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Öğe Burnout and anxiety level of healthcare professionals during the COVID-19 pandemic in Turkey(Ios Press, 2021) Dogru-Huzmeli, Esra; Cam, Yagmur; Urfali, Senem; Gokcek, Ozden; Bezgin, Sabiha; Urfali, Boran; Uysal, HakanBACKGROUND: COVID-19 has affected many countries in the world and has been known as one of the fast-spreading viruses in recent history. OBJECTIVE: Our aim is to reveal the level of anxiety and burnout, attitudes, thoughts, and behaviors of healthcare professionals about COVID-19 in Turkey. METHODS: The individuals included in the study answered seven questions containing demographic information, 27 questions determining their views and perspectives on COVID-19. Anxiety level was measured by Beck Anxiety Scale (BAI), and State Anxiety Inventory (SAT); burnout was measured by Maslach Burnout Inventory (MBT). RESULTS: We included 66 health staff (50 female, 16 male) whose mean age was 31.71 +/- 5.18 years (22-46 ranged). Twenty-two (33.3%) of the participants worked on the COVID-19 frontline while 44 (66.6%) of them worked on usual wards. We found that participants' anxiety was at a moderate level in BAI (mean: 14.00 +/- 12.66). The mean of the SAI was 49.93 +/- 13.06. MBI subscales were low. We found that there was a significant difference in BAI between COVID-19 frontline healthcare professionals and those who worked on the usual wards (p = 0.01). CONCLUSIONS: It is important to consider the level of anxiety and burnout in all healthcare professionals and to help them to protect their mental health.Öğe Calcified chronic subdural hematoma(2012) Aras, Mustafa; Altaş, Murat; Yilmaz, Atilla; Serarslan, Yurdal; Urfali, Boran; Yilmaz, NebiCalcified subdural hematoma is a rarely seen event. It may develop secondary to previous trauma or inappropriate surgical procedures. Due to the not well understood etiology, there are variations in the treatment choices. We present a 27-year old male patient with calcified chronic subdural hematoma. He was operated on following an motorcycle accident in another hospital 5 years ago. He was admitted to our hospital complaining about seizure, headache and dizziness. Neuroradiological examination revealed a calcified chronic subdural hematoma was detected on the right hemisphere. The patient was hospitalized and put on anti-epileptic and analgesic drugs. Any surgical treatment was not applied. In cases with calcified chronic subdural hematoma, the decision of surgical operation should be decided after a carefully and meticulously investigation. It should be avoided any profitless and likely harmful surgical procedures. The clinical observation may be appropriate in the determination of treatment approaches. © 2012 OMU.Öğe Complications of Cervical Disc Prosthesis Dislocation: A Retrospective Clinical Study(Galenos Yayincilik, 2021) Akyuva, Yener; Ozger, Ozkan; Urfali, Boran; Kaplan, Necati; Aykut, Ali MaksutObjective: The most commonly used method for the surgical treatment of cervical disc herniation (CDH) is anterior disc excision with Smith-Robinson's approach. Following the excision of pathological disc space, disc prosthesis is placed if a continuation of dynamic movement in the disc space is desired and a cervical cage is placed for the purpose of fusion. Cervical disc prosthesis seems superior to cervical cage; however, it is not suitable for every patient and can cause serious complications. Our study include data of patients who developed complications following the dislocation of cervical prosthesis and who were referred to our clinic. The aim of our study is to emphasize that the cervical prosthesis is not suitable for every patient and may cause serious complications. Methods: Data of the patients who were operated due to the diagnosis of CDH in other centers and underwent revision surgery for the development of cervical prosthesis dislocation between 2013 and 2020 were collected. Results: This study analysed the data of four male and three female patients. The median value of patient ages was 42 (28-53). Neck pain and swallowing difficulty were the most common reasons for admission to the clinic. Dislocation was found to develop after trauma in three patients. Anterior and posterior dislocations were found to develop in five and two patients, respectively. Seven patients underwent revision surgery. All these patients were found to have dislocations at the C5-6 level. Conclusion: The prosthesis to be placed in the surgical treatment of CDH should be determined based on the patient. Detailed information should be provided to the patient for whom cervical disc prosthesis is to be placed and prosthesis of the most appropriate size for disc space should be placed properly.