Acta Medica Ruha

How Much Do Guidelines in Thoracic Surgery Influence Our Daily Practice? – A Review of the Current Routine

Onur Derdiyok — 2024-09-20

Guidelines are formulated based on the results of randomised clinical trials, other non-randomized studies, and expert opinions (i.e., the opinions of most guideline committees). A randomised, multicenter, controlled trial is the ideal study to determine a patient population's mean values. However, some diseases and populations do not lend themselves easily to this format, and therefore, studies with less stringent design and enrollment criteria are often used. The latest guidelines have more reliable data and distinct subgroups and carry a higher risk of misinterpreting results than older models. Guidelines are part of a continuous educational program to facilitate a more homogeneous approach to all patients with the same disease, reduce inappropriate and unnecessary testing, ineffective treatments, and health costs, and ultimately improve care. As a result, guidelines are allegiant. The surgeon should question why and how this guideline was prepared, who supported its creation, who is on its organisation committee, and what it represents. Within the scope of this review, recommendations to improve the guidelines will be presented.

Obesity-Induced Inflammation and Cardiovascular Events

Yasemin Hacanlı — 2024-09-20

Obesity is a condition that leads to increased morbidity and mortality. It is associated with cardiovascular diseases, type 2 diabetes, cancer and many other diseases. Cardiovascular diseases are the leading cause of death in obese individuals. In addition, many diseases including infection, obesity and diabetes are linked to inflammation. Obesity is associated with an increase in inflammatory cytokines such as interleukin-6, tumor necrosis factor-α and C-reactive protein. Inflammation is also known to be increased in heart diseases such as atherosclerosis, hypertrophic heart failure and myocardial infarction. Adipokines such as leptin, resistin, retinol binding protein 4 and inflammation mediators such as interleukin-1β, interleukin-6, CRP, tumor necrosis factor-alpha, plasminogen activator inhibitor-1, etc. are involved in chronic inflammation. Inflammatory cytokines are mainly released by cells of the immune system but are also synthesized by endothelial cells, cardiomyocytes and cardiac fibroblasts after ischemic or hypertrophic stress. The heart has natural resources of endogenous origin to minimize the inflammation that occurs. To reduce cardiac inflammation, it is necessary either to increase the concentration of anti-inflammatory mediators or to decrease the concentration of pro-inflammatory mediators. Therefore, natural mechanisms of endogenous origin in the heart come into play to positively regulate cardiac function. In conclusion, reducing systemic inflammation and minimizing the activity of inflammatory immune cells will make a major positive contribution to cardiac inflammation.

Prognostic Significance of Tumor Budding in Bladder Cancer: A Call for Molecular Insights

Tunay Doğan — 2024-09-20

Dear Editor,

We wish to share our insights on the critical prognostic significance of tumor budding (TB) in bladder cancer (BC) and underscore the urgent necessity for further molecular-level investigations in this domain, prompted by recent studies. Tumor buds, also referred to as “sprouts,” are defined as isolated single tumor cells and/or small clusters comprising fewer than five tumor cells, which originate from the invasive tumor margin and infiltrate the stroma. These entities were first characterized by Imai in the 1950s (1). The TB scoring system, established by the “International Tumour Budding Consensus Conference” (ITBCC) in 2016, has been validated as an independent predictor of lymph node metastasis in pT1 colorectal cancer cases and poor survival outcomes in stage 2 colon cancer cases, and it is now routinely reported by pathologists (2). Tumor buds are intimately associated with epithelial-mesenchymal transition (EMT) and engage in interactions with the tumor microenvironment (TME), tumor stroma, and immune system cells (3). This dynamic interaction at the molecular level in budding tumor cells establishes a distinctive signature characterized by: upregulation of MMP-7 and MMP-9 expressions, which play a role in extracellular matrix degradation; anoikis resistance through the enhanced expression of TrkB; frequent upregulation of stem cell markers such as LGR5, ALDH1, and CD44; immune evasion facilitated by the loss of MHC class I expression; increased TGFβ expression and regulation of TGFβ signaling; regulation of WNT signaling; a decrease in miRNA-200 expression, accompanied by the epigenetic upregulation of EMT-associated transcription factors, including ZEB, TWIST, and SNAIL; reduced expression of E-cadherin, particularly at the cell membrane, and β-catenin; an increase in mesenchymal markers like Vimentin, alongside a reduction in Cytokeratin expression; low levels of Ki-67 and Caspase-3 expression; and a relatively spindle-shaped morphology with podia formation (3). While it is generally accepted in solid tumors that “an increase in tumor buds correlates with a poorer clinical outcome” (3), the body of research examining TB as a prognostic marker in non-gastrointestinal tumors—particularly in BC—remains limited. As of August 8, 2024, a PubMed search using the MeSH terms “tumor budding AND bladder cancer*” yielded 34 studies, of which only 10 were found to be directly relevant to this subject.

