Ankara Atatürk Training and Research Hospital
Recent publications
Objectives There are limited data about nosocomial coinfections of COVID-19 cases monitored in the intensive care unit. This study aims to investigate coinfections in COVID-19 patients followed in an intensive care unit of a university hospital. Methods This study analyzed retrospectively the data of coinfections of 351 COVID-19 patients in the period 28.02.2020–15.01.2021 in a tertiary care intensive care unit in a university hospital. Results Bacterial coinfections were present in 216 of the 351 cases. One hundred and thirty of these cases were evaluated as nosocomial infections. On the third day the Sequential Organ Failure Assessment Score, usage of invasive mechanical ventilation and presence of septic shock were significantly higher in the coinfected group. The neutrophil/lymphocyte ratio, polymorphonuclear leukocyte count, procalcitonin, ferritin, and blood urea nitrogen values were significantly higher in the coinfection group. White blood cells (WBC) (OR: 1.075, 95% CI 1.032–1.121, p = 0.001) and ICU hospitalization day (OR: 1.114, 95% CI 1.063–1.167, p < 0.001) were found to be independent risk factors for coinfection in the multivariate logistic regression analysis. The rates of hospitalization day on the day of arrival, the 21st day, as well as total mortality (p = 0.004), were significantly higher in the coinfected group. Conclusion Bacterial coinfections of COVID-19 patients in the intensive care unit remain a problem. Identifying the infectious agent, classifying colonizations and infections, and using the proper treatment of antibiotics are of great importance in the case management of COVID-19 patients in the intensive care unit.
Inflammatory granulomatous mastitis is a benign inflammatory disease of the breast mostly presenting in puerperal women. The disease is characterized by recurrent bouts of mastitis with clinical picture of hyperemia, breast mass, and swelling of the breast with or without purulent discharge depending on the severity of the underlying inflammatory process. Although no true prevalence and incidence have been reported in the literature, there are several reported studies setting forth a predilection in specific ethnic groups and/ or geographical areas. Due to the intricate nature of the disease, quite often inflammatory granulomatous mastitis may be mistaken for malignant processes of the breast and even so, there are no pathognomonic imaging appearances to differentiate one from another. The histopathological analysis is a definite way of diagnosis. In this article, we review the imaging manifestations and clinical and histopathological findings along with current trends of available treatment options in the literature and briefly discussed our institutional perspective regarding grading of inflammatory granulomatous mastitis based on ultrasonographic appearances.
Primary monosymptomatic nocturnal enuresis is a common clinical condition in childhood and affects the psychosocial development of the child. The management of this clinical condition, which includes the preschool and adolescence period, is very important for child development. Diagnostic evaluation should be performed in terms of diabetes mellitus, diabetes inspidus, neurogenic bladder, spinal anomalies, and congenital urogenital system anomalies. Treatment modalities in primary monosymptomatic nocturnal enuresis include enuretic alarm therapy, behavioral therapy, and pharmacological treatments such as desmopressin, tricyclic antidepressants, and anticholinergics. There are also experimental treatments such as percutaneous nerve stimulation, acupuncture, and manual therapy. In this study, we examined randomized controlled studies in the literature that included alarm monotherapy and combined therapy. We aimed to present the efficacy, advantages, and disadvantages of combined treatment with the results of the studies.
Introduction and hypothesisThe main objective of this study was to compare the effectiveness of pelvic floor muscle training, and vitamin D replacement in the treatment of urinary incontinence in the postpartum period of pregnant women with vitamin D deficiency.Methods The study was planned as an ancillary study of a study on the determination of the relationship between vitamin D deficiency and urinary incontinence in third-trimester pregnant women. Total 61 women who defined urinary incontinence at postpartum 8th week were included in the study. The participants were divided into two groups: the vitamin D replacement group and the pelvic floor muscle training (PFMT) group. Participants in both groups received appropriate treatment for 12 weeks. İnitial evaluations of which Pelvic Organ Prolapse-Quantification stage, International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) query, and pelvic floor muscle strength were repeated after 12 weeks of treatment for each patient.ResultsIn the vitamin D replacement group, there was a significant increase in Oxford scores measured after treatment compared with pre-treatment and a significant decrease in ICIQ-FLUTS scores. In the comparison of the groups, it was determined that the changes in the Oxford and ICIQ-FLUTS scores of the vitamin D group after treatment were significantly higher than those of the PFMT group. In this pilot study, it was determined that the effectiveness of vitamin D replacement in the treatment of pelvic floor dysfunction in pregnant women with hypovitaminosis D was significantly higher than PFMT.Conclusion Vitamin D replacement may be useful in the treatment of urinary incontinence in pregnant women with hypovitaminosis D.