Öğe The Matrix Metalloproteinase Inhibitor Batimastat Reduces Epidural Fibrosis After Laminectomy in Rats(Turkish Neurosurgical Soc, 2023) Yurtal, Ziya; Ozkan, Huseyin; Kutlu, Tuncer; Deveci, Mehmet Zeki Yilmaz; Urfali, Boran; Urfali, SenemAIM: To investigate the efficacy of locally applied batimastat after laminectomy in preventing postoperative epidural fibrosis. MATERIAL and METHODS: Thirty-two Wistar albino male rats weighing 200-250 g were used. The rats were assigned to four different groups (I-Control group, II-sham group, III-Laminectomy+Batimastat group, and IV-Laminectomy+Spongostan (TM) group). The rats were euthanized 28 days after surgery before TNF-alpha, IL6, IL-1 beta, IL10, TGF-beta 1, and MMP9 gene expression levels of tissue in the surgical area were determined with qPCR. TNF-alpha, IL6, and IL10 protein levels were also measured in both tissue and plasma. In addition, the surgical area was evaluated by histopathological and immunohistochemical methods. RESULTS: TNF-alpha, IL6, and IL-1 beta gene expression levels were higher in the batimastat group than in the control group. Whereas IL10 gene expression levels increased about two-fold in the sham and Spongostan (TM) groups, in the batimastat group, it was similar to that in the control group. TGF-beta 1 gene expression was three-fold higher in the sham group but was similar to that in the control group in both batimastat and Spongostan (TM) groups. MMP9 gene expression levels significantly decreased only in the batimastat group. In addition, fibrosis score, fibroblast cell count, inflammatory cell count, and CD105 expression decreased in the batimastat group relative to the control. CONCLUSION: Molecular and pathological examination results suggested that batimastat is an effective agent in reducing the occurrence of epidural fibrosis after laminectomy.Öğe Non-traumatic spontaneous acute epidural hematoma in a patient with sickle cell disease(Elsevier Doyma Sl, 2014) Serarslan, Yurdal; Aras, Mustafa; Altas, Murat; Kaya, Hasan; Urfali, BoranA 19-year-old female with sickle cell anemia (SCD) was referred to our hospital after two days of hospitalization at another hospital for a headache crisis. This headache crisis was due to a raised intracranial pressure; these symptoms were noted and included in her comprehensive list of symptoms. There was an acute drop in the hemoglobin and hematocrit levels. The cranial CT scan demonstrated a left fronto-parietal acute epidural hematoma (AEH) and a calvarial bone expansion, which was suggestive of medullary hematopoiesis. The patient underwent emergent craniotomy and evacuation of the hematoma. There were no abnormal findings intra-operatively apart from the AEH, except skull thickening and active petechial bleeding from the dural arteries. Repeated CT scan showed a complete evacuation of the hematoma. The possible underlying pathophysiological mechanisms were discussed. In addition to the factors mentioned in the relevant literature, any active petechial bleeding from the dural arteries on the separated surface of the dura from the skull could have contributed to the expanding of the AEH in our patient. Neurosurgeons and other health care providers should be aware of spontaneous AEH in patients with SCD. (C) 2013 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L. All rights reserved.Öğe Percutaneous Kyphoplasty Is Bilateral Approach Necessary?