Cilt 12

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BI-RADS OUTCOME ASSESSMENT OF MAMMOGRAPHY SCREENING; MEDICAL AUDIT OF A BREAST IMAGING CENTER
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Güldoğan, Nilgün; Gürleyik, Damla; Küçükkaya, Fikret; Arıbal, Erkin
MAMOGRAFİ TARAMA SONUÇLARININ BI-RADS’A GÖRE DEĞERLENDİRİLMESİ; BİR MEME GÖRÜNTÜLEME MERKEZİNİN TIBBİ DENETİMİ ÖZET Amaç: Kliniğimizde 2017 ve 2018 yıllarında yapılan tarama mamografilerinin sonuçlarının American College of Radiology (ACR) önerileri doğrultusunda karşılaştırmalı olarak değerlendirmeyi amaçladık. Yöntem: 14 Mart 2017 ve 31 Aralık 2018 tarihleri arasında yapılan tarama mamografi sonuçlarını kaydedip analiz ettik. Bu analizleri kullanarak tarama mamografi uygulamalarımızı denetledik. Sonuçlar ACR BI-RADS önerileri ve performans kriterlerine göre değerlendirildi. Bulgular: Meme kanseri öyküsü bulunmayan kadınlara yapılan tarama mamografisi sayısı toplam 2413‘tü. Pozitif Öngörü Değeri (PÖD)1, PÖD2 ve PÖD3 hesaplamalarımız sırasıyla %5,6, %30,8 ve %52,9 idi. Geri çağırma oranı ise %11’di. Kanser saptama oranı, minimal kanser oranı, erken evre kanser oranı ve lenf nodu negatifliği çıktıları sırasıyla %0,74, %50, %77 ve %64 olarak saptandı. Sonuç: Tarama mamografilerinin değerlendirme çıktılarının ACR performans kriterleri ile uyumlu olduğu görüldü. Erken evre meme kanseri saptama oranı istenildiği gibi yüksek olmasına rağmen aksiller lenf nodu negatiflik oranının istenilen %75’lik oranın altında kaldığı görüldü. Medikal denetleme, meme görüntüleme biriminin tarama ve tanı çalışmalarının etkinliğini gösterme ve birimin uygulamalarının iyileşmesi için etkili bir geri bildirim yöntemi olması açısından önemlidir.
Usual and Unusual Pathologies of Appendicitis: A Retrospective Analysis of 385 Patients
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Yardımcı, Veysi Hakan; Uras, Cihan
ABSTRACT Purpose: Appendectomy is the most common abdominal surgery performed worldwide. In this report, we evaluated the results of pathological examinations of acute appendicitis specimens. Methods: We performed a retrospective analysis of patients operated on for acute appendicitis at our surgical department from 2009 to 2017. Data on age, gender, and pathological diagnostic parameters were analyzed. Results: A total of 385 patients (168 women [43.6%] and 217 men [56.4%]), were classified into acute appendicitis (Group 1), normal appendix (Group 2), and unusual pathological findings (Group 3) groups. The patients undergoing appendectomy were mostly in the 21–30 (n = 136, 35.3%) and 31–40 years (n = 118, 30.6%) age groups. The negative appendectomy rate was 4.4% in Group 2, and the proportion of women (70.6%) was significantly higher in that group than the other groups (p <0.05). In total, 24 (6.2%) patients had unexpected findings. Among the appendix tumors (n = 12 [3.1%]) in our series, low-grade mucinous neoplasm (n = 6, 1.6%) was the most common, followed by a well differentiated neuroendocrine tumor (n = 3, 0.8%). Conclusion: Although unusual pathological findings are rare during appendectomy, all appendectomy specimens should be sent for routine histopathological examination. The abnormal incidental findings of 24 cases in this series had a significant impact on management. Patients with rare abnormalities should be treated according to the results of their pathological reports.
