Retention period prediction for pension policies

Customer Retention in Pension market refers to the activities and actions companies and organizations take to reduce the number of customer defections. How long the customer will be with our company or will stay in the system is retention. There are already workings in my company and other companies in the market about customer retention. Existing works generally contains how to measure customer retention and how to define distribution channels are successful in customer retention. Also existing predictive models are working on the feature set customer fund, total collection, un-paid premium frequency in general. In pension market companies have small margin of profit from pension policies. To make a profit from pension policies the companies have to retain their customer for long years. It ‘s approximately nine year to make profit from a pension policy because of high sales costs. Therefore to gain a new customer is less profitable than retaining present customers in Pension Market. In my project, I want to look retention in the pension application phase of customer. My main purpose is when the customer applied for pension product predict its retention period. If I produce an applicable model, It will be used in my company’s sales channels.Bir Emeklilik Şirketi için yeni sözleşme/poliçe satışları ve çıkışlar şirket karlılığını etkilemektedir. Eğer müşteriler uzun süre şirkette kalırlar ve düzenli prim öderler ise şirketler emeklilik sisteminden bekledikleri faydayı elde edebiliyorlar. Bu noktada daha satış aşamasında yapılan satışın kalitesini belirlemek önemli hale geliyor. Doğru müşteri ye doğru ürün satılması sözleşmenin emeklilik şirketindeki yaşam süresini etkiliyor. Satış ekiplerinin kazanç oranlarını artırmak üzere yaptıkları, sisteme ve şirket için fayda yaratmayan satışları belirlemek veya kazanç sisteminin bir parçası olarak satış aşamasında satışın kalitesini bir değişken olarak değerlendirmek emeklilik şirketlerinin karlılığını artıracak ve doğru müşteriye doğru ürün eşleşemesini destekleyerek müşteri memnuniyeti oluşturacatır. Bu amaçla sözleşmenin satış aşamasında retention periyodunu belirleyecek bir model oluşturmak amaç edinilmiştir

Coincidental Killian-Jamieson Diverticulum During Thyroid Surgery: A Rare Cause of Dysphagia

The aim of this case report is to demonstrate a very rare coincidental existence and management of the Killian- Jamieson diverticulum during thyroid surgery in a patient with dysphagia. An 18-year-old female patient with the complaints of progressive dysphagia and a rapidly growing mass at the anterior cervical region was undergone thyroid lobectomy. Coincidentally, a 2×2 cm Killian-Jamieson diverticulum was observed and simultaneously excised with the thyroid lobe, preserving the recurrent laryngeal nerve. Dysphagia is a frequent symptom, especially in patients with a rapidly growing thyroid mass. Thyroid surgeons should keep in mind that hypopharyngeal and upper esophageal pathologies can mimic the symptoms of a thyroid mass; therefore, detailed imaging techniques should be used for the differential diagnosis

Importance of Sonoelastography in Assessing Non-Thyroid Neck Masses

Objective: To evaluate the feasibility and value of sonoelastography in assessing non-thyroid neck masses.Methods: Non-thyroid neck masses requiring surgical interventions were evaluated using conventional B-mode ultrasonography (US) (size, short/long axis rate, shape, hilum, echogenity, calcification, necrosis, and peripheral edema) and sonoelastograpy (SE) with strain ratio (SR) and elasticity score (ES) before surgery. These parameters were compared with the histopathological examination.Results: In total, 116 non-thyroid neck masses (66 lymph node, 35 parotid gland, eight submandibular gland, and seven cervical mass) of 89 patients (51 men, 38 women) with a mean age of 50.3±15.1 (19-79) years were evaluated. Thirty-seven malignant lymph nodes (23 metastatic and 14 lymphoma), seven malignant parotid tumors, two malignant submandibular tumors, 29 benign lymph nodes, 28 benign parotid lesions, and six benign submandibular lesions were evaluated. Mean SR and ES values of malignant masses were 6.3/3.2 for lymph nodes, 5.5/3.3for the parotid gland, and 4.2/3 for the submandibular gland. Mean SR and ES values of benign lesions were 2.0/2.1 for lymph nodes, 4.4/3.2 for the parotid gland, and 3.2/3 for the submandibular gland. SR and ES were significantly higher for malignant masses compared with those for benign ones. SR was more predictive than ES in evaluating malignant lymph nodes. The area under the curve was 0.917(0.827-1.00) (p<0.05) for SR in differentiating benign-malignant lymph nodes, and the upper cut-off value was two. SR and ES were higher in the malign parotid and submandibular gland lesions than the benign ones, but the difference was not statistically significant.Conclusion: Strain ratio value could be a useful parameter in differentiating benign-malignant lymph nodes. More studies are necessary for differentiating benign-malignant parotid and submandibular lesions using SE

