This study has been carried out to determine the learning needs of patients undergoing hematopoietic stem cell transplantation at the discharge stage. 100 patients undergoing transplantation in the ...Stem Cell Transplantation Unit of a university hospital in Turkey in 2018 have constituted the sample of the study. The "Patient Information Form" and the "Patient Learning Needs Scale" have been used as data collection tools in the study. In the study, the data have been collected 2-48 hours before the patients were discharged. The mean total score of the Patient Learning Needs Scale of the patients is 212.93±29.37, and the learning needs of the patients are generally high. The mean score of the treatment and complications subscale is 4.40±0.61, and the level of significance of the patients' learning needs is highest in this dimension. This is followed by; quality of life, drugs, life activities, community and follow-up, skin care and feelings about the condition, respectively. The mean total score of the scale was not affected by gender, marital status, employment status, existing chronic disease, educational level, and type of transplantation (p>0.05). It was concluded that the learning needs of each patient undergoing hematopoietic stem cell transplantation were high.
Bu araştırma, hematopoetik kök hücre nakli uygulanan hastaların taburculuk aşamasında öğrenme gereksinimlerini belirlemek amacıyla yapılmıştır. Araştırmanın örneklemini Türkiye’de bir üniversite hastanesinin Kök Hücre Nakil Ünitesinde 2018 yılında nakil olan 100 hasta oluşturmuştur. Araştırmada veri toplama aracı olarak “Hasta Bilgi Formu” ve “Hasta Öğrenme Gereksinimleri Ölçeği” kullanılmıştır. Araştırmada veriler hasta taburcu olamadan 2-48 saat önce toplanmıştır. Hastaların ölçek toplam puan ortalaması 212.93±29.37 olup, hastaların genel olarak öğrenme gereksinimleri yüksektir. Tedavi ve Komplikasyonlar alt boyut puan ortalaması 4.40±0.61 olup hastaların öğrenme gereksinimlerinin en yüksek olduğu boyuttur. Bunu sırasıyla yaşam kalitesi, ilaçlar, yaşam aktiviteleri, toplum ve izlem, cilt bakımı ve duruma ilişkin duygular izlemektedir. Ölçek toplam puan ortalamasını cinsiyet, medeni durum, çalışma durumu, mevcut kronik hastalık, eğitim düzeyi, nakil tipi etkilememektedir (p>0.05). Hematopoetik kök hücre nakli uygulanan her hastanın öğrenim gereksinimlerinin yüksek olduğu sonucuna ulaşılmıştır.
Classic Kaposi's sarcoma: A review of 156 cases Cetin, Bulent; Aktas, Bilge; Bal, Oznur ...
Dermatologica Sinica,
December 2018, 2018-12-00, 2018-12-01, Letnik:
36, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Kaposi's sarcoma (KS) is a reactive, multifocal, multicentric, angiogenic neoplastic proliferation that is thought to originate from endothelial cells that are infected with human herpesvirus-8 ...(HHV-8). This report examines a cohort of patients with classic Kaposi's sarcoma (KS) evaluated at the national institute of oncology over the 13-year period.
A retrospective analysis of 156 patients with classic KS, between January 2000 and November 2013, was performed. This study focused on the clinical presentation, staging, diagnosis, and treatment of classic KS.
One hundred fifty-six patients (median age 69 and 115 male) were enrolled into the study. Median age at diagnosis was 69 (range: 32–95 years). Male/female ratio was 2.80. The most common location was the lower limbs. There were 75 stage I patients (48.1%), 8 stage II patients (22.4%), 31 stage III patients (19.9%) and 15 stage IV patients (9.6%). Surgery was the most common local treatment method (43%). 44 patients (28.2%) received radiotherapy (RT) at diagnosis. Cytotoxic treatment with chemotherapy or interferon-α was administered in 57 patients. Visceral involvement was observed in 10 patients (lung: nine patients, liver: one patient) and bone metastasis occurred in two patients at relapse.
This study is one of the largest reported series. Further studies are required and it will be important to standardize the assessment of disease activity and clinical response.
Inoperable and metastatic hepatocellular carcinoma (HCC) is associated with a poor prognosis and low chemotherapeutic efficiency. Sorafenib is an oral multi-kinase inhibitor exerting its effects via ...the RAF/ MEK/ERK pathway, vascular endothelial growth factor receptor (VEGFR) and platelet derived growth factor receptor beta (PDGFR-β) tyrosine kinases. Randomized studies have shown a significant contribution of sorafenib to life expectancy and quality of life of cancer patients. The aim of the present study is to evaluate the efficacy and side effects of sorafenib therapy in Turkey.
