To describe the disease activity and retention rate in rheumatoid arthritis (RA) patients with inadequate response (IR) to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) ...and/or tumor necrosis factor inhibitors (TNFis) who were prescribed tocilizumab (TCZ) as first-line or second-line biologic treatment in real-world setting.
Data gathered from patients' files was used in a multicenter and retrospective context. Retention rates and the Disease Activity Score in 28 joints with CRP (DAS28-CRP) were evaluated at time points. The relationship of drug efficacy with factors such as smoking, obesity, and previous use of TNFis was also examined.
One hundred and twenty-four patients with a median (IQR) RA duration of 3.7 (7.4) years were included. Mean (SD) age was52.9 (12.9) and 75% of the patients were female. TCZ retention rates in the 6th and 12th months were 94.1% and 86.6%, respectively. In all patients, DAS28-CRP level decreased significantly from baseline to Months 3 and 6. There was an increase in patients with remission and/or low disease activity and a decrease in patients with high disease activity at Month 3 and Month 6 (p < 0.001 for both). Disease activity was similar between subgroups based on body mass index, smoking status, and previous use of TNFis at any time point. Regression analysis showed that absence of concomitant corticosteroid treatment independently was associated with remission/LDA achievement at Month 6 OR = 0.31, 95% CI (0.14- 0.72), p = 0.006, and Month 12 OR = 0.35, 95% CI (0.13-0.94), p = 0.037. Overall, 25 mild adverse events were reported.
TCZ was found to be effective and safe in RA patients with IR to csDMARDs and/or TNFis. The drug retention rate was considered satisfactory with more than half of the patients continuing TCZ treatment at Month 12.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objectives:
The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar ...spondylosis patients.
Patients and methods:
This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG Turkish League Against Rheumatism-Osteoarthritis Study Group) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings.
Results:
Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200).
Conclusion:
The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.
Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration ...decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors.
This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%.
Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65).
Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.
Digital ulcers (DUs) are associated with a significant burden in systemic sclerosis (SSc) by leading to severe pain, physical disability, and reduced quality of life. This effort aimed to develop ...recommendations of the Turkish Society for Rheumatology (TRD) on the management of DUs associated with SSc.
In the first meeting held in December 2020 with the participation of a task force consisting of 23 rheumatologists the scope of the recommendations and research questions were determined. A systematic literature review was conducted by 5 fellows and results were presented to the task force during the second meeting. The Oxford system was used to determine the level of evidence. The preliminary recommendations were discussed, modified, and voted by the task force and then by members of TRD via e-mail invitation allowing personalised access to a web-based questionnaire SurveyMonkey®.
A total of 23 recommendations under 7 main headings were formulated covering non-pharmacological measures for the prevention of DUs and pharmacological treatments including vasodilators, anti-aggregants, antibiotics, wound care, pain control, and interventions including sympathectomy, botulinum toxin, and surgery. Risk factors, poor prognostic factors, prevention of DU and adverse effects of medical treatments were reported as 4 overarching principles.
These evidence-based recommendations for the management of SSc-associated DUs were developed to provide a useful guide to all physicians who are involved in the care of patients with SSc, as well as to point out unmet needs in this field.
Aim. To investigate the effect of exenatide treatment on serum ghrelin levels in obese female patients with type 2 diabetes mellitus. Methods. Fourteen female patients with type 2 diabetes mellitus ...being treated with metformin and exenatide were enrolled. A mixed meal test was applied to the patients while continuing with their daily medications. Blood samples were taken before and at 60, 120, and 180 minutes following mixed meal test to measure serum total ghrelin, glucose, and insulin levels. The following week, exenatide treatment of the patients was paused for 24 hours and the same experimental procedures were repeated. Results. Serum ghrelin levels were suppressed significantly at 180 minutes with exenatide treatment compared with baseline ( 294.4 ± 57.5 versus 234.5 ± 59.4 pg/mL) ( p < 0.00 1 ). Serum ghrelin levels at 180 minutes were statistically different when percentage change in serum ghrelin levels after mixed meal tests with and without exenatide usage were compared ( p = 0.001 ). Estimated total area under the curve values for serum ghrelin concentrations was also significantly lower with exenatide compared with omitted treatment ( p = 0.035 ). Conclusion. These results suggest that the effect of exenatide on weight loss may be related with the suppression of serum ghrelin levels, which is an orexigenic peptide.
