Turgut Ozal Medical Center Research Articles

Effects of extracorporeal photopheresis on survival in chronic graft versus host disease

ABSTRACT Objective: Chronic graft versus host disease (cGVHD) develops after allogeneic hematopoietic cell transplantation, when immune cells from a non-identical donor initiate an immune reaction against the transplant recipient. Extracorporeal photopheresis (ECP) can be used in combination with prednisone in steroid-resistant cGVHD. In this study, the effect of ECP use on survival in cGVHD was examined. Patients and Methods: Twenty-six patients who were followed up in the adult Hematology Clinic of Inonu University Turgut Ozal Medical Center for cGVHD were included in the study. Stem cell transplantation and ECP application parameters that may affect the survival of the patients were examined. Results: The degree of involvement in cGVHD affects survival. Involvements with clinical and laboratory scores of 2 and above according to the National Institutes of Health consensus criteria, significantly reduced survival. The development time of cGVHD was found to be associated with survival, and that it had a positive impact on survival, especially when the disease developed after 220 days after the transplantation. It was observed that steroid dose taken during ECP, patient age and cGVHD prophylaxis used affected survival. Conclusion: The use of ECP may be effective in survival, especially, in patients who develop cGVHD, 220 days after allogeneic transplantation. Concurrent use of steroids with ECP affects survival.

Evaluation of busulfan, cyclophosphamide, and etoposide as a preparation regimen for autologous stem cell transplantation in Hodgkin’s lymphoma patients

Abstract: BACKGROUND: Hodgkin’s lymphoma (HL) exhibits a cure rate of 90% in patients diagnosed at an early stage and a cure rate ranging from 70% to 90% in patients diagnosed at an advanced stage. In the case of patients with relapsed/refractory HL (r/rHL), it is recommended to provide salvage chemotherapy initially, followed by autologous stem cell transplantation (ASCT). The ideal conditioning regimen for the transplantation process is still being investigated. OBJECTIVES: For individuals with r/rHL, high-dose chemotherapy combined with ASCT (HD-ASCT) is thought to be the most effective method of treatment. The purpose of this research was to evaluate the effectiveness and safety of the busulfan, cyclophosphamide, and etoposide (BuCyE) preparation regimen in r/rHL patients. MATERIALS AND METHODS: Retrospective analysis was conducted on the data of 67 lymphoma patients older than 18 years who had HD-ASCT with the BuCyE conditioning regimen between September 2014 and November 2021 (86 months). The research consisted of 34 r/r HL patients among them. A parenteral regimen of 0.8 mg/kg of busulfan every 6 h from day −7 to day −5, 50 mg/kg of cyclophosphamide on days −3 and −2, and 400 mg/m2 of etoposide on days −5 and −4 comprised the patient preparation regimen before ASCT. All data were collected from inpatient files and the Inonu University Turgut Ozal Medical Center Hospital Information System. RESULTS: The median age of the patients was 43 years, and 67.6% were males. The most common type of HL was nodular sclerosis, which was followed by mixed cellularity. The median time for platelet and neutrophil engraftment was 14 and 11 days, respectively. 5.0 × 106/kg was the median transplanted dose of CD34+ cells (2.1–13.55). Liver toxicity was observed in 6 (17.6%) patients. Eight patients suffered from pulmonary side effects. The median number of previous chemotherapies was 2 (2–4). In all lymphoma patients, the complete response rate was 61.8% (n = 21), whereas the disease progression rate was 32.3% (n = 11). Transplantation-related mortality on the 100th day was 8.8% (n = 3). Three-year overall survival was 57.17%. CONCLUSION: When the literature was reviewed, the studies with the BuCyE preparation regimen in patients with r/rHL were limited. This conditioning regimen was found to have fewer side effects and a lower cost. It can be preferable when compared to carmustine (BCNU), etoposide, cytarabine (ARA-C), and melphalan (known as BEAM) in r/rHL.

The effect of thrombocytapheresis on hemogram and biochemistry parameters in patients with essential thrombocytemia.