The Effects of Superficial Musculoaponeurotic System Flap on the Development of Frey’s Syndrome and Cosmetic Outcomes After Superficial Parotidectomy

Objective:To investigate the outcomes of superficial musculoaponeurotic system (SMAS) flap and classic techniques in superficial parotidectomy in terms of Frey’s syndrome (FS) and cosmetic satisfaction.Methods:In this study, a retrospective chart review of patients that underwent superficial parotidectomy was performed. These patients were divided into two subgroups: group 1 included patients in which the SMAS flap was harvested and group 2 comprised the remaining patients on whom classic superficial parotidectomy was performed. All the patients were evaluated clinically and with Minor’s starch-iodine test for FS. For the evaluation of the cosmetic results, the patient’s satisfaction was queried according to the incision scar and surgical field skin retraction/facial symmetry. Both groups were compared in terms of complications and numbness of surgical area.Results:Fifty-five patients (31 male and 24 female) with a mean age of 50.19 years were included in the study. Thirty-two patients were in group 1 and 23 in group 2. Thirteen patients (23.7%) described as having FS and six of them were in group 1, while seven were in group 2. Minor’s starch-iodine test was positive in nine patients in group 1 (28.1%) and six patients in group 2 (26.1%) (p=1.000). With regard to cosmetic satisfaction, eight patients (25%) stated mild discomfort from the incision scar and two patients (6.3%) stated cosmetic dissatisfaction for facial asymmetry in group 1. In group 2 for the same factors the number of patients were 11 (47.8%) and 2 two (8.7%), respectively (p=0.027). There were no statistically significant differences in means of complication and numbness (p>0.05).Conclusion:According to our study results, there was no superiority between both the groups in terms of FS and incision scar satisfaction. We determined that there was a significant benefit of SMAS flap application in the prevention of volume loss and surgical area retraction

Prognostic and Clinical Role of Contrast Enhancement on Magnetic Resonance Imaging in Patients with Bell’s Palsy

Objective:To investigate the prognostic value of the magnetic resonance imaging in Bell’s palsy patients.Methods:Patients who were diagnosed and treated with Bell’s palsy between October 2013 and March 2016 retrospectively selected. House–Brackmann grades, pre- and post-treatment pure tone audiograms, stapedial reflexes were analyzed and magnetic resonance imaging (MRI) scans with gadolinium-based contrast agents were evaluated. Contrast-enhanced segments of the facial nerve were determined. MRI findings were compared statistically with pre- and post-treatment grade, recurrence rate of Bell’s palsy, MRI scanning timing, presence of stapes reflexes and posttreatment recovery data.Results:No significant correlation was observed between pretreatment House–Brackmann grades and enhancement (p>0.05). Similarly, there was no significant correlation between clinical recovery and enhancement (p>0.05). Also, no significant correlation was observed between MRI scanning time, the recurrence rate of Bell’s palsy and MRI findings (p>0.05). None of the MRIs showed neoplastic contrast enhancement.Conclusion:The routine use of the contrast-enhanced temporal MRI is not recommended in the diagnosis and monitoring of Bell’s palsy patients, because the contrast enhancement pattern of the facial nerve has no effect on the prognosis of Bell’s palsy. MRI should be used in cases that do not heal despite treatment, for the differential diagnosis of facial nerve tumors and in patients who are candidates for surgical decompression