The Impact of Job Satisfaction on Organizational Commitment Among Generation Y Healthcare Employees
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Bektaş, Gülfer; Mısırlıoğlu, Volkan; İşçi, Emre
ABSTRACT Objective: This study reported on the knowledge on the factors impacting job satisfaction and organizational commitment in the healthcare sector. It critically examined the relationship between job satisfaction and organizational commitment among Generational Y healthcare workers. Methods: The study involved 236 healthcare professionals working in a private healthcare group in Istanbul, The primary method of data collection was a questionnaire composed of three sections. The first section recorded data concerning participants’ demographic information. The second and third sections aimed to assess the participant’s job satisfaction and organizational commitment by applying the Minnesota Job Satisfaction scale and the Organizational Commitment scale developed by Meyer and Allen. In data analysis and evaluations, frequency tables, central and prevalence criteria, Pearson’s correlation test and simple linear regression analysis were employed and analysed in the SPSS 20 statistical package program. Results: Of 236 healthcare workers, 49.4% of the participants expressed that they have been working in the organization for 1 to 5 years. Among those healthcare workers who belonged to generation Y, a significant and positive relationship was found between job satisfaction and organizational commitment (r = 0.719, p = 0.000). Conclusion: Our study results demonstrated a positive and significant relationship between job satisfaction and their organizational commitment among Generation Y healthcare workers. Among the factors identified, it was observed that pecuniary and moral support received by employees have increased the perception of job satisfaction, whereas economic security and rewards associated with the employment strengthened organizational commitment. The study discussed human resources practices that will strengthen job satisfaction and organizational commitment.
Dispne Yönetiminde El Fanının Etkisi
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Kocatepe, Vildan; Can, Gülbeyaz
ÖZET Dispnenin yönetiminde farmakolojik yaklaşımların yanı sıra farklı non farmakolojik yaklaşımlar da kullanılmaktadır. Yüze soğuk hava uygulamasının 2. ve 3. trigeminal sinirlere soğutma ve hava akışı sağlayarak nefes darlığını azaltıp, egzersiz toleransını arttırdığı belirtilmiştir. Bu mekanizmanın nazal ya da hava yolu mukozasının soğutulması ya da yüz derisinin serinletilmesi ile ortaya çıktığı düşünülmektedir. Farklı bir bakış açısı ise el fanının solunum afferent sinirlerinden gelen sinyallerin beyin tarafından algılanmasını değiştirerek psikolojik ve duygusal yönetimi sağladığıdır. Yapılan çalışmalarda orta ve şiddetli dispneli hastalara beş dakika boyunca, 15 cm uzaktan, burnun iki yanı ve üst dudağın üst kısımlarına fan uygulanmasının etkili bir yaklaşım olabileceği bildirilmiştir. Bazı çalışmalarda el fanı uygulamasının dispne ile birlikte solunum sayısı ve oksijen saturasyonunu da etkilediği görülmüştür. Pil ile çalışan el fanları hem ucuz hem de taşıması kolay olması ile hastaların tercih edeceği bir araçtır. El fanı uygulamasının yan etkilerinin olmaması ve uygulanabilirliğinin kolay olması hastanın yaşam kalitesini arttırabilir. Bu derlemenin amacı dispnenin yöentiminde el fanının etkisini tartışmaktır.
Transcriptomics Analysis of Nrf2 Regulators in Cancer Resistant and Long-Lived Naked Mole-Rats
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Bozaykut Eker, Perinur
ABSTRACT Purpose: Naked mole-rats (NMR, Heterocephalus glaber) have extreme resistance to cancer although they are known as the longest-living rodent with their 30-year maximum lifespan. Therefore, NMRs have rapidly emerged as a natural model for biomedical research. Studies have shown that NMRs can better tolerate stress due to mechanisms, such as upregulation of the Nrf2 pathway. Another mechanism proposed to contribute to their protection from stress involves stem cells. Therefore, in this study, we aimed to identify the regulation of Nrf2 signaling in NMR fibroblasts and induced pluripotent stem cells (iPSCs). Methods: The transcriptomics data of NMR and laboratory mice (Mus musculus) were used in the study. Particularly, the genes that are accepted as Nrf2 activators (Dpp3, Sqstm1, Palb2, Amer1, Mapk14, Trp53) and inhibitors (Keap1, Siah1, Btrc) were comparatively analyzed in fibroblasts and iPSCs of both species. Results: Our data demonstrated differentially expressed gene expressions between different cell types. Among target Nrf2 activators, Palb2 RNA expression was found to be increased significantly (p<0.0001) in NMR fibroblasts when compared to mouse fibroblasts. In addition, the expression of Palb2 was even more increased in NMR iPSCs when compared to NMR fibroblasts (p<0.0001). Conclusion: It was shown, for the first time, Palb2 could be partially responsible for the activation of Nrf2 pathway. These results contribute to literature on the stress resistance of the NMRs and its relationship with their superior features of aging and cancer.