The main goal of identification in forensic sciences is to estimate characteristics such as sex, age, stature, and ancestry. One of the regions of the human skeleton that most clearly shows sexual dimorphism is the skull. This study aims to evaluate whether the orbital dimensions could be used for sex estimation using Computed Tomography. We examined the orbital measurements of adult Turkish individuals (300 males and 300 females) aged 21–50. We measured Orbital Width, Orbital Height, Biorbital Breadth, and Interocular Breadth by Computed Tomography. The data of the variables showed a normal distribution; therefore, functions of uni/multivariate variables were obtained using Discriminant Function Analysis. Using Discriminant Function Analysis, a significant difference between men and women was determined with an accuracy of 73%. The orbital measurements of the adult Turkish population showed limited forensic significance for sex estimation. Conversely, their potential for examining the interpopulation and intrapopulation differences have been shown.
Background: The transmembrane receptor tyrosine kinase-like orphan receptor 1 (ROR1) has acted on the causation and sustentation of mature B cell lymphomagenesis for chronic lymphocytic leukemia (CLL) cells. The aim of this study was to show whether there is a relationship between the level of ROR1 surface expression in CLL cells and disease findings. Materials and Methods: The level of ROR1 cell surface expression was determined in accordance with the flow cytometric analysis of CLL patients at the first diagnosis time. 2 groups were formed according to the high and low ROR1 levels. The cut-off point to the ROR1 level was calculated for advanced-stage disease by using receiver operating characteristic (ROC) curves. A two-sided p-value
Objective: To develop near-infrared spectroscopy (NIR spectroscopy) device to diagnose testicular torsion with high sensitivity and specificity. Specifically, we aim to investigate the differentiation between testicular torsion from other pathologies such as orchidoepididymitis, varicocele, and hydrocele. Methods: Two LEDs with wavelengths of 660 nm and 940 nm were used as light sources in the device. Each wavelength was sent to the testicle successively, and a photodiode detected back-reflected diffuse light. The ratio of the light intensities of 660 nm to 940 nm was used as a diagnostic parameter. A multi-center clinical trial was performed in five different hospitals. Results: In total, 62 patients in urology clinics with acute testicular pain have been recruited for the study. The developed NIR spectroscopy correctly defined all eight testicular torsion cases. Besides, three orchidoepididymitis, one varicocele, and three hydrocele cases were correctly distinguished from testicular torsion. Only one hydrocele case was misdiagnosed as a torsion. The range of the ratio was between 0.14-1.16 overall measurements. The ratio varied between 0.14-0.3 for the testicle with torsion. The ratio was between 0.49-1.16 for the normal testicle and testicle with other pathologies mentioned above. Conclusions: We have chosen the threshold ratio of 0.4 to differentiate between the normal and torsion testis and diagnosed all the torsion cases among all normal and other pathologies. The developed optical device to diagnose testicular torsion is inexpensive, user-friendly, and works based on objective criteria with high sensitivity and specificity in real time.
Aim: Peripheral nerve damage mainly develops after mechanical trauma, and microenvironment impairment after damage delays the healing process. Additionally, digoxin is a glycoside with proven anti-inflammatory activity. Thus, this study aimed to demonstrate the curative effect of digoxin on peripheral nerve damage with its anti-inflammatory role on interleukin (IL)-17. Material and methods: The study was conducted with 30 male Sprague Dawley albino mature rats, of which 10 formed the control group, 10 were surgically treated and administered saline (group S), and another 10 were surgically treated and administered digoxin (group D). Motor functions and immunohistochemical and biochemical variables of the rats were assessed after therapy. Results: The amplitude of the inclined plane test scores and the compound muscle action potential levels were greater in group D than in group S. Likewise, there were higher nerve growth factor percentages, higher axon counts, and lower fibrosis score percentages in group D than is group S. Lastly, lower tissue malondialdehyde and plasma IL-17 levels were determined in group D, while the IL-10 level was higher. Conclusion: Digoxin contributes to nerve healing and neuroprotective effect by demonstrating its anti-inflammatory effect on IL-17. It can be considered an adjunctive therapy for peripheral nerve injury.
