Abstract
Background
There is an ongoing search for standardized scales appropriate for each culture to evaluate professionalism, which is one of the basic competencies of a physician. The ...Professionalism Mini-evaluation Exercise (P-MEX) instrument was originally developed in Canada to meet this need. In this study, it was aimed to adapt the P-MEX to Turkish and to evaluate the validity and reliability of the Turkish version.
Methods
A total of 58 residents at Bakirkoy Dr. Sadi Konuk Training and Research Hospital were assessed with the Turkish version of P-MEX by 24 raters consisting of faculty members, attending physicians, peer residents, and nurses during patient room visits, outpatient clinic and group practices. For construct validity, the confirmatory factor analysis was performed. For reliability, Cronbach’s alpha scores were calculated. Generalizibility and decision studies were undertaken to predict the reliability of the validated tool under different conditions. After the administration of P-MEX was completed, the participants were asked to provide feedback on the acceptability, feasibility, and educational impact of the instrument.
Results
A total of 696 forms were obtained from the administration of P-MEX. The content validity of P-MEX was found to be appropriate by the faculty members. In the confirmatory factor analysis of the original structure of the 24-item Turkish scale, the goodness-of-fit parameters were calculated as follows: CFI = 0.675, TLI = 0.604, and RMSEA = 0.089. In the second stage, the factors on which the items loaded were changed without removing any item, and the model was modified. For the modified model, the CFI, TLI, and RMSEA values were calculated as 0.857, 0.834, and 0.057, respectively. The decision study on the results obtained from the use of P-MEX in a Turkish population revealed the necessity to perform this evaluation 18 times to correctly evaluate professionalism with this instrument. Cronbach’s alpha score was 0.844. All the faculty members provided positive feedback on the acceptability, feasibility, and educational impact of the adapted P-MEX.
Conclusion
The findings of this study showed that the Turkish version of P-MEX had sufficient validity and reliability in assessing professionalism among residents. Similarly, the acceptability and feasibility of the instrument were found to be high, and it had a positive impact on education.
Trial registration
2020/249, Bakirkoy Dr. Sadi Konuk Training and Research Hospital.
Aim:Hypercalcemia (HCM) is a common clinical problem characterized by a serum corrected calcium (cCa) level of >10.7 mg/dL. Primary hyperparathyroidism and malignancy are mostly (90%) involved in the ...etiology. In this study, we aimed to determine the relationship of cCa and phosphorus (P) levels, cCa/P ratio and gender with the etiology of HCM and one-week mortality.Methods:Records of HCM patients older than 18 years of age who were hospitalized between January 1, 2017 and December 31, 2018 were retrospectively reviewed. Age, gender, cCa and P levels, HCM etiology and one-week survival status of the patients were recorded. Subsequently, the patients were divided into two groups according to whether the etiology of HCM was benign or malignant. Then, the groups were compared statistically in terms of gender, biochemical values and one-week survival.Results:The median level of serum cCa was found to be significantly higher in males (p<0.00). The frequency of malignancy-associated HCM was higher in males than in females. When the groups were compared, serum cCa and P levels were found to be higher in malignancy-associated group (p<0.000 and p=0.005, respectively). The one-week mortality rate in all patients was 18.99%. However, surprisingly, the one-week mortality rate in malignancy-associated HCM was lower than in the other group.Conclusion:Our study results show that serum cCa and P levels at the time of admission, and gender may help early evaluation of the etiology and/or prognosis of HCM.
Down syndrome (DS) is one of the main genetic abnormalities of newborns. Therefore, prenatal diagnosis of this syndrome is of paramount importance to the family and the community. The microbiota ...system is important in early brain development. We tried to study and compare gut microbiota (GM) composition in pregnancies that resulted in DS neonates with pregnancies that resulted in healthy children. The study population consisted of 21 pregnant women having delivered DS newborns (group 1) and 22 pregnant women who had given birth to healthy newborns (group 2). The GM composition was determined and compared between the two groups. There were no significant age and gestational age differences between the two groups (p>0.005 both). Regarding GM analysis, microorganisms of the families
Clostridiaceae
and
Pasteurellaceae
were more abundant in the group of women having delivered DS neonates than the group of women having delivered healthy newborns (p<0.05). The results of our pilot study showed that the GM system might have a role in the pathophysiology of DS. The GM changes may be used in the prenatal diagnosis and prevention of this syndrome. Further studies are needed in this field.
The prevalence of diabetes mellitus is growing worldwide, as well as in the aging population, and its comorbidity and mortality rates are higher in aging people than they are in young people. It has ...been observed that the number of drugs used increases in aging patients, especially in diabetic patients. This study aimed to investigate the relationship between polypharmacy and modified Charlson Comorbidity Index (CCI) and Katz Index of Independence in Activities of Daily Living (Katz ADL) scores in aging diabetic and non-diabetic patients.
This prospective study included 184 diabetic and 62 non-diabetic subjects who were ≥65 years old. Comorbidity was determined with CCI, and dependency on daily basic activities was assessed with Katz ADL.