Nikotinin Sıçan Pankreatit Modelindeki Hafifletici Etkisinde Vagusun Rolünün Araştırılması
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Kolgazi, Meltem; Güleken, Zozan; Kolbaşı, Bircan; Başıbüyük, Canberk Sami; Ercan, Feriha; Yeğen, Berrak Ç.
ÖZET Nikotinin birçok farklı dokuda anti-inflamatuvar etkilere sahip olduğu ve bu etkileri kolinerjik anti-inflamatuvar yolağı aktive ederek gerçekleştirdiği gösterilmiştir. Çalışmada akut pankreatit modelinde nikotin tedavisinin etkilerini ve bu etkilerin kolinerjik yolla ilişkisini araştırmak amaçlanmıştır. Wistar albino sıçanların pankreas-safra ortak kanalı bağlanırken (PSKB),bir gruba da yalancı-cerrahi (YC) uygulandı. PSKB sıçanlara vagal aferent denervasyon (perivagal kapsaisin; 10mg/ml) veya trunkal vagotomi uygulandı ya da vagusları sağlam bırakıldı. PSKB grupları cerrahi sonrası ikiye ayrılarak 4 gün boyunca intraperitoneal nikotin (1 mg/kg/gün) ya da serum fizyolojik verildi. Dördüncü günde dekapitasyonu takiben, serumda tümör nekroz faktör (TNF)-∝ ve interlökin (IL)-10 ölçümü, akciğer, karaciğer ve pankreas dokularında miyeloperoksidaz aktivitesi (MPO), malondialdehit (MDA), glutatyon (GSH) ölçümleri ve histolojik inceleme yapıldı. TNF-∝ düzeyi PSKB grubunda YC grubuna göre belirgin şekilde daha yüksekken, nikotin tedavisi alanlarda belirgin şekilde daha düşüktü. IL-10 düzeyi ise SF tedavisi almış PSKB grubunda YC grubuna göre daha düşüktü ve nikotin tedavisi ile arttığı gözlendi.YC grubuna göre PSKB grubunun pankreas, karaciğer ve akciğer dokularında mikroskopik hasar, MDA, MPO düzeyleri artarken GSH düzeyleri azaldı. Nikotin tedavisi ile karaciğer ve pankreas dokularındaki hasar, MDA, MPO düzeyleri azaldı ve GSH miktarları korundu. Vagal aferent denervasyon ya da trunkal vagotomi yapılması nikotinin bu koruyucu etkilerini değiştirmedi. Sonuçlar, nikotinin pankreatit hasarına karşı koruyucu etkilerini vagal yoldan bağımsız olarak, doğrudan immün hücreler üzerindeki ∝7nAChR aktivasyonu ile nötrofil infiltrasyonunu ve pro-inflamatuvar sitokinleri inhibe ederek gerçekleştirdiğini ortaya koymaktadır.
