İlhami Ünlüoğlu

Relationship between 1,25‑dihydroxy Vitamin D levels and homeostatic model assessment insulin resistance values in obese subjects

AIM In this study, our aim is to evaluate the insulin resistance and quality of life in obese subjects and nonobese subjects and to find out the Vitamin D (VD) status and correlations between obesity and control groups and also according to their quality of life scores. MATERIALS AND METHOD The study was carried out between May and October 2013 which is the period of VD synthesis in Turkey. The participants of this study were volunteering individuals - obese and nonobese individuals defined according to the body mass index (BMI) - that did not receive any VD support in the last 1-year and did not have any known chronic diseases. 1,25-OH VD status and homeostatic model assessment insulin resistance (HOMA-IR) values were evaluated. RESULTS The study population consisted of 39 individuals with normal weight (23 women, 16 men) and 66 individuals categorized as obese (51 women, 15 men). The difference in HOMA-IR and VD values between the group of obese individuals and the group of nonobese individuals was significant (P < 0.001 vs. P <0.001). The median value of HOMA-IR was higher in the obese group than in the nonobese group (P < 0.001) while the median value of VD was higher in the nonobese group than in the obese group (P < 0.001). The results regarding the relationship of BMI with HOMA-IR and VD show that there was a positive correlation between HOMA-IR and BMI (rs = 0.507; P < 0.001) and there was a negative correlation between HOMA-IR and VD (rs = -0.316; P = 0.0001). CONCLUSION Given serious diseases associated with low serum VD levels such as diabetes and cardiovascular disorders as well as low side effect incidence and low cost of VD treatment, it would be a reasonable approach to identify routine serum 25(OH) D and/or 1,25-OH VD levels of obese patients and administer a treatment to patients with low levels of VD.

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.

Contemporary Home Care Service and Family Medicine in Turkey

Home care service is providing health care to the patient in his or her dwelling when care in the hospital is no longer required. Home care services provide not only medical services but also the social services that the human needs. Studies concerning home care services bear great importance. In this review, the authors aim to guide new studies by stating the legal and scientific point reached at the moment in Turkey.

Factors Affecting Mortality and Complications in Mushroom Poisonings Over a 20 Year Period: A Report from Central Anatolia

SUMMARY Objectives Mushroom poisoning (MP) is one of the worlds leading seasonal and regional health problems. The aim of this study was to analyze the relationship between clinical factors and outcomes of mushroom poisoning. Methods The study was conducted in the emergency department. The patients who presented between January 1st, 1991 and December 31, 2010 were retrospectively reviewed. Results 599 MP cases were enrolled into the statistical analysis. The elderly group had a higher rate of mortality (8.8%) and complications (12.3%) (p=0.005) (OR 3.98, 95% CI: 1.9291 to 8.2290; p=0.0002). The patients who presented in summer had a higher rate of mortality (9.5%) and complications (11.9%) (p≤0.001). (OR: 3.83, 95% CI 1.7068 to 8.6074, p=0.0011). The rate of mortality and complications in patients who had eaten self-harvested wild mushrooms (WM) was 6.8%, while those who purchased WM had a mortality and complication rate of 15.2% (p=0.016), (Purchased WM OR 2.46, 95% CI 1.1609 to 5.2353, p=0.0189). The rate of mortality and complications in the patients who presented with gastrointestinal symptoms was 9.9% (OR: 3.98, 95% CI 1.5503 to 10.2679; p=0.0041). Conclusions Factors such as being elderly, summer season, purchased WM, and gastrointestinal symptoms were significantly associated with mortality and complications in our study.

Eskişehir Osmangazi Üniversitesi Tıp Fakültesi araştırma görevlisi doktorlarının uyku kalitelerinin ve uyku kalitelerine etki edebilecek faktörlerin değerlendirilmesi

