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Öğe Are Turkish doctors in deep water? The role of professional ethics and factors affecting the medical brain drain: A qualitative study from Turkey(Wiley, 2023) Onal, F. Gulsum; Akay, Fatih ErkanWith the increased rate of the Turkish medical brain drain (MDB) in recent years, there is a need for more comprehensive studies to elucidate its vague migratory factors. The aim of this paper is to try to narrow that gap by analyzing present impacts of the MDB in Turkey and to evaluate if these aspects were driven by professional ethical values, and if so, what ethical principles they were based on. In-depth interviews were conducted with 19 doctors from various backgrounds, followed by a thematic analysis. The MDB in Turkey demonstrated a multifactorial structure, with prominent push factors that are intertwined at macro-meso-micro levels. The effort to maintain the principles of beneficence, non-maleficence, and protecting professional autonomy were the most important in the context of professional ethics. Only deep-rooted regulations might ensure the prevention of the MDB in Turkey and the prospect of doctors returning in the future. Conclusively, the recent criticisms the MDB has been garnering may inspire improvements in deteriorating human and health rights in Turkey.Öğe Assessment of the Awareness and Opinions of Turkish Medical Students Towards Violence Against Women: a Questionnaire-Based Study(Trakya Üniversitesi, 2021) Akay, Fatih Erkan; Kılıç, Ilgın; İşkan, Nur Gülce; Söyleyici, Begüm; Şenyiğit, Ece; Önal, F. GülsümAims: This study aims to evaluate the opinions of medical students about violence against women, the education they receive during medical school regarding violence against women, and how they would manage a case of violence victims if they were to encounter it in their medical careers. Methods: In this question- naire-based study, 610 medical students from 37 medical schools were approached, and their opinions towards violence against women were evaluated through an online questionnaire. Demographic data such as age and gender were also gathered. Students were grouped according to their gender (male and female) and study levels; 1st, 2nd, and 3rd grades were grouped as pre-clinical, whereas students in 4th, 5th, and 6th grades were grouped as clinical. In comparing para- metric variables, the Student’s t-test was used, whereas, in non-parametric variables, the Mann-Whitney U test was used. The Chi-square test was used in the comparison of categorical variables. Results: There was a statistically significant difference within both groups (gender and study levels) for questions 5 (Which of the following would you describe as violence? [Multiple answers are allowed.]) and 13 (Do you think female physicians are exposed to violence more?). Our results also demonstrate a statistically significant difference for questions 15 (Is it obligatory for a physician to keep a legal report for a female patient who has been admitted to the emergency department as a victim of violence), 16 (It is not obligatory for a physician to keep a legal report for a female patient who has been admitted to the emergency department as a victim of violence without her consent.), and 17 (A physician is not obliged to complete the physical examina- tion or continue the diagnosis-treatment process of a female patient who has been a subject of violence without her consent.) between pre-clinical and clinical groups, where the clinical group gave the most correct answers. Conclusion: In conclusion, our results gave us a perspective that clinical students' awareness and management of violence against women is higher than pre-clinical students'. These results may be attributed to two factors; lectures on violence against women or the experience students attain during their clinical practices. Female students were keener in participating in our study. Further prospective studies with equal gender distribution investigating the possible impact of lectures about violence against women on physicians' management of similar situations are needed.