Hamidiye Etfal Training Research Articles

Pre-operative pulmonary risk assessment in surgery patients

Aims: Postoperative pulmonary complications (PPC) that may develop after surgery are important causes of morbidity and mortality. PPCs cause a prolongation of hospital stays and an increase in hospitalization costs. The study aims to determine factors associated with PPCs to predict PPCs in surgical patients undergoing preoperative evaluation. Methods: A retrospective cohort study was conducted at Şişli Hamidiye Etfal Training and Research Hospital using data from 200 patients referred for preoperative pulmonary evaluation from anesthesia and surgery clinics. This study analyzed the characteristics and outcomes of patients with PPC and those without PPC. The Canet pulmonary risk scores are used for PPC in all preoperative surgery patients. The study’s primary endpoints are to determine the development of respiratory failure, bronchospasm/asthma, COPD exacerbation, atelectasis, pleural effusion, or pneumonia. The study also analyzed the effective respiratory function parameters for PPC development using a logistic regression model. Results: The total study population included 200 patients with a median age of 53.5 years (aged between 19-88), 103 (51.5%) of whom were female. PPCs were observed in 38% (n=76) of the study group. There was a statistically significant difference between the patients in terms of the development of postoperative pulmonary complications according to gender (higher in males, p=0.001) and smoking (p=0.0001). Preoperative oxygen saturation (SpO2) and FEV1/FVC ratio were significant predictors of PPC development, and complications were more frequent in low-saturated patients (p=0.0001, p=0.013 respectively). The relationship between SpO2 and PPC was confirmed via logistic regression analysis. A one-unit increase in saturation reduced the occurrence of postoperative respiratory complications by 0.645-fold. The cut-off value for the saturation value was 97.5%, with a sensitivity of 46.8% and a specificity of 71.1% [p=0.0001, 95% CI, (0.521-0.798)]. Conclusion: In this study, the Canet (ARISCAT) score, a preoperative evaluation scale validated in Turkey that predicts postoperative pulmonary complications and mortality, was used. The Canet risk score is a simple risk score with moderate discriminatory performance for predicting PPCs. It may be useful in identifying individual patients at high risk of PPC and in the design of future studies to evaluate interventions to prevent these complications. However, a customized preoperative risk assessment system is needed for each patient.

Turkish Translation and Cross-Cultural Validity of WHOQOL-HIV Bref Tool.

The assessment of health-related quality of life among people living with HIV (PLWH) has gained increasing importance as it assesses their overall well-being, guides treatment decisions, and addresses psychosocial challenges, improving their quality of life. This study focuses on adapting and validating the Turkish version of the WHOQOL-HIV Bref, a tool developed by the World Health Organization (WHO) to measure health-related quality of life in PLWH. This adaptation is based on the generic WHOQOL-Bref Turkish and WHOQOL-HIV Bref inventory. In line with WHO guidelines, the tool was translated and tested on 189 PLWH from İstanbul Şişli Hamidiye Etfal Training and Research Hospital's HIV outpatient clinic. A variety of statistical methods were employed to assess content, construct, concurrent, and known-group validity, as well as internal consistency and reliability. Participants' median age was 35 years (IQR: 14), with 178(94%) being male. The Turkish WHOQOL-HIV Bref showed overall satisfactory psychometric properties. Despite limitations in the spirituality domain, it demonstrated good internal consistency (alpha coefficient: 0.93) and strong validity across several metrics, including test-retest reliability (ICC: 0.79). The WHOQOL-HIV BREF in Turkish is a reliable and valid instrument for assessing the quality of life in Turkish PLWH.

How well is acupuncture known?

In our study, we aimed to assess participants' attitudes and knowledge of the use of acupuncture among those who were 18-65 years old. During the period of May 1–June 1, 2023, a descriptive cross-sectional study was carried out. Between the stated dates, anyone between the ages of 18 and 65 who applied to the Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital's Family Medicine Outpatient Clinics for any reason and who accepted to participate in the study were included. The researcher administered the 24 questioned data form face-to-face with the individuals after obtaining their sociodemographic characteristics, chronic illnesses, knowledge of various TCM treatments and acupuncture. Among the participants, 167 people (73.6%) had information about acupuncture. Acupuncture was one of the most used applications in our survey, and most of the patients who experienced it were referred by physicians. Those who previously received acupuncture treatment knew more about the practice with a statistically significant difference (p=0.004). Those who knew about acupuncture and those who had previously had acupuncture said there was no danger or damage in receiving acupuncture, with a statistically significant difference (p=0.015, p=0.0001, respectively). Although acupuncture is one of the most well-known TCM uses, its use remains in the background. The internet being the most widely used information source limits access to reliable data. Acupuncture should be performed, like all TCM applications, by qualified physicians in authorized centers while taking the outcomes into consideration.

