Investigation of the Parameters That May Predict Hemodialysis Frequency

DergiPark: 819242tmsjAims: This study investigates the relationship between the clinical parameters at the beginning of hemodialysis therapy and the changing in the frequency of weekly hemodialysis sessions in ongoing treatment. Methods: The study population was composed of all of the patients that were started chronic hemodialysis treatment between January 2015 and January 2020. The patients were classified as twice-weekly (2/7) and thrice-weekly (3/7) groups according to the hemodialysis schedule at the start of treat- ment. The 3/7 group is additionally subdivided according to the dialysis schedule switches to the thrice-weekly program. Basal demographics and biochemical parameters were obtained from medical records at the start of hemodialysis. Results: The total number of subjects in the study was 433 (141 in the twice-weekly program, 292 in the thrice-weekly program). Forty-six (32.6%) patients in twice-weekly hemodialysis program were shifted to a thrice-weekly program during the follow-up. The female/ male ratio in the 2/7 program is different from the 3/7 program. Serum creatinine and C-reactive protein levels were higher in patients on the 3/7 program. Serum calcium and albumin levels were higher in patients on a 2/7 program. The statistically sig- nificant increments were found in calcium, hemoglobin, hematocrit, urea, creatinine, and potassium levels between the before and after switch results of the 3/7 group which switched from 2/7. Conclusion: Urea, creatinine, and potassium levels can guide the decision to compose a hemodialysis schedule. However, patients' future weekly treatment schedules cannot be predicted by biochemical parameters obtained at the start of hemodialysis

Awareness of Symptoms and Signs in Spondyloarthritis Among Family Physicians in Edirne City Center

DergiPark: 584645tmsjAims: The aim of this study is to evaluate the knowledge of signs and symptoms of spondyloarthritis among family physiciansworking in Family Health Centers in Edirne. Methods: In this study, a questionnaire consisting of 17 questions were applied tothe family physicians working in the Family Health Centers of Edirne Province. The data were analyzed using non-parametricSpearman Correlation test and Mann-Whitney U test on IBM SPSS version 20.0. Results: The total number of subjects in thestudy was 45. All subjects’ median age was 47 years (1st quartile, 42 years; 3rd quartile, 51 years). Five of the participants werefamily medicine specialist. The median duration of medical practice was 20 years (1st quartile, 13 years; 3rd quartile, 25.5 years).Four of the participants were trained in rheumatology. The median number of patients examined by the participants was 60 perday (1st quartile, 47.5; 3rd quartile, 70). Forty-one of the participants stated that they referred patients with back pain to thehospital for further examination. The median number of referral percentage was 15 (1st quartile, 5; 3rd quartile, 25). Conclusion:Spondyloarthritis is a disease that is diagnosed too late and reduces patients’ quality of life. In this study, it was investigated whichfactors could be related to spondyloarthritis awareness of family physicians in a limited area. The most important output of this isstudy is the relation between referrals to rheumatology and awareness of spondyloarthritis. These parameters are related to eachother and the physician. Keywords: Back pain, arthritis, family physician

Case Report of An Incidental Unicentric Castleman Disease

DergiPark: 889347tmsjAims: To emphasize the hardship of diagnosing Castleman disease and present a potential treatment method. Case Report: A sixty-three-year-old male patient was admitted to the outpatient clinic with an attack of acute cholecystitis. The patient’s abdominal computed tomography revealed an incidentally detected lipid dense solid mass (64x53x37 mm) at the level of right renal hilum with 29x13 mm solid components in the middle. The patient was admitted to the urology department and underwent surgery where the mass was totally excised due to suspicion of a malignancy (liposarcoma). Histopathological examination later on resulted with unicentric Castleman disease, hyaline vascular subtype. Conclusion: Since unicentric Castleman disease has an asymptomatic clinical course and is quite rare, it is necessary to rule out many potential possibilities before reaching a proper diagnosis. However, unicentric Castleman disease usually exhibits a good prognosis after the removal of the affected lymph node. Still, Castleman disease should be a candidate considered in the differential diagnosis of patients with incidentally discovered lymphadenopathy. On the whole, for a better understanding of underlying pathophysiology, there still lies a gap to be filled with knowledge acquired through further studies

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

Evaluating the Effects of Night Shifts on Attention and Executive Function of Trakya University Residents Using the Tower of Hanoi Test

DergiPark: 700193tmsjAims: This study aims to evaluate the effects of night shifts on attention and executive function among residents working atTrakya University Hospital. Methods: This prospective study was performed between November 2019 – January 2020 on 83residents working at Trakya University Hospital. The Tower of Hanoi test was used to measure the attention and function level oftwo different groups of residents. The first group being residents working with night shifts and the other group being residentswith regular working hours. After the participants finished solving the puzzle, the number of moves and the finishing time wererecorded. The demographic data about smoking, coffee intake, sleep hours, departments, and hand dominance were also recorded. Results: The participants were composed of 36 (43.4 %) female and 47 (56.6 %) male residents. The difference in smokingrate and sleep time between the two groups were found to be statistically significant whereas the difference between the completion time and moves was not statistically significant. Conclusion: Smoking and duration of sleep may affect the Tower of Hanoipuzzle performance. Although residents working with night shifts did not under-perform, the importance of sleep for cognitiveskills such as attention and coordination cannot be underestimated. Stress caused by night shifts may affect reaction time forproblem-solving, but further studies are needed. Keywords: Nightshift, attention, Tower of Hanoi tes