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Objectives: To determine the effect of intravesical onabotulinum toxin‐A (BoNT‐A) treatment on sexual functions in female patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS). Methods: Female patients with IC/BPS refractory to previous treatments were included in the study between January 2020 and April 2022. Patients were treated with the trigone‐sparing injection (Group 1) or trigone‐included injection (Group 2) techniques. 100 Units of BoNT‐A was applied submucosally on 20 different points. The patients were evaluated with visual analog scale (VAS), O'Leary‐Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Female Sexual Function Index (FSFI) questionnaires, 3‐day voiding diary, uroflowmetry, and post‐voiding residual volume analysis in the preoperative period, as well as on the 30th and 90th days postoperatively. For the repeated measurements, analysis of variance was used to assess the time‐dependent variation across groups. Results: The baseline FSFI score of the patients was 15.96 ± 3.82. Following the treatment, the FSFI scores were 22.43 ± 4.93 and 24.41 ± 5.94 on the 30th and 90th days, respectively (p <.001). We observed statistically significant improvement in all FSFI subdomains (p <.05). Statistically significant improvements with treatment on ICSI, ICPI, and VAS scores were achieved (p <.05). Preoperative FSFI scores were similar in Group 1 and Group 2 (p =.147). While the preoperative FSFI scores were 17.00 ± 3.73 and 14.84 ± 3.72 for Group 1 and Group 2, respectively, the scores after the treatment were 22.85 ± 5.01 and 21.98 ± 5.01 on the 30th day, and 24.62 ± 6.06 and 24.19 ± 6.05 on the 90th day postoperatively. Significant improvement was observed in FSFI scores with treatment, and no difference was observed between the two groups in terms of treatment response (p =.706). Conclusions: Intravesical BoNT‐A injection in the treatment of women with refractory IC/BPS improves sexual functions. It also significantly improves pain and symptom scores. Both trigone‐sparing and trigone‐including injections are similarly safe and effective. [ABSTRACT FROM AUTHOR]

Objective: During interventions, firemen are exposed to fire smoke. Fire smoke contains many air pollutants. Smoke exposure may increase the risk of pulmonary and cardiovascular diseases. The aim of this study was to evaluate the effect of long-term occupational smoke inhalation on respiratory functions and related risk factors in working firemen. Methods: Between February and March 2012, 523 working firemen were retrospectively evaluated within the scope of a screening program in Ankara Numune Training and Research Hospital. The study included 250 firemen actively participating in a fire and a control group of 273 firemen working in the office. Detailed evaluation of the firemen included age, gender, height, weight, spirometric measurements (FEV1, FVC, FEV1/FVC, PEF, FEF25-75), smoking status and duration, duration of work, and comorbidities. Results: According to the results obtained from the study, FEV1 values were significantly decreased in firemen actively participating in firefıghts compared to the low-risk group. The duration of the study did not significantly affect pulmonary functions. Conclusion: Respiratory functions decrease in active working firefighters. Development of diseases related to exposure to smoke may be prevented by the development of more effective apparatus protecting from smoke, working in cycles in different fire types, quitting smoking, and regular annual screenings. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to adapt the student version of the Jefferson Scale of Physician Empathy (JSPE) to Turkish medical students in order to assess its reliability and validity, and to analyze the gender and year differences. Materials and Methods: The student version of the JSPE was translated into Turkish using back-translation procedures, and was administered to 752 medical school students from the first to fifth years of study. To assess the dimensionality of the scale, confirmatory factor analysis (CFA) for categorical data was carried out. Internal consistency was assessed by Cronbach's alpha. Subscale scores were compared in terms of gender and year. Results: The three-dimensional structure of the JSPE was confirmed by CFA except item 18. The internal consistencies of the subscales were 0.83, 0.70 and 0.60, respectively. There were statistically significant gender and medical school year differences in terms of "perspective taking" and "compassionate care" scores. Conclusion: The student version of JSPE was successfully adapted, and the adapted scale can be used in Turkey. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we investigated the psychometric properties of the International Classification of Functioning, Disability and Health (ICF) core set for low back pain (LBP). Patients and methods: One-hundred outpatients with LBP (73 females, 27 males; mean age 55.3 years; range 24 to 84 years) were assessed by the ICF core set for LBP. The patients also completed the Roland-Morris disability questionnaire (RMDQ) and Short Form-36 (SF-36) questionnaire. The internal construct validity of the ICF core set for LBP was assessed by Rasch analysis and external construct validity by correlations with the RMDQ and SF-36 Health Survey version 1.0. Reliability was tested by internal consistency and person separation index. Results: After rescoring the disordered response categories and deletion of some items, "body functions and body structures" and "activities and participation" item sets satistifed Rasch model expectations with a mean item fit of 0.005 (SD 0.619) and -0.006 (SD 0.730), and person fit of -0.165 (SD 0.561) and -0.084 (SD 0.806) respectively. Both item sets were unidimensional and showed no differential item functioning. Their reliabilities were good with Cronbach's alpha coefficient and person separation index levels above 0.77. Although the mean functionality level of the patients was lower than the mean difficulty level of the items, the distribution of the difficulty level of the items overlapped with the distribution of the functionality level of the patients for both item sets. The presence of the expected level of correlations between both item sets and RMDQ and SF-36 has confirmed the external construct validity. "Environmental factors" did not meet the assumptions of the Rasch analysis. Conclusion: After some modifications, a 15-item "body functions and body structures" set and a 21-item "activities and participation" set from the ICF comprehensive core set were found to be reliable and valid to assess functioning in patients with LBP. [ABSTRACT FROM AUTHOR]