The Role of Dynamic Changes in Hematologic and Biochemical Parameters in Predicting Mortality in Covid-19 Patients.

The role of hematologic, inflammatory and biochemical parameters as biomarkers, their role in identifying risky patients in the early stage and their role in prognosis in COVID-19 Coronavirus disease 2019 (COVID-19) were investigated. The study included patients who were hospitalized and followed up with a prediagnosis of COVID-19 in the first wave in our country at the University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital Demographic and clinical characteristics as well as complete blood count, C reactive protein (CRP), procalcitonin (PCT), fibrinogen (FIB), ferritin, albumin (ALB), lactate dehydrogenase (LDH) levels on admission, third, seventh and 14th days were analyzed. Patients were grouped and compared according to the occurrence of death during hospital follow-up. Variables considered significant on mortality were analyzed with univariate and multivariate logistic regression models. The study was conducted with 485 patients, 273 (56.3%) males and 212 (43.72%) females. The mean age of the patients was 58±16.2 years, and 71% were in the mild-moderate and 29% in the severe-critical disease group. Disease severity, the need for intensive care unit (ICU) follow-up, and the development of death were positively correlated with age, comorbidity, neutrophil (NE), leukocyte, neutrophil-lymphocyte ratio (NLR), PCT, CRP, ferritin, LDH values, and negatively correlated with lymphocyte (LE), ALB and hemoglobin (HGB) values. In multivariate analysis, elevated PCT at hospital admission (OR: 6.96 [1.63;39.65]), LDH ≥ 352U/L (OR: 4.35 [1.23;16.61]), LE<0.810 × 109/L (OR: 3.0 [1.16;7.85]) and advanced age (OR: 1.08 [1.03;1.14]) were independently associated with in-hospital death. In hemogram and acute phase reactant monitoring, PCT, CRP and LDH were the most valuable markers for predicting death, respectively (third-day AUC: 0.90;0.83;0.83 and seventh-day AUC: 0.95;0.90;0.89, respectively). In our study, leukocytes, lymphocytes, NLR, CRP, PCT, ferritin, albumin and LDH at admission were valuable in predicting poor prognosis. In addition, it was determined that increases in PCT, LDH and CRP during follow-up could be used to predict in-hospital death and to identify patients requiring close follow-up.

Coexistence of Thyroglossal Cyst and Thyroid Disease in Adults: Surgical Outcomes From A Single Center.

Thyroglossal cysts (TGCs) usually present during childhood and before the age of 30, however, they can also be seen in adults, even in advanced age. Nodular thyroid disease is also common in adults. In the literature, there is an ongoing debate regarding the differences in clinical presentation, gender, and postoperative recurrence of TGC between children and adults. In this study, we aimed to process the data of adult patients who underwent surgery for TGC in our clinic, along with the data on concurrent thyroid disease and thyroid surgery. The data of patients over 18 years old who were operated on for TGC at the General Surgery Clinic of Sisli Hamidiye Etfal Training and Research Hospital between 2018 and 2024 were retrospectively evaluated. A total of 16 patients with a mean age of 43.94±12.98 (21-67) years, were included in the study (11 F/5 M). The diagnosis of TGC was made in 12 patients (75%) by ultrasonography (USG), in 1 patient (6.25%) by computed tomography, in 1 patient (6.25%) by magnetic resonance imaging (MRI), and in 2 patients (12.5%) incidentally intraoperatively. 13 patients (81.25%) underwent the Sistrunk procedure, and 3 patients (18.75%) underwent cyst excision. Among the 16 TGC patients, papillary thyroid cancer in the cyst was detected in one patient (6.25%) preoperatively. During preoperative evaluation, nodular thyroid disease was found in 12 patients (75%). Of these, papillary thyroid cancer was detected in 3 patients (18.75%) preoperatively. Of the TGC group, 3 (18.75%) underwent thyroidectomy for thyroid malignancy, and five (31.25%) underwent additional thyroid surgery for nodular thyroid disease. The patients were followed for a mean of 22.63±18.32 months (3-67 months), and no recurrence of TGC was observed during the follow-up period. In patients with TGC, thyroid diseases and the requirement for thyroidectomy due to benign or malignant thyroid disease are not uncommon. Patients with TGC should be evaluated for thyroid disease before surgical treatment. While the Sistrunk procedure is the standard surgical technique in the treatment of TGC, in adults, if the cyst terminates below the hyoid bone, total cyst excision without removing the central portion of the hyoid bone may be sufficient.

