1. | Frontmatters Pages I - V |
RESEARCH ARTICLE | |
2. | Anxiety, depression, and sleep disorders among healthcare workers during the COVID-19 pandemic Sacit Icten, Alper Gorkem Solakoglu, Neslihan Uluk, Yasemin Cag, Kurtulus Aciksari, Sunay Guner, Sevim Karakis PMID: 36276558 PMCID: PMC9514078 doi: 10.14744/nci.2022.06936 Pages 295 - 303 OBJECTIVE: In this study, we examined the level of anxiety and depression, daytime sleepiness, and sleep quality in healthcare workers working during the COVID-19 pandemic. METHODS: This study was conducted in a tertiary care university hospital. Socio-demographic information form, Beck Anxiety Scale, Beck Depression Scale, Pittsburg Sleep Quality Index, and Epworth Sleepiness Scale were used as data collection tools. RESULTS: A total of 273 healthcare workers were recruited into the study. It was determined that there is an enormous mental health burden on healthcare workers. About 100% and 45.4% of the participants got above-threshold scores from Beck Anxiety Scale, and Beck Depression Scale, and the prevalence of daytime sleepiness and impaired sleep quality was 11.4% and 38.8%, respectively. The female gender was found to have more severe anxiety levels and lower sleep quality (p<0.001). In logistic regression analysis, the female gender was a risk factor for having a level of severe anxiety, and the nursing profession was a risk factor for having severe anxiety and low sleep quality (p<0.05). CONCLUSION: Global serious outbreaks cause increased depression and anxiety levels and sleep disorders in healthcare workers. Therefore, we believe that trainings and support which aims to strengthen the psychological well-being of healthcare workers should be implemented. |
3. | HPV prevention in women aged 30–65 in Istanbul: Effect of early diagnosis of cervical cancer Abdullah Emre Guner, Soner Sabirli, Seniz Kavak, Kemal Kural, Ates Karateke PMID: 36276562 PMCID: PMC9514075 doi: 10.14744/nci.2022.74507 Pages 304 - 310 OBJECTIVE: Earlier detection and timely interventions against cancers are well known to reduce the morbidity and mortality. Screening programs provide opportunity to detect cancers as early as precancerous stages. Cancers of cervix of uterus are one of the cancers that have widely applicable screening methods and are one of the three cancer types that have population-based screening program in Turkiye. In this article, it is aimed to evaluate cervical cancer screenings in Istanbul. METHODS: The study methodology for cervical cancer screening conducted between 2015 and 2020 in Istanbul, Turkiye’s largest city, was introduced. The results obtained in the first round of screening of 723,068 women with the human papillomavirus (HPV) method as a new methodology are discussed. RESULTS: As a summary of results, the HPV positivity ratio was found to be 6.5% and the positivity rate was higher in younger women. The results also show that majority of the subjects with positive result were infected with more than 1 strains of HPV. Most prevalent subtypes detected were HPV16, HPV51, HPV31, HPV52, and HPV66, respectively. Total detection rate for any of the high-risk HPV subtypes was 29.95%. CONCLUSION: Although HPV-16 is the highest subtype to be infected and total percentage of infection with any high-risk strains is approximating to one-third of the total positivity, cytological results revealed only 8.1% meaningful results. |
4. | Neostigmine versus sugammadex on post-operative recovery following bariatric surgery Osman Ekinci, Duygu Demiriz Gulmez, Ferhunde Dilek Subasi, Asu Ozgultekin, Oznur Demiroluk PMID: 36276569 PMCID: PMC9514077 doi: 10.14744/nci.2021.94715 Pages 311 - 316 OBJECTIVE: The purpose of our study was to compare the recovery characteristics and side effects of sugammadex (SM) and neostigmine (NT) in morbidly obese patients undergoing bariatric surgery. Residual neuromuscular block is a serious condition that increases pulmonary complications after anesthesia. Although acetylcholinesterase inhibitors help reverse this block, they may be insufficient, especially when administered with inhalational anesthetics. SM, a selective antagonist, may be more effective in reversing the block. METHODS: Patients were randomly divided into NT group (Group NT, n=34) and SM group (Group SM, n=34).For the induction, fentanil (1–1.5 µ/kg), propofol (2–3 mg/kg), and rocuronium (0.6 mg/kg) were used.For the maintenance, 50% O2 + air, 1% sevoflurane, and