Öğe Assessment of the Opinions and Attitudes of Medical Students Towards Lgbtqia+ Individuals(Trakya Üniversitesi, 2020) Akay, Fatih Erkan; Koçyiğit, Beliz; Kafadar, Amila; Ay, Beril; Çifcibaşı, Kaan; Girit, Çağrı; Kükürtcü, NazlıcanAims: The aim of this multicentral study is to analyze the opinions and attitudes of medical students towards lesbian, gay, bi- sexual, transgender, queer, intersex, and asexual individuals. Methods: A total of 1116 medical students from 59 universities in Turkey, 1 from Bosnia and Herzegovina, and 7 universities from Germany have participated in this study. The questionnaire consisted of 23 multiple-choice questions and an open-ended question. Data about the comparison of 1st and 6th year medical students were analyzed using the Pearson Chi-Squared test and the Fisher Exact test in IBM SPSS version 23.0.00. Results: The mean age of the participants was 21.2 ± 2.1 years (range: 17-34 years). There were 693 female, 417 male, 3 nonbinary, and 1 qu- eer participants, and two did not declare their gender. There were 263 (23.6%) 1st year, 315 (28.3%) 2nd year, 179 (16.0%) 3rd year, 112 (10.0%) 4th year, 98 (8.8%) 5th year, and 139 (12.5%) 6th year students. There were 10 (0.9%) missing data. In the 15th question asking whether LGBTQIA+ individuals have the right to adoption or not, the 18th question asking if their school is providing education on sexual health, the 19th question asking if they consider themselves educated about safe sexual intercour- se as an individual, and the 22nd question asking if they think that LGBTQIA+ individuals are more prone to catching sexually transmitted diseases, there were a significant difference between 1st graders and 6th graders. Conclusion: PIn conclusion, thou- gh the majority of answers given indicate a positive approach towards LGBTQIA+ individuals, it can be stated that the attitude of medical students towards LGBTQIA+ individuals is by far suboptimal.Öğe A Case Report With Fibrin-Associated Diffuse Large B-Cell Lymphoma Secondary to Cardiac Myxoma(Trakya Üniversitesi, 2021) Akay, Fatih Erkan; Bilaovi?, NurijaAims: To raise awareness for differential diagnosis of fibrin-associated diffuse large B-cell lymphoma with patients that have sustained chronic inflammation or are immunocompetent with a previous Epstein-Barr virus infection. Case Report: A 58-year-old male patient was admitted to the Clinical Center of Sarajevo University, Cardiovascular Surgery Department with the symptoms of getting tired quickly accompanied by dyspnea. His echocardiography findings exhibited a large polymorphic clavicle type highly mobile formation in his left atrium with a size of 76x23mm, intermittently prolapsing the annulus of the mitral valve and reaching the middle of the extended left ventricle. After the detection of a cardiac mass, the patient underwent surgery and had a total excision of the mass. His- topathological analysis showed a tumor made of stellate cells that form complex structures resembling wires together with an islet of plasma cells embedded in a myxoid/fibrinoid background. Immunohistochemically, lymphoma cells were positively stained for CD20, CD30, MUM1, and EBER. After excluding all other systemic manifestations of any other diseases, the patient was diagnosed with fibrin-associated diffuse large B-cell lymphoma, as a primary cardiac lymphoma, and myxoma. Conclusion: In conclusion, we are reporting a very rare case seen approximately 3% of all lymphomas in the Western Population associated with Epstein-Barr virus B-cell Lymphoproliferative disorders, therefore making them harder to diagnose due to limited experience. Albeit being an infrequent disease fibrin-associated diffuse large B-cell lymphoma should be an entity included in the differential diagnosis of the patients that have sustained chronic inflammation or are immunocompetent with a previous Epstein-Barr virus infection.Öğe Clinical and Histopathological Evaluation of Eyelid Lesions: Retrospective Analysis of Tertiary Medical Center Referrals(Trakya Üniversitesi, 2021) İzzettinoğlu, Mustafa Ömer; Akay, Fatih Erkan; Garip, RüveydeAims: To clinically and histopathologically examine eyelid lesions and evaluate the consistency of clinical examination by comparing the provisional diagnoses of patients with their postoperative histopathology results. Methods: In this study, the records of 408 patients who applied to Trakya University, Department of Ophthalmology with an eyelid mass and underwent surgery between January 2000 to November 2019 were retrospectively analyzed. Patients’ data comprised age, gender, location of the mass, lesion distribution according to age and gender, provisional clinical diagnosis of the patients, and histopathological reports. Results: Out of 408 patients, 220 (54%) were female, and 188 (46%) were male. The mean age of the patients was 46.9 ± 20.17 years (range; 5-90 years). In the histopathological examination of the lesions, 318 (77.9%) of them were benign, and 90 (22.1%) of them were malignant. The most common benign lesion was chalazion [112 (35.2%)], while the most common malignant lesion was basal cell carcinoma [71 (78.9%)]. The clinical pre-diagnosis and histopathological di- agnosis were found to be compatible in 81 (90%) patients with a malignant lesion. There was a statistically significant difference in age between malignant and benign lesions, where malignant lesions were found more in older patients. The histopathological examination ended up being malignant in 2.2% of the lesions with a benign provisional diagnosis. Conclusion: In conclusion, even though most common eyelid lesions in our study were found to be benign, some lesions diagnosed as benign in clinic were found to be malignant after histopathological examination. Hence all excisions should be evaluated histopathologically to achieve a better clinical outcome in all patients with an eyelid lesion.Öğe Clinicopathological Features of Myeloid Sarcoma Patients From a Single Center Experience(Trakya Üniversitesi, 2020) Akay, Fatih Erkan; Kırkızlar, Hakkı Onur; Mercan, Elif; Öz Puyan, FulyaAims: This retrospective study aims to emphasize clinicopathological data and diagnosis of an uncommon myeloid neoplasm;myeloid sarcoma. Methods: Data of all patients from 2000-2019 were retrieved from the archives of Trakya University Schoolof Medicine Hematology and Pathology Departments. Patients’ charts were examined retrospectively by collecting data including age, gender, anatomic site, history of hematological malignancy, blood count, pathological characteristics and treatmentsadministered. Results: There were 8 patients; 6 male and 2 female. The median age was 42.5 years (range: 29-69 years). Themost prevalently involved sites were skin, lymph node and bone/soft tissue. There were six patients as myeloid sarcoma withpreexisting or concurrent acute myeloid leukemia, one patient as de novo and one patient as acute myeloid leukemia with myelodysplasia related changes. One of the concurrent acute myeloid leukemia patients was Down syndrome related acute myeloidleukemia with myeloid sarcoma. Immunohistochemically, out of 8 patients, 4 were of myelomonocytic, 2 were of the myelocyticand 2 were of the monocytic differentiation. Conclusion: Myeloid sarcoma is a tumor mass made up of immature myeloid blastsappearing at an anatomical site other than bone marrow. Taking into account of having a challenging diagnosis, unusual cellularinfiltration at any site on a patient especially with a history of acute myeloid leukemia should have myeloid sarcoma in theirdifferential diagnosis. Keywords: Myeloid sarcoma, acute myeloid leukemia, myeloid neoplasiaÖğe The Fourth Horseman of 21St Century: Covid-19 Pandemic(Trakya Üniversitesi, 2020) Kadribey, İnci; Akay, Fatih ErkanAs the end of 2020 is approaching, its finest message to all of us has been how a pernicious virus like Sars-CoV-2 can change the pace of the world, by being an impetus to a global pandemic. COVID-19 was declared a pandemic by WHO on March 11, 2020. Since then, it has infected more than 40 million and killed at least 1.1 million people as this review was written (October 2020). However, the 2020's come not only with challenges, such as the pandemic itself, but also with opportunities for possible breakthroughs. Throughout human history, physicians examined their patients by touching them, arranged appropriate treat- ments by diagnosing them applying both usual and unusual methods, and tried their best to protect public health, in some cases even by testing the drugs and vaccines they discovered on themselves first. Bedside medicine to hospital medicine, followed by laboratory medicine, are the three crucial cornerstones accepted in the medical history. We now face a fourth potential corner- stone-to-be: could the telecommunication of physicians with their patients through the internet become the fourth essential cornerstone in the history of medicine?