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Item Allergenic pollens in Turkey(Bilimsel Tıp Yayınevi, 2019) Bıçakçı, Adem; Tosunoğlu, Aycan; Uludağ Üniversitesi/Fen-Edebiyat Fakültesi/Biyoloji Bölümü.; 0000-0002-6333-3123; 0000-0003-2303-672X; O-1244-2018; 6701674542; 35235434000In this study, atmospheric pollen data of previous studies belonging to 54 different stations in Turkey, conducted by using the gravimetric and/or volumetric method, were evaluated in terms of flora, biogeography and aeropalynology. In line with these data, Turkey is divided into 5 aeropalyno-geographical regions, which are represented with their characteristics (North, West, South, Central, and East), and the skin prick tests were evaluated on the basis of pollen allergy data regionally and concurrently. In general, the dominant pollen seen in Turkey's atmosphere has been found to be represented by 29 different types. The pollen sum of these 29 taxa was found to represent more than 85% of the total pollen concentration detected in the atmosphere when evaluated according to different regions. Of these pollen types, 20 belong to woody and nine belong to herbaceous plants. It has generally been reported that there are higher pollen concentrations of woody plants in the atmosphere in Turkey. Overall, Cupressaceae/Taxaceae, Pinus, and Gramineae pollens were found as the common types to all of Turkey's five aeropalyno-geographic regions, in which they were recorded within the first three dominant pollen types. It has also been observed that Quercus, Platanus and Populus pollens from woody plants, and Amaranthaceae and Urticaceae pollens from the herbaceous plants were commonly recorded in high amounts for all regions. However, when the revised data are examined in detail, it has been determined that tree pollens like Fagus, Carpinus, Alnus, Corylus and Betula in the atmosphere were characteristic for the Northern Turkey region; the highest amounts of Olea europaea pollen for the Western Turkey region; higher quantities of the Cupressaceae/Taxaceae pollen for the Southern Turkey region; and very high amounts of Gramineae, Morus, Fraxinus and Artemisia pollens for the Eastern Turkey region have been recorded as characteristic in the atmosphere. Compared to Europe; Morus, Salix, Populus, Mercurialis and Plantago pollens in the atmosphere of Turkey differ in their presence and quantity. On the other hand, invasive plants such as Ambrosia and Ailanthus or exotic plants such as Casuarina and Eucalyptus, which have allergenic pollens, must be remembered among the dominant taxa in the air in different regions on a seasonal basis. It has been shown that the ideal allergen panels have to be updated according to the area and especially by including the dominant taxa. However, these updates should be made by taking into account cross-reactions, and at least one of the reacting taxa should be included in the panel.Item Anksiyete belirtilerinin eşlik ettiği majör depresif bozukluğun tanı ve sağaltımındaki güçlükler(Türkiye Sinir ve Ruh Sağlığı Derneği, 2006) Akkaya, Cengiz; Uludağ Üniversitesi/Tıp Fakültesi/Psikiyatri Anabilim Dalı.; 14061855100Major depressive disorder (MDD) is a common and costly disorder MDD often occurs with comorbid symptoms of anxiety. While symptoms of anxiety are not part of the diagnosis criteria of MDD, it has been recognized for many years that anxiety may play a critical role in depressive illness. The presence of anxiety has been associated with greater severity of depression and functional impairment, as well as increased suicide risk. Moreover, anxiety symptoms have been associated with reduced antidepressant response, in addition to greater risk of relapse and chronicity. Recently, emphasis has been placed on remission as the goal in the treatment of MDD. Patients who achieve remission have more favorable long-term outcomes than those who have appreciable improvement, but still have residual symptoms. Given the burden of illness caused by MDD, and given that anxiety is a common component of MDD and that full symptom resolution should be the goal of antidepressant therapy, efficacy in treating the symptoms of anxiety associated with depression may be an important component of the overall treatment of depression. Treatment of anxious depression presents unique challenges, optimally involving pharmacological agents that are effective for both depression and anxiety. The likely role of abnormal serotonergic neurotransmission