(Lippincott Williams & Wilkins, 2018) Yilmaz, Atilla; Cakir, Murteza; Yucetas, Cem Seyho; Urfali, Boran; Ucler, Necati; Altas, Murat; Aras, MustafaStudy Design. A multicenter retrospective study of patients who underwent unilateral and bilateral balloon kyphoplasty. Objective. The aim of this study was to compare the radiographic and clinical results of unilateral and bilateral balloon kyphoplasty to treat osteoporotic vertebral compression fractures. Summary of Background Data. Percutaneous kyphoplasty has long been used as a successful method in the treatment of osteoporotic vertebral compression fractures. Although the bilateral approach is considered to be the mainstay application of percutaneous kyphoplasty, the unilateral approach has also been shown to be sufficient and even more effective in some cases. Methods. A total of 87 patients who underwent percutaneous kyphoplasty due to osteoporotic vertebral compression fractures between 2009 and 2016 were retrospectively evaluated and divided into two groups as patients who underwent unilateral or bilateral percutaneous kyphoplasty. Unilateral percutaneous kyphoplasty was performed in 36 and bilateral percutaneous kyphoplasty in 51 patients. The groups were compared in terms of clinical outcomes, radiological findings, and complications. Clinical outcomes were evaluated using Visual Analogue Scale and Oswestry Disability Index and the radiological findings were evaluated by comparing the preoperative and postoperative day 1 and year 1 values of anterior, middle, and posterior vertebral heights and kyphosis angle. Results. Clinical improvement occurred in both groups but no significant difference was observed. In radiological workup, no significant difference was found between the groups in terms of improvements in vertebral heights and kyphosis angle. Operative time and the amount of cement used for the surgery were significantly lower in the patients that underwent unilateral kyphoplasty. Conclusion. Unilateral percutaneous kyphoplasty is as effective as bilateral percutaneous kyphoplasty both radiologically and clinically. Operative time and the amount of cement used for the surgery are significantly lower in unilateral kyphoplasty, which may play a role in decreasing complication rates.Öğe Protective Effects of Minocycline against Short-Term Ischemia-Reperfusion Injury in Rat Brain(Karger, 2013) Aras, Mustafa; Urfali, Boran; Serarslan, Yurdal; Ozgur, Tumay; Ulutas, Kemal Turker; Urfali, Senem; Altas, MuratThe aim of this study was to assess the effects of minocycline on cerebral ischemia-reperfusion (I/R) injury in rats. The study was carried out on 24 male Wistar albino rats, weighing 200-250 g, which were divided into three groups: (i) control (n = 8), (ii) I/R (n = 8) and (iii) I/R + minocycline (n = 8). Minocycline was administrated at a dose of 90 mg/kg p.o. to the I/R group 48, 24 and 1 h before ischemia. Following bilateral exposure of the common carotid arteries by anterior cervical dissection and separation of the vagus nerve, I/R injury was performed by occlusion. Following reperfusion, malondialdehyde (MDA), superoxide dismutase, glutathione peroxidase and catalase levels in the blood and brain tissue, and creatine kinase (CK), CK-BB, lactate dehydrogenase (LDH), neuron-specific enolase (NSE) and protein S100 beta levels in the blood were measured and the histopathological changes were monitored. Regarding histopathological evaluation, symptoms of degeneration were significantly improved in the I/R + minocycline group compared to the I/R-only group. Statistical analysis of the biochemical parameters revealed significant differences in MDA (p < 0.001), nitric oxide (p < 0.05), CK (p < 0.05) and CK-MB (p < 0.05) levels between the I/R + minocycline group and the I/R group. According to the literature, the effect of minocycline is firstly assessed by LDH, CK-MB, NSE and S-100 beta analysis in addition to antioxidant status and histopathological analysis. (C) 2014 S. Karger AG, BaselÖğe A Rare Pediatric Tumor: Supratentorial High-Grade Astroblastoma Presenting as a huge Mass(Georg Thieme Verlag Kg, 2023) Surmeli, Deniz; Urfali, Boran; Ozgur, TuemayBackground Astroblastoma is a rare neuroepithelial tumor of unknown origin, usually seen in children and young adults. It is usually localized to the cerebral hemisphere. Computed tomography and magnetic resonance imaging show a well-demarcated, contrast-enhancing mass with a cystic area. Characteristic histological findings are perivascular pseudorosette formation and frequent vascular hyalinization. The presented case is a 3.7-month-old female patient diagnosed with high-grade astroblastoma.Case Presentation We report the case of a 3.7-year-old female patient admitted to the neurosurgery clinic with strabismus for 25 days. Magnetic resonance imaging revealed a contrast-enhancing mass that contained cystic and necrotic areas. The tumor mass has been totally resected and histological examination combined with immunohistochemical study confirmed the diagnosis of high-grade astroblastoma.