Considering the increasing use of the transcatheter aortic valve implantation (TAVI) procedure, the relationship of contrast-induced nephropathy (CIN) with post-TAVI mortality has become important. The Mehran score was developed to detect the risk of CIN development after cardiac intervention. We aimed to compare the role of the modified Mehran score, which can be calculated pre-procedure, in predicting CIN development and compare it with the original Mehran score. We retrospectively collected data from TAVI procedures at our institution between December 2016 and June 2021; of 171 patients, 44 (25.7%) had CIN. We found no association between contrast media volume and CIN (387 ± 120 vs 418 ± 139 mL, P = .303). High and very high modified Mehran score and preoperative C-reactive protein (CRP) level were independent risk factors for CIN development after TAVI procedure. The area under curve (AUC) was .686 with 95% CI: .591-.780 and P < .001, and also, with a cut-off point of >7.5 points, there was 79.5% sensitivity and 63.0% specificity; otherwise, with a cut-off point of >9.5 points, there was 54.5% sensitivity and 71.7% specificity, for the modified Mehran score. The modified Mehran score comes into prominence compared with the original Mehran score since it can be calculated pre-procedure.
Background: A new clinical manifestation called post or long coronavirus disease (p/l COVID) has walked into our lives after the acute COVID-19 phase. P/l COVID may lead to myocardial injury with subsequent cardiac problems. Diagnosing these patients quickly and simply has become more important due to the increasing number of patients with p/l COVID. Objectives: We compared strain echocardiography (SE) parameters of patients who suffered from atypical chest pain and had sequel myocarditis findings on cardiac magnetic resonance (CMR). We aimed to investigate the value of SE for detection of myocardial involvement in patients with p/l COVID. Methods: A total of 42 patients were enrolled. Our population was separated into two groups. The CMR(-) group (n = 21) had no myocardial sequelae on CMR, whereas the CMR(+) group had myocardial sequelae on CMR (n = 21). The predictive value of SE for myocarditis was also evaluated by age-adjusted multivariate analysis. P values < 0.05 were considered statistically significant. Results: When compared with left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) had a stronger relationship (LVEF, p = 0.05; GLS, p < 0.001; GCS, p < 0.001) with p/l COVID associated myocardial involvement. GLS < 20.35 had 85.7% sensitivity and 81% specificity; GCS < 21.35 had 81% sensitivity and 81% specificity as diagnostic values for myocardial sequelae detected with CMR. While there was no difference between the groups in terms of inflammatory markers (C-reactive protein, p = 0.31), a difference was observed between biochemical markers, which are indicators of cardiac involvement (brain natriuretic peptide, p < 0.001). Conclusion: SE is more useful than traditional echocardiography for making diagnosis quickly and accurately in order not to delay treatment in the presence of myocardial involvement.
The risk of venous thromboembolism (VTE) is increased in non-small cell lung cancer (NSCLC), and defining at-risk patients is important. Thus, we aimed to assess the association between programmed cell death ligand 1 (PD-L1) expression and VTE [pulmonary embolism (PE), deep venous thrombosis (DVT)] in NSCLC. In this retrospective, observational multicentre study, 369 patients with NSCLC who had PD-L1 immunohistochemistry based on biopsies taken between January 2017 and December 2019, were divided as PD-L1-positive (n = 181) and -negative (n = 188) groups, and low-positive (n = 99) and high-positive (n = 82) PD-L1 groups. Among all population, 12.5% of them developed a VTE during a median follow-up of 474 days. The rates of DVT, PE, and PE + DVT were 5.7%, 6% and 0.8%, respectively. VTE (15.5% vs. 9.5%) and DVT (3.8% vs. 7.4%) were similar between two groups, while PE was significantly higher in PD‑L1-positive group than those in PD-L1-negative group (11.1% vs 1%, p < 0.001). There were no significant differences between low- and high-positive groups in terms of VTE (14.1% vs. 17%), PE (12.1% vs. 9.8%), and DVT (2% vs. 6.1%). In the multivariate analysis, multiple metastases (Hazard ratio [HR] 4.02; 95% confidence interval [Cl] 1.18–13.63; p = 0.07) and PD-L1 positivity was associated with an increased PE risk (HR 8.39; 95% Cl 2.07–34.07; p = 0.003). In conclusion, PD-L1 positivity may be of important role in predicting the increased risk of PE in patients with NSCLC and thereby may be used to define patients likely to benefit from thromboprophylaxis.
