Pharmacy Students' Knowledge and Attitudes about Homeopathy: A Descriptive Survey Conducted in Turkey.

BACKGROUND: Homeopathy belongs to "Traditional and Complementary Medicine" (TCM) and is defined in the TCM regulation in Turkey as a holistic practice method that aims to improve health status with personalized medicines. The international and national literature includes a limited number of studies that examine individuals' knowledge, attitudes and behaviors toward homeopathy. Although in Turkey the Regulation on Pharmacists and Pharmacies states that the sale of homeopathic medicines is allowed only in pharmacies, no study was found that evaluated awareness about homeopathy among pharmacy students. OBJECTIVE: The present study aims to assess pharmacy students' knowledge and attitudes toward homeopathy and to identify the factors that influence them. METHODS: This descriptive study was conducted between December 1, 2021 and February 1, 2022 among the students of the Faculty of Pharmacy, Karadeniz Technical University (KTU), through a face-to-face survey. In total, 418 questionnaires suitable for data quality were included in the study. The SPSS 23.0 statistical program was used to analyze the data and the statistical significance level was taken as p < 0.05. RESULTS: It was determined that 73% of the participants had heard about TCM practices and 55% had heard of homeopathy. Students in the fifth grade (p = 0.0001) and those working in an income-generating job (p = 0.026) were found to be those most aware of homeopathy. The students of the Faculty of Pharmacy correctly knew the basic working principles of homeopathy (p = 0.002). The source from which students obtained the most information about homeopathy was undergraduate courses. 80.4% of the participants thought that homeopathy should be applied by pharmacists. 47.0% of the students wanted to learn more about homeopathy or to carry out studies in the field of homeopathy in their careers. CONCLUSION: The results of this research revealed a high awareness amongst KTU pharmacy students about the practice of homeopathy.

A novel computer based risk prediction model for vocal cord palsy before thyroidectomy.

BACKGROUND: Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts suspicious findings on fine needle aspiration (FNA) biopsy, dyspnea from airway compression or dysphagia from cervical esophageal compression, etc. The incidences of vocal cord palsy (VCP) caused by thyroid surgery were reported to range from 3.4% to 7.2% and 0.2% to 0.9% for temporary and permanent vocal fold palsy respectively which is a serious complication of thyroidectomy that is worrisome for patients. OBJECTIVE: Therefore, it is aimed to determine the patients who have the risk of developing vocal cord palsy before thyroidectomy by using machine learning methods in the study. In this way, the possibility of developing palsy can be reduced by applying appropriate surgical techniques to individuals in the high-risk group. METHOD: For this aim, 1039 patients with thyroidectomy, between the years 2015 and 2018, have been used from Karadeniz Technical University Medical Faculty Farabi Hospital at the department of general surgery. The clinical risk prediction model was developed using the proposed sampling and random forest classification method on the dataset. CONCLUSION: As a result, a novel quite a satisfactory prediction model with 100% accuracy was developed for VCP before thyroidectomy. Using this clinical risk prediction model, physicians can be helped to identify patients at high risk of developing post-operative palsy before the operation.

Prediction of gestational diabetes using deep learning and Bayesian optimization and traditional machine learning techniques.

The study aimed to develop a clinical diagnosis system to identify patients in the GD risk group and reduce unnecessary oral glucose tolerance test (OGTT) applications for pregnant women who are not in the GD risk group using deep learning algorithms. With this aim, a prospective study was designed and the data was taken from 489 patients between the years 2019 and 2021, and informed consent was obtained. The clinical decision support system for the diagnosis of GD was developed using the generated dataset with deep learning algorithms and Bayesian optimization. As a result, a novel successful decision support model was developed using RNN-LSTM with Bayesian optimization that gave 95% sensitivity and 99% specificity on the dataset for the diagnosis of patients in the GD risk group by obtaining 98% AUC (95% CI (0.95-1.00) and p < 0.001). Thus, with the clinical diagnosis system developed to assist physicians, it is planned to save both cost and time, and reduce possible adverse effects by preventing unnecessary OGTT for patients who are not in the GD risk group.

