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Rowh, Adam, Marta Rowh, and Mark Goodman. "Emergency Department Treatment Provides Immediate and Durable Relief Following Vaccine Injury: A Case Report." Clinical Practice and Cases in Emergency Medicine 7, no. 1 (January 24, 2023): 29–32. http://dx.doi.org/10.5811/cpcem.2022.11.57642.
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Introduction: Intramuscular administration of vaccines into the deltoid muscle is the recommended route for most vaccines in adults. Ectopic injection into the subdeltoid/subacromial bursa can produce an inflammatory bursitis that is associated with significant long-term morbidity. Case Report: We describe a novel approach to treatment of this condition: ultrasound-guided administration of dexamethasone by the emergency physician within six hours of vaccine administration. This approach resulted in complete and durable long-term resolution of symptoms with no functional impairment. Conclusion: This outcome is superior to that described for usual care, and the approach is well-suited to emergency physicians.
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Fortuna, Robert J., Bethany Marston, Susan Messing, Gunnar Wagoner, Tiffany L. Pulcino, Todd Bingemann, Enrico Caiola, Steven Scofield, Karen Nead, and Brett W. Robbins. "Ambulatory Training Program to Expand Procedural Skills in Primary Care." Journal of Medical Education and Curricular Development 6 (January 2019): 238212051985929. http://dx.doi.org/10.1177/2382120519859298.
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Introduction: Outpatient procedures are an important component of primary care, yet few programs incorporate procedural training into their curriculum. We examined a 4-year procedural curriculum to improve understanding of ambulatory procedures and increase the number of procedures performed. Methods: A total of 56 resident and 8 faculty physicians participated in a procedural curriculum directed at joint injections (knee, shoulder, elbow, trochanteric bursa, carpal tunnel, wrist, and ankle), subdermal contraceptive insertion/removal, skin biopsies, and ultrasound use in primary care. We administered annual surveys and used generalized estimating equations to model changes. Results: Across the 4 years, there was an average 96% response rate. Mean comfort level with the indications for procedures increased for both resident (62.5 to 78.8; P < .0001) and faculty physicians (61.5 to 94.8; P < .0001). Similarly, mean comfort with performing procedures increased for both resident (32.1 to 62.3; P < .0001) and faculty physicians (42.2 to 85.4; P < .0001). Residents’ comfort level performing procedures increased for all individual procedures measured. The mean number of procedures performed per year increased for resident (1.9 to 8.2; P < .0001) and faculty physicians (14.7 to 25.2; P = .087). Conclusions: A longitudinal ambulatory-based procedural curriculum can increase resident and faculty physician understanding and comfort performing primary-care-based procedures. This, in turn, increased the total number of procedures performed.
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Kahya, Esin. "Did the Ottoman Physicians Make Any Contributions to the Medical Science in the Ottoman Empire in the Fourteenth Century (At the Flourishing Period of the Empire)." Belleten 70, no. 257 (April 1, 2006): 155–66. http://dx.doi.org/10.37879/belleten.2006.155.
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During the fourteenth century, Ottomans opened madrasa in where they invaded. The first madrasa was founded in Nicosia (Iznik). The second was founded in Brussa. All of them were built to let the people learn religion including in astronomy and mathematics, as it happened in some other places of Anatolia during the Seljukids in the eleventh, twelfth and thirteenth century. They also founded hospitals in the same places. One of them was Yıldırım Hospital in Bursa. It was also served as a medical school. Its first physician was Physician Husnu. The first medical studies in the Ottoman Empire appeared in the fourteenth century. Among them can be mentioned Ishaq b. Murad, Hadji Pahsa, Physician Barakat and Cemal al-Din Aksarayi. Except Aksarayi who was interested in religious science in addition to medicine, they preferred to write in Turkish. Hadji Pasha had works in Turkish and Arabic. Although the other scientists who were interested in mathematics, astronomy, physics and chemistry preferred to write in Arabic or sometimes in Persian, the physicians wrote their works in Turkish.They felt to have to explain why they used Turkish language and said that they wrote their works in Turkish because they wished to understand what they said in their works. Their works were mainly on diseases, their treatments and the drugs which were used during the treatment of the illnesses.
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Dübek, Asli, and Müjgan Öztürk. "Study on Effects of Physicians Training Regards to Cadaveric Organ Donation in Bursa." Transplantation 101 (August 2017): S133. http://dx.doi.org/10.1097/01.tp.0000525190.66759.00.
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Majerski, Paweł. "Bursa – po awangardzie? Powrót do lektury Malarstwa obłąkanego." Przegląd Humanistyczny, no. 67/1 (June 18, 2023): 62–85. http://dx.doi.org/10.31338/2657-599x.ph.2023-1.4.
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Andrzej Bursa’s poem Painting Gone Mad (Malarstwo obłąkanego) takes over and sets in motion a machinery of images that are gradually disembodied. The recorded image of the world is superimposed here with the world of delusions and mental “deviations”, deforming all that is subject to poetic intervention and – in the case of other poems – perceived perhaps in terms of existential paradoxes. The psychotic construction of the subject allows the activation of games of imagination, which, in the field of creative possibilities, activate “surreal” images. The perspective of post-human transformations of years ago, technicization, and indeed fantastic, “surrealistic” textualization of borderline states of consciousness (madness, insanity) of a person from a triumphantly and dramatically modernized world is intriguing. The sketch includes interpretive remarks on the poems of Tytus Czyżewski and the text Without the Help of the Physicians by Jan Brzękowski. These works are juxtaposed with Painting Gone Mad due to the common perspective of psychiatric confrontation with the world and “mechanization” and, in the case of the latter poet, the organic-technical experience of the lyrical character.
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Uysal Biyik, Muzelfe, and Yasemin Akbal Ergun. "Evaluation of nurses’ opinions about computer physician order entry." New Trends and Issues Proceedings on Advances in Pure and Applied Sciences, no. 10 (September 28, 2018): 82–88. http://dx.doi.org/10.18844/gjpaas.v0i10.3747.
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This research was performed as a descriptive and analytic study to determine the perceptions of the nurses regarding the computerised physician order entry system. The study was conducted with 207 nurses working in four hospitals using this system in Bursa. Sociodemographic data form and the computerised physician order entry system perception scale were used as data collection tool. Obtained data were analysed by statistical methods and nonparametric tests. The scale met an acceptable level of reliability and validity (α = 0.94). There was a statistically significant difference between the groups according to age, position, service and institution, years of institution experience and the period of using the system in terms of scale and sub-dimensions. Finally, it was determined that the nurses perceived the system as positive in spite of some difficulties related to this system. It is suggested that the problems with the system should be solved and training programmes should be organised.Keywords: Nurse, computer physician order entry, medication errors.
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GÜVEN, Deniz, Elif Güler KAZANCI, Ayşe ÖREN, Livanur SEVER, and Pelin ÜNLÜ. "The Knowledge of Students at Bursa Faculty of Medicine towards Artificial Intelligence: A Survey Study." Journal of Bursa Faculty of Medicine 2, no. 1 (January 29, 2024): 20–26. http://dx.doi.org/10.61678/bursamed.1390634.
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Objectives: Artificial intelligence (AI) is being increasingly widely employed in medicine. Various artificial intelligence software solutions will most certainly be available to medical students when they begin their jobs after completing school. The goal of this study was to assess medical faculty students' knowledge and attitudes about AI in medicine.
Methods: In 2020-2021, students at the University of Health Sciences, Bursa Training and Research Hospital participated in an online survey using Google Forms. The survey included sections assessing demographic features and attitudes toward AI in medicine.
Results: The questionnaire was completed by 85 students (57 females and 28 males). 50 medical school students and 35 pediatric medical specialty students completed the questionnaire. The mean time spent on the internet per day was 7.5400 ±3.67123 hours in MS and 3.1143 ± 2.0547 hours in MA (p < 0.001). All of the participants had heard AI before (p = 0.500). 62% of MS and 65.7% of MA worried about AI doing many things today; no statistically significant difference was found between the two groups (p = 0.453). 56.5% of participants felt “curiosity”, 16.4% felt “excited”, 11.8% felt “look positive”, 15.3% felt “frightened” about the increased use of artificial intelligence in our lives. 24% of the MS and 37.1% of the MA knew AI applications used in medicine; there was no statistically significant difference between the two groups (p = 0.191). The most commonly known applications of AI in medicine were in the fields of robotic surgery (10.5%) and radiology (3.6%). While 8% of the MS participated in the project / study related to AI; none of the MA participated, there was a statistically significant difference between the two groups (p = 0.036). On the contrary, the use of AI in medicine was 5.7% in MA; it was never possible in MS, there was no statistically significant difference between the two groups (p = 0.057). 91.8% of the participants would like to use AI in their future careers as physicians. 68% of MS and 94.3% of MA thought AI could not replace doctors in the future; there was a statistically significant difference between the two groups (p = 0.004).