Essential thrombocythemia is one of the chronic myeloproliferative neoplasms characterized by clonal proliferation of myeloid cells with variable morphological maturation and hematopoietic activity.It is characterized by excessive clonal platelet production with a tendency to thrombosis and bleeding. Thrombocytapheresıs is the removal of platelets by apheresis techniques. Thrombocytapheresıs is generally recommended in patients with essential thrombocythemia with acute, severe thrombotic or hemorrhagic events. The study included 39 patients who were diagnosed with essential thrombocythemia, started cytoreductive and aspirin therapy, and underwent thrombocytapheresıs due to the development of acute severe thrombotic or hemorrhagic events, diagnosed in the adult hematology clinic of İnönü University Turgut Ozal Medical Center. Hemogram and biochemistry values of the patients were scanned retrospectively. After thrombocytapheresıs, a statistically significant difference was found between the first and last measurements of hemoglobin, mean platelet volume, White blood cell, neutrophil, platelet, platelet distribution width, creatine, lactate dehydrogenase, fibronogen and calcium levels of the patients. The use of thrombocytapheresıs in patients with essential thrombocytosis causes a rapid decrease in platelet values as well as an effect on hemogram and biochemistry parameters. Other hemogram and biochemistry parameters such as platelet value should be monitored in patients.

Effect of troponin I and coagulation parameters on mortality in COVID-19 patients

Objective: Our aim is to determine the levels of troponin-I and some coagulation markers (D-dimer, fibrinogen and International Normalized Ratio (INR)) in coronavirus disease 2019 (COVID-19) patients and to investigate the effects of these markers on mortality.
 Patients and Methods: It is planned as a descriptive, cross-sectional and analytical study. The study was conducted by retrospectively scanning the files of COVID-19 patients who applied to Inonu University Turgut Ozal Medical Center between 01.03.2020 and 31.12.2020. Levels of cardiac troponin I markers and coagulation parameters (D-dimer, fibrinogen and INR) were detected.
 Results: The results of a total of 1858 patients were obtained. One thousand, three hundred and twenty-six patients with only troponin I and D-dimer results (Group 1), 606 patients with only troponin I and fibrinogen results (Group 2), and 1308 patients with only troponin I and INR results (Group 3) were included. Troponin I levels were significantly higher in all patients who died. 96.6% of the patients with high D-dimer levels died in Group 1, 85.5% of the patients with high fibrinogen levels died in Group 2 and 77.3 % of the patients with high INR levels died in Group 3. 
 Conclusion: Measurements of troponin-I and coagulation markers such as D-dimer, fibrinogen and INR can help predict clinical severity and mortality in COVID-19 patients.

LONG TERM FUNCTIONAL GRAFT SURVIVAL RESULTS OF THE 3RD STAGE SINGLE CENTRE LIVING AND CADAVERIC DONOR TRANSPLANTS.

ABSTRACT Aim: Kidney transplantation is the most optimal end stage renal disease (ESRD) treatment. It is more advantageous treatment regard to both its effect on the patient’s life quality or mortality. The number of patients who underwent or followed after renal transplant is constantly increasing while their survival becomes a topic more frequently. Different centers therefore report different survival rates in the post-transplantation process. In this study, the transplantation progress and the functional graft survival rates of the patients who have received renal transplants and are followed in our center and the factors which influence the survival rates are explored. Materials and methods: The patients over 18 years old who applied to Inonu University Turgut Ozal Medical Center Nephrology Department Policlinics who received transplants retrospectively analyzed. Results: While the median for the functional graft period of the patients were 84.8 months, the longest was found to be 324 months. The grafts of our 77% patients are functional, while 3.7% are exitus with functional graft due to various reasons. 5.3% of the patients received HD again, 3% started PD and 1.3% underwent retransplantation Conclusions: While the number of transplants are increasing day by day in Turkey, studies on the long term functional graft survival results and the patients’ pre- and post-transplant characteristics are limited and there is not much literature data related to Turkey. We aimed to contribute to the literature with our data. Also, the duration of ESRD increases, the lower is the functional graft time significantly. The preferred ESRD treatment should, therefore, be renal transplantation. Renal transplants could be preferred in suitable patients or donors of advanced age, and transplant age spectrum could be extended.