CCI and the number of drugs were significantly higher in diabetic groups (
= .001). In all subjects and in the diabetic group, there was a negative correlation between CCI and Katz ADL (r = -0.343,
= .001; r = -0.383,
= .001, respectively); there was a positive correlation between CCI and number of drugs (r = 0.430,
= .001; r = 0.248,
= .001, respectively).
We found an increase in the number of drugs taken by the aging patients, positively correlated with the CCI score. The increase in the number of drugs used is closely related to the insufficiency in daily life activity and comorbidity, and this predicts 10-year survival. Patients should be directed to special centers or physicians who will be scheduled for multidisciplinary treatment for the prevention of polypharmacy, especially in the aging.
Aim:There is no enough data on pulmonary involvement in autosomal dominant polycystic kidney disease (ADPKD). The aim of this study is to examine pulmonary function test in patients with ADPKD with ...varying stages of renal function and to compare them with those in healthy controls.Methods:Forty-six patients with ADPKD and 43 healthy control subjects were included in the study. Pulmonary function test was performed for each patient after routine physical examination and biochemical analysis.Results:Age, gender, weight, height and smoking rate were similar in both groups. Seven patients (15.2%) had restrictive pattern and one (2.1%) had obstructive pattern in ADPKD group while one patient (2.3%) had obstructive pattern and two (4.6%) had restrictive pattern in the control group. The frequency of restrictive pattern was not significantly higher (p=0.15), but forced vital capacity volume was significantly lower in the patient group (p=0.04).Conclusion:Restrictive spirometric pattern was more prevalent in the patient group, but there was no statistically significant difference. It is thought that the difference may be statistically significant when the study is performed with kidney volume analysis and larger patient population.
Aim: In critical cases, electrolyte disturbances such as hypophosphatemia have been shown to be associated with mortality and in our study, we aimed to examine the relationship between ...hypophosphatemia, a symptom disorder with COVID-19, and death.
Material and Methods: This study is a retrospective, cross-sectional investigation that encompasses patients diagnosed with COVID-19 and subsequently admitted for treatment at our hospital. Based on their serum phosphate levels, the patients were bifurcated into two distinct categories: those with serum phosphate levels below 2.5 mg/dl, classified as hypophosphatemic, and those with levels above this benchmark, categorized as non-hypophosphatemic. The comparisons drawn between these two cohorts were facilitated using a range of statistical methodologies, and the resulting findings were subsequently analyzed and interpreted within this framework.
Results: Compared to the hypophosphatemia group, the diagnoses of DM (p<0.001) and CKD (p=0.015) were statistically significantly higher in the group without hypophosphatemia. A statistically significant difference was found between phosphorus groups and mortality and length of stay (p<0.001). In addition, age and length of hospitalization were found to be statistically significantly higher in those who died compared to those who were alive (p<0.001; p=0.002).
Conclusions: Hypophosphatemia has been shown to be associated with mortality in patients with COVID-19, as in many studies and in our study, and it may be a biomarker in predicting severe disease.
Amaç: Kritik hastalıklarda hipofosfatemi gibi elektrolit bozukluklarının mortalite ile ilişkisi gösterilmiştir. Biz de çalışmamızda COVID-19’lu hastalarda bir elektrolit bozukluğu olan hipofosfateminin mortalite ile ilişkisini incelemeyi amaçladık.
Gereç ve Yöntemler: Bu retrospektif kesitsel çalışma, hastanemizde COVID-19 tanısı alıp, yatarak tedavi gören hastaları içermektedir. Hastalar, serum fosfor düzeylerine göre iki gruba ayrılmıştır: serum fosfor düzeyi 2.5 mg/dl'nin altında olanlar (hipofosfatemi) ve bu seviyenin üzerinde olanlar (hipofosfatemi olmayanlar). İki grup arasındaki karşılaştırmalar, çeşitli istatistiksel yöntemler kullanılarak yapılmış ve sonuçlar bu veriler ışığında değerlendirilmiştir.
Bulgular: Hipofosfatemi grubuyla karşılaştırıldığında, hipofosfatemi olmayan grupta DM (p<0,001) ve KBY (p=0,015) tanıları istatistiksel olarak anlamlı yüksekti. Fosfor grupları ile mortalite ve yatış süresi arasında da istatistiksel olarak anlamlı farklılık saptandı (p<0.001). Ayrıca yaş ve yatış süreleri sağ olanlara kıyasla exitus olanlarda istatistiksel olarak anlamlı yüksek bulundu (p<0.001; p=0.002).
Sonuç: Hipofosfatemi yapılan birçok çalışmada ve bizim çalışmamızda da olduğu gibi COVID-19’lu hastalarda mortalite ile ilişkisi gösterilmiştir ve şiddetli hastalığı öngörmede bir biyobelirteç olabilir.
