thirty-seven patients who had spinal cord injury for at least 2 years were enrolled from six centers in the neurogenic bladder study group. They were asked to fill-out a questionnaire about treatments they received and techniques they used for bladder management.Results:The study included 246 male and 91 female patients with a mean age of 42±14 years. Intermittent catheterization ( IC) was performed in 77.9% of the patients, 3.8% had indwelling catheters, 13.8% had normal spontaneous micturition, 2.6% performed voiding maneuvers, 1.3% used diapers and 0.6% used condom catheters. No gender difference was found regarding the techniques used in bladder rehabilitation ( P>0.05). Overall, 63.2% of patients used anticholinergic drugs; anticholinergic drug use was similar between genders ( P>0.05). The most common anticholinergic drug used was oxybutynin ( 40.3%), followed by trospium ( 32.6%), tolterodine ( 19.3%) darifenacin ( 3.3%), propiverine ( 3.3%) and solifenacin ( 1.1%). The specialties of the physicians who first prescribed the anticholinergic drug were physiatrists ( 76.2%), urologists ( 22.1%) and neurologists ( 1.7%). Only four patients had previously received injections of botulinum-toxin-A into the detrusor muscle and three of them stated that their symptoms showed improvement. Most of the patients ( 77%) had regular follow-up examinations, including urine cultures, urinary system ultrasound and urodynamic tests, when necessary; the reasons for not having regular control visits were living distant from hospital ( 15.3%) and monetary problems ( 7.7%). Of the patients, 42.7% did not experience urinary tract infections ( UTI), 36.4% had bacteriuria but no UTI episodes with fever, 15.9% had 1-2 clinical UTI episodes per year and 5% had ≥3 clinical UTIs. The clinical characteristics of patients with and without UTI ( at least one symptomatic UTI during 1 year) were similar ( P>0.05). The frequency of symptomatic UTI was similar in patients using different bladder management techniques ( P>0.05).Conclusion:The most frequently used technique for bladder rehabilitation in patients with SCI was IC ( 77.9%). In all, 63.2% of patients used anticholinergic drugs, oxybutynin being the most commonly used drug. Also, 77% of patients had regular control visits for neurogenic bladder; 42.7% did not experience any UTIs. © 2014 International Spinal Cord Society

Intermittent catheterization in patients with traumatic spinal cord injury: Obstacles, worries, level of satisfaction

Objectives: The aim of this study is to examine the obstacles in people with traumatic spinal cord injury (SCI) face performing intermittent catheterization (IC), also their worries and level of satisfaction. Methods: Two hundred sixty-nine patients performing IC for at least 3 months were asked to fill-out a questionnaire about their opinions on IC. Results: In total, 69.5% of patients performed IC themselves, 10.4% had performed by their mothers, 7.8% by another caregiver and 7.4% by their spouse. For the 72 (26%) patients unable to apply IC, reasons were insufficient hand function (56.1%), being unable to sit appropriately (35.4%) and spasticity (8.5%). In all, 70% of male patients had insufficient hand function, 20% could not sit and 10% had spasticity while 56.3% of female patients could not sit, 37.5% had insufficient hand function and 63% had spasticity. Difference between sexes was found to be statistically significant (P<0.05). Worries patients had when starting IC were fear of being dependent on IC (50.2%), accidentally injuring self (43.8%), embarrassment (43.2%), causing an infection (40.2%), bleeding (32.7%), fear of feeling pain (30.2%) and hygiene (24.7%). More women felt embarrassment; other items were similar in both sexes. In all, 46.9% of patients had urinary incontinence in intervals. Conclusion: In total, 69.5% of patients performed IC themselves. Men's most common obstacle was insufficient hand function while women's was being unable to sit appropriately. Patients' most common worries were being dependent on IC for life. In all, 46.9% had incontinence in intervals; 47.9% said IC improved their life quality; and 97.4% preferred IC over continuous catheterization. © 2014 International Spinal Cord Society All rights reserved

Can we improve the compliance of spinal cord injury patients to clean intermittent catheterization (multiple letters) [2] [Omurilik Yaralanmali Hastalarin Temiz Aralikli Kateterizasyon Programina Uyumunu Arttirabilir miyiz?]