A comparison of multivariate statistical methods to detect risk factors for Type 2 diabetes mellitus

Aim: The goal of this study is to compare the performances of Logistic Regression (LR), Artificial Neural Networks (ANN) and Decision Tree models, which are machine learning classification methods, in the diagnosis of Type 2 Diabetes Mellitus (DM) and to determine the most successful method. It is also the examination of risk factors affecting Type 2 DM using these models. Method: The study's data was collected from patients who visited the Diabetes and Thyroid polyclinic at the Inonu University Faculty of Medicine Turgut Ozal Medical Center, Department of Internal Medicine. The k-Nearest Neighbor algorithm, which is one of the missing value assignment methods, was used to eliminate the problems related to missing values. Sensitivity, accuracy, precision, specificity, AUC F1-score, and classification error were used as performance evaluation criteria. Evolutionary algorithm parameter optimization method was used to optimize the parameters of the ANN model. Missing value assignment, modeling and parameter optimization were done with Rapidminer Studio Free version 8.1. Results: Among the three methods applied in the diagnosis of Type 2 DM, the ANN gave the best classification performance. The accuracy, sensitivity, selectivity, precision, F1-score, AUC and classification error values obtained from this method are respectively; 98.94%, 100%, 97.73%, 98.04%, 99.01%, 0.978 and 1.06. For the ANN method, the importance values of the gender, long-term drug use, family history, concomitant disease, cortisone use, stress factor, high blood pressure, smoking, high cholesterol, heart disease, exercise status, carbohydrate use, alcohol consumption, vegetable use, meat use, age, weight, height, starting age, daily bread consumption, LDL, HDL, Total Cholesterol, Triglyceride, Fasting blood sugar the importance values of independent variables are respectively; 0.017, 0.009, 0.013, 0.017, 0.008, 0.016, 0.008, 0.006, 0.053, 0.024, 0.023, 0.040, 0.007, 0.020, 0.007, 0.046, 0.083, 0.049, 0.024, 0.066, 0.084, 0.083, 0.020, 0.031, 0.244. Conclusion: According to the performance criteria obtained from the three classification models used to predict Type 2 DM; it has been found that the best classification performance belongs to the ANN model. According to the ANN method, the three most important risk factors that may cause Type 2 DM were found to be fasting blood glucose, LDL, and HDL, respectively.

Post-traumatic stress disorder and related psychopathology in parents of children with epilepsy

Mental difficulties and psychiatric illnesses are common in families of children with epilepsy. The aim of this study is to investigate the prevalence and possible risk factors of post-traumatic stress disorder, depression, and anxiety in a sample of parents of children with epilepsy. Parents of children with epilepsy who presented to Turgut Ozal Medical Center Pediatric Neurology Outpatient Treatment Unit between January and March 2023 were invited to this cross-sectional study. Participants filled out a questionnaire examining demographic variables. Depression and anxiety levels were evaluated with the Hospital Anxiety and Depression Scale (HAD-S), and post-traumatic stress levels were evaluated with the Post-Traumatic Stress Disorder short scale (PTSD-short scale). A total of 89 parents, including 47 mothers, and 42 fathers, participated in the study. Of the study participants, 10.11% were at risk for depression and 3.4% for anxiety disorder. 6.7% had PTSD. There was a positive correlation between HAD-S subscale scores and PTSD-short scale scores. According to the linear regression model, PTSD was negatively correlated with having a job and education level, and positively correlated with anxiety and depression. Anxiety and depression were only associated with PTSD. Parents of epileptic children are at risk for PTSD, depression, and anxiety. Clinicians need to identify at-risk parents at an early stage and develop specific assist-oriented intervention programs to provide systematic support.

