PubMed | Middle East Cancer Consortium, Bnai Zion Hospital, Jordan University of Science and Technology, Ministry of Health and 10 more.
Type: Journal Article | Journal: Journal of cancer research and clinical oncology | Year: 2016
The use of complementary and traditional medicine (CTM ) in Middle Eastern countries is widespread, including among patients with cancer. Perspectives of oncology healthcare professionals (HCPs) in this region regarding the integration of CTM within conventional supportive cancer care were explored.An 11-item questionnaire with an open-ended question asking respondents to comment about the integration of CTM within supportive cancer care was sent to Middle Eastern oncology HCPs, using snowball sampling methodology. The narratives provided were examined using thematic analysis.A total of 339 oncology HCPs completed and returned the study tool (80.3 % response rate ), of which 178 from 15 Middle Eastern countries responded to the open-ended question. The majority of respondents are in favor of the integration of CTM within supportive cancer care, though ideas on how this should be implemented varied. Thematic analysis identified multifactorial barriers to integration, which focused on HCPs perspectives (e.g., a lack of knowledge and training; a skeptical approach to CTM), attitudes of patients and caregivers (e.g., unrealistic expectations regarding the outcomes of CTM treatments) and HCP-patient communication. In order to overcome these barriers, respondents suggested education and training programs for oncology HCPs which would focus on improving patients quality-of-life-related outcomes.Middle Eastern oncology HCPs support the integration of CTM within supportive cancer care, while recognizing the need for education and training in this field. A better understanding of CTM would provide the knowledge and skills which would promote a non-judgmental, evidence-based approach, fostering better communication with patients.
PubMed | Middle East Cancer Consortium, Bnai Zion Hospital, Jordan University of Science and Technology, Ministry of Health and 12 more.
Type: Journal Article | Journal: Cancer | Year: 2016
The authors assessed the use of herbal medicine by Middle Eastern patients with cancer, as reported by their oncology health care professionals (HCPs). Herbal products identified by the study HCPs were evaluated for potential negative effects.Oncology HCPs from 16 Middle Eastern countries received a 17-item questionnaire asking them to list 5 herbal products in use by their patients with cancer. A literature search (PubMed, Micromedex, AltMedDex, and the Natural Medicine Comprehensive Database) was conducted to identify safety-related concerns associated with the products listed.A total of 339 HCPs completed the study questionnaire (response rate of 80.3%), identifying 44 herbal and 3 nonherbal nutritional supplements. Safety-related concerns were associated with 29 products, including herb-drug interactions with altered pharmacodynamics (15 herbs), direct toxic effects (18 herbs), and increased in vitro response of cancer cells to chemotherapy (7 herbs).Herbal medicine use, which is prevalent in Middle Eastern countries, has several potentially negative effects that include direct toxic effects, negative interactions with anticancer drugs, and increased chemosensitivity of cancer cells, requiring a reduction in dose-density. Oncology HCPs working in countries in which herbal medicine use is prevalent need to better understand the implications of this practice. The presence of integrative physicians with training in complementary and traditional medicine can help patients and their HCPs reach an informed decision regarding the safety and effective use of these products.
PubMed | Ankara University, Bursa State Hospital and Dr Ay Ankara Oncology Training And Research Hospital
Type: | Journal: Community mental health journal | Year: 2016
This study aims to identify the help seeking behaviours of patients from two geographically distinct provinces of Turkey. A questionnaire about sociodemographic characteristics and help seeking ways was applied to 49 schizophrenia patients from Van, 99 from Ankara. The ratio of patients seeking psychiatric help at the beginning of their illness was 76% in Ankara, the capital city, in contrast to 54% in Van (p=0.01). Twenty-two percent of patients from Ankara and 69% from Van reported that non-psychiatric help seeking was the choice of their families (p<0.001). Thirty-five percent of all patients sought religious support when their symptoms started. Patients with lower education levels sought more religious help (p=0.002). Help seeking behaviours show regional variations. Religious help seeking behaviour is a major way of dealing with the illness. Psychoeducation is a crucial need both for patients and families.
