Yesim Senol

Anxiety, depression and stressful life events among medical students : a prospective study in Antalya, Turkey

To assess psychological changes in medical students in Antalya, Turkey during their undergraduate education. The first‐year follow‐up outcomes are presented in this article.

Efficacy, tolerability, and side effects of oxcarbazepine monotherapy: A prospective study in adult and elderly patients with newly diagnosed partial epilepsy

OBJECTIVE The aim of the study described here was to investigate the efficacy, tolerability, and side effects of oxcarbazepine (OXC) monotherapy in newly diagnosed, previously untreated adult and elderly patients with partial epilepsy. METHODS We prospectively analyzed and recorded the efficacy, tolerability, and side effects of OXC monotherapy. The results were analyzed on the basis of etiologic classifications and age distributions. Remission was defined as seizure freedom for at least 1 year. RESULTS A total of 147 patients were evaluated in a single center for a median of 18 months (range: 14-36 months). Overall, 92 patients (62.6%) were seizure free for at least 12 months and 55 of them (37.4%) were unresponsive despite treatment with the maximum tolerable dose of OXC. There was a significant difference in the outcomes of patients with cryptogenic (75% remission) and symptomatic (51.9% remission) epilepsy (P=0.004). Patients with cerebral tumors did worse than the remainder of the patients in the symptomatic group (36.7% remission) (P=0.03). Results were favorable for the elderly; 14 patients (73.6%) in the elderly subgroup became seizure free for at least 1 year, and the remission was achieved with low to moderate doses (approximately 900 mg/day). Overall, 13 patients (8.8%) discontinued OXC due to intolerable side effects. Side effects leading to discontinuation were: Stevens-Johnson syndrome (n=2, 1.4%); fatigue and drowsiness (n=2, 1.4%); dizziness, nausea, and vomiting with normal laboratory tests (n=2, 1.4%); dizziness, nausea, and vomiting with serum Na levels <130 mEq/L (n=5, 3.4%); and elevated serum gamma-glutamyl transferase levels (GGT>200mg/dL) (n=1, 0.7%). OXC proved to be a tolerable drug for the elderly; only one patient experienced symptomatic hyponatremia with mild symptoms and responded well to fluid restriction, which did not lead to discontinuation of OXC. CONCLUSION Although the limitations of our study include its open-label design, the results suggest that OXC monotherapy may be regarded as an effective first-line monotherapy option for adult and elderly patients with partial epilepsy, but has low efficacy in patients with cerebral tumors.

The incidence of smoking and risk factors for smoking initiation in medical faculty students: cohort study

BackgroundMedical education requires detailed investigation because it is a period during which the attitudes and behaviors of physicians develop. The purpose of this study was to calculate the yearly smoking prevalence and incidence rates of medical faculty students and to identify the risk factors for adopting smoking behaviour.MethodsThis is a cohort study in which every student was asked about their smoking habits at the time of first registration to the medical faculty, and was monitored every year. Smoking prevalence, yearly incidence of initiation of smoking and average years of smoking were calculated in analysis.ResultsAt the time of registration, 21.8% of the students smoked. At the end of six years, males had smoked for an average of 2.6 ± 3.0 years and females for 1.0 ± 1.8 years (p < 0.05). Of the 93 medical students who were not smokers at the time of registration, 30 (32.3%) were smokers at the end of the 6 years of the course.ConclusionThe first 3 years of medical education are the most risky period for initiation of smoking. We found that factors such as being male, having a smoking friend in the same environment and having a high trait anxiety score were related to the initiation of smoking. Targeted smoking training should be mandatory for students in the Medical Faculty.

Withdrawal of antiepileptic drugs in adult patients free of seizures for 4 years: A prospective study

We aimed to assess the relapse rate of epilepsy, prospectively attributable to antiepileptic drug (AED) withdrawal in seizure-free patients and to determine the risk factors for seizure recurrence. Seventy-nine patients with epilepsy who were seizure-free for at least 4 years were enrolled into the study. The AEDs were tapered by one-sixth every 2 months. The EEG and clinical examination were performed at the beginning; at each visit during discontinuation and 2, 6, 12, 24, and 36 months after the complete drug withdrawal. For each patient, records were obtained of the main demographic and clinical variables. A total of 49 patients completed the discontinuation programme. Twenty-eight patients (57%) relapsed while 21 of those (42.8%) did not suffer a relapse at the end of the study period. In patients discontinuing treatment, the probability of relapse was 21.4% during the tapering period (especially in the last months), 28.6% at 1 month, 14.3% at 3 months, 3.6% at 6 months, 7.1% at 12 months, 17.8% at 24 months, and 7.1% at 36 months. The age at onset of epilepsy and the duration of active disease were found to affect the risk of relapse. Although drug withdrawal could be considered in adult patients free of seizures for 4 years, the final decision should be tailored to the patients clinical, emotional, and socio-cultural profile.

Internalized stigma in psoriasis: A multicenter study

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a persons illness. It causes decreased self‐esteem and life‐satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross‐sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire‐12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

Assessment of women who applied for the uterine transplant project as potential candidates for uterus transplantation.

