Ahmet Keskin

The Use of START/STOPP Criteria for Elderly Patients in Primary Care

Aim. Our aim was to detect older patients who were prescribed inappropriate drugs according to START/STOPP criteria in primary care. Materials and Method. Patients aged over 65, admitted to health center no. 5 in Afyon, were included. The files of the subjects were surveyed retrospectively for the final one year in the digital environment, using the Family Medicine Information System. The files surveyed allowed us to list the drugs they used in the past year and to detect inappropriate drug use. Results. The number of patients that took part in this study was 325 (average age: 73.23 ± 6.44 years). We found that, among these participants, 48 patients (14.8%) were using drugs inappropriately according to STOPP criteria. Conclusion. Further focus on avoiding inappropriate drug use will allow clinicians and other health professionals to reduce side effects and other complications. In patients aged over 65, there is a need to attach particular importance to inappropriate drug use, drug interactions, and avoidance of side effects.

Effects of Sleep Disorders on Hemoglobin A1c Levels in Type 2 Diabetic Patients

Background: Studies have reported the presence of sleep disorders in approximately 50–70% of diabetic patients, and these may contribute to poor glycemic control, diabetic neuropathy, and overnight hypoglycemia. The aim of this study was to determine the frequency of sleep disorders in diabetic patients, and to investigate possible relationships between scores of these sleep disorders and obstructive sleep apnea syndrome (OSAS) and diabetic parameters (fasting blood glucose, glycated hemoglobin A1c [HbA1c], and lipid levels). Methods: We used the Berlin questionnaire (BQ) for OSAS, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI) to determine the frequency of sleep disorders and their possible relationships with fasting blood glucose, HbA1c, and lipid levels. Results: The study included 585 type 2 diabetic patients admitted to family medicine clinics between October and December 2014. Sleep, sleep quality, and sleep scores were used as the dependent variables in the analysis. The ESS scores showed that 54.40% of patients experienced excessive daytime sleepiness, and according to the PSQI, 64.30% experienced poor-quality sleep. The BQ results indicated that 50.20% of patients were at high-risk of OSAS. HbA1c levels correlated significantly with the ESS and PSQI results (r = 0.23, P < 0.001 and r = 0.14, P = 0.001, respectively), and were significantly higher in those with high-risk of OSAS as defined by the BQ (P < 0.001). These results showed that HbA1c levels were related to sleep disorders. Conclusions: Sleep disorders are common in diabetic patients and negatively affect the control of diabetes. Conversely, poor diabetes control is an important factor disturbing sleep quality. Addressing sleep disturbances in patients who have difficulty controlling their blood glucose has dual benefits: Preventing diabetic complications caused by sleep disturbance and improving diabetes control.

Inappropriate use of nonsteroidal anti-inflammatory drugs and other drugs in chronic kidney disease patients without renal replacement therapy.

Abstract Objective: The main goal of chronic kidney disease (CKD) treatment is the prevention of progression of the disease and complications. Inappropriate drug use in patients with CKD is an important issue, which may cause adverse effects on patients and progression of chronic renal failure. The aim of this study is to find the rate of inappropriate drug use among CKD patients. Methods: The subjects of this study were selected from the patients with a CKD history of minimum one year, who did not receive renal replacement therapy. Patients were asked to provide a digital record of the drugs they used over the last one year. Individually, for each patient, the drugs that may be contraindicative and that require dose adjustment were identified based on glomerular filtration rate (GFR). Results: This study includes a total of 185 participants – 97 female (52.4%) and 88 male (47.6%) patients. The average age of patients was 60.50 ± 14.56. It was shown that 149 patients (80.5%) were using inappropriate drugs. Seventy (47.0%) were using one, 79 (53.0%) two, 30 (20/1%) three, and 9 (6.4%) four inappropriate drugs. Of CKD patients, 44.3% were aged 65 or over; and in this age group, inappropriate drug use was more frequent compared to the population below 65 (86.6% vs. 75.7%). The drugs used inappropriately were, respectively, nonsteroidal anti-inflammatory drugs (65.8%), quinolone antibiotics (39.0%), ACE inhibitors (26.9%). Discussion: Health professionals are required to consider renal functions of all patients, mainly those aged over 65, when administering a treatment.

Occupational Allergic Diseases in Kitchen and Health Care Workers: An Underestimated Health Issue

Objective. This study evaluated the frequencies of allergic symptoms and rate of upper respiratory infections during the past year in the general population, kitchen workers (KW) and health care workers (HCW). Methods. The European Community Respiratory Health Survey (ECRHS) was used to inquire retrospectively about asthma and asthma-like symptoms and the number of treatments required for previous upper respiratory tract infections (URTI: acute pharyngitis, acute sinusitis, etc.) during the past year for health care workers, kitchen workers, and members of the general population. Adjusted odds ratios by gender, age, and smoking status were calculated. Results. 579 subjects (186 from the general population, 205 KW, and 188 HCW; 263 females, 316 males) participated in the study. Noninfectious (allergic) rhinitis was significantly higher in the HCW and KW groups than in the general population (P < 0.001). Cumulative asthma was significantly higher only in the HCW group (P < 0.05). In addition, the HCW and KW groups had significantly higher risks of ≥2/year URTI (OR: 1.59, 95% CI: 1.07–2.38 versus OR: 1.57, 95% CI: 1.05–2.38) than the general population. Conclusion. Occupational allergic respiratory diseases are an important and growing health issue. Health care providers should become familiar with workplace environments and environmental causes of occupational rhinitis and asthma.