Conclusion: Medical students, who will be the physicians of the future, regarded AI applications positively, and they wanted to gain education and experience in this subject with deep curiosity. Since the knowledge level of future physicians in this field is not sufficient, it is important to provide more AI training in medicine, to participate in more projects in this field, and to increase the use of AI by medical students in the field of medicine.
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GÜMÜŞKANAT TABUR, Zeynep, Hamit Harun BAĞCI, and Tuğba GÜLER SÖNMEZ. "Evaluation of personal protective behaviors among healthcare workers after receiving COVID-19 vaccination." Journal of Contemporary Medicine 13, no. 3 (May 31, 2023): 418–25. http://dx.doi.org/10.16899/jcm.1221630.
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Aim: The aim of the study was to evaluate personal protective behaviors after COVID-19 vaccination in healthcare workers.
Methods: This cross-sectional study was conducted with healthcare workers (physician, dentist, midwife, nurse, health officer or emergency medicine technician) in Bursa City Hospital between September 1, 2021 and September 1, 2022. Data was collected with a questionnaire form which was sent to participants via WhatsApp or email.
Results: All participants had received at least one dose of a COVID-19 vaccine and 31.0% had had experienced at least one COVID-19 infection. It was determined that while the use of N95 masks in the workplace (p
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Akpinar, Yakup, Hakan Demirci, Ersin Budak, Ayse Karalar Baran, Ali Candar, and Gokhan Ocakoglu. "Why do patients with minor complaints choose emergency departments and does satisfaction with primary care services influence their decisions?" Primary Health Care Research & Development 19, no. 04 (December 18, 2017): 398–406. http://dx.doi.org/10.1017/s1463423617000822.
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AimTo identify the reasons why patients with minor complaints choose emergency departments (EDs) as a first contact of care and whether dissatisfaction with primary care services influences their decisions.MethodsIn this study, a self-completed survey called EUROPEP was given to 535 outpatients who were admitted to the XXXXX Hospital in Bursa and examined in the green zone in July 2015. Patients were asked about their complaints and why they preferred EDs as a first contact of care.ResultsEDs were the first contact of care in 87.8% of cases. In all, 9% of patients registered to family physicians who were working outside the city of Bursa. There was no relationship between patient satisfaction and the number of previous visits to EDs in last 12 months (P=0.09). The main reasons for admitting to the emergency services were feeling excessive pain (20.4%), perception of urgency (14.5%) and that the family doctor services were closed outside working hours (13.2%). The mean patient satisfaction with family practice offices was calculated to be 68.1%.ConclusionsThe frequency of admission to EDs as a first contact of care was extremely high in the absence of a referral system. Patients who did not have family doctors in the settlement where they live put an extra burden on the EDs. Overall, patient satisfaction with their GPs did not influence the number of visits to EDs but accessibility remains a big challenge.
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Jang, Chan Woong, Myeonghwan Bang, Jung Hyun Park, and Han Eol Cho. "Value of Online Videos as a Shoulder Injection Training Tool for Physicians and Usability of Current Video Evaluation Tools." International Journal of Environmental Research and Public Health 19, no. 22 (November 17, 2022): 15177. http://dx.doi.org/10.3390/ijerph192215177.
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This study aimed to evaluate the reliability, overall quality, and educational value of online videos for learning the techniques related to shoulder injection treatments and analyzing the usability of video evaluation tools for musculoskeletal injections. Online video searches were performed in February 2022 using the terms “shoulder injection”, “glenohumeral joint injection”, “acromioclavicular joint injection”, and “subacromial bursa injection.” Included videos were scored by modified DISCERN (mDISCERN), global quality score (GQS), and shoulder injection score (SIS). Correlations between scoring systems were analyzed. Of the 150 videos, 49 (32.67%) contained highly reliable information. Regarding the assessment of overall quality by the GQS, 109 (72.67%) videos were of low quality. Regarding SIS, 114 (76.00%) scored not >5, of which 77 (51.33%) scored <3. Most of the SIS domains were fully explained in <40% of the included videos. A weak positive relationship was noted between the mDISCERN and SIS (r2 = 0.38), while a moderately positive relationship was observed between the GQS and SIS (r2 = 0.49). The majority of online videos about shoulder injection treatment showed low reliability, overall quality, and educational value. Additionally, a new scoring system is required to accurately evaluate musculoskeletal injection videos for educational purposes.
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Algarni, Abdulrahman D. "Prepatellar Bursal Infection Caused by Mycobacterium tuberculosis with an In Situ Total Knee Arthroplasty: A Case Report and Comprehensive Literature Review." Case Reports in Infectious Diseases 2019 (January 2, 2019): 1–4. http://dx.doi.org/10.1155/2019/4536714.
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Prepatellar bursal infection is a rare occurrence. The incidence of tuberculosis, including musculoskeletal type, is increasing. We present a case of isolated prepatellar bursal swelling associated with a discharging sinus; the condition developed in an elderly patient 4 years after total knee arthroplasty. Aspiration of the bursa revealed acid-fast bacilli on Ziehl–Neelsen staining, typical of Mycobacterium tuberculosis; this was confirmed later on culture. The patient was successfully treated with a 6-month course of antituberculous chemotherapy. To the best of our knowledge, only two previous cases of tuberculous prepatellar bursal infection have been reported in English literature. Our case illustrates the importance of considering tuberculous prepatellar bursal infection in the differential diagnosis of anterior knee swelling. All physicians treating patients with musculoskeletal disease should be aware of the possibility of this diagnosis and maintain a high index of suspicion; this is especially true in areas where tuberculosis is still endemic and in high-risk patients, such as the elderly.
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BAKEWELL, CATHERINE J., and GREGORY C. GARDNER. "A Survey of Arthrocentesis and Soft-Tissue Injection Procedures Performed in Primary Care Practice: Effect of Resident Training and Using Data to Shape Curriculum." Journal of Rheumatology 38, no. 9 (July 15, 2011): 1986–89. http://dx.doi.org/10.3899/jrheum.110041.
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Objective.The purpose of this study is (1) to survey graduates of our internal medicine program for use of musculoskeletal (MSK) procedures in primary care practice and assess the influence of participating in a first-year resident arthrocentesis and soft-tissue injection training course on their MSK procedure comfort/utilization; and (2) to use the results to modify our MSK procedure curriculum.Methods.A questionnaire designed to assess numbers of, comfort with, and effect of resident training on MSK procedures in the preceding year was sent to 2002–2006 graduates of the internal medicine training program in outpatient primary care (OPC). Graduates practicing hospital medicine (HM) also received the questionnaire and served as a comparison group.Results.There were 52 responses from this group of 84 graduates (64% response rate). OPC graduates (N = 32) were more comfortable doing procedures than those practicing HM exclusively (N = 20), and performed significantly more procedures in the preceding year (32.9 procedures per OPC/year vs 2.2 for HM). The most common procedures performed were knee joint, subacromial bursa, and trochanteric bursa, comprising > 75% of all procedures performed. A structured resident course in MSK procedures had a significant effect on the OPC physicians. Course participants (N = 17) performed almost twice the number of procedures/year as the nonparticipants (N = 15), were more comfortable with the procedures, and were significantly less likely to refer procedures to other clinicians. Written comments by respondents suggest additional MSK procedure training during and after residency is needed.Conclusion.Our results suggest a structured resident course in MSK procedures has a longterm influence. A progressively more focused approach to training is needed.
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Jiang, Xingfang, Zhiyan Guo, Linlin Hu, Pan Liu, Leiming Xu, and Jiangfeng Pan. "Values of Magnetic Resonance Imaging and Computed Tomography in the Diagnosis of Patients with Syndromes of Subacromial Impingement." Journal of Nanomaterials 2021 (April 29, 2021): 1–5. http://dx.doi.org/10.1155/2021/9920481.
