Rational use of drugs in healthcare services: a sample of tertiary hospital.

OBJECTIVE: This study aimed at evaluating physicians' attitudes towards the rational use of drugs (RUD) at a training and research hospital. SUBJECTS AND METHODS: This cross-sectional study was conducted in a training and research hospital affiliated with the Ministry of Health between December 2014 and April 2015. All 424 active-duty physicians were asked to participate in the survey study. Of these physicians, 193 (45.5%) volunteered to respond to a 64-item survey. A total of 193 (45.5%) physicians volunteered to participate in the study. The chi-squared test, ANOVA, and multiple logistic regression analysis were used for the evaluation of the study data. RESULTS: Of the physicians who participated in the study, 58.0% were male. Prescriptions were dispensed for 52.73% (± 27.44) of the patients, with a mean of 2.67±0.98 items per prescription. The rational use of drugs was defined as prescribing an effective drug for the patient (85.4%), prescribing an appropriate drug for the patient (84.9%), and prescribing a safe drug for the patient (77.2%). Compared to residents, the prescription preferences of specialists were affected 2-fold by follow-up visit (p=0.010, ß 0.694, CI 1.180 3.396), 1-fold by patient examination percentage (p=0.002, ß 0.022, CI 1.008 1.037), and 3.5-fold by prescribing iron supplements (p=0.001, ß 1.274, CI 1.644 7.774) (R2 0.259, p=0.001). CONCLUSIONS: The results of the study showed that tertiary hospital specialists and residents have similar attitudes towards patients, their prescribing preferences and RUD knowledge level. This study provides comprehensive information on physicians' attitudes towards RUD.

Do tumor localization, microsatellite instability and mismatch repair deficiency have an impact on the prognosis of colorectal cancer?

BACKGROUND: Recent reports have shown that left-and right-sided colon cancers display different clinical and biological features. Chromosomal instability, epigenetic alterations, and defects in the deoxyribonucleic acid (DNA) mismatch repair (MMR) system may lead to the development of colorectal cancer (CRC). Besides microsatellite instability (MSI) caused by DNA MMR activity degradation increases the risk for CRC. AIM: We aimed to show the differences between CRCs in different locations, to research the cause of these differences, to present whether there is a relation between MMR and MSI, and to evaluate their effects on prognosis. PATIENTS AND METHODS: 641 CRC cases were divided into three groups: Group 1 (right-sided), Group 2 (left-sided), and Group 3 (rectum). Demographics, cancer stages, location of the tumors, number of the lymph nodes removed, MMR deficiency or proficiency, MSI status, and survival were assessed by retrospective review of the patients. RESULTS: Among 641 patients, 64.9% were males. Group 1, 2, and 3 comprised 31.2%, 45.7%, and 23.1% of all the cases, respectively. There was a significant difference in terms of survival and location only in stage II tumors. Stage II left colon cancer (LCCs) had a statistically significant lower survival rate. There was no significant difference in survival between both MSI and MMR statuses. In addition, cases were also stratified by stages. According to this data, 10.1, 45.7, and 44.2% of the patients had stages I, II, and III disease, respectively. CONCLUSIONS: Although it was not statistically significant, tumors with MMR deficiency (dMMR) and high microsatellite instability (MSI-H) are more common in right-sided colon tumors.

The relationship between consumption of animal products and expenditure levels with Quality of Life Scores (SF-36) by veterinary students in Turkey / [A relação entre o consumo de produtos de origem animal e níveis de gasto com Scores de Qualidade de Vida (SF-36) por alunos de veterinária na Turquia]

The present study aimed to calculate the quality of life scores (Short Form-36) of veterinary students in Turkey and review their scores with regards to different socio-demographic characteristics. A total of 1211 students studying veterinary medicine in 26 different faculties in Turkey were selected by stratified sampling method and were asked questions concerning their consumption of and expenditures on foods of animal origin using the SF-36 questionnaire between October and December 2018. Significant differences were found between SF-36 components in terms of year level, gender, accommodation status, income level, and level of expenditures on foods and foods of animal origin (P<0.01). With the increase in the size of the budget set aside for animal products, the scores in the domains of physical functioning, vitality, mental health, pain, and general health perception also enhanced, and statistically significant differences were found (P<0.01). The low quality of life scores of the veterinary students can be improved by increasing their income level and consumption of foods of animal origin. This will ensure that they are energetic and have the desired level of mental and general health perceptions.(AU)

O presente estudo teve como objetivo calcular os escores de qualidade de vida (SF-36) de estudantes de veterinária na Turquia e revisar seus escores no que diz respeito a diferentes características sociodemográficas. Um total de 1211 estudantes de medicina veterinária em 26 faculdades diferentes na Turquia foram selecionados pelo método de amostragem estratificada e foram questionadas sobre o consumo e as despesas com alimentos de origem animal usando o questionário SF-36 entre outubro e dezembro de 2018. Diferenças significativas foram encontradas entre os participantes do SF-36 em termos de nível do ano, gênero, status de acomodação, nível de renda e nível de gastos com alimentos e alimentos de origem animal (P <0,01). Com o aumento do orçamento reservado para produtos de origem animal, as pontuações nos domínios de funcionamento físico, vitalidade, saúde mental, dor e percepção geral de saúde também aumentaram e foram encontradas diferenças estatisticamente significativas (P <0,01). Os baixos índices de qualidade de vida dos veterinários podem ser melhorados, aumentando o nível de renda e o consumo de alimentos de origem animal. Isso garantirá mais energia e que tenham o nível desejado de percepção mental e geral de saúde.(AU)

Detection of twin pregnancies in ewes by pregnancy-associated glycoprotein assay and transabdominal ultrasonography.