Objective: To investigate the psychometric properties of the Health Assessment Questionnaire Disability Index (HAQ-DI) and the modified HAQ (MHAQ) in patients with knee osteoarthritis (OA). Materials and Methods: The internal construct validity of the HAQ-DI and MHAQ were assessed by Rasch analysis and external construct validity by associations with the Western Ontario and McMaster Universities Index of Osteoarthritis Index (WOMAC), the World Health Organization Disability Assessment Schedule (WHODAS-II) and the Nottingham Health Profile (NHP). Reliability was tested by internal consistency and person separation index. Results: Two hundred and fifteen outpatients with knee OA (mean age±standard deviation (SD) 57.7±10.9 years; 81% female) filled in the assessment scales including HAQ-DI, WOMAC, WHODAS-II and the NHP. MHAQ was not administered as a separate measure but scored by using the HAQ-DI forms. Both the HAQ-DI and the MHAQ data satisfied Rasch model expectations with a mean item fit of 0.096 (SD 1.186) and -0.312 (SD 1.063), and person fit of 0.307 (SD 0.895) and -0.329 (SD 0.879), respectively. Both scales were unidimensional and showed no differential item functioning. The reliabilities of both scales were good with high Cronbach's alpha and PSI levels above 0.85. However neither of them was particularly well targeted to the current population who displayed a level of disability much below the average difficulty level of the scales. External construct validity was confirmed by expected correlations with WOMAC, WHODAS-II and NHP. Although the distribution of both scales was right skewed, the floor effect was more prominent in MHAQ. Conclusion: Both the HAQ-DI and MHAQ are found to be reliable and valid to assess physical disability in patients with knee OA. However, the possible floor effect in this diagnostic group should be kept in mind. [ABSTRACT FROM AUTHOR]

Background: An important aspect of the ‘description’ of a variable is the shape of its distribution, which tells you the frequency of values from different ranges of the variable. Typically, as most of the statistical tests are based on the normality assumption, a researcher is interested in how well the distribution can be approximated by the normal distribution. Unless there are extreme violations of the normality assumptions, approved statistical tests usually provide accurate results. Although simple descriptive statistics can provide some information relevant to this issue, more precise information can be obtained by performing one of the tests of normality to determine whether the sample comes from a normally distributed population or not. Aim: Lilliefors corrected Kolmogorov-Smirnov, Shapiro-Wilk, D'Agostino Pearson and Jarqua-Bera tests were aimed to be compared in terms of Type I error and power of the tests. Materials and Methods: The simulation was run 1000 times for 23 different sample sizes and for 8 different distributions. Lilliefors corrected Kolmogorov-Smirnov, Shapiro-Wilk, D'Agostino Pearson and Jarqua-Bera tests were compared in terms of Type I error and power of the tests. Results: The most powerful results for normal distributions were given by the Jarqua-Bera and for nonnormal distributions by the Shapiro-Wilk test. Conclusions: As it had the lowest Type I error rate, the Jarqua-Bera test was superior for normal and standard normal distributions. For nonnormal distributions, achieving sufficient power at smaller sample sizes, the Shapiro-Wilk was the most powerful. [ABSTRACT FROM AUTHOR]

Aim To develop a Turkish version of the 25-item Cardiff Visual Ability Questionnaire for Children (CVAQC) and to evaluate the validity and reliability of the questionnaire. Methods The study involved two main phases. The first phase involved a cross-cultural adaptation of the CVAQC from English into Turkish. The second phase involved the completion of the Turkish version of the CVAQC by 150 partially sighted children (6-18 years old) and validity and reliability checks. Extent and construct validity were investigated using Rasch analysis and reliability by internal consistency and person separation index (PSI). Results An adequate conceptual equivalence was achieved following the linguistic adaptation process. The dataset for validation comprised 150 participants, 88 (58.7%) of whom were male. Evidence of disordered thresholds was found for one item (item 17). This item was recorded by collapsing two categories and ordered thresholds were evident. All items of the CVAQC were found to fit the Rasch model (χ2 (df)=59.90 (2), p=0.159). The internal construct validity was good (mean item fit (SD) -0.054 (1.132), person fit (SD) -0.629 (2.079)) indicating a single underlying construct. The reliability was good with Cronbach's α of 0.91 and PSI of 0.94. Differential item functioning (DIF) was tested for age, sex, diagnosis, degree of visual impairment, and comorbidity. Evidence of DIF was found on age for one item (item 10, reading the board at school). Conclusions The Turkish version of the CVAQC is a valid, reliable, and unidimensional questionnaire for partially sighted children aged 6-18 years. [ABSTRACT FROM AUTHOR]

Background: Problem-based learning (PBL) is most commonly used in medical education to enhance self-regulated learning (SRL) skills. Self-efficacy beliefs affect students' motivation through self-regulatory processes. The purpose of this study is to examine the relationship between medical students' self-reported SRL skills and their self-efficacy in PBL. Methods: A cross-sectional study was conducted with second (286; 83.1%) and third (275; 80.2%) year students at the Ankara University School of Medicine. The SRL perception (SRLP) scale and self-efficacy for problem-based learning (SPBL) scale were used in the study. Results: The SRLP subscales were positively correlated with the SPBL subscales. There was a weak but meaningful correlation between the subscales of SRLP (with the exception of the lack of self-directedness scale) and the subscales of SPBL and the students' views on benefiting from PBL. The female students' mean score was higher for the 'planning and goal setting' subscale of SRLP (p=0.017), and the second-year students' mean score was higher than that of the third-year students for the 'lack of self-directedness' subscale of SRLP (p=0.001) with small effect sizes (Cohen's d is 0.17 and 0.27). There was no statistically significant difference between the year and subscales of SPBL. With regard to gender, the female students had higher scores than the male students on the 'responsibility' subscale of SPBL (p=0.003; Cohen's d=0.26). Conclusions: The study showed that medical students used SRL skills and believed in their ability to learn effectively in the PBL context and demonstrated the relationship between SRL skills and self-efficacy beliefs. Monitoring students' development in these skills and giving them feedback could be beneficial for the cognitive achievement of students with learning difficulties and insufficient study skills. Further studies need to be undertaken to investigate issues such as the curriculum, learning environment, individual differences, and how these can affect the SRL process. [ABSTRACT FROM AUTHOR]