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Subacromial impingement syndrome (SIS) is defined as pressurization and impingement between the acromion, the bursa under the acromion, and the rotator cuff during the abduction and elevation of the shoulder joint, resulting in pain and a functional disturbance of elevation. It is the most common disorder of the shoulder, accounting for 44-65% of all complaints of shoulder pain during a physician’s office visit. The study was performed with the aim of valuing the magnetic resonance imaging (MRI) and computed tomography (CT) in diagnosing patients with SIS. A total of 68 patients with SIS were selected as study subjects and subjected to MRI and CT examinations. The diagnostic accuracy and sensitivity of MRI and CT were, respectively, 97.06 and 70.59% ( P < 0.05 ); the detection rates of SIS grade I, grade II, and grade III by MRI were 91.67%, 96.77%, and 100%, respectively, which were significantly higher than 50%, 80.65%, and 68% by CT, respectively ( P < 0.05 ). MRI and CT detection indicated that there was no significant difference in extensive rotator cuff tear, acromion stenosis, and normal acromion detected by MRI and CT ( P > 0.05 ). In conclusion, the diagnostic accuracy, sensitivity, and detection rate of acromion of MRI were higher compared with those of CT examination, and MRI is more suitable in the clinical diagnosis of SIS.
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Gurlek, Feridun, and Eyyup Tasdemir. "How much drug allergies affect quality of life?" International Journal of Research in Medical Sciences 8, no. 12 (November 27, 2020): 4232. http://dx.doi.org/10.18203/2320-6012.ijrms20205295.
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Background: Drug hypersensitivity reactions are considered public health problems due to associated morbidity and socioeconomic costs. The evaluation of health-related quality of life in patients with drug hypersensitivity is still a widely unconsidered topic. The aim of our study is to reveal the effects of drug allergy on the quality of life of patients who apply to our outpatient clinic with the complaint of drug allergy.Methods: This study is prospective a questionnaire study under supervision. Patients who applied to the University of Health Sciences, Bursa Postgraduate Research and Training Hospital Department of Allergy outpatient clinic between August 2019 and May 2020 with the complaint of drug allergy filled out the quality of life questionnaire (DrHy-Q), and short questionnaire of psychological well-being index (PGWBIs) under the supervision of a specialist physician before the diagnostic procedures.Results: The study was conducted with 150 cases and 73.3 % (n=110) of the cases were female and 26.7% (n=40) were male. No significant correlation was found between the demographic characteristics of the patients, the observed symptoms, the culprit drugs, familial and individual comorbid and psychological diseases, and DrHY-Q (p>0.05). DrHY-Q was only affected from the type of allergic reaction. A negative statistically significant weak correlation was also detected between the total DrHY-Q score and the PGWBI total score (r: -0.283; p<0.01).Conclusions: We found that DrHY-Q is sensitive to reaction type and able to discriminative type 1 and type 2 reactions (p=0.017; p<0.05). We think that more comprehensive studies are needed on this subject.
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Wittmann, Rebecca. "The Nuremberg Medical Trial: The Holocaust and the Origin of the Nuremberg Medical Code. By Horst H. Freyhofer. New York: Peter Lang Publishing. 2004. Pp. 209. Paperback, $35.95. ISBN 0-8204-6797-9." Central European History 39, no. 2 (May 19, 2006): 346–48. http://dx.doi.org/10.1017/s0008938906360128.
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In his examination of the Nuremberg Medical Trial conducted by the American Military Tribunal in 1946, Horst H. Freyhofer has not, in fact, written a book about an important war crimes trial; this is rather a book that ponders whether we can “comprehend” the crimes of Nazi doctors engaged in some of the most heinous medical experiments in history. This is a short volume that tries to cover too much: the Hippocratic oath; the history of human experimentation by doctors; the ethical implications of medical crimes from the beginning of “Western Civilization” to the present; and a theoretical analysis of medical ethics from Goldhagen, to Socrates, to Darwin, to Nietzsche, to Hegel. Freyhofer fails to provide a contextual examination of the medical trial or of Nazi trials in general. The book would have benefited greatly from an examination of the important literature on war crimes trials (Gary Bass, Belinda Cooper, Ian Buruma, Lawrence Douglas, Jörg Friedrich, Michael Marrus, and Mark Osiel, to name but a few). These scholars address key questions about the trope of the trial as a forum for the teaching of history lessons, as a political event, and for its success and failure in seeking justice in cases of mass atrocity. Freyhofer does not explore any of these avenues. Instead, the author's main thesis is that the trial “symbolizes a break, not so much with the image physicians have of themselves, but with the image patients have of themselves” (p. 11). Freyhofer argues that the trial made patients conscious—for the first time—that doctors did not always have their best interests at heart. While this is an interesting observation, it does not suffice to keep the reader engaged in the history of the trial.
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Rogier, C., M. Van der Ven, A. Van der Helm - van Mil, and P. De Jong. "AB1127 IS SHOULDER INVOLVEMENT IN CLINICALLY SUSPECT ARTHRALGIA AN EARLY FEATURE OF RHEUMATOID ARTHRITIS? -A LONGITUDINAL ULTRASOUND STUDY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1853.1–1853. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1506.
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Background:Multiple studies have demonstrated that shoulder complaints are frequent in Rheumatoid arthritis (RA). Recently, it has been shown that shoulder involvement is predictive for RA development in patients with undifferentiated arthritis(UA) and its value is comparable to that of small joint involvement. The phase of clinically suspect arthralgia (CSA) precedes the phase of clinically apparent arthritis; in this phase subclinical tenosynovitis of the hands, is associated with the development of RA. Given the similarities in predictive values between the shoulder and small joints in UA, and the predictive value of tenosynovitis in CSA, we hypothesized that subclinical tenosynovitis of the bicep tendon is also associated with RA development. We examined the biceps tendon, since this is the only tendon of the shoulder that is enclosed by a synovial sheath as it passes through the bicipital groove.Objectives:Therefore, the aim of this study is to examine the predictive value of tenosynovitis of the bicep tendon by ultrasound (US) on developing inflammatory arthritis (IA) in CSA-patients.Methods:The SONAR (Sonographic evaluation of hands, shoulders and feet in patients presenting with inflammatory arthralgia to identify subclinical arthritis) is a multi-center observational cohort study in which patients were followed for the development of clinically apparent inflammatory arthritis (IA). Visits were done at baseline and 6 monthly thereafter. At baseline a US of both shoulders was made. 1-year follow-up data were used. IA was defined as having an arthritis verified by the treating physician. US abnormalities of (1) the biceps tendon, (2) the glenohumeral joint and (3) the subdeltoid bursa, were assessed for tenosynovitis, arthritis and bursitis.. Reference values for tendon thickness and effusion of the bursa were determined according to Schmidt et al.(1)Results:A total of 170 patients were included and underwent bilateral ultrasound (US) of the shoulder joint. Shoulder symptoms were infrequent (Table 1). After one year 37 patients developed IA (22%). ACPA positivity was associated with the development of IA (Table 1). As presented in Table 1, US abnormalities of the shoulder were found but none were associated with IA-development. In particular biceps tenosynovitis was not increased in the patients that developed IA.Table 1.Baseline characteristics and ultrasound abnormalities at baseline in patients with CSA.Baseline characteristicsAll CSA-patientsn=170CSA-patients with IA(n=37)CSA-patients without IA (n=133)P valueGender, female, n (%)140 (82)30 (81)110 (83)0.82Age, years, mean (SD)45 (12)47 (12)44 (12)0.28Symptom duration, weeks median (IQR)30 (19-43)37 (23-43)28 (19-39)0.14TJC44, median (IQR)5 (3-8)5 (3-8)5 (3-8)0.81Shoulder pain, n (%)9 (5)0 (0)9 (6.8)0.10SJC44, median (IQR)0 (0-0)0 (0-0)0 (0-0)-ESR, median (IQR)10 (5-21)9 (5-22)11 (5-21)0.66RF-positive, n (%)46 (28)12 (34)34 (26)0.33ACPA-positive, n (%)26 (16)10 (29)16 (12)0.019US abnormalitiesof the shoulderAny USabnormalities, n (%)(n=170)50 (29)8 (22)42 (32)0.24Biceps tendon Tenosynovitis, n (%)(n=164)19 (12)5 (15)14 (11)0.48Biceps tendon thickness, n (%)(n=164)6 (4)0 (0)6 (5)0.19Subdeltoid bursa effusion, n (%)(n=159)29 (18)3 (9)26 (21)0.094Effusion joint, n (%)(n=157)0 (0)0 (0)0 (0)-Abbreviations:IA: Inflammatory Arthritis, TJC44: Tender Joint Count in 44 joints, SCJ44: Swollen Joint Count in 44 joints,, ESR: Erythrocyte sedimentation rate, RF: Rheumatoid Factor, ACPA: Anti-citrullinated Protein AntibodyConclusion:Subclinical tenosynovitis of the shoulder is not an early feature of RA in patients with CSA.Reference:[1]Schmidt WA, Schmidt H, et al.Standard reference values for musculoskeletal ultrasonography.Ann Rheum Dis. 2004 Aug;63(8):988-94.Acknowledgments:*van der Helm- van Mil and de Jong contributed equal to this studyDisclosure of Interests:None declared
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Engin, Melih, and Fatih Gürses. "Adoption of Hospital Information Systems in Public Hospitals in Turkey: An Analysis with the Unified Theory of Acceptance and Use of Technology Model." International Journal of Innovation and Technology Management 16, no. 06 (October 2019): 1950043. http://dx.doi.org/10.1142/s0219877019500433.