A prospective study for gestational diabetes mellitus: Analysis of risk factors in Turkish women for early prediction.

OBJECTIVE: To define risk factors for the early prediction of gestational diabetes mellitus (GDM) because the risk of pre-eclampsia and preterm birth increases in mothers who are diagnosed with GDM. MATERIALS AND METHODS: A prospective study was designed and the data were collected by physicians prospectively from the patients who came to the clinic between the years 2019 and 2021; informed consent was obtained from the women. The prospective data comprised 489 patient records with 72 variables and the risk factors for early prediction of GDM were determined using logistic regression and random forest (RF), which is an advanced analysis method. RESULTS: The obtained sensitivity and specificity values are 90% and 75% for logistic regression and 71% and 90% for the RF, respectively. CONCLUSION: In this prospective study of GDM in Turkish women; age, body mass index, level of hemoglobin A1c, level of fasting blood sugar, physical activity time in first trimester, gravidity, triglycerides, and high-density lipoprotein cholesterol were confirmed to be risk factors in analysis results.

A rare case of acute acalculous cholecystitis secondary to hantavirus infection with renal syndrome.

Hantaviruses are single-stranded RNA viruses. They are transmitted to humans by rodents and insectivore hosts. Some Hantavirus subtypes are the causative agents of haemorrhagic fever with renal syndrome (HFRS), which is characterized by fever, thrombocytopenia, and acute kidney injury. Hantavirus infection is difficult to diagnose due to its non-specific clinical symptoms. Causes of acalculous cholecystitis are severe trauma or burn, surgery, long-term starvation and some viral infections. It is very rare for Hantavirus to cause acute acalculous cholecystitis. The treatment of acute acalculous cholecystitis is usually directed towards its symptoms. A 22-year-old male forest worker was admitted to our emergency outpatient clinic with the complaints of fatigue, oliguria, fever, abdominal pain and vomiting. After the clinical and laboratory examinations, HFRS and acute cholecystitis secondary to Hantavirus infection were diagnosed. The patient's condition and clinical findings improved after supportive treatment. Hantavirus infection should be considered in patients with acute kidney injury, cholecystitis and thrombocytopenia (Fig. 2, Ref. 10). Keywords: Hantavirus, acute kidney injury, acalculous cholecystitis, thrombocytopeni.

Evaluation of alarm fatigue of nurses working in the COVID-19 Intensive Care Service: A mixed methods study.

AIMS AND OBJECTIVES: To reveal the existence of alarms in COVID-19 intensive care units, where medical devices with alarm function are frequently used, the effects of alarms on nurses, especially their on-the-job performances and social lives, and their coping methods. METHODOLOGY/METHODS: This was a mixed design, including descriptive and qualitative research methods with two stages, and was carried out between March and April 2021. The study adhered to the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies. SETTING: Nurses in the COVID-19 intensive care unit of a university hospital constituted the sample. 58 nurses participated in the quantitative data phase, and 18 nurses in the qualitative interviews. RESULTS: More than half of the nurses worked in the COVID-19 intensive care unit for more than 5 months and overtime, and 87.9 had day and night shifts. The monthly income level of 65.5% was between the hunger and poverty lines, and 12.1 % received psychiatric support in the last 6 months. A positive and significant relationship was found between the mean score obtained from the alarm fatigue questionnaire and the level of discomfort felt due to the alarms (1-10 points) (p = 0.001). Five themes and thirty sub-themes were emerged in the focus group interviews. CONCLUSION: The number of alarms of the medical devices in the COVID-19 intensive care units was more than the other intensive care units, resulting in fatigue in nurses. Since alarm fatigue is directly related to patient safety, the effective management of medical device alarms can reduce alarm fatigue and prevent potentially dangerous outcomes. RELEVANCE TO CLINICAL PRACTICE: Nurses care for patients with severe clinical conditions in COVID-19 intensive care units. This situation caused them to be exposed to more alarms. Nurses should make efforts to reduce their alarm intensity.

Refractive, Topographic, and Aberrometric Results at 2-Year Follow-Up for Accelerated Corneal Cross-Link for Progressive Keratoconus.