Aim: This study assessed the ability of tissue harmonic imaging ultrasound combined with power Doppler ultrasound in the detection of childhood febrile urinary tract infections in comparison with the gold standard reference method: Tc-99m dimercaptosuccinicacid renal cortical scintigraphy. Material and Methods: This prospective study included 60 patients who were hospitalized with a first episode of febrile urinary tract infections. All children were examined with dimercaptosuccinicacid scan and tissue harmonic imaging ultrasound combined with power Doppler ultrasound within the first 3 days of admission. Results: Signs indicative of acute infection were observed in 29 patients according to the results of tissue harmonic imaging ultrasound combined with power Doppler ultrasound while dimercaptosuccinicacid scan revealed abnormal findings in 33 patients. The sensitivity, specificity, positive predictive value and negative predictive value of tissue harmonic imaging combined with power Doppler ultrasound using dimercaptosuccinicacid scintigraphy as the reference method in patients diagnosed with first episode febrile urinary tract infections were calculated as 57.58% (95% confi - dence interval: 40.81%-72.76%); 62.96% (95% confidence interval: 44.23%-78.47%); 65.52% (95% confidence interval: 52.04%-77%); 54.84% (95% confidence interval: 41.54%-67.52%); respectively. Conclusions : Although current results exhibit inadequate success of power Doppler ultrasound, this practical and radiation-free method may soon be comprise a part of the routine ultrasonographic evaluation of febrile urinary tract infections of childhood if patients are evaluated early and under appropriate sedation. (Turk Pediatri Ars 2015; 50: 90-5) [ABSTRACT FROM AUTHOR]

Objective: To evaluate the frequency and predictability of side effects, including tremor, cramp, and palpitation, due to treatment in patients with chronic obstructive pulmonary disease and asthma. Methods: We prepared a standard questionnaire for 299 patients concerning their diagnosis, treatment, and side effects of the treatment in February 2007 at Hacettepe University, Faculty of Medicine, Department of Pulmonary Diseases. We prospectively examined the clinical status of the patients and side effects of the treatment at the 15th, 30th, and 180th days of the treatment. Results: In our study, there were 38 (12.7%) patients with drug-induced tremor. Of these, 27 (71.1%) had asthma (p=0.004) and 18 (47.4%) had anamnestic palpitation. Drug-induced tremor risk was 15.3 times higher in patients who used a beta-mimetic compared with those who used any drugs. Cramp risk increased with beta-mimetic use only. In our study, drug-induced tremor was still present at the 180th day of examination in 32 (84.2%) patients. Conclusion: This study demonstrated that side effects, including tremor, palpitation, and cramp, were more common in our patients compared with those in other studies. These side effects were directly related to the primary disease and the use of beta-2-agonists. Another finding of our study is that tolerance did not develop as much as that reported in literature. [ABSTRACT FROM AUTHOR]

Purpose: To compare the intraocular pressure (IOP) measured by dynamic contour tonometry (DCT), Goldmann applanation tonometry (GAT), non-contact tonometry (NCT) and Tono-Pen and also to assess whether ocular parameters such as corneal thickness, keratometry and axial length affect the measurements by the tonometers. Materials and Methods: One hundred healthy subjects prospectively underwent IOP measurement with DCT, GAT, NCT and Tono-Pen. The correlation between the tonometer readings as well as the effect of keratometry, central corneal thickness (CCT), axial length and anterior chamber depth on IOP measurements were assessed. Results: DCT readings were higher than NCT (ΔIOP=2.0±3.2 mmHg, p<0.001) and GAT (ΔIOP=1.3±2.1 mmHg, p=0.003) but not Tono-Pen (ΔIOP=0.1±2.7 mmHg, p=0.981). DCT, GAT and NCT correlated positively with CCT (p=0.039, p=0.020 and p=0.001). GAT and NCT readings were significantly higher in eyes with thick cornea (>568 μm) compared to eyes with thin cornea (<535 μm) (p=0.021 and p=0.003). Ocular parameters other than CCT did not have a significant effect on the readings of tonometers. Conclusion: Despite significant correlation; DCT readings were higher than GAT and NCT but not Tono-Pen. DCT, NCT and GAT readings significantly correlated with CCT. GAT and NCT readings were significantly higher in eyes with thick cornea compared to eyes with thin cornea. [ABSTRACT FROM AUTHOR]

Objective: Co-dependency is defined as a behavioral pattern, personality, psychiatric disorder and pathology of interpersonal relations. There are similarities between the characteristics of personality, behavioral patterns and interpersonal relations of codependents and the individuals who have been mobbed. The present study aimed to investigate the relationship between co-dependency and mobbing. Methods: Two hundred and ten nurses participants who are employed in a university hospital, filled Codependency Assessment Tool (CODAT), Beck Depression Inventory (BDI) and Workplace Psychologically Violent Behaviors Instrument (WPVBI). Results: Results showed that there is a positive relationship between all subscales of CODAT and WPVBI subscales and also statistically significant relations between the subscales of CODAT; medical problems, self-worth and WPVBI. There were statistically significant relationships between the self-worth and attack on personality, the medical problems and attack on professional status, attack on personality, the family of origin issues and attack on professional status, hiding self and direct negative behaviors. Conclusion: This research results support the relationship between co-dependency and mobbing/bullying. However, further studies should be conducted to support the findings of this study. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the importance of neuro-ophthalmological magnetic resonance imaging (MRI) findings in the identification of the aetiology of rhinorrhoea, and the differentiation of spontaneous rhinorrhoea from non-spontaneous rhinorrhoea. MR images of 25 patients with spontaneous and 21 patients with non-spontaneous rhinorrhoea were evaluated for the presence of neuro-ophthalmological findings of intracranial hypertension (IHT). These include optic nerve vertical tortuosity, optic nerve sheath enlargement, flattening of the posterior sclera and optic nerve protrusion, as well as other MRI findings of ICH, such as partial empty sella, dilatation of Meckel's cave and the presence of arachnoid pits. IHT findings were more common in the spontaneous group. Six criteria (optic nerve distention, optic nerve vertical tortuosity, posterior flattening of the sclera, partial empty sella, Meckel's cave dilatation and presence of arachnoid pits) differentiate between patient and control groups. Patients with spontaneous cerebrospinal fluid (CSF) leaks should be evaluated for signs of IHT on MRI, as they are present in the majority of spontaneous CSF leaks and are representative of increased intracranial pressure. [ABSTRACT FROM AUTHOR]

