Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Medical Education in Times of Pandemic: To Practice or to Protect?(2022) Gultekingil, Ayse; Canbolat, Elif; Gurel, Fazil Serdar; Baskin, Esra; 0000-0001-7955-5735; AAR-9945-2020Introduction: In the beginning of March 2020 with first case of COVID-19 reported in Turkey, measures that were assumed to decrease the spread of SARSCoV-2 were taken quickly. Use of personel protective equipments and limiting number of people contacting with the patients were some of the most important precautions. Although these precautions protected medical student from risk of infection, they limited their practical learning oportunities and probably negatively effected their education. Aim of our study was to measure the effect of pandemic on medical education of grade 6 medical students. Materials and Methods: We had 6th grade medical students that finished their education between July 2020 and June 2021 fill out a questionnaire that measures their self-esteem on evaluation and procedural practice in pediatric patients and presents their subjective opinions on this period and their solution suggestions with closed and open ended questions. Results: Forty nine grade 6 student was included in the study. Their self-esteem was average (general competency in pediatric patients was 2.31 +/- 0.94 and general self reported competency in clinical practices was 2.65 +/- 1.42). The practice they feel most confident was hand washing (4.44 +/- 1.16), and the practice the feel least confident was establishment of vascular access (1.94 +/- 1.09). When they were asked to evaluate their self-competency in pediatric patients from 1 to 5,the procedure they most frequently observed was establishment of vascular access (74%) and least frequently observed was lumbar puncture (12%). Most frequently performed procedure was urinary catheterization (20%). 80.9% them stated that they felt unlucky to be 6th grade in COVID-19 pandemic and they would like to have more opportunities to contact with the patients with personal protective equipment (PPE). Conclusion: Education of 6th grade medical students affected negatively with decreasing number and diversity of patients and limited opportunity to evaluate patients and observe and perform procedures. Improvements should be made in pediatric departments to increase possibility of student to encounter patients and continue hands on learning with the right precautions.Item Prognostic Value of Procalcitonin in Infection-Related Mortality of Cancer Patients(2016) Sedef, Ali Murat; Kose, Fatih; Sumbul, Ahmet Taner; Dogan, Ozlem; Kursun, Ebru; Yurdakul, Zafer; Gultepe, Bilge Sumbul; Mertsoylu, Huseyin; Sezer, Ahmet; Ozyilkan, Ozgur; https://orcid.org/0000-0002-0156-5973; https://orcid.org/0000-0002-5573-906X; https://orcid.org/0000-0002-1932-9784; https://orcid.org/0000-0002-6445-1439; https://orcid.org/0000-0001-8825-4918; 27569098; G-4827-2016; D-4793-2014; GZH-1913-2022; AAG-5020-2020; M-9530-2014; AAD-2667-2020; AAD-2817-2021Purpose: Infectious diseases are a major cause of morbidity and mortality in cancer patients. Tumor-induced inflammatory responses may increase the value of classical inflammatory markers in blood, so these markers may not be as useful in cancer patients as in non-cancer patients. Serum procalcitonin (PCT) is a sensitive and specific biomarker for severe infection, and has been shown to be unaffected by tumor-induced inflammatory response. In this study we aimed to evaluate the possible role of PCT in mortality in cancer patients with infection. Methods: In total, 104 consecutive adult cancer patients who presented with fever (body temperature >= 38.3 degrees C or >= 38 degrees C on two consecutive measurements) during follow-up and needing hospitalization for infection were enrolled in this study. Results: The majority (72%) of the patients were male. The most common diagnosis and type of infection were lung cancer (40.4%) and pneumonia (56.7%), respectively. The overall mortality rate was 17%. Statistical analysis showed a significant relationship between PCT levels and mortality (p=0.001), but not between classical inflammatory markers and mortality (p>0.05). The mortality rate of patients with a PCT value > 2 ng/mL was 34.3%, compared with 9.6% in patients with a PCT below this value (p=0.005). Furthermore, PCT predicted in-ward cancer patient mortality with a sensitivity of 66% and a specificity of 76%. Conclusion: PCT is a unique serum biomarker significantly related to infection-related mortality and predicts mortality with a relatively high sensitivity and specificity.Item Double-Layered Circular Advancement Flap for Reconstruction of Inguinal Defects(2017) Arpaci, Enver; Altun, SerdarObjective: Vascular graft infections are rare complications but can lead to life-threatening outcomes for the patient. Conventional treatment methods are the removal of the vascular graft and an extra-anatomic by-pass procedure. Unfortunately, this treatment presents high morbidity and mortality rates. Treatment of the deep-level perivascular synthetic graft infection and closure of exposed vascular graft reduce graft infection, thereby help to reduce mortality and morbidity rates. Material and Methods: Between 2009-2013 seven cases of complicated defect that involved perivascular graft infection in the inguinal region were performed using omega advancement flaps. In this technique, a circular-shaped flap with a diameter corresponding to the defect was planned adjacent to the defect after debridement of the infected perivascular and the necrotic skin areas. To facilitate the advancement of the flap and to support the subcutaneous region, deepithelialized equilateral triangular flaps were designed on both sides of the main circular flap. Results: Wound dehiscence and infection