Fukumoto and colleagues investigated the prognostic effects of TB in 121 cases of pT1 non-muscle-invasive bladder cancer (NMIBC) and demonstrated that TB positivity was statistically significantly associated with pT1 sub-staging (microinvasion/extensive lamina propria invasion) (p=0.002), tumor architecture (papillary/nodular) (p=0.023), and lymphovascular invasion (LVI) positivity (p=0.001) (4). Additionally, it was reported that the 5-year progression-free survival rate was statistically significantly higher (p=0.001) in TB-negative pT1 BC cases (88.4%), and that TB was an independent risk predictor for progression to muscle-invasive bladder cancer (MIBC) in both the entire pT1 BC cohort and the subgroup receiving intravesical BCG instillation according to Cox regression analysis (4). Building on these findings, the researchers also observed that in 86% of TB-positive cases, E-cadherin immunoexpression in the tumor center was higher than in the TB areas, highlighting the relationship between TB and EMT in pT1 BC cases (4). While Fukumoto et al. focused on the clinical implications of TB, Miyake and colleagues delved into the underlying molecular mechanisms. In their comprehensive study, they used MGH-U3, UM-UC-14, and UM-UC-3 cells in an orthotopic bladder tumor model in SCID mice and suggested that COL4A1 and COL13A1 might play a primary role in the formation of the infiltrative pattern of TB (5). However, as accurate TB analysis can be complicated by peritumoral inflammatory infiltrate or reactive stromal cells, Brieu and colleagues adopted a different approach by targeting cytokeratin, which had previously been shown to effectively distinguish TBs. They enhanced their analysis by applying machine learning and automated image analysis to IF-stained samples, thereby achieving more accurate quantification in a sample of 100 MIBC cases (6). In addition to these efforts to improve prognostic assessments, Liu and colleagues conducted a bioinformatics-based study in which they evaluated the tumor stroma ratio (TSR) and TB together in MIBC cases. By developing a TSR-TB scoring system, they reported that increased TSR-TB might be an independent poor prognostic factor for overall survival (7). In contrast, in the study conducted by Kucuk and colleagues on a sample of 60 MIBC cases, no statistically significant relationship was found between TB and tumor necrosis (p=1.000), LVI (p=0.114), or perineural invasion (p=0.712) (8). However, a different perspective is offered by Seker and colleagues, who, in their study involving a sample of 108 MIBC cases, found that TB was statistically significantly associated with overall survival (p=0.004) (9). The researchers reported that TB could be a useful parameter for predicting prognosis in MIBC cases (9). Further emphasizing the prognostic importance of TB, Soriano and colleagues quantified TB in a sample of 108 MIBC cases that had undergone pancytokeratin staining and reported that TB is an independent risk predictor for mortality (10). The researchers further noted that MIBC cases with 14 or more TBs were associated with an increased risk of mortality as well as a higher tumor stage, suggesting that each additional TB increases the cancer-specific mortality risk by approximately 2% in these cases (10). Expanding on these findings, Busquets and colleagues, in their study involving 168 high-grade stage pT1 NMIBC cases, reported that TB (when present with a count of 6 or more) (p=0.032, HR: 2.1), along with the presence of carcinoma in situ (CIS), endoscopic tumor pattern (papillary/solid), and the absence of BCG induction, was significant in predicting disease progression according to multivariate variance analysis (11). The researchers also emphasized that the inclusion of TB in the TNM staging system should be carefully considered and that it could assist in the decision-making process for early radical cystectomy in high-grade stage pT1 NMIBC cases (11). Eckstein and colleagues built on this by studying 92 pT1 NMIBC cases with pancytokeratin staining. They reported that, according to Kaplan–Meier analysis, TB was statistically significantly associated with worsened recurrence-free survival (p=0.005), progression-free survival (p=0.017), and cancer-specific survival (p=0.002) (12). The researchers also found that the presence of TB was associated with multifocal tumors (p=0.003) and extensive lamina propria invasion when pT1 sub-staging was performed (p<0.001) (12). Interestingly, among the cases that received BCG instillation, those without TB not only had better recurrence-free survival (p=0.012), progression-free survival (p=0.011), and cancer-specific survival (p=0.022), but also no progression or disease-related deaths were observed in this group (12). Finally, Yang and colleagues contributed further by conducting a retrospective study involving 80 BC cases (36 NMIBC and 44 MIBC) (13). They investigated the prognostic effects of EPDR1 immunoexpression and TB quantification (13). The researchers quantified TB in 44 MIBC samples, considering those with six or more TBs as positive. The study found that EPDR1 immunoexpression varied statistically significantly (p<0.05) with tumor stage, and MIBC cases with high EPDR1 immunoexpression were statistically significantly more likely to have increased TB (p<0.05) (13). Furthermore, an increased TB count was associated with a tendency toward a worse clinical status in MIBC cases (p<0.001) (13).

