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Öğe A cross sectional evaluation of patients with ostomy in Turkey(Galenos Publishing House, 2021) Yılmaz, Gökhan; Harputlu, Deniz; Pala, Miraç İlker; Mert, Tuba; Çakıt, Hakan; Sücüllü, İlker; Kuzu, AyhanAim: Despite recent technological developments, a stoma formation is needed for the treatment of many diseases, especially in colorectal surgery. Due to the radical principles of cancer treatment, the number of patients living with stoma is increasing. However, there is no study that quantitatively evaluates the stoma patients nationally. In this study, it was aimed to retrospectively evaluate the demographic data, indications, preferred types of stoma and the outcomes of patients who had a stoma formation in our country in the last three years. Method: In our country, there are 3 companies that operate in the field, provide materials for 95% of stoma patients. The data of patients who had a stoma between 2017 and 2019 were collected from these companies retrospectively by protecting personal privacy of patients. The distribution of indications and type of stoma acording to indications were determined. Average age, stoma closure rates and mortality rates were calculated. All data are presented as numbers and percentages and categorical variables are shown as median (minimum-maximum), continuous variables are shown as ± standard deviation. Results: The most common indication for stoma creation was colorectal malignancy (58.4%) and followed by mechanical bowel obstructions (29.6%). Other malignancies (4.16%), inflammatory causes (4.58%), traumatic causes (1.88%) and congenital anomalies (1.17%) constituted a total of 11% stoma indications. It was observed that. ostomies opened due to colorectal malignancy,were closed in 40% of patients with loop ileostomy, 30.1% of patients with loop colostomy, and only 13% of patients with end colostomy. Conclusion: We aimed to obtain a national perspective by evaluating the patients who had a stoma in the last 3 years and to show up the distribution of stoma formation indications in our country. We have determined the demographic data of patients with stoma and calculated the stoma closure and mortality rates according to stoma types. Although this study is a cross-sectional evaluation of patients in the whole country, weak point of our study is there are deficiencies in our evaluation due to the lack of retrospective data. We think that prospective studies should be planned by detailing subgroups.Öğe Comparison of laser haemorrhoidoplasty and ferguson haemorrhoidectomy in treating grade III and grade IV haemorrhoids: A prospective randomised study(College of Physicians and Surgeons Pakistan, 2023) Mert, TubaObjective: To compare the efficiency and safety of laser haemorrhoidoplasty (LH) with Ferguson haemorrhoidectomy (FH) in patients with third- and fourth-grade haemorrhoids. Study Design: Randomised controlled trial. Place and Duration of Study: General Surgery Clinic, Medipol University Pendik Hospital, İstanbul, Turkey, from 1st December 2021 to 1st May 2022. Methodology: The patients who had an indication for surgery for grade III or grade IV haemorrhoidal disease (HD) and who were 18 years and older were randomly allocated to the two study groups. While LH was performed using a 980-diode laser in the patients enrolled in the laser group, a standard FH was performed using diathermy in the patients in the second study group. The length of surgery (LOS), the number of excised lumps, wound healing time, time to symptom relief, pre- and postoperative Visual Analogue Scale (VAS) scores and the difference between them (? VAS), and complication rates were compared between two study groups. Results: LH had less LOS with a similar number of excised lumps, furthermore, it provided faster-wound healing and less time-to-symptom relief when compared to FH. The median VAS score decreased from 5 to 0 in the LH group and from 5 to 2 in FH, and ? VAS scores of the groups were statistically significantly different (p<0.001). LH also had better outcomes than FH in terms of having any type of postoperative complication. Conclusion: LH might be an alternative treatment modality in patients with grade III and grade IV HD with a low level of complication rate.