In low‐grade glioma, metastasis is rarely seen. Few cases of leptomeningeal dissemination have been reported in children. Vertebral bone metastasis has not been reported so far. Herein is described ...the case of a pediatric patient with the diagnosis of pilocytic astrocytoma, and leptomeningeal dissemination detected at the time of diagnosis, who then received radiotherapy and chemotherapy upon development of vertebral bone metastasis during treatment.
Introduction: The effectivity of cloth masks is one of the major concerns during pandemic. In this study, the filtration ability of different cloth masks was compared. Materials and Methods: We ...examined the filtration ability of different cloth masks in “Touch Screen Aerosol Photometer” DOP3500 machine by testing 0,3-0,5 µm diameter standart “aerosol” particle at mask factory (MAKSAM) of Mechanical and Chemical Industry Company located in Ankara. In order to show the difference in filtration ability of the cloth maskes clearly, particule size was defined as 0,3-0,5 µm. Pure silk 100%, 80% silk + 20% polyester, 100% satin, 100% polyester, 100% cotton, 100% bamboo and 50% cotton + 50% polyester were compared. Cloth masks made from these materials were tested three times; before washing, after ten times washing and combined using with a medical mask. Results: N95/FFP-2 respirator was used as a “positive control” with a filtration ability of 99.7%. Measurable filtration ability of total particle counts was 18.2% of three layered medical mask. When we tested double medical mask, reduction of total particle counts reached to 31.6%. According to our result, we conclude that wearing double medical mask is more protective than wearing a single medical mask. Measureable reduction of total particle counts were different for all tested cloth masks. Cloth masks were tested second time after 10 times washing. Un-washed cloth mask made from 80% silk + 20% polyester was found to be protective, however after ten times washing particle counts of the same mask reduced markedly. Measurable reduction of total particle counts were also reduced after ten times washing of cloth masks made from 100% satin and 100% polyester. The most efficient cloth mask for blocking particules was 100% cotton after ten times washing. Conclusion: Our study offers evidence in favor of synthetic and polyester materials are not suitable for cloth masks since their filtration ability is reduced after multiple washing. Instead, use of cotton masks is more preventive than the others because of its increased filtration ability after washing. Combined wearing of medical mask and cloth mask together resulted in increased efficacy of filtration ability of both masks. We conclude that, wearing double mask is more effective than wearing a single mask when we consider the actual status of the pandemic with widespread distribution of mutant viruses and the high number of infected individuals in the public.
Field experiments were conducted to evaluate the impact of seed and seedling inoculation by plant growth promoting rhizobacteria (PGPR) on nitrogen use efficiency, growth, yield, and chemical ...composition of cabbage at varying levels of nitrogen (N). Data revealed that N alone or in combination with PGPR either as seed or seedling inoculation significantly improved growth, yield, and nutrients of cabbage. PGPR inoculations were more efficient than non-inoculated controls in terms of yield and yield parameters. This study showed that seed and seedling inoculation increased yield and yield parameters as well as chlorophyll reading value and stomatal conductance versus controls. Applications of mineral fertilizers with microbial applications save 25% of mineral fertilizers yet give 33% more yield versus full doses of mineral application without microbial applications. Both seed and seedling treatments increased the nitrogen use efficiency (NUE) rates by 45, 53, 58, 45, and 40%, and 49, 59, 68, 69, 60, and 55%, respectively.
The foramen magnum (FM) has a vital importance to have a direct view of the vertebral artery, lower cranial nerves, and the brainstem. The morphologic analysis of the FM was studied in 352 occipital ...bones of adult human skulls by 3D-Doctor V 3.5.050402 Demo version. The perimeter and area of the FM were calculated as 115.6 (SD, 9.9) mm and 829 (SD, 137.7) mm(2), respectively. The FM index was found as 84.02%, and the majority (38.4%) of holes were observed to have a narrow index.The FM was observed to 8 different types. The most frequently observed types were the tetragonal type in 25.66%, and the one formed by the combination of 2 semicircles in 23.28%. The large anterior margin of the FM type, such as types 1, 4, 5, and 6, can be easily performed partially. In the cases of types 2, 3, and 8, the anterior margin was determined as narrow, the resection procedure is completed with more difficulty. In Pearson correlation analysis, it is significant that a statistically strong relation was found between the area and perimeter, and the area and length of FM. This findings suggest that the resection should be started at the anterior margin, just lateral and then extended superolaterally.
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