Mental disorders frequency alternative and complementary medicine usage among patients with hypertension and type 2 diabetes mellitus

OBJECTIVES Diabetes mellitus (DM) and hypertension (HT) are chronic disorders with which mental disorders may coexist and for which patients may resort to alternative medicine use. Alternative and complementary medicine is a treatment option that patients tend to use. This study is to determine the prevalence of mental disorders among patients diagnosed with DM and HT and their use of alternative medicine methods. Materials and Methods The study was conducted in a primary care setting. The data were collected from the Family Health Center No. 4 at Ηankaya, Ankara, Turkey. It involved patients aged between 18 and 65, who were on follow-up treatment for DM and HT. Patients accepted to participate in the study were administered the sociodemographic data form, the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire and the alternative medicine inquiry form. PARTICIPANTS One hundred and sixteen patients with HT and 119 patients with DM (type 2) were recruited for the study. RESULTS In this study, 47.4% of HT patients and 53.8% of the DM patients were diagnosed with a PRIME-MD. The most commonly encountered disorder was mood disorders, in 37.1% of the HT patients and 45.4% of the DM patients. In this study, four HT patients (0.3%) and no DM patients stated that they resorted to complimentary medicine, which can use be used alongside conventional medical treatment and may help to feel better and cope better with any chronic condition. All four HT patients were using multivitamin combinations to support the treatment. As the alternative medicine usage was described as treatment used instead of conventional medical treatment we did not find any patient using alternative medicine. CONCLUSIONS Mental disorders may coexist with HT and DM. Some of the HT and DM patients suffering from a mental disorder seek psychiatric support, while others do not. We believe that it is important to examine patients for mental disorders, while being followed-up for a chronic disease.

Kosta Köprüleşmesi: Olgu Sunumu

Konjenital kosta anomalileri, genellikle tek basina bir semptom ve/veya hastaliga yol acmamaktadir. Dogumsal anomaliler olarak, cesitli hastaliklara eslik edebilmesi ve akciger grafisinde baska patolojilerle karisabilmesi acisindan da onem arz etmektedir. Olgumuzda, kirk dokuz yasinda astim hastasi olan kadin hasta, nefes darligi ve oksuruk sikayetleri ile gogus hastaliklari poliklinigine basvurdu. Oyku, muayene, laboratuvar testleri ve goruntuleme sonucu hastada alt solunum yolu enfeksiyonu ile tetiklenen astim atagi dusunulerek tedavisi verildi. Şikayetlerine yonelik istenen akciger grafisinde 2-3. kostalar arasinda koprulesme tespit edildi. Olguda kosta koprulesmesi ile mevcut klinik yakinmalar iliskilendirilmedi. Bu olgudan yola cikarak, diger olgu serileri ve bilimsel arastirmalar isiginda, kosta anomalilerine nasil bir yaklasim gosterilebilecegini incelemek istedik.

Bir Olgu Sunumu: Epigastrik Ağrıdan Renal Atrofiye

Uriner sistem obstruksiyonu; ciddi boyutta morbidite ve mortalite oranlarina sebep olabilen uriner sistem enfeksiyonu, hipertansiyon ve akut ya da kronik bobrek yetersizligi etyolojisinde rol oynayabilecek risk faktorlerinden biridir. Bobrek yetersizlikleri ise dunyada ve ulkemizde onemli bir halk sagligi sorunudur. Bobrek yetersizlikleri etyolojisinde rol oynayabilen urolitiazis iliskili uriner obstruksiyon sonucunda gelisen renal atrofi olgumuzla birinci basamakta erken tani ve tedavinin onemine dikkat cekmek istedik.

Aile Hekimliği Uygulamasında Geliştirilmesi Gereken Noktalar

Aile Hekimligi uygulamasi ile birinci basamak saglik hizmetlerinin guclendirilmesi ve yeniden yapilandirilmasi hedeflenmistir. Uygulamada bazi uyumsuzluklar yasanmaktadir. Bu yazida, tespit edilen problemler ile bu problemlere yonelik olarak cozum onerileri tartisilmaktadir.

Türkiye'deki Aile Hekimliği Uygulamasında Geliştirilmesi Gereken Noktalar

Aile Hekimligi uygulamasi ile birinci basamak saglik hizmetlerinin guclendirilmesi ve yeniden yapilandirilmasi hedeflenmistir. Uygulamada bazi uyumsuzluklar yasanmaktadir. Bu yazida, tespit edilen problemler ile bu problemlere yonelik olarak cozum onerileri tartisilmaktadir.

Points to be Improved in Family Practice in Turkey

Aile Hekimligi uygulamasi ile birinci basamak saglik hizmetlerinin guclendirilmesi ve yeniden yapilandirilmasi hedeflenmistir. Uygulamada bazi uyumsuzluklar yasanmaktadir. Bu yazida, tespit edilen problemler ile bu problemlere yonelik olarak cozum onerileri tartisilmaktadir.