The scoring of TB varies depending on the type of solid tumor. As a result, following the development of a standardized scoring system that can be adapted to BC, the inclusion of TB as a prognostic marker in routine histopathological evaluation could provide clinicians with significant advantages in risk stratification and treatment planning, particularly in managing patients with high-grade stage pT1 NMIBC who require accurate progression prediction. Although TB scoring is more easily and reliably performed on slides stained with pancytokeratin IHC, the fact that it can also be commonly done on routine H&E stained slides makes this cost-effective marker an attractive option for clinical use in BC as well. Since tumor budding is biologically closely related to EMT and the TME, detailed investigation of the underlying molecular mechanisms holds promise for the development of actionable targets. In this context, we believe that further multicenter prospective studies and more detailed molecular analyses are necessary to validate the clinical utility of TB and evaluate its integration into existing prognostic models. These investigations could not only validate the clinical utility of TB but also pave the way for more personalized treatment strategies in BC.

Sincerely.

Noninvasive Diagnostic Methods Are Useful in Malignant Pleural Effusions

Fatoş Kozanlı — 2024-09-20

I read with interest the case report titled "Chronic Lymphocytic Leukemia Hospitalized Due to Pleural Effusion - Case Report" written by Bahar Ağaoğlu Şanlı in the Acta Medica Ruha journal, page 1.3 (2023): 468-473. As a writer interested in pleural effusions in thoracic surgery, the case caught my attention. Pleural effusions are an area that requires research because they are a common clinical condition with multiple pathophysiologies [1].