The effect of individual nutritional support and nurse follow-up on weight loss during radiotherapy in cancer patients
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Yücel, Serap; Oskeroğlu Kaplan, Sedenay; Güral, Zeynep; Kayış, Ayşin; Işık, Fethullah; Ağaoğlu, Fulya
ABSTRACT Purpose: The aim of this study was to evaluate the nutritional status of patients receiving definitive or adjuvant radiotherapy with head and neck, pelvic, thoracic and intraabdominal tumors and to determine their weight loss. Methods: 40 patients admitted to the radiation oncology outpatient clinic since 01.11.2015 and planned; head, thoracic, abdominal and pelvic radiotherapy, were included in the study. The patients were evaluated before the treatment and in addition to the daily nutrition of the patients, special nutritional support was provided as 35 kcal/kg energy, 2gr/kg protein and 15 mg glutamine daily. The weight loss of the patients evaluated by radiation oncologists and nurses was recorded. Results: The mean age was 61 years (range, 39-86 years). 9 patients with lung cancer were over 70 years old and had definitive radiotherapy. All patients underwent radiotherapy treatment without interrupting treatment, except for an 86-year-old patient scheduled for adjuvant therapy with gastric cancer and two patients with lung cancer receiving chemoradiotherapy. 72% of the patients continued their nutritional support during the entire treatment. When weight loss was evaluated, only 8% of patients had more than 10% weight loss. According to nutritional support, weight loss rates were found to be significantly lower in patients who fully applied for nutritional support (p: 0.003). Conclusion: Early and intense nutritional support of cancer patients with risk of malnutrition may lead to less weight loss during radiotherapy.
Endonasal Dacryocystorhinostomy; the learning curve and our experience
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Emre, İsmet Emrah; Çelebi, Ali Rıza Cenk Çelebi
ABSTRACT Aim: It was aimed to give an insight on the learning curve adopted by an ophthalmic surgeon while performing endonasal dacryocystorhinostomy under the supervision of an otolaryngologist with the results experienced during this survey. Materials and Methods: In this retrospective study, consecutive cases with endonasal dacryocystorhinostomy (DCR) surgery were performed by a single ophthalmic surgeon while a second otolaryngologist was overlooking the procedures. A total of 29 surgeries were performed on 23 patients. Patients that were diagnosed with complete nasolacrimal duct obstruction were then evaluated and proceeded to the surgery. The intraoperative video was recorded in all surgical cases and recording time was noted for each case. All of the complications that occurred during or at the postoperative stages were noted. Results: The mean age of the 23 patients was 55.25±18.6 years (15 y-80 y), of which 20 cases (87%) were female. The left side was involved in 69% (20/29) of cases. At the final follow-up of the mean of 12,4 months, the anatomical and functional success was achieved in 89% (26/29) cases. The mean time spent in the operating theatre was 84±17.2 minutes (range, 40–110 min). It was found that the only 3 failed surgeries were in the first 5 surgeries performed with no surgical failure in the remaining 24 eyes. Conclusions: Endonasal dacryocystorhinostomy is a safe, effective and cosmetically pleasing surgery for the treatment of nasolacrimal duct obstruction. Although it has a somewhat longer learning curve than some surgeries, once handling of the endoscope has been mastered and familiarity with the surgical field is improved, the duration of the surgery will decrease significantly. We believe multidisciplinary coordination plays an important role in decreasing potential complication rates and also in perfecting the technique.
The Impact of Paternalistic Leadership Behaviour on Organizational Trust among Healthcare Professionals
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Bektaş, Gülfer; Kanatlı, Kübra; İşçi, Emre
ABSTRACT Objective: The aim of the current study was to investigate the impact of paternalistic leadership on organizational trust among healthcare professionals. As a starting point, it acknowledges that the impact of paternalistic leadership may vary depending on the cultural values of a given society. The study then offers the regression model between the variables among with implications of this relationship for healthcare management. Methods: A questionnaire-based cross-sectional study and face-to-face interviews were conducted at a private hospital group in Istanbul. The study sample encompassed 329 employees. In data analysis and evaluations, frequency tables, central and prevalence criteria, Pearson’s correlation test and simple linear regression analysis were employed and analysed with the SPSS 20 statistical package program. Results: A statistically significant and positive correlation was found between paternalistic leadership behaviour and organizational trust (r = 0.669, p = 0.000; R2 = 0.448). The analysis indicated that paternalistic leadership behaviour explained about 45% of the variance in organizational trust. Conclusion: In study, it was found that paternalistic leadership behaviours are strongly related to organizational trust among healthcare professionals. Paternalistic leadership, particularly in collectivist cultures with high power-distance structures, may yield to positive organizational outcomes.
