Natural History of Cirrhosis: Changing Trends in Etiology Over the Years.

BACKGROUND AND GOALS: The aims of the present study were to investigate the natural history of cirrhosis and to determine trends in the etiology of cirrhosis. METHODS: Between January 2001 and January 2018, a total of 1,341 patients had been diagnosed with cirrhosis and were included. RESULTS: A total of 898 cirrhotic patients, who were followed up for at least 6 months were included into the analysis. The median age was 54 years. The median Child-Pugh and MELD scores were 7.5 and 11, respectively. Ascites (51%) was the most common causes of decompensation. Chronic viral hepatitis was the most frequent cause of cirrhosis (58%). Hepatitis B virus (HBV) infection was the main etiology (34%), followed by hepatitis C virus (HCV) infection (18%). Among 129 patients with cryptogenic cirrhosis (CC), 60 had metabolic abnormalities. If these 60 patients with CC were considered to have nonalcoholic fatty liver disease (NAFLD)-related cirrhosis, the proportion of NAFLD-related cirrhosis increased from 1.8 to 8.0%. At admission, 74 patients (8%) had been diagnosed with hepatocellular carcinoma (HCC). A new HCC developed in 80 patients during the follow-up period. The probability of developing HCC was 3.9% at 12 months. Logistic regression analysis showed that the development of HCC was significantly associated with older age (p < 0.001), male gender (p < 0.001), viral etiology (p = 0.026), and baseline high aspartate aminotransferase level (p = 0.01). Overall, 104 cirrhotic patients died. CONCLUSION: HBV and HCV remain the leading causes of etiology in cirrhosis and HCC. However, NAFLD-related cirrhosis is recognized as a growing burden.

A Teleconference With Related Donors Years After Allogeneic Hematopoietic Stem Cell Transplantation.

OBJECTIVES: During and after allogeneic hematopoietic stem cell donation, donors may experience adverse events. This situation can increase anxiety of candidate donors. Time to return to daily life routine and work, presentation of comorbid diseases in follow-up, and donor opinions are topics of interest. MATERIALS AND METHODS: We conducted a 14-question survey among related stem cell donors between January 2010 and March 2019 by telephone interview. RESULTS: Of 257 related donors, 175 (68.1%) were interviewed; 87 (49.7%) were female and 88 (50.3%) were male. Among donors interviewed, 144 (82.3%) donated from only peripheral blood. After harvesting of stem cells, adverse events included hip pain (38.7%), bone pain (57.2%) during mobilization, and paresthesia (28.9%) during apheresis. After apheresis, 2 serious adverse events were reported in 2 (1.3%) female donors (1 salpingo-oophorectomy and 1 nephrectomy). Splenomegaly was observed in 1 male donor (0.7%). Among donors interviewed, 77 (44%) reported being able to perform daily activities on the same day. The shortest time to daily activity was in the peripheral blood group, and the longest was in the bone marrow group (P = .001). Among working donors, 23 (27.4%) returned to work on the same day; all were peripheral blood donors. Among donors interviewed, 114 (65.1%) wanted to volunteer to donate again. One donor (0.6%) expressed guilt after donation, and 162 (92.6%) recommended other people to be stem cell donors. During the follow-up period, musculoskeletal-joint diseases increased after donation (P = .012). CONCLUSIONS: It is important to raise awareness in society about stem cell donation and to reduce the concerns among donor candidates. Although most of the adverse events after donation are temporary and mild, a few serious adverse events in donors have been observed. Stem cell donation does not cause loss of daily activity or inability to return to the work force.

[Rational Drug Usage Status of Nursing Students]. / Hemsirelik Ögrencilerinin Akilci Ilaç Kullanma Durumlari.

AIM: This study was conducted to determine nursing students' rational use of medicines. METHOD: The population of this descriptive study was composed of 1177 students who were studying at a faculty of nursing in Istanbul. The study sample, on the other hand, consisted of 303 students who were selected from the population by the "stratified random sampling" method, a probabilistic sampling method. The sample size was calculated using the Minitab software. Data were collected with data collection form between February and March 2016. In data analysis, percentage, median, Pearson Chi-square and Fisher's Exact test was used. RESULTS: It was found that the average age of the participating nursing students was 20.25±1.71, 85.5% of the participants were female, 98.7% were single, 66.3% graduated from Anatolian High School and 29.4% of them were in their third year of study. Also, 11.6% of the participants used medicines continuously, 16.2% used medicines frequently, the most frequent reason for using medicines (69%) was pain, 93.7% read the prospectus of the medicines they used, 70.6% took their medicines on time, 86.8% were careful about using their medicines before or after meals, 78.5% did not change doses of medicines themselves, 63% stopped using medicines when symptoms of disease were over, 62% did not always take medicines with prescription, and 97.3% used pain relievers most without a prescription. In addition, there were significant differences between the participants' gender and reading the prospectus before using medicines, between having a chronic disease and continuous and frequent use of medicines, and between alcohol consumption and frequent use of medicines (p<0.05). CONCLUSION: The nursing students in our study were found to have inadequacies in some issues related to rational use of medicines (e.g. taking medicines with a prescription, using medicines on time and not changing medicine doses without physician's suggestions). In this context, it is advisable to develop guidance and counseling programs for the development of rational drug use behaviors of nursing students and to include this subject in detail in nursing undergraduate education course curricula.