Öğe Gastrointestinal Tract Multiple Lymphomatous Polyposis Presented As Mantle Cell Lymphoma(Trakya Üniversitesi, 2019) Akay, Fatih Erkan; Can, Nuray; Cezik, Mert; Kırkızlar, Hakkı Onur; Soyluoğlu, Fatma Selin; Öz Puyan, FulyaAims: Mantle cell lymphoma is a mature B cell non-Hodgkin lymphoma which may be presented with the involvement of the gastrointestinal tract as multiple lymphomatous polyposis. The aim of this case report is to increase the awareness of including lymphomatoid polyposis as an entity in the differential diagnosis of multiple polyposis of the gastrointestinal tract. Case Report: A 69-year-old male patient was admitted to the Trakya University Emergency Department with acute abdominal pain. His cli-nical findings were anorexia that started 3-4 months ago together with constipation and nausea causing him to lose 10-15 kg in 7-8 months, with denial of other parameters of B-symptoms (fevers and night sweats). Endoscopic biopsies that were taken from bulbus and duodenum were investigated and he was diagnosed with mantle cell lymphoma. The patient went through an ileoce-cal resection due to his intussusception that caused abdominal pain in the first place. Conclusion: Although being an infrequent disease, gastrointestinal lymphomatoid polyposis should be an entity comprised in differential diagnosis for multiple polyposis of the gastrointestinal tract. On the other hand, there is still not a therapeutic protocol with a definitive cure for gastrointestinal tract mantle cell lymphoma. Elderly patients in high risk group such as our patient should be given treatment by taking their conditions into consideration. Keywords: Mantle cell lymphoma, polyp, non-Hodgkin lymphomaÖğe The Investigation of Medical Student Journals(Trakya Üniversitesi, 2021) Akay, Fatih Erkan; Koçyiğit, Beliz; Tan, Berfin; Yüksel, Ceren; Şenödeyici, Eylül; Çalışkan, Elif; Özdemir, JansetAims: The aim of our study is to examine and evaluate data of medical student journals from around the world for the year 2020. Methods: In this observational study 20 medical student journals were examined. Data analyzed comprised of the year of foundation, country of origin, number of issues per year, types of articles published, and the total number of articles published in a year. Issues that were published in 2020 only were taken into consideration. Results: In 2020, the majority of medical student journals were based in the United States of America, followed by Canada. There were only four indexed (Scopus, Science Citation Index Expanded, PubMed) medical student journals; three were from the United States of America, and one from Canada. In comparison with other journals, the Yale Journal of Biology and Medicine had the most published issues. They also have the most crowded editorial board. Overall, the median of people on the editorial boards and advisory boards were 17.5 and 14, respectively. The median for issues per year was 2. The median number of publications in medical student journals in 2020 was 23. Among them, 13.1% were original research articles, 10.8% review articles, 9.4% case reports, 4.9% editorials, and 2.9% letters to the editor. The remaining 59.0% were publications that fell into the "others" category. Conclusion: In conclusion, the majority of medical student journals are based in North America and Europe, and a substantial amount of the published articles falls into the “others” category. Considering the lack of effective guidance and regulations with relevance to indexing. Medical student journals face certain challenges regarding visibility, accessibility, and publishing articles. However, provided that the editors of medical student journals remain keen, motivated, and focused, medical student journals will contribute to the scientific community by creating a supportive and intellectual environment for aspiring researchers where they can enhance their understanding of scientific research and publishing skills.Öğe Length of Hospital Stays of Patients Operated Due to Glioma Tumours in Neurosurgery Clinics and Intensive Care Units(Trakya Üniversitesi, 2021) Özyiğit, Irmak; Akay, Fatih Erkan; Cengiz, Elif; Özdemir, Janset; Tuncer, Pınar; Şenödeyici, Eylül; Kızılkaya, SarperAims: To evaluate the relationship between the length of hospital stay and age, gender, and disease characteristics among glioma patients who went under surgery in Trakya University School of Medicine. Methods: The data of 51 glioma patients over 18 years of age, who have been followed up during 2019-2020 in Trakya University School of Medicine, Department of Neurosurgery were analyzed. Patients' data comprised of sex, age, tumour location, grades of the tu- mours, the presence of isocitrate dehydrogenase mutation, whether the patients were hospitalized in the intensive care unit or the neurosurgery clinic, duration of hospitalization, and whether radiotherapy and chemotherapy was received. Length of hospital stay was evaluated separately as intensive care unit and the neurosurgery clinic. Results: Out of 51 patients diagnosed with glioma, 18 (35.3%) were