remifentanil (0.5–0.3 µg/kg/min) were used. Additional rocuronium was given to maintain the train of four (TOF) ratio ≤2. On completion of surgery and when the TOF ratio was 2, group NT received 50 µg/kg of NT with 20 µg/kg of atropine, whereas group SM received 2 mg/kg of SM. Hemodynamic parameters and peripheral oxygen saturation (SpO2) were recorded every 10 minfirst, and every 5 min after the reversal agents were given. When the TOF ratio was 0.9 or higher, time to reach a TOF ratio of 0.9, and time to extubation were recorded. Patients were observed in the recovery room for 30 min for adverse effects. RESULTS: Demographic characteristics of the patients and total rocuronium use in two groups were similar (p>0.05).Time to extubation, time to TOF ratio of 0.9, time until patients responded to stimuli, time until cooperation, and time until orientation were significantly shorter in the SM group than in the NT group. Time to reach the Aldrete score of 9 was also significantly shorter in the SM group (p<0.05).In the post-operative period, hemodynamic variables and side effects such asrespiratory difficulty, nausea, vomiting, hypo/hypertension, and presence of pain showed no statistically significant differences between the groups (p>0.05). CONCLUSION: Considering the high risk of post-operative respiratory insufficiency inmorbidly obese patients, SM could be a safer choice in this patient group. |
5. | Evaluation of the relationship between the mean platelet volume and the neutrophil/lymphocyte ratio with progression of chronic kidney disease in patients with autosomal dominant polycystic kidney disease Mahmut Gok PMID: 36276574 PMCID: PMC9514079 doi: 10.14744/nci.2021.89657 Pages 317 - 322 OBJECTIVE: Increased inflammation is known to cause higher mortality and morbidity in autosomal dominant polycystic kidney disease (ADPKD). At the same time, inflammation has been shown to contribute in chronic kidney disease (CKD) progression pathogenesis. Neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) have been lately found to be related with systemic inflammation. Therefore, in this study, it was intended to evaluate any correlation between the NLR and MPV degree and poor prognosis in ADPKD patients. METHODS: The study sample comprised 86 adult patients (male: 80.2%, mean age: 35.35 years) screened in the Nephrology Outpatient Clinic with the diagnosis of ADPKD. Data were obtained from the electronic database of the hospital. Two groups were made from the patients: Group I included ADPKD patients with CKD Stages I–II and Group II included ADPKD patients with CKD Stages III–V. The relationships between CKD stage and laboratory parameters were analyzed. RESULTS: Significantly higher NLR (2.64±1.43 vs. 2.02±0.89, p=0.024), MPV (9.84±1.65 vs. 9.08±1.17, p=0.045), and hs-CRP (10.7±2.2 vs. 22.4±8.3, p=0.001) values were determined in Group II than in those with Group I. Positive correlations were statistically significative observed between hs-CRP and MPV and NLR in the patients with ADPKD. CONCLUSION: The study results demonstrated that significantly NLR and MPV are increased in ADPKD patients with progression of CKD. Therefore, lowering the NLR and MPV level could be new, therapeutic, and preventive alternatives for patients with ADPKD. |
6. | A randomized controlled trial to study the effect of intratracheal and intravenous lignocaine on airway and hemodynamic response during emergence and extubation following general anesthesia Divya V. Gladston, Sudha Padmam, Rajasree Omanakutty Amma, Rachel Cherian, Jagathnath Krishna K M, Jayasree Vijayan, Nimmy George, Praveen Rajendran PMID: 36276564 PMCID: PMC9514071 doi: 10.14744/nci.2021.33407 Pages 323 - 330 OBJECTIVE: Intratracheal (IT) and intravenous (IV) lignocaine suppress airway reflex and hemodynamic response during extubation, but studies regarding this are sparse. The primary aim was to compare the effect of IT and IV lignocaine on attenuation of airway reflex to endotracheal extubation and the secondary aim was to compare the hemodynamic responses to extubation, using lignocaine by the two different routes. METHODS: Seventy-five female patients with comparable age, body mass index, and American Society of Anesthesiologists Physical Status undergoing carcinoma breast surgery were randomized into three groups. Group A received 2% lignocaine 3 mg/kg intratracheally 5 min and Group B received 2% lignocaine 1.5 mg/kg intravenously 3 min