Effectiveness of Lactate Clearance to Predict In-Hospital Mortality in Patients with Upper Gastrointestinal Bleeding.

To determine the performance of lactate clearance to predict prognosis in patients with upper gastrointestinal bleeding (UGIB). Observational study. Place and Duration of the Study: Department of Emergency Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey, from January 2018 to 2022. This study was conducted with 141 patients with UGIB. Lactate clearance was calculated based on the lactate levels at the time of admission and 6th hour. The primary outcome was survival. The secondary outcomes were the need for intensive care unit, endoscopic intervention, blood transfusion, and length of hospital stay. The median age of the patients was 71 years and 65.2% were males. In the non-survivor group; systolic blood pressure, diastolic blood pressure, base deficit, delta lactate, and lactate clearance were significantly lower; however, heart rate, baseline lactate and final lactate were significantly higher. The median lactate clearance of survivors and non-survivors were 23.61 and -0.51, respectively (p = 0.002). A unit decrease in lactate clearance increased mortality 1.011-fold. The performance of lactate clearance in predicting mortality was followed as; sensitivity 76.4, specificity 51.4 (AUC = 0.673, p = 0.002), and the cut-off value was 21.51. Lactate clearance was not statistically significant in determining the need for intensive care (p = 0.110), endoscopic intervention (p = 0.152) and blood transfusion (p = 0.266) in UGIB. Lactate clearance was an independent predictor of in-hospital mortality in UGIB. It is thought that the study will guide clinicians in the differentiation of critically-ill patients and an effective treatment planning. Upper gastrointestinal haemorrhage, Lactate, Lactate clearance, Mortality, endoscopy, Blood transfusion, Intensive care.

Revizyon Yapılan Enfekte Kalça Artroplastilerinde İntraoperatif Hipokloröz Asit Kullanımı

Aim: Arthroplasty infections are serious and difficult to treat complications. Hypochlorous acid (HOCl) is an oxidant produced endogenously in the body as a physiological part of the inflammatory process, with the aim of eliminating pathogens activated by neutrophils. The aim of this study was to evaluate the positive and negative effects on clinical results of HOCl used as an irrigation solution during surgical treatment. Material and Methods: The study included 37 patients who underwent single- or two-stage revision surgery at the University of Health Sciences Şişli Hamidiye Etfal Training and Research Hospital Orthopedics and Traumatology Clinic between January 2017 and December 2021. Treatment was applied according to our standard protocol of irrigation with 450 cc HOCl following implant removal and an additional 50 cc HOCl to the subcutaneous tissue after closing the fascia. The patients were evaluated during follow-up in respect of infections. Results: While single-stage revision surgery applied to 20 patients, two-stage revision surgery applied to 17 patients. 17 (45.9%) of the patients were male and 20 (54.1%) were female with a mean age of 72.8±11.1 years. The mean follow-up period was 25.8±14.1 months. Revision surgery was performed on one patient in each of the single and two-stage surgery groups. A success rate of 94.6% (n=37) was obtained when all patients were evaluated. Conclusion: The HOCl solution can be considered to make a positive contribution to the eradication of infections in revision hip arthroplasty and can be an effective and safe alternative to other irrigation solutions.

