The relationship between healthcare workers' satisfaction level and patients' satisfaction: Results of a path analysis model.

INTRODUCTION: Patient and healthcare workers' satisfaction is an important issue in the healthcare sector today. This study aims to evaluate the relationship between healthcare workers and patient satisfaction levels among Turkish individuals, with particular emphasis on the contribution of the former to the latter. MATERIALS AND METHODS: The current study was conducted in a state hospital in Istanbul, Türkiye. Face-to-face surveys were conducted from January to April 2022 to administer two diverse questionnaires for inpatients and attending healthcare workers in the same clinic. Path analysis was used to examine the relationships. RESULTS: The path analysis demonstrated that 25.2% of patient satisfaction was constituted by the satisfaction of healthcare workers. The final model had an excellent fit with the data x2 (112.89), x2/df (2.130); SRMR=0.0679, CFI=0.956, RMSEA=0.0798. According to the results of this analysis, healthcare worker satisfaction positively influences patient satisfaction and causes it to increase. CONCLUSION: Healthcare satisfaction plays a central role in providing patient satisfaction, which in turn helps with the challenges that healthcare faces today.

Polyploidy Phenomenon as a Cause of Early Miscarriages in Abortion Materials.

Objectives: Chromosomal abnormalities are an important cause of especially early miscarriages. The aim of this study was to analyze the chromosomal aberrations and determine the frequencies of numerical and structural chromosome abnormalities in spontaneous abortion materials. Methods: This was a prospective research and ninety two abortion samples obtained from women who had one or more miscarriages were included in the study. Conventional karyotype analysis was performed on each sample to identify possible chromosomal abnormalities. Results: By karyotype analysis, 11 polyploidy cases, (9 triploids and 2 tetraploids), 8 trisomies (one of which was mosaic), 2 monosomies (monosomy X), 1 isochromosome, 1 Xq deletion, and 4 translocations were detected in abortion materials. Isochromosome and Xq deletion cases were also mosaic. In addition, five polymorphic variants were revealed. We found higher paternal age in polyploidy cases. Conclusion: The most common anomaly we found in abortion materials was polyploidy. This was followed by aneuploidy (trisomy and monosomy). Polyploidy (triploidy or tetraploidy) emerged as an important cause in cases of spontaneous abortion. Paternal age may be associated with polyploidy especially triploidy.

Metronidazole resistance in Trichomonas vaginalis determined by molecular and conventional methods.

Trichomonas vaginalis (T. vaginalis) is a protozoan parasite that infects the urogenital tract of both women and men worldwide. Trichomoniasis can cause serious symptoms if untreated. Metronidazole is the drug of choice for the treatment of trichomoniasis. In recent years metronidazole-resistant T. vaginalis has often been mentioned in clinical isolates. The aim of this study was to determine the conventional and molecular methods to determine metronidazole-resistant T. vaginalis, which is seen commonly and to discuss the possible reasons for this. Samples taken from patients diagnosed with T. vaginalis from the gynaecology and obstetrics clinic between April 2015 and June 2016 were evaluated for metronidazoleresistance using molecular and conventional methods. A total of 170 patients were examined and T. vaginalis was determined in 6 (3.5%) patients. Metronidazole resistance was determined in 2 (33.3%) of the 6 clinical isolates as a result of the molecular and conventional tests applied. Metronidazole resistance was determined using nitroreductase genes ntr4Tv and ntr6Tv. These findings suggest that metronidazole-resistance T. vaginalis strains can be determined in laboratory samples of cases with trichomoniasis. This may be an important underlying factor in the unsuccessful management of recurrent cases seen in routine gynecological practice.

Testosterone replacement in transgenic sickle cell mice controls priapic activity and upregulates PDE5 expression and eNOS activity in the penis.