before extubation. Group C was control group. The airway and hemodynamic responses were noted in terms of episodes of cough during emergence and extubation. Categorical variables assessed using Fisher’s exact test and continuous variables assessed using one-way analysis of variance. RESULTS: Cough suppression was present in Groups A and B, with better results observed with IT than with IV lignocaine. In the control group, Grade III cough reflex was present predominantly. There was a statistically significant difference (p<0.001) in blood pressure and heart rate between Group A versus Group C and in Group B versus Group C, but not between Group A and Group B. CONCLUSION: IT lignocaine administered before extubation significantly attenuates post-extubation cough reflex than IV lignocaine. Both IT and IV lignocaine can effectively attenuate the airway and hemodynamic response to extubation. (NCI-2021-4-39/R1) |
7. | Survival outcomes of hypomethylating agents maintenance therapy in new diagnosed AML patients: Real experience data Volkan Karakus, Senem Maral, Egemen Kaya, Aliihsan Gemici, Yelda Dere, Omur Gokmen Sevindik PMID: 36276561 PMCID: PMC9514083 doi: 10.14744/nci.2021.42800 Pages 331 - 336 OBJECTIVE: Acute myeloid leukemia (AML) is a hematological malignancy that frequently affects elderly population. With introducing the hypomethylating agents (HMAs) in elderly AML treatment, survival rates and quality of life have improved. However, long-term management in elderly and frail patients is still a challenge. In the present study, we aimed to determine whether HMA maintenance therapy is required until disease progression in frail and elderly AML patients by examining with a real-life data. METHODS: In a multicenter study, we analyzed non-promyelocytic elderly AML patients who were treated with first-line azacitidine or decitabine monotherapy in two different groups, retrospectively. While patients were treated with HMA until progression in the maintenance group, 6+3 cycles of azacitidine or decitabine were administered as a standard care of elderly AML patients in the non-maintenance group. Survival outcomes were compared between the groups. RESULTS: HMA therapy was maintained until progression in 20 patients, and HMA therapy was terminated after 6+3 cycles in 21 patients. Patients received a median of 6 (1–14) HMA cycles during follow-up time. The median 7.5 months of overall survival were observed (2–17 months) in maintenance and 3 months (1–13 months) in non-maintenance groups (p=0.001). CONCLUSION: Despite long-term exposure to HMA may appear as a risk factor for complications and toxicities in elderly and frail AML patients, the maintenance of therapy until disease progression provides a significant survival advantage. Therefore, we suggest that HMA therapy should continue until disease progression regardless the sort of HMA. |
8. | Diagnostic and prognostic value of F-18 FDG PET/CT in patients with carcinoma of unknown primary Nilufer Bicakci PMID: 36276560 PMCID: PMC9514081 doi: 10.14744/nci.2021.71598 Pages 337 - 346 OBJECTIVE: Carcinoma of unknown primary (CUP) is inability to detect primary tumor despite all imaging methods with a biopsy-proven tumor metastasis. In the present study, we aimed to investigate the diagnostic and prognostic value of F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) in patients with CUP. METHODS: The patients with a diagnosis of CUP between November 2009 and January 2020 were evaluated retrospectively. A total of 155 patients (96 men and 59 women) were included in the study. Survival rates of the patients were evaluated by Kaplan–Meier and log-rank statistical analysis. RESULTS: The correctly determined primary tumor by F-18 FDG PET/CT was found in 64 patients (41%) (true positive). F-18 FDG PET CT results were negative (false negative) in determining primary tumor localization in 14 (9%) patients whose had local disease. Of the 155 patients, 66 (42.5%) had true-negative results and 11 (7%) had false-positive results. The sensitivity of 82%, specificity of 86%, and accuracy of 84% were calculated. The SUVmax value of the malignant lesion was on average 8.9 (range 3.6–26.1). Kaplan–Meier analysis revealed that the 1-year survival rates were 37.3% in regional disease and 16% in extensive disease (log-rank test, p=0.021). CONCLUSION: F-18 FDG PET/CT is a useful method in the detection of primary tumor in patients with CUP. F-18 FDG PET/CT can be helpful the evaluation of the prognosis by showing the extent of the disease. |