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Information and communication technologies (ICTs) has become a tool which cannot be ignored in terms of public administrations, which provides advantage to the administrations as far as they can be adapted. The use of ICTs become widespread in the health sector as it is in all other sectors. In hospitals, hospital information systems (HIS) are used to keep records of patients and hospitals securely, to improve appointment, in-hospital management, decision support and workflow processes. Therefore, HISs are also used to increase efficiency and productivity, to reduce error rates, to increase service quality, to reduce service costs and to realize the specific purposes such as ensuring patient satisfaction. It is necessary that the end users should adopt HISs to obtain the expected benefits and to implement HIS successfully in public hospitals. The adoption of a technology product is also a sociological phenomenon at the same time. In this regard, the issue of adoption in the relevant literature is addressed in the context of a wide variety of models and many variables. This study is also a study of technology adoption. The subject of the study is the adoption of HISs in public hospitals in Turkey. In this context. The study aimed to determine the factors affecting the adoption of HISs by the personnel working in public hospitals in Turkey, in accordance with the Unified Theory of Acceptance and Use of Technology (UTAUT) model in the literature on technology adoption. In the study, the universe of the study consisted of the personnels (physicians, nurses, health officers, medical secretaries] which were working in public hospitals in the Bursa and Balıkesir Metropolitan Municipalities at the time of the study. According to the results of the study, performance expectancy, effort expectancy and social influence variables have positive and significant effects on the behavioral intention of hospital staff for using of HISs. In addition, facilitating conditions and behavioral intention variables have a positive and significant effect on usage behavior. On the other hand, it was found that gender has a moderator effect on the relationship between performance expectancy, effort expectancy and behavioral intention. Experience has a moderator effect on the relationship between the social influence and the behavioral intention while age has a moderator effect on the relationship between facilitating conditions and use behavior.
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ARIK, Melis, Deniz SİMSEK, Burcu DİNÇGEZ, and Emin ÜSTÜNYURT. "Tek kat ve çift kat onarımın rezidüel miyometriyal kalınlık, istmosel oluşumu ve jinekolojik bozukluklar üzerine etkisi: Prospektif Randomize Kontrollü Bir Çalışma." Journal of Contemporary Medicine 13, no. 3 (May 31, 2023): 444–50. http://dx.doi.org/10.16899/jcm.1229480.
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Abstract:
Physicians are making great efforts to decrease the long-term complications of the cesarean section such as placental adherent syndromes, uterine scar pregnancies, uterine rupture, abnormal menstrual bleeding, or isthmocele. There is a controversy about the closure technique of the cesarean incision. The purpose of that study was to compare the impact of single layer versus double-layer closure of the hysterotomy incision on the residual myometrial thickness, isthmocele, menstrual disorders, dysmenorrhea, and dyspareunia.
Material and Method
A prospective randomized cohort study has been performed in a tertiary center named Bursa Yuksek İhtisas Training Research Hospital between July – October 2021. Patients were randomly assigned to each procedure (1:1) to the Single Layer Locked Continuous group and Double-layer Continuous un-locked group as uterine closure technique. Patients were examined via transvaginal ultrasound to evaluate the isthmocele occurrence, residual myometrium thickness, and inquired about menstrual properties, dysmenorrhea, and dyspareunia. Patients were also divided into groups via underwent first cesarean and more than one cesarean.
Results:
The numbers of the women whose hysterotomy incision was closed by single-layer locked continuous( SLLC) technique and double-layer un-locked continuous(DLUC) technique 68 and 71 respectively. There was no statistically significant difference in terms of demographic variables, obstetric history, post-operative complications, neonatal outcomes. The comparison of these groups revealed that there was no significant difference in terms of post-menstrual bleeding, heavy menstrual bleeding, post-coital bleeding, dysmenorrhea, dyspareunia. The incisional residual myometrial thickness was higher in the DLUC group with a p-value of 0,007. Six patients in SLLC and 5 patients in the DLUC group have detected isthmocele (p: 0,941).
Patients have also been categorized as women who undergone their first cesarean section (SLLC n: 33 versus DLUC, n:33) and more than one cesarean section (SLLC n: 35 versus DLUC, n:38). Comparing the patients in these subgroups also did not differ significantly in terms of isthmocele occurrence, menstrual disorders, or residual myometrial thickness.
Conclusion:
No significant difference had occurred in terms of isthmocele incidence, or menstrual disorders comparing the single layer versus double-layer closure. However, women whose hysterotomy insicions were closed with double-layer un-locked continuous technique have a thicker resudial myometrium than single layer closure group especially women who underwent repeated cesarean.
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Gimenes, Fernanda Ferreira, and Caio César Costa Ribeiro Mira. "O ETHOS DISCURSIVO EM INTERAÇÕES DE UM GRUPO DE APOIO A FAMILIARES DE PESSOAS COM A DOENÇA DE ALZHEIMER." Revista DisSoL - Discurso, Sociedade e Linguagem, no. 9 (July 9, 2019): 195. http://dx.doi.org/10.35501/dissol.v0i9.606.
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Resumo:No Brasil, o contingente da população acometida pela Doença de Alzheimer (DA), é responsável por cerca de 50-70% das demências em idosos (BURLA et al., 2013), fator que limita ou dificulta as atividades diárias e tem impactos diretos na qualidade de vida da pessoa acometida pela patologia e por seus familiares. Nesse contexto, os Grupos de Apoio (GA) constituem espaços importantes de socialização onde familiares e cuidadores podem compartilhar experiências de cuidado e de convívio com a pessoa acometida pela DA. Este artigo visa à análise da noção de ethos discursivo em interações ocorridas no contexto institucional de um Grupo de Apoio. O referencial teórico deste trabalho está fundamentando no campo Análise do Discurso, especificamente nos estudos acerca da noção de ethos desenvolvidos por Maingueneau (1997; 2011) e Amossy (2005). Analisamos um corpus proveniente de gravações de vídeo de reuniões do GA, que são mediadas por um médico neurogeriatra. Os resultados de nossas análises demonstram que ocorre uma alternância de imagens discursivas do médico, revelando a autoridade enunciativa do profissional de saúde e a aproximação com os interlocutores no contexto interacional do GA.Palavras chave: doença de alzheimer; ethos; grupo de apoio. DISCURSIVE ETHOS IN INTERACTIONS OF A SUPPORT GROUP FOR FAMILY OF PEOPLE WITH ALZHEIMER'S DISEASEAbstract:In Brazil, the contingent of the population affected by Alzheimer's disease, according Burlá et al (2013), accounts for about 50-70% of dementias in the elderly, a factor that limits or hinders daily activities and has direct impacts over the life’s quality of the person affected by the disease and his relatives. In this context, Support Groups are important spaces of socialization where family members and caregivers can share experiences of care in the search for a better acceptance. This article aims to demonstrate the notion of discursive ethos in interactions that occurred in the institutional context of a Support Group for family members and caregivers of people affected by Alzheimer 's disease. The theoretical reference of this work is based on the Discourse Analysis field, specifically in the ethos studies of Maingueneau (1997,2011) and Amossy (2005). We analyzed a corpus derived from video recordings of meetings of this group, mediated by a neurogeriatric. The analysis of GA interactions demonstrates the physician as an enunciator of authority through what is enunciated by him, as well as an approximation of the pre-discursive ethos which is revealed in the enunciation scene.Keywords: Alzheimer’s disease; ethos; support groups.
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El Mehdi, Wichou, Bencherki Youssef, Ettanji Adnane, Mohammed Dakir, Debbagh Adil, and Aboutaieb Rachid. "Neglected Spermatic Cord Twisting: Experience of the University Hospital Center of Casablanca." European Journal of Medical and Health Sciences 3, no. 1 (February 22, 2021): 181–85. http://dx.doi.org/10.24018/ejmed.2021.3.1.717.