Cengiz M.,Dr Ay Ankara Oncology Training And Research Hospital |
Ozenirler S.,Gazi University |
Elbeg S.,Gazi University
Journal of Gastroenterology and Hepatology (Australia) | Year: 2015
Background and Aim: Non-alcoholic fatty liver disease is a common cause of chronic liver disease, including non-alcoholic steatohepatitis (NASH). Our aim was to investigate whether serum toll-like receptors 2 and 4 (TLR2 and TLR4) levels are correlated with NASH and able to predict liver fibrosis, as well as to compare these markers with other non-invasive fibrosis scores (aspartate aminotransferase [AST] to alanine aminotransferase ratio, AST to platelet ratio index, fibrosis index, fibrosis 4, and fibrosis cirrhosis index). Methods: Serum samples were obtained from consecutive biopsy proven NASH patients and healthy controls. Serum TLR2 and TLR4 were measured using ELISA. Stage of fibrosis was evaluated using the Brunt Criteria. The different non-invasive fibrosis scores were compared using areas under the curve. Results: Fifty-seven patients with NASH and 57 healthy individuals were enrolled in the study. Serum TLR2 levels were not significantly different between the healthy controls and NASH patients. The medians were 3.88ng/mL±0.29 versus 3.81ng/mL±0.32, respectively (P=0.587). In comparing the levels of TLR4 between groups, the medians were 1.05ng/mL±0.13 versus 1.46ng/mL±0.27, respectively (P<0.001). In NASH patients, the levels of serum TLR4 increased with the stage of fibrosis: TLR4 medians were F0:1.01, F1:1.46, F2:2.14, F3:3.74, F4:5.83 (P<0.001). TLR4 produced AUCs for ≥F1,≥F2, and ≥F3 of 0.862, 0.810, and 0.905, respectively (P<0.001). TLR4 levels were more predictive than other non-invasive fibrosis scores in liver fibrosis. Conclusion: Serum TLR4 levels but not TLR2 were elevated in NASH patients in comparison with healthy controls. And in NASH patients, serum TLR4 levels both correlated with and were able to predict liver fibrosis. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.
Comparative diagnostic accuracy of red cell distribution width-to-platelet ratio versus noninvasive fibrosis scores for the diagnosis of liver fibrosis in biopsy-proven nonalcoholic fatty liver disease
Cengiz M.,Dr Ay Ankara Oncology Training And Research Hospital |
Ozenirler S.,Gazi University
European Journal of Gastroenterology and Hepatology | Year: 2015
Objective Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease and assessment of liver fibrosis is important. We aimed to investigate the performance of red cell volume distribution width-to-platelet ratio (RPR) in predicting liver fibrosis in patients with NAFLD and to compare it with well-known noninvasive predicting fibrosis scores (alanine aminotransferase ratio, aspartate aminotransferase platelet ratio index, fibrosis index, fibrosis 4, and fibrosis, cirrhosis index). Materials and methods Serum samples of consecutive biopsy-proven NAFLD patients were used to calculate the RPR index. Fibrosis stages were evaluated using the Brunt Criteria. Area under receiver operating characteristics curve was used to calculate predicting performance and compare with other noninvasive fibrosis scores. Results One hundred and twenty-three consecutive patients with biopsy-confirmed NAFLD were recruited; 54 patients (43.9%) were women. The median age of the patients was 49 years. Fibrosis scores were F0-1, F2, F3, and F4 in 79 (64.2%), 27 (22%), 11 (8.9%), and 6 (4.9%) patients, respectively. The median RPR increased as the fibrosis scores progressed: F0, 0.0524; F1, 0.0534; F2, 0.0606; F3, 0.0815; and F4 0.2022. Area under receiver operating characteristics curve of the RPR was 0.69 in predicting significant fibrosis (≥F2), 0.81 in advanced fibrosis (≥ F3), and 0.85 in F4, and all were statistically significant (P <0.001). Comparisons with other noninvasive fibrosis scores were not statistically significant (P>0.05). RPR was correlated with fibrosis r: 0.37, 95% confidence interval: (0.21-0.52), P< 0.001. RPR was an independent predicting factor for identifying both significant and advanced fibrosis in regression analysis (P <0.05). Conclusion RPR was both correlated and able to predict liver fibrosis and may be suggested to reduce liver biopsy in NAFLD. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Cengiz M.,Dr Ay Ankara Oncology Training And Research Hospital |