in anxiety is widely supported, while the role of norepinephrine is less clear A large body of evidence supports the hypothesis that a perturbation in norepinephrine neurotransmission contributes to the symptoms of anxiety. It has been suggested that agents with dual reuptake inhibition of 5-HT and norepinephrine may be particularly effective in treating anxiety.Item Çocuklarda ilaç alerjileri(Galenos Yayıncılık, 2012-06) Sapan, Nihat; Aktaş, Belgin; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Alerji Bölümü.; 6602156485; 24467710200Drug allergy when compared with other allergic diseases can be the cause of most serious reactions and in the absence of true diagnosis fatal outcome can be accepted. In clinical practice, a wide range of symptoms from mild urticaria to anaphylaxis can be seen so that it can mimic the symptoms of all allergic disease. One of the significant consequences of allergic drug reactions is causing the use of less effective, more expensive or more toxic drugs in the future. A thorough history is essential to the management of drug allergy. Laboratory testing has a very limited role in the management of drug allergy. Confirmatory tests, if available, should be used to determine the allergic status of the patient. If these tests are not avaliable, depending on the type of clinical reaction previously demonstrated, a graded challenge or desensitization may be considered. Education of the patient and primary care physician is an important component of management.Item Effect of pre/postconditioning at temporary clipping(Türk Nöroşirürji Derneği, 2013-10-26) Taşkapılıoğlu, Mevlüt Özgür; Morali, Tuğba Güler; Ocakoğlu, Gökhan; Korfalı, Ender; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0001-5472-9065; ABB-8161-2020; HPH-3049-2023; AAW-5254-2020; HLG-6346-2023; AAH-5180-2021; 25936798300; 56729201700; 15832295800; 7004641343Intracranial aneurysms and their treatment is one of the leading problems of neurosurgery that create high mortality and morbidity. The technique of safe clipping is as generally used depends on the temporary occlusion of the cerebral vasculature during surgery. However, there is no exact data about temporary clipping or timing of this procedure. Preconditioning by exposure to sublethal hypoxic stress, hours or days before severe hypoxia, decreases cell death, and this resistance of the brain to injury is known as ischemic tolerance. Brief alternating periods of reperfusion-reocclusion at the beginning of reperfusion is defined as postconditioning. Cerebral ischemic pre/postconditioning protects against stroke, but is clinically feasible only when the occurrence of stroke is predictable. Brief, repetitive occlusion and release of the main trunk of a vessel during early aneurysm surgery or before long-lasting temporary artery occlusion may protect the brain against later possible vasospasm/ischemia.Item Establishing and using reference intervals(Walter de Gruyter, 2020-01-18) Özarda, Yeşim; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Klinik Biyokimya Anabilim Dalı.; AAL-8873-2021; 35741320500Reference intervals (RIs) and clinical decision limits (CDLs) are fundamental tools used by healthcare and laboratory professionals to interpret patient laboratory test results. The traditional method for establishing RIs, known as the direct approach, is based on collecting samples from members of a preselected reference population, making the measurements and then determining the intervals. For challenging groups such as pediatric and geriatric age groups, indirect methods are appointed for the derivation of RIs in the EP28-A3c guideline. However, there has been an increasing demand to use the indirect methods of deriving RIs by the use of routine laboratory data stored in the laboratory information system. International Federation of Clinical Chemistry (IFCC), Committee on Reference Intervals and Decision Limits (C-RIDL) is currently working on the study for the comparison of the conventional (direct) and alternative (indirect) approaches for the determination of reference intervals. As a matter of fact that, the process of developing RIs is often beyond the capabilities of an individual laboratory due to the complex, expensive and time-consuming process to develop them. Therefore, a laboratory can alternatively transfer and verify RIs established by an external source (i.e. manufacturers' package inserts, publications). IFCC, C-RIDL has focused primarily on