Pamukkale University Hospital Research Articles

Platelet apheresis donation: Demographic findings, processing and harvest properties

Purpose:The aim of the study is to evaluate the demographic findings of healthy volunteer donors who presented to the blood center in Pamukkale University Faculty of Medicine and the properties of obtained products from the donors. Materials and methods:Apheresis platelet donors who donated to the Pamukkale University Hospital Blood Bank between February 2013 and May 2014 were evaluated. The demographic findings, processing and harvest properties of those volunteer platelet apheresis donors determined as eligible were analyzed. Results: A total of 1717 persons were found to be eligible for plateletapheresis donations; 1680 (%97,8) male and 37 (%2,2) female. Median age was 35 (18-60) years; median height was 174 (151-193) cm, median weight was found to be 81 (56-114) kg. After plateletapheresis, product variables were analysed, single plateletapheresis suspension median volume was 285 (140-350) ml and platelet yield was found to be 3,3 (2,2-4,5) /1011. Double plateletapheresis suspension median volume was 570 (410-600) ml and platelet yield was found 6,0 (4,5-6,2) /1011. Conclusion: A sufficient amount of platelet products was obtained from the donors who donated to the Hospital Blood Bank between February 2013 and May 2014. Especially, this study seems to support plateletapheresis, where both arms are used, because of the high product and platelet yield. Pam Med J 2015;8(1):19-22

Assessment of the relation of violence and burnout among physicians working in the emergency departments in Turkey.

Violence and burnout are frequently seen among medical doctors; however, the relation is not clear. This study aimed to assess the violence and its possible effects on burnout in physicians working in emergency units. This cross-sectional study targeted all physicians working in the emergency units of Pamukkale University Hospital, County and City Hospitals, 112 Emergency Services, and Private Hospitals in Denizli. Data were obtained by means of a self-administered questionnaire that consisted of questions on the demographics of the participants, Turkish version of the Maslach Burnout Inventory, and of the perpetrators of violence. What was also documented on the questionnaire was whether participants had been subjected to or had witnessed any verbal or physical violence during the previous one month of emergency physicians' certification program. A total of one hundred and seventy-four physicians were included into the study (85% of the targeted group). Many of the participants were between 24 and 59 years of age, with a mean age of 36.8±5.8 years. Married male doctors working in the City Hospital made up the majority. There were significant associations between emotional exhaustion and total violence (p=0.012) and verbal violence (p=0.016); depersonalization and total violence (p=0.021) and verbal violence (p=0.012). The results presented here indicated that there was a strong relation between burnout and violence experienced by physicians working in emergency units. Violence in the emergency department has a substantial effect on the physicians' well-being.

HIF1A as a major vascular endothelial growth factor regulator: do its polymorphisms have an association with age-related macular degeneration?

To investigate the association between age-related macular degeneration (AMD) and the polymorphisms of HIF1A, a major vascular epithelial growth factor regulator under hypoxic conditions. The associations of AMD and polymorphisms of genes CFH, SKIV2L and MYRIP were also studied. Prospective study. Eighty-seven AMD patients and 80 healthy subjects admitted to the Department of Ophthalmology at Pamukkale University Hospital, Denizli, Turkey, were included: 45 (52%) had wet type AMD, and 42 (48%) had dry type AMD. Polymorphisms rs1061170 (CFH), rs429608 (SKIV2L), rs2679798 (MYRIP) and both rs11549465 and rs11549467 (HIF1A) were investigated in DNA isolated from peripheral blood samples of the cases and controls by dye-termination DNA sequencing. Genotype distribution of rs1061170 (CFH), rs429608 (SKIV2L), rs2679798 (MYRIP) and both rs11549465 and rs11549467 (HIF1A) in AMD cases and healthy controls; association between genotypes and AMD subtypes. Given the significant difference between the mean age of case and control groups (72.13 ± 5.77 vs. 62.80 ± 5.22, respectively) (P = .000), subsequent analyses were adjusted for age. We found that having at least one C allele for polymorphism rs1061170 increases AMD risk independent of age (OR = 2.42, 95% confidence interval [CI], 1.22-4.81). The ancestral T allele for polymorphism rs1061170 has a protective effect for AMD (OR = 0.53, 95% CI, 0.34-0.83). No statistically significant difference for distributions of other single nucleotide polymorphisms (SNPs) emerged between patients and healthy subjects. No associations appeared between HIF1A SNPs and AMD, which were studied here for the first time; however, polymorphism rs1061170 of the CFH gene is associated with AMD in our population.

