Natural History of Cirrhosis: Changing Trends in Etiology Over the Years.

BACKGROUND AND GOALS: The aims of the present study were to investigate the natural history of cirrhosis and to determine trends in the etiology of cirrhosis. METHODS: Between January 2001 and January 2018, a total of 1,341 patients had been diagnosed with cirrhosis and were included. RESULTS: A total of 898 cirrhotic patients, who were followed up for at least 6 months were included into the analysis. The median age was 54 years. The median Child-Pugh and MELD scores were 7.5 and 11, respectively. Ascites (51%) was the most common causes of decompensation. Chronic viral hepatitis was the most frequent cause of cirrhosis (58%). Hepatitis B virus (HBV) infection was the main etiology (34%), followed by hepatitis C virus (HCV) infection (18%). Among 129 patients with cryptogenic cirrhosis (CC), 60 had metabolic abnormalities. If these 60 patients with CC were considered to have nonalcoholic fatty liver disease (NAFLD)-related cirrhosis, the proportion of NAFLD-related cirrhosis increased from 1.8 to 8.0%. At admission, 74 patients (8%) had been diagnosed with hepatocellular carcinoma (HCC). A new HCC developed in 80 patients during the follow-up period. The probability of developing HCC was 3.9% at 12 months. Logistic regression analysis showed that the development of HCC was significantly associated with older age (p < 0.001), male gender (p < 0.001), viral etiology (p = 0.026), and baseline high aspartate aminotransferase level (p = 0.01). Overall, 104 cirrhotic patients died. CONCLUSION: HBV and HCV remain the leading causes of etiology in cirrhosis and HCC. However, NAFLD-related cirrhosis is recognized as a growing burden.

[Rational Drug Usage Status of Nursing Students]. / Hemsirelik Ögrencilerinin Akilci Ilaç Kullanma Durumlari.

AIM: This study was conducted to determine nursing students' rational use of medicines. METHOD: The population of this descriptive study was composed of 1177 students who were studying at a faculty of nursing in Istanbul. The study sample, on the other hand, consisted of 303 students who were selected from the population by the "stratified random sampling" method, a probabilistic sampling method. The sample size was calculated using the Minitab software. Data were collected with data collection form between February and March 2016. In data analysis, percentage, median, Pearson Chi-square and Fisher's Exact test was used. RESULTS: It was found that the average age of the participating nursing students was 20.25±1.71, 85.5% of the participants were female, 98.7% were single, 66.3% graduated from Anatolian High School and 29.4% of them were in their third year of study. Also, 11.6% of the participants used medicines continuously, 16.2% used medicines frequently, the most frequent reason for using medicines (69%) was pain, 93.7% read the prospectus of the medicines they used, 70.6% took their medicines on time, 86.8% were careful about using their medicines before or after meals, 78.5% did not change doses of medicines themselves, 63% stopped using medicines when symptoms of disease were over, 62% did not always take medicines with prescription, and 97.3% used pain relievers most without a prescription. In addition, there were significant differences between the participants' gender and reading the prospectus before using medicines, between having a chronic disease and continuous and frequent use of medicines, and between alcohol consumption and frequent use of medicines (p<0.05). CONCLUSION: The nursing students in our study were found to have inadequacies in some issues related to rational use of medicines (e.g. taking medicines with a prescription, using medicines on time and not changing medicine doses without physician's suggestions). In this context, it is advisable to develop guidance and counseling programs for the development of rational drug use behaviors of nursing students and to include this subject in detail in nursing undergraduate education course curricula.