female, and 33 (64.7%) were male. The length of neurosurgery clinic and intensive care unit stays were not associated with radiotherapy and chemotherapy approaches. There was a statistically significant difference between the male and female patients in terms of the number of days stayed in the neurosurgery clinic. Conclusion: In conclusion, gender affected the length of neurosurgery clinic stays with a longer duration for female patients in our clinic. A waste number of parameters, including social ones, affect hospital stays. To reveal predictors of postoperative hospitalization thoroughly and overcome the study’s limitations, further prospective studies with larger sample sizes are needed.Öğe Preoperative Lipid Profile of Patients Operated For Coronary Bypass Surgery(Trakya Üniversitesi, 2017) Yiğitbilek, Furkan; Güldağ, Mahmut Alper; Akay, Fatih Erkan; Memiş, İdil; Yüksel, VolkanAims: Dyslipidemia is a major risk factor for atherosclerosis and coronary heart disease. Evidence showed that an atherogenic lipid pattern is characterized by high levels of small, dense low-density lipoprotein, low levels of high-density lipoprotein cholesterol, elevated triglyceride and total cholesterol levels; similar with the lipid profiles of diabetics.Methods: In this study, 91 patients who underwent coronary artery bypass grafting in Trakya University Hospital Department of Cardiovascular Surgery from April 2017 to September 2017 were analyzed retrospectively. As for statistical analysis, Student’s t-test and Mann Whitney U tests were performed.Results: The lipid profiles of patients were not significantly related to their ages and genders. However, when diabetic patients’ lipid profiles were analyzed, their low-density lipoprotein, and total cholesterol values were found to be significantly lower.Conclusion: It is unexpected to see that patients with diabetes had significantly lower total cholesterol and low-density lipoprotein levels than non-diabetic patients. As for the reason, it is thought that patients with diabetes are more conscious of their health conditionÖğe The Relationship Between Digit Ratio (2D: 4D) and Cardiovascular Capacity in Young Adults(Trakya Üniversitesi, 2017) Akay, Fatih Erkan; Duran, Betül; Keyfoğlu, Mehmet Can; Yavuz, SelçukAims: The ratio of the second-to-fourth finger length was first proposed as a prenatal testosterone biomarker. Studying this matter with a different point of view, the aim of this study is to find whether there is a positive relationship between digit ratio and cardiovascular capacity.Methods: The data of 82 students who were between the ages of 18 and 25 old from Trakya University Faculty of Medicine were analyzed by evaluating the results of the six-minute walking test and the results of their digit measurements. Independent Samples T-Test was used to determine the correlation between the prevalence of longer 4th digit and six-minute walking test results.Results: The data obtained from the test results of the students, that were grouped regarding digit ratio, were statistically evaluated. With the results of the six-minute walking test, students that have lower digit ratio walked 593.87 ± 73.2 meters while students with higher digit ratio walked 584.17 ± 71 meters showing us that there is not a significant relationship between cardiovascular capacity and digit ratio.Conclusion: With the gathered information and results, it is seen that there is not a positive relationship between digit ratio and cardiovascular capacity. In conclusion it can be said that digit ratio does not have a beneficial effect on a persons cardiovascular capacity. Usage of digit ratio as a prenatal hormone exposure has been increasing, and extensive studies in physiological and psychological conditions in humans have been correlated with digit ratio, including athletic ability, fertility, social behaviors, sex-biased diseases, and sexual orientationÖğe Retrospective Analysis of Chronic Myeloid Leukemia Patients in Trakya University School of Medicine(Trakya Üniversitesi, 2019) Akay, Fatih Erkan; Koçyiğit, Beliz; Tan, Berfin; Atlı, Emine İkbal; Baş, Volkan; Kırkızlar, Hakkı OnurAims: This study aims to establish the data; including demographic features, molecular response status, disease characteristics, and survival rate of chronic myeloid leukemia patients treated with tyrosine kinase inhibitors in Trakya University School of Medicine. Methods: In this study, the data of 102 patients over 18 years old who were diagnosed with chronic myeloid leukemia in Trakya University