Pamukkale Üniversitesi Hastanesi Dahili Tıp Bilimlerinde Çalışan Araştırma Görevlilerinin Akılcı İlaç Kullanımı Konusundaki Bilgi ve Tutumları

Amaç: Çalışmamızda Pamukkale Üniversitesi Tıp Fakültesi Hastanesi dahili tıp bilimlerinde çalışan araştırma görevlisi doktorların akılcı ilaç kullanımı (AİK) konusunda, bilgi ve tutumlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmamız kesitsel tipte bir araştırma olup; 2013 yılı Ağustos ayında yapılmıştır. Araştırmanın evrenini Pamukkale Üniversitesi Tıp Fakültesi Hastanesi dahili tıp bilimlerinde çalışan 165 asistan hekim oluşturmaktadır. Veriler, araştırmacılar tarafından hazırlanan akılcı ilaç kullanımı bilgi ve tutumunu değerlendiren 51 soruluk bir anketle toplanmıştır. Bulgular: AİK konusunda kendisini yeterli bulanların oranı % 28.8, kısmen yeterli bulanların oranı % 60.6, yetersiz bulanların oranı % 10.6’ dır. AİK ile ilgili kurs, seminer vs. almak isteyenlerin oranı % 62.9’ dur. Çalışmaya katılan asistan hekimlerden ‘’Hastaya hastalığını ve nedenlerini anlatırım’’ diyenlerin oranı % 92.3’ dür. ‘’Hastaya tedavi uygulama gerekçelerini anlatırım’’ diyenlerin oranı % 88.5 ’dir. ‘’Yazdığım ilaçlarla ilgili bilgi veririm’’ diyenlerin oranı % 84.6’dır. İlaçlarla ilgili güncel bilgi öğrenmede en sık internet (%62.0) kullanılmaktadır. Sonuç: Üçüncü basamak sağlık kuruluşunda yaptığımız bu çalışmada, hekimlerin AİK konusunda kendilerini yeterli bulma durumları düşük çıkmıştır. Bu sebeple sürekli tıp eğitimi kapsamında bilgilendirilmeleri gerekmektedir. Hekimlerin ilaçlarla ilgili güncel bilgi öğrenme aracı olarak internet ve dijital bilgi kaynaklarını daha çok tercih ettiklerini göstermiştir. Bu sebepten AİK eğitimleri ve bilgilendirme için bu kaynakların kullanılması daha uygundur.

Patients' Satisfaction at Tertiary Care

Purpose: Assessing quality and efficacy in health care services through patients’ satisfaction questionnaires is a method reflecting patients’ opinions. This study aims to investigate patients’ satisfaction status at a tertiary health facility. Materials and methods: This study was conducted from May to June 2013 at the Pamukkale University Hospital including 102 patients. A questionnaire, prepared after literature research and discussions among authors, was used. The questionnaire consisted of two parts containing 7 and 14 items. The first part included demographical items and the second part included the patients’ satisfaction status. Patients in the waiting rooms were asked to participate in the questionnaire and a face-to-face method was used after acceptance. The questionnaire took approximately 4 minutes to complete and the names of patients were not required. Results: In the majority (78.4%), patients were satisfied with the health care services. 73.5% of the patients noted that the consulting physician listened carefully to them. 70.6% stated that they were not able to choose the physician and 59.8% stated that they were not able to see a physician in 15 minutes. Adverse effects of medication prescribed were not mentioned in 66.7% of the consultations. Conclusion: Factors effecting satisfaction status positively were caring and time sparing physician, cleanliness and comfort of the environment, polite and respectful care, respect for intimacy and informative care. Sex, educational level and income were not effective on patients’ satisfaction status. The preference for a physician, counselling about drug adverse effects and consultation waiting times were not related to satisfaction levels. The need for further research into patients’ satisfaction is obvious. Pam Med J 2014;7(1):57-62

Mental health screening and increased risk for anxiety and depression among treatment-seeking smokers.