Öğe Safety and Complications of Sedation Anesthesia during Pediatric Auditory Brainstem Response Testing(Karger, 2022) Urfali, Senem; Urfali, Boran; Sarac, Elif Tugba; Koyuncu, OnurObjective: The auditory brainstem response (ABR) test has been widely used in childhood. Although it is a painless procedure, sedation can be needed in pediatric patients. Thus, this study aimed to evaluate safety and complications of sedation anesthesia applied in pediatric patients during ABR testing. Methods: Medical records of 75 children who underwent ABR testing between 2018 and 2020 were evaluated retrospectively in terms of applicability, safety, and complications of sedation anesthesia. Results: The ages ranged from 3 to 9 (mean 6.2) years. Comorbidity was detected in 20% (n = 15); 3 had multiple comorbidities, and the most common comorbidity was Down syndrome (4%). The drugs used in sedation anesthesia were midazolam in 81.3% (n = 61), a combination of propofol and ketamine in 14.7% (n = 11), and only propofol in 4% (n = 3) of the patients. An additional drug use was needed in 44% (n = 33). The mean procedure time was 40 (range 30-55) min. The mean anesthesia duration was 45 (range 35-60) min. The mean recovery time was 10 (range 5-15) min. Complications related to anesthesia developed in 4 (5.33%) of the patients; respiratory distress, agitation, cough, and nausea-vomiting were seen in one of the patients, respectively. Complications like bradycardia and respiratory or cardiac arrest were not seen at all. Conclusions: The complication rate of sedation anesthesia performed during ABR testing of pediatric patients is quite low. It may be more beneficial to use combinations of sedation drugs instead of using a single sedation drug. Although sedation anesthesia appears to be safe in general, the potentially life-threatening complications of sedative agents should be remembered, especially in children who have comorbidities.Öğe Sleep Quality in Neurodegenerative Diseases(Academic Press Ltd-Elsevier Science Ltd, 2020) Okuyucu, Esra; Urfali, Boran; Guntel, Murat[Abstract Not Available]Öğe Use of programmable versus nonprogrammable shunts in the management of normal pressure hydrocephalus A multicenter retrospective study with cost-benefit analysis in Turkey(Lippincott Williams & Wilkins, 2017) Serarslan, Yurdal; Yilmaz, Atilla; Cakir, Murteza; Guzel, Ebru; Akakin, Akin; Guzel, Asian; Urfali, BoranVentriculoperitoneal shunt systems that are used in the treatment of normal pressure hydrocephalus are often associated with drainage problems. Adjustable shunt systems can prevent or treat these problems, but they may be expensive. The aim of our study is to compare the complications and total cost of several shunt systems. Patients with normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between 2011 and 2016 were included in the study. The study involves patient consent and the informed consent was given. Complications and the average cost per person were compared between patients with adjustable and nonadjustable shunts. Shunt prices, surgical complications, and revision costs were taken into account to calculate the average cost. Of the 110 patients who were evaluated, 80 had a nonadjustable shunt and 30 had an adjustable shunt. In the group with adjustable shunts, the rates of subdural effusion and hematoma were 19.73% and 3.29%, respectively. In the group with nonadjustable shunts, these rates were 22.75% and 13.75%, respectively. One patient in the adjustable group underwent surgery for subdural hematoma, while 8 patients in the nonadjustable group underwent the same surgery. Ten patients required surgical intervention for subdural effusion and existing shunt systems in these patients were replaced by an adjustable shunt system. When these additional costs were factored into the analysis, the difference in cost between the shunt systems was reduced from 600 United States dollars (USD) to 111 USD. When the complications and additional costs that arise during surgical treatment of normal pressure hydrocephalus were considered, the price difference between adjustable and nonadjustable shunt systems was estimated to be much lower.