Antiviral Kullanımına Bağlı Gelişen Femoral Nöropati: Olgu Sunumu
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Önder, Burcu; Önder, Fatih Oğuz; Yavuz Keleş, Betül
ÖZET Femoral sinir lezyonu, kalça fleksiyonu ve diz ekstansiyonunda kuvvetsizlik, patella derin tendon refleksinde azalma, uyluk ve bacak anteromedialinde hipoestezi ile seyreder. İlaç kullanımına bağlı olarak nadir de olsa görülebilmektedir.
Outcomes of Endovenous Cyanoacrylate Closure Using Venaseal System for Chronic Venous Insufficiency
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Temur, Bahar; Aydın, Selim
ABSTRACT Purpose: Endovenous cyanoacrylate closure of saphenous veins is a nonthermal, nonsclerosant ablation technique with satisfactory results. The objective of this study is to indicate the impact of Venaseal closure system in chronic venous insufficiency. Methods: Between March 2014- March 2019, 27 patients underwent a total of 40 procedures with the VenaSeal closure system for symptomatic saphenous vein reflux in our hospital. Beside glue ablation procedures, 16 patients underwent concomitant mini phlebectomy, 3 patients underwent perforan vein ligation and 1 patient underwent anterior accessory saphenous vein ligation. The mean age of the patients were 44.4±13.8 (19-67). Doppler ultrasound of the target vein was performed one and 12 months after treatment. Tumescent anesthesia and compression stockings were not used. Results: Mean follow up time was 34.3 ±17 months. The anatomical success rate was 100% at 1 month and 100% at 1 year and there was no recanalization in treated vein segment. All procedures were well tolerated with a median visual analog scale (VAS) pain score of 3.0 (range: 2–5) on a 10-point scale. The mean pre-operative revised venous clinical severity score was 7.5±2.6, which improved to 2.6±0.7, p< 0.001 at one month follow-up. Deep vein thrombosis and pulmonary thromboembolism were not detected. Phlebitis was seen in 2 (7,4%) patients and hypersensitivity reaction occured in one patient (3,7%). Conclusion: Endovenous cyanoacrylate closure of refluxing saphenous veins offers a safe and effective treatment with reduced side effects.
Changing Behaviors of Adults for Ensuring the Food Hygiene During Covid-19 Outbreak: The Case of Turkey
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Sağlam, Duygu; Arıcı Çolak , Gözde; Baş, Murat
ABSTRACT Objective: The aim of this study is to determine the behavior of individuals for buying, preparing, and cooking processes of the foods during the Covid-19 epidemic. Materials and Methods: This study carried out with 999 adult individuals, 15.0% (n = 150) men and 85.0% (n = 849) women, aged 19-65. The questionnaire includes questions regarding the provision of food hygiene before and during the Covid-19 outbreak. Results: While the preference rate for markets’ take-out services increased in the Covid-19 epidemic process (22.8% before Covid-19; 55.7% in the Covid-19 outbreak), there was a decrease in the proportion of those who preferred neighborhood farm markets (66.8% before Covid-19; 27.5% during Covid-19 outbreak) (p <0.01). The proportion of those who chose to buy packaged bread and fruit during the epidemic also increased (p = 0.001). Conclusion: No scientific data are available on the consumption of nutrients with a potentially contaminated risk and the transmission of the virus. However, it is believed that the concerns about carrying this virus with food can be prevented by the consumers more carefully applying the routine hygiene rules.