Aim This study aimed to explore the potential of an inclusive and fully integrated measurement system for the Activities component of the International Classification of Functioning, Disability and Health (ICF), incorporating four classical scales, including the Health Assessment Questionnaire (HAQ), and a Computerized Adaptive Testing (CAT). Methods Three hundred patients with rheumatoid arthritis (RA) answered relevant questions from four questionnaires. Rasch analysis was performed to create an item bank using this item pool. A further 100 RA patients were recruited for a CAT application. Both real and simulated CATs were applied and the agreement between these CAT-based scores and 'paper-pencil' scores was evaluated with intraclass correlation coefficient (ICC). Anchoring strategies were used to obtain a direct translation from the item bank common metric to the HAQ score. Results Mean age of 300 patients was 52.3 ± 11.7 years; disease duration was 11.3 ± 8.0 years; 74.7% were women. After testing for the assumptions of Rasch analysis, a 28-item Activities item bank was created. The agreement between CAT-based scores and paper-pencil scores were high (ICC = 0.993). Using those HAQ items in the item bank as anchoring items, another Rasch analysis was performed with HAQ-8 scores as separate items together with anchoring items. Finally a conversion table of the item bank common metric to the HAQ scores was created. Conclusion A fully integrated and inclusive health assessment system, illustrating the Activities component of the ICF, was built to assess RA patients. Raw score to metric conversions and vice versa were available, giving access to the metric by a simple look-up table. [ABSTRACT FROM AUTHOR]

Objective: We examined the change in apelin concentration and its relationship with left ventricular diastolic function in patients treated for hypertension. Methods: Ninety treatment-naive patients with newly diagnosed hypertension and 33 age- and sex-matched control subjects were prospectively enrolled. Patients with hypertension were randomized to treatment either with telmisartan 80 mg or amlodipine 10 mg. Apelin concentration was measured and echocardiography was performed at baseline and after 1 month of treatment. Results: The data of 77 patients and 33 controls were analyzed. Mean age, gender, baseline blood pressure, apelin levels, and echocardiographic measurements were similar between the treatment groups (p>0.05 for all). Apelin concentration was significantly lower in patients with hypertension than in controls. There was a significant increase in apelin level after 1 month of treatment in both groups (0.32±0.17 vs. 0.38±0.17 ng/dL in telmisartan group, p=0.009, and 0.27±0.13 vs. 0.34±0.18 ng/dL in amlodipine group, p=0.013). Diastolic function improved significantly in both groups (p<0.05) but was not significantly associated with change in apelin concentration. Conclusion: Apelin concentration increased significantly after 1 month of effective treatment with telmisartan or amlodipine to a similar extent. Change in apelin concentration was not associated with improvement in diastolic function. [ABSTRACT FROM AUTHOR]

Background/aim: Exhaled CO level provides an objective measure of a patient's smoking status. The relationship between CO levels and nicotine dependence is controversial. The aim of this study is to evaluate the relationship between exhaled CO levels and nicotine dependence as well as to demonstrate that exhaled CO levels may be used as a marker of nicotine dependence. Materials and methods: Two hundred eighty-nine patients (132 females, 157 males) were included in the study. Smoking duration, the age of smoking initiation, exhaled CO levels, and Fagerström Test for Nicotine Dependence (FTND) scores were recorded. The relationship between FTND scores and exhaled CO levels was investigated. Results: There was a statistically significant correlation between FTND score and exhaled CO levels (P < 0.001). We found that a cut-off score of 7.5 ppm for exhaled CO may be useful as a marker for heavy smoking. The sensitivity and specificity of this cut-off score for exhaled CO was 69.3% and 49.3%, respectively (P < 0.001). Conclusion: We found that exhaled CO levels significantly correlated with FTND scores. For patients who are unable to provide reliable answers to questions in the FTND, exhaled CO measurements may be used as an alternative test for estimating the status of heavy smoking. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the impact of reflective practices on the attitudes of the medical students towards mental illnesses and to determine the impact of some variables on the attitude change. Methods: A quasi-experimental study was carried out in two medical schools in Turkey. Educational intervention, included written and verbal reflection practices for student experience in interview with patients during psychiatry clerkship, was applied in intervention groups. The impact was evaluated by collecting data at before and after psychiatry clerkship using Beliefs towards Mental Illness Inventory (BMI) in intervention and control groups. Results: Total 190 students were included in the intervention (51.6%) and (48.4%) control groups. Mean score of total BMI was found to be significantly lower after intervention in both groups, however, no statistical difference was observed between the two groups. The impact of two subscales of the empathy and basic personal traits of the students and self-experience of mental illness on attitude change were found to be statistically significant. After correction was done for these variables, time affect (psychiatry training) could not be found statistically significant. Verbal reflective practice was found to be more beneficial than written one. Discussion: Psychiatry clerkship training created a small and meaningful impact, but reflective practices did not show a significant impact on attitude change of students towards mental illness. Empathy, basic personal traits and self-experience of mental illnesses can be taken into consideration as factors related with stigma in improving attitudes of students. [ABSTRACT FROM AUTHOR]