Purpose. To report the visual, refractive, and corneal topography and wavefront aberration results of accelerated corneal cross-linking (CXL) during a 24-month follow-up. Methods. Forty-seven eyes underwent riboflavin-ultraviolet A-induced accelerated CXL treatment (30 mW/cm2 with a total dose of 7.2 joules/cm2). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical values, keratometry (K) measurements (Ksteep, Kflat, Kavg, and Kapex), central corneal thickness, and anterior corneal aberrometric analyses including total wavefront error (WFE), total high order aberration (HOA), astigmatism, trefoil, coma, quadrafoil, secondary astigmatism, and spherical aberration were evaluated. Results. The mean UDVA and CDVA were significantly improved at 1 (p = 0.003 and p = 0.004, resp.) and 2 years after treatment (p = 0.001 and p = 0.001, resp.). The mean Ksteep, Kflat, Kaverage, and Kapex values were significantly lower than baseline at 12 months (p = 0.008, p = 0.024, p = 0.001, and p = 0.014, resp.) and 24 months (p = 0.014, p = 0.017, p = 0.001, and p = 0.012, resp.). Corneal thickness showed a significant decrease at 1 month. Total HOA and coma decreased significantly at the 12-month (p = 0.001 and p = 0.009, resp.) and 24-month visits (p = 0.001 and p = 0.007, resp.). Conclusion. Accelerated CXL (30 mW/cm2) was found to be effective in improving UDVA, CDVA, corneal topography readings, total HOA, and coma aberrations during the 24-month follow-up.

Accelerated (18 mW/cm(2)) Corneal Cross-Linking for Progressive Keratoconus: 18-Month Results.

PURPOSE: The aim of this study is to report the results of 18 months of follow-up after treatment with accelerated (18 mW/cm(2)) corneal cross-linking in patients with progressive keratoconus. METHODS: Forty-two eyes of 42 patients with progressive keratoconus were included in this retrospective study. All patients underwent accelerated corneal cross-linking at an irradiance of 18 mW/cm(2) for 5 min (total surface dose 5.4 J/cm(2)). Visual acuity, topographic findings (Kflat, Ksteep, Kaverage, and apical keratometry), and central corneal thickness were evaluated during the 18-month follow-up period. RESULTS: The mean ± standard deviation age of the 16 female and 26 male patients was 24.28 ± 6.32 years (range 14-36). Uncorrected distance visual acuity improved clinically significant from 0.52 ± 0.31 to 0.44 ± 0.25 logMAR (P = 0.031), and corrected distance visual acuity improved clinically significant from 0.34 ± 0.21 to 0.28 ± 0.19 logMAR (P = 0.018). At the last examination during the follow-up period, the flat keratometry (Kflat) decreased from a baseline of 45.65 ± 2.71 to 45.41 ± 2.72 diopters (D) (P = 0.001), the steep keratometry (Ksteep) decreased from 49.20 ± 3.54 to 48.96 ± 3.43 D (P = 0.023), and apical keratometry decreased from 56.62 ± 6.43 to 55.19 ± 5.69 D (P = 0.001), all of them were clinically significant at the 18-month visit. The preoperative values of central corneal thickness changed from 458.95 ± 38.79 to 461.85 ± 41.36 µm 18 months after the operation (P = 0.476). CONCLUSION: The accelerated corneal cross-linking was found to be effective for the stabilization of progressive keratoconus during the 18 months of follow-up visits.

Accelerated Corneal Collagen Cross-Linking in Thin Keratoconic Corneas.