PROGNOSTIC VALUE OF NEUTROPHIL / LYMPHOCYTE, PLATELET / LYMPHOCYTE, AND MPV IN PATIENTS DIAGNOSED WITH PULMONARY EMBOLI

Aim: Pulmonary Embolism (PE) is an obstructive disease of the pulmonary arterial system of varying degrees and localization and usually stems from the embolization of the thrombus or non-thrombotic substances originating from the deep veins of the lower extremities. Pulmonary embolism is a preventable disease that has a high probability of recurrence, high mortality, and morbidity. The differential diagnosis and clinical treatment of pulmonary embolism have a very important place in emergency service applications. The purpose of the present study was to retrospectively examine the patients who applied to Inonu University Turgut Ozal Medical Center Emergency Service between 2014 and 2019 and were diagnosed with PE. Materials and Methods: In the present study, the data were collected retrospectively from a total of 144 patients including 80 female and 64 male patients who applied to Turgut Ozal Medical Center (TOTM) Emergency Department with the complaints of sweating, chest pain, cough, hemoptysis, and syncope between January 2014 and August 2019 and diagnosed with PE with the I-26 diagnostic code according to the ICD 10 coding system. The quantitative data obtained from the patients were summarized as mean and standard deviation or median, as well as minimum and maximum, and the qualitative data were summarized as numbers and percentages. The compatibility of the data with the normal distribution was evaluated with the Kolmogorov Smirnov test and the homogeneity of the variances was examined with the Levene test. The Independent Samples t-test and Mann Whitney U test were used to analyze the data. The IBM SPSS Statistics version 26.0 for Windows package program was used in the analyses. A P<0.05 value was taken as statistically significant. Results: No significant differences were detected in terms of systolic arterial blood pressure, diastolic arterial blood pressure, and laboratory variables of leukocyte, lymphocyte, neutrophil, neutrophil/lymphocyte, and platelet/lymphocyte ratios between the PE patients with and without right ventricular dilatation on ECHO. Statistically significant differences were detected for platelet, MPV, and CRP between the patients with and without right ventricular dilatation in ECHO. Conclusion: It is considered that these findings will provide data on the prognosis and general condition of patients and will help the clinician to make an earlier and easier prediction about the clinical prognosis of patients.

Distribution of intestinal parasites in patients applied to Inonu University Turgut Ozal Medical Center Parasitology Laboratory between 2018-2022

Distribution of intestinal parasites in patients applied to Inonu University Turgut Ozal Medical Center Parasitology Laboratory between 2018-2022

Evaluation of Doctors’ Knowledge of Rational Laboratory Use, A Descriptive Study From Turkey

Objective: The effects of health expenditures on the economy of countries have become more evident in recent years. Especially unnecessary and inappropriate laboratory tests increase both the cost and the workload. In this study, it was aimed to evaluate the level of knowledge of physicians about rational laboratory use and procedure for frequently ordered tests in clinical practice.
 Methods: This study was planned to be a descriptive study. A questionnaire based on the current circular about 'Rational Laboratory Use' and including sociodemographic data was applied to physicians working at Turgut Ozal Medical Center.
 Results: The questionnaire was applied to a total of 400 physicians working in internal medicine and surgical branches. The average age of the physicians was 33.01 ± 5.97 (min = 22, max = 59) years. The question about order period of blood lipids was answered correctly by 3.3% of physicians, HbA1c by 80.8%, Urea / creatinine by 64.5%, and vitamin D and vitamin B12 was answered by 40% of physicians. On the other hand 85.3% of the physicians were not aware of the rational laboratory test ordering procedure and 94% had not received any training on rational laboratory use.
 Conclusions: It was found that physicians had insufficient knowledge about rational laboratory use and they did not receive any training about the test procedures. In order to reduce health expenditures, more training on this subject should be organized for physicians and awareness should be raised.

Knowledge and behaviors of nurses working at Inonu University Turgut Ozal Medical Center on childhood vaccine refusal

ABSTRACT Among 10 global problems of 2019 determined by the World Health Organization, vaccine refusal was one of the problems mentioned. In this context, health services and health personnel whose main objectives are to keep individuals healthy and to prevent diseases have major responsibilities. This study aims to analyze knowledge and behavior of nurses working at Inonu University Turgut Ozal Medical Center on childhood vaccine refusal. This study, conducted between June and July 2019, is a descriptive cross-sectional study. It was conducted in a hospital located in Malatya in eastern Turkey. At the time of the study, 850 nurses work in this hospital. Sample size was calculated to be 263 at a confidence interval of 95% and strength of 80%. Chi-square test and Fisher’s exact test were used in statistical analyses. In the present study, 31.7% of the participating nurses stated that they had concerns about childhood vaccines. Two-thirds of nurses stated that their knowledge on vaccines was from their education. The level of hesitance in those agreeing to the fact that vaccines caused autism and infertility, those stating that they did not trust vaccine-producing companies, and those stating that catching the disease was a better immunization method than vaccination was significantly higher than those not agreeing to these and those who were indecisive (p < .05). One-third of nurses was proven to have hesitance on childhood vaccines, and this rate is rather high. Nurses, being both health personnel and the communication channel for guiding parents, should be provided necessary training and practices in order to ease their hesitance on vaccination.