The objectives of the present study were to evaluate and compare the accuracy of transabdominal ultrasonography and pregnancy-associated glycoprotein (PAG) assay in the diagnosis of twin pregnancies in ewes and to evaluate the utility of the PAG assay for predicting fetal gender in singleton pregnancies. The animals in the study consisted of 179 pregnant ewes. The number of fetuses in the ewe was determined using transabdominal ultrasonography between days 40 and 60 (on days 40, 45, 50, 55, and 60). Blood samples were collected from all the ewes on the same day to determine the PAG concentrations. The results found were highly sensitive for the detection of twin pregnancies by transabdominal ultrasonography. The accuracy of transabdominal ultrasonography in detecting twin pregnancies was found to be higher on day 60 than on other days (P < 0.05). The sensitivities of PAG assay in detecting twin pregnancies on days 40, 45, 50, 55, and 60 were 91.67%, 66.67%, 81.82%, 88.89%, and 33.33%, respectively. The accuracies of the PAG assay in detecting twin pregnancies on days 40, 45, and 50 were found to be statistically significant higher than other days (P < 0.05). The PAG assay had low sensitivity and specificity for predicting fetal gender. It was concluded that twin pregnancies in ewes can be diagnosed with high accuracy using transabdominal ultrasonography on day 60 of pregnancy and as well as using the PAG assay during the early days of pregnancy (on days 40, 45, and 50). The PAG assay is not useful for predicting fetal gender.

Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: A prospective study.

BACKGROUND AND AIMS: Cardiovascular disease (CVD) is one of the leading causes of mortality in obese patients. We aimed to investigate the influence of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on carotid intima media thickness (CIMT) and epicardial fat thickness (EFT) which are the independent predictors of subclinical atherosclerosis. METHODS AND RESULTS: Patients were recruited for standard indications. A total of 105 patients (79 women and 26 men) with the mean age of 43.61 ± 12.42 were prospectively enrolled. On B-mode duplex ultrasound; the mean CIMT at the far wall of both left and right common carotid arteries were measured. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Delta (Δ) values were obtained by subtracting sixth month values from the baseline values. Body mass index (BMI) was significantly reduced from 46.95 ± 7.54 to 33.54 ± 6.41 kg/m2 (p < 0.001) in sixth months after LSG. Both EFT and CIMT were significantly decreased after surgery (8.68 ± 1.95 mm vs. 7.41 ± 1.87 mm; p < 0.001 and 0.74 ± 0.13 mm vs. 0.67 ± 0.11 mm; p < 0.001 respectively). A significant correlation between ΔEFT and ΔBMI (r = 0.431, p < 0.001) was shown. ΔCIMT is significantly correlated with ΔEFT, ΔBMI and Δ systolic blood pressure (r = 0.310, r = 0.285 and r = 0.231 respectively, p < 0.05 for all). In multivariate stepwise linear regression analysis; among variables only ΔBMI was the independent predictor of ΔEFT (ß = 153, p = 0.001). CONCLUSION: Early atherosclerotic structural changes may be reversed or improved by sustained weight loss after LSG in asymptomatic obese patients.

Effects of alendronate and pamidronate on apoptosis and cell proliferation in cultured primary human gingival fibroblasts.

Data arising from the recent literature directed the researchers to study on the degree and extent of bisphosphonate toxicity on oral mucosa in further detail. The aim of this study is to determine the half maximal inhibitory concentration of pamidronate (PAM) and alendronate (ALN) on human gingival fibroblasts in vitro using 3-[4.5-thiazol-2-yl]-2.5-diphenyltetrazolium bromide (MTT) assay and to evaluate the effects of both agents on the proliferation and apoptotic indices. Cells used in the study were generated from human gingival specimens and divided into alendronate (n = 240), PAM (n = 240), and control groups (n = 60). Based on the MTT assay results, 10(-4), 10(-5), 10(-6), and 10(-7) M concentrations of both drugs were administered and the effects were evaluated for 6, 12, 24, 48, or 72 h periods. An indirect immunofluorescence technique was used to evaluate apoptotic (anti-caspase 3) and proliferation (anti-Ki67) indices. Toxicity of both PAM and ALN was found to be the most potent at 10(-4)-10(-5) M range. The apoptotic index of PAM group was found to be significantly higher than ALN group for all concentrations especially at 24 h incubation time (p < 0.05). The decrease in the proliferation index was found similar in first 48 h for both drugs; however, after 72 h of incubation decrease in proliferation index in PAM group was found to be significantly higher (p < 0.05). Micromolar concentrations of not only PAM but also ALN rapidly affect cells generated from human oral gingival tissue by inducing apoptosis together with inhibition of proliferation. Cytotoxic effects of both ALN and PAM on primary human gingival fibroblasts, which cause significant changes in apoptotic and proliferative indices as shown in this in vitro study, suggests that the defective epithelialization of oral mucosa is possibly a major factor on the onset of bisphosphonate-related osteonecrosis of the jaw cases.