PURPOSE: To report the outcomes of accelerated corneal collagen cross-linking in patients with thin corneas (minimum corneal thickness < 400 µm). METHODS: Thirty-four eyes of 34 patients with a minimum corneal thickness less than 400 µm were included. All patients underwent accelerated corneal collagen cross-linking (irradiance power of 30 mW/cm² at 3 minutes with a total surface dose of 5.4 J/cm²). Uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest refraction (diopters [D]), and topography were evaluated at baseline and at the 1-, 6-, and 12-month follow-up visit. Endothelial cell density (cells/mm²) was calculated preoperatively and postoperatively at 12 months. The corneal stromal demarcation line was measured using anterior segment optical coherence tomography at 1 month postoperatively. RESULTS: The mean age of all patients (14 women and 20 men) was 23.08 ± 3.90 years (range: 16 to 29 years). UDVA and CDVA increased but not significantly. UDVA improved from 0.67 ± 0.32 (20/93 ± 20/41 Snellen) to 0.56 ± 0.28 logMAR (20/72 ± 20/38 Snellen) (P = .033) and CDVA improved from 0.49 ± 0.19 (20/61 ± 20/30 Snellen) to 0.42 ± 0.19 logMAR (20/52 ± 20/30 Snellen) (P = .009) at the last follow-up visit. The mean spherical and cylindrical refractions did not significantly change (P = .100 and 0.139, respectively). At the last follow-up visit, the flat keratometry decreased from 47.40 ± 2.52 to 46.95 ± 2.48 D, steep keratometry decreased from 51.04 ± 3.71 to 50.62 ± 3.57 D, and apex keratometry decreased from 57.58 ± 4.49 to 56.26 ± 4.47 D (P = .001, = .0019, = .001, respectively) from baseline. The mean endothelial cell density changed from 2,726.02 ± 230.21 to 2,714.58 ± 218.26 cells/mm² at 12 months postoperatively (P =.086). CONCLUSION: The results of this study revealed that accelerated corneal collagen cross-linking stabilized the progression of keratoconus without a significant endothelial cell density loss during the 12 months of follow-up.

Corneal Wavefront Aberrations After Primary and Recurrent Pterygium Surgery.

PURPOSE: To evaluate the effect of primary and recurrent pterygium surgery on corneal wavefront aberrations. METHODS: This prospective and interventional study included the 47 eyes of 47 patients with primary pterygium (primary group) and 41 eyes of 41 patients with recurrent pterygium (recurrent group). All patients underwent pterygium excision with conjunctival autograft transplantation. Corneal wavefront aberrations were measured using Sirius corneal topography and aberrometry system (Costruzione Strumenti Oftalmici, Florence, Italy) before surgery and at 3 and 12 months after surgery. The main outcome measures were root mean square values of total wavefront error (WFE), higher-order aberrations (HOAs), coma, trefoil, and spherical aberrations. RESULTS: Corneal wavefront aberrations were not significantly different between the primary and recurrent groups at baseline (P>0.05). Total WFE, HOA, trefoil, and coma decreased significantly in both primary and recurrent groups at postoperative 3 and 12 months compared with preoperative measurements (P<0.05). The mean spherical aberration was not significantly changed at 3 and 12 months compared with preoperative measurements (P>0.05). Total WFE, HOA, trefoil, and coma were significantly higher in the recurrent group than in the primary group at postoperative 3 and 12 months (P<0.05). CONCLUSIONS: Pterygium surgery can significantly reduce corneal wavefront aberrations, including total WFE, HOA, trefoil, and coma in eyes with primary or recurrent pterygium. However, postoperative corneal aberrations were higher in the recurrent group than in the primary group.

Evaluation of corneal stromal demarcation line after two different protocols of accelerated corneal collagen cross-linking procedures using anterior segment optical coherence tomography and confocal microscopy.

Purpose. To evaluate the depth of corneal stromal demarcation line using AS-OCT and confocal microscopy after two different protocols of accelerated corneal collagen cross-linking procedures (CXL). Methods. Patients with keratoconus were divided into two groups. Peschke CXL device (Peschke CCL-VARIO Meditrade GmbH) applied UVA light with an intended irradiance of 18.0 mW/cm(2) for 5 minutes after applying riboflavin for 20 minutes (group 1) and 30 minutes (group 2). One month postoperatively, corneal stromal demarcation line was measured using AS-OCT and confocal microscopy. Results. This study enrolled 34 eyes of 34 patients (17 eyes in group 1 and 17 eyes in group 2). The mean depth of the corneal stromal demarcation line was 208.64 ± 18.41 µm in group 1 and 240.37 ± 18.89 µm in group 2 measured with AS OCT, while it was 210.29 ± 18.66 µm in group 1 and 239.37 ± 20.07 µm in group 2 measured with confocal microscopy. Corneal stromal demarcation line depth measured with AS OCT or confocal microscopy was significantly deeper in group 2 than group 1 (P < 0.01). Conclusion. The group in which riboflavin was applied for 30 minutes showed significantly deeper corneal stromal demarcation line than the group in which riboflavin was applied for 20 minutes.