Öğe Evaluation of knowledge and practice regarding mammography among a group of Turkish women attending a tertiary hospital(Turkish Surgical Association, 2022) Mert, TubaObjective: Early detection is the most important cornerstone of breast cancer in determining treatment outcome and survival. In this study, it was aimed to investigate the level of knowledge, attitude, and practice of mammography in the early diagnosis of breast cancer in a group of women. Material and Methods: Data of this descriptive study were collected under observation with the help of a questionnaire. Female patients over 40 years of age or over 30 years of age with a family history of breast cancer admitted to our general surgery outpatient clinic for a health problem other than breast were included. Results: A total of 300 female patients with a mean age of 48.7 +/- 10.9 years (min-max, 33-83 years) were included. Median frequency of correct answers among the women participating in the study was 83.7% (76.0-92.0). Mean score obtained by the participants from the questionnaire was 75.7 +/- 15.8 (the median score 80; 25th-75th centiles, 73.3-86.7). Slightly more than half of the patients (159 patients, 53%) had at least one mammography scan before. The level of mammography knowledge was negatively correlated with age and the number of previous mammographies, and positively correlated with education level (r= -0.700, p< 0.001; r= -0.419, p< 0.001 and r= 0.643, p< 0.001, respectively). Conclusion: Although the level of knowledge about breast cancer and early diagnosis methods in women was at a satisfactory level, it is obvious that mammography screening practice of women without any breast symptoms is very low. Therefore, it should be aimed to increase women's awareness of cancer prevention and compliance with early diagnosis methods and to promote participation in mammography screening.Öğe Impact of capsella bursa-pastoris (Shepherd’s Purse) herbal tea preparations on symptoms and severity of hemorrhoidal disease: A prospective randomized study(Duzce University, 2022) Mert, Tuba; Yiğit, EceObjectives: Medicinal herbs have been used to treat hemorrhoidal disease for centuries. Given its anti-oxidant and anti-inflammatory mechanisms, Capsella bursa-pastoris (Shepherd’s purse) may potentially lead to regression of the hemorrhoidal plexuses. In this context, the objective of this study is to investigate the effect of Capsella bursa-pastoris, an affordable and easy-to-use herbal medicine, on the severity and physical examination findings of hemorrhoidal disease in patients, who receive conventional treatment for hemorrhoids. Material-Method: This study was designed as a prospective, randomized study. The population of the study comprised symptomatic patients who presented with second and third-degree hemorrhoids to the Internal Medicine and General Surgery departments of Istanbul Medipol University Hospital, İstanbul, Turkey, between October 2021 and February 2022. The patients were randomized into two groups: the control group, that is, the group of patients, who were to receive conservative treatment only for three months, and the study group, that is, the group of patients who were to receive conservative treatment and use herbal tea preparations of Capsella bursa-pastoris for three months. Demographic (age and gender) and baseline and 3-month clinical characteristics were recorded. The study's primary outcome was the changes observed in the symptoms and physical examination findings of hemorrhoidal disease in the study group relative to those in the control group. Results: The study sample consisted of a total of 218 patients, who were randomized into the study and control groups, with 109 patients in each group. Significantly older patients were seen in Group CT (39.5 ± 14.6 and 35.5 ± 11.7 years, p=0.030). There was no significant difference between the groups in terms of other characteristics (p>0.05). At the 3rd-month follow-up examination, it was determined that there were significantly fewer patients with bleeding and difficulty during defecation in the study group compared to the control group (p=0.001 for both cases). Patients in the study group had significantly lower VAS scores for pain and the number of affected quadrants compared to those in the control group (p<0.001 for both cases). The proportion of patients with Grade II and III hemorrhoidal disease was significantly lower in the study group. Conclusion: The findings of this study, which revealed significant improvements in the symptoms and physical examination findings of hemorrhoidal disease, suggest that the use of Capsella bursa-pastoris herbal tea may benefit patients with symptomatic hemorrhoids.