Determination of anti-HCV signal to cut-off value in patients with hepatitis C virus infection and the variety of antibody responses

Objectives: The diagnosis of hepatitis C virus (HCV) infection starts with the detection of antibodies against recombinant or synthetic HCV proteins by Enzyme Immunoassay (EIA). Although EIA tests are highly sensitive, false positivity rates are not low. Positive anti-HCV results are generally confirmed with complementary tests such as Nucleic Acid Amplification Tests (NAAT), or Western Blot modifications. Methods: The anti-HCV results of 199,516 individuals referred from various clinics between 2015 and 2019 were evaluated retrospectively at University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Medical Microbiology Laboratory. From the 2039 samples, of which EIA tests resulted borderline and reactive, 1419 samples having Line Immunoassay (LIA) confirmatory test results were included in the study. Results: LIA tests yielded positive, negative and indeterminate for 820 (57.8%), 519 (36.6%) and 80 (5.6%) of 1419 samples, respectively. The optimal threshold point for EIA anti-HCV signal to cut-off (S/Co) according to LIA was found to be 15.85 corresponded to diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 94.9%, 94.8%, 96.6%, 92.1%, 94.9%, respectively. The most common proteins detected in LIA positive samples were C1 96.3%, C2 90.4%, and NS3 93.2%. Conclusions: To prevent false positivities, confirmatory tests must be used for samples with low S/Co ratios. The use of S/Co value will make significant contribution to reducing both false-positive results and the LIA confirmatory test consumption. There was no correlation between the number of bands and EIA index values in LIA positive samples, while the relationship between the number of 3+ bands and index values was remarkable.

A Comparison of Pediatric Appendicitis During the COVID-19 Pandemic and the Same Period Previous Year

Background: Although appendicitis is the most common emergency abdominal surgical pathology in the pediatric age group, there are a limited number of publications in the literature on how appendicitis has affected patients during the COVID-19 pandemic. Objectives: This study examined the effects of fear of being infected with COVID-19 and isolation measures on complications and morbidity in pediatric appendicitis cases. Methods: This study was performed in the Department of Pediatric Surgery, Faculty of Medicine, Health Sciences University, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey. Patients aged 18 years and younger who were operated on for appendicitis between 11 March 2019 and 11 May 2019 were classified as group 1, and patients aged 18 years and younger who were operated on for appendicitis between 11 March 2020 and 11 May 2020 (during the pandemic) were classified as group 2. Both groups were compared in terms of age, gender, symptoms, duration of symptoms, surgical method, duration of operation, length of hospital stay, and postoperative complications. Results: There were 85 patients in group 1 and 49 in group 2. The mean age was 11.5 ± 3.5 years in group 1 and 12.2 ± 3.0 years in group 2. While the mean hospital admission time for group 1 was 52.2 ± 38.5 hours, it was 50.2 ± 40.0 hours for group 2. The complicated appendicitis rates were 37% and 25% in group 1 and group 2, respectively. In group 1, 94.1% of the operations were completed laparoscopically, whereas, in group 2, this rate was 88.6%. The mean operation time was 64.0 ± 24.4 minutes in group 1 and 69.0 ± 33.0 minutes in group 2. The mean length of hospital stay was 2.9 ± 2.0 days in group 1 and 3.1 ± 3.40 days in group 2. The complication rate was 8.2% in group 1 and 11.4% in group 2. Conclusions: Despite the isolation measures and the risk of virus transmission, the psychosocial effects of the pandemic did not prevent real emergency cases with appendicitis from visiting hospitals.

Sleep-related Breathing Disorders in Children with Asthma: Impact on Asthma Control.

To investigate the frequency of sleep-related breathing disorder and the relationship between asthma control and sleep-related breathing disorder in children with persistent asthma. Comparative cross-sectional study. University of Health Sciences, Hamidiye Etfal Training and Research Hospital, Istanbul/Turkey, from January 2019 to June 2019. Children aged 4-11 years with persistent asthma were included. At enrollment, socio-demographic and asthmatic characteristics were investigated, and pediatric sleep questionnaire and childhood asthma control tests were administered. Out of 120 patients, 75 (62.5%) were males and 45 (37%) females. According to GINA guidelines, asthma was well controlled in 23.3% children, partially controlled in 50.8% children and uncontrolled in 25.8% children. The frequency of habitual snoring was reported as 20.8% and the frequency of sleep-related breathing disorder was 29.2%. The prevalence of sleep-related breathing disorders was significantly higher in the uncontrolled asthma group (p <0.001). Significant-independent efficacy of physician-diagnosed allergic rhinitis, habitual snoring, and low asthma control test scores was observed in predicting sleep-related breathing disorders in multivariate logistic regression model (p <0.001). Uncontrolled asthma is associated with sleep-related disordered breathing. The authors suggest that allergic rhinitis, habitual snoring, and low asthma control test scores are important risk factors for sleep-related breathing disorders in children with persistent asthma. Asthma, Asthma control test, Allergic rhinitis, Habitual snoring, Pediatric sleep questionnaire, Sleep-related breathing disorder.