Accelerated corneal cross-linking in pediatric patients with keratoconus: 24-month outcomes.

PURPOSE: To compare the efficiency and safety of accelerated corneal cross-linking in pediatric patients with progressive keratoconus. METHODS: In this retrospective interventional case series, 44 eyes of 38 pediatric patients with progressive keratoconus were enrolled. All consecutive patients underwent accelerated corneal cross-linking with settings of 30 mW/cm(2) for 4 minutes, corresponding to a total dose of 7.2 J. The efficacy and safety of the procedure were assessed over a 24-month follow-up period. RESULTS: Mean ± standard deviation age of 10 girls and 28 boys was 15.3 ± 2.1 years (range: 9 to 18 years). Uncorrected distance visual acuity improved significantly from 0.52 ± 0.36 to 0.39 ± 0.26 logMAR (P = .002), and corrected distance visual acuity improved significantly from 0.38 ± 0.24 to 0.30 ± 0.20 logMAR (P < .001). Mean spherical and cylindrical refraction were not significantly altered (P > .001 for both). At the last follow-up visit, the flat keratometry value decreased from baseline from 46.4 ± 3.0 to 46.0 ± 2.9 diopters and the steep keratometry value decreased from 50.6 ± 4.2 to 50.1 ± 4.0 diopters (P < .001 for both). The total higher-order aberrations, coma, and astigmatism II values were also significantly decreased at 24 months after treatment (P < .05 for all). No serious complications were recorded during the follow-up. CONCLUSIONS: The findings revealed that accelerated corneal cross-linking halted the keratoconus progression without relevant side effects in pediatric patients over a 24-month follow-up period. Visual acuity, keratometric values, and corneal aberrations also improved.

Evaluation of pachymetric measurements with scheimpflug photography-based system and optical coherence tomography pachymetry at different stages of keratoconus.

The aim of this study was to compare the central and peripheral pachymetric measurements determined with Sirius system and Visante OCT and evaluate the agreement between them at different stages of keratoconus. Measurements were not significantly different in all patients and subgroups and showed high correlation for the corneal thicknesses of the entire cornea in different stages of keratoconus.

Effects of posterior capsular opacification on the evaluation of retinal nerve fiber layer as measured by Stratus optical coherence tomography.

OBJECTIVE: To evaluate the effects of posterior capsular opacification (PCO) and Nd:YAG laser capsulotomy on the evaluation of peripapillary retinal nerve fibre layer (RNFL) as measured by Stratus (Carl Zeiss Meditec, Dublin, CA) optical coherence tomography (OCT). DESIGN: Prospective interventional case series. PARTICIPANTS: We studied 98 eyes of 89 patients experiencing PCO. METHODS: We performed a complete ophthalmologic examination and evaluation of RNFL as measured by Stratus OCT before and after Nd:YAG capsulotomy. The patients were classified on the basis of PCO score or signal strength (SS) obtained by prelaser OCT scans. RESULTS: The preoperative and postoperative peripapillary RNFL thicknesses were 90.24 ± 15.9 µm and 98.27 ± 14.1 µm, respectively (p < 0.001). The mean preoperative SSs were 5.4 ± 1.6, and they improved to 9.5 ± 0.5 postoperatively (p < 0.001). Prelaser and postlaser RNFL thicknesses differed significantly in eyes with preoperative SSs less than 7 (p < 0.05). Also, in patients with preoperative PCO grades higher than 2, there were significant increases in RNFL thickness after laser capsulotomy (p < 0.05). CONCLUSION: RNFL thickness measured by the Stratus OCT is affected by PCO. RFNL thickness may be underestimated in eyes with preoperative PCO grades higher than 2 and in eyes with preoperative SSs lower than 7.