9. | Comparison of thyroid surgery experiences of “East” and “West” regions in Turkiye Elbrus Zarbaliyev, Dauren Sarsenov, Payam Hacisalihoglu, Sebahattin Celik PMID: 36276571 PMCID: PMC9514073 doi: 10.14744/nci.2021.75057 Pages 347 - 352 OBJECTIVE: This study aimed to evaluate the differences between the types of thyroidectomy surgeries and surgical treatment approaches according to thyroid pathology results, in Turkiye’s two non-endemic regions. METHODS: Two different centers of the country, which differ in many respects and are non-endemic for thyroidal diseases were included in the study. Data on patients from both sexes, who underwent thyroidectomy in the western (1st center) and the eastern (2nd center) regions between 2011 and 2017 have been reviewed. RESULTS: Two hundred and forty patients from Istanbul (1st center) and 992 patients from Van (2nd center); a total of 1232 patients were included in the study. According to the pre-operative ultrasonography and laboratory results, toxic nodular goiter and multinodular goiter were the most common diseases in the first and second centers, respectively. There was a significant statistical difference between the radiological diagnostic findings between the two centers (p<0.001). The rate of bilateral total thyroidectomy in the first center was 82.5% (198 patients), whereas this rate was 58.5% (555 patients) in the second center. The type of surgery may change from center to center, (p<0.001). The most common early post-thyroidectomy complication was hypocalcemia in both centers. CONCLUSION: The results from only two centers from the western and eastern Turkiye show that there is a difference between the thyroidectomy preferences. Future similar national studies will contribute to the provision of a consensus in surgical treatment of thyroid diseases. (NCI-2021-3-14/R1) |
10. | Isolated abducens nerve palsy: Comparison of microvascular and other causes Yuksel Erdal, Taskin Gunes, Ufuk Emre PMID: 36276565 PMCID: PMC9514074 doi: 10.14744/nci.2021.15483 Pages 353 - 357 OBJECTIVE: Abducens nerve paralysis is the most common ocular motor neuropathy. In this article, we aimed to compare the causes of isolated abducens nerve palsy in terms of demographic, clinical features, and prognosis. METHODS: Thirty-six isolated abducens nerve palsy patients were prospectively enrolled in the study. The demographic, clinical features, and prognosis compared in two etiological groups as microvascular and other causes. RESULTS: The most common etiology was microvascular, which was seen in 16/36 (44.4%) patients. Mean clinical recovery time was 2.5±1.3 months (range, 10 days–6 months). When etiological groups were compared as microvascular and other causes, the mean age of the microvascular group was significantly higher (62.8±13.3 vs. 44.5±16.4, p=0.001). Diabetes mellitus was seen significantly higher in the microvascular group than other causes group (p=0.001), but no significant difference was observed in terms of other atherosclerotic risk factors (p>0.05). The fasting blood glucose and hemoglobin A1c value were significantly higher in the microvascular group (p=0.02 and p=0.02, respectively). There was no significant difference in terms of clinical improvement and clinical recovery times between groups (p>0.05). CONCLUSION: There is no difference between microvascular group and other causes in terms of clinical outcome, while the mean age and presence of diabetes were higher in the microvascular group. The presence of diabetes should be questioned in cases with isolated abducens nerve palsy. |
11. | Empathy Assessment Scale Cem Malakcioglu PMID: 36276566 PMCID: PMC9514084 doi: 10.14744/nci.2022.55649 Pages 358 - 366 OBJECTIVE: Empathy is a prosocial ability and communication skill to feel, understand, and respond to emotions of others; it includes affective and cognitive behavioral aspects of therapeutic communication. For instance, physicians should communicate empathically with their patients. Thus, empathy levels of medical students should be improved during their education. It is important to comparatively evaluate the dimensions of empathy to have a clearer picture of this ability. The aim of this study is to determine the validity and reliability of the Empathy Assessment Scale (EAS) and its subscales. METHODS: Data were collected between October and December