Objectives: To determine the clinical features and the distribution of diagnosis in partially sighted school-age children, to report the chosen low vision rehabilitation methods and to emphasize the importance of low vision rehabilitation. Materials and Methods: The study included 150 partially sighted children between the ages of 6 and 18 years. The distribution of diagnosis, accompanying ocular findings, visual acuity of the children both for near and distance with and without low vision devices, and the methods of low vision rehabilitation (for distance and for near) were determined. The demographic characteristics of the children and the parental consanguinity were recorded. Results: The mean age of children was 10.6 years and the median age was 10 years; 88 (58.7%) of them were male and 62 (41.3%) of them were female. According to distribution of diagnoses among the children, the most frequent diagnosis was hereditary fundus dystrophies (36%) followed by cortical visual impairment (18%). The most frequently used rehabilitation methods were: telescopic lenses (91.3%) for distance vision; magnifiers (38.7%) and telemicroscopic systems (26.0%) for near vision. A significant improvement in visual acuity both for distance and near vision were determined with low vision aids. Conclusion: A significant improvement in visual acuity can be achieved both for distance and near vision with low vision rehabilitation in partially sighted school-age children. It is important for ophthalmologists and pediatricians to guide parents and children to low vision rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the interrelation between serum E2 level on hCG day, score of transferred embryos and pregnancy achievement. Methods: Records of 350 women aged 18-40 years who underwent ovarian hyperstimulation in fresh cycles down regulated either with GnRH agonist ( n = 70) or GnRH antagonist ( n = 280) followed by oocyte pick-up, ICSI and embryo transfer are retrospectively analyzed. Results: Median E2 levels on hCG day of cycles ending with and without pregnancy were similar ( p = 0.308). ROC curve for AUC of E2 on hCG day with dependent variable pregnancy rate also demonstrated that the E2 level on hCG day cannot be used to predict pregnancy in IVF/ICSI cycles (AUC 0.532, 95 % confidence interval: 0.471-0.593). Grouping cycles according to their E2 levels on hCG day also did not demonstrate any detrimental effect of either low or high E2 levels on hCG day both in agonist and antagonist cycles. Pregnancy rates are strongly correlated with mean and total score of transferred embryos. Interrelation of E2 on hCG day and pregnancy rate is independent from score of transferred embryos. Conclusions: E2 on hCG day is not correlated with pregnancy rates and cannot be used to predict pregnancy in neither agonist nor antagonist cycles, no matter its level or percentile is used. [ABSTRACT FROM AUTHOR]

Purpose(s): To evaluate results of neoadjuvant chemotherapy (NACT) following debulking surgery in patients with extensive metastatic disease and/or poor medical performance Method(s): Advanced stage epithelial ovarian cancer patients were treated with either NACT followed by debulking surgery or primary surgery followed by adjuvant chemotherapy after assessment of the extent of disease by laparoscopy or laparotomy. Results: Out of 297, 223 patients were in the primary surgery group, whereas 74 of them met NACT criteria. Optimal cytoreduction rates were 63.2 % in primary surgery group and 60.8 % in NACT group, respectively ( p: 0.709). In the primary surgery group, the overall survival was significantly higher ( p: 0.002). Mean patient age was more advanced ( p: 0.014) and the performance status of patients was poorer ( p < 0.001) in NACT group. Only patient group (primary surgery or neoadjuvant chemotherapy) ( p: 0.001) retained significance as predictors of survival in multivariate analyses. Conclusion(s): Improved rate of optimal cytoreduction with NACT in advanced ovarian cancer patients does not prolong survival. The extent of disease at diagnosis is the primary determinant of survival. Randomizing patients with equally extensive disease and performance status to either NACT or primary debulking surgery in a future study will better clarify benefits attributed to NACT. [ABSTRACT FROM AUTHOR]

Objective: Propofol has been widely used for anaesthesiology, although about 60%-70% of patients experience pain on injection. The aim of our study was to compare two storage patterns of propofol, namely room temperature versus refrigeration, in terms of their effect on incidence and severity of pain caused by its injection. Methods: Two hundred patients referred to gastrointestinal or urologic surgery with general anaesthesiology were included in a prospective randomized, double-blind study. After routine monitoring, 5 mL of propofol at room temperature and 5 mL of propofol kept in the fridge was administered within 10 seconds to patients in Group 1 and Group 2, respectively. An investigator assessed pain intensity. Propofol temperature-pH were measured by another researcher. Results: The overall incidence of pain on injection of propofol was 73.7% in Group 1, and 83.2% in Group 2. There was no significant difference between groups regarding the incidence of pain. There was a significant difference between groups in terms of pain severity based on a 6-point verbal rating scale. While the median VRS value for Group 1 was 2, it was 3 in Group 2. Conclusion: Cold application has a local anesthetic effect of its own. In the present study it was observed that cold application of propofol caused pain more frequently, although it was statistically not significant; moreover, it was found that it statistically significantly increased the severity of pain. These findings indicate that propofol should be kept at room temperature instead of in the refrigerator in order to reduce injection pain. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate how imputing missing values in data obtained from the Health Assessment Questionnaire Disability Index (HAQ-DI) influences the bias and precision of patient disability measurements. Patients and methods: Hypothetical missing data sets were created by deleting item responses completely at random from the original data set with three missingness proportions (0.10, 0.30 and 0.50). Multiple imputation was carried out using the response function method for each hypothetical data set containing the missing values. The Rasch model was used to estimate the patients' latent trait levels for the original data, the hypothetical incomplete data sets, and the multiple imputed data sets. Then the estimates from the hypothetical missing data sets and the multiple imputed data sets were compared with those of the original data set. Results: A bias in disability estimates was observed, particularly as the missingness proportion increased for both the incomplete and imputed data; however, this bias was indiscernible even for the 0.50 proportion of missingness. In terms of the uncertainty of the disability estimates, the imputed data had a higher precision of estimates than the incomplete data. Conclusion: When researchers encounter missingness in data collected with the HAQ-DI, the response function imputation could be a convenient approach to impute missing values in order to improve the precision of the patient disability level estimates. [ABSTRACT FROM AUTHOR]