BackgroundThe aim of this study was to compare the risk for mental health disorders between smokers and non-smokers and to assess the risk for depression and anxiety according to addiction severity.MethodsThis cross-sectional study assesses the mental health status and relationship with the severity of nicotine addiction in a sample of smokers admitted to Pamukkale University Hospital Smoking Cessation Clinic (n = 101) from 1 June 2012 to 31 August 2012 compared to a group of non-smokers from the general population (n = 101). We conducted semi-structured face-to-face interviews to collect sociodemographic data; we assessed the participants’ mental health status with the General Health Questionnaire-12 (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS), and we measured nicotine addiction severity with the Fagerström Test.ResultsThe risk for mental illness reported by smokers based on the GHQ-12 was significantly higher than that for non-smokers (p = 0.001). The anxiety and depression scores according to HADS were higher among smokers (16.8% and 22.8%, respectively) than non-smokers (4.0% and 5.0%, respectively) (p = 0.006 and p = 0.001, respectively). The nicotine addiction severity was higher in smokers with higher anxiety and depression scores (p = 0.008).ConclusionsWe found high scores for mental illness in treatment-seeking smokers compared with non-smokers. The risk for anxiety and depression was higher among smokers. Increased nicotine addiction severity was associated with increased risk for mental illness and increased scores of anxiety and depression.

Costs of treatment, follow-up, and complications of chronic hepatitis B and hepatitis C infections.

Few studies have addressed the indirect costs of chronic hepatitis B and C, and none has assessed the real costs of these conditions, including indirect costs caused by loss of work, in Turkey. This study therefore analysed the costs of treatment, follow-up, and complications of chronic hepatitis B and hepatitis C infections to the community. Cross-sectional study. This study analysed patients with chronic hepatitis B and hepatitis C treated at Pamukkale University Hospital Infectious Diseases and Clinical Microbiology Clinic, Denizli, Turkey between June 2009 and June 2010. Costs of antiviral treatment and follow-up were calculated from patients' medical records, and indirect costs were analysed from questionnaires completed by patients. Data were analysed for 284 patients with chronic viral hepatitis. Indirect, hospital, treatment and total expenses were significantly higher for patients with chronic hepatitis B than for inactive hepatitis B virus carriers and patients with chronic hepatitis C. Hospital and total expenses of patients with complications were significantly higher than for patients with chronic hepatitis C. Hospital and total expenses were significantly higher for patients with than for individuals without cirrhosis. Indirect, hospital, treatment and total costs of patients were significantly higher for patients receiving combination therapy than monotherapy. Reducing the costs to society of chronic hepatitis requires the development of protection and screening programs.

Saphenous vein graft aneurysm in a young patient with familial dyslipidemia

DOI 10.1007/s00059-012-3740-8 Received: 1 November 2012 Accepted: 2 December 2012 Published online: 23 January 2013 © Urban & Vogel 2013 I.D. Kilic1 · Y.I. Alihanoglu1 · Y. Alsancak2 · O. Coskun3 · B. Emrecan3 1 Medical Faculty, Department of Cardiology, Pamukkale University Hospital, Denizli 2 Medical Faculty, Department of Cardiology, Gazi University, Ankara 3 Medical Faculty, Department of Cardiovascular Surgery, Pamukkale University, Denizli

The Real Meaning of the World Federation of Neurological Societies 2013 Meeting in Seoul

The Real Meaning of the World Federation of Neurological Societies 2013 Meeting in Seoul

What would be left behind if subtotal thyroidectomy were preferred instead of total thyroidectomy?

Background The choice between subtotal thyroidectomy (STT) and total thyroidectomy (TT) for multinodular goiter (MNG) remains controversial. Methods Thyroid tissue samples of 34 patients who underwent TT for multinodular disease between October 2005 and June 2007 in Pamukkale University Hospital, Department of General Surgery were evaluated. Thyroid tissues weighing 2 g each from either side were separated from the main specimen to simulate the tissues that would be left behind if a subtotal resection were performed instead of a total resection. Ki-67 staining was performed. Results The mean age of subjects was 49.3 ± 12 years and 25 (73.5%) were females. Papillary microcarcinomas were found in 4 patients, 1 of which was in a residual thyroid specimen (RTS). Micronodule formations were found in 73.5% of specimens simulating residual thyroid. While Ki-67 indexes of residual thyroid tissues were 4.65% in nodules and 1.91% in normal areas ( P < .05), they were 5.42% and 2.84%, respectively, for nodular and normal areas in the main specimens ( P < .05). Conclusion Remnant thyroid tissues, following STT, have a high percentage of micronodule formation with a remarkable cellular proliferative activity.