in 2021 from 651 students studying medicine in Istanbul Medeniyet University. Item pool of the scale was developed by the researcher based on the literature review. Two counseling psychologists, two clinical psychologist, and two psychiatrists evaluated the items to detect the face and content validity in the final application form. Both explanatory and confirmatory factor analyses (EFA and CFA) were carried out. The Toronto Empathy Questionnaire was also applied for concurrent validity. IBM SPSS 25 and AMOS 24 were utilized to analyze the construct and concurrent validities, internal consistency, and test-retest reliabilities. RESULTS: KMO and Bartlett’s sphericity tests showed that the dataset was suitable for factor analyses (KMO=0.812, Chi-square=5535.718, df=78). A three-factor structure with 13 items was confirmed by EFA, 67.1% of the variance was explained by these three factors. According to CFA, the factor loads of the items varied between 0.39 and 0.98 and data model fit was suitable according to the fit indices (CFI=0.95, TLI=0.91, RMSEA=0.049, SRMR=0.055, and Chi-square/df=1.316). Concurrent validity of the scale was also confirmed by the Pearson correlation (r=0.467, p<0.001). The test-retest reliability values (r) within four weeks interval were all above 0.60 at 0.01 significance level. Cronbach’s alpha coefficients were 0.845 (EAS total scale score, 13 items), 0.696 (social interaction subscale score, 4 items), 0.802 (cognitive behavior subscale score, 5 items), and 0.964 (emotional identification subscale score, 4 items). CONCLUSION: EAS is a valid and reliable measurement tool to assess the empathy levels of individuals in three dimensions: Social interaction, cognitive behavior, and emotional identification. EAS can be used to evaluate the empathy levels for research, educational, and other interventional purposes. |
12. | Knowledge levels, attitudes, and awareness of nurses toward organ donation Sami Akbulut, Khaled Demyati, Murat Tamer, Selver Unsal, Sakine Beyoglu, Hasan Saritas PMID: 36276570 PMCID: PMC9514080 doi: 10.14744/nci.2022.24478 Pages 367 - 375 OBJECTIVE: The aim of this study was to assess the knowledge, attitudes, and practices of nurses in Turkiye concerning organ donation. METHODS: This survey-based, descriptive cross-sectional study was conducted from January 2020 to March 2020, recruiting 560 of 850 nurses currently working in a tertiary university hospital with a face-to-face interview technique. The questionnaire consisted of 35 questions evaluating sociodemographic features, organ donation knowledge level, attitude, and nurses’ awareness. RESULTS: This study showed that only 6.5% of the nurses donated their organs. While 31.9% stated that they are willing to consider organ donation in the future, 41.3% were not decided about organ donation yet, and 27% rejected organ donation in any condition. Among the nurses who refused organ donation, 69.6% had no specific reason and 10.6% worried that their organs might be taken without proper diagnosis of brain death. About 10% denied organ donation for religious beliefs, and 5% were because of concerns about body integrity. Hesitation about procuring organs for commercial purposes was present in 7.2% of the nurses. Following a possible diagnosis of brain death of a relative, 33.8% of the nurses said that they would consent for organ donation to him/her, whereas 47.1% were not sure about this issue. Among the nurses, 76.6% agreed on a possible living-related organ donor for a close relative, 53.3% accepted receiving an organ from a close relative if required. Furthermore, this investigation showed that nurses who reported attending previous seminars, conferences, or training programs about organ donation have significantly better donation rates and stronger attitudes toward organ donation. Nurses who donated their organs are found to know better about brain death irreversibility, understand better the related national legal regulations for organ donation, and are more informed about the compatibility of organ donation with religious beliefs. CONCLUSION: This study showed that nurses have a relatively positive attitude toward donation and transplantation but are unwilling to bequeath their organs. This study underlines the indispensable contribution of nurses promoting organ donation and highlights the need for well-structured educational programs to enhance their role in organ donation and transplantation. |