Kronik Böbrek Yetmezliği, Obezite ve Kanser Hastalarında Vitamin D Düzeyleri Üzerine Bir İnceleme

OBJECTIVE: In our study, it was purposed to research the distribution of vitamin D according to age, sex, and seasons of thepatients diagnosed with obesity, cancer, and chronic renal failure who applied to Inonu University Turgut Ozal Medical Centerbetween 2018-2021.MATERIALS AND METHODS: In our descriptive study, vitamin D measurements from 01.01.2018-01.01.2021 users who visitedInonu University Turgut Ozal Medical Center and were diagnosed with obesity, cancer, and chronic renal failure were scanned intheir files and assessed retrospectively. The patients were grouped according to their sex, age, and seasons in which the sampleswere taken. 25(OH)D levels were analyzed by LC-MS/MS method. The patients were classified as deficient, inadequate, andnormal in terms of vitamin D levelRESULTS: Vitamin D deficiency was monitored in 54.9% (n = 981) of 1787 cancer patients admitted to our hospital, 63.3% (n =558) of 882 chronic renal failure patients, and 65.8% (n = 1903) of 2894 obese patients.CONCLUSION: Of the 5563 obesity, cancer, and chronic renal failure patients who applied to our hospital; vitamin D deficiencywas found in 61.9% (n = 3442), vitamin D deficiency was found in 23.1% (n = 1284), while vitamin D level was found to be normalin only 15% (n = 837). In terms of vitamin D deficiency, the highest deficiency was seen in obese patients with a rate

Evaluation of the relationship between physical activity level and functional capacity, depression and quality of life in patients with knee osteoarthritis

Aim: The aim of this study was to investigate the effects of physical activity level on functional capacity, depression and quality of life in patients with knee osteoarthritis (OA).Materials and Methods: Seventy nine patients who were diagnosed with knee OA according to ACR (American College of Rheumatology) criteria who applied to Inonu University, Turgut Ozal Medical Center, Department of Physical Medicine and Rehabilitation, were included in the study. Radiological stage of knee osteoarthritis was evaluated according to the Kellgren Lawrence score. The patients were divided into two groups as Inadequate Activity Group (IAG) and Physically Active Group (PAG) according to their answers to the International Physical Activity Questionnaire (IPAQ-SF). Patients were evaluated using the ShortForm 36 (SF-36) questionnaire, the Beck Depression Inventory (BDI), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results: WOMAC physical function scores were lower on PAG. The average BDI score of PAG was significantly lower than IAG. The average SF-36 scores in PAG were found to be significantly higher when compared with the IAG (p 0.05).Conclusion: Increased physical activity in patients with knee osteoarthritis; It has positive effects on functional capacity, depression and quality of life.

Eating disorders and related factors of individuals who applied to the diet outpatient clinic of Turgut Ozal Medical Center

Eating disorders and related factors of individuals who applied to the diet outpatient clinic of Turgut Ozal Medical Center