In the case report, it is seen that the author performed diagnostic methods related to pleural effusion management, but preferred to perform a blind biopsy because the patient's general condition was not suitable for surgical biopsy. In the study, no malignant cells were observed in the pleural fluid and no malignant cells were detected as a result of blind biopsy. I believe that the author's contribution to the dark side of pleural effusions with this case resulting in mortality will bring a remarkable perspective to the literature and I congratulate the author. Currently, aspiration and cytological evaluation of pleural fluid is the main diagnostic method. However, cytological evaluation is 60% sensitive for diagnosis. The presence of tumor cells in pleural effusion has diagnostic value in malignant pleural effusions; however, the chance of finding tumor cells in the fluid is low[1]. Since the pleural biopsy performed in the study was a blind biopsy, the probability of finding pathological tissue in the pleura would also be low. There is a higher chance of finding tumor markers instead [2].

In a retrospective study conducted by us in 2022, it was revealed that immature granulocyte levels contributed to the diagnosis of malignant pleural effusion[1]. The author's study has shown once again that the probability of finding malignant cells in malignant pleural effusions is low even with repeated thoracentesis. Not every patient may be clinically suitable for surgical biopsy. Some malignancies may show low 18-Fludeoxyglucose uptake in positron emission tomography. In this case, less invasive peripheral markers can also be used in diagnosis.

Retrospective Analysis of Spontaneous Pneumothorax Cases Associated with COVID-19

Şebnem Kılıç — 2024-09-20

Introduction: Spontaneous pneumothorax is the presence of air in the pleural space without a history of trauma. The risk of developing spontaneous pneumothorax was 40 to 100 times higher in patients with COVID-19 compared to those without.

Objective: Within the scope of this research, we aimed to elucidate spontaneous pneumothorax cases associated with COVID-19 in a retrospective manner.

Method: Patients diagnosed with COVID-19 and spontaneous pneumothorax at our were included in this retrospective analysis. The patients' admission complaints, comorbidities, COVID-19, RT-PCR results, laboratory findings, imaging results, treatment methods applied, and hospitalization or discharge were recorded.

Results: A total of 31 patients aged between 21 and 90 were included in the analysis. Patients were divided into two subgroups: discharge (n=20) and exitus (n=11). While the average hospitalization period of the discharge group was 14.7±22/days, the average hospitalization period of the exitus group was calculated as 2.6±2.1/days (p<0.001). While 15 (75%) patients in the discharge group required intensive care follow-up, all in the exitus group required intensive care follow-up (p =0.133). A statistically significant difference was detected between the mean values of hemoglobin, INR, D-Dimer, and PLT in the laboratory examinations of the discharge group and the exitus group (p-value; 0.022, 0.004, 0.005, and 0.042, respectively). It was found that there was a strong positive relationship between the length of hospital stay of the patients and laboratory findings, PLR, and NLR (correlation coefficient: 0.818 and 0.818, respectively).

Conclusion: Although many different clinical conditions that develop during COVID-19 infection are in the literature, cases of pneumothorax and pneumomediastinum have been rarely reported. In addition, the possibility of high mortality in these clinical conditions that may be seen in the actively ongoing COVID-19 pandemic should also be taken into consideration.

Evaluation of the Relationship Between Vitamin D Levels and Glycemic Parameters in Prediabetic Individuals

Uğur Ergün — 2024-09-20

Objective: Prediabetic condition is a precursor clinical picture that poses a significant risk for the development of diabetes. Early diagnosis and treatment are crucial for preventing micro and macro complications. Numerous studies have been conducted to explore the relationship between Vitamin D and the development of diabetes, attempting to clarify this connection. We planned this study to examine the relationship between Vitamin D and glycemic parameters in prediabetic individuals and to lay the groundwork for future research in this direction.

Method: Our study included 192 patients aged 24‐65 who presented to internal medicine clinics. The study retrospectively examined 93 prediabetic individuals and 99 healthy individuals without any diseases, drug use, Vitamin D supplementation, or any other significant characteristics. The selected patients' demographic data, fasting glucose levels, HbA1C, insulin, HOMA-IR, 25(OH)D vitamin, calcium, and albumin levels were analyzed using chromatography equipment, HPLC method. The Chi-Square test was used to determine the differences in categorical data between groups. The level of statistical significance was set at p<0.05.