13. | Real-life experience of tofacitinib in patients with treatment-resistant rheumatoid arthritis: A 5-year follow-up: Monocentric experience Ozlem Pehlivan PMID: 36276563 PMCID: PMC9514069 doi: 10.14744/nci.2022.05863 Pages 376 - 384 OBJECTIVE: The present study aims to assess the short- and long-term effects of tofacitinib (TOFA) therapy on efficacy, safety, and drug retention rate patients with rheumatoid arthritis (RA) refractory to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and/or biological disease-modifying anti-rheumatic drugs (bDMARDs). METHODS: Thirty-five patients with RA who received TOFA therapy for at least 3 months in rheumatology outpatient clinic between December 2015 and December 2020 were included in the study. The prospectively follow-up results of the patients obtained on the 6th month and 5th year are presented. Demographic characteristics of the patients, the disease activity score-28 for RA with erythrocyte sedimentation rate (DAS 28-4 [ESR]), change in DAS-28, health assessment questionnaire score, patient visual analog scale score, and laboratory parameters were recorded. The data at 6 months and 5 years of treatment were compared with baseline data. All side effects were recorded at each follow-up visit. Wilcoxon signed-rank tests were used for analysis. RESULTS: Of the 35 patients, 23 received TOFA treatment after receiving ≥1 bDMARDs, while the remaining 12 patients received TOFA therapy were biologic naive. On the 6-month follow-up, DAS 28-4 (ESR) score and DAS28 improvement significantly decreased at the 6th months from baseline (p<0.001 and p<0.001, respectively), and moderate disease activity was achieved in 13 patients. High disease activity persisted in four patients. DAS28 improvement according to the EULAR response criteria was good response in 86% of the patients. DAS 28-4 (ESR) score and DAS28 improvement significantly decreased at 5 years from baseline (p<0.01 and p<0.001, respectively), and the moderate disease activity was achieved in 10 patients. High disease activity persisted in two patients. Drug retention rate at 5-year follow-up was 54% and the daily glucocorticoid therapy could be discontinued in 9 patients (47%). Three patients (15%) were tested positive for COVID-19. None of them required hospitalization and no deaths were occurred due to COVID-19. CONCLUSION: TOFA is effective and well-tolerated treatment options that reduce the need for steroids in patients with RA. |
14. | The influence of corneal incision size on endothelial cell loss and surgically induced astigmatism following phacoemulsification cataract surgery Mustafa Hepokur, Esra Bulut Kizilay, Ebubekir Durmus, Veysel Aykut, Fehim Esen, Halit Oguz PMID: 36276567 PMCID: PMC9514070 doi: 10.14744/nci.2021.81084 Pages 385 - 390 OBJECTIVE: Corneal incision size has influence both on corneal biomechanics and intracameral fluid dynamics during phacoemulsification cataract surgery. The aim of this study was to evaluate the impact of corneal incision size on endothelial cell loss and surgically induced astigmatism (SIA) following phacoemulsification cataract surgery. METHODS: This prospective, randomized, and comparative study included 61 eyes with senile cataracts. The patients were randomly assigned to 2.2 mm and 2.8 mm corneal incision sizes and were operated with the same phacoemulsification system. Phacoemulsifcation energy parameters, pre-operative and post-operative endothelial cell counts and corneal astigmatism values were specifically recorded. SIA was calculated according to Alpins method and the results of both groups were compared. RESULTS: There were 31 eyes in the microincisional (2.2 mm) group and 30 eyes in the standard incision (2.8 mm) group. There was no significant difference between the groups for age and gender distribution (p=0.09 and p=0.18, respectively). Similar levels of cumulative dissipated energy was used during phacoemulsification in both groups (p=0.70). SIA was slightly higher in the standard incision group compared to microincisional group (0.47D at 64° vs. 0.37D at 61°, p=0.30). Pre-operative and post-operative uncorrected visual acuity (UCVA) was similar between the groups (p=0.45 and p=0.27).Endothelial cell loss tended to be slightly higher in the microincisional group compared to standard incision group (174.87±132.27 vs. 160.84±121.58, p=0.75), but this difference was not statistically significant. CONCLUSION: Smaller corneal incisions slightly reduced SIA, but tended to induce more endothelial cell loss. This small difference in SIA did not cause a significant change in the postoperative UCVA. Therefore, the trend in reducing corneal incision sizes below 2.8 mm might not be contributing the surgical outcomes of the patients, especially when we consider potential corneal endothelial changes. |