Sickle cell disease (SCD)-associated priapism is characterized by decreased nitric oxide (NO) signaling and downregulated phosphodiesterase (PDE)5 protein expression and activity in the penis. Priapism is also associated with testosterone deficiency, but molecular mechanisms underlying testosterone effects in the penis in SCD are not known. Given the critical role of androgens in erection physiology and NO synthase (NOS)/PDE5 expression, we hypothesized that testosterone replacement to eugonadal testosterone levels reduces priapism by reversing impaired endothelial (e)NOS activity and molecular abnormalities involving PDE5. Adult male transgenic Berkeley sickle cell (Sickle) and wild-type (WT) mice were implanted with testosterone pellets, which release 1.2 µg testosterone/day for 21 days, or vehicle. After 21 days, animals underwent erectile function assessment followed by collection of blood for serum testosterone measurements, penes for molecular analysis, and seminal vesicles as testosterone-responsive tissue. Serum testosterone levels were measured by radioimmunoassay; protein expressions of PDE5, α-smooth muscle actin, eNOS and nNOS, and phosphorylation of PDE5 at Ser-92, eNOS at Ser-1177, neuronal (n) NOS at Ser-1412, and Akt at Ser-473 were measured by Western blot in penile tissue. Testosterone treatment reversed downregulated serum testosterone levels and increased (p < 0.05) the weight of seminal vesicles in Sickle mice to levels comparable to that of WT mice, indicating restored testosterone levels in Sickle mice. Testosterone treatment reduced (p < 0.05) prolonged detumescence in Sickle mice and normalized downregulated P-PDE5 (Ser-92), PDE5, P-eNOS (Ser-1177), and P-Akt (Ser-473) protein expressions in the Sickle mouse penis. Testosterone treatment did not affect P-nNOS (Ser-1412), eNOS, nNOS, or α-smooth muscle actin protein expressions in the Sickle mouse penis. In conclusion, in the mouse model of human SCD, increasing testosterone to eugonadal levels reduced priapic activity and reversed impaired Akt/eNOS activity and PDE5 protein expression in the penis.

A simple technique for small-diameter urethrocutaneous fistula repair: Ligation.

OBJECTIVE: To describe a simple and effective technique for repairing a small-diameter urethrocutaneous fistula. METHODS AND TECHNIQUE: A total of 13 patients with a solitary and small-diameter (≤2 mm) urethrocutaneous fistula underwent repair with a ligation technique. RESULTS: None of the patients had voiding difficulties. One recurrent urethrocutaneous fistula occurred and it was successfully repaired with the same technique. CONCLUSION: This is a simple, quick and useful technique, particularly for small-diameter (≤2 mm) urethrocutaneous fistulas.

Cytoreductive surgery and perioperative intraperitoneal chemotherapy for gynecological malignancies: a single center experience.

INTRODUCTION: The objective of this study was to assess the outcome of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) plus early postoperative intraperitoneal chemotherapy (EPIC) in patients with advanced gynecological malignancies. MATERIALS AND METHODS: A retrospective series of 51 patients with advanced gynecologic cancer, evaluated between May 2008 to February 2014. Peritoneal Cancer Index (PCI) and Completeness of Cytoreduction (CCR) score were used in the study group. The study group consisted of the cancers of ovarian, fallopian tube, endometrial, and uterine sarcomas. RESULTS: Mean PCI score of the study group was 18, and the postoperative complications were similar with the literature. Patients were followed in a period of 15 days to 64 months and the mean survival time was 22.8 months. Fifty-two percent of the patients were alive without evidence of the disease and overall one-year survival was found 56%. CONCLUSIONS: The authors concluded that CRS, HIPEC, EPIC, and peritonectomy are a crucial options in patients with advanced gynecological cancers.

Reproductive outcomes following hysteroscopic resection of endometrial polyps of different location, number and size in patients with infertility.

We aimed to assess the pregnancy rates after hysteroscopic polypectomy in infertility patients with endometrial polyps and to compare pregnancy rates among subgroups with polyps of different location, size and number. All patients who underwent hysteroscopic evaluation which revealed endometrial polyps were included. Patients with any intrauterine pathology other than polyp and those undergoing frozen embryo transfer (ET) cycles were excluded. Patients were evaluated according to polyp location, size and number. Rates of ß-hCG positivity and clinical pregnancy were compared. Clinical pregnancy rates after polypectomy was 41.7% for multiple polyps, 30.8% for isthmus zone polyps, 28.6% for anterior wall polyps, 27.3% for cornual zone, 22.2% for posterior uterine wall polyps and 11.8% for fundal polyps (p = 0.532). There appears no difference regarding reproductive outcomes after hysteroscopic resection of polyps situated in different intrauterine locations. Similarly, chance of conceiving seems not to change after hysteroscopic treatment of polyps of different size and number.

The effects of intraperitoneal chemotherapeutic agents on adhesion formation.

PURPOSE: Intra-abdominal adhesions are a major complication of healing. Furthermore these adhesions may cause morbidity and sometimes mortality for patients, and also are a financial burden to the health system. MATERIALS AND METHODS: Cecum abrasion was performed in all rats and solutions containing saline to group 1, 5-fluorouracil to group 2, cisplatin to group 3, paclitaxel to the group 4, and mitomycin-C were administered into the abdomen of the groups, respectively. The intra-abdominal adhesions were scored after the macroscopic evaluation. RESULTS: Among the chemotherapeutic drugs, paclitaxel significantly increases occurring of intra-abdominal adhesions in comparison with the control group and the other drugs according to the evaluation of scoring and statistical studies. CONCLUSION: It is suggested to use the drugs which have a proven anti-adhesion feature or barriers to the patients who are going to be applied intraperitoneal chemotherapy with paclitaxel.