[No abstract available

Drug-induced rheumatic syndromes: Review article [İlaca bagli romati·zmal sendromlar: Derleme]

Drug-induced rheumatic syndromes occur after starting a drug, and symptoms and signs generally disappear with discontinuation of the treatment. A variety of drugs have been reported to be associated with rheumatic syndromes. New associations have been published with the introduction of new therapeutic agents in recent years. Systemic lupus erythematosus or scleroderma like disorders are the most frequently reported drug induced rheumatic syndrome. Some newer drugs appear to lead to myositis or vasculitis. Systemic lupus erythematosus ,scleroderma, myositis and vasculitis induced by a variety of drugs are reviewed in this manuscript

The relationship between Bath indexes and osteoporosis in male patients with axial Ankylosing Spondylitis [Aksiyal İskelet tutulumu olan erkek ankilozan spondilit hastalarinda Bath i·ndekslerinin osteoporoz i·le i·lişkisi]

Objective: Osteoporosis is a common complication of patients with ankylosing spondylitis (AS). There is no avaible data for the indications of bone mineral density (BMD) measurement related to osteoporosis diagnosis at AS patients. The aim of this study is to investigate the relationship between Bath indexes and BMD in patients with AS. Materials and Methods: 45 male AS patients (mean age: 46.96±13.58 years) and 41 healthy male controls (mean age: 48.93±6.86 years) were enrolled in the study. Patients with AS were evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Spondylitis Metrology Index (BASMI) and Bath Ankylosing spondylitis Radiology Index (BASRI). The BMD of AS and control group patients were assessed at hip (femoral neck, Ward's triangle and femur trochanter) and lumbar area. Results: We have found a significant difference at the femoral ward triangle and lomber spine BMD and T scores in favour of AS patients (p<0.05). BASMI scores were negatively correlated with femoral neck and femoral ward triangle (p<0.05). BASDAI, BASFI scores were not correlated with BMD and T scores of any measured regions. Conclusion: We found that femur ward triangle may be appropriate to evaluate bone loss in patients with AS. BASMI score is a useful tool to determine BMD in patients with AS

Effect of pulmonary involvement on bath indexes, quality of life and psychological symptoms in patients with ankylosing spondylitis [Ankilozan spondilite bagli pulmoner tutulumun bath i·ndeksleri, yaşam kalitesi ve psikolojik semptomlar üzerine etkisi]

Objective: Pain and stiffness disturb the psychological status and quality of life in ankylosing spondylitis (AS) patients, which may be further deteriorated by pulmonary involvement. Therefore, detection of pulmonary involvement in AS patients is important. In this study, we aimed to detect pulmonary involvement in AS patients and to assess the effects of pulmonary involvement on Bath indexes, quality of life and psychological symptoms. Material and Methods: The study included 26 AS patients (mean age: 47.5±10.8 years). Pulmonary status of the patients was assessed by spirometric measurements and radiographic methods (chest X-ray, high resolution computerized tomography [HRCT]); clinical status was assessed by Bath indexes (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], Bath Spondylitis Metrology Index [BASMI], Bath Ankylosing Spondylitis Radiology Index [BASRI]); quality of life was assessed by Nottingham Health Profile-1 (NHP) and St. George Respiratory Questionnaire (SGRQ); and psychological symptoms were assessed by Beck Depression Scale (BDS). Results: Respiratory function tests were impaired in 15.4% of the patients (n: 3/1, restrictive/obstructive). HRCT revealed pathologic findings in 20.9% of the patients (n: 5). A negative correlation was detected between forced expiratory volume in 1 second (FEV1%) and BASFI (r=-0.56, p0.05). Conclusion: Our study showed that pulmonary involvement may be observed among non-smoker AS patients with longer duration of disease; however, pulmonary involvement is not related with clinical status, quality of life or psychological symptoms

Common problems in the elderly: Urinary incontinence, pain, immobilization [Yaşlilara özgü sorunlar: Üriner i·nkontinans, agri, i·mmobilizasyon]

In this review, urinary incontinence, pain and immobilization problems in elderly people have been discussed. Urinary incontinence is a growing medical, social and economic health problem for the elderly people. Urge urinary incontinence and stress urinary incontinence are the most common forms of incontinence and they both affect the quality of life of the elderly. Assessment and treatment of urinary incontinence will significantly influence the elder's quality of life. Many older adults consider pain as a natural part of aging. While elderly people are more likely to experience pain than the general population, in many cases, they are undertreated. Safe pharmacological and non-pharmacological pain treatment options are available for the elderly. Bed rest and immobilization are a common consequence of many diseases and are also a proposed treatment modality for several acute and chronic disorders. It has been approved that inactivity fosters the healing of the affected part of the body; however, the deleterious effects and complications of prolonged bed rest and immobility have been increasingly recognized since the mid-1940s. Although the unfavorable effects and complications of immobilization seem to be variable for individuals, the elderly people are likely to lose significant independent functions easier and faster