15. | Direct cost analysis for 32,783 samples with preanalytical phase errors Pinar Eker PMID: 36276573 PMCID: PMC9514066 doi: 10.14744/nci.2022.73555 Pages 391 - 400 OBJECTIVE: Errors in the laboratory process often occur in the preanalytical phase (PA). The study aims to calculate the direct cost elements of PA errors, including material, logistics, transfer, personnel workforce, and medical waste. METHODS: Medical laboratory PA phase errors were retrospectively reviewed using the Laboratory Information Management System. We evaluated the whole 2019 laboratory data of the 836-bed Health Sciences University Umraniye Training and Research Hospital (UTRH). We assessed the direct cost elements of PA errors, such as those related to material, logistics, transfer, human resources, and waste. We performed the procedure for both samples analyzed in the hospital and transferred to the central laboratory. RESULTS: We analyzed 1,939,650 patient samples and 46,534,532 parameters studied in 2019 for UTRH. The rates for rejected tests and rejected samples (tube) for UTRH were noted as 0.32% and 1.7%, respectively. The total direct cost for PA errors was TRY 438,284.51 (68,918.07 euros) for 32,783 patient samples and 147,893 tests. We calculated the total cost for PA test errors detected in the hospital as TRY 390,238.06, while the total cost for PA test errors detected in the central laboratory was TRY 48,046.45. 89% of the total cost was for PA errors detected in the hospital, and 11% was for the errors detected in the central laboratory. The 2019 direct PA error cost we calculated based on our hospital’s data was 0.153% of the 2019 hospital operating cost. We calculated the direct cost per rejected sample as TRY 13.37 (2.1 Euro). CONCLUSION: Providing reliable laboratory service with the least possible financial loss is one of the main goals in terms of laboratory medicine. In achieving this goal, the prevention of error costs is a priority. The direct cost elements for the PA phase, where laboratory errors are concentrated, can be easily identified. The amount of PA phase error direct cost will attract the attention of health policy decision-makers and field professionals and inspire further research. Therefore, we tried to determine a threshold cost regarding interventions and practices required to prevent PA phase errors. |
16. | Analysis of Doppler ultrasonography and computer tomography angiography for predicting amputation level and re-amputation rate Levent Adiyeke, Bekir Karagoz PMID: 36276557 PMCID: PMC9514072 doi: 10.14744/nci.2021.25665 Pages 401 - 407 OBJECTIVE: Peripheral arterial disease of the lower extremities is one of the most common causes of non-traumatic lower extremity amputation. Computed tomography (CT) angiography and Doppler ultrasonography are mainly used to evaluate distal vascular structures. Our objective was to evaluate the predictive efficacy of Doppler ultrasound and CT angiographic radiographic examinations in determining amputation levels and reamputation rates in patients undergoing lower extremity amputation. METHODS: Patients with major or minor amputation at various levels due to lower extremity lesions were included in the study. Standard demographic information, clinical accompanying diseases, reamputation datas, Doppler ultrasound, and CT angiography radiological evaluation reports were obtained retrospectively from the hospital system records of the patients. RESULTS: A total of 166 cases including 119 (71.7%) males and 47 (28.3%) females were included in the study. About 36.7% (n=61) cases had amputation at the level of surgery above the knee, 38.6% (n=64) below the knee and 24.7% (n=41) at the level of foot/finger. In patients who underwent amputation above the knee, occlusion was seen at the level of the iliac artery (88.9%), femoral artery (47.8%), and popliteal artery (37%). The rate of occlusion at the level of the popliteral artery in patients with below-knee amputation (59.3%) was found in patients with foot/finger amputation (51.5%) at the levels arteria dorsalis pedis and posterior tibial artery. According to the level of occlusion at all blood flow levels, it was observed that the rate of reamputation was most common in occlusions at the level of popliteal artery. CONCLUSION: It was found that radiological data are effective in planning amputation according to blood flow level and does not make any difference per se. It was found that the reamputation rates were related to the determination of the level of blood flow in the primary surgical phase. |