Endovenous Laser Ablation of Varicose Veins of the Lower Extremities: Report of the relationship Between Vascular Access And Procedural Pain
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Çakmakçı, Emin; Çalışkan, Kosti Can
ABSTRACT Objective: The aim of this study is to evaluate the effects of vascular access (proximal or distal) on postoperative pain in patients diagnosed with isolated varicose small saphenous vein who underwent endovenous laser ablation. Materials and Methods: Medical records of 49 patients (35 female, 14 male) with isolated saphenous venous insufficiency were reviewed. Endovenous laser ablation was performed in all patients at an emission wavelength of 1470 nm, using 7 Watt laser energy at the proximal and distal ports. The pain was evaluated using a visual analog scale at 7 days, 1, 3 and 6 months. Results: In 30 of the 49 patients, vascular access was performed from the distal to the below the knee section of the small saphenous vein and in 19 cases from proximal to the small saphenous vein. The results of these two groups showed that access into the larger proximal part of the varicose vein provides an easy route with reduced local pain scores in the endovenous laser ablation of varicose veins (p<0.001). Conclusion: In patients diagnosed with isolated varicose small saphenous vein and undergoing endovenous laser ablation, the vascular access route (proximal or distal) did not have a significant effect on postoperative pain, but the proximal route was more easily accessed and the procedure lasted shorter.
Inverted Colonic Diverticula Cases
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Tiftikçi, Arzu; Parlak, Emrehan; Boğa, Bircan; Yılmaz, Serpil; Çiçek, Bahattin
ABSTRACT Colonic diverticula are outpouchings of mucosa and submucosa through the large intestine wall. Inverted colonic diverticula can be confused with colonic adenoma. It is important to differentiate them. Here we report two cases of inverted diverticula that seem to like adenomas.
Effectiveness of Simulation-Based Cooperative Learning Method in Electrocardiography Education
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Uslu, Yasemin; Kocatepe, Vildan; Ünver, Vesile; Karabacak, Ükke
ABSTRACT Objective: The study was conducted to evaluate the effectiveness of basic electrocardiography education designed in accordance with the simulation-based cooperative learning method. Methods: This is a single group, quasi-experimental study. A two-day electrocardiography (ECG) education program was designed for the nursing internship (4th year) program (n=125). Data were gathered with pre-posttest, Students’ Satisfaction and Self-Confidence Scale, Simulation Design Scale and Educational Practices Questionnaire. Results: The knowledge pretest score and the knowledge posttest score averages of the students were 40.36±20.24 and 75.39±11.46 respectively, with a significant difference (p=.001; t=-14.78). The mean score for satisfaction with current learning was 4.77±.42 and the mean score for self-confidence was 4.51±.54. The mean total score for Simulation Design Scale was 4.44±.67 and the mean total score for Educational Practices Questionnaire was 4.66±.56. Conclusion: After simulation-based cooperative learning method, knowledge and skills of the students improved also had high self-confidence and satisfaction with learning.
Laparoskopik Sleeve Gastrektomi Operasyonunun Kısa Dönemde Besin Alımı, Biyokimyasal Kan Parametreleri ve Antropometrik Ölçümlere Etkisinin Değerlendirilmesi
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Arıtıcı Çolak, Gözde; Sağlam, Duygu
ÖZET Amaç: Laparoskopik sleeve gastrektominin ameliyat sonrası kısa dönemde (6 ay) besin alımı, antropometrik ölçümleri ve biyokimyasal kan parametrelerine etkisinin değerlendirilmesidir. Gereç-Yöntem: Bu çalışmaya Acıbadem Taksim hastanesine Haziran 2018 – Eylül 2018 tarihleri arasında laparoskopik sleeve gastrektomi operasyonu geçiren 21 gönüllü kadın birey katılmıştır. Çalışmaya katılan kadınların genel özelliklerini belirlemeye yönelik anket formu uygulanmış, operasyon öncesi ve operasyondan 6 ay sonraki besin tüketimleri, vücut ağırlıkları ve biyokimyasal kan parametreleri değerlendirilmiştir. Verilerin değerlendirilmesinde SPSS Windows 22.0 istatistik paket programı kullanılmıştır. Bu çalışma Acıbadem Mehmet Ali Aydınlar Üniversitesi tıbbi araştırmalar değerlendirme kurulu tarafından değerlendirilmiş 2017-4/20 karar numarası ile tıbbi etik yönden uygun bulunmuştur. Bulgular: Çalışmaya katılan kadınların yaş ortalaması 42.04 yıldır. Operasyon öncesi BKI değerleri ortalaması 40.7±8.0 kg/m2 iken altı ayın sonunda 28.9±5.7 kg/m2 olarak belirlenmiş ve aradaki fark istatiksel olarak anlamlı bulunmuştur (p<0.01). Altı ayın sonunda açlık kan glukozu, trigliserit, LDL-kolesterol, total kolesterol, ALT ve AST değerlerinde azalma, HDL-kolesterol değerinde ise artmanın olduğu ve aradaki farkın istatiksel olarak anlamlı olduğu bulunmuştur (p<0.05). Operasyon sonrasında kadınların total enerji ve makro besin öğelerinin alımında önemli azalmanın olduğu belirlenmiştir (p<0.05). Sonuç: Çalışmanın sonunda laparoskopik sleeve gastrektomi operasyonu sonrasında kısa dönemde biyokimyasal kan parametrelerinde ve antropometrik ölçümlerde operasyon öncesi dönem ile karşılaştırıldığında önemli azalmaların olduğu bu durumun uzun dönem devam etmesi ve kaybedilen ağırlığın korunması durumunda obezite kaynaklı hastalıklara yakalanma olasılığının azalabileceği sonucuna varılmıştır.