Evaluation of the relationship between lower urinary tract symptoms and fall risks in male patients over 65 years old

Objective. In our study, we aimed to evaluate the relationship between LUTS and fall risk in patients over 65 years old.Methods. 183 people over 65 years old who attended to Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital Family Medicine Polyclinics and Recep Tayyip Erdoğan University Family Medicine Polyclinics between February 2017-May 2017 were included in the study and ‘Individual Presentation Form’ prepared by the researcher questioning socio-demographic characteristics was applied to the participants by face-to-face questioning method, International Prostate Symptom Score (IPSS) and Morse Fall Scale (MFS) were completed afterwards and ROC analysis of IPSS was performed for those who have high risk in terms of MFS. Results. When evaluating the relationship between MFS and IPSS, we observed that as all subscores and total score of IPSS increased, the MFS score increased. The MFS scores of the participants whose IPSS classification was evaluated as severe were found to be significantly higher. ROC analysis of IPSS was performed for those who have high risk in terms of MFS. It was found that area under curve is 78.4%, and those with an IPSS of 13.5 and above show a high fall risk with 71.4% sensitivity and 70% specificity.Conclusions. In our study, we found that as the IPSS of the participants increased, the risk of falling increased. Moreover, we found that age, occupation type, type and number of chronic diseases were effective in both fall and IPSS. In addition to LUTS screening in males, evaluation should be done for the risk of falling.

Adult vaccine-related knowledge, attitudes, and behaviors in Turkey.

PurposeAdult vaccination, which is among the duties of family physicians, is an important issue that reduces morbidity and mortality. In this study, it was aimed to evaluate knowledge, attitudes, and behaviors of adults about adult vaccines.Materials and MethodsThis study is a descriptive, cross-sectional research; which was performed by a questionnaire including sociodemographic data and questions about adult vaccination to the patients and their relatives who applied to Şişli Hamidiye Etfal Training and Research Hospital Family Medicine Polyclinics for any reason. Mean, standard deviation and chi-square tests were used for the analysis; p<0.05 was considered significant.ResultsThe study included 182 people, 93 of them were women (51.1%) and 89 (48.9%) were men. The mean age was 32.9±12.8 years; most of them (n=144, 79.1%) were high educated and 38.5% were married. The most known vaccine was tetanus (n=154, 84.6%), the least known was zona vaccine (n=30, 16.5%). Health care professionals and television (n=60, 33%) were the most information sources about vaccines (n=78, 42.9%). Vaccination was mostly (26.9%) recommended by family physicians 144 (79.1%). The students had more knowledge about human papilloma virus (HPV), zoster, and measles, mumps, and rubella vaccines (p≤0.05), and mostly the information was got from internet and school (p≤0.05). As education status increased, knowledge about tetanus, hepatitis A, pneumonia, and HPV vaccines increased significantly, whereas only tetanus vaccination was performed in practice (p≤0.05). As the income increased, knowledge about pneumonia and HPV vaccines increased, but vaccination was not performed as expected.ConclusionAge, occupation, education, and income level are directly related to knowledge and attitudes about adult vaccination. Adult vaccines are still not known and performed enough in Turkey. It is important to encourage and increase the number of trainings via media on this subject.

Role of Radiology and Laparoscopy in Childhood Peptic Ulcer Perforation.