Purpose: Psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke have received some attention recently, mostly using classical approaches, but there is still an absence of investigation from a modern psychometric perspective. This study aimed to test the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis. Methods: A total of 188 community-dwelling poststroke patients were recruited. Internal construct validity was assessed by Rasch analysis, reliability by internal consistency and person separation index (PSI), and external construct validity by associations with Functional Independence Measure (FIM™). Results: Rasch analysis indicated that total score (based upon 32 items, omitting the work-related items) was satisfactory, after adjustment for local dependency. The proposed 'activities' and 'participation' components also satisfied Rasch model expectations. An existing short form was problematic due to inclusion of a work-related item, but an alternative 10-item version was acceptable. Cronbach's α for the WHODAS-II, its domains and components varied between 0.83 and 0.99 and PSI between 0.70 and 0.95. External construct validity was confirmed by expected correlations with FIM™. Conclusions: WHODAS-II provides a reliable and valid instrument for measuring disability and components of 'activities' and 'participation' in stroke survivors. Various combinations of the item set may provide a range of scales to suit most research needs. [ABSTRACT FROM AUTHOR]

Purpose: To assess clinical, surgical and pathologic variables in survival of advanced endometrial cancer. Methods: Sixty-seven advanced-stage (stages III and IV according to FIGO 2009) endometrial cancer cases were evaluated retrospectively. The effects on survival of age, histologic subtype, stage, grade, myometrial invasion, optimal cytoreduction, parity and cervical involvement were analyzed. Results: Cervical involvement ( P = 0.033) and nulliparity ( P = 0.042) were worsening features in terms of survival. In 56 cases (83.5%) optimal cytoreduction could be achieved and survival was significantly longer in this group than the group who were not optimally cytoreduced (mean 30.4 vs. 9.6 months) ( P < 0.01). Depth of myometrial invasion, histologic type of tumor, stage, grade, and age younger or older than 60 years were not found to be related to survival. Neither adjuvant therapy type nor their combination were superior to each other for improving survival. Conclusions: Cervical stromal involvement is a poor prognostic factor in cases of advanced endometrial carcinoma. Further studies are required to describe the effect of different surgical approaches such as radical hysterectomy on survival in the presence of cervical stromal invasion. [ABSTRACT FROM AUTHOR]

Most cases of idiopathic Parkinson disease (IPD) are believed to be due to a combination of genetic and environmental factors. The purpose of this study is to investigate the relationship between toxocariasis and Parkinson disease (PD). Patients were selected from people who were admitted to the Movement Disorders Branch, Neurology Department of Elazig University Faculty of Medicine Elazig, Turkey. We studied specific IgG antibodies against Toxocara canis (T. canis) in 50 patients with idiopathic Parkinson and 50 healthy volunteers. We investigated the clinical history of three patients infected with T. canis. We also studied specific IgG antibodies against Toxoplasma gondii in these groups. Antibodies anti-Toxocara canis were found in 3 idiopathic PD (6%) (P = 0.121) and antibody titer was not found in control. A patient had history of the presence of dog in current dog ownership. We did not detect any statistically significant association between T. canis and IPD. But, we believe that further comprehensive studies are required for understanding whether there is a causal relation between toxocariasis and PD. We didn't find possible association between Toxoplasma gondii and IPD (P = 0.617). [ABSTRACT FROM AUTHOR]

It is well known that the serum procalcitonin (PCT) levels increase in severe bacterial infections. However, there is little information about the levels of PCT in diverse diseases except mainly the infectious diseases. The aim of this study was to investigate the progress of serum levels of PCT together with traditional acute phase reactants in children with familial Mediterranean fever (FMF) during the attack and attack-free periods and to test whether PCT could help to diagnose the attack in FMF patients. The study group comprised 21 FMF patients (mean age 10 ± 4.6 years) and 19 healthy controls (mean age 10.6 ± 4.2 years). Serum levels of PCT and traditional acute phase reactants were measured during the attack and attack-free periods. Blood samples were obtained within the first 6-24 h of the attack period, 7 days later, and at least 2 months after the attack. Traditional acute phase reactants (hs-CRP, ESR, and fibrinogen) during the attack period were significantly higher than the attack-free levels and controls. PCT levels of the FMF patients during the attack period were also significantly higher than the attack-free and control group levels (median values, 0.044 ng/ml vs. 0.028 ng/ml and 0.031 ng/ml, P = 0.04, respectively). Although this difference was statistically significant ( P = 0.04), median PCT values of the attack, attack-free period, and healthy subjects were lower than 0.05 ng/ml. As a result, these findings suggested that PCT levels were not conspicuously affected from inflammation and could not be used as a descriptive marker for attack in FMF patients. [ABSTRACT FROM AUTHOR]

Objectives. The main aim of this study was to investigate the clinical utility and sensitivity to change of faces pain scale (FPS) in patients with shoulder pain, chosen as a chronic pain model. The secondary aim was to determine the association of FPS with psychologic status and quality of life of these patients. Methods. Thirty Turkish patients with chronic shoulder pain were included in the study. Pain intensity was evaluated by visual analog scale (VAS), which is a commonly used pain scale besides FPS. Depression and quality of life were screened by Beck Depression Inventory (BDI) and Short Form-36 (SF-36). All assessments were done before and after the physical therapy. Results. There was a statistically significant decrease in pain severity after the treatment as indicated by FPS and VAS ( P = 0.000). The standardized response mean (SRM) value of FPS of 2.35 was accepted as a good responsiveness. The FPS showed a strong correlation with VAS (r = 0.62 and 0.73) both before and after the treatment. Also, moderate to strong correlations were detected between the FPS and physical functioning (PF), physical role (PR), bodily pain (BP), emotional role (ER), general health (GH), mental health (MH) subscales of SF-36 (r = −0.58-0.80), and BDI scores (r = 0.39) before the treatment. However, there were moderate and weak correlations with FPS and PR and social functioning (SF) subscales of SF-36 only after the treatment (r = −0.52 and r = −0.39). Conclusions. FPS is a satisfactory tool to assess pain in patients with chronic pain conditions and demonstrates sensitivity to detect changes after the treatment. [ABSTRACT FROM AUTHOR]