Results: The mean age was 53.18±12.71 in the prediabetic group and 42.44±14.72 in the control group. No statistically significant difference was observed in gender distribution between the two groups (p=0.9072). When comparing Vitamin D levels between the two groups, it was found to be 14.62±6.87 ng/mL in the prediabetic group and 17.53±11.02 ng/mL in the control group, which was statistically significant (p=0.029).

Conclusion: Our study found a significant difference in Vitamin D levels between prediabetic individuals and healthy individuals with normoglycemic progression. Observational studies suggest a significant relationship between Vitamin D and diabetes mellitus, and similar findings are observed in prediabetic individuals. We believe that Vitamin D supplementation in the prediabetic population could have significant effects on public health and glucose metabolism.

Assessment of Environmental Factors, Sleep Quality, Functional Independence and Posture Anatomy in Lung Cancer Patients

Ozden Gokcek — 2024-09-20

Introduction: Lung cancer is a common problem. Many reasons can make life difficult for these patients.

Objective: The aim of our study was to evaluate environmental factors, sleep quality, independence level and posture anatomy in lung cancer.

Method: In the study in which 40 patients diagnosed with lung cancer were included, demographic information and disease history were questioned, Medical Research Council Dyspnoea Scale, Pittsburgh Sleep Quality Index, Visual Analogue Scale, Barthel Activities of Daily Living Index and New York Posture Analysis were performed.

Results: Among the clinical findings, 77% of the participants had cough, 72.5% had sputum, 42.5% had chest pain, 62.5% had dyspnoea, and 37.5% had hoarseness. In the evaluation of dyspnoea, 27.5% of the patients had a dyspnoea score of 4, 22.5% had a dyspnoea score of 3 and 12.5% had no complaint. Diabetes mellitus (22.5%) was found to be the most common systemic disease in the patient history. It was also determined that 75% of the individuals had poor sleep quality, 25% were severely dependent and 35% were moderately dependent according to the Barthel index. When cancer was evaluated in terms of genetic factors, 87.5% of the patients did not have a family history of cancer. 90% of the patients used stove as a means of heating at home.

Conclusion: In the study, it was determined that the patients had symptoms such as pain, shortness of breath, cough and sleep quality was significantly affected. In this respect, it was concluded that the rehabilitation process is important in the treatment planning of patients. The high number of individuals without a family history of cancer suggests that environmental factors are important in terms of public health evaluation.

Bibliometric And Visual Analysis of Video Assisted Thoracoskopic Surgery

Ahmet Acıpayam — 2024-09-20

Introduction: The video-assisted thoracoscopic surgery (VATS) method has been used in thoracic surgery for the last three decades, and segmentectomy operations performed by VATS have an increasingly broader area of usage including thoracic surgery, oncologic surgery, lung cancer, and metastatic lung tumors. The definition and applicability of VATS segmentectomy are dynamically broadening over time, and the number of published reports in this field is increasing. However, no bibliometric analysis of the segmental anatomy in VATS segmentectomy procedures was encountered.

Objective: In this study, keywords and phrases including “VATS segmentectomy” were searched in the Web of Science (WoS) Core Collection, and the collected data were analyzed using the RStudio and VOSviewer programs.

Method: The analyses focused on the current state of research on VATS segmentectomy, previous studies, recent studies, and expectations for the future.

Results: A total of 693 publications were found. The average number of publications per year was 8.16. The most productive countries were respectively China and the US. The country with the highest number of citations was the US. The two most prominent WoS categories were surgery and the respiratory system. The most involved institution was Tongji University (China).

Conclusion: In the keyword analyses, it was seen that the keywords segmentectomy and lung cancer were frequently used, and there were strong connections between the two. It was seen that the recent trend in research in this field involved video-assisted thoracoscopies and robotic surgery, but strong connections indicating the controversial nature of the outputs of research were identified.