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Introduction: Spermatic cord twisting (SCT) is a life-threatening emergency of the testis, causing testicular ischemic lesions by vascular constriction. Neglected SCT is an atypical variant of torsion with a late diagnostic delay. It is characterized by the presence of testicular necrosis, requiring an orchiectomy. The objective of our study is to investigate possible factors that may be responsible for the delayed diagnosis of TCS, and thus favor the occurrence of the neglected form. In order to act on these factors and prevent the harmful consequences of SCT, in particular testicular necrosis.
Material and methods: This is a retrospective and descriptive study, conducted over a period of 7 years (January 2013-December 2019). Interesting 34 patients admitted to the urology department of the CHU Ibn Rochd of Casablanca, in a neglected SCT picture. The collection of information was carried out from the patients' files through an exhaustive exploitation sheet.
Results: A total of 34 cases of neglected SCT were collected. The mean age was 17.97 years (extremes: 14-37 years). 94% of the subjects were less than 25 years old. 15% of the subjects were from rural areas. 77% of cases occurred during the cold season. The absence of employment characterized 61.5% of the major subjects and 42.8% of the guardians of the minor patients. Only 26.5% of subjects had health coverage. Non-education characterized 62% of adult patients and 65% of guardians of minor patients. The occurrence of neglected SCT was on an ectopic testicle in 1 case (3%) and on an oscillating testicle in 1 case (3%). The involvement was on the left side in 70.6% of cases. The average time to visit the emergency room at the CHU was 86 hours with extremes of 12 hours and 12 days. 38% of the patients had consulted directly at the CHU, while 62% were referred from other health structures. All patients were admitted to the emergency room after the pain had disappeared (scrotal in 94% and inguinal with vacuity of the homolateral bursa in 6%). Echodoppler allowed the dg to be applied in 100% of cases. Delayed consultation of the patient was present in 82.4% of cases. A diagnostic delay due to anaberration in medical management was found in 17.6%. Therapeutic management was orchidectomy in 100% of the cases, and orchidopexy of the contralateral testis was immediate in 24% of the cases and delayed in 76% of the cases. 24% of the cases and delayed in 76% of the cases. Only 29.4% of patients presented for medical check-up at 6 months postoperatively. 80% of these patients had testicular atrophy on clinical and ultrasound examination, and frank oligospermia with asthenospermia on spermogram.
Conclusion: Multiple factors are likely to act on the prolongation of the diagnostic delay of SCT and may be at the origin of the occurrence of its neglected form. The delay in the diagnosis of SCT may be related to a delay in patient consultation or to an aberration in medical management, thus favoring the development of testicular necrosis and consequently requiring an orchiectomy. Hence the interest in knowing these factors in order to act on them by raising public awareness of the importance of emergency consultation in the face of acute scrotal pain, as well as continuing education of physicians and medical staff to prevent the occurrence of neglected SCT.
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Abaza, N. "THU0587 TB OR NOT TB? THIS IS THE QUESTION. CASE REPORT OF AN EXTRAPULMONARY TUBERCULOUS ARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 535.2–536. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2488.
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Background:Tuberculous (TB) arthritis consists of 1-3% of all TB cases, whereas TB tenosynovitis & bursitis account for 1%. Primarily it involves large joints but occasionally smaller non-weight-bearing joints. Diagnosis is usually delayed due to lack of awareness, radiographic findings & constitutional or pulmonary involvement.Objectives:We aim to increase rheumatologists awareness to detect possible TB etiology for arthritis & tenosynovitis.Methods:Our case is a 32 years old male complaining of polyarthritis of wrists, MCPs, ankle joints 4 months prior to presentation. Patient was referred as diagnosed rheumatoid patient resistant to treatment based on clinical presentation & laboratory investigation. His lab. was as follows; ESR 76 mm/hr, CRP 56.6 mg/L, RF 181.8 IU/ml, Serum creat 0.8 mg/dL, SGOT 20 SGPT 22, FBS 94, Uric acid 5.4, Hepatitis & HIV negative. CBC showing Hb 14.1 g/dL, TLC 7030/ml & platelets 289000/ml. There was no history of genitourinary, gastrointestinal manifestations, oral/genital ulcers, ophthalmological, mucocutaneous, cardiac, pulmonary, hepatic nor renal manifestations. The treatment at time of presentation was Methotrexare 25mg/week IM injection, Leflunamide 20mg/d & low dose steroids, prednisolone 5mg/d. Patient was referred to our department to assess activity, perform musculoskeletal ultrasound to the various involved joints. Hence, expected by referring physician to shift from DMARDs to biologic treatment.Results:MSUS study following eular guidlines showed active synovitis in both radiocarpal & midcarpal joints bilaterally grade II by doppler signal (figure 1). Other active synovitis in multiple MCPs as well as tenosynovitis of Peroneus longus and brevis bilaterally was detected (figure 1). The swelling aound the ankle was alarming though the other swollen joints seemed to be consistent with a case of RA in activity. This swelling revealed a well-defined hypoechoic heterogeneous cystic fluid collection with posterior through-transmission (figure 2) & hyperechoic hyperemic wall on PD imaging opposite medial malleolous of right fibula. The laboratory investigations prior to shifting patient had to included TB tests, tuberculin test and PCR following the positive result that we found in the skin test. Aspiration was performed from the cystic swelling and sent for clinical pathology analysis. Thick yellowish fluid aspirate on cytology revealed moderately cellular mainly of PMN cells, neutrophils, nuclear debris in proteinaceous background no atypical or malignant cells were found. As regards bacteriology no pus with no growth (both aerobic & anerobic). These results warranted us to perform a culture for atypical bacteria and revealed growth of mycobacterium tuberculosis. AntiTB therapy was started for 9 months in the form of 2 months of isoniazid (INH) and rifampicin (RIF), pyrazinamide (PZA) and ethambutol (EMB) followed by 7 months of INH and RIF. Excision of the synovial cyst was done on the spot.Figure 1.Figure 2.Conclusion:Extrapulmonary TB is usually diagnosed late due to a reduced diagnostic suspicion. A variant of 8 - 60% of TB cases are +ve for RF & 7–39% +ve for ACPA. Musculoskeletal manifestations occur in approximately 1-3% of TB cases. Of these, spondylitis and arthritis are the most frequent, whereas bursitis and tenosynovitis are exceptional. Extraarticular cystic masses occur in tuberculous arthritis. Mixture of septic tuberculous arthritis and Poncet’s disease is rare but documented.References:[1]Varshney et al. Isolated tuberculosis of Achilles tendon. Joint Bone Spine, 74 (2007): 103-106.[2]Lee et al.Tuberculous Tenosynovitis and Ulnar Bursitis of the Wrist.Ann Rehabil Med. 2013 Aug; 37(4): 572–576.[3]Rekha et al. Tuberculous Olecranon Bursitis. Case Reports in Clinical Medicine, 2014, 3, 281-285.[4]Kim et al. Tuberculosis of the trochanteric bursa: a case report. Journal of Orthopaedic Surgery 2014;22(1):126-9.Disclosure of Interests:None declared
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Karayurek, Yusuf, and Hakan Demirci. "Reasons for the relocation of contracted family physicians and job satisfaction." Family Practice, March 18, 2021. http://dx.doi.org/10.1093/fampra/cmab015.
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Abstract Aim The aim of this study was to determine the reasons for the relocation of contracted family physicians and the relationship of this situation with burnout and job satisfaction status. Methods This study was conducted with contracted family physicians in Bursa province between May 2019 and December 2019. The physicians were visited in the family health centres where they worked. The participants were asked to fill out a socio-demographic data form, Maslach Burnout Inventory Scale and Minnesota Job Satisfaction Questionnaire. In addition, physicians who had relocated were asked to fill out a questionnaire examining the reasons for this change. Results The most common reasons for the relocation of physicians were distance from home (65.30%), novelty seeking (25.60%) and burnout (24.80%). Being female (P = 0.004), duration of medical experience (P < 0.001), shorter time passed in family practice (P = 0.043) and job dissatisfaction (P = 0.006) were risk factors for relocation in a regression analysis model. Receiver operating characteristic analysis revealed a cut-off point value for the Minnesota overall score as ≤3. Conclusions In family practice, it is favourable to provide continuity of care to the patient with the same physician. However, migration of physicians within the province for social and cultural reasons to more prosperous regions, often to where they live, was observed. Young female family doctors will probably continue to migrate to better locations within the city regardless of payment advantages in poor settlements. The roles of female physicians in society (as mother, wife and daughter) may have an effect on this preference.