Data for 103 patients (82 males, 21 females) receiving sorafenib therapy in 13 centers from February 2008 to December 2012 were evaluated. Median age was 61 years and median ECOG performance status was 1 (range: 0-2). 60 patients (58%) had hepatitis B, 15 patients (15%) had hepatitis C infection and 12 patients (12%) had a history of alcohol consumption. All of the patients had Child scores meeting the utilization permit of the drug in our country (Child A).
A total of 571 cycles of sorafenib therapy were administered with a median of four per patient. Among the evaluable cases, there was partial response in 15 (15%), stable disease in 52 (50%), and progressive disease in 36 (35%). Median progression-free survival was 18 weeks and median overall survival was 48 weeks. The dose was reduced only in 6 patients and discontinued in 2 patients due to grade 3-4 toxicity, 18 patients (17%) suffering hand-foot syndrome, 7 (7%) diarrhea, and 2 (2%) vomiting.
This retrospective study demonstrated better efficacy of sorafenib therapy in patients with advanced HCC compared to the literature while progression-free survival and overall survival findings were comparable. The side effect rates indicate that the drug was tolerated well. In conclusion, among the available treatment options, sorafenib is an efficient and tolerable agent in patients with inoperable or metastatic HCC.
Surgical resection of asymptomatic primary colorectal cancer in patients presenting with synchronous unresectable metastatic disease is controversial. Concerns and controversies remain over combining ...cytotoxic chemotherapy with bevacizumab in this patient population.
We identified medical records of 99 patients with synchronous metastatic primary colorectal cancer who received chemotherapy with bevacizumab as their initial treatment. The incidence of subsequent use of surgery and surgical outcomes were recorded. Patients were also assessed for overall survival.
Patients who received bevacizumab-containing chemotherapy for synchronous metastatic primary colorectal cancer were divided into the non-surgery and surgery groups according to the resection status of their asymptomatic primary tumor. In the non-surgery group, two patients (4.4%) underwent additional surgery, while three patients (5.7%) required surgery for rectovesical fistula in the surgery group. The median overall survival was 17 months for the non-surgery group (95% CI: 10.6-23.3 months) and 23 months for the surgery group (95% CI: 21.3-24.6 months; P = 0.322).
This study utilizing chemotherapy with bevacizumab did not result in an increased rate of morbidity related to the unresected primary tumor. Survival is not compromised by leaving the primary colon tumor intact.
AIM:To determine the relationship between non-alcoholic steatohepatitis(NASH)and bone mineral density(BMD).METHODS:A total of 38 patients(25 males)with a diagnosis of histologically proven NASH and ...42 healthy controls(24 males)were enrolled in the study.Demographic features,clinical findings,complete blood count and routine biochemical analysis,as well as adrenal,thyroid and gonadal functions,were recorded.Additionally,intact parathormone,25-OH-vitamin-D3,tumor necrosis factor-α,interleukin-6,interleukin-1,in-sulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels were measured in both groups.Furthermore,lumbar spine and femoral neck BMD of both groups were measured by the dual-energy X-ray absorptiometry(DXA)method.RESULTS:The mean age was 41±12 years in the NASH group and 43±11 years in the control group.Among demographic features,waist circumference was significantly larger in the NASH group compared to the control group(P<0.019).Among laboratory parameters,serum triglyceride(P<0.008),alanine transaminase(P<0.0001),aspartate transaminase(P<0.001),alkaline phosphatase(P<0.016),gamma glutamyl transferase(P<0.0001),ferritin(P<0.001)and 25-OH-vitamin-D3levels(P<0.0001)were significantly higher in the NASH group compared to the control group.Lumbar BMD was significantly higher in the NASH group compared to the control group(1.057±0.119 g/cm2vs 0.941±0.133 g/cm2;P<0.001,respectively).In the NASH group,there was no significant relationship between BMD and fibrosis stage in liver biopsy.CONCLUSION:NASH increases BMD and may be related to an elevated serum 25-OH-vitamin D3 level.