Retrospective Evaluation of Patients Who Admitted to the Emergency Department Due to Pneumothorax

Şebnem Kılıç — 2024-09-20

Introduction: Spontaneous pneumothorax is a severe life-threatening situation, especially in the elderly and individuals with comorbid diseases.

Objective: In this research, we aimed to elucidate the demographic and clinical characteristics of spontaneous pneumothorax cases in a retrospective manner.

Method: Patients (n=325) diagnosed with pneumothorax at our institution's Emergency Medicine Clinic were included in this retrospective analysis. The patient data were obtained from patient files and data in the hospital automation system. The patients' admission complaints, comorbidities, laboratory findings, imaging results, treatment methods, and hospitalization or discharge were recorded.

Results: Within the scope of the study, 325 patients aged between 1 and 90 were included in the evaluation. Patients were divided into two groups according to age: <40 years (n=163) and ≥40 years (n=162). A statistically significant difference was observed in the distribution of malignancy, diabetes mellitus (DM), hypertension (HT), chronic obstructive pulmonary disease (COPD), chronic kidney failure (CKF), primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP), traumatic pneumothorax, falls, rib fracture, thoracotomy and outcomes (p< 0.05). While mortality was observed in a total of 25 patients, a statistically significant difference was found in the ≥40-years-old patient group (n=21) compared to the <40-years-old patient group (n=4). The diagnosis of PSP was statistically significantly higher in the <40 age group (n=119) than in the ≥40 age group (n=79). It was observed that the hemoglobin, lymphocyte count, and estimated glomerular filtration rate (eGFR) in patients younger than 40 were higher than in patients older than 40.

Conclusion: As a result, spontaneous pneumothorax is a clinical entity that is treated according to age, clinical condition, and underlying causes, is often benign when seen in young people, and is life-threatening if not urgently intervened in elderly patients with limited pulmonary reserve. Mortality and morbidity can be prevented with timely diagnosis and appropriate treatment.

Investigation of Risk Factors Related to The Use of Non-Prescription Proton Pump Inhibitors in Patients Referred to A Tertiary Health Care Institution

Uğur Ergün — 2024-09-20

Introduction: Proton pump inhibitors are benzamidazole derivative drugs that act by inhibiting gastric acid secretion controlled by parietal cells in the gastric epithelium through neuroendocrine pathways. Today, they are widely used worldwide for the treatment of all gastric acid-related diseases, especially gastroesophageal reflux disease.

Objective: It is known that these drugs, which are most commonly prescribed to patients in our society, have recently been prescribed for inappropriate and unnecessary indications as well as over-the-counter use. The aim of this study was to investigate the risk factors related to the use of over-the-counter proton pump inhibitors in outpatients presenting to a tertiary health care centre.

Method: In this cross-sectional and analytical study, a questionnaire was administered face-to-face by the investigators to 300 volunteer patients who applied to the Internal and Surgical Outpatient Clinics of Balıkesir Atatürk City Hospital.

Results: It was found that 115 (38.3%) and 26 (8.7%) of the participants were male. It was found that 283 (94.3%) of the cases were prescription drugs, and when the reasons for use were analysed, it was determined that 116 (38.7%) were multiple drug use and 125 (41.7%) were dyspepsia in the first two. It was determined that an increase in age decreased the risk of using non-prescription proton pump inhibitors at a statistically significant level, and a higher level of education increased the risk of using non-prescription proton pump inhibitors 5.791 times at a statistically significant level.

Conclusion: In this study, it was observed that the use of proton pump inhibitors in patients admitted to outpatient hospitals is extremely common. It is evident that the use of over-the-counter medication has increased recently with off-label prescription. For this reason, it has become imperative to conduct new multicentre studies to examine the use of over-the-counter drugs and the factors affecting this.