recurrence did not occur in the follow-up period. No secondary surgeries were required to change the segment of the vascular graft. All flaps survived without any complications such as hematoma, flap necrosis or infection. The results were satisfactory both aesthetically and functionally. Conclusion: Omega fasciocutaneous advancement flap is a reliable, suitable and easy method for the reconstruction of complex inguinal vascular infections.Item Sternotomy with electrocautery and sternal wound infection in congenital heart surgery in patients under 1 year of age(2021) Celik, Mehmet; Aygun, Fatih; Ozkan, Murat; 33896040Objective The present study aimed to compare the rate of wound site infection in patients <1 year of age who underwent sternotomy using electrocautery, a routinely performed procedure in our clinic, with those reported in the literature. Methods This double-center study included patients In our study, seven patients developed SSI, which was superficial in six (1.3%) patients and in the form of mediastinitis in one (0.2%) patient. Conclusion Sternotomy with electrocautery, which we consider an easy and safe method, was also not found to be statistically different from the other methods in terms of SWI.Item Do Hemodialysis Patients Need Immune Boosting with Vitamin, Mineral, and Probiotic Supplementation during COVID-19 Pandemic?(2021) Gungor, Ozkan; Ulu, Sena; Hasbal, Nuri Baris; Onan, Engin; Turgut, Didem; Arici, MustafaCoronavirus disease 2019 (COVID-19) has been accepted as a global pandemic, and poses a greater risk to the elderly and those with comorbidities. Comorbid diseases (particularly end-stage kidney disease with hemodialysis) and impaired immunity place patients in the high-risk group for COVID-19. In recent studies, it was also mentioned that exaggerated inflammation and a cytokine storm were the underlying causes related to the high mortality in COVID-19 patients. Currently, treatment modalities to balance the immune system of such vulnerable patient groups are essential, to protect them from the disease. Several vitamins (like vitamins C, D, and E), trace elements like zinc, and probiotics have been proposed as immune boosters to protect and combat infectious conditions. It is well known that these vitamins and elements are insufficient in hemodialysis patients. In this review, we aimed to evaluate the immune-boosting mechanisms of vitamins C, D, E, zinc, and probiotics, the studies related to their beneficial effects against infections, and their possible benefits for hemodialysis patients during the COVID-19 pandemic.Item The mid-term effects on quality of life and foot functions following pilon fracture(2020) Yaradilmis, Yuksel Ugur; Okkaoglu, Mustafa Caner; Kilic, Alparslan; Haberal, Bahtiyar; Demirkale, Ismail; Altay, Murat; 0000-0002-1668-6997; 32946104; W-9080-2019BACKGROUND: Although pilon fractures are uncommon, they are of importance to orthopaedic surgeons because of the difficulty of treatment. Poor outcomes and high complication rates are seen despite various surgical methods. This study aims to examine the changes affecting the quality of life and foot functions in patients applied with open reduction and internal fixation (ORIF) for a pilon fracture. METHODS: In this study, a total of 45 patients treated with ORIF for a pilon fracture in our clinic between January 2010 and December 2016 were evaluated with AOFAS and SF-12 in a total of 10 categories according to demographic data, fracture classification and surgical technique. In addition to functional values, patient records were examined regarding complications, including infection, soft-tissue defect, malalignment, non-union, arthrosis and Sudeck atrophy. In patients with AOFAS <85 and low SF-12 scores, variables were examined and the relationship with complications was evaluated. RESULTS: The mean follow-up period was 3.7 years (range 2 to 7). The AOFAS value was determined to fall to <85 when the Ruedi Allgower classification increased (p=0.010), when AO classification increased (p=0.020), when there was a concomitant lateral malleolar fracture (p=0.028), and when the status was non-anatomic according to the Ovadia Bell criteria (p=0.031). The SF-12 PCS value was observed to decrease when the Ruedi Allgower classification increased ( p=0.018) and when the status was non-anatomic according to the Ovadia Bell criteria (p=0.012). A correlation was determined between the SF-12 PCS and the AOFAS values (p=0.000). CONCLUSION: The reasons for the failure of ORIF in tibia pilon fractures were found to be Ruedi 3 classification, concomitant lateral malleolar fracture, and non-anatomic surgical reduction. Failure in foot functions has a direct effect on quality of life in both the short and mid term.Item Clinical management of coronavirus disease 2019 (COVID-19) in pregnancy: recommendations of WAPM-World Association of Perinatal Medicine(2020) Api, Olus; Sen, Cihat; Debska, Marzena; Saccone, Gabriele; D'Antonio, Francesco; Volpe, Nicola; Yayla, Murat; Esin, Sertac; Turan, Sifa; Kurjak, Asim; Chervenak, Frank; 0000-0001-9577-4946; 32692708; AAI-8810-2021These guidelines follow the mission of the World Association of Perinatal Medicine, which brings together groups and individuals throughout the world with the goal of improving outcomes of maternal, fetal and neonatal (perinatal) patients. Guidelines for auditing, evaluation, and clinical care in perinatal medicine enable physicians diagnose, treat and follow-up of COVID-19-exposed pregnant women. These guidelines are based on quality evidence in the peer review literature as well as the experience of perinatal expert throughout the world. Physicians are advised to apply these guidelines to the local realities which they face. We plan to update these guidelines as new evidence become available.