RIs and has performed multicenter studies to obtain common RIs in recent years. However, as the broader responsibility of the Committee, from its name, includes "decision limits", the C-RIDL also emphasizes the importance of the correct use of both RIs and CDLs and to encourage laboratories to specify the appropriate information to clinicians as needed.Item A meta-analysis and an evaluation of trends in obesity prevalence among children and adolescents in Turkey: 1990 through 2015(Galenos Publishing House, 2018-03) Alper, Züleyha; Ercan, İlker; Uncu, Yeşim; Uludağ Üniversitesi/Tıp Fakültesi/Aile Hekimliği Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0002-8349-9868; 0000-0002-5225-4403; ABE-2261-2020; ABF-2367-2020; D-9597-2016; 8580079400; 6603789069; 8892370600Objective: Obesity in childhood and adolescence is one of the most serious public health problems due to a remarkable increase in prevalence in recent years and its close relationship with non-communicable diseases, such as diabetes and hypertension, resulting in increased adult morbidity and mortality. This study aims to quantify the secular trend in different regions of Turkey from 1990 to 2015 by performing a meta-analysis of childhood and adolescent obesity prevalence studies conducted. Methods: Uludag University Library Database was searched for relevant articles published prior to March 2017. The heterogeneity of the studies in the meta-analysis was tested by the I2 statistic and Cochran's Q test. The obesity trend analyses were examined by chi-square trend analysis with respect to five year periods. The statistical significance level was taken as alpha=0.05. Results: A total of 76 papers were initially identified addressing childhood and adolescent obesity in Turkey. Fifty-eight papers were selected for analysis. The prevalence of obesity increased from 0.6% to 7.3% with an 11.6-fold increase between the periods 1990-1995 to 2011-2015. The prevalence of obesity increased in both genders. However, boys were more likely to be obese than girls. Conclusion: Studies on obesity prevalence in the 5-19 age group in Turkey have gained importance, especially in the 2000s. While a remarkable number of prevalence studies, mostly regional, have been conducted between 2005-2011, a gradual decline was observed thereafter. Further national and population-based surveys on prevalence of obesity in children and adolescents are definitely needed in Turkey.Item Multiple extracranial metastases from secondary glioblastoma: A case report and review of the literature(Türk Nöroloji Derneği, 2013) Taşkapılıoğlu, Mevlüt Özgür; Aktaş, Ulaş; Eser Ocak, Pınar; Tolunay, Şahsine; Bekâr, Ahmet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroşirürji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; 0000-0001-5472-9065; 0000-0003-0132-9927; AAI-2073-2021; AAW-5254-2020; ABB-8161-2020; AAI-1612-2021; 25936798300; 55122917500; 55211742300; 6602604390; 6603677218Glioblastoma represents extreme anaplasia in astrocytic tumors. In spite of this aggressiveness, extracranial metastasis of glioblastoma is very rare and has been documented in only a few patients in the literature. In this article, a 30-year-old woman with secondary glioblastoma associated with extracranial distant metastasis was presented. In September 2008, an intracranial lesion in the left frontal region was diagnosed by magnetic resonance imaging (MRI) after admission to the hospital by headache and seizure and subsequently resected. The histology of the lesion revealed an anaplastic astrocytoma (grade III). Upon recurrence of the tumor 7 months later, the patient underwent a second craniotomy for recurrence tumor resection. The histological diagnosis was glioblastoma. After radiotherapy and chemotherapy, cranial computerized tomography (CT) and whole body scintigraphy revealed metastatic lesions in the right cervical lymph nodes and the left ischium. A neck dissection and parathyroidectomy on the right side was performed. The cytomorphological and histological features of the tumor supported the diagnosis of metastatic glioblastoma.Item Neuroproctective effects of ischemic tolerance (preconditioning) and postconditioning(Türk Nöroşirürji Derneği, 2009-10) Alkan, Tülin; Uludağ Üniversitesi/Tıp Fakültesi/Fizyoloji Anabilim Dalı.; 0000-0001-6466-5042; AAH-1792-2021; 6601953747Elucidation of the endogenous cell survival pathways involved in ischemic tolerance (preconditioning) and postconditioning has