Objectives: To adapt the London Handicap Scale into the Turkish language, and to investigate the scaling properties of this version in a sample of people who have experienced a stroke.Design: After the translation process, the internal construct validity was tested by Rasch analysis and the reliability by internal consistency and intraclass correlation coefficient. The interval scaling properties were assessed by contrasting the raw and weighted London Handicap Scale scores with the Rasch latent estimates. Setting: An outpatient rehabilitation unit of a university hospital.Subjects: One hundred and eighty-eight community-dwelling post-stroke patients (mean age 63 (SD 12) years, 54% male) were assessed by the Turkish version of the London Handicap Scale.Results: After adjustment for local dependency, the data showed good fit to Rasch model expectations with a mean item fit -0.240 (SD 1.868), person fit -0.403 (SD 0.893) and chi-square interaction 8.55 (df 10, P =0.575). The reliability was good with a Cronbach’s α and intraclass correlation coefficient of 0.845. Analysis of the scaling properties showed that either the raw London Handicap Scale score or its weighted score were non-linear with respect to the Rasch latent estimate.Conclusions: The London Handicap Scale is a valid and reliable scale for use in stroke in Turkey. Its unweighted raw scores and weighted scores are equivalent and ordinal, but a linear transformation is possible through Rasch analysis. [ABSTRACT FROM PUBLISHER]

The objective of this study is to test the reliability and validity of WHODAS-II (Turkish version) for the assessment of disability in patients with osteoarthritis. This study is designed as follows: the internal construct validity of WHODAS-II in patients with knee osteoarthritis was assessed by Rasch analysis, and external construct validity by association with the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) and the Nottingham Health Profile (NHP); reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and test-retest ICC. Our study presents the results of 225 outpatients assessed with mean age 58.4 years (SD 11.1) of whom 80.9% were female. Cronbach's α, ICC, and test-retest ICC values for the six subscales of WHODAS-II varied between 0.71 and 0.94, 0.71 and 0.94, and 0.87 and 0.97, respectively. Rasch analysis of WHODAS-II indicated that after adjustment for local dependency, satisfactory fit was achieved . Two separate 'activities' and 'participation' components could also be identified. External construct validity of the scale was confirmed with expected correlations with WOMAC and NHP. This study concludes that WHODAS-II provides a reliable and valid health status instrument for measuring disability and components of 'activities' and 'participation' in patients with osteoarthritis. Thus, it provides the opportunity to model the consequences of disease according to the International Classification of Functioning, Disability and Health framework . [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare postoperative radiotherapy and observation for survival and recurrence rates in stage IC endometrial carcinoma patients who underwent comprehensive surgical staging. Study design: Fifty-seven stage IC endometrial cancer patients who underwent surgical staging were included in this study. Twenty cases (35%) received postoperative radiotherapy and 37 (65%) were observed without additional therapy. The two groups were compared for survival and recurrence rates. Results: Mean follow-up times for the radiotherapy and observation groups were 52.05 and 38.71 months, respectively. Five-year disease-free survival rates for the radiotherapy and observation groups were 91% and 63%, respectively, and 5-year overall survival rates for the radiotherapy and observation groups were 90.0% and 80.8%, respectively. Both the disease-free and overall survival rates were similar between the two groups (p >0.05). One (5%) of the 20 patients in the radiotherapy group, and four (10.8%) of the 37 patients in the observation group had recurrences and there was no statistical difference for the recurrence rates (p >0.05). Disease grade had no prognostic significance in terms of survival after surgical staging. Conclusions: Comprehensive surgical staging might minimize the unfavorable role of deep myometrial invasion and grade. After surgical staging, postoperative observation without radiotherapy may be an appropriate approach in stage IC, all grades, endometrial carcinoma. [Copyright &y& Elsevier]

Abstract: This study was conducted to determine the effects of methionine, inositol and carnitine on sperm (motility, abnormality, DNA integrity and in vivo fertility) and oxidative stress parameters (lipid peroxidation, total glutathione and antioxidant potential levels) of bovine semen after the freeze–thawing process. Nine ejaculates, collected with the aid of an artificial vagina twice a week from each Simmental bovine, were included in the study. Each ejaculate, splitted into seven equal groups and diluted in Tris-based extender containing methionine (2.5 and 7.5mM), carnitine (2.5 and 7.5mM), inositol (2.5 and 7.5mM) and no additive (control), was cooled to 5°C and then frozen in 0.25ml straws. Frozen straws were then thawed individually at 37°C for 20s in a water bath for the evaluation. The extender supplemented with 7.5mM doses of carnitine and inositol led to higher subjective motility percentages (61.9±1.3% and 51.3±1.6%) compared to the other groups. The addition of methionine and carnitine at doses of 2.5 and 7.5mM and inositol at doses of 7.5mM provided a greater protective effect in the percentages of total abnormality in comparison to the control and inositol 2.5mM (P <0.001). As regards CASA motility, 7.5mM carnitine (41.6±2.9% and 54.2±4.9%) and inositol (34.9±2.0% and 47.3±2.2%) caused insignificant increases in CASA and total motility in comparison to the other groups. All of the antioxidants at 2.5 and 7.5mM resulted in lower sperm with damaged DNA than that of control, thus reducing the DNA damage (P <0.05). No significant differences were observed in CASA progressive motility and sperm motion characteristics among the groups. In fertility results based on 59-day non-returns, no significant differences were observed in non-return rates among groups. As regards biochemical parameters, supplementation with antioxidants did not significantly affect LPO and total GSH levels in comparison to the control group (P >0.05). The maintenance of AOP level in methionine 2.5mM was demonstrated to be higher (5.06±0.38mM) than that of control (0.96±0.29mM) following the freeze–thawing (P <0.001). Supplementation with these antioxidants prior to the cryopreservation process protected the DNA integrity against the cryodamage. Furthermore, future research should focus on the molecular mechanisms of the antioxidative effects of the antioxidants methionine, carnitine and inositol during cryopreservation. [Copyright &y& Elsevier]