Hekimler meslek hayatlari boyunca, ozellikle de arastirma gorevlisi olarak calistiklari donemde uzun ve yorucu calisma sureleriyle bas etmek zorunda kalirlar. Bu donemde uyku kaliteleri bircok sebepten olumsuz etkilenebilir. Calismamizda Eskisehir Osmangazi Universitesi (ESOGU) Tip Fakultesi arastirma gorevlisi hekimlerin uyku kalitelerinin saptanmasi ve uyku kalitelerine etki edebilecek faktorlerin arastirilarak uygun istatistiksel yontemlerle degerlendirilmesi amaclandi. Calismamiza ESOGU Tip Fakultesi’nde Eylul 2015 - Aralik 2015 tarihleri arasinda gorev yapan 189 arastirma gorevlisi hekim dahil edilmistir. Hazirlanan sosyodemografik veri formu, uyku kalitesini etkileyebilecek faktorler formu ve Pittsburgh Uyku Kalitesi Olcegi (PUKO) arastirma gorevlisi hekimlerle yuzyuze gorusulerek doldurulmustur. Veriler IBM SPSS Versiyon 21.0 istatistiksel paket programi ile degerlendirilmistir. Arastirma gorevlisi hekimlerin ortalama uyku suresi 6,41±1,15 saat, PUKO puan ortalamalari 6,75±3,08 olarak belirlenmistir. Calismamiza katilan 189 arastirma gorevlisi hekimin 46 (%24,3)’sinin uyku kalitesinin iyi oldugu, 143 (%75,7)’unun uyku kalitesinin kotu oldugu saptanmistir. Calismamizda arastirma gorevlisi hekimlerin medeni durumlari, bazi aliskanliklari ve calisma kosullari, meslek memnuniyet durumlari ile uyku kaliteleri arasinda istatistiksel olarak anlamli iliski (p<0,05) oldugunu belirledik. Arastirma gorevlisi hekimlerin dortte uc gibi buyuk bir bolumunun uyku kalitelerinin kotu oldugu tespit edildi. Arastirma gorevlisi hekimlerin uyku kalitelerinin iyilestirilmesi, dolayisiyla daha kaliteli uzmanlik egitimi alip daha kaliteli saglik hizmeti sunabilmeleri icin, arastirma gorevlisi hekimlerin ve calisma duzeni programlayicilarinin uyku kalitesini bozabilecek olumsuzluklarin duzeltilmesinde daha fazla cabalarina gereksinim oldugu kanaatindeyiz.

THU0478 Determination of comorbidities in fibromyalgia syndrome

Background Although fibromyalgia syndrome is diagnosed by excluding other possible diagnosis based on the patients clinical features, in recent the studies, it was shown that comorbid diseases affect the course of fibromyalgia. Objectives The aim of this study is to evaluate the comorbid diseases of patients with fibromyalgia and to determine the rates of comorbid diseases Methods In this study, age, gender and comorbid diseases of patients above 18 years and diagnosed with fibromyalgia by a were evaluated in the database system of the hospital retrospectively. Results A total of 509 patients were examined in our study. 51 of the patients were male, 458 were female (mean age was 50.24±12.32). Of the patients, 345 (67.8%) had at least one comorbid disease while 164 (32.2%) had no comorbid disease. In the study, 187 of the patients (36.7%) had cardiovascular diseases, 157 of the patients (30.8%) had endocrine diseases, 63 of the patients (12.4%) had rheumatologic diseases, 30 of the patients (5.9%) had neurological diseases, 14 of the patients (2.8%) had other autoimmune diseases, 10 of the patients (2.0%) had cancers, 129 of the patients (25.3%) had mental disorders, 45 of the patients (8.8%) had chronic lung diseases, 37 of the patients (7.3%) had osteoporosis, 11 of the patients (2.2%) had other diseases (chronic pancreatitis, chronic renal failure, nephrotic syndrome, deep vein thrombosis, hepatitis serology positivity, pulmonary thromboembolism, organ transplantation). Conclusions FMS is an important disease that is increasing in frequency in recent years. FMS, which can be seen with many diseases, is in fact related to physicians from many branches, and it is useful to evaluate FMS patients with their comorbid conditions on their follow-up. References Choy EH & Mease PJ. Key symptom domains to be assessed in fibromyalgia (outcome measures in rheumatoid arthritis clinical trials). Rheumatic Disease Clinics of North America, 2009; 35(2):329–337. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis & Rheumatism, 1990; 33(2):160–172. Soran N, Altındağ Ö, Demirkol A, Sallı A, Yılmaz H, Kocabaş H, et al. Depression level and relation with clinical parameters in fibromyalgia syndrome. Rheumatism, 2008; 23:1–4. Disclosure of Interest None declared

2005-2015 Yılları Arasındaki Aile Hekimliği Uzmanlık Tezlerinin Değerlendirilmesi