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Cervantes, Briana A., Prateek Gowda, Lisa G. Rider, Frederick W. Miller, Marcus Y. Chen, and Adam Schiffenbauer. "Development of a computed tomography calcium scoring technique for assessing calcinosis distribution, pattern and burden in dermatomyositis." Rheumatology, June 7, 2023. http://dx.doi.org/10.1093/rheumatology/kead256.
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Abstract Objectives To utilize whole-body computed tomography (CT) imaging and calcium scoring techniques as tools for calcinosis assessment in a prospective cohort of patients with adult and juvenile dermatomyositis (DM and JDM, respectively). Methods Thirty-one patients (14 DM and 17 JDM) who fulfilled Bohan and Peter Classification criteria as probable or definite DM, the EULAR-ACR for definite DM, and with calcinosis identified by physical examination or prior imaging studies were included. Non-contrast whole-body CT scans were obtained using low dose radiation procedures. Scans were read qualitatively and quantitated. We calculated the sensitivity and specificity of calcinosis detection of physician physical exam against CT. We quantified calcinosis burden using the Agatston scoring technique. Results We identified five distinct calcinosis patterns: Clustered, Disjoint, Interfascial, Confluent, and Fluid-filled. Novel locations of calcinosis were observed, including the cardiac tissue, pelvic and shoulder bursa, and the spermatic cord. Quantitative measures using Agatston scoring for calcinosis were used in regional distributions across the body. Physician physical exams had a sensitivity of 59% and a specificity of 90% compared with CT detection. A higher calcium score correlated with higher Physician Global Damage, Calcinosis Severity scores, and disease duration. Conclusion Whole-body CT scans and the Agatston scoring metric define distinct calcinosis patterns and provide novel insights relating to calcinosis in DM and JDM patients. Physicians’ physical examinations underrepresented the presence of calcium. Calcium scoring of CT scans correlated with clinical measures, which suggests that this method may be used to assess calcinosis and follow its progression.
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Timur, Ahmet, and Salih Metin. "HEALTH LITERACY LEVEL OF A PROVINCE AND FACTORS AFFECTING IT." Eskisehir Medical Journal, Eskisehir City Hospital, March 31, 2023. http://dx.doi.org/10.48176/esmj.2023.104.
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Objective: In this study, it was aimed to determine the level of health literacy and related factors in Bursa. Methods: It was determined by the simple random random sampling method from the population of the Family Physicians in Bursa and the 17 districts of Bursa were weighted according to their populations, and the districts where less than 50 questionnaires would be applied were excluded from the scope of the study. In June-July 2018, 2200 people were surveyed, 188 surveys were excluded from the research due to inadequacies in the data and a total of 2012 surveys were evaluated. Results: As a result of the logistic regression analysis of the factors age, education, health status, income level and reading habits were found to be associated with having sufficient health literacy level. Accordingly, adequate level of health literacy; in individuals aged 15- 44, 1.25 times compared to individuals aged 45 and over, 1.36 times more than those with a high school or higher education, secondary school and below, 1.81 times more than those with good health and poor health, it was observed that it was 1.32 times higher in those with a good income level than those with a low income level and 1.45 times more in those with a habit of reading books than in those without a habit of reading. Conclusion: In our health literacy study conducted in Bursa province, we showed the relationship between age, education status, income level, education level, reading habits and health literacy. Health literacy; a concept that has been put forward for the last twenty years for health service delivery, is known to be effective in a wide process ranging from cost-effective patient-physician satisfaction, where it can change the results of health service expectations. In order to protect the society without the need for rehabilitation without getting sick for a total welfare, screening and education activities should increasingly continue
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Goktas, Olgun, Canan Ersoy, and Admin. "Evaluating a physicians' perspective on the use of probiotics and vitamins against coronavirus disease." Journal of the Pakistan Medical Association, August 16, 2022. http://dx.doi.org/10.47391/jpma.5405.
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Objective: To evaluate the perspective of family physicians on probiotics and vitamins against coronavirus disease-2019. Methods: The cross-sectional study was conducted from June 1 to 30, 2021, after approval from the ethics review committee of Bursa Uludag University, Bursa, Turkey, and comprised family physicians of either gender working at family health centres in the country. Data was collected using an online questionnaire to measure the sociodemographic characteristics, habits, health status related to coronavirus disease-2019, and their knowledge, awareness and behaviour towards the use of probiotics and vitamins during the pandemic. Data was analysed using SPSS 25. Results: Of the 218 family physicians, 130(59.6%) were male and 88(40.4%) were female. The overall mean age was 46.82±5.85 years, mean professional experience was 22.32±8.75 years, and mean experience in family medicine was 10.14±3.51 years. The knowledge and awareness level about coronavirus disease-2019 was high 4.18±0.58, exposure to the disease 3.36±0.83 and their inclination towards the use of vitamins and probiotics 1.68±0.75 was low. Among the participants, 90(41.3%) used probiotic products and 120(55%) used drugs, such as vitamins and minerals. Vitamin C 99(45.4%) was the most commonly used supplement. Conclusion: Physicians' knowledge and awareness and a realistic scientific approach are important when recommending supplements, such as probiotics, vitamins and minerals, to individuals during the pandemic. Key Words: COVID-19, SARS-CoV-2, Probiotics, Vitamins, Survey.
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Yuan, Xiaoning, Ryan Lowder, Kathelynn Aviles-Wetherell, Christian Skroce, Katherine V. Yao, and Jennifer Soo Hoo. "Reliability of point-of-care shoulder ultrasound measurements for subacromial impingement in asymptomatic participants." Frontiers in Rehabilitation Sciences 3 (August 17, 2022). http://dx.doi.org/10.3389/fresc.2022.964613.
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BackgroundRehabilitation is the key to management of patients with subacromial impingement syndrome to prevent disability and loss of function. While point-of-care musculoskeletal ultrasound aids clinical diagnosis of subacromial impingement syndrome, many patients do not demonstrate the classic findings of dynamic supraspinatus tendon impingement beneath the acromion on ultrasound. The objective of this study was to establish the most reliable shoulder ultrasound measurements for subacromial impingement, by evaluating the intra-rater and inter-rater reliability of measurements in asymptomatic participants.MethodsEighteen participants (9 women, 9 men, mean ± standard deviation: 34.6 ± 7.9 years of age) underwent bilateral shoulder ultrasound evaluations with measurements for subacromial impingement (acromiohumeral distance, acromion-greater tuberosity distance, supraspinatus tendon, subacromial-subdeltoid bursa, and subacromial-subdeltoid bursal fluid thickness) performed by two sports medicine physicians. Intra-class coefficients were calculated to determine the intra- and inter-rater reliability of shoulder ultrasound images and measurements.ResultsIntra-rater reliability for acromiohumeral distance (0.76–0.79), supraspinatus tendon (0.91–0.95), subacromial-subdeltoid bursa (0.76–0.84), and subacromial-subdeltoid bursal fluid thickness (0.75–0.81) was found to be good to excellent, whereas inter-rater reliability ranged from poor to moderate.ConclusionsAcromiohumeral distance in neutral position and short axis ultrasound measurements of supraspinatus tendon, subacromial-subdeltoid bursa, and subacromial-subdeltoid bursal fluid thickness in the modified Crass position were the most reliable for subacromial impingement in asymptomatic participants. We recommend validation of these measurements in a symptomatic population to aid diagnosis and direct rehabilitation of patients with suspected subacromial impingement, and to increase point-of-care ultrasound uptake, availability, and training among rehabilitation professionals across health systems.
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Cushman, Daniel M., Masaru Teramoto, Alexandra Asay, Nathan D. Clements, and Zachary L. McCormick. "Corticosteroid and Local Anesthetic Use Trends for Large Joint and Bursa Injections: Results of a Survey of Sports Medicine Physicians." PM&R, November 23, 2020. http://dx.doi.org/10.1002/pmrj.12499.
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Tawfeeq, Essa. "Thorwaldt’s Cyst: Management by Combined Endoscopic Approach and Literature Review." Otolaryngology Open Access Journal 6, no. 2 (2021). http://dx.doi.org/10.23880/ooaj-16000222.
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Thornwaldt cysts occur in the midline bursa of the nasopharynx above the upper border of the superior constrictor muscle. They represent a communication between notochord remnants and the pharyngeal endoderm. It is usually asymptomatic unless an infection or obstruction occurs, then, a Thornwaldt's cyst might develop. It is relatively uncommon, with a prevalence rate of 0.2% to 4%. Due to its nonspecific symptoms, physician often misdiagnose thornwaldt cyst. It is usually diagnosed as an incidental finding on MRI. Surgical excision is the definitive treatment. This paper describes a case of thornwaldt cyst in a 39 years old gentleman presented with neck stiffness. It also includes a literature review that aids in the clinical suspicion, prevalence, diagnosis, and treatment of thornwald cyst.