To review the medical charts of women who applied for the uterine transplant project from June 2008 to June 2011 in our hospital retrospectively (18–40 years).

Epilepsy and stigmatization in Turkey

Patients with epilepsy experience stigmatization quite often. Studies investigating stigmatization perceived by patients with epilepsy in Turkey are limited in number. In this study, we aimed to understand the relationship between stigmatization and psychopathology and also to identify the effects of stigmatization on the quality of life in epilepsy. Patients completed a socio-demographical data form and epilepsy information form. They were evaluated in terms of psychiatric diagnosis using SCID I and they were asked to complete SCL-90 R, Epilepsy Stigmatization Scale and SF 36. The percentages of patients who did and did not report perception of stigmatization were similar in the study group. Depression was the most common diagnosis followed by anxiety disorder. In comparison to patients who did not feel stigmatized, patients who reported perceived stigmatization had a higher frequency of generalized tonic clonic seizures and injuries during seizures and more frequently missed taking their medication. They also showed higher rates of both suicide attempts and psychopathology as evidenced by a higher rate of psychiatric diagnosis and higher score in all the subscales of SCL 90. With regard to their quality of life they were observed to be more disabled in the physical functioning, general health perception, vitality, social role functioning and mental health dimensions. A logistic regression analysis revealed that stigmatization was best predicted by three variables: history of suicide attempts, receiving a psychiatric diagnosis and higher score in SCL90PST. Our study has shown that psychopathology is a more significant predictor of stigmatization than the other variables related with seizure control.

A retrospective analysis of pregnancy outcomes after kidney transplantation in a single center.

Background: We reported pregnancy outcomes after kidney transplantation in a single transplant center. Methods: We reviewed the perinatal outcomes of female kidney transplant patients of reproductive age (18-40 years) from 1987 to 2011. Results: A total of 246 patients were reviewed. Of these, 43 women registered a pregnancy following kidney transplantation. The mean patient age was 31.3 ± 4.2 years (range 24-40). The mean transplant-conception interval was 35.9 ± 12.6 months (range 24-120); 9 patients had a cadaveric allograft. The human leukocyte antigen match was ≥3/6 for 34 patients. The rate of live births was 29/43 (67.4%), miscarriage 10/43 (23.2%), preterm delivery 7/29 (24.1%), preeclampsia 5/29 (17.2%), and intrauterine growth retardation 2/29 (6.9%). Overall, 3/29 patients (10.3%) received a blood transfusion during pregnancy due to persistent symptomatic anemia, despite iron replacement and erythropoietin therapy; 24 patients (82%) had a cesarean section delivery; 3 patients had kidney rejection during pregnancy, with 2 occurring during the 6th postpartum month. Conclusion: Pregnancy should be considered a high risk in renal transplant recipients, necessitating close follow-up.

Effects and Permanency of the Training Program “Communication with Cancer Patients” on the Opinions of Students

Learning to develop the doctor–patient relationship is very important in the treatment of patients with cancer. We aim to train our students in the early years of study about this subject with a course on the patient–doctor communication, prepared for third year students. One hundred fifty-four third year students participated in our study during the 2006–2007 academic years. The same questionnaire was given to the students in the 2009–2010 academic year; their sixth year of study. The rate of return for the questionnaire is 88.7%. Based on this study, we have the opinion that the training given in the third year is beneficial; however, the efficacy of the training diminishes with the advancing years, and therefore, the length of this training should be increased in the upper classes and additional hours should be added.

Exploring first grade medical students’ professional identity using metaphors: implications for medical curricula

Background Although professional identity development is an important concept in medical education, the process has not been well-investigated from a student perspective. Purpose This study examines the metaphorical images formulated by first grade medical students in Turkey to describe physicians in the context of establishing a professional identity, along with its limitations. Method Participants (N=148) completed the prompt: A physician is like _____ because _____ to indicate their conceptualizations of physician. The data were analyzed both qualitatively and quantitatively. Results Altogether, 71 well-articulated metaphorical images were identified – comprising six conceptual themes. Conclusions While subject to some limitations, the use of metaphors to formulate and describe professional identities can be helpful in reflecting the personal beliefs and values of matriculants to medical school, as well as providing some guidance and feedback to curriculum development efforts.Background Although professional identity development is an important concept in medical education, the process has not been well-investigated from a student perspective. Purpose This study examines the metaphorical images formulated by first grade medical students in Turkey to describe physicians in the context of establishing a professional identity, along with its limitations. Method Participants (N=148) completed the prompt: A physician is like _____ because _____ to indicate their conceptualizations of physician. The data were analyzed both qualitatively and quantitatively. Results Altogether, 71 well-articulated metaphorical images were identified - comprising six conceptual themes. Conclusions While subject to some limitations, the use of metaphors to formulate and describe professional identities can be helpful in reflecting the personal beliefs and values of matriculants to medical school, as well as providing some guidance and feedback to curriculum development efforts.