Evaluation of febrile neutropenic attacks in a tertiary care medical center in Turkey

Infectious complications in febrile neutropenic patients are still major causes of morbidity and mortality despite significant advances in diagnostic techniques and antimicrobial therapy. In this study, we describe the characteristics of patients with hematological malignancies who were evaluated for suspected infection. This study was also conducted to assess the isolation rate of bacterial and fungal causative agents in febrile neutropenic attacks. The study was conducted at Pamukkale University Hospital, Turkey. In order to identify the characteristics of patients with hematological malignancies in the presence/suspicion of any accompanying infectious disease, patients' charts with hematological malignancies were reviewed for signs/symptoms of any infection between October 1, 2001, and May 31, 2005, retrospectively. Overall, 90 infectious episodes occurred in 59 patients. The most common underlying diseases were acute myelogenous leukemia (61.0%) and acute lymphocytic leukemia (15.3%). The absolute neutrophil count was lower than 100/mm(3) in 33 (36.7%) episodes. Microbiologically and clinically documented infections and fever of unknown origin were observed in 35.6%, 28.9%, and 35.6% of the participants, respectively. Bloodstream infections and pneumonia were detected in 21.1% and 18.9% of episodes, respectively. Gram negative organisms were most common (58.4%), followed by gram positive cocci. A combination of third generation cephalosporin and an aminoglycoside were used in 44.4% of episodes initially. Fever resolved in 24.4% of episodes using the initial therapy. The mortality rate was 15.6%. These results showed that infections with gram-negative bacteria continue to predominate in febrile neutopenic episodes in our center.

Evaluation of Device Associated Infection Rates in Intensive Care Units of Pamukkale University Hospital

Intensive care units (ICUs) are unfortunately the epicenters of nosocomial infections. The aim of the study was to investigate device associated infection rates in a small Turkish hospital. Device utilization ratios and device associated infection rates were calculated according to definitions of the Centers for Disease Control (CDC). During a period of 24 months 1,387 patients were surveyed in our ICUs. A total of 287 device associated infections were detected. In our study ventilator associated pneumonia was the most frequent nosocomial infection with a rate of 59.7 per 1,000 ventilator days. The most frequent pathogen of device associated infection was Candida spp. High rates of device associated infections in a small Turkish hospital clearly indicate the urgent need of the implementation of infection control guidelines.

A study of depression and anxiety among doctors working in emergency units in Denizli, Turkey

Background: Major work has been carried out on the psychological well-being of emergency room doctors in the US, Canada and in other developed countries, but little has been published regarding...

Hemoptysis developing soon after use of sildenafil: an observation on two cases

Our group from Pamukkale University Hospital would like to present an observation on hemoptysis that was probably associated with sildenafil usage in two patients. Since hemoptysis occurred immediately the drug was taken and has not recurred following the discontinuation of the drug. We think that after eliminating other risk factors, sildenafil might be a probable cause of transient hemoptysis.

Surgical Antibiotic Prophylaxis in a Turkish University Hospital

A prospective study was performed to assess the practice of antibiotic prophylaxis for surgical procedures in Pamukkale University Hospital, Denizli, Turkey. All surgical procedures performed between April 1 and July 31, 2001, were included. During the study period 897 operations were reviewed. 96% of all procedures were elective, 4% emergencies. Approximately 70.7% were clean surgery, 25.3% clean-contaminated, 2.8% contaminated, and 1.2% dirty. 98% of patients (879) received antibiotic prophylaxis. Although timing of prophylaxis was appropriate in all procedures, the duration of prophylaxis was optimal in only 47.7% of all cases. Sulbactam/ampicillin (SAM), cefazolin and cefepime were the most commonly used antibiotics during the study period. The results of our study suggest that the choice of prophylactic antimicrobial agent was inappropriate in most cases. In conclusion, we think that compliance regarding the optimal choice, frequency, and duration of perioperative antibiotic prophylaxis is not adequate in our hospital, and that more education on the subject is necessary.