Introduction The goal in appendicitis is early diagnosis and early treatment. Complications develop as treatment is delayed. Therefore, there is a need for fast, low-cost markers that can be diagnosed earlier. The aim of this study is to show the effectiveness of immature granulocyte (IG) level in determining the complication of acute appendicitis. Method In this retrospective cross-sectional study, 99 patients with acute appendicitis and 41 control groups were included in the study. Acute appendicitis patients were divided into two groups as acute simple appendicitis(n = 65) and acute complicated appendicitis(n = 34). In all groups, demographic data, immature granulocyte (IG) count(x10 ³ /μL), IG ratio (IG%), white blood cell (WBC), polymorphonuclear leukocytes (PNL), lymphocyte, monocyte, platelet, mean platelet volume (MPV), ferritin levels were recorded. The blood analyses were performed the Mindray BC6800 automated hematology analyzer using standard laboratory protocols. All statistical testing was undertaken using IBM SPSS Statistics for Mac. Results Compared to the acute simple appendicitis, acute complicated appendicitis patients had significantly higher levels WBC, PNL, monocyte, IG count, and IG% (p = 0.009, p = 0047, p = 0.001, p = 0.018; respectively) while there was no significant difference in ferritin between groups (p = 0.49). In the ROC analysis, AUC value was found for IG count and IG% (0.893 and 0.725, cut-off 0.005 and 0.05; respectively) for acute appendicitis. The negative predictive value of IG for Acute Appendicitis was 85% and was the same as that of WBC. In acute complicated appendicitis, the AUC for IG and IG% was 0.796 (cut-off 0.02) and 0.693 (cut-off 0.2), respectively. Positive Likelihood Ratio (+LR; 2.1) value of IG was found higher than other complete blood count (CBC) tests. Conclusion The IG count is test with fast, more predictive value than another CBC tests, and without cost in the early diagnosis of acute complicated appendicitis. It is strong negative predictive test for Acute Appendicitis disease.
Background and aim: Vaccinations have been one of the main approaches to reducing mortality and exacerbations caused by infectious agents in chronic obstructive pulmonary disease (COPD). Among viral pathogens, coronaviruses have been described to play a role. This study aims to investigate the role of coronavirus disease 2019 (COVID-19) vaccination on exacerbation reduction in patients with COPD. Methods: Patients diagnosed with COPD prior to the study date were considered the study population. Exacerbations of COPD before and after the COVID-19 vaccination were recorded. Patients with influenza and/or pneumococcal vaccination were excluded from the study due to their known role in reducing exacerbations of COPD. Results: The study included 152 patients with a mean age of 67.5 ± 9.7 years. Most patients were classified under Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 2 and 3. In fully vaccinated patients, COPD exacerbation was observed to be higher than in those without full vaccination (70.5% vs. 55.3%, respectively). Total risk status and vaccination status, however, were seen to be in a positive correlation, with higher risk and complete vaccination status presenting with a higher count of COPD exacerbation. Conclusion: Although it is known that the administration of COVID-19 vaccines in patients in risk groups reduces the risk of disease, there is no study showing a positive effect on COPD exacerbations alone. In our study, it was observed that only the COVID-19 vaccine was ineffective in attacks without influenza and pneumococcal vaccines.
Background The men infected with COVID-19 have been shown to have more severe disease and a higher mortality rate. Morbidity and mortality associated with COVID-19 are mediated through intense viral inflammation and increased levels of inflammatory biomarkers. We aimed to retrospectively evaluate any gender difference in patients with severe COVID-19 pneumonia in terms of inflammatory biomarkers. Methods Our study included 132 patients. The general characteristics, radiological features and laboratory parameters of the patients were recorded. Results No difference was observed between the genders according to comorbidities, pulse steroid requirement and hypoxemia. There was no difference between the male and female participants in terms of age, white blood cell count, lymphocyte count, red cell distribution width, C-reactive protein, troponin, albumin and D-dimer. However, duration of hospitalization; percentage of polymorphonuclear leukocyte (PNL); and haemoglobin, alanine aminotransferase and ferritin values were higher in the males, and lymphocyte percentage and platelet count were higher in the women participants. Conclusion Larger studies with gender-specific reporting and robust analyses are required to clarify how gender alters the cellular and molecular pathways associated with COVID-19. This would improve the interpretation of biomarkers and the clinical management of COVID-19 patients by facilitating a personalised medical approach to risk stratification, prevention and treatment.