School of Medicine between January 2003-October 2019 were analyzed retrospectively. Data was analyzed using SPSS 23.0.0.0. Results: The total number of patients in the study was 102. There were 95 (93.1%) patients on chronic phase and 6 (5.9%) patients on accelerated phase. Eighty-three (81.4%) of the patients had at least a major molecular response and 17 (16.7%) patients could not achieve at least a major molecular response. Conclusion: As our study showed, first line treatment with imatinib may not be enough for some of the patients to recover and therefore different TKIs such as dasatinib, nilotinib, bo-sutinib, and ponatinib are being used in the treatment of CML. Inadequate response, drug side effects and incompliances are the causes of switching the drug choice. Further studies are needed to thoroughly reveal the epidemiology and treatment regimens.Keywords: Chronic myeloid leukemia, tyrosine kinase, neoplasmsÖğe Retrospective Analysis of Follicular Lymphoma Patients in Trakya University School of Medicine: a Single Center Experience(Trakya Üniversitesi, 2021) Akay, Fatih Erkan; Koçyiğit, Beliz; Şişman, Fevzi Oktay; Ayrık, Mert Yücel; Savaşır, İpek; Cengiz, Elif; Demirci, UfukAims: To establish a dataset including demographic features, disease characteristics, and survival rate of follicular lymphoma patients in Trakya Universi- ty School of Medicine and contribute to the database of follicular lymphoma in Turkey. Methods: In this retrospective cross-sectional study, we analyzed data constituting of follicular lymphoma patients over 18 years of age followed during the years of 2015-2020 in Trakya University Division of Hematology. Results: Out of 43 patients, 22 (51.2%) were female and 21 (48.8%) were male. The mean age was 56.56 (standard deviation 13.24) years. There were 5 (11.6%) pa- tients with B symptoms, presence of bone marrow involvement was seen in 17 (39.5%) patients, lastly, there were 18 (41.9%) patients with splenomegaly. Twen- ty-one (48.8%) patients received rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone, making it the most common treatment protocol administered in our study. Conclusion: Follicular lymphoma patients usually end up getting diagnosed at an advanced stage of the disease, presenting with incidentally noticed painless lymphadenopathy. Additionally, based on evidence in the literature, a clear gap in the successful diagnosis of follic- ular lymphoma patients can be observed between developed and developing countries. To overcome this hurdle, enhanced cooperation with hematopathology may lead to an increased awareness enabling physicians to make a more accurate diagnosis. Nonetheless, further studies are still needed to fully apprehend the epidemiology of follicular lymphoma patients in Turkey.Öğe Risk Factors and Management of Hepatitis B Virus Reactivation in Patients With Hematological Disorders(Trakya Üniversitesi, 2018) Akay, Fatih Erkan; Tan, Berfin; Güldağ, Mahmut Alper; Çifcibaşı, Hilal Sena; Elmacı, Kubilay; Ümit, Elif GülsümAims: The aim of this study is to evaluate hepatitis B virus serological status and to categorize the risks of our treatmentmodalities in patients with both benign and malignant hematological disorders.Methods: This was a retrospective study of 552 patients who were admitted to the Trakya University Hospital Hematologyunit between 01.01.2017 and 31.12.2017. All data regarding the diagnosis, treatment and HBV serologicalstatus were collected from patient files. Data were analyzed with IBM SPSS V.20 using descriptive statistical analysis.Results: Hepatitis B surface antigen was positive in 45 (8.2%) patients, antibody to the hepatitis B surface antigenwas positive in 279 (50.5%) patients and antibody to the hepatitis B core antigen was positive in 247 (44.7%) patients.According to these results, 32 patients were found to be vaccinated for hepatitis B virus. Reactivation was observed in4 (0.7%) patients who have been hepatitis B surface antigen positive and have received adequate duration of antiviralprophylaxis with tenofovir. These 4 patients have received monoclonal antibody for immunosuppressive treatment.Conclusion: To conclude, although the rate of hepatitis B surface antigen reactivation is quite low, as many patientsas possible should be vaccinated to reduce the costs of antiviral treatments and monitorization. If there is notime to vaccinate, patients should be categorized according to guidelines by their hepatitis B surface antigen serologicalstatus and by the planned immunosuppressive treatments.