Bu araştırmanın amacı Fransa’da iki dilli öğrencilerin Türkçe dersleri için sunulan birleştirilmiş sınıf yapılarının öğrenme-öğretme süreçlerini ortaya koymayı amaçlamaktadır. Araştırma verileri ...Fransa’nın çeşitli bölgelerinde en az bir yıllık görev tecrübesi bulunan aktif görevdeki öğretmenlerden elde edilmiştir. Öğretmenlere sekiz soruluk yarı yapılandırılmış görüşme formu uygulanarak veriler nitel araştırma desenlerinden bütüncül tek durum kullanılmıştır. Böylelikle birleştirilmiş sınıf yapıları durum olarak belirlenmiş ve durumla ilgili belirli aktörlerin algılarına odaklanılmıştır. Elde edilen veriler kategori ve tema ekseninde kodlanarak düzenlenmiş ve yorumlanmıştır. Elde edilen verilerden hareketle farklı değişkenlerden kaynaklı olarak öğrencilerin Türkçe dil seviyelerinde çok ciddi farklılıklar söz konusudur. Yaş ve dil seviyesindeki çeşitliliğe bağlı olarak heterojen sınıf yapılarının dil öğretimi açısından ciddi sorunlar oluşturduğu ortaya çıkmıştır. Öğretmenler bu sorunların etkisini en aza indirebilmek adına yaş ve seviye farklılıklarını dikkate alarak materyal ve etkinlik tasarımına ağırlık verdiklerini, farklı dil seviyesi grupları oluşturdukları, ilgi çekiciliği ve motivasyonu artırmaya yönelik öğretim yöntem tekniklerine ağırlık verdiklerini dile getirmişlerdir. Öğretim sürecine yön verebilmek adına heterojen yapıdaki öğrenci kitlesinin hazırbulunuşluk düzeylerinin belirlenmesi de ciddi bir sorun oluşturmaktadır. Bunun için de öğretmenler süreç ve ürün odaklı ölçme yöntemlerine ve uygulamalara başvurmaktadır. Aynı zamanda hazırbulunuşluk düzeylerindeki farklılıkların giderilmesi için öğretmenlerin öğrenci ilgisini ve motivasyonu ön planda tutan uyarıcı zenginliği fazla olan materyallere ve aktivitelere yönelmektelerdir. Öğretmenler, öğrenme-öğretme süreçlerindeki en büyük sıkıntıları birleştirilmiş sınıf yapısından kaynaklı olarak yaşadıklarını dile getirmektedir. Çalışmadan elde edilen sonuçların alanyazında birleştirilmiş sınıflarda dil öğretimine yönelik gerçekleştirilen benzer araştırmaların sonuçlarıyla büyük oranda tutarlılık gösterdiği saptanmış ve bu doğrultuda önerilerde bulunulmuştur.
The aim of this study is to reveal the teaching-learning processes of the unified classroom structures offered for bilingual students’ Turkish classes in France. The data were collected from active teachers with at least one year of teaching experience in various regions of France. An eight-question semi-structured interview form was applied to the teachers and the data were analyzed using a holistic single case from qualitative research designs. In this way, unified classroom structures were determined as a case and the perceptions of certain actors about the situation were focused on. The data obtained were coded, organized and interpreted in terms of categories and themes. Based on the data obtained, there are serious differences in students’ Turkish language levels due to different variables. It has been revealed that heterogeneous classroom structures due to diversity in age and language level pose serious problems in terms of language teaching. In order to minimize the impact of these problems, teachers stated that they focused on material and activity design taking into account age and level differences, formed different language level groups, and focused on teaching method techniques to increase interest and motivation. Determining the readiness levels of the heterogeneous student population in order to guide the teaching process also poses a serious problem. For this, teachers resort to process and product-oriented measurement methods and practices. At the same time, in order to eliminate the differences in readiness levels, teachers tend to use stimulus-rich materials and activities that prioritize student interest and motivation. Teachers state that they experience the biggest problems in the learning-teaching processes due to the unified classroom structure. The results obtained from the study were found to be largely consistent with the results of similar studies conducted in the literature on language teaching in unified classrooms and suggestions were made accordingly.
Background
The incidence of multiple pregnancies is increasing with the availability of assisted reproductive techniques. Preterm labor and preterm rupture of membranes are major complications in ...such pregnancies. Preterm delivery of the first fetus is often followed by delivery of the remaining fetuses. However, conservative management in such circumstances might allow for fetal lung maturity in the remaining fetuses.
Case
We present a case of conservative management of an in vitro-fertilized triplet pregnancy with early loss of the leading triplet. A 33-year-old woman in the 21st week of a triplet pregnancy delivered her one of the fetuses, 4 days after the preterm rupture of membranes. To save the surviving fetuses, ligation of the umbilical cord at the cervical level was performed. Patient received antibiotics, tocolytics and corticosteroids after then. The second and the third fetuses were successfully delivered by cesarean section in the 28th week of pregnancy, 43 days after the first fetus was born.