Objective Peptic ulcer disease (PUD) in children is an uncommon disorder. An estimated 1.3 percent to 20 percent of people die from perforated peptic ulcers (PPU), a PUD consequence. Using a database, we assess the prevalence and prognosis of PPU in patients. We also do radiological and laparoscopic operations for PPU in young patients. In pediatric patients, sufficient accumulation of knowledge about laparoscopic repair is at the level of case reports. This study aims to assess the results in pediatric cases operated for PUP by open or laparoscopic surgery and determine the role of computed tomography (CT) in diagnosing PUP. Methods Data was collected from the Department of Pediatric Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Turkey, from 2015 to 2020. Patients under 18 years of age who were operated on for PUP between 2015 and 2020 were divided into two groups. Group 1 involved those patients operated by laparoscopic surgery, whereas Group 2 involved those used by open surgery. Both groups were retrospectively evaluated in terms of demographic data, clinical findings, preoperative-intraoperative findings and surgical methods (open or laparoscopic), duration of surgery, duration of nasogastric intubation, time of return to oral feeding, length of hospital stay, and postoperative complications. Results 18 patients consisting of 15 boys and 3 girls were included in the study. Group 1 involved 10 patients, whereas Group 2 involved 8 patients. In Group 1, the symptom onset period was 1.6 ± 1.9 days, and in Group 2, it was 6.6 ± 6.1 days. In the erect abdominal radiographs (AXR) of 10 (58.8%) patients, the air was under the diaphragm. Six patients whose erect AXRs showed no attitude under the diaphragm but had abdominal pain and acute abdominal manifestation were given abdominal computed tomography (CT) scanning. In all patients with PUP, laparoscopic/open surgery involves primary suturing and repair by omentoplasty (Graham patch). The mean operative time was 87.0 ± 26.3 minutes in Group 1 and 122.5 ± 57.6 minutes in Group 2. The mean length of hospital stay was 3.9 ± 1.3 days in Group 1 and 5.8 ± 2.1 days in Group 2. Neither group developed any major surgical complications. Conclusions Adolescents with a history of sudden onset and severe abdominal pain may present with peptic ulcer perforation even if there is no known diagnosis of peptic ulcer or predisposing factor. In cases suspected of PUP, it is vital to order and carefully examine erect AXR, which is an easy and inexpensive method. Computed tomography should be the first choice in patients without free air in ADBG but whose anamnesis and findings match peptic ulcer perforation.

Evde Bakım Hastalarında D Vitamini Düzeylerinin Değerlendirilmesi

Objective: Vitamin D deficiency has become an epidemic for all age groups in the world. The aim of this research is to evaluate the vitamin D deficiency in-home care patients and related lifestyle reasons. Method: This research is done on Home Care patients registered to İstanbul Şişli Hamidiye Etfal Training and Research Hospital between January 2015 – February 2016. After getting the patients’ vitamin D records retrospectively, we have inquired patients if they have regular exposure to sunlight, whether they have a history of fracture or osteoporosis, and other related lifestyles.D vitamin deficiency was grouped as; normal(&amp;gt;30ng/ml), insufficiency(20-30ng/ml), deficiency(lower than 20ng/ml)and the severe deficiency(lower than &amp;lt;10ng/ml). We used the SPSS20.0 program; frequency, chi-square, and T-test were evaluated. Results: Totally 232 patients were included in this study. There were 160(%69) women and 72 (%31) men. Vitamin D insufficiency was found in 11.2% (n=26), and vitamin D deficiency in 70.3% (n=163). 70.1% (n=96) of 137 patients who answered the questions were female and 29.9% (n=41) were male. 86.1% of them (n=118) did not benefit from sunlight, 63.5% (n=87) had not received vitamin D treatment before. Vitamin D deficiency was detected in 79.3% (n=69) of those who did not receive vitamin D treatment, and a significant relationship was found between them. Conclusion: In our study, we have found that most homecare patients have low levels of Vitamin D, do not have regular exposure to sunlight, not do exercise regularly. Vitamin D replacement is vital in home-care patients as vitamin D deficiency increases the risk of osteoporosis, falls, and fractures.

The Impact of the Perception of Chemotherapy-Induced Alopecia on Psychosocial Life.