Idiopathic Parkinson's disease defines a group of Parkinson's disease (PD) of which the aetiology is unknown but an underlying brain disease is suspected. We selected patients of this subgroup of PD and investigated the seropositivity rate for anti-Toxoplasma IgG antibody by Sabin–Feldman dye test (SFDT). By measuring seropositivity in PD patients, we searched for a probable relationship between Toxoplasma gondii infection and idiopathic PD incidence. Fifty patients diagnosed with idiopathic PD and 50 healthy volunteers were included in the study. Blood samples were taken from all 100 participants and anti-T. gondii antibody titres were investigated using SFDT. Anti-T. gondii antibodies were detected at a titre of ≥1/16 in 25 of the 50 patients (50%) and in 20 of the control group (40%). No higher antibody titre was found in the control group. In conclusion, despite the emerging literature on a possible relationship between T. gondii infection and neurological disease, and the high anti-T. gondii seropositivity found in our PD patients, we did not detect any statistically significant association between T. gondii and idiopathic PD. [ABSTRACT FROM AUTHOR]

Aim: The differential diagnosis of pulmonary thromboembolism (PTE) and pneumonia remains difficult in emergency rooms. High D-dimer levels in the pneumonia may be misdiagnosed as PTE on the basis of similar clinical, radiological, and laboratory findings. Since D-dimer elevation may also be seen in pneumonia cases, the comparison of D-dimer values in patients diagnosed as pneumonia and PTE, in order to determine a cut-off value between the 2 diseases, was aimed in this study. Materials and methods: Patients in the community acquired pneumonia (CAP) group were classified according to the American Thoracic Society (ATS) 2001 criteria. Groups III and IV patients, who were hospitalized, were included in the study. The final CAP group consisted of 52 patients (30 in Group IIIa, 15 in Group IIIb, 2 in Group IVa, and 5 in Group IVb) and 68 patients with a diagnosis of PTE. All patients' D-dimer levels in the first day were recorded. Results:Mean D-dimer levels of the PTE and pneumonia group were 4868 ng/mL and 2068 ng/mL, respectively (P < 0.001). Cut-off value was 4374 ng/mL. Mean levels of D-dimer in the massive PTE group and sub-massive PTE group were 5438 ng/mL and 4175 ng/mL,respectively, (P = 0.04). Conclusion: Elevation of D-dimer is more significant in PTE than pneumonia. As a result, if Ddimer level is higher than 4374 ng/mL, the patient should be evaluated for the diagnosis of PTE. A cut-off value of 4374 ng/mL will help the discrimination of PTE and pneumonia. [ABSTRACT FROM AUTHOR]

Pharmacogenetics is the study of genetic variations that cause a variable drug response characterized by alteration in drug metabolism or in pharmacodynamics. The polymorphisms in genes encoding receptors relevant to treatment cause variation in sensitivity to many drugs. β2 Adrenoceptor genetic variation contributes to regulation of blood pressure and hemodynamic changes by mediating peripheral vasodilatation. Laryngoscopy and tracheal intubation associated with hemodynamic changes. Although there are four nonsynomic single-nucleotide polymorphisms (SNPs) of β2 adrenoceptor gene, codon 16 (Arg16Gly) and codon 27 (Gln27Glu) SNPs are both common and functionally important. In this paper, the authors investigated the β2 adrenoceptor Gly16 and Glu27 SNPs in response to drugs relevant to anesthesia and how these SNPs impacted upon the cardiovascular phenotypes. The authors measured arterial systolic and diastolic blood pressure, heart rate, and rate-pressure product before induction of anesthesia and 1 min following laryngoscopy and tracheal intubation. Genomic DNA was amplified and genotyped using allele-specific polymerase chain reaction (ASPCR) and restriction fragment length polymorphism (RFLP) assays, respectively. When the authors compared hemodynamic results according to genotypes, the patients with Gln homozygote allele at codon 27 exhibited significant increase of heart rate than patients with Glu allele after laryngoscope and tracheal intubation. [ABSTRACT FROM AUTHOR]

Most cases of idiopathic Parkinson disease (IPD) are believed to be due to a combination of genetic and environmental factors. The purpose of this study is to investigate the relationship between toxocariasis and Parkinson disease (PD). Patients were selected from people who were admitted to the Movement Disorders Branch, Neurology Department of Elaz¿¿ University Faculty of Medicine Elaz¿¿, Turkey. We studied specific IgG antibodies against Toxocara canis (T. canis) in 50 patients with idiopathic Parkinson and 50 healthy volunteers. We investigated the clinical history of three patients infected with T. canis. We also studied specific IgG antibodies against Toxoplasma gondii in these groups. Antibodies anti-Toxocara canis were found in 3 idiopathic PD (6%) (P = 0.121) and antibody titer was not found in control. A patient had history of the presence of dog in current dog ownership. We did not detect any statistically significant association between T. canis and IPD. But, we believe that further comprehensive studies are required for understanding whether there is a causal relation between toxocariasis and PD. We didn't find possible association between Toxoplasma gondii and IPD (P = 0.617). [ABSTRACT FROM AUTHOR]