Ozenirler S.,Gazi University |
Kocabiyik M.,Gazi University
European Journal of Gastroenterology and Hepatology | Year: 2016
Objective Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease and evaluation of fibrosis is important. We aimed to investigate the utility of serum β-trophin in NAFLD and its ability to predict liver fibrosis. Patients and methods Serum samples of consecutive patients with biopsy-proven NAFLD and age-matched and sexmatched healthy controls were used to measure β-trophin using ELISA. Correlations between histopathological features of NAFLD and β-trophin were analyzed. Whereas patients with fibrosis scores less than 2 were grouped in the mild fibrosis group, patients with scores of 2 or more were grouped in the significant fibrosis group. Univariate/multivariate logistic regression analyses were carried out to evaluate the independent predicting factors of liver fibrosis. Receiver operating characteristics (ROCs) were assessed to determine the best cut-off values for NAFLD and fibrosis. Results Sixty-nine patients with NAFLD and 69 healthy controls were enrolled in the study. Serum β-trophin levels were lower in NAFLD patients compared with the controls (2.34 ± 0.06 vs. 1.94 ± 0.09 ng/ml, respectively, P<0.001). In NAFLD, serum β-trophin was related to liver fibrosis and inflammation. The mild fibrosis group had higher serum β-trophin levels than the significant fibrosis group (2.11 ± 0.12 vs. 1.72 ± 0.11, respectively, P<0.001). In multivariate analysis, β-trophin remained an independent predictor of significant fibrosis (odds ratio, 0.237; 95% confidence interval, 0.059-0.949; P< 0.001). ROC analysis showed that serum β-trophin was statistically significant in the identification of significant fibrosis (area under receiver operating characteristic, 0.844; 95% confidence interval, 0.718-0.970; P<0.001). The best cut-off value was 1.786, with the best sensitivity (71.43%) and specificity (95.65%). Conclusion Serum β-trophin may be a potential noninvasive marker for the identification of NAFLD and significant liver fibrosis. Eur J Gastroenterol Hepatol 28:57-63. © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Durnali A.,Dr Ay Ankara Oncology Training And Research Hospital |
Alkis N.,Dr Ay Ankara Oncology Training And Research Hospital |
Cangur S.,Duzce University |
Yukruk F.A.,Dr Ay Ankara Oncology Training And Research Hospital |
And 10 more authors.
Medical Oncology | Year: 2013
The aim of this retrospective, multicenter study was to evaluate clinicopathological characteristics, prognostic factors and treatment outcomes of teenage and adult patients with high-grade osteosarcoma. A total of 240 osteosarcoma patients who were diagnosed and treated from March 1995 to September 2011 were analyzed. Median age was 20 years (range 13-74 years), and 153 patients (63.8 %) were male. Primary tumor localization was extremity in 204 patients (85.4 %), trunk in 21 patients (8.8 %) and head and neck region in 14 patients (5.9 %). According to American Joint Committee on Cancer staging system, 186 patients (77.5 %) were stage II, 3 (1.3 %) were stage III and 48 (20.0 %) were stage IV. Median overall survival (OS) was 55 months (95 % CI 36.8-73.1 months).OS after 2, 5 and 10 years were 67, 49 and 42 %, respectively. Univariable analysis for OS showed that male gender (p = 0.032), high baseline lactate dehydrogenase (LDH) level (p < 0.001), high baseline serum alkaline phosphatase level (p = 0.002), telangiectatic subtype (p = 0.023), presence of metastasis at diagnosis (p < 0.001), presence of tumor positive margins after primary surgery (p = 0.015), poor pathological response to preoperative chemotherapy (p = 0.006) and presence of recurrent disease during follow-up period (p < 0.001) were significantly associated with poor survival. Patientswho received postoperative methotrexate plus doxorubicin plus cisplatin (M + A + P) combination regimen (p = 0.019), underwent surgery for recurrent disease (p < 0.001) and received chemotherapy for recurrent disease (p < 0.001) had longer OS. Inmultivariable analysis for OS, only high LDH level (p = 0.002) and the presence of metastasis at diagnosis (p = 0.011) were associated with poor OS, whereas the patients who received chemotherapy for recurrent disease had a longer OS (p = 0.009). © Springer Science+Business Media New York 2013.