AIMThis study was planned to evaluate the perception of alopecia as a side effect of chemotherapy, and its effect on the psychosocial life of patients.Methods: This cross-sectional and descriptive study was carried out at Şişli Hamidiye Etfal Training and Research Hospital, with inpatients in the Radiation Oncology Clinic and outpatients in the Chemotherapy Unit between January 12, 2013 and January 12, 2014. The data for the study were collected by face-to-face interviews using the Patient Identification Form, Disease and Alopecia-Related Features Form, and the Chemotherapy-induced Alopecia Quality of Life Scale, of 213 of the patients who faced chemotherapy-induced alopecia. Descriptive statistics for the statistical evaluation of the data and non-parametric tests such as the Mann–Whitney U-test and the Kruskal–Wallis test for independent group comparisons were used.ResultsThe study group consisted mostly of elementary school graduates (71.8%), married (74.2%) and female (73.7%) patients residing in Istanbul. A large number of patients stated that they did not have any complaints when their hair began to fall, while a few patients stated that they felt itching. The Chemotherapy-induced Alopecia Quality of Life Scale average scores (23.9 ± 5.4) were found to be low and quality of life of the patients was negatively affected by their alopecia. Also, the impact of alopecia diminished with increasing level of the patient‘s education. It was found that the alopecia-related quality of life scores were lower for the patients who were already wearing a headscarf before illness, compared to the patients who started to wear a headscarf after illness.ConclusionIn conclusion, chemotherapy-induced alopecia is an important problem affecting the psychosocial life of patients.

Evaluation of the Diagnostic Performance of Different Principles of SARS-CoV-2 Commercial Antibody Tests in COVID-19 Patients

Following the emergence of severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) and using only PCR for diagnosis, antibody tests have been rapidly developed by various commercial companies. There are differences between the sensitivity and specificity of these tests due to the usage of different viral target proteins and antibody subclasses. In order to evaluate the diagnostic use of these tests, we aimed to examine the diagnostic performance, especially sensitivity and specificity, of SARS-CoV-2 IgM, IgA and IgG tests of various companies (Abbott, Roche, Euroimmun, Dia.Pro, Anshlabs, Vircell, UnScience and RedCell), which have different principles (ECLIA/CLIA, EIA, LFA). Current (n= 180) and past (n= 180) COVID-19 patients with clinical and molecular diagnosis of COVID-19 admitted to Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine Hospital, Pandemic Polyclinic with suspected COVID-19 infection, were included in our study. The patients admitted within the first 3 weeks after the onset of symptoms were included in the current patient group, and those admitted at the third and after the third week were included in the past patient group. Serum samples (n= 180) obtained from Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Blood Center between April and June 2018 before the COVID-19 pandemic were included in the study as a control group. All the tests included in our study were studied with the recommendations of the manufacturer companies. Between the IgG detection tests with different principles in patients with past COVID-19, the sensitivity and specificity values of the most effective tests were; 86.7%/99.4% (Abbott), 86.1%/98.9% (Dia.Pro), 91.3%/95% (RedCell). Between the IgM detection tests with different principles in current COVID-19 patients, the sensitivity and specificity values were; 67.8%/99.4% (Abbott), 68.9%/98.6% (Vircell), 50%/97.5% (RedCell). Abbott IgM with a kappa coefficient of 0.67 and Vircell IgM + IgA test with a kappa coefficient of 0.65 showed the best fit in patients with current COVID-19 infection. In patients with past COVID-19, Abbott IgG with 0.86 kappa coefficient and Dia.Pro IgG test with 0.85 kappa coefficient showed the best match. Due to the low sensitivity of IgM detection antibody tests, they should not be preferred instead of real-time reverse transcriptase polymerase chain reaction in routine diagnosis. IgG detection tests may be preferred to detect the antibody response and the titers in people who have had COVID-19 for population seroprevalence and especially therapeutic immune plasma production. However, it is thought that the combined use of both ECLIA/CLIA-based and EIA/ELISA-based tests together may be more effective in routine use for SARS-CoV-2 IgG tests.

Evaluation of Human Epidermal Growth Factor Receptor 2 Overexpression, Clinicopathological Characteristics, and Factors Affecting Survival in Gastric Cancer.