Meme Kanseri Radyoterapisinde IMRT ve Konformal Radyoterapi Uygulamaları için Tedavi Planlama Sisteminde Planlanan Doz Dağılımının Rando Fantomda Ölçülen Doz Dağılımıyla Uyumunun Araştırılması
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Göksel, Özlem; Göksel, Evren; Küçücük, Halil; Garipağaoğlu, Melahat
ÖZET Amaç: Bu çalışmada, meme kanseri radyoterapisinde kullanılan 3B konformal radyoterapi (3BKRT), Alan içinde alan (Field in Field, FinF) ve yoğunluk ayarlı radyoterapi (IMRT) tekniklerinin planlanan-ölçülen doz farklarının araştırılması amaçlanmıştır. Gereç ve Yöntem: Bu çalışma için su eşdeğeri bolus materyalinden meme şeklinde fantomlar (MŞF) oluşturularak, Alderson rando fantom üzerine yerleştirilmiş ve planlama amaçlı bilgisayarlı tomografisi çekilmiştir. Hedef yapı ve kritik organlar konturlandıktan sonra 3BKRT, FinF ve IMRT teknikleri için planlama (Varian Eclipse 8,6, PencilBeam) yapılmıştır. MŞF‘nın izomerkezden geçen sagital ve transvers düzlemlerine ayrı ayrı Gafchromic EBT2 filmler yerleştirilmiş ve her bir teknik için fantom ikişer kez ışınlanmıştır. İzomerkezden ve izomerkezin 1’er cm anterior-posterir, superior – inferior ve sağ-solundan geçen eksenlerden film üzerinden ölçülen dozlar aynı eksenlerde tedavi planlama sisteminden (TPS) okunan dozlarla kaşrılaştırılmıştır. Bulgular: Uygulanan tekniklerde planlanan-ölçülen doz farkı en yüksek %4.5 ile FinF tekniğinde, en az %0.05 ile IMRT tekniğinde bulunmuştur. Farkların %66.6‘sında ölçülen doz planlanandan daha yüksek bulunurken, bütün farkların %93‘ünde fark %3‘ün altında bulunmuştur. En az fark izomerkezden geçen eksenler boyunca görülürken, izomerkezden uzaklaştıkça farkın artığı bulunmuştur. Eksenlerle farklar arasında anlamlı bir ilişki bulunamamıştır. Sonuç: TPS’te hesaplanan doz dağılımları rando fantom üzerinde film ile ölçülen doz dağılımlarıyla karşılaştırıldığında, en iyi IMRT için olmak üzere her üç teknik için de uyumlu bulunmuştur.