significant clinical implications for preventing neuronal damage in susceptible patients. Ischemic tolerance is a phenomenon in which the brain protects itself against future injury by adapting to low doses of noxious insults. Ischemic postconditioning is defined as brief periods of reperfusion alternating with re-occlusion applied during the very early minutes of reperfusion that mechanically alters the hydrodynamics of reperfusion. Similar pathways and molecules play a role in pre-and postconditioning but their roles and timing are different in each conditioning. Understanding the neuroprotective effects of mechanisms underlying conditionings has been elusive, but NNMA receptor activation, nitric oxide, inflammatory cytokines, and suppression of the innate immune system appear to have a role. Reactive oxygen species and classical ligand stimuli play a role in postconditioning with KATP channels and protein kinase C pathways acting as mediators.Item New features for child metrics: Further growth references and blood pressure calculations(Galenos Yayıncılık, 2019-09-01) Demir, K.; Konakçı, E.; Demir, BK.; Özen, S.; Aydın, M.; Darendeliler, F.; Özkaya, Güven; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatik.; 0000-0003-0297-846X; A-4421-2016; 16316866500Many new features have recently been incorporated to CEDD Cozum/Child Metrics, an online and freely accessible scientific toolset. Various auxological assessments can now be made with data of children with genetic diseases (Prader Willi syndrome, Noonan syndrome, Turner syndrome, Down syndrome, and Achondroplasia) and preterm and term newborns. More detailed reports for height, weight, and body mass index data of a given child are now available. Last but not least, office and 24-hour ambulatory blood pressure values can be analyzed according to normative data.Item Polycythemia vera: Diagnosis, clinical course, and current management(TÜBİTAK, 2018-08-09) Büyükaşık, Yahya; Ar, Cem; Turgut, Mehmet; Yavuz, Selim; Saydam, Güray; Ali, Rıdvan; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Hematoloji Anabilim Dalı.; 7201813027Very important developments related to polycythemia vera (PV) have occurred during the last two decades. The discovery of Janus kinase (JAK) 2 mutations has changed both the diagnosis and clinical management of PV. Currently JAK2 molecular testing is essential in the diagnostic work-up and JAK2 mutation positivity is a major diagnostic criterion. The discovery of JAK2 mutations suggested that abnormal JAK-STAT signaling was a pivotal feature in the pathogenesis of Philadelphia-negative myeloproliferative neoplasms. This idea led to the development of JAK inhibitors. Currently ruxolitinib, a JAK1/JAK2 inhibitor, is also approved for PV patients with hydroxyurea resistance or intolerance. International collaborations have made it possible to describe disease characteristics and evolution better. Presently it is possible to quantify the symptomatic burden of the disease and to estimate prognosis. In spite of these developments, management of PV still largely depends on estimation of thromboembolic risk and trying to decrease the risk with or without cytoreductive medications. Different approaches have been proposed by international disease experts for the diagnosis, thromboembolic risk estimation, and drug selection. This paper aims to review clinical aspects of PV and propose a management algorithm. The authors also point to still unresolved questions and unmet needs in diagnosis and management.Item Turkish thoracic society experts consensus report: Recommendations for pulmonary function tests during and after COVID 19 pandemic(Türk Toraks Derneği, 2020-05-25) Gemicioğlu, Bilun; Börekçi, Şermin; Ulubay, Gaye; Azap, Özlem; Saryal, Sevgi; Dilektaşlı, Aslı Görek; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; CNP-1063-2022; 36466376600The recommendation of conducting pulmonary function tests (PFTs) from different societies during and after the coronavirus disease (COVID-19) pandemic was rated by the experts of the Turkish Thoracic Society (TTS) and presented as the TTS experts consensus report. Information about the topic has been provided. Globally, as of mid-May 2020, there have been over 4.4 million confirmed cases of COVID-19. There are two main routes of transmission of COVID-19: respiratory droplets and contact transmission. PFTs are non-invasive tests that are commonly performed in routine assessment and follow-up of patients in