We aimed to investigate the effects of comorbid diseases and antihypertensive drugs on the clinical outcome of hospitalized patients with COVID-19 infection. A total of 1045 patients whose data could ...be gathered and confirmed from both hospital files and Turkish National Health Network records were retrospectively screened, and 264 of 1045 patients were excluded because of having more than one comorbid disease. The study population consisted of a total of 781 patients, of which 482 had no comorbid disease, while the remaining 299 patients had only one comorbid disease. The mortality risk was 7.532 times higher in those over 65 years of age compared to cases younger than 30 years (OR: 7.532; 95% CI: 1.733-32.730); the risk of mortality in men was 2.131 times higher than in women (OR: 2.131; 95% CI: 1.230-3.693); and presence of diabetes mellitus (DM) increased mortality risk 2.784 times (OR: 2.784; 95% CI: 1.288-6.019). While hypertension was not found to be an independent risk factor for COVID-19 mortality, age, gender, and presence of DM were independent risk factors for COVID-19 mortality. There was no association between antihypertensive drugs and mortality. Accordingly, age (>65 years), gender (male), and presence of DM were independent risk factors for COVID-19 mortality, whereas hypertension and use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and their combinations with other antihypertensive drugs were not risk factors for COVID-19 mortality. Keywords: COVID-19; Hypertension; Diabetes mellitus; Angiotensin-converting enzyme inhibitor; Angiotensin II receptor blocker Cilj istrazivanja bio je ispitati ucinak supostojeeih bolesti i antihipertenzivnih lijekova na klinicki ishod hospitaliziranih bolesnika s infekcijom COVID-19. Retrospektivnim probirom obuhvaceno je ukupno 1045 bolesnika cije podatke smo mogli prikupiti i potvrditi iz bolnickih kartona i zapisa Turske nacionalne zdravstvene mreze; od tih bolesnika njih 264 je iskljuceno, jer su imali vise od jedne supostojece bolesti. Tako je u studiju ukljucen ukupno 781 bolesnik, od kojih njih 482 nisu imali nikakve supostojece bolesti, dokje preostalih 299 imalo samo jednu supostojecu bolest. Rizik od smrtnog ishoda bio je 7,532 puta veci kod bolesnika starijih od 65 godina u usporedbi sa slucajevima mladim od 30 godina (OR: 7,532; 95% CI: 1,733-32,730); rizik od smrtnog ishoda bio je 2,131 puta veci kod muskaraca u nego kod zena (OR: 2,131; 95% CI: 1,230-3,693); prisutnost dijabetes melitusa (DM) povecala je rizik od smrti 2,784 puta (OR: 2,784; 95% CI: 1,288-6,019). Hipertenzija nije utvrdena kao cimbenik rizika za smrtnost kod infekcije COVID-19, ali su se dob, spol i prisutnost DM pokazali neovisnim rizicnim cimbenicima za smrtnost kod infekcije COVID-19. Prema tome, dob (iznad 65 godina), spol (muski) i prisutnost DM utvrdeni su kao neovisni cimbenici rizika za smrtnost kod infekcije COVID-19, dok hipertenzija i uzimanje inhibitora angiotenzin-konvertirajuceg enzima, blokatora receptora angiotenzina i njihovih kombinacija s drugim antihipertenzivnim lijekovima nisu utvrdeni kao rizicni cimbenici smrtnosti kod infekcije COVID-19. Kljucne rijeci: COVID-19; Hipertenzija; Dijabetes meliTus; Inhibitor angiotenzin-konvertirajuceg enzima; Blokator receptora angiotenzina II
•In vitro cytokines’ productions have not been studied yet in COVID-19 infection.•Their correlation with nasopharyngeal microbiota (NM) has not been studied as well.•Some of these in vitro cytokines ...production was lowest in severe COVID-19 patients.•IL-1beta and IL-10 levels showed a significant correlation with some NM species.•These could be candidate biomarkers in the management of COVID-19 infection.
To determine and compare nasopharyngeal microbiota (NM) composition, in vitro basal (Nil tube), provoked (Mitogen tube) production of cytokines at the early stage of COVID-19.
This cross-sectional study included 4 age and sex-matched study groups; group 1 (recovered COVID-19) (n = 26), group 2 (mild COVID-19) (n = 24), group 3 (severe COVID-19) (n = 25), and group 4 (healthy controls) (n = 25). The study parameters obtained from the COVID-19 (group 2, and 3) at the early phase of hospital admission.
The results from the reaserch deoicted that the Mean ± SD age was 53.09 ± 14.51 years. Some of the in vitro cytokines production was significantly different between the study groups. Some of the findinggs on cytokines depicted a significant differences between study groups were interleukin (IL)-1β Nil, IL-1β Mitogen, and their subtraction (i.e Mitogen-Nil). Regarding IL-10, and IL-17a levels, Mitogen, and Mitogen-Nil tube production levels were significantly different between the groups. Surprisingly, most of these measures were lowest in the severe COVID-19 patients’ group. Using discriminant analysis effect size (LEfSe), Taxa of NM with significant abundance was determined. About 20 taxa with an LDA score > 4 were identified as candidate biomarkers. Some of these taxa showed a significant correlation with IL-1β and IL-10 Mitogen and Mitogen- Nil levels (R > 0.3 or < -0.3, p < 0.05).
The findings of this perticular study regarting the early stage of COVID-19 showed that in vitro cytokines production, studies might be more useful than the ordinary cytokines' blood level measurement. Besides, the study identified some NM species that could be candidate biomarkers in managing this infection. However, further detailed studies are needed in these fields.
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