Evaluation of drug poisoning cases in pediatric emergency department

Aim: This study aims to examine the demographic and clinical characteristics of childhood drug poisoning, review changes indiagnostic methods and treatments and identify factors affecting mortality to ultimately determine the present clinical picture. Indoing so, more insight can be provided on the diagnosis, treatment, and prevention of poisonings.Materials and Methods: The retrospective evaluation of 655 patients between ages 1 month-18 years who were admitted to thePediatric Emergency Department of Turgut Ozal Medical Center between January 2009 and June 2016 with cases of drug poisoning(mean 44±18 months).Results: Four hundred and nine female (62.4%) and 246 male patients (37.6%) were evaluated for a total of 655 cases. Drug poisoningcases were found to account for 1.08% of all visits to the emergency department. It was discovered that 62.1% of the poisonings wereaccidental, whereas 33% were suicide attempts and 4.9% therapeutic mistakes. 94.8% of drug poisonings occurred at households,while 5.2% occurred in non-household environments. Drug poisonings presented differences in terms of gender (62.4% female,37.6% male). The number of drug poisoning cases were found to be higher in the months of summer and spring. The number offemale cases peaked in the 13-18 age group (211 cases) and were higher than the same age group of males (30 cases).Conclusions: In our present study, we highlighted the profile of pediatric drug poisoning cases admitted to the Pediatric EmergencyService.

Cost analysis of disposable/reusable Surgical drapes used in Turgut Ozal Medicine Center

Aim: It was targeted to calculate unit cost of reusable and disposable surgical drape sets using benefit/cost analysis and to determine how much these sets cost for the general hospital budget. Materials and Methods: The study was carried out in Inonu University Turgut Ozal Medical Center in Malatya city center, Turkey. In the study, a total of 500 packages and each package contain 7 drapes, 6 towels and 4 gowns. The packages, half of which are reusable and half of which are disposable and shared equally. Cost evaluation; it was obtained by calculating the purchase and waste disposal costs for disposable drapes. For reusable drapes, sewing, sterilization, washing, labor and waste disposal costs are calculated one by one. Afterwards, the total of costs obtained was analyzed and compared separately. Results: As a result of the analysis, it was found that the cost of reusable surgical drapes were cheaper than disposable drapes, and using reusable surgical drapes could provide a 33.74% saving in overall annual cost for hospital budget. Conclusion: Based on the novel findings; it is thought that by using reusable gowns and drapes can be contributed to the hospital's budget.

Caregiving burdens, depression levels, and related factors of attendants who care physical treatment and rehabilitation patients who applied to Turgut Ozal Medical Center

Aim: The aim of this study was to evaluate the caregiving burden, depression and related factors of the caregivers of chronic patients who received physical therapy.Materials and Methods: Research was conducted as a cross-sectional descriptor. The sample of the study included 129 people who met the criteria for participation in the study and who applied to Turgut Ozal Medical Center between 1 March 2018 and 1 March 2019, and cared for physical therapy and rehabilitation patients. Data was collected by using The Patient Information Form, Personal Care Form, Zarit Burden Interview (ZBI) and, Beck Depression Inventory (BDI), which were prepared by the researcher. Results: The mean of the caregiving burden was found to be as 38.48 ± 12.68, and the mean depression score as 13.68 ± 9.41. These values indicate that the caregiving burden is low-moderate and the depression score is mild. There was a significant positive correlation between the scores obtained from ZBI and the scores obtained from BDI (r:0.782, p<0.001). In the study, it was determined that factors such as age, gender, marital status, degree of proximity, income level, getting help, caregiving break, the presence of chronic disease of the caregiver affect the caregiving burden and depression level. It has been observed that some features of the patients affect the care burden and depression scores.Conclusion: As a result of the study, it was determined that the level of depression increased as the caregiving burden increased. A positive relationship was found between the caregiving burden and depression. It is advisable to arrange training and consultancy programs for caregivers to deal with the problems they face and to monitor caregivers at regular intervals.

The effect of mindfulness-based education given to individuals with substance-use disorder according to self-efficacy theory on self-efficacy perception

The aim of this research is to find the effect of mindfulness-based education given to ındividuals with substance-use disorder according to self-efficacy theory on self-efficacy perception. The research was planned as a test model with pretest-posttest control groups. Individuals who have been diagnosed with substance abuse in the substance abuse clinic of Turgut Ozal Medical Center, and at the Substance Abuse Treatment and Education Centre of Gaziantep 25 Aralık State Hospital formed the core of this study. The research was conducted between January 2018–May 2019. 112 patients, 56 in the treatment and 56 in the control group, participated in the study. Scientific research started after ethical approval. Mindfulness therapy was applied to experimental group patients. For the data collection, the Socio-Demographic Characteristics Questionnaire and Self-Efficacy-Sufficiency scale were used. t-Test for dependent variables to compare the mean scores of experimental and control groups and t-test for independent variables were used. It was seen that the average total Self-Efficacy-Sufficiency score of the patients in the treatment group was 76.50 ± 12.62 before the intervention and increased to 85.50 ± 14.95 after the intervention. There is a significant difference between the average scores. Even when the treatment and control groups are compared, a significant difference was still detected between the groups. There was no significant difference between the groups in two of the Self-Efficacy-Sufficiency steps after the intervention in the experimental group, but there were significant differences between the other two factors and total score averages.