Antenatal counseling against passive smoking may improve birth weight for gestational age.

AIM: The authors determined the impact of antenatal counseling against exposure to environmental cigarette smoke on the prevention of reduced neonatal birth weight according to gestational age. MATERIALS AND METHODS: A cross-sectional study was conducted in pregnant women, with 77 passive smokers and 88 non-smokers. During motivational interviews, passive smoking status was monitored and additional follow-up visits were arranged to increase the knowledge regarding perinatal risks of passive smoking, including intrauterine growth restriction and low birth weight. The authors aimed to increase the woman's motivation to avoid second-hand tobacco smoke exposure. RESULTS: The demographic and clinical findings of the study groups were found considerably similar, in this context, and the authors found positive and strong correlations between the gestational age and neonatal birth weight (r = 0.80 and r = 0.76, respectively; p < 0.05). CONCLUSIONS: During antenatal care of women, regular counseling against second-hand smoke exposure may prevent negative effect of passive smoking on neonatal birth weight according to gestational age. This promising finding needs to be supported by further studies with larger sample size considering covariates relevant to passive smoking.

Long-term results of half-dose photodynamic therapy for chronic central serous chorioretinopathy with contrast sensitivity changes.

PURPOSE: To evaluate the efficacy and safety of photodynamic therapy (PDT) with half-dose verteporfin in patients with chronic central serous chorioretinopathy (CCSC) and retinal functional changes, by functional acuity contrast test (FACT). METHODS: In this study, 27 eyes of 24 patients with CCSC were treated with PDT with half-dose verteporfin. Best-corrected visual acuity (BCVA), central foveal thickness (CFT) and resolution of subretinal fluid on optical coherence tomography (OCT), and leakage on fluorescein angiography (FA) and indocyanine green angiography (ICGA) were assessed. Contrast sensitivity test was performed at baseline and at 12th month for investigating retinal functional changes. RESULTS: The mean follow-up period was 25.33 ± 11.08 months. The mean age was 43.7 ± 8.6 years. Seventeen patients were male (70.8%) and seven patients were female (29.2%). Post PDT at 1st, 3rd, 6th, 12th month and at last follow-up, BCVA were significantly improved compared with the baseline BCVA (P<0.001), and CFT post PDT were significantly thinner than the baseline measurement (P<0.001). There was significant difference between pre- and post-PDT 12th month contrast sensitivities at all five different spatial frequency channels (P<0.01). CONCLUSIONS: Half-dose PDT is an effective and safe method in the treatment of CCSC with anatomical and functional success. The measurement of contrast sensitivity by FACT can be useful for evaluating the functional effectiveness of half-dose PDT for CCSC.

The effect of enalapril on renal resistive index, urine electrolyte levels and TGF-ß1 levels of kidney tissues in rats with unilateral partial ureteropelvic junction obstruction.

BACKGROUND: This study aimed to investigate renal arterial resistive index measurements and urine electrolytes before and after enalapril therapy in a rat model of unilateral ureteropelvic obstruction. The transforming growth factor (TGF)-ß1 response of the renal tissue was also investigated. MATERIALS AND METHODS: 30 Wistar albino rats were randomly allocated into 5 groups (n=6). Group C rats served as controls. Group S rats had only laparotomy. Group E rats were only treated with enalapril. Rats in group UP and group UPE underwent laparotomy to create a left unilateral moderate partial obstruction. 2 weeks after establishing partial ureteropelvic junction obstruction, group UPE rats were treated with enalapril. Urine was collected over 24 h in all groups. Intrarenal arterial resistive index measurements were performed before and 2 weeks after surgery and after enalapril treatment in group UPE, and before and after enalapril treatment in group E. Rats were sacrificed by intracardiac puncture and left kidneys were harvested to evaluate levels of mRNA TGF-ß1. RESULTS: There was no significant difference in ARI values in group E. In group UPE, the difference between ARI values before and after surgery was statistically significant; the difference between ARI values after surgery and after enalapril treatment was also statistically significant. There was no statistically significant intra-group difference in urine electrolyte levels for UP group or UPE group. There was no difference in renal mRNA TGF-ß1 levels. CONCLUSION: Enalapril maintained renal blood flow by decreasing the arterial resistive index and maintained renal tubular function by protecting urine concentration and dilution ability in a rat model with unilateral ureteropelvic junction obstruction.