Assesment of castellani solution's ototoxic effects on guinea pigs using otoacoustic emission and auditory evoked brainstem potentials

Amaç: Otomikoz tedavisinde güçlü etkiye sahip ve ototoksik etkisi olmayan ilaç araştırmaları günümüzde de devam etmektedir. Kulak Burun Boğaz pratiğinde timpan membran perforasyonu bulunan hastalarda topikal otomikoz ilaçlarının kullanılmasından ototoksik etkileri nedeniyle kaçınılmaktadır. Fungal eksternal otit tedavisi için kullanılan nonspesifik ototopikal ilaçlardan birisi olan Castellani solüsyonu, uzun yıllardır özellikle Türkiye'de tercih edilmektedir. Timpan membran perforasyonu olan hastalarda da otomikoz tedavisi için kullanılmakta olan Castellani solüsyonunun ototoksik etkisine ışık tutabilmek amacıyla bu çalışma gerçekleştirilmiştir. Gereç ve Yöntem: Ondört dişi erişkin albino kobay çalışmaya alındı. Tüm işitme testlerinin uygulanmasından önce, kobayların otomikroskopik incelemeleri gerçekleştirilerek distorsiyon ürünü otoakustik emisyon ve beyinsapı işitsel uyarılmış potansiyellerinin yanıtları kaydedildi. Beyinsapı işitsel uyarılmış potansiyelleri testinde klik, 6 kHz ve 8 kHz ton burst uyarılar kullanıldı. Sonrasında 7 kobayın sol orta kulağına, 7 gün boyunca, intratimpanik 0.2 ml (40 mg/ml) Gentamisin enjeksiyonu uygulandı (Grup 1). Diğer 7 kobayın sol kulağına, 7 gün boyunca 0.1 ml Castellani solüsyonu enjeksiyonu uygulandı (Grup 2). Tüm kobayların sağ kulağına, 7 gün boyunca, intratimpanik 0.2 ml serum fizyolojik enjeksiyonu uygulandı (Grup 3). Enjeksiyonların başlangıcından 10 ve 21 gün sonra, distorsiyon ürünü otoakustik emisyon ile beyinsapı işitsel uyarılmış potansiyelleri testleri tekrarlandı. Testlerin verileri, Wilcoxon Signed Ranks Testi, Mann - Whitney U Testi ve Kruskal - Wallis Testi kullanılarak istatistiksel olarak analiz edildi. Bulgular: Distorsiyon ürünü otoakustik emisyon yanıtları Grup 1 ve Grup 2'de incelenen kulaklarda 10 ve 21. günlerde alınamazken, Grup 3'teki kulaklarda bu yanıtlar elde edildi. Grup 1 ve Grup 2'deki kobay kulaklarında, enjeksiyon öncesiyle 10 ve 21. gün beyinsapı işitsel uyarılmış potansiyelleri eşikleri karşılaştırıldığında, anlamlı bir eşik artışı gözlendi. Bununla birlikte, serum fizyolojik uygulanmasından önce ve 21. günde elde edilen işitsel uyarılmış potansiyel eşiklerinde anlamlı bir değişiklik saptandıysa da bu fark hiçbir kulakta aslında 5 dB sınırını aşmamaktaydı. Bu nedenle, bu farklılığın ototoksisiteyle bağlantılı olduğu düşünülmedi. Yapılan istatistiksel analizlerde, her iki işitme testi kullanılarak Grup 1 ile Grup 3 ve Grup 2 ile Grup 3 arasında gerçekleştirilen karşılaştırmaların tümünde anlamlı farklılıklar gözlendi. Sonuç: Yukardaki bulgular ışığında, Castellani solüsyonunun kobaylarda ototoksik etkisinin bulunduğu sonucuna varıldı. Ototoksisiteye insandan daha duyarlı olduğu bilinen kobayda Castellani solüsyonunun ototoksik olması, insanda da ototoksik etkisi olacağı anlamına gelmemektedir. Bununla birlikte, bu çalışmanın sonucuna göre, timpan membran perforasyonu bulunan otomikozlu hastalarda Castellani solüsyonunun kullanılması önerilemez. İleri çalışma olarak Castellani solüsyonunun içeriğinde bulunan tüm maddelerin ototoksik etkisinin ayrı ayrı araştırılması gerektiği kanaatine varıldı. Anahtar kelimeler: Ototoksisite, Castellani solüsyonu, Gentamisin, otomikoz, ototopikal ilaçlar. Objective: Research seeking an agent that has an intense impact on otomycosis treatment with less ototoxicity has been continuing. Use