Öğe Serum selenyum seviyesi düşük subklinik hipotiroidili hastalarda oral selenyum replasman tedavisinin TSH üzerine etkileri(Afyon Kocatepe Üniversitesi, 2022) Yılmaz, Gökhan; Yiğit, Ece; Pala, İlker; Mert, TubaAMAÇ: Selenyum insan vücudunun önemli metabolik yolaklarının vazgeçilmez bir bileşenidir. Aktif bölgesine selenosistein şeklinde selenyum katılmış proteinler, selenoproteinler olarak tanımlanmaktadır ve bu proteinlerin fonksiyonlarını yerine getirmeleri için selenyuma gereksinimleri vardır. Selenyum elementi, Glutatyonperoksidaz (GPXs), Tioredoksinredüktaz (TRs) ve iyodotironindeiyodinaz (İD) gibi selenoproteinlerin yapısında bulunmaktadır. Selenoproteinler, tiroid hormon biyosentezine ve metabolizmasına, antioksidan savunma sisteminin kontrolüne katkı sağlamaktadır. Çalışmamızda subklinik hipotiroidisi olan otoimmün tiroidit hastalarına selenyum düşüklüğünün ne sıklıkla eşlik ettiğini ve selenyumu düşük olan hastalarda oral selenyum replasmanının tiroit stimülan hormon (TSH) üzerine etkilerini ortaya koymayı hedefledik.GEREÇ VE YÖNTEM: Çalışmamızda Aralık 2019 ile Temmuz 2020 aralığında 18 yaşından büyük olup polikliniğimize başvurmuş olan, asemptomatik subklinik hipotiroidisi olan 69 hastayı değerlendirdik. Serum selenyum düzeyi 80 ?g/L’den düşük olan hastalara 3 ay süre ile yumuşak bir jel kapsül içinde oral yolla günde 83 mcg selenometiyonin verildi. Başka bir tedavi uygulanmadı. Üçüncü ayın sonunda tüm hastalarda serum tiroid hormon profiline ve selenyum seviyelerine bakıldı. Subklinik hipotiroidisi olan otoimmün tiroiditli hastaların, yüzdelik dilimler kullanılarak, oral selenyum replasmanı sonrası TSH seviyelerindeki değişiklikler gözlemlendi.BULGULAR: Çalışmamızda Aralık 2019 ile Temmuz 2020 arasında polikliniğimizde tespit edilen 69 asemptomatik subklinik hipotiroidisi olan hasta değerlendirildi. Çalışma kriterlerine uyumlu 43 hastanın 12 tanesinde (%28) serum selenyum düzeyi normal, 31 (%72) tanesinde serum selenyum düzeyi düşük (<80 ?g/L) olarak tespit edildi. Üç ay boyunca günlük 83 mcg selenometiyonin oral selenyum replasman tedavisi verilen hastaların 19 (%61)’unda TSH değerinin normal sınırlar içerisine gerilediği görüldü (0,5mIU/L10.00 mIU/L) tespit edilirken, 9 (%29) hastada ise TSH değerinin halen 4.26 mIU/L- 10.00 mIU/L aralığında olduğu görülerek bu hastlara levotiroksin tedavisi başlandı.SONUÇ: Çalışmamızda selenyum eksikliği bulunan asemptomatik otoimmün subklinik hipotiroidi hastalarına oral selenyum replasmanı yaparak, serum TSH değerleri üzerindeki kısa dönem etkilerini değerlendirdik ve hastaların %61 inin 3 ay içerisinde ötiroid olduğunu gözlemledik. Selenyum eksikliğinin replase edilmesinin, teorik anlamda otoimmün tiroidit başta olmak üzere tüm otoimmün hastalıkların inflamatuar ve oksidatif hasar sürecine olan olumlu etkileri mevcuttur. Ancak bu konuda deneysel ve klinik prospektif planlanmış ve alt grupların detaylandırıldığı kapsamlı çalışmaların yapılması gerektiğini düşünüyoruz.Öğe The importance of topical metronidazole in the treatment of acute anal fissure: A double-blind study controlled for prospective randomization(Seoul: Korean Society of Coloproctology, 2023) Mert, TubaPurpose: Acute anal fissure, a disease characterized by severe pain in the anorectal area, reduces quality of life and becomes chronic absent appropriate treatment. More recently, anaerobic infections have been noted as contributive to etiopathogenesis. This study investigates topical metronidazole's effect in the treatment of acute anal fissure. Methods: Our prospective randomized controlled double-blind study included 2 groups of 100 patients older than 18 years from our General Surgery Clinic with anal fissure complaints for less than 8 weeks. Topical diltiazem treatment was started in group 1, and topical diltiazem and metronidazole treatment in group 2. Pain levels were evaluated by the visual analogue scale (VAS) score, and recovery status was evaluated by physical examination findings ab initio and at the 1st, 4th, and 6th weeks. VAS score levels, demographic, clinical, and recovery status were then compared. Results: There was no difference between the groups as to age, sex, pain on defecation, bleeding, constipation, and duration of pain, bleeding and constipation (P>0.05). From week 1, fissure epithelialization and healing rates were higher in group 2 (P<0.001); group 2 VAS score levels were lower than in group 1 (P<0.001) and achieved by group 1 only in week 4 (P=0.073). Conclusion: Adding topical metronidazole to treatment reduces the duration and severity of pain, shortens healing time, and increases the healing rate.