Conclusion
We can improve the life expectancy of the retained fetuses by conservative management using tocolytics, antenatal steroids to stimulate lung maturation and antibiotics following the delivery of the first fetus.
Aim
The goal of this study is to evaluate possible factors affecting the survival of patients treated with gonadotropin‐releasing hormone (GnRH) analogues.
Methods
Demographic characteristics, ...treatment modalities, overall survival (OS) and the possible factors affecting the survival a total of 554 premenopausal breast cancer patients in Turkey evaluated retrospectively.
Results
The median duration of GnRH analogues use was 22 ± 13.6 (range, 1–87) months. Patients were divided into three groups according to the duration of GNRH analogues use; 4–12 months (Group A), 13–24 months (Group B) and ≥25 months (Group C). Overall, 530 patients were analyzed; 23.2%, 45.8%, 30.9% of the patients were in Group A, B and C, respectively. The median follow‐up duration was 34 ± 30.3 (range, 4–188) months. The OS in patients ≤35 years of age was found to be significantly longer than that of patients >35 years of age in Group B (log rank, P = 0.023). The disease‐free survival of the patients in Group A was significantly shorter than that of patients in Group C (log rank, P = 0.003). The OS of Group A patients was significantly shorter in comparison to that of Group B and Group C patients (log rank, P = 0.000) and the OS of Group B patients was significantly shorter than Group C (log rank, P = 0,000).
Conclusion
There is currently no definite data on the optimal duration of GnRH analogues use. One of the important results of this study that will provide an insight to the future studies is the improvement gained in OS by the increase in the duration of GnRH analogues use.
We aimed to evaluate the safety of nivolumab + ipilimumab (nivo + ipi) in advanced melanoma patients who had relapsed after ≥1 line of systemic treatment in a real-world setting.
Adult patients with ...advanced melanoma who had progressed after ≥1 line of systemic treatment were eligible for nivo 1 mg/kg + ipi 3 mg/kg Q3W × 4, followed by nivo 3 mg/kg Q2W until progression, or unacceptable toxicity for up to 24 months in the Early Access Program (EAP) in Turkey. Treatment-related adverse events (TRAEs) were recorded and analyzed.
Forty patients who received at least one dose of nivo + ipi were included. Median number of doses (Nivo + ipi and nivo alone) were 4 with a median follow-up of 19 weeks. Thirty patients (75%) were alive and 24 patients (60%) were on treatment. TRAEs of any grade and grade 3–4 occurred in 53% and 20% of the patients, respectively. One patient died due to TRAEs (colitis and diarrhea) after the second dose of nivo + ipi. Median times to onset and resolution of TRAEs were 6 and 3 weeks, respectively. Eleven patients (28%) discontinued treatment for reasons other than TRAEs. TRAEs of any grade led to discontinuation in 5 patients (13%). Most of the TRAEs were reversible when managed with available guidelines.
Safety profile of N + I was found to be consistent with early reports. Increased experience with the management of TRAEs of immunotherapies, short follow-up and ≥2 line real-world setting may account for lower TRAEs rates. Long-term follow is needed.
The present study aimed to establish the epidemiological and clinical characteristics of patients who were histopathologically diagnosed with malignant melanoma (MM).
The present study ...retrospectively analyzed the data of 78 patients who were histopathologically diagnosed with MM in Dicle University Medical Faculty, Dermatology and Medical Oncology departments between 2005 and 2014.
The study included 78 patients in total with 44 (56.4%) male and 34 (43.6%) female. Median age of the patients was 62.50 years (range: 27 - 84 years). Of the patients, 78.2% (n = 61) had cutaneous melanoma, 8.9% had solid organ melanoma, and 2.5% had ocular and mucosal melanoma. The most common tumor localization among the patients was the lower extremities with 29.4% (n = 23). The most common histopathological type was nodular malignant melanoma with 35.8% (n = 28). Based on TNM, Clark and Breslow classifications, 26.9% (n = 21) of the patients were stage 4, 26.9% (n = 21) were Clark stage 4, and 37.1% (n = 29) were Breslow stage 4. Median overall survival in all patients was 14.9 months (95% CI 10.9 - 18.8 months). In the multivariate Cox analysis, only stage statistically significantly affecting survival odds ratio (OR): 0.54; (95% CI 0.16-1.82, p = 0.02).
Malignant melanoma data are also important for the optimal utilization of effective methods and healthcare resources to prevent the disease. In order to minimize MM mortality and morbidity, not only the society but also physicians from primary and secondary care hospitals should become familiar with melanoma.
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