Introduction: In malignant pleural mesothelioma (MPM), useful tools are needed to predict survival. Thus, we aimed to evaluate the LENT score, and demonstrate the performance of the LENT score in predicting survival in patients with MPM. Materials and methods: This was a retrospective, observational single-center study. Sixty-nine patients diagnosed with MPM who had pleural effusion (March 2009-December 2020) were divided into groups according to their LENT score and compared. Median survivals were estimated and compared according to the LENT score and parameters of the LENT score. Result: Fifty-four patients were in the low-LENT score group, 15 patients were in the moderate-LENT score group, and there were no patients in the highLENT score group. The two groups had similar characteristics in terms of age, gender, and histological subtype distribution. There were no patients with ECOG-PS 0 in the moderate-LENT score group. Serum neutrophil-tolymphocyte ratio (NLR), pleural lactate dehydrogenase (LDH), patients with serum NLR> 9, and patients with pleural LDH> 1500 were significantly higher in the moderate-LENT score group (p= 0.002, 0.001, <0.01, <0.01, respectively). Fifty patients had died during a median follow-up of 38.6 ± 6.5 (95% CI= 25.84-51.41) months. The median survival for all patients was 28.63 ± 3.2 (95% CI= 22.33-34.92) months, higher than the original study. It was 30.97 ± 2 months in the low-LENT score group, and 20.7 ± 3.4 months in the moderate-LENT score group (p= 0.98). The median survival for patients with pleural LDH<1500 was significantly higher than for patients with pleural LDH> 1500 (p= 0.006) (30.97 vs. 16.73 months), while ECOG-PS (0 vs. 1) and NLR (<9 vs. >9) showed no differences. Conclusions: The survival in our resultant groups was higher than those reported in the original study, and the LENT score had no discriminatory ability for predicting survival in patients with MPM. We nevertheless believe that before reaching more definite conclusions, further large-scale multicenter prospective studies are needed to better define the clinical utility of the LENT score.
Introduction: It is known that there is a relationship between severe exacerbations of chronic obstructive pulmonary disease(COPD) requiring hospitalization with loss of forced expiratory volume in one second (FEV1), impaired quality of life, and increased mortality. The aim of this study was to investigate factors [health-related quality of life with COPD Assessment Test (CAT), physical activity, FEV1, PaO2] affecting the time to first exacerbation (TTFE) after discharge in patients hospitalized with exacerbation. Materials and methods: Seventy-five patients who were hospitalized due to COPD acute exacerbation were included in the study and were prospectively monitored. First exacerbation after discharge was recorded. During the first three days of hospitalization, patients were fitted with a pedometer on any of these days; 24-hour step counts were recorded and CAT was administered through face-to-face interviews. Data on age, sex, PaO2, FEV1, and comorbidities were recorded. The median value of the CAT scores of the participants were taken as the cut-off point. High scores were considered as an indicator of poor quality of life. Cox regression models were created for multivariate analyses and hazard ratios (HR) with 95% confidence interval (95% CI) provided. Result: There was a statistically significant relationship between the TTFE and CAT score (p= 0.001), FEV1 (pred %) (p= 0.02) and PaO2 (p= 0.02). No statistically significant relationship was found between TTFE and the number of steps used as an indicator of physical activity (p= 0.3). In multivariate analysis, age and sex adjusted CAT and PaO2 significantly affected the TTFE (HR= 2.06 CI 95%= 1.17-3.65 and HR= 5.50 CI 95%= 2.09-14.49, respectively) while adjusted FEV1 (pred %) was not significantly affected the TTFE (HR= 1.54 CI 95%= 0.88-2.70). Conclusions: The results of this study suggest that using CAT may be an easy-to-apply and practical tool to help identify patients with an increased risk of exacerbation. No significant correlation was found with the daily number of steps, which is an easily measurable indicator of physical activity.
Objective The aim of this randomized controlled study was to compare the efficacy and safety of intravenous (IV) ibuprofen with IV dexketoprofen trometamol in patients with migraine attack-related headaches and receiving IV metoclopramide as part of their standard care.Methods This double-blinded and randomized controlled study was conducted among patients with acute migraine-related headaches admitted to the emergency department (ED). Eligible patients were randomly assigned in a 1:1 ratio to receive ibuprofen or dexketoprofen trometamol. In addition, all participants received 10 mg of IV metoclopramide. All patients’ headache scores were measured with a visual analog scale (VAS); 0 points was considered no pain, while 100 points were considered worst pain. The primary outcome was defined as the absolute change in the headache scores between the groups at 0 and 60 min.ResultsA total of 160 patients were randomized into two groups with similar baseline migraine characteristics and VAS scores. In each group, the baseline VAS scores significantly decreased statistically over time. However, when the decreasing trends of VAS values were compared according to the treatment groups, a statistically significant difference was found in the VAS values at 30 min, but no difference was found for the 60 min VAS values. There was no statistically significant difference in the need for rescue treatment and side effects between the two groups.Conclusion Intravenous ibuprofen and dexketoprofen trometamol treatments are equal to each other in terms of efficacy, side effects, and need for rescue treatment in the management of acute migraine-related headaches.