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Panda, Bharti, Sumitra Bhoi, Arati Panda, and Mamata Pandey. "Spiritual health assessment among MBBS students of Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India." National Journal of Physiology, Pharmacy and Pharmacology, 2024, 1. http://dx.doi.org/10.5455/njppp.2024.14.12575202314022024.
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Background: Spiritual health is a state which not only increases the meaning of life but also increases mental satisfaction and gist in life. It improves the verbal communication between physician and patients, which reflects future patient care by strengthening their relationship. Aims and Objectives: (1) The present study was planned to assess the spiritual health status of undergraduate medical students of Veer Surendra Sai Institute of Medical Sciences and Research, Burla, by use of the Spiritual Health Assessment Scale (SHAS) and coping orientation for problem experiences (COPE) score and (2) to find the association between sociodemographic variables and spiritual health status of the students. Materials and Methods: For this study, 750 undergraduate students of either sex were recruited between August 2023 and November 2023. The data were collected through “sociodemographic characteristic questionnaire’s,” “SHAS,” and “cope score.” Results: In our study, most of the students were female, i.e., 56.94%. Majority of students were having mean SHA score (96.83 ± 4.72). Regarding copping score, we found that 287 students have scored high score between 42 and 46 (38.26%). A significant association was found between SHAS and type of family (P = 0.001), ritual gathering (P = 0.000), father’s education level (P = 0.009), and mother’s education level (P = 0.003) at P < 0.05. Conclusion: This study concludes that the spiritual health is directly and indirectly associated with lifestyle modification of the MBBS students which help very easily to overcome from stress and anxiety.
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Kizmaz, Muhammed Ali, Abdurrahman Simsek, Figen Aymak, E. Halis Akalin, H. Barbaros Oral, and Ferah Budak. "The prevalence of HLA-B*57 serotype associated with hypersensitivity reactions in the treatment of HIV infection in the Turkish population." Current HIV Research 21 (July 31, 2023). http://dx.doi.org/10.2174/1570162x21666230731145350.
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Objectives: The aim of our study is to reveal the prevalence of HLA-B*57 in the Turkish population and to provide new perspectives to physicians starting abacavir therapy in HIV patients. Background: Abacavir, one of the drugs used to treat HIV infection, can cause hypersensitivity reactions in some patients. These hypersensitivity reactions have been shown to be associated with the HLA-B*57:01 allele. High-resolution HLA-B*57:01 scanning has a time and cost disadvantage compared with low-resolution HLA-B*57 scanning. Before starting abacavir treatment, we will discuss whether high-resolution scanning is more beneficial in individuals who are positive on HLA-B*57 screening. This is the study with the largest cohort to investigate the prevalence of HLA-B*57 in Turkey. Methods: The results of 25 thousand 318 people who applied to Bursa Uludağ University Faculty of Medicine, Department of Immunology for HLA-B* typing were scanned. Results: In our study, the HLA-B*57 serotype was detected in 827 (3.3%) individuals. Conclusion: Considering these results, it can be assumed that the prevalence of HLA-B*57:01 in Turkey is lower than 3.3%. Instead of a high-resolution HLA-B*57:01 scan in all patients starting abacavir therapy, a high-resolution HLA-B*57:01 scan might be of greater benefit in patients who are positive on a low-resolution HLA-B*57 scan.
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Goktas, Olgun, Canan Ersoy, and Admin. "Assessment of awareness about COVID-19 disease and vaccine uptake." Journal of the Pakistan Medical Association, November 10, 2022. http://dx.doi.org/10.47391/jpma.5084.
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Objective: To evaluate the awareness of individuals about coronavirus disease-2019 disease and vaccines during the pandemic. Method: The descriptive, cross-sectional survey-based study was conducted at family health centres in the Bursa province between of Turkey from July 1 to 7, 2021. The face-to-face survey of registered individuals had 20 items that measured coronavirus disease-2019 and vaccines. The scale was named the Coronavirus Disease-2019 and Vaccine Awareness level. It was carried out by family physicians using an online weblink. The Cronbach alpha coefficient was 0.87. Data was analysed using SPSS 25. Results: Of the 228 subjects, 129(56.6%) were males and 99(43.4%) were females. The overall mean age was 27.82±10.28 years. Awareness levels were high with a mean value of 2.41±0.31. Female participants were more aware than males (p=0.04) and those with monthly income between 2000-10000 Turkish lira had lower awareness level compared to other income groups (p=0.03). Marital status (p=0.32), education level (p=0.49) comorbidities (p=0.23), regular drug usage (p=0.13) and exercise status (p=0.24) did not affect the awareness levels. Non-smokers were more aware than the smokers (p=0.01). Conclusion: The level of awareness about coronavirus disease-2019 and its vaccine was higher in the female gender and non-smokers, it was lower in the middle-income group. Key Words: COVID-19, SARS-CoV-2 infection, Vaccination, Awareness, Survey.
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Xie, Hui-Min, Xiao-Tan Zhang, Lin Xu, Ning Wang, Rui Wang, Zi-Shan Jia, and Li-Ning Zhang. "Magnetic resonance imaging findings in painful hemiplegic shoulder patients with or without subluxation: A retrospective cohort study." Frontiers in Neurology 13 (November 14, 2022). http://dx.doi.org/10.3389/fneur.2022.1032676.
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The relationship between hemiplegic shoulder pain (HSP) and subluxation is unclear. This study aimed to determine the differences of magnetic resonance imaging (MRI) findings in HSP patients with or without subluxation after stroke, and to analyze the etiology of shoulder pain. This retrospective study included 53 patients with HSP after stroke from September 2013 to February 2020. Patients underwent MRI of the shoulder because of shoulder pain. Clinical characteristics, including age, sex, stroke duration, body mass index, stroke type, visual analog scale score, Brunnstrom stage, and MRI arthrography findings of the affected shoulder, were recorded. Patients were classified into the glenohumeral subluxation (GHS) group (n = 27) or non-glenohumeral subluxation (nGHS) group (n = 26). We found that patients with HSP may be prone to bursa effusion, rotator cuff injury, ligament injury, and cartilage injury, even though there was no significant difference between the GHS and nGHS groups. MRI revealed 14 cases of long bicipital tendon-glenoid labrum injury (51.8%) in the GHS group and 6 cases (23.1%) in the nGHS group (p = 0.030). We also found 10 cases (37%) of glenoid labrum injury in the GHS group and 2 cases (7.7%) in the nGHS group (p = 0.026). Eight cases (29.6%) and 1 case (3.8%) of bone marrow edema were found in the GHS and nGHS groups, respectively (p = 0.033). Compared with painful hemiplegic shoulder patients without subluxation, patients with subluxation may be more susceptible to some injuries, such as long bicipital tendon-glenoid labrum injury, glenoid labrum injury, and bone marrow edema. During rehabilitation, physicians need to pay attention to these injuries.
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Chang, Sheng, Gang Liu, Lewei Zhao, Weili Zheng, Di Yan, Peter Chen, Xiangpan Li, et al. "Redefine the Role of Spot-Scanning Proton Beam Therapy for the Single Brain Metastasis Stereotactic Radiosurgery." Frontiers in Oncology 12 (May 19, 2022). http://dx.doi.org/10.3389/fonc.2022.804036.
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PurposeTo explore the role of using Pencil Beam Scanning (PBS) proton beam therapy in single lesion brain stereotactic radiosurgery (SRS), we developed and validated a dosimetric in silico model to assist in the selection of an optimal treatment approach among the conventional Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Proton Therapy (IMPT) and Spot-scanning Proton Arc (SPArc).Material and MethodsA patient’s head CT data set was used as an in silico model. A series of targets (volume range from 0.3 cc to 33.03 cc) were inserted in the deep central and peripheral region, simulating targets with different sizes and locations. Three planning groups: IMPT, VMAT, and SPArc were created for dosimetric comparison purposes and a decision tree was built based on this in silico model. Nine patients with single brain metastases were retrospectively selected for validation. Multiple dosimetric metrics were analyzed to assess the plan quality, such as dose Conformity Index (CI) (ratio of the target volume to 100% prescription isodose volume); R50 (ratio of 50% prescription isodose volume to the target volume); V12Gy (volume of brain tissue minus GTV receiving 12 Gy), and mean dose of the normal brain. Normal tissue complication probability (NTCP) of brain radionecrosis (RN) was calculated using the Lyman-Kutcher-Burman (LKB) model and total treatment delivery time was calculated. Six physicians from different institutions participated in the blind survey to evaluate the plan quality and rank their choices.ResultsThe study showed that SPArc has a dosimetric advantage in the V12Gy and R50 with target volumes > 9.00 cc compared to VMAT and IMPT. A significant clinical benefit can be found in deep centrally located lesions larger than 20.00 cc using SPArc because of the superior dose conformity and mean dose reduction in healthy brain tissue. Nine retrospective clinical cases and the blind survey showed good agreement with the in silico dosimetric model and decision tree. Additionally, SPArc significantly reduced the treatment delivery time compared to VMAT (SPArc 184.46 ± 59.51s vs. VMAT: 1574.78 ± 213.65s).ConclusionThe study demonstrated the feasibility of using Proton beam therapy for single brain metastasis patients utilizing the SPArc technique. At the current stage of technological development, VMAT remains the current standard modality of choice for single lesion brain SRS. The in silico dosimetric model and decision tree presented here could be used as a practical clinical decision tool to assist the selection of the optimal treatment modality among VMAT, IMPT, and SPArc in centers that have both photon and proton capabilities.