CASE REPORT | |
17. | Sonoelastography findings of myofibroblastoma Hakan Abdullah Ozgul, Isil Basara Akın, Canan Altay, Merih Guray Durak, Suleyman Ozkan Aksoy, Pinar Balci PMID: 36276559 PMCID: PMC9514068 doi: 10.14744/nci.2021.73693 Pages 408 - 410 Myofibrolastoma of the breast (MFB) is a rare and benign stromal tumor. Although MFB is a benign entity, in radiologic evaluation, there is no specific diagnostic feature. Conventional breast imaging findings have been published before. Sonoelastography has been used as an imaging method that allows us to evaluate tissue stiffness in vivo and increases the specificity of B-mode ultrasonography in the discrimination of benign-malignant lesions. In this case report, it was shown that MFB is of high stiffness in shear wave elastography (SWE) evaluation. SWE findings of MFB, which is a benign lesion, have been described for the first time in the literature. |
18. | Axenfeld-Rieger syndrome in monozygotic twin brothers: Case report Betul Ilkay Sezgin Akcay, Esra Kardes, Utku Limon PMID: 36276572 PMCID: PMC9514076 doi: 10.14744/nci.2021.89577 Pages 411 - 413 Axenfeld-Rieger syndrome (ARS) is a genetic disease affecting multiple organ systems. In the eye, it is associated with anterior segment dysgenesis with a high risk for glaucoma. Dental anomalies, cardiovascular malformations, hypospadias, and craniofacial abnormalities are other associated systemic conditions. Five years old monozygotic twin brothers with ARS were referred to Umraniye Training and Research Hospital, ophthalmology clinic for iris abnormalities. At presentation, pathognomonic components of ARS were found in both patients, including iris anomaly (corectopia, iris hypoplasia, and iris strands in Scwalbe’s ring), oligodontia, hypodontia, hypospadias, and periumbilical skin fold. Intraocular pressure was within normal ranges in both of the patients. Patients were followed up in the glaucoma unit. |
REVIEW | |
19. | Accuracy of magnetic resonance imaging in assessing knee cartilage changes over time in patients with osteoarthritis: A systematic review Yashar Hashemi Aghdam, Amin Moradi, Lars Gerhard Großterlinden, Morteza Seyed Jafari, Johannes T. Heverhagen, Keivan Daneshvar PMID: 36276575 PMCID: PMC9514082 doi: 10.14744/nci.2021.34270 Pages 414 - 418 Magnetic resonance imaging (MRI) is a technique useful for the diagnosis of cartilage damage due to high sensitivity to identify subchondral bone abnormalities and full-thickness cartilage lesions. The lack of a study on knee cartilage changes over time in patients with osteoarthritis (OA) by MRI technique led us to investigate the accuracy of MRI in identifying knee cartilage changes over time in patients with OA in a systematic review. In the present systematic review, started from the beginning of 2020 in one of the University Hospitals in Iran, the databases of CINAHL, Ovid, Elsevier, Scopus, PubMed, Science Direct, and Web of Science were searched using the keywords MRI, OA, Cartilage Lesion, Imaging Techniques. A total of 169 articles were retrieved in the initial search, and after reviewing the titles, abstracts, and full-texts, finally, seven were enrolled in the systematic review. Review of the selected papers showed that a total of 1091 subjects were studied, of which 355 were males. The results of all the studies, except one, indicated the high accuracy of MRI to identify knee cartilage changes over time. MRI technique can show cartilage changes with high accuracy in patients with knee OA over time. We proved the potential of MRI to identify articular cartilage injuries in patients with OA and its importance to the evaluation of articular cartilage lesions along with other available techniques. (NCI-2021-8-10/R1) |
LETTER TO THE EDITOR | |
20. | Low hematocrit is very common among monkeypox male cases: Observations Pathum Sookaromdee, Viroj Wiwanitkit PMID: 36276568 PMCID: PMC9514067 doi: 10.14744/nci.2022.88528 Pages 419 - 420 NCI-2022-8-9 |