Efficacy of Posttransplant Ledipasvir-Sofosbuvir in the Treatment of Patients Who Have Undergone Chronic Hepatitis C-Related Liver Transplant.

This study investigated the efficacy of ledipasvir-sofosbuvir, a newly developed direct-acting antiviral drug combination for hepatitis C virus infection recurrence in patients who have developed cirrhosis secondary to hepatitis C virus and who have undergone liver transplant. We retrospectively analyzed 27 patients who underwent liver transplant due to hepatitis C virus-related cirrhosis and who received ledipasvir-sofosbuvirfor 12 weeks between January 1, 2016 and December 31, 2017 following transplant procedures conducted at the Inonu University Turgut Ozal Medical Center Gastroenterology Department between January 1, 2008 and December 31, 2017. None of the donors had hepatitis C virus infection. Most donor grafts used in transplants were from children of recipients, with the remaining donated grafts from husbands (7%), nephews (4%), wives (7%), and deceased donors (7%). Twenty patients were ultimately included in the study. Hepatitis C virus genotypes, hepatitis C virus RNA, blood counts, and liver enzyme levels of patients before and at 1, 2, and 6 months after treatment were evaluated. At the end of month 6, in addition to hepatitis C virus RNA levels of all patients decreased to unmeasurable levels, levels of alanine and aspartate aminotransferase and gamma-glutamyltransferase had also significantly decreased (all P < .001). None of the patients experienced a complication that led to cessation of treatment. With its reliability and high success rate, the ledipasvir-sofosbuvir combination is a strongly preferable treatment for patients who have undergone liver transplant due to chronic hepatitis C virus-related cirrhosis and who have virus recurrence posttransplant.

Ameliyathane Hemşirelerinin Eleştirel Düşünme Eğilimlerinin Belirlenmesi

Objective: An examination of the critical thinking tendencies of nurses working in Turgut Ozal Medical center’s TOMC operating room was done descriptively with the aim.Materials and Methods: 58 nurses working in the Turgut Ozal Medical center’s TOMC operating room ,who are umreported and unauthorized?? And voluntarily accepted to participate in the study, were presented. The data were collected between November 2013 and January 2014. Personal data form consisting of 7 questions and California Critical Thinking Tendency Scale were used in data collection. The statistical analysis of the data obtained in this study was evaluated using SPSS 16, calculating frequency, percentage, arithmetic mean and standard deviations.Results: The vast majority of the nurses participating in this study were consisted of 51.7% nurses between the ages of 18-25. Considering the occupational period of service, the vast majority of the nurses 63.8% were between 1-5 years in service. In addition to this, it was noticed that 79.3% of nurses had education status and 91.4% of them had knowledge about the concept of critical thinking . 30.2% of nurses have learned the concept of critical thinking from their lessons at the university and 45.3% said that the events they experienced in the business environment affected their critical thinking. According to the critical thinking trend scale, the mean score of analytical thinking was 46.15 ± 5.53, open mindedness score 44.13 ± 9.02, curiosity score 41.77 ± 4.72, self confidence score 30.24 ± 5.18, accuracy analysis ability score 24.74 ± 4.81, systematic score average 23.82 ± 2.95. The California Critical Thinking Tendency Scale average score was found as 210.85.Conclusion: As a result of this study, it was found that critical thinking of nurses was inadequate due to the adverse effects of working conditions. It is anticipated that the tendency of critical thinking of nurses will increase if the nurses’ working hours are kept as 40 hours per week, and the nurses are being educated about their critical thinking