Aim:Cerebral small vessel disease (CSVD) is a representative cause of stroke, cognitive impairment, and age-related disability, and it is shown to be associated with some traditional atherosclerotic risk factors. This study investigated relationship between the presence and severity of intracranial arterial calcification (ICAS) and the findings of CSVD.Methods:Three hundred eighty-nine patients over the age of 40 who underwent non-enhanced cranial computed tomography (CT) and magnetic resonance imaging between January 01 and December 31, 2018, were included in the retrospective study. ICAS was scored on CT. CSVD findings, enlarged perivascular spaces (BGPVS, CSPVS), white matter hyperintensities [white matter hyperintensity was scored at periventricular (PVWMHI), white matter hyperintensity was scored at subcortical (SCWMHI)], cortical atrophy [global atrophy (GA) score, and medial temporal atrophy (MTA), Koedam score] were scored in MR images. The presence of acute, chronic, and lacunar infarcts was recorded. After controlling for age and gender, the correlation between ICAS and CSVD markers was examined.Results:A positive correlation was found between ICAS score and BGPVS (r: 0.463 p
Hypertension is an important public health problem due to its high prevalence and common complications. The aim of this study was to evaluate the quality of videos on YouTube related to reducing blood pressure and hypertension treatment. Using the six search terms “hypertension treatment”, “cure hypertension”, “hypertension medication”, “control high blood pressure”, “lower high blood pressure”, and “reduce high blood pressure”, a total of 360 relevant videos on YouTube were evaluated. Some parameters, i.e., the length of the video, number of days on YouTube, number of view counts, and number of likes, dislikes, and comments, were noted for all videos. The Global Quality Scale (GQS) was used to evaluate the quality of the videos. We categorized the video content as useful or misleading using the evidence-based medical literature. After exclusions, 104 videos were evaluated by two independent reviewers. Out of all the videos, 51% were useful, and 49% were misleading. Videos mentioned lifestyle changes (LCs) more (65 videos, 62.5%), and only 39.4% (41 videos) of all the videos contained information about pharmacological treatment (PT). Videos about alternative treatment (AT) had high numbers of views, and videos about PT had low numbers of views, and this difference was statistically significant. Videos that did not include PT but did include LCs and AT had more likes, similar to the number of views. YouTube, which is an important source of information, can guide individuals to in reducing high blood pressure with nonpharmacological and pharmacological methods. Uploaders; doctors (31.7%), herbalists/nutritionists (18.3%), independent users (10.6%), chiropractors (6.7%), yoga teachers (4.8%), and others (27.9%). (B) Country of origin; United States of America (58.7%), India (16.3%), Australia (5.8%), United Kingdom (3.8%), others (4.8%), and unknown (10.6%). (C) Usefulness rate by content (%). PT, pharmacological treatment; LC, lifestyle change; AT, alternative treatment. Uploaders; doctors (31.7%), herbalists/nutritionists (18.3%), independent users (10.6%), chiropractors (6.7%), yoga teachers (4.8%), and others (27.9%). (B) Country of origin; United States of America (58.7%), India (16.3%), Australia (5.8%), United Kingdom (3.8%), others (4.8%), and unknown (10.6%). (C) Usefulness rate by content (%). PT, pharmacological treatment; LC, lifestyle change; AT, alternative treatment. Uploaders; doctors (31.7%), herbalists/nutritionists (18.3%), independent users (10.6%), chiropractors (6.7%), yoga teachers (4.8%), and others (27.9%). (B) Country of origin; United States of America (58.7%), India (16.3%), Australia (5.8%), United Kingdom (3.8%), others (4.8%), and unknown (10.6%). (C) Usefulness rate by content (%). PT, pharmacological treatment; LC, lifestyle change; AT, alternative treatment.
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97 members
mehmet faik çetindağ
  • Radiation Oncology
Muhammet Fuat Ozcan
  • Department of Urology
Selma Emre
  • Departement of Dermatology
Gulhan Kurtoglu
  • Department of emergency medicine
Gul Pamukcu Gunaydın
  • Emergency Medicine
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Ankara, Turkey