Individual-Level Abortion Stigma and Affecting Factors in Women with Abortion Experience

Hatice Nur Özgen — 2024-09-20

Introduction: Women may decide to have an abortion for various reasons such as not wanting a child, maternal/fetal health problems, age, financial difficulties, family or partner pressure and lack of social support. Therefore, many women face psychological problems as a result of the individual-level abortion stigma they experience for sociodemographic and cultural reasons. Measuring individual-level abortion stigma is important in terms of preventing individual stigma and the health problems it may cause.

Objective: This study aims to determine the individual-level abortion stigma and the factors affecting this situation in women with abortion experience.

Method: The population of this cross-sectional study consisted of women who applied to the gynaecology and obstetrics outpatient clinic of a hospital. The sample consisted of 127 participants who met the inclusion criteria and agreed to participate in the study. Data were collected using Personal Information Form and Individual Level Abortion Stigma Scale.

Results: In the study, 77.2% of the participants were between the ages of 18-35, 89.0% had at least one living child, and 92.9% had 3 or less abortions. Among women, 95.3% of abortions were for medical reasons and 89.3% of these were due to fetal indication. The mean score of the Individual Level Stigma in Abortion Scale was 1.61±0.57. There was no significant relationship between socio-demographic and obstetric characteristics and scale score (p>0.05).

Conclusion: The individual-level abortion stigma was found to be at a moderate level in women with abortion experience. Individual-level abortion stigma was found to be independent of individual and environmental factors.

Examination of Nurses' Post-Earthquake Health Perception, Coping with Earthquake Stress and Insomnia

Fatma Ersin — 2024-09-20

Introduction: Earthquakes occur suddenly. In the subsequent process, it causes physiological, psychological and social problems in individuals. Nurses, on the other hand, try to find solutions to both their own problems and the problems of the individuals they care for in earthquake situations.

Objective: The study aimed to determine nurses' health perception levels after the earthquake, their coping strategies with earthquake stress, and their insomnia.

Method: It is a descriptive type study. It was conducted on nurses working at Training and Research Hospital. The study was carried out between April 2023 and June 2023. There are 601 nurses in the sample. An introductory information form, Health Perception Scale, Earthquake Stress Coping Strategies Scale and Insomnia Severity Index were used to collect data. In the analysis of the data, t test, analysis of variance and Pearson correlation analysis were performed in independent groups.

Results: It was found that health perception was affected by marital status and educational status, and sub-dimensions of the earthquake stress coping strategies scale were affected by educational status (p<0.05). It was determined that 44.3% of the nurses were at the lower threshold of insomnia. A weak relationship was found between health perception and the religious coping sub-dimension of the earthquake stress coping strategies scale (r =-.199, p = .000).

Conclusion: It is recommended to carry out interventional studies that will increase nurses' health perception, enable them to use coping strategies effectively in earthquake situations, and help them cope with sleep problems.

Comparison of the Efficacies of Alteplase and Streptokinase Used for Fibrinolytic Treatment in Parapneumonic Pleural Effusion and Empyema

Şamil Günay — 2024-09-20

Introduction: Used rarely in the fibrinolytic treatment of parapneumonic pleural effusion (PPE) and empyema, alteplase is a plasminogen activator (tPA) analogue.

Objective: In our study, we divided the patients with PPE and empyema, to whom we implemented video-assisted thoracic surgery, into two groups and we implemented VATS to one group and alteplase plus fibrinolysis following VATS to the other. We compared these two groups through clinical and biochemical parameters.

Methods: Totally 66 patients were involved in the study. The patients were divided into 2 groups randomly. 5-20 mg alteplase was administered to 40 patients in the first group (Alteplase) through tube thoracostomy following VATS. And only VATS was implemented to 26 patients in the second group (Control). The chest tube removal times of the patients and their lengths of hospitalization, C-Reactive Protein (CRP) and White Blood Cells (WBC) values were compared statistically.