of topical otomycosis drugs on patients with tympanic membrane perforation has been problematic in ENT practice because of potential ototoxicity. One of the nonspecific topical drug is Castellani's solution. It is used for fungal external otitis treatment and commonly preferred in Turkey for years. It is likely that guinea pigs are more susceptible to topical ototoxic drugs than are humans. Thus, this research is planned to evaluate ototoxic effects of Castellani's solution on guinea pigs when used intratimpanically. Material and Methods: Fourteen female adult albino guinea pigs were used in this experiment. Distortion product otoacoustic emissions and auditory evoked brainstem potentials were recorded in order to evaluate the effect of intratympanic injections. All treatments were performed seven consecutive days using intratympanic injection. The first group comprised of the left ears of seven guinea pigs and received 0.2 ml of gentamicin (40 mg/ml (Group 1). The second group comprised of the left ears of the other seven guinea pigs and received 0.1 ml of Castellani's solution (Group 2). Contralateral ears of all these fourteen guinea pigs were used as negative control group and received 0.2 ml of saline solution intratimpanically for seven consecutive days (Group 3). All these treatments were performed simultaneously. Otomicroscopic evaluation was performed in order to check the external ear canal and tympanic membrane of pigs prior to all recordings. For auditory evoked brainstem potential recordings, standart alternating clicks as well as 6 and 8 kHz tone bursts were delivered through an insert earphone. Distortion product otoacoustic emissions and auditory evoked brainstem potentials were recorded, three times for each guinea pig, prior to intratympanic injection, on the tenth and twenty-first days after the injections. Wilcoxon Signed Ranks Test, Mann - Whitney U Test and Kruskal - Wallis Test were used for statistical analysis of data. Results: In Groups 1 and 2, following Castellani and gentamicin injections, distortion product otoacoustic emissions were absent on tenth and twenty-first days of the experiment. However, for Group 3, there was no significant change in both responses for the same time periods. The only statistical difference was occurred between the auditory evoked brainstem potential thresholds before and after the twenty-first day of the experiment of the saline solution. On the tenth and twenty-first day of the experiment, in the ears belong to Groups 1 and 2, auditory evoked brainstem potentials thresholds were found to be significantly increased, whereas in Group 3 ears any threshold shifts obtained were 5 dB HL only. Thus, the latter result is not considered to be due to ototoxicity. According to statistical analysis, significant differences were found between Groups 1 and 3 as well as Groups 2 and 3. Conclusion: It is concluded that Castellani's solution has ototoxic effect on guinea pigs. Thus, Castellani's solution is not to be recommended to patients with tympanic membrane perforation. As a further research, all the components of Castellani's solution should be tested individually. Key words: Ototoxicity, Castellani's solution, gentamicin, otomycosis, ototopical agents

Bilateral superficial cervical plexus block combined with bilateral greater occipital nerve block reduces the impact of different sources of pain after thyroid surgery with less consumption of morphine-PCA: a randomized trial