Amac: Turkiye’de saglik sisteminde 2005 yilinda aile hekimligi uygulamasina gecilmesini goz onune alarak, 2005-2015 yillari arasinda internet agi uzerinden ulasabildigimiz aile hekimligi uzmanlik tezlerini degerlendirmeyi amacladik. Materyal ve Metot: Gozlemsel, analitik, retrospektif calismamizda tezler, hazirladigimiz Tez Bilgi Formu ile degerlendirilmistir. Bulgular: Toplamda 492 tez degerlendirmeye alindi. En cok teze ulasilan yil %23,58 orani ile 2008 yilidir. Tezlerin %50,80’i Istanbul’da bulunan 10 egitim arastirma hastanelerine aittir. Tezlerin %49,20’si 33 universitenin tip fakultelerine aittir. Tez sahiplerinin %50,80’i kadin, %49,20’si erkektir. Tezlerin %87,80’inde tez danismani belirtilmistir. Aile hekimligi uzmanlari %40,93 orani ile en cok tez danismanligi yapan brans hekimidir. Aile hekimligi uzmanlarinin tez danismanligi yillar icinde artmistir. Tez konularinda %21,91 oraninda en cok endokrin sistem, beslenme, metabolizma konulari islenmistir. Diabetes Mellitus ve glikoz metabolizma bozukluklari en cok (%12,07) islenen konudur. Tezlerin %21,75’i saha, %76,63’u hastane calismasidir. Orneklem gruplari en cok 101-200 (%24,80) kisi arasindadir. Sonuc: Yillar icinde anket kullanimi anlamli olarak artmis, laboratuvar test kullanimi anlamli olarak azalmistir. Yillar icinde tez danismani belirtilme durumu, proje destek alimi, arastirma tipi belirtilme durumu anlamli olarak artmistir. Bu da bize tezlerin daha ozenli hazirlandigini gostermektedir. Yillar icinde saha calismasinin anlamli olarak artmasina ragmen yetersiz olup koruyucu hekimlik gibi birinci basamagin temel konularina az deginilmistir.

Evolution of family medicine specialty in legislations

İmparatorluk döneminde tıp doktorlarının uzmanlık eğitimi ve uzmanlık ünvanlarını düzenleyen genel bir mevzuat bulunmamaktaydı. Türkiye’de tıp eğitimi sonrası uzmanlık eğitimi ile ilgili ilk düzenleme 1929 yılında yapılmıştır. 08.05.1929 tarihli “Tababet ve ihtisas vesikaları hakkında nizamname” ile hekimlerin üç alan üzerinde uzmanlık eğitimi alabilecekleri hükme bağlanmıştır. Bu alanlar klinik (seririyat) uzmanlıklar, laboratuvar uzmanlıkları ve koruyucu hekimlik (hıfzıssıhha) olarak belirlenmiştir. Klinik uzmanlıklar kendi içinde dokuz, laboratuvar uzmanlıkları ise beş alana ayrılmıştır. Uzmanlık süresi iç hastalıkları (emraz-ı dâhiliye) ve genel cerrahi (emraz-ı hariciye) için üç yıl, tüm diğer uzmanlıklar için iki yıl, koruyucu hekimlik (hıfzıssıhha) uzmanlığı için ise dört yıl olarak belirlenmiştir. Genel bir kural olarak hekimlerin hıfzıssıhha uzmanlığı için mezuniyetlerinden üç yıl, dahiliye ve genel cerrahi uzmanlığı için iki ve diğer uzmanlıklar için ise bir buçuk yıl sonra sınava girmelerine izin verilmiştir.[1] Böylece sahanın he-kim ihtiyacının karşılanması hedeflenmiştir.

A Historical Perspective of Medical Education

Even though there are significant developments in recent years in medical education, physicians are still needed reform and innovation in order to prepare the information society. The spots in the forefront of medical education in recent years; holistic approach in all processes, including health education, evidence-based medicine and professionalism. Medical education; undergraduate, postgraduate and continuing medical education covering the period varies from country to country for the duration of this period. Increasing day pursuing the importance of medical education and student-centered education and is spread across the country as well as in blended learning model that includes educational centered education. Medical faculty, students and teaching staff should be informed about innovations and developments should offer opportunities for that matter, should support administrative and economic necessarily.