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ten Hove, Fenneken Laura, Pieter Bas de Witte, Monique Reijnierse, and Ana Navas. "Needling and Lavage in Rotator Cuff Calcific Tendinitis." JBJS Essential Surgical Techniques 14, no. 1 (2024). http://dx.doi.org/10.2106/jbjs.st.23.00029.
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Background: Rotator cuff calcific tendinitis (RCCT) is a commonly occurring disease, with a prevalence of up to 42.5% in patients with shoulder pain 1,2 . RCCT is characterized by hydroxyapatite deposits in the tendons of the rotator cuff and is considered a self-limiting disease that can be treated nonoperatively 3 . However, in a substantial group of patients, RCCT can have a very disabling and long-lasting course 1,4 , requiring additional treatment. Ultrasound-guided percutaneous needling and lavage (i.e., barbotage) is a safe and effective treatment option for RCCT 5 . In the present article, we focus on the 1-needle barbotage technique utilized in combination with an injection of corticosteroids in the subacromial bursa. Description: It must be emphasized that symptomatic RCCT should be confirmed before barbotage is performed. Therefore, we recommend a diagnostic ultrasound and/or physical examination prior to the barbotage. Barbotage is performed under ultrasound guidance with the patient in the supine position. After sterile preparation and localization of the calcified deposit(s), local anesthesia in the soft tissue (10 mL lidocaine 1%) is administered. Next, the subacromial bursa is injected with 4 mL bupivacaine (5 mg/mL) and 1 mL methylprednisolone (40 mg/mL) with use of a 21G needle. The deposit(s) are then punctured with use of an 18G needle. When the tip of the needle is in the center of the deposit(s), they are flushed with a 0.9% saline solution and the dissolved calcium re-enters the syringe passively. This process is repeated several times until no more calcium enters the syringe. In the case of solid deposits, it may not be possible to aspirate calcium; if so, an attempt to fragment the deposits by repeated perforations, and thus promote resorption, can be made. Postoperatively, patients are instructed to take analgesics and to cool the shoulder. Alternatives: RCTT can initially be treated nonoperatively with rest, nonsteroidal anti-inflammatory drugs, and/or physiotherapy 3 . If the initial nonoperative treatment fails, extracorporeal shockwave therapy (ESWT), corticosteroid injections, and/or barbotage can be considered 8 . In severe chronic recalcitrant cases, arthroscopic debridement and/or removal can be performed as a last resort. Rationale: Both barbotage and ESWT result in a reduction of calcific deposits, as well as significant pain reduction and improvement of function 8 . No standard of care has been established until now; however, several prior meta-analyses concluded that barbotage is the most effective treatment option, with superior clinical outcomes after 1 to 2 years of follow-up 9–11 . No difference in complication rates has been reported between the various minimally invasive techniques. The purpose of barbotage is to stimulate the resorption process, which is promoted by the perforation of the deposits. Clinical outcomes are not associated with the success of the aspiration 7,12 . Patients with ≥1 larger deposit show greater improvement following barbotage than patients with small deposits 12 , in contrast with ESWT, in which larger deposits have been associated with worse outcomes. The inferior outcome of barbotage in patients with small deposits remains the subject of debate, but outcomes may be confounded by the fact that patients with smaller deposits might be less symptomatic at baseline and are therefore less likely to demonstrate improvement 4 . Expected Outcomes: In the first weeks after barbotage, there is generally a substantial reduction in symptoms. Symptoms can recur at around 3 months, presumably because the effect of the corticosteroids is temporary 5 . After 6 months and 1 year, patients show substantial improvement in pain, shoulder function, and quality of life, with results superior to those shown for subacromial injections and ESWT 9,10,13,14 . At 5 years postoperatively, there are no significant differences in outcomes between barbotage and subacromial injections 15 . This may demonstrate a self-limiting course in the long term. Important Tips: Good candidates for barbotage are those with RCCT who have ≥1 large calcific deposit.If a patient has a solid deposit, the physician can gently rotate and repeatedly puncture the deposit to promote disaggregation and fragmentation.Barbotage generally results in adequate pain relief and functional improvement even in patients in whom calcium deposits cannot be aspirated 12 . Acronyms and Abbreviations: SAI = injection in the subacromial bursaNSAIDs = nonsteroidal anti-inflammatory drugs
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Lee, Ju-Hao, Ni-Chung Lee, and Yi-Ching Tung. "SUN-033 A Rare Case: Bone Pain and Continued Linear Growth in a Young Adult Male Due to Aromatase Deficiency." Journal of the Endocrine Society 4, Supplement_1 (April 2020). http://dx.doi.org/10.1210/jendso/bvaa046.212.
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Abstract Introduction: Aromatase, the product of CYP19A1, catalyzes the conversion of androgens to estrogens. 46, XX infants with aromatase deficiency, due to androgen excess, present with ambiguous genitalia at birth. In 46, XY individuals, however, the subtle phenotypic features make the diagnosis even more difficult. Less than 15 male cases were reported in the literature and we present the first case of aromatase deficiency diagnosed in Taiwan. Clinical Case: A 23-year-old man, Burman overseas student of Chinese descent, presented to an orthopedist with a two-year history of left ankle pain, which was diagnosed as gout by his previous physician. Unexpectedly, unfused growth plates were discovered so he was referred to our pediatric endocrine clinic for evaluation. Reviewing his past history, we learned he is the third child of consanguineous parents. His mother experienced deepening of voice during this pregnancy which resolved following parturition. He was 177 cm tall at the age of 19. At the time he presented to our clinic, he weighed 95.3 kg and was 183 cm tall. Physical exam showed the ratio of U/L segment to be 0.82, stretched penile length 6.5 cm, bilateral testes > 25 mL, pubic hair at Tanner stage V, and presence of genu valgum. The skeletal age was 14 years and 6 months. Labs showed FSH 19.7 IU/L (0.7–11.1), LH 8.18 IU/L (0.8–7.6), total testosterone 1335 ng/dL (240–871), estradiol <20 pg/mL, DHEA-S 13.41 μmol/L (6.5–14.6), androstenedione 5.73 nmol/L (3.5–9.8) and 17-OH progesterone 6.55 nmol/L (2–10). GnRH (100 μg i.v) stimulation test showed a supranormal basal FSH level and a normal to higher LH response (FSH at baseline/peak were 23.0/38.6 IU/L; LH at baseline/peak were 8.81/47.7 IU/L). Under the clinical suspicion of aromatase deficiency, we performed genetic sequencing of CYP19A1 (NM_031226) and found a homozygous missense variant c.1108G>A (V370M), a previously reported pathogenic mutation. A diagnosis of aromatase deficiency was made. He also had hypertension (156/87 mmHg), dyslipidemia (T-cholesterol 236 mg/dL, LDL-C 175 mg/dL) and insulin resistance (AC glucose 87 mg/dL, insulin 23.5 μU/mL, HOMA-IR 5.0, Hb1Ac 5.6%). Bone mineral density of lumbar spine (DXA) showed a T-score of -2.8, consistent with the diagnosis of osteoporosis. Conclusion: Estrogen is pivotal for epiphyseal closure in both sexes. As demonstrated in this case, estrogen deficiency in men results in tall stature and eunuchoid habitus, while it is also associated with low bone density and metabolic syndrome. The gonadotropin response in this report suggests the inhibitory role of estrogen in the male HPG axis. Clinicians may consider this rare diagnosis for men in their late teens or early twenties, who have spontaneous initiation of puberty, presenting with bone pain and continued linear growth.