Assessment of Mobbing and Job Satisfaction Relationship in Nurses: A Systematic Review and Meta-Analysis
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Kurnaz, Mustafa; Oğuzhan, Gülpembe
ABSTRACT Aim: The aim of this study to examine the perceived mobbing levels, and to look into the relationship between mobbing and job satisfaction of nurses working in Turkey through a meta-analysis. Methods: This systematic review and meta-analysis is based on the Joanna Briggs Institute guidelines. A total of 850 studies on perceived mobbing levels, and 50 studies on the relationship between mobbing and job satisfaction were retrieved from databases which are Ulusal Tez Merkezi, DergiPark, PubMed, EBSCO Host, and Web of Science. The articles and dissertations were written in Turkish and English and published before December 31, 2018. The PRISMA statement was used to report systematic review and meta-analysis. Results: The perceived mobbing level was found to be 1.867, and a negative and medium-level relationship was observed between mobbing and job satisfaction in nurses who work in Turkey (r = -.510, p = .000). Conclusions: The perceived mobbing level, according to the meta-analysis, were found to show that nurses are exposed to a high degree of mobbing behavior in Turkey. The relationship between mobbing and job satisfaction showed a negative and moderate correlation. In other words, as the mobbing level increases, the job satisfaction level decreases.
Risk Factors Associated with Dysfunction of Permanent Tunneled Cuffed Hemodialysis Catheters; Single Center Experience
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Yıldız, Işıl
ABSTRACT Purpose: Permanent tunneled cuffed catheters are frequently preferred for hemodialysis in patients with chronic renal failure (CRF), but the factors associated with the dysfunction of these catheters are not well known. Our goal is to investigate these risk factors. Materials and Methods: All cases with a diagnosis of CRF and a permanent tunneled cuffed catheter inserted into the central vein for the first time in our radiology clinic between 2014 and 2019 and who developed catheter dysfunction were included in the study. Demographic and clinical data of the cases were obtained from file records. The relationship between the causes of catheter dysfunction and the presence of diabetes and hypertension was investigated. Results: Of the total 123 cases, 78 (63.4%) were male, 45 (36.6%) were female, the median age was 55 (28-78). Twenty-nine (23.6%) of the cases had thrombosis, 72 (58.5%) had venous stenosis and 22 (17.9%) had catheter dysfunction due to fibrin sheath. Dysfunction groups were compared with each other in terms of age, gender, duration of operation of the catheter, CRF etiology, comorbid diseases, the vein where the catheter was placed and the use of anticoagulants. The most important cause of catheter dysfunction in the early period was thrombosis (p = 0.003). When the causes of dysfunction were examined, the most common causes of dysfunction were venous stenosis in patients with hypertension, thrombosis in patients with diabetes as a concomitant disease without diabetes in the etiology of CRF, and thrombosis in patients with diabetes in CRF etiology (p <0.001). In addition, it was found that catheter dysfunction due to thrombosis developed less in patients using anticoagulants (p <0.001). There was no statistically significant difference between the groups in terms of other parameters (p> 0.05). Conclusion: The use of low-dose anticoagulants plays a protective role against thrombosis. The use of low-dose anticoagulants in patients without contraindications, especially in diabetic patients, may reduce especially early catheter dysfunction.
Sensitive Detection of Molecular Targets in Cancer by Minisequencing
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Yüksel, Şirin K.; Akyerli, Cemaliye B.
ABSTRACT Purpose: Molecular alterations leading to specific mutations are essential for tumor development and survival. Accurate analysis of these molecular targets is important for diagnosis, early detection, forecasting of prognosis and aiding in the treatment of different cancer types. Therefore, for sensitive analysis of molecular markers, we aimed to optimize and use minisequencing protocols besides Sanger sequencing. Methods and Materials: Sanger sequencing and minisequencing were performed for IDH1 R132, IDH2 R140/R172 and TERT promoter C228/C250 mutations using genomic DNA isolated from glioma samples. Minisequencing reactions were performed with detection primers using SnaPshot Multiplex Ready Reaction Mix and run on an automated capillary electrophoresis. Multiplex peaks were analyzed with GeneMapper Software. Results: In the multiplex minisequencing analyses, peaks corresponding to wild type alleles and different mutations were detected. The presence of the peaks next to the wild type peaks points to the presence of variations in that location and the nature of the mutation can be identified according to the color. Conclusions: Identification of molecular markers in cancer is very important. Minisequencing is a reliable method for the detection of molecular targets.