the pulmonology units. However, PFTs may generate aerosols and require sharing common surfaces. With regard to the high prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the community, PFTs should not be performed routinely in confirmed or suspected patients with COVID-19 during the pandemic. Because of the risk of human-to-human transmission of COVID-19, PFTs should be restricted to a small patient population with selected indications. Triage for COVID-19 should be performed prior to testing. Only essential PFTs such as spirometry, diffusion capacity of the lungs for carbon monoxide (DLCO), arterial blood gas analysis, or pulse oximetry should be performed in the selected cases. Tests should be scheduled to allow sufficient time for donning and doffing of the technical personnel with the full personal protective equipment (PPE) (gown, a filtering respirator mask, goggles or full-face shield, and disposable gloves), ventilation of the room, and application of post-test cleaning and disinfection procedures of the equipment and the testing room.Item Urothelial carcinoma of the bladder in pediatric patient: Four case series and review of the literature(Galenos Yayınevi, 2017-11-09) Uçar, Murat; Demirkaya, Metin; Vuruşkan, Berna Aytaç; Balkan, Emin; Kılıç, Nizamettin; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Ürolojisi Anabilim Dalı/Çocuk Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Pediatrik Onkoloji Bilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; 0000-0001-6977-7430; AAI-3656-2021; L-5017-2019; AAH-9746-2021; AAI-2145-2021; 8614664900; 24331130000; 57053559100; 7004109012; 7005266570Background: Urothelial carcinoma of the bladder is a rare condition in children, and most cases in this age group are noninvasive and low-grade. However, no follow-up protocol has been defined for this patient group. The objective of this study was to draw attention to bladder tumors in children and focus on the current recommendations for postoperative follow-up along with a case study of four patients. Case Report: Four patients aged <18 years with urothelial carcinoma who were treated in our clinics between 2001 and 2015 were retrospectively evaluated. The results were compared with those of published pediatric case series in the literature. No abnormalities were found in the patients' physical examinations and laboratory analyses, except hematuria (microscopic or macroscopic). Ultrasonography was used in all the patients to detect lesions in the bladder. Surgical resections were performed endoscopically, except in one patient. Histopathological evaluations revealed low-grade superficial urothelial carcinoma. No recurrence or complication was observed for all patients. Conclusion: Although rarely encountered during childhood, urothelial carcinoma should be considered as a differential diagnosis in pediatric patients with hematuria.Item Uzmanlık eğitiminde tıp etiği(Türk Kardiyoloji Derneği, 2009-04) Sarıkaya, Özlem; Balcıoğlu, Harun; Civaner, Murat; Uludağ Üniversitesi/Tıp Fakültesi/Deontoloji Anabilim Dalı.; 24075622600Tıp etiği eğitimi, uzmanlık eğitimine ilişkin tartışmaların önemli başlıklarından birini oluşturmakta, tıp etiği eğitiminin gerekliliği çeşitli ulusal ve uluslararası metinlerde dile getirilmektedir. Gerek sağlık hizmetlerinin örgütlenme ve finansman modeliyle birlikte hasta-hekim ilişkisi, hekim kimliği ve giderek mesleğin toplumsal yeri ve algılanışının değişiyor olması, gerekse de teknolojik olanaklılıkların artmasıyla ortaya çıkan yeni sorun alanları tıp etiğini güncel kılmaktadır. Günümüzde hekimler, mesleki değerleri korumakta her zamankinden çok zorlanmakta, hızla değişen koşullar yeni ve haklı çıkarılabilen kararlar verilmesini talep edebilmektedir. Hekimlerin mesleki değerleri koruyacak çözümleri bulabilmeleri için mezuniyet öncesinde ve mezuniyet sonrası dönemde özellikle uzmanlık eğitiminde uygun nitelikte tıp etiği eğitimi almaları bu anlamda önemlidir. Bu yazının amacı tıpta uzmanlık eğitiminde tıp etiği eğitiminin yerini gerekçeleriyle dile getirmek ve tıp etiği eğitiminin yapılandırılması için konu başlıkları ve yöntemler önermektir. Bu amaçla uzmanlık öğrencisi hekimlerin mezuniyet öncesi eğitimleri, çalışma koşulları, seçme sınavının özellikleri, nasıl bir ortamda çalışıp eğitim aldıkları gözden geçirilmekte, sonrasında uzmanlık eğitimi ile yetiştirilmesi hedeflenen hekimin özellikleri ve bu hedeflere nasıl bir içerik ve yöntemle ulaşılabileceğinden söz edilmektedir.