Bilateral ureteropelvic junction disruption in a 5-year-old boy.

Ureteral injuries represent less than 1% of all traumatic genitourinary injuries. The rarity of traumatic ureteral injury is at least in part because the ureters are relatively well protected in the retroperitoneum. Ureteral injuries after blunt trauma are not common, and bilateral disruption of the ureteropelvic junction (UPJ) has only been previously reported in just one child. This is the first documented case of operative ureteral repair of bilateral complete UPJ disruption with double J ureteral stents in a child.

Impact of hepatitis serology on development of leukopenia after solid organ transplantation.

BACKGROUND: Homologous organ transplantation is an accepted therapeutic modality for end-stage disease of the kidney and liver. In posttransplantation periods leukopenia is a common problem with a wide range of differential diagnoses. Not only can it lead to an increased incidence of infections, but preclude the use of adequate immunosuppressive therapy and antimicrobial regimens because of their potential leukopenic side effects. One reason for leukopenia is viral hepatitis, which is frequently seen in transplant recipients. Herein this report, we searched for the relationship of leukopenic bouts among kidney and liver transplantation recipients to hepatitis serology. METHODS: We retrospectively evaluated the records of 569 patients who received solid transplants between January 1996 and October 2006. Because 27 patients did not come for follow-up examinations, their data were excluded, and 14 patients had 2 transplantations, yielding 556 primary transplantation cases for leukopenic attacks. RESULTS: Leukopenic attacks showed a strong relationship with hepatitis B virus (HBV) infection, but were independent of HBV DNA status (P = .002). No relationship with hepatitis C virus (HCV) infection status was found. CONCLUSIONS: Leukopenia is a common, important complication that can be seen during the posttransplantation period of recipients affecting both mortality and morbidity. HBV infection is a risk factor for development of leukopenia after transplantation. Adequate treatment of HBV infection in transplant recipients is important to obtain leukocyte counts in the normal range, allowing easier and safe antibacterial and immunosuppressive therapy in the posttransplantation period.

Management of recurrent thrombosis in liver transplant recipients: a case report.

Intra-abdominal thrombotic complications in orthotopic liver transplantation can cause devastating results. The management of these patients after thrombosis remains a difficult clinical problem. We present a case report of a patient who developed recurrent venous, thrombosis after liver transplantation performed because of cirrhosis due to autoimmune hepatitis. She had bleeding episodes during and early after the transplantation procedure and developed portal vein thrombosis after a single dose of recombinant factor VII, which was given for treatment of hemorrhage. She had her second thrombotic attack while she was on warfarin therapy which was initiated after the first bout. No hereditary or immunologic risk factors were found. Management of these patients can be difficult because of the liver's effect on the coagulation profile.

Cytogenetic findings and clinical outcomes of adult acute myeloid leukaemia patients.

The role of cytogenetic findings in determining the diagnosis, therapy and prognosis of acute myeloid leukaemia (AML) has become more valuable by the day. In this study, the results of conventional and molecular cytogenetic analyses and clinical outcomes of 66 AML patients of different subgroups aged between 16 and 82 were evaluated. Chromosomal abnormalities were detected in 17 (25.7%) patients cytogenetically at the time of diagnosis, whereas molecular cytogenetic abnormalities were detected in 21 (31.8%) patients by fluorescence in situ hybridisation (FISH). Thirty-eight (57.6%) patients had a normal karyotype. In 8 patients, we did not obtain suitable chromosomes for karyotype analysis and in 3 patients conventional cytogenetics were not requested by the physician. During clinical follow-up, 21 patients (31.8%) achieved complete remission (CR), 2 had partial remission (PR) (3.0%) and 4 patients had progressive disease (6.06%). Twenty-eight (42.4%) patients died during treatment and no follow-up data were available in 7 cases. Among patients with chromosome abnormalities detected by either one of the two cytogenetic methods (n=28), 12 had achieved CR, 9 of whom were already categorised in the good prognostic group with t(15;17), inv16 or t(8;21). As for the normal karyotype, each patient displayed a different clinical course, which is probably due to the molecular changes in leukaemia-related genes. Here we report our findings, which correlate with previous reports and conclude that cytogenetics is a crucial marker in leukaemia diagnosis and conventional and molecular cytogenetics should be performed as well as molecular genetic diagnostic methods.

The first 2 years of clinical experience with peripheral blood stem cell transplantation for various hematological malignancies: results from a single Baskent University Center.