Objectives:The objective of the study was to evaluate the human epidermal growth factor receptor 2 (HER2) overexpression, clinicopathological features, and factors affecting survival in patients with gastric cancer.Methods:The study is a retrospective study conducted with 128 cases of gastric cancer who were admitted to Şişli Hamidiye Etfal Training and Research Hospital between 2005 and 2012. Patients’ demographic characteristics, performance score, tumor localization, information about surgery, HER2 measurements, histopathological characteristics, stage, treatment features, metastasis sites, and overall survival time were obtained from medical records. Immunohistochemical analysis was performed for HER2 scoring.Results:There were 89 (69.5%) men and 39 (30.5%) women in the study group, and the median age of the patients was 64 years. The median survival time of the patients was 24.43 months. The survival rate of the patients was calculated as 35.4±5.9%. Overall survival time was found to be shorter in the group with higher HER2 levels and also those with advanced-stage cancer. The survival rate was found to be significantly lower in patients with perineural invasion and advanced stage. However, the survival rate was not associated with lymphovascular invasion, surgical margin involvement, and HER2 levels. In the multivariate Cox Regression analysis performed to assess the effects of gender, histological subtype, stage, and surgical margin on overall survival, disease stage was found to be the only factor effective on survival. Gender, histological subtype, and the surgical margin did not affect prognosis.Conclusion:The survival rate in gastric cancers was found to be lower in those with advanced-stage disease. Higher HER2 level and the disease stage were associated with shorter overall survival time.

Nosocomial Infection Agents of Şişli Hamidiye Etfal Training and Research Hospital: Comparison of 1995 and 2017 Data.

Nosocomial Infection Agents of Şişli Hamidiye Etfal Training and Research Hospital: Comparison of 1995 and 2017 Data.

Ventriculo-Peritoneal Shunt Infections in a Tertiary Center, 3 Years Experience

Objective: Ventriculo-peritoneal shunt infection is the most important complication of shunt applications. In pediatric age, shunt infections are associated with shunt dysfunction, requirement for shunt revision, neurodevelopmental delay, prolonged hospital stay, and high treatment costs. In this study, we aimed to evaluate the characteristics of shunt infections of our patients and to compare the differences between early and late infections, infections caused by staphylococci and other strains and infection that did and did not recur. Methods: In this retrospective study, shunt infections treated in the Pediatric Infection Clinic of Hamidiye Etfal Training and Research Hospital between July 2008 and July 2011 were evaluated. Results: Forty-seven shunt infections in 42 patients were evaluated. Congenital anomalies were the most common etiology of hydrocephalus and fever was the most common symptom of the patients. Higher rates of early shunt infections, shunt infections in early childhood and infections caused by staphylococci species were observed. Patients with infections caused by staphylococci species received shorter duration of antibiotherapy (p=0.024). Infections that recurred in the six months of follow-up had higher rates of positive blood cultures (p=0.022). There was no statistically significant difference between early and late-term shunt infections. Conclusion: Shunt infections were evaluated in different aspects in our study. Direct colonization of the shunt catheter still seems to be most important cause for the shunt infections because early infections and infections caused by skin flora were more common in our patient group.

Evaluation of Knowledge, Attitudes and Behaviors of Physicians on Vaccine and Anti-vaccination

Introduction: Anti-vaccination movement is an increasing public health problem at present. Healthcare providers play an important role to solve this movement. The knowledge level of healthcare providers about vaccines has an effect on vaccine recommendations, and this affects not only individuals but also public health. This study aimed to evaluate the knowledge level and attitudes and behaviors of medical practitioners about vaccines and anti-vaccination. Materials and Methods: This study is single-centered, prospective and cross-sectional. The sample size was calculated with sample size estimation method in simple random sampling from medical practitioners working at University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital as of October 2018. Statistical significance was set at p&lt; 0.05. Results: Two hundred and eighty-four medical doctors participated in this study. Sixty-two of the 284 (21.8%) physicians were family practitioners, 51 of 284 (18%) were pediatricians, 51 of 284 (18%) were surgery practitioners and 120 of 284 (42.3%) were from other clinical departments. Thirty-two of the participants (11.3%) were under the assumption that vaccines could cause autism. Five of the participants (1.8%) were under the assumption that the ratio of severe complications after vaccination is 5-10%, and 36 of them (12.7%) were under assumption that this ratio is 1-5%. There were various concerns about the vaccines including the ingredients of the vaccines (77 participants 27.1%), proper storage of the vaccines (35 of participants 12.3%) and production of vthe accines in other countries (90 of participants 31.7%).Two hundered and sixty-one of participants (91.9%) thought that vaccination of children should be legally mandatory. Conclusion: There is a need for regular educational programs on vaccines before and after graduation in order to eliminate the lack of knowledge and concerns of physicians about vaccination.