Bayir, Omer/0000-0001-9445-6129WOS: 000358736300006Background Our aim was to demonstrate the analgesic efficacy of the bilateral superficial cervical plexus block (BSCPB) combined with bilateral greater occipital nerve block (BGONB) on different sources of pain after thyroid surgery; in terms of pain scores and morphine-PCA consumption in the first 24 h. Materials and method Sixty patients were randomized into three groups; Group C (n = 20) to receive management without blocks; Group GS (n = 20), the combination of BSCPB and BGONB; and Group S (n = 20), BSCPB alone. Levobupivacaine of 0.25 % (15 ml (each side) for BSCPB; 5 ml (each side) BGONB) was used for nerve blocks. All patients received morphine-PCA for the first 24 h postoperatively. In all, 0 h, 1 h, 2 h, 4 h, 6 h, 12 h, and 24 h were the measurement times for incision pain at rest, pain on swallowing, headache, and posterior neck pain scores (VAS) and PONV. Requirement for rescue analgesics and 24 h morphine consumption were recorded. Results Incision pain scores at rest and on swallowing was lower in Groups GS and S (p 3 was lower in Group GS (p < 0.001). In Groups GS and S 24 h morphine consumption was lower, compared to Group C (p < 0.001). PONV and rescue analgesic use were similar. Conclusion The combination of three-injection technique BSCPB with BGONB performed before surgical incision by using 0.25 % levobupivacaine, significantly reduced incision pain at rest, incision pain on swallowing, headache and posterior neck pain after thyroid surgery, while reducing morphine consumption in 24 h postoperatively

Effects of methotrexate in a toluene diisocyanate-induced allergic rhinitis rat model

Objectives: This study aims to investigate the therapeutic effect of low-dose topical administration of methotrexate (MTX) in a toluene diisocyanate (TDI)-induced allergic rhinitis rat model. Materials and Methods: The experiments were performed on 18 healthy male Wistar albino rats weighing between 250-270 g. Rats were divided into four study groups: control group (n=5), sham group (n=3), steroid group (n=5), and MTX group (n=5). After the drugs were administered, multiple biopsies were taken bilaterally from the nasal mucosal areas and evaluated histologically for fibrosis, loss of cilia and goblet cells, edema, squamous cell metaplasia, and vascular proliferation. Results: Fibrosis, loss of cilia cells, edema, and vascular proliferation were significantly lower in both MTX and steroid groups than in the control group (p0.05). There were no statistically significant differences with respect to loss of goblet cells and squamous cell metaplasia among the studied groups (p>0.05). Conclusion: Methotrexate may be an alternative or adjuvant therapeutic agent in allergic rhinitis

Increased mean platelet volume in patients with vestibular migraine

Objectives: The purpose of this study was to investigate relation between mean platelet volume, plateletdistribution width, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio and vestibular migraine.Methods: This study was planned in prospective manner and conducted in Ankara Polatlı State Hospitalbetween April 2017 and May 2018. Thirty patients diagnosed with vestibular migraine and thirty healthy, ageand sex-matched subjects were enrolled to the study. Mean platelet volume, platelet distribution width, plateletcount, neutrophil count and lymphocyte count in blood samples were measured.Results: The mean age of the patients with vestibular migraine was 39.90 ± 7.16 and the study group consistedof 11 males and 19 females. The mean platelet volume and platelet distribution width values in patients withvestibular migraine were significantly higher than the control group (p < 0.001). There were no difference onmean neutrophil/lymphocyte ratio and platelet/lymphocyte ratio values between patient group and controlgroup.Conclusions: We found a positive relation of increased levels of mean platelet volume and platelet distributionwidth with vestibular migraine. Higher mean platelet volume is associated with atherosclerosis andthromboembolism. Vascular pathologies are blamed for both headache syndromes like migraine and vertiginoussyndromes. This theory supports our study but pathophysiological mechanism is not clear