Results: It was determined that the groups were homogeneous statistically (P>0.05), CRP values (11.99±9.63) in the alteplase group were statistically significantly higher comparing to the control (4.07±5.10) group (P<0.05), Alteplase group was better in the comparison of the removal times of chest tubes, lengths of hospitalization and WBC values, however the findings were not statistically significant (P>0.05).

Conclusion: Alteplase is a significantly efficient fibrinolytic treatment with a success rate of 87.5%, which can be used in PPE and empyema with minimum side effects in appropriate dosages.

The Relationship Between Personality Traits and Pregnancy Adaptation: The Case of Primigravida Pregnant Women

Sidar Gül — 2024-09-20

Introduction: Adaptation to pregnancy is essential for expectant mothers who will have their first experience. It includes personality traits and thus contributes to shaping the role of motherhood.

Objective: This study investigated the relationship between personality traits and pregnancy adjustment in primigravida pregnant women.

Method: This cross-sectional study was conducted with 280 women in a province in the south-eastern Anatolia region of Turkey between January and June 2024. Participants were selected randomly. The data were collected using the “Introductory Information Form,” “Ten-Item Personality Inventory (TIPI),” and “Prenatal Self Evaluation Questionnaire (PSEQ).” The data were analyzed using number, percentage, mean, correlation, and regression analysis in the SPSS program.

Results: The mean scores of the participants' TIPI sub-dimensions of openness to experience, conscientiousness, extraversion, agreeableness, and emotional stability were 9.62±2.32, 10.89±2.05, 9.52±2.44, 11.43±2.88, 10.51±2.15, respectively. The mean total score of the PSEQ was 178.50±26.54, and pregnancy adjustment was moderate. There was a moderate negative relationship between pregnancy adjustment and openness to experience (r=-0.615, p=0.003), conscientiousness (r=-0.625, p=0.015), agreeableness (r=-0.605, p≤0.001), and emotional stability (r=-0.630, p≤0.001) personality traits. According to the results of the multiple linear regression model, openness to experience (β=-2.718, p=0.001) and conscientiousness (β=-3.35, p=0.004) variables are important determinants of pregnancy adjustment, and these variables explain 27.6% of the total variance in pregnancy adjustment.

Conclusion: Women who are not open to experience and have low responsibility personality traits are at-risk groups in terms of pregnancy adjustment in their first pregnancy.

Royal Jelly Supplementation Enhances Post-Exhaustive Exercise Energy Metabolism

Seyhan Taşkın — 2024-09-20

Introduction: Lactate accumulation, free radical increase and changes in the activity of regulatory enzymes in energy metabolism that occur after acute exhaustion exercise disrupt the muscle adaptation mechanism and lead to muscle damage. Royal jelly, which is considered a superfood with its cell regeneration and therapeutic effects, can compensate for the effects that occur after exercise.

Objective: In this study, the effects of royal jelly supplementation were investigated in Balb-c type mice in which an acute exhaustion exercise model was created.

Methods: Mice were randomly divided into four groups: control, royal jelly, acute exhaustion exercise, acute exhaustion exercise + royal jelly. In all groups, the levels of mitochondrial biogenesis markers Ppargc1a and TFAM, which regulate muscle adaptation, and the levels of PDHa and Slc16a1, which are effective in aerobic and anaerobic regulation, were analyzed by ELISA method.

Results: PDHa and Slc16a1 levels were statistically significant between groups (p=0.024, p=0.029, respectively), but Ppargc1a and TFAM levels were not significant between groups (p=0.087, p=0.082, respectively). It was found that PDHa, Slc16a1, Ppargc1a and TFAM levels increased in the group receiving royal jelly supplementation with acute exhaustion exercise compared to the group not receiving supplementation.

Conclusions: These findings highlight the effective potential of royal jelly in developing/improving aerobic and anaerobic respiratory pathways and in the muscle adaptation process against the impaired muscle adaptation mechanism caused by acute exhausting exercise. Based on these promising results, further research is required to explore new knowledge in exercise physiology and sports sciences.