Autologous stem cell transplantation is the current standard approach for patients with multiple myeloma and relapsed or refractory lymphoma. Nonmyeloablative allogeneic stem cell transplantation has been applied worldwide. We analyzed the results of transplantation activity from 2004 to 2006. Seven evaluable patients younger than 65 years old with stage II/III multiple myeloma were treated with high-dose melphalan therapy (140 mg/m(2)) plus autologous peripheral blood stem cell transplantation. Complete responses or tumor reductions of more than 75% were obtained in all patients. At a median follow-up of 10 months, all patients remained disease-free. Four patients with acute myeloblastic leukemia underwent nonmyeloablative allogeneic peripheral stem cell transplantation. Their median age was 30 years. One patient was refractory and the others were in hematological remission. The patients received fludarabine-based preparative regimens. All patients received fully matched blood from a related donor 2 days after chemotherapy in conjunction with graft-versus-host disease prophylaxis. One refractory patient with >90% engraftment had late autologous reconstitution at 3 months with evidence of relapse. All other patients in remission remained with >90% donor cell engraftment. These patients are disease-free at 13, 10, and 2 months. Toxicity was minimal. These results showed promise due to the minimal toxicity observed with the conditioning regimens which indicated the feasibility of these procedures.

Polycythemia as the first manifestation of Cushing's disease.

A 39-yr-old man presented to our hospital with unexplained erythrocytosis and hypertension. His follow-up for erythrocytosis had begun 2 yr earlier in another hospital and he had been diagnosed with polycythemia rubra vera. On admission to our hospital he was hypertensive (165/95 mmHg) and, except for the presence of moon-like face and facial plethora, his physical examination was normal. His hemoglobin concentration was 19.2 g/dl, and hematocrit was 58.9% with an increased red blood cell mass of 58 ml/kg as measured by radioisotope (Cr51). Blood film, other hematological indices except for elevated leukocyte alkaline phosphatase score, arterial gas analysis, and examination of aspirated bone marrow were all normal. An abdominal ultrasonography showed no evidence of splenomegaly. A diagnosis of probable secondary erythrocytosis was made. Early-morning serum cortisol and 24-h urinary free cortisol concentration as well as serum ACTH were high. Serum cortisol was not suppressed by low-dose dexamethasone, but suppressed by high-dose dexamethasone. Pituitary magnetic resonance imaging showed no lesion. After inferior petrosal sinus sampling suggesting right-central ACTH secretion, the patient underwent transnasal-transsphenoidal pituitary adenomectomy. Both hypercortisolemia and erythrocytosis regressed completely after the adenomectomy. After the operation, the patient's hemoglobin concentration and hematocrit decreased steadily, and 1 month post-adenomectomy his hemoglobin is 14.9 g/dl and hematocrit 44.8%. Thus, Cushing's syndrome should be a routine part of evaluation of unexplained polycythemia.

Benign cystic mesothelioma presenting as a huge pelvic mass--a case report.

Benign cystic mesothelioma is an extremely rare peritoneal tumor. It is reported in women of childbearing [corrected] age but also in males and needs a careful [corrected] differential diagnosis between benign and malign neoplasia to choose the most [corrected] adeguate therapy. A 25-year-old female [corrected] was treated in our clinic for a gigantic cystic mass (25 x 22 x 3 cm in diameter) containing [corrected] many to [corrected] cysts of different sizes. All tumoral markers were within normal range. Surgical [corrected] treatment consisted of radical excision of the mass and the prognosis was good [corrected].

Conventional and molecular cytogenetic findings of myelodysplastic syndrome patients.

Myelodysplastic syndrome (MDS) involves myeloid cells of the bone marrow, which is important in progressive bone marrow insufficiency. Of all MDS patients, 40%-50% have at least one chromosomal rearrangement. Loss of specific chromosomal regions like 5q- and 7q- are usually the secondary cytogenetic abnormalities associated with MDS. In order to detect chromosome abnormalities associated with MDS, bone marrow samples from 26 patients diagnosed as MDS were obtained prior to chemotherapy. Both conventional cytogenetic analyses and fluorescence in situ hybridisation (FISH) methods were performed and locus-specific probes for 5q and 7q were used. Results obtained were compared. Twenty-one patients had normal karyotypes and four patients had abnormal karyotypes, while in one patient we could not obtain metaphases from cultures. Three patients with normal karyotypes revealed del (5q), two patients had del (7q) and one patient had monosomy (7). A total of 10 of 26 patients had chromosome changes visualised by either conventional or molecular cytogenetics (approximately 38.5%). Our results show that both methods are important in diagnosis and follow up of MDS patients. When used together, conventional cytogenetics and FISH detect clinically significant chromosome abnormalities in MDS patients.