PubMed | Guven Hospital, Dr Ay Ankara Oncology Training And Research Hospital and Bahcesehir University
Type: Journal Article | Journal: PloS one | Year: 2016
Osteosarcomas with lung metastases are rather heterogenous group. We aimed to evaluate the clinicopathological characteristics and outcomes of osteosarcoma patients with lung metastases and to compare the synchronous and metachronous lung metastatic groups. A total of 93 adolescent and adult patients with lung metastatic osteosarcoma, from March 1995 to July 2011, in a single center, were included. Sixty-five patients (69.9%) were male. The median age was 19 years (range, 14-74). Thirty-nine patients (41.9%) had synchronous lung metastases (Group A) and 54 patients (58.1%) had metachronous lung metastases (Group B). The 5-year and 10-year post-lung metastases overall survival (PLM-OS) was 17% and 15%, respectively. In multivariate analysis for PLM-OS, time to lung metastases (p = 0.010), number of metastatic pulmonary nodules (p = 0.020), presence of pulmonary metastasectomy (p = 0.007) and presence of chemotherapy for lung metastases (p< 0.001) were found to be independent prognostic factors. The median PLM-OS of Group A and Group B was 16 months and 9 months, respectively. In Group B, the median PLM-OS of the patients who developed lung metastases within 12 months was 6 months, whereas that of the patients who developed lung metastases later was 16 months. Time to lung metastases, number and laterality of metastatic pulmonary nodules, chemotherapy for lung metastatic disease and pulmonary metastasectomy were independent prognostic factors for patients with lung metastatic osteosarcoma. The best PLM-OS was in the subgroup of patients treated both surgery and chemotherapy. The prognosis of the patients who developed lung metastases within 12 months after diagnosis was worst.
PubMed | Ankara University, Ankara Numune Training and Education Hospital, Agri State Hospital, Dr Ay Ankara Oncology Training And Research Hospital and Yenimahelle Training and Research Hospital
Type: Journal Article | Journal: Clinical and experimental hypertension (New York, N.Y. : 1993) | Year: 2016
Endocan, a cysteine-rich dermatan sulfate proteoglycan expressed by endothelial cells, is seemed to be a new biomarker for endothelial dysfunction. Pre-eclampsia (PE) is characterized by the new onset of hypertension, proteinuria after 20 weeks of gestation, placental vascular remodeling, systemic vascular inflammation and endothelial dysfunction. The aim of this study was to investigate the relationship of PE and its severity with serum endocan levels.A cross-sectional study was performed. Serum was collected from women with PE and normotensive controls. Serum endocan and tumor necrosis factor alpha (TNF-) concentrations were measured by a specific enzyme linked immunosorbent assay.Patients with PE had significantly higher median (interquartile range) endocan and mean TNF- concentrations than controls [20.04 (12.26)ng/mL vs 15.55 (6.19)ng/mL, p<0.001 for endocan; 26.4912.14pg/mL vs 14.625.61pg/mL, p<0.001 for TNF-; respectively]. Serum endocan concentrations were positively correlated with systolic blood pressure (r=0.618, p<0.001), diastolic blood pressure (r=0.608, p<0.001), the amount of 24-h proteinuria (r=0.786, p<0.001) and TNF- (r=0.474, p<0.001) in women with PE. In subgroup analysis, patients with severe PE had significantly higher endocan concentrations than those with mild PE. Receiver operating characteristic analysis of endocan was used to identify the patients with PE and also discriminating between mild and severe PE.Serum endocan concentrations were significantly